An infectious disease outbreak turning into a global pandemic has long been on the radar of public health experts and government agencies, who have sounded dire warnings about the likelihood and impact of such an event. The pandemic is now here. It has exposed fraught national public healthcare systems as well as the sharp divides in global politics. It has sparked debates, pitching globalism versus nativism and populist governments versus experts, while the policies of many global leaders have become inward looking. All of this is distracting from the concerted global response required to curb the coronavirus.
Strong global initiatives are required to trace and detect cases; fund not-for-profit scientific research into vaccines and cures; and achieve a balance between travel restrictions and necessary trade. However, such initiatives have been discredited in recent years, by political agendas undermining the concept of globalisation. The growing geopolitical fragmentation since the global financial crisis – with a world increasingly multipolar and with competing ‘value-systems’ – have weakened the role of the global institutions precisely designed to coordinate a response.
US President Trump’s ‘America First’ agenda, and similar populist agendas around the world, are incompatible with the concept of multilateralism. In this context, global agencies such as the UN’s WHO – which were designed to help tackle such crises – have had their purpose and credibility questioned, and their role reduced. Even in the middle of the crisis, Trump announced in April he would halt US funding (the world’s largest) for the World Health Organisation.
The struggle for a global response
The initial global response to the coronavirus outbreak has been criticised as piecemeal and contradictory: some countries in the West saw it as ‘an Asian problem’; the EU’s inconsistent national policies struggled to deliver a coordinated response; Trump called it a ‘hoax’ aimed at discrediting his leadership, while contradicting public health experts on Twitter; and, in Brazil, President Bolsonaro defied health agencies to attend packed public rallies.
Travel restrictions, in many cases, blindsided countries. For example, the US ban on visitors who had been into the Schengen area came without warning, impacting airlines on both sides of the Atlantic.
US – the politics of healthcare
Healthcare challenges - already top-of-mind for voters - will play heavily into the ongoing US election campaign. Healthcare policy is fast becoming the central theme of the race. Republican’s attempts to dismantle the ‘Obamacare’ or Affordable Care Act (which has been weakened but is not dead) are likely to be a key campaign theme for the Democratic nominee.
While the US’ diagnostic capabilities, medical R&D, and ability to treat medically complex cases are among the most sophisticated in the world, the system at large – balkanised and without universal coverage – is ill-equipped to deal with an epidemic. The US has half the number of doctors per patient compared with Germany and lags substantially behind many OECD countries in its ratio of beds to 1,000 patients.
Inadequate insurance coverage in the US also risks undermining treatment and containment of the outbreak. Around 28 million (or 10 per cent) of non-elderly Americans did not have medical insurance in 2018, according to the Kaiser Family Foundation, a non-profit organisation that analyses healthcare issues.
As voters in the US increase their focus on healthcare benefits, Democratic presidential candidate Joe Biden may shift his stance closer to that of former rival Bernie Sanders, who has advocated universal health coverage in the form of ‘Medicare for all’. In that sense, the coronavirus crisis may be a crucial factor in shaping the Democratic platform.
Euro area – fractures and a possible Brexit impact
Europe’s ability to stage a unified response to the crisis has also faced initial setbacks amid disparate (or even contradictory) national responses; coordination issues between France and Germany (on the border closing, for example); and chaos at borders between countries that took unilateral decisions to close them. In addition, Italian bond yields saw their steepest rise since the global financial crisis after ECB President Lagarde said it was not the ECB’s job to close spreads - a comment she subsequently apologised for.
Only on 17 March did European countries agree to the 30-day closure of EU and Schengen external borders. In the UK, meanwhile, the initial public health response diverged sharply from that of most European countries. The government initially saw no need to impose restrictions on movement or activities, instead allowing the virus to spread based on the scientific concept of ‘herd immunity'. This stance was reversed when models showed that the statistical occurrence of cases requiring ICU treatment would quickly overwhelm the National Health Service.
In the UK, the health crisis could have an impact on Brexit negotiations and the government’s narrative. Each passing week without progress makes the UK’s December 2020 deadline more unrealistic.
Should healthcare be a public good?
The pandemic also raises the more fundamental political question of whether healthcare should be primarily a ‘public good’ or a personal choice.
