Editor’s note: Some facts have been updated since the article was originally published to reflect the continued spread of the coronavirus pandemic.
THE NEW CORONAVIRUS has spread rapidly across the world, reaching more than 150 countries in just over two months, infecting more than 250,000 people. From lockdowns in Italy and China and California to disruptions in international travel and trade to school closings across America, unprecedented public challenges are requiring public leaders to consider unprecedented measures. What should the public sector do to address this crisis? What can governments do to contain this pandemic and manage the severe disruption it is causing? And what are they doing wrong? We asked experts at Harvard Kennedy School to identify public problems and public solutions.
- Matthew Baum on credible communication
- Wendy Sherman on drawing together
- Mark Harvey on a whole-of-society approach
- Juliette Kayyem on disruption as the plan
- Soroush Saghafian on transparency, control, and prioritization
- Arn Howitt and Dutch Leonard on energetically mobilizing the whole system
- Amitabh Chandra on vaccine investment
- Nadja West on the boring basics
- Kathryn Sikkink on rights and responsibilities
- Linda Bilmes on new priorities
Critical to containing, and mitigating the effects of, COVID-19 is credibly communicating essential information to the public, without politicizing the message. We have seen in previous epidemics, such as H1N1 in 2009, that when a public health emergency is politicized, citizens become less likely to trust the government to provide reliable information. Such skepticism has consequences. In 2009 it hindered public vaccination efforts, likely resulting in more infections and possibly also fatalities. Similar problems are emerging today, with sometimes conflicting messages emanating from the Trump White House and public health officials, and resulting public confusion and skepticism.
It is thus essential that the Trump administration pair credible partisan figures from both parties with public health experts in their public communications, while presenting a unified message. If people who are skeptical of public health officials but trust the administration see partisan and scientific leaders presenting a common message, they are more likely to accept it as reliable. The same holds for people who are skeptical of the administration but inclined to trust public health experts. Such a joining of forces, as when Mike Pence last week shared a press conference stage with Dr. Anthony Fauci, is the best way to persuade the public to follow the guidance of the nation’s public health professionals as they attempt to navigate the nation through this emergency.
Matthew Baum is the Marvin Kalb Professor of Global Communications and professor of public policy at Harvard Kennedy School and Harvard University's Department of Government.
The World Health Organization is playing a very key role throughout the world in providing guidance, test kits, protective gear, technical assistance, and more to countries challenged in this time of coronavirus. The injunction to prepare, plan, and proceed is exactly what is needed, including here in America. We must take bold action now to hasten the end of this novel virus or live with uncertainty for a very long time. The Trump administration often seems preoccupied with optics rather than with action and, as a result, left Americans uncertain about what to do. Governors are trying to fill the void with urgency, not panic, and prudence, not politics. As we create social distance to confront a virus that knows no borders, we need to draw together, even if virtually, as we have always done in times of crisis.
Wendy Sherman is a professor of the practice of public leadership and director of the Center for Public Leadership at the Harvard Kennedy School. In addition, she is a senior fellow at the School’s Belfer Center for Science and International Affairs. Sherman is senior counselor at Albright Stonebridge Group and former U.S. under secretary of state for political affairs.
The public sector must lead a whole-of-society, global approach to mitigating the impact of the coronavirus pandemic. This involves public health emergency actions, identifying economic impacts, and combating misinformation and disinformation about the disease and its spread. Effective risk communication must be a consistent factor throughout.
With a public health emergency in place and $8.3 billion in emergency funding, it is time to research and develop effective treatments. This should mean not only developing a vaccine, but also leveraging the quick work to sequence the coronavirus genome by examining potential gene editing, synthetic biology, and other innovative biotechnology solutions to heighten immune response to the virus. Ideally, this happens in coordination with international efforts so the global medical community can best leverage disparate areas of expertise.
Beyond direct research and medical support, government can also provide productive outlets for public concern. Recruiting and training members of community emergency response teams to support public health preparedness measures can help neighborhoods understand mitigation measures while better preparing them for more restrictive mitigation actions.
