This first appeared on the Duck of Minerva website
History sometimes has a way of rearing its ugly head repeatedly. The COVID-19 pandemic is something few people have ever seen, but it is not new in history. Neither is the fragmented nor uneven and missing policy responses to it. How political leaders respond during the initial stages of pandemics can affect their trajectory and duration.
Research from political science, public health, and government agencies shows that political leadership at the executive level generally serves three critical functions in combatting pandemics: mitigating risk, framing the collective problem, and providing direction and purpose for a plan to battle the virus.
What Do We Mean by Political Leadership?
The notion of leadership and what constitutes it are as elusive as ever in political research. Often research highlights the charismatic of individual psychological motivations behind leaders’ policies. This research focuses on particularistic aspects of leadership but leaves one with a sense similar to what Justice Potter Stewart said about obscenity: “I know it when I see it.”
No matter whether the leader is a dictator or democrat, political leadership, or political judgment as the political philosopher Isaiah Berlin called it, has a practical reasoning or a sense of what “works” and what “doesn’t work” within a deep understanding of policy and politics.
Berlin said that judgement is a “…sense of what fits with what, what springs from what, what leads to what; how things seem to vary to different observers, what the effect of such experience upon them may be; what the result is likely to be in a concrete situation of the interplay of human beings and impersonal forces — geographical or biological or psychological...” If that seems somewhat vague, it is.
For Berlin, the essence of political leadership lies in the leader’s ability to see the scope and depth of a crisis and to navigate multiple avenues to solve the individual problems that appear within the crisis. This characteristic is particularly needed during crises such as pandemics.
How do countries mitigate risk?
National and international security are about threats to countries and decreasing the risks posed by those threats. It doesn’t matter whether it’s a military threat or a viral threat. Intelligence and foreign policy agencies spend most of their time collecting and reacting to information that helps minimize risks posed by threats.
Regarding pandemics, these agencies engage in global health intelligence collecting that seeks to unearth emerging viral threats. In January 2020, this process was well underway as the Centers for Disease Control (CDC) issued its first public warning about the outbreak of a novel coronavirus in China.
In mitigating risks, health intelligence can enhance the preparedness and responses to potential pandemics. What policy makers do with that information is separate from this information collecting process. But failure to pay attention to the warnings can be catastrophic.
For instance, at the start of the 1918 Spanish influenza, the infection of US soldiers fighting overseas in WWI with influenza gave President Woodrow Wilson information before it hit the US mainland in full force. Woodrow Wilson had little, if anything, to say about the pandemic. To be fair to Wilson, we did not know much about viral surveillance and behavior during this time. But Wilson’s lack of interest is even more astounding given his own bout with the influenza and the staggering U.S. death toll that was nearly six times greater than those the country lost in battle during World War I.
We have also observed inadequate leadership in more contemporary outbreaks. A little over six years ago, a two-year old boy in Meliandou, Guinea died suddenly after two days of violent illness; the World Health Organization would later identify him as the first suspected victim of the Ebola outbreak in West Africa. In 2014, during the initial Ebola outbreak in West Africa, Guinea’s President Alpha Conde assured international organizations and the U.S. government that the outbreak in his country was under control. Such a response seemed remarkable given Guinea’s health infrastructure is one of the poorest in the world, with few doctors, medical facilities, and hospitals present in the country.
These conditions would become significant contributory factors to the rapid deterioration of the government’s handling of the epidemic. However, Conde also had been preoccupied, much like Wilson, with other matters. He was shopping for mining companies to invest over $20 billion in Guinea’s mining sector and did not want the Ebola story to spook investors away from a potential deal.
My own research has shown that President Conde actively downplayed the severity of the outbreak. He attacked domestic opposition leaders and NGOs that dared to suggest the government’s response was lacking. Guinean government officials were left with a fragmented decision-making process that proved ineffectual at containing the epidemic, and eventually led to an external intervention in West Africa to contain the epidemic.
Why is Framing the Collective Problem Important?
Leadership often involves marshalling people and resources to combat problems. In pandemics, strong political leadership unites the population behind one message: stop the virus.
