With the novel coronavirus disease COVID-19 reaching pandemic proportions and US President Donald Trump declaring a national emergency, now is a critical moment to learn from countries' responses thus far and rapidly implement effective strategies to limit the impact of the virus. Yet Americans are at risk of learning the wrong comparative lessons in the face of this global emergency. In times of crisis, authoritarian responses based in high-profile displays of state power can seem attractive. But it is the far less conspicuous public-health work that seems to be separating the effective responses so far.
Last week, Trump announced a surprise ban on travelers from much of Europe and extended it on Saturday to the United Kingdom and Ireland. This travel ban, which goes against World Health Organization (WHO) advice and international law, is unlikely to significantly affect the US COVID-19 epidemic. Indeed, it may have worsened it, by creating crowded scenes in unprepared airports as panicked travelers returned home.
But it mirrors headline-grabbing efforts in China and elsewhere that use forced restrictions on travel and movement to try to stop transmission. This can distract from the success of widespread testing, openness and transparency, and effective public-health communication, which have been the key ingredients of effective response in several countries where political openness is also valued.
China's response to the coronavirus in late January was a remarkable show of state power that included a lockdown of nearly 60 million people in Hubei province, with strict measures sequestering people to their homes and cutting off nearly all travel, and further restraints on another 700 million people or more throughout the country. This response has been lauded by Trump as "strong" and showing "great discipline" and by the WHO director-general as "setting a new standard for outbreak response." China has seen a rapid decline in new cases in recent weeks and may be on the way to controlling the outbreak. Some have worried that this kind of authoritarian state control cannot be replicated in more open societies.
But focusing on social control may miss many of the most effective components of China's response. A recent transmission modeling study in the journal Science suggests that restrictions on movement in Hubei did not stop the spread of the virus within China, but likely only slowed it by three to five days. More research is needed to understand what has and has not worked in China. But while the unprecedented lockdowns have gotten the most attention, the country has also employed more recognized public-health measures at extraordinary scale, including building temporary hospitals and deploying thousands of health workers to screen people, isolate those with the virus, and provide medical care.
Authoritarian political institutions actually contributed to the early failures that allowed the outbreak to grow in the first place, as those who attempted to raise the alarm early were threatened and critical information flows to leaders and the public were blocked. Many fled Wuhan to avoid the lockdowns.
South Korea's response, in stark contrast, has been grounded in transparency, open information, and technology-supported deployment of public-health measures. The state has a clear strategy built by the executive branch and communicated transparently to the public through twice-daily press briefings. The government has concentrated on testing large numbers of people and identifying the hot spots of infections, such as the cities of Daegu and Gyeongsan, which have been designated "special care zones" and flooded with extra supplies and staff.
Testing has been made free and easy—with some 50 drive-thru centers providing testing and supporting rigorous contact-tracing. Instead of city-wide cordons and universal lockdowns, the government has deployed a smartphone app to allow self-quarantine for people who have come in contact with coronavirus, connecting them to case workers and monitoring to ensure they follow quarantine orders. Travelers from China have not been banned, but instead must download a "Self-Diagnosis App" and use it to send daily updates on their condition. A massive social-distancing campaign has been deployed to cancel mass gatherings and slow the spread of the virus through voluntary measures that keep people apart.
This approach is born out of a very different political context. In South Korea, open media report widely, elections are highly competitive, and the previous president was removed by impeachment after massive street protests by millions over her handling of a previous crisis. The main opposition party has been active in criticizing the government response to coronavirus in the lead-up to the next elections, including pushing back against suggestions of a broader lockdown of Daegu.
New cases in South Korea have begun to slow, and the country is hopefully turning a corner. President Moon Jae-in has suggested that the country is entering a "phase of stability." This shows that democratic governance and noncoercive approaches can be effective against the coronavirus—but only if they are vigorous and rooted in all-out efforts to deploy public-health measures.
On Friday Trump declared a state of emergency under the Stafford Act that triggers a surge in government powers and funding. These powers should be focused on ramping up public-health capacities, getting testing on track, and enabling widespread voluntary participation in measures to halt the virus, not on sweeping coercive measures. Using public-health powers to ensure social distancing is appropriate—the prohibition of mass gatherings by local authorities can be paired with the use of the president's bully pulpit in support of a voluntary social-distancing campaign. Deploying technologically advanced options for basic public-health activities such as isolation and contact tracing should be a top priority. But there is an important line between public-health measures to encourage distancing and isolate people with the virus and sweeping lockdowns that outlaw travel and movement.
We can be learning from, and collaborating with, countries and regions that appear to be balancing democratic openness with rapid, concerted public-health action, including South Korea, Taiwan, and Hong Kong. No response is perfect, and the world may yet see resurgent outbreaks, but relative success thus far demonstrates the value of rapid deployment of core public-health intervention amid open politics.
Travel bans are dramatic. They are a unilateral prerogative of executive power. And they fit well into a narrative about keeping out "foreign" disease. But they have largely proved ineffective in fighting disease outbreaks and evidence suggests this holds true in this outbreak. US officials still assert coronavirus-related bans have been helpful, but concede that the efforts at containment have not prevented the virus from spreading within US communities unchecked and untracked. Perhaps most importantly, they drive a wedge between countries at a time when coordinated global action is urgently needed.
In the medium term, shifting from isolationism to transnational cooperation and coordination can enable the United States to learn in real time what's working and coordinate policies across borders to stop transmission. Quickly rebuilding coordination capacity for global health inside the National Security Council could help. South Korea's global health diplomacy efforts and decision to provide regular public updates in English provide a model. The United States, a permanent member of the UN Security Council, could be pushing to (virtually) convene world leaders in a more coordinated response. The Chinese example can and should push the United States to ramp up global health efforts in support for low- and middle-income countries where people may face the harshest impacts of this outbreak. Focusing on the right lessons from abroad could make or break the course of this fast-changing pandemic.
Now is not the time for authoritarian disease response or for isolationism. Neither will serve the United States well.
Matthew Kavanagh is a Global Health Analyst