It is tempting to think that we can learn lessons from how other countries have handled COVID-19, and from studying those outcomes. But, warn Linda Hantrais (LSE) and Susanne MacGregor (LSHTM), we should avoid drawing simplistic conclusions

Hantrais, Linda

MacGregor, Susanne

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LSE Research Online

Containing	COVID,	part	4	|	The	limits	of	knowledgeexchangeIt	is	tempting	to	think	that	we	can	learn	lessons	from	how	other	countries	have	handled	COVID-19,	and	fromstudying	those	outcomes.	But,	warn	Linda	Hantrais	(LSE)	and	Susanne	MacGregor	(LSHTM),	we	should	avoiddrawing	simplistic	conclusions.Read	the	first,	second	and	third	posts	in	this	seriesJust	as	underlying	health	conditions	and	socio-economic	factors	affect	the	likelihood	of	contracting	and	dying	fromCOVID,	underlying	societal	and	political	factors	hampered	the	application	of	policy	lessons.	Countries	at	theepicentre	of	the	first	wave	of	the	pandemic	might	have	been	expected	to	learn	from	their	own	experience,	and	topass	on	lessons	about	successes	and	failures	to	other	countries	as	the	virus	spread.	But	the	capacity	ofgovernments	to	learn	how	to	prevent	or	contain	new	waves	was	constrained	by	both	endogenous	and	exogenousfactors.Populations	do	not	all	face	the	same	risk	of	contracting	or	dying	from	COVID.	Psychological,	institutional,	andstrategic	factors	all	play	a	role	in	how	well	a	country’s	government	can	contain	the	virus,	prevent	excess	mortalityand	control	future	outbreaks.	Countries	do	not	adopt	the	same	policy	instruments,	or	achieve	the	same	effects	byapplying	them,	thereby	limiting	the	value	of	later	attempts	to	identify	causal	explanations	for	the	success	or	failure	ofpolicy	responses.Problems	were	amplified	where	there	were	entrenched	political	divisions,	unstable,	dysfunctional	or	populistgovernments	and	sceptical	electorates.	By	contrast,	as	historians	and	political	scientists	predicted,	governments	didbetter	in	places	with	political	stability	and	consensus,	public	trust	in	governments	and	in	the	scientific	evidence	onwhich	they	relied	as	a	basis	for	policy	choices,	a	strong	sense	of	individual	and	social	responsibility	and	respect	forthe	rule	of	law.	In	their	analysis	of	the	handling	of	COVID	in	New	Zealand,	a	country	that	is	in	many	ways	culturallycloser	to	the	UK	than	Singapore,	South	Korea	or	Vietnam,	political	scientists	have	attributed	success	in	‘curvecrushing’	to	anticipatory	policymaking	and	point	out	the	need	for	long-term	planning	rather	than	‘reactive’policymaking.The	odds	were	stacked	more	heavily	against	some	governments	than	othersContextual	factors	are	key	not	only	in	determining	why	countries	were	deemed	to	be	successful	in	dealing	with	theimpact	of	the	pandemic	on	social	and	economic	life,	but	also	in	understanding	whether	successes	could	bereplicated	in	other	environments.	Demographers	and	social	policy	analysts	have	found	that	the	odds	were	stackedmore	heavily	against	some	governments	than	others.	Human	overpopulation	and	teeming	cities,	for	example,	makeit	harder	to	control	infections.	Evidence	accumulated	in	the	early	phase	of	the	pandemic	suggested	that	Westerncountries	with	densely	populated,	high	urban	concentrations	and	internationally	connected	populations,	inconjunction	with	high	old	age	dependency	ratios	and	high	rates	of	underlying	health	conditions	(obesity,	diabetes)would	be	more	likely	to	record	larger	numbers	of	cases	and	COVID	deaths.	Other	socio-demographic,	economicand	environmental	factors	included	poorly	funded	and	equipped	public	healthcare	provision,	and	underdevelopedtechnological	infrastructures.	Ethnicity,	crowded	living	conditions	and	precarious	working	arrangements	were	shownto	compound	the	risk	of	contracting	and	dying	from	the	virus	once	it	became	established	in	a	population.Recognising	that	‘the	nature	of	the	policy	responses	around	COVID-19	were	not	only	unknown	but	also	contestedand	highly	uncertain’,	a	case	was	made	for	disentangling	empirically	verifiable	natural	dimensions	of	the	pandemicfrom	socially	and	psychologically	constructed	ones.	