Fear and uncertainty can escalate during pandemics. They potentially create “us vs. them” social conditions that divide and stigmatize people. Political leadership embodies the capacity to connect people in the common struggle. In failing to do so, the results can be harmful and potentially deadly.
Almost 40 years ago, the US Centers for Disease Control reported the first cases of a rare pneumonia in young, healthy gay men. Those cases would become the first officially reported HIV cases in the United States, though HIV had been making its way across the world for a much longer period, possibly decades.
In 1981, President Ronald Reagan took office riding a wave of popular support for a strong foreign policy and a conservative social platform. When the killer virus affecting predominantly gay men appeared in 1981, the social environment helped to foster an “us vs. them,” “gay vs straight” dynamic.
The federal government did not have a concerted response to the HIV pandemic. In fact, Reagan administration members joked about a “gay plague” and Reagan himself did not publicly address the epidemic significantly until 1987, though his administration heavily debated the response to the epidemic. The administration’s delayed response left individual states and activist groups to devise policy strategies for coping with the pandemic. Such rhetoric fueled harassment, assaults, and even murders of LGBTQ people. By the end of the administration, over 680,000 Americans had become infected and were living with HIV.
More recently, as Person et. al show, the 2002 SARS pandemic which originated in China, much like today’s COVID-19 pandemic, created a backlash against Asians and Asian Americans that led to their stigmatization as the source of the outbreak. Political leadership can convey the moral voice of reason that may decrease stigmatization and the incidences of hate and violence. And the absence of leadership can create a vacuum in which abuse and stigma flourish.
Leading the Response against a Pandemic
In any crisis, political leaders are the ultimate decisionmakers providing directions for a plan to resolve it.
Technical experts recommend operational plans to respond to outbreaks, but political leaders direct the plan. Federal political leadership makes the decisions about how to prioritize issues, to expend increasingly scarce resources, and to whom those scarce resources go. Transparency in doing so minimizes public panic and promotes coordination among federal governments, subnational states, and health advisors and policymakers.
In the 1918 Spanish influenza pandemic, as the virus ravaged multiple U.S. cities, a mixture of uncoordinated state and local policies produced mixed results. Efforts to control the pandemic included social distancing, disinfecting surfaces and other contact points, washing one’s hands, and isolation of infected people. Political leaders, however, enacted these measures in an uncoordinated manner. The uncoordinated policy measures produced some successes against the virus, but disastrous failures in many other cities such as Boston, Pittsburgh, New York, Philadelphia, and Washington DC. City officials across the country either claimed their cities were not affected by the pandemic or denied the severity of it. Some local leaders’ slow and uneven response to the pandemic exacerbated its impact through three waves of the virus.
Have Leaders Been Successful in Controlling Outbreaks?
On balance, history shows more leadership failures than successes, which begs the question: what does successful pandemic and epidemic control look like? Some lessons can be draw from the Ebola outbreak in West Africa and the current pandemic response in New Zealand.
While the governments in Guinea, Sierra Leone, and Liberia can provide some textbook examples of what not to do in an epidemic outbreak, Nigeria may represent the textbook case on what successful leadership and policies look like during an epidemic outbreak.
On July 20, 2014, a Liberian American lawyer named Patrick Sawyer boarded a flight in Monrovia, Liberia and landed in Lagos, Nigeria, the country’s and Africa’s most populous city of 21 million people. Sawyer was symptomatic during his flight, having been exposed to the Ebola virus while in Liberia. He was admitted to a hospital in Lagos and the hospital informed the Nigerian government of the presence of an Ebola victim. On July 23, the Nigerian Federal Ministry of Health along with the Lagos State government created the Ebola Incident Management Center. Five days later, the Nigerian government announced that Sawyer had died from Ebola. The potential for rapid Ebola transmissions through a city of 21 million people instilled images of the worst case scenario for the epidemic in West Africa: a deadly viral outbreak in the most populous city on the continent with thousands of travelers passing through the airport and into the city on a daily basis.