Economically, governments can prioritize acquisition and allocation of medical supplies that will be necessary to treat the disease. But coronavirus is also impacting global supply chains outside the medical community in ways that are not well understood. The United States should work with critical infrastructure owners and operators to understand the stresses on their systems and functions to use other authorities, such as the Defense Production Act, to mitigate critical supply and service disruptions.
Finally, this is the first significant disease outbreak since nations have engaged in the deliberate spread of disinformation via social media. Even the Zika outbreak in 2015–2016 occurred before the U.S. election influence efforts in 2016. Because risk communication is so important, governments need to focus on providing authoritative information via multiple sources to ensure accurate data is driving actions and discussion.
Mark Harvey is a spring 2020 Resident Fellow at the Institute of Politics at Harvard Kennedy School. He is a former special assistant to the United States president and senior director for resilience policy on the National Security Council.
Disruption is the plan
I come to this from the response planning side. And we have quickly moved from the containment phase to the mitigation one. And we know the only goal now, assuming community spread, is to slow the spread so that we don’t stress our health care system all at once. And as a planner, that means that the best way to do this is by aggressive and consistent social distancing planning that will be disruptive.
It will seem abrupt; it always is. Decisions are made and we must respond. It is the nature of a pandemic that has no “start” moment, so the right timing is always a guesstimate—too late, and you miss your window; too soon, and you may interrupt unnecessarily. But this is the new normal. Disruption is the plan.
Juliette Kayyem is the Senior Belfer Lecturer in International Security and the chair of the Belfer Center’s Homeland Security and Security and Global Health Projects. She served as President Obama’s assistant secretary for intergovernmental affairs at the Department of Homeland Security.
Transparency, control, prioritization
What governments must do mainly involves increasing transparency, imposing control measures and appropriate restrictions, designing suitable prioritization guidelines regarding allocation of scarce resources, and making use of effective technologies such as tele-medicine. First, transparency—making data on spread, successful treatments, death rates, and other related outcomes publicly available in a timely manner—is a major factor that some countries, including the United States, continue to limit, and this can be lethal. Absent transparency, it becomes exponentially challenging to find effective ways of containing the disease and treating those who are affected.
Second, imposing control measures and appropriate restrictions (including travel restrictions, school closures, and prohibiting large gatherings) can be extremely effective. Countries like Italy and China have made use of these levers. But there is a time dimension that is highly critical: these levers become less effective if used late in the game. Third, deciding on who should get scarce resources (such as test kits, hospital beds, ventilators, and the attention of medical professionals) is incredibly hard but also important. Some countries, such as Bahrain, may face the need to make prioritization decisions less than the others, since they moved early on to stockpile enough test kits and prepare to deal with demand spikes. In other countries, prioritization guidelines are highly vital. Finally, a smart response requires the widespread use of remote technologies such as tele-medicine. Relaxing the restrictive laws on using these technologies can be highly effective in addressing the needs of the public and offsetting some limitations in facing scarce resources.
Soroush Saghafian is an assistant professor of public policy at Harvard Kennedy School. He is interested in using and developing operations research and management science techniques that can have significant public benefits. He has been collaborating with a variety of hospitals in improving their operational efficiency, patient flow, medical decision making, and more broadly, healthcare delivery policies. He also serves as a faculty affiliate for both the Harvard PhD Program in Health Policy and the Harvard Center for Health Decision Science, and is an associated faculty member of Harvard Ariadne Labs.
As the coronavirus epidemic accelerates, the United States must rapidly enhance the preparedness of its health care system. Looking ahead, we will need to handle the surge of severe respiratory illnesses likely to swell demand for scarce hospital resources. Simultaneously, we will need to manage the normal flow of all other cases that require high-level institutional care.
In January and February, China struggled to provide care for the burgeoning volume of severe coronavirus cases, especially in Wuhan and Hubei province overall, while also tragically squeezing out people who needed critical routine care (e.g., kidney dialysis or treatment for diabetes or cardiovascular disease). It is likely that many Chinese deaths resulted from these shortcomings.