Factors	shaping	policy	responses	could	then	be	identified	as‘the	nature	of	national	leadership,	the	organisation	of	government	and	civil	society,	and	blindspots	towards	thevulnerabilities	of	certain	population	segments’.LSE Covid 19 Blog: Containing COVID, part 4 | The limits of knowledge exchange Page 1 of 2		Date originally posted: 2021-04-29Permalink: https://blogs.lse.ac.uk/covid19/2021/04/29/containing-covid-part-4-the-limits-of-knowledge-exchange/Blog homepage: https://blogs.lse.ac.uk/covid19/Work	on	previous	pandemics	demonstrated	that	policies	would	be	needed	to	deal	with	the	socio-economicinequalities	that	they	exacerbate.	In	the	context	of	COVID,	while	new	technologies	offered	digital	solutions	formonitoring	and	tracking	the	disease,	and	for	socio-economic	groups	able	to	access	online	schooling	and	homeworking,	it	intensified	existing	inequalities	by	starkly	exposing	whole	swathes	of	populations	deprived	of	suchaccess.	These	inequities	extended	to	inequalities	in	the	distribution	of	vaccines	and	varying	attitudes	to	vaccination,as	well	as	the	role	played	by	misinformation,	reflecting	the	importance	of	nurturing	trust	in	both	politicians	andexperts,	and	countering	the	harmful	influence	of	social	media	by	careful	management	and	delivery	of	moderncommunication	strategies.Efficacious	vaccines	and	the	spread	of	new	variants	of	the	virus	changed	the	dynamics	of	the	pandemic	in	2021.Gradually,	valuations	of	scientific	advice	began	to	take	account	of	the	great	socio-cultural	diversity	between	andwithin	countries,	and	of	the	multiple	factors	influencing	the	transmission,	lethality,	and	impacts	of	COVID	on	social,economic	and	cultural	life	and	attitudes	towards	vaccination.	Governments	face	deep-seated	dilemmas	inassessing	the	costs	and	benefits	of	the	policy	options	they	adopt,	and	successful	policy	responses	implemented	inone	jurisdiction	could	not	always	be	readily	transferred	to	another.A	wide-ranging	analysis	of	contrasting	outcomes	in	lower-income	countries	(India,	Nigeria,	sub-Saharan	Africa)	−known	to	have	been	hardest	hit	by	infectious	diseases	such	as	malaria,	typhoid,	diphtheria,	HIV	−	and	high-incomecountries	(US,	Europe)	that	suffered	far	larger	numbers	of	COVID	deaths	in	2020	gives	the	lie	to	much	of	thereceived	wisdom.	Siddhartha	Mukherjee	suggests	that	various	combinations	of	dynamic	factors	must	be	at	work.The	predictive	value	of	age,	family	living	arrangements,	public	health	policy	responses,	and	public	compliance	couldnot	explain	major	discrepancies	in	the	impact	of	the	pandemic	at	different	stages	in	its	development.	Heacknowledges	that	under-reporting	was	a	serious	problem	in	some	of	the	lower	income	countries,	but	moreimportant	was	the	indirect	effect	of	the	virus	on	death	rates	due	to	disruptions	to	medical	care	and	preventionprogrammes.	Other	factors	were	the	need	for	a	greater	understanding	of	the	immunological	and	socio-ecologicalprofiles	in	populations,	and	the	role	played	by	strong	leadership.These	factors	are	important	in	understanding	variations	not	only	in	the	public	health	impacts	of	the	pandemic	butalso	in	state	responses	to	COVID,	and	in	assessing	whether	some	countries	had	learnt	more	than	others	from	theirexperiences,	and	whether	they	applied	this	knowledge.	The	policy	learning	process	is	complex	and	we	should	avoidexplanations	that	attribute	it	to	simple	causal	relationships.This	post	represents	the	views	of	the	author	and	not	those	of	the	COVID-19	blog,	nor	LSE.LSE Covid 19 Blog: Containing COVID, part 4 | The limits of knowledge exchange Page 2 of 2		Date originally posted: 2021-04-29Permalink: https://blogs.lse.ac.uk/covid19/2021/04/29/containing-covid-part-4-the-limits-of-knowledge-exchange/Blog homepage: https://blogs.lse.ac.uk/covid19/

Containing COVID, part 4. The limits of knowledge exchange

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Containing COVID, part 4. The limits of knowledge exchange

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