On July 26, a day after the government announced Sawyer’s death, Nigerian officials put in place a rapid response to contain the virus. That response included isolation, contact tracing, and public surveillance. Public health workers screened arriving passengers at Lagos’ Murtala Muhammad airport and established holding rooms to isolate suspected Ebola victims arriving in the country. Government officials suspended flights from Sierra Leone and Liberia to keep potentially infected victims from entering the country.
Public health officials isolated medical staff that treated Sawyer in Lagos and closed down and quarantined the hospital that treated him. All passengers on Sawyers flight into Lagos were located for monitoring, isolation, and treatment if needed.
Despite these fast efforts, Nigeria reported its second Ebola case on August 4th. On August 5, Nigeria reported that one of the nurses who treated Sawyer succumbed to Ebola and that six Nigerians on Sawyer’s flight into Lagos were experiencing Ebola-like symptoms.
On August 8, the World Health Organization declared Ebola a public health emergency of international concern. That same day, Nigerian President Goodluck Jonathan requested that Nigerians quarantine, avoid public gatherings, and not touch or move the bodies of Ebola victims. He also began immediate funding of anti-Ebola efforts in Nigeria.
Lagos State started contact tracing and surveillance of all first, second, and third tier contacts of suspected and confirmed Ebola victims. Local governments in the state mobilized education efforts within communities. State and national discussions and seminars and information-sharing sessions that promoted transparency were held by agencies handling the governments’ response to the outbreak. The governments at the federal and local levels began cooperating and providing support to those responding closest to the outbreak at the local level. Contact tracing and surveillance teams were deployed throughout the country.
The results of this all-out effort were impressive. On September 22, the World Health Organization announced that Ebola had been contained in Nigeria. The US CDC concurred with that assessment eight days later. On October 20, the Ebola outbreak was officially declared over after two successive 21-day incubation periods had based with no additional cases detected in the country. Nigeria then continued to assist other West African states with their containment efforts both financially and in providing healthcare workers to infected areas.
Nigeria’s response was not perfect at the beginning, but the leadership at the local, state, national, and international levels brought the outbreak to a rapid conclusion. These leaders were transparent in the events transpiring in Nigeria, promoted calm and compassionate responses toward victims, and executed a comprehensive plan to counter the outbreak.
In our current COVID-19 outbreak, amidst a series of state leadership missteps and ill-conceived policies, global agencies and public health officials have praised New Zealand’s response to the pandemic. New Zealand’s public has embraced Prime Minister Jacinda Ardern’s response to the pandemic as compassionate, sympathetic, and involved. Her approach is transparent and understanding, knowing that life for the average Kiwi had abruptly changed, even if temporarily, as she prepared the country for a lockdown that will last weeks. She encouraged people to be patient and not to venture out for fear of contracting or spreading the virus.
But sympathy and empathy only go so far. Ardern’s policies also show strong leadership and decication based on sound scientific principles. She implemented an early alert system that helped to prepare the people for the possibility of stricter measures. Her policies have included rapid and expansive testing, a lockdown of the country earlier than most all other countries, and a travel ban on people from China that started in February before any case had been detected in New Zealand. Non-residents were also banned from coming into New Zealand. She also has involved public health officials, local leaders, opposition leaders, and the people in a collective response against the virus.
While New Zealand may be helped by its relatively isolated geographical position, this still does not negate the active and strong response from state officials watching events as they unfolded in China. The enacted policies are not unique to New Zealand; they are based on what we know works historically and based on sound scientific principles.
What can we take away from history?
Leaders are not responsible for the onset of pandemics. But their policies create conditions that either mitigate or exacerbated them. Political leadership can shape the preparedness, strength, and direction of the overall pandemic response. The cases discussed here represent calamitous, tragic events. Weak political leadership at the outset and during these pandemics hampered the response needed to combat viruses effectively, with many dying as a result.
For political leaders today, history serves as both dire warning and foreshadow of our current coronavirus pandemic. Acting on early information and providing a strong coordinated response are crucial to easing public fear and confusion. Piecemeal policies amongst individual states or countries inadvertently foster viral spread and policy confusion.