Effectively meeting likely health care needs in the United States is only partially the task of hospitals. Civil society, government, and the entire public health and health care system must, on the one hand, seek to limit demand on hospitals and, on the other, use limited medical resources efficiently. We all can contribute to slowing the spread of the virus, thus diminishing the numbers needing care at the peak of the epidemic and ultimately reducing the overall number of people infected. Public health, buttressed by civil society organizations, can support this by effectively educating people about the need for conscientious social distancing (e.g., limiting travel, exposure to crowds, and handshaking) and better hygiene (e.g., careful handwashing and not touching our faces). We all need to comply, both for our own welfare and for the common good.
To ensure that advanced care is available for those who need it most, the health care system must match patients with the level of care truly needed. Private practitioners and clinics must divert non-critical cases—the 80% of infected individuals who will have few or moderate symptoms—to home care with sufficient isolation to prevent transmission to family members. Hospitals, for their part, will have to limit elective procedures and discharge patients promptly to free space. That will reserve scarce hospital beds and intensive care facilities only for critically ill patients.
Caring for people in the home setting will require logistical support as well, and this also needs to be thought of as part of the healthcare system. To hold space in hospitals for the most critically ill, we will be outsourcing to home the care of the less-severely ill, but they and their families will need assistance in meeting both medical needs and daily living needs in that setting. Support can be mobilized from the public sector (e.g., National Guard units), the social sector (Visiting Nurses Associations and organizations like Meals on Wheels), from community organizations (churches, Rotary Clubs, …), and from community volunteers—but this takes thought, organization, and management that is not self-executing.
Robust external support for the health care system is crucial. We need a vigorous logistics system to ensure adequate supplies of test kits for diagnosis, personal protective gear for clinicians and support staff (e.g., masks, gloves, and protective clothing), and necessary equipment such as respirators to care for patients. We need to exercise great care that critical facilities and clinical staff are not contaminated or infected and therefore forced out of operation, as several hospitals were in Toronto during its 2003 SARS outbreak. Finally, we must not only safeguard health care workers’ physical needs but also recognize the potential for psychological burnout from long hours of work and potential demoralization from persistent stress.
The likely challenges to health care from an accelerating coronavirus epidemic will be challenging. Many public health and health care entities are already hard at work getting ready. To minimize the dangers and produce the best results possible, we must even more energetically mobilize the whole system.
Arn Howitt (top), adjunct lecturer in public policy, is senior advisor of the Roy and Lila Ash Center for Democratic Governance and Innovation at HKS. He also co-directs the Program on Crisis Leadership, jointly sponsored by the Ash Center and the Taubman Center for State and Local Government. Herman (Dutch) Leonard (bottom) is George F. Baker Jr. Professor of Public Management at the Kennedy School and Eliot I. Snider and Family Professor of Business Administration and co-chair of the Social Enterprise Initiative at Harvard Business School. He teaches leadership, organizational strategy, crisis management, and financial management.
The reason that we are resorting to public health measures such as quarantining ourselves is that there is no vaccine for the virus. If we had an effective vaccine, people would not have died or needed hospitalizations; none of the cancellations would be necessary and we would not be experiencing a sell-off in markets. There is no vaccine because society’s willingness to pay for the vaccine is low relative to the benefits of a vaccine. The principal reason for this is that there is a free-rider problem with vaccines—if you take the vaccine and don’t get the virus, then others who didn’t pay for the vaccine benefit too. We see this behavior in the relatively low take-up rates for the seasonal flu shot. This externality reduces the incentives to invent vaccines because vaccine manufacturers only capture a fraction of the value of their inventions. It’s classic market-failure.
But there is more. Imagine that a company were to discover a vaccine for this strain of coronavirus—one that would inoculate us against this scourge completely—and offered to sell the unlimited rights to this technology for $70 billion, which is substantially less than 1 percent of the more than $7 trillion in coronavirus-induced health and economic losses. We could imagine politicians and pundits proposing the seizure of the patents, instead of paying this price. But this timidity discourages vaccine production. Paying $70 billion for unlimited use of this vaccine is much better than losing $7,000 billion, and building a large arsenal of treatments and vaccines for the next coronavirus is better than society experiencing death, hospitalizations, disruptions, and catastrophic economic losses.
