A comparative analysis of COVID-19 policies across 18 countries, led by researchers from Cornell and Harvard University, reveals that different countries reacted to the pandemic with a variety of policies – resulting in widely varied public health and economic outcomes linked to underlying characteristics of each society.
“Just as the virus exploits pre-existing conditions in the body, it exploits pre-existing social conflicts in the body politic,” said Stephen Hilgartner, professor of science and technology studies in the College of Arts and Sciences and co-leader of the study. “In polarized societies, things have gotten worse and things have been managed less well.”
Hilgartner and co-leader Sheila Jasanoff, Harvard science and technology studies professor, presented an interim report of their findings Jan. 12 during the Futures Forum on Preparedness, hosted by philanthropic organization Schmidt Futures. The public event featured national and world public health, science and policy leaders, including U.S. coronavirus task force leader Dr. Anthony Fauci, M.D. ’66, and Tedros Adhanom Ghebreyesus, director-general of the World Health Organization.
“Your work is helping to unravel why compliance with public health guidelines was high in some places and low in others,” Ghebreyesus said to Hilgartner and his collaborators during the forum.
The Cornell/Harvard project started in May with support from the National Science Foundation and the Cornell Center for Social Sciences. Nearly 60 science and technology scholars in 16 core countries (including China, Germany, Japan, the United Kingdom and the United States) and two affiliate countries (Indonesia and Peru) have been observing unfolding policy situations to shed light on the relationship between expertise, trust and policymaking during the pandemic.
“To understand a nation’s response to the pandemic, you can’t just look at the public health system in isolation,” Hilgartner said during the forum presentation. “You also have to look at the economic system and the political system. Because these systems are coupled, any problems in any of those systems tend to spill over into others.”
In each country, scholars closely tracked policy discussions, decisions and reactions. They produced timelines and systematically collected data on 74 policy-related questions. They paid special attention to which policies created controversy, which varied considerably across different countries.
“The U.S. is an outlier in this respect; almost everything was controversial,” Hilgartner said.
A pattern emerged from the data, Hilgartner said, placing countries into three categories. In “control countries” (China, Singapore, South Korean and Taiwan) authority from the government and trust from the people kept the virus in check.
“Consensus countries” (exemplified by Germany) had less success in controlling the virus but were able to “draw on a reservoir of social solidarity to battle things together,” Hilgartner said.
And in “chaos countries” (Brazil, India, Italy and the United States) “things have gone wrong in public health, the economy and politics, and divisions have increased,” Hilgartner said.
The researchers’ findings challenged conventional wisdom about pandemic response in several ways:
- Many countries, including the United States, had pandemic response “playbooks” ready but “a playbook only works if the key actors agree it’s the right play,” Hilgartner said. “If the politics change, the key government players might throw out the script.”
- Emergency situations amplify – not transcend – pre-existing social, economic and political conflicts, Hilgartner said.
- Indications of success and failure are not always clear. Said Hilgartner: “Outcome measures are always value-laden, always contested, and always erase important features of their context.”
- Scientific advisers do not always clearly enable policymakers. “In crisis situations, technical knowledge is subject to interpretation, and the experts rarely speak with one voice,” Hilgartner said. “Rather, trust in official advice correlates with trust in government, and in countries where you have higher trust in government, you have higher trust in expert advice.”
- Finally, distrust in public health advice may reflect developing research, and not necessarily scientific illiteracy among the public. “As scientists research moving targets, (the) estimates, models, predictions and so forth change over time, and you get overconfident expert recommendations based on evolving data – and people notice this,” Hilgartner said.
Schmidt Futures, founded by former Google CEO Eric Schmidt and Wendy Schmidt, synthesized the Cornell/Harvard findings with a similar project led by Columbia University examining five African countries. Taken together, the synthesis drew on 78 researchers from 47 institutions around the world to outline lessons learned that may contribute to improve public health interventions.
In an interview during the forum, Fauci called on Americans to capture a “spirit of solidarity” in approaching the pandemic.
“Infectious diseases don’t know any boundaries,” Fauci said, “and when you’re involved in an infectious disease that’s a global pandemic, everyone has to pull together. Pull together within a nation, and pull together as part of the global community.”
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