For the most part, infectious diseases that pose a collective threat – such as cholera, smallpox and the plague – have disappeared from our collective memories and are, rather, frightening tales of an ancient past. Today, 71 per cent of global deaths annually (more in developed countries) are from non-communicable diseases such as heart disease and cancer; these diseases – arguably – often demand personal rather than collective healthcare choices.
But all of this is fundamentally put into question when faced with a pandemic like COVID-19 which demands a collective response, and the health of the entire population – whether rich or poor – becomes interdependent. Personal risks and costs become secondary to the systemic response needed to contain the outbreak.
The COVID-19 pandemic has also intensified the focus on healthcare policy outside the US, particularly as governments face increasing fiscal constraints on their ability to provide such benefits. In several countries – including in Europe, where universal healthcare is already part of the social contract but has faced fiscal constraints – budget priorities could be reassessed in the wake of the coronavirus crisis. French President Emmanuel Macron has cited the crisis as evidence that healthcare must remain a public good and be prioritised.
Government responses: local versus national
In the US, the virus reignited the debate on federal versus local government. During the coronavirus outbreak, sub-national governments were the first movers in dealing with the crisis; state and city governments moved faster than the federal government in declaring states of emergency and restrictions on movement. The Trump administration has recently attempted to take the lead on the US national policy response to the coronavirus outbreak, in cooperation with Congress. But local authorities (at the governor, state and city level) have continued to disagree with the White House on which measures to adopt. The crisis could exacerbate the longstanding divide on this issue, with Democrats tending to be more supportive than Republicans of a stronger role for the federal government.
This stands in stark contrast to most other countries – including those with relatively high levels of decentralisation, such as Italy or Germany – where major public crises tend to trigger a strong top-down approach, with a centralised decision-making process and policy direction.
Information, fake news, and politics
While a public health crisis would, by definition, appear apolitical and a strict science/sanitary challenge, public perceptions of the coronavirus have proved very different depending on their political affiliations and the echo chamber they live in. Leadership, trust, science-based language, transparency and resistance to politicising data are all key elements of success but have been lacking in this crisis, in many geographies. Polls in the US have revealed that deep political and cultural divide in the understanding of the crisis. In the current polarised climate, two sides of the country appear to be living in different “realities”. An early March poll (NBC News/WSJ,) showed 80 per cent of Democrats thought the worst of the coronavirus outbreak was yet to come, versus 40 per cent of Republicans (and 57 per cent of independents).
Similarly, 56 per cent of Democrats believed their day-to-day lives would change in a major way in the future because of the crisis, while only 26 per cent of Republicans thought so. This clearly shows the impact of political affiliations on perceptions of the health crisis.
These divergent perceptions have been shaped partly by political signalling from leaders of the two parties, but also by different sources of information. Trump, for instance, repeatedly downplayed the risks, comparing it to the seasonal flu and calling it a hoax. This view was echoed on conservative news networks and websites.
Partisan approach to the crisis or the spread of misinformation is not a US specific situation. Data and info have been widely used for political gains in Brazil, Turkey, Russia but also among various fringe-parties in Europe. Fake news and conspiracy theories have flourished; a widely circulated idea linking the spread of the coronavirus to 5G technology has led to hundreds of incidents – such as wireless towers being set ablaze – in multiple countries. Other incidents involved people dousing themselves or others with chlorine – causing serious injuries – as they read it would kill the virus. This led to the UN creating a specific website dedicated to busting false information.
Will the virus shape the future of healthcare?
Healthcare systems in many counties have very limited ability to absorb massive shocks like the one being caused by the COVID-19 outbreak. Even in rich economies such as the US and the UK, the lack of emergency healthcare facilities has forced an economic shutdown, which could have been less severe if adequate treatment facilities had been available. In the US, the question of universal healthcare will come back as a main policy topic (probably through an Obamacare reform) while in many other countries – such as in Europe – where universal healthcare is already a reality, the question will turn to budget prioritisation when recent years of deficit reduction had often meant cuts in these public healthcare systems.
The cost implications of rescuing economies from collapse are immense. As we emerge from this crisis, policymakers across the world, with varying approaches to public health, will need to consider how to build and fund healthcare systems with enough capacity to deal with the next pandemic, without needing to shut down economies for long periods of time.
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