The world will continue to experience assaults from coronavirus’ (SARS, MERS and COVID-19) and infectious diseases like Ebola. At the same time, climate change will expose us to more malaria and West-Nile virus. Advanced purchase commitments from government for transformational drugs would greatly reduce the human and economic toll from these diseases.
Amitabh Chandra is Edith Zimmerman Wiener Professor of Public Policy at Harvard Kennedy School and McCance Family Professor of Business Administration at Harvard Business School. His research focuses on innovation and pricing in the biopharmaceutical industry, value in health care, medical malpractice, and racial disparities in healthcare.
The boring basics
In a call for unity and action, President John F. Kennedy, the namesake of this School, once challenged the citizens of our nation to “ask what you can do for your country.” As we are confronted with a global health crisis, that challenge is more opportune than ever. We must all ask “what WE can do” for ourselves, our neighbors, our country and our world. All of us, at every level.
Though the current threat we face is a “novel” virus, some of the actions we can take are “unsatisfyingly” boring and routine; but effective. Prevention is not nearly as exciting as intervention, but it can mitigate risks and save lives. While the world’s scientists and researchers are working to develop countermeasures and cures, it is rediscovering the basics that will hold the line until the weakness of COVID-19 is exploited, allowing a breakthrough to victory.
Practicing the basics is “what we can do” as leaders. It will allow us to remain agile and adaptable to any circumstance, and will build resilience to prevent panic and enable early action in each new emerging situation. We must remind ourselves that we are all leaders, if only of ourselves. One aspect of leadership is being responsible.
As individuals, we can own our behavior and ensure that we take all precautions to protect ourselves. In this setting, it involves maintaining the highest level of wellness possible with proper self-care; remaining aware of our environment; avoiding situations of close contact with others to minimize potential for disease spread; practicing good discipline of frequent and thorough hand-washing; and refraining from touching our faces.
As members of the community we can demonstrate responsibility by ensuring we do not put others at risk by staying at home if we are ill, managing our own secretions by coughing or sneezing responsibly into a tissue or our cubital fossae (elbows) and, again, by practicing hand-washing discipline. We can lead by sharing information and recommendations from our public health authorities, so there is a consistent message to prevent confusion and panic.
As leaders of any entity (business, institution, team, etc.), we can leverage our positions to protect those we lead. Again, the boring basics. Lead by example by following the articulated national and local policies, and modeling them. Communicate the latest information early and often throughout our organizations. Empower teammates to operationalize the recommendations to fit our organizations and provide forums to address questions and concerns. Be truthful and consistent and provide honest assessments. This will reduce confusion, distrust and panic while increasing compliance. Foster an environment that engenders trust and encourages information flow, good and bad, throughout the organization. Toxic leadership is never appropriate: an oppressive environment during a public health emergency can lead to fear, mistrust, hiding of issues or concerns, and adverse outcomes.
The universal basics of prevention and leadership rule the day. When routinely exercised they will become habits that can be adapted quickly and efficiently to respond or react to any public health crisis that manifests itself today or in the future.
Nadja West, a Hauser Leader at Harvard Kennedy School’s Center for Public Leadership, is the 44th Surgeon General of the U.S Army and former commanding general of the Army’s Medical Command. A retired lieutenant general, she was the senior medical advisor to the chairman of the Joint Chiefs of Staff during the United States military’s response to the Ebola crisis in Africa in 2014.
Rights and responsibilities
The Coronavirus pandemic involves both human rights and ethical and political responsibilities. A range of human rights are involved that need to be taken into account include our right to health, but also a right to freedom and movement, to education, to information, to shelter. As countries ramp up exclusionary travel and border policies, some of these rights may be imperiled, and governments need to strike a balance between protecting health and respecting human rights, as the World Health Organization secretary general has recognized.
At the same time, in order for everyone to have the ability to enjoy these rights, all actors socially connected to this problem and able to act must also practice responsibilities that are not always well defined. In order to protect our collective right to health, we may need to recognize that we have a right to travel, but may have a responsibility not to travel in certain circumstances; a right to education, but a responsibility to accept that it may be suspended temporarily or delivered on-line.
International organizations, especially the World Health Organization, appear to have stepped up to their responsibilities in impressive ways. I recommend anyone who wants to be well informed in a way that both prevents panic and promotes action to spend time on the coronavirus part of the WHO website. States need to take responsibility, and some are doing a far better job than others. The U.S. case is especially worrisome, where action by the Centers for Disease Control has been hampered by the initial political instincts of the Trump administration to downplay the problem. In this context, one of the individual political responsibilities that may be most important is the responsibility to vote.
But responsibilities do not stop with the national government, but also exist for state and municipal governments, health care institutions, the media, nonprofits, universities, and down to the individual. At the individual level, our responsibilities in the face of the COVID-19 crisis include such diverse issues as the responsibility to be informed, not to panic, but also to wash hands, to stay at home if we feel unwell, to cover one’s mouth when coughing. Who would have thought that new norms about hand washing would become a crucial global governance issue? And yet this appears to be the single most important action individuals can take.
Kathryn Sikkink is the Ryan Family Professor of Human Rights Policy at Harvard Kennedy School and the Carol K. Pforzheimer Professor at the Radcliffe Institute for Advanced Study. Sikkink works on international norms and institutions, transnational advocacy networks, the impact of human rights law and policies, and transitional justice.
The dangers of the coronavirus to our public health and economy requires that we radically overhaul our national spending priorities.
People in our society depend on their employment for their health insurance and security. The coronavirus shows that the well-being of every person in this country depends on the least-insured and least well-cared-for individual.
Fortunately we are a rich country so we can afford to take bold steps. In the short term, we can do the following: guarantee that all COVID-19 tests and treatment will be free to all; suspend all payments on student loans; require credit card companies and banks to suspend all late payment charges; provide immediate no-strings unemployment payments to the millions of workers in service and gig jobs and others who are out of work; and enact an immediate cash stimulus for everyone in the country of $1000 per person. Also, states that need it should expand Medicare. A bipartisan team led by smart, serious thinkers like Elizabeth Warren and Marco Rubio should rush this sort of plan through Congress.
The federal government was not prepared for this crisis. Bill Gates has been warning for years that the United States should prepare for a likely pandemic “the way we prepare for war,” but no administration of either party has done this. President Trump cut the budget for the Centers for Disease Control in each of the past three years, and with breathtakingly bad timing, he even slashed the tiny budget for “emerging and zoonotic diseases” that jump the species barrier (like coronavirus) and disbanded the White House emergency pandemic preparedness team.
Our national budget should be re-prioritized. The defense budget is at its highest level since World War II because we squandered trillions of dollars on unnecessary, unwinnable wars in Iraq and Afghanistan. We also turned a blind eye to rampant profiteering by defense contractors, for example devoting $1.5 trillion to the F-35 fighter jet, which is behind schedule, over budget, and plagued by performance flaws.
Right now the United States needs to spend whatever it takes to safeguard the health of our people and economy.
Some will ask: but how much does that cost? Can we afford it? These are the questions we should have asked before we invaded Iraq in 2003 and bailed out Wall Street in 2008. But the current situation demands quick action. We can’t depend on the trickle-down of federal “emergency” dollars to states and local governments, which can take months or years. We must take advantage of historically low interest rates to spend money on health care and economic survival.
If we are agile and bold now, we can avert catastrophe, bend the curve of infection, and then step back to reconsider longer-term steps to improve the way resources are distributed. Such long-term steps could include a bold infrastructure program and adding a public option to the Affordable Care Act. After that we should apply this sense of urgency to climate change and restructure our spending priorities accordingly.
Linda J. Bilmes, the Daniel Patrick Moynihan Senior Lecturer in Public Policy, is a leading expert on budgetary and public financial issues. Her research focuses on budgeting and public administration in the public, private and non-profit sectors.
Photos by ChinaDailyCDIC and Andrew Kelly; portraits by Martha Stewart