The ability to achieve national unity can be viewed as a three-way tug of war seeking to balance public health interventions with their economic consequences while keeping the population on board with interventions that can involve social and economic hardship and the restriction of liberties. Solidarity at a national level therefore hinges to a large degree on the relationships between policymakers, the scientific and public health communities, and the population.
Solidarity and politics
The politicization of global crises, including pandemics, is not a new phenomenon. The HIV epidemic, the SARS epidemic, the 2014–16 West Africa Ebola outbreaks and the 2015–16 Zika virus outbreaks were all used to advance political interests. In the case of COVID-19, some politicians have derived political mileage from attacking and blaming other countries or institutions (such as China or WHO) for the scale of the crisis; denying the severity of the threat; alienating the scientific and public health communities; or propagating alternative facts and rejecting public health guidance on mask-wearing or physical distancing, handwashing and vaccine uptake. The repercussions of pandemic politicization can be extensive: it not only hampers efforts to foster national unity, but can also encourage ethnic and racial discrimination among individuals, societies and countries.
Research conducted by the Lowy Institute found that, to date, no single political system has emerged as significantly or consistently more effective in managing the pandemic. Using several health outcome indicators, the institute developed a COVID Performance Index, which found that authoritarian regimes (classified according to the Economist Intelligence Unit’s Democracy Index 2019) performed only marginally better (scoring 49.6) than democracies (scoring 46.8). This is in keeping with our findings that solidarity can prevail in countries with different political systems and different governance arrangements.
Some interviewees observed that two-party systems and partisan politics can, however, be a barrier to solidarity. Decisions related to the pandemic response can manifest more as political calculation than evidence-based, and are easily politicized along party lines. While one-party systems or those leaning towards authoritarianism might make it easier to achieve solidarity, as one interviewee pointed out, it still very much depends on whether the elected leader seeks to unify in times of crisis or to achieve opportunistic political gain. For example, in Tanzania (now deceased) President John Magufuli’s ‘aggressive COVID denialism’ resulted in a lack of reliable reporting, public health inaction and refusal of vaccines, which reflected the ruling party’s antagonism towards mabeberu (imperialists), its tight control over information and aversion to scientific evidence.,
Interviewees recognized that achieving national unity is increasingly a function of political leadership and the ability of policymakers to engage in a process of meaningful negotiation and compromise, such as by bringing in multiple different parties and actors to agree on a policy. In Bhutan, for example, with its population of about 780,000 and just one recorded death from COVID-19 up to the end of May 2021, an important factor in its success has been the high level of political commitment, in which King Jigme Khesar Namgyel Wangchuck has played a leading role. Community mobilization also played a major part in this emerging success story, particularly the DeSuung volunteers (Guardians of the Peace), a movement initiated by the King. Above all, there has been a high level of mutual trust between leaders and the population.,
Similarly, in Finland, the government formed a committee between the ruling and opposition parties to fight the pandemic together. Another example is Tunisia, where the government created a National COVID-19 Monitoring Authority that includes senior officials from all ministries, to facilitate better compliance across sectors, as well as coordination with subnational committees.
The relationship between policymakers and public health leaders
In times of crisis, the actions of policymakers and the advice of public health experts are critical to gaining public trust and acceptance of new policies or interventions. The relationship between these two groups has a significant impact on how much solidarity the population demonstrates with the national response. Governments have taken different approaches, informed to a greater or lesser extent by science, but ultimately accountability for pandemic response policy rests with political leaders.
Several interviewees attributed strong working relationships between policymakers and scientific/public health communities to recent experience of cooperating to control disease outbreaks. For example, in Mexico, following the 2009 H1N1 pandemic, the national disease surveillance system was expanded and decentralized. Over time, this encouraged more routine coordination and communication between branches of government and the scientific community. This was evident during the current pandemic, as one interviewee remarked on the swift, government-initiated calls to different diagnostic centres to evaluate capacities and supplies. At the highest levels of government, however, solidarity between the political leadership and the nation’s public health community failed; President Andrés Manuel López Obrador was in conflict with the advice of his public health authorities and with the country’s medical community, amid unrest in the population.
In Nigeria, the experience with Ebola in 2014 galvanized greater cooperation and collaboration between policymakers, clinicians and public health leaders at both national and subnational levels. The Bill to Act, which was signed by President Muhammadu Buhari in 2018, established the Nigeria CDC (NCDC) as a parastatal agency legally mandated to respond to public health threats, signalling the high level of trust between the federal government and the NCDC. As a result, interviewees observed minimal political interference and strong agreement between the public health authorities and government on the best way forward. Again, this relationship is not without its challenges, as one interviewee remarked on the impact of Nigeria’s police brutality crisis on the levels of public trust in the NCDC, which was viewed by many as ‘corrupt’ and ‘all part of the same government’ (NP-023).
Interviewees observed minimal political interference and strong agreement between the public health authorities and government on the best way forward.
The examples of Mexico and Nigeria illustrate the complexity and fragility of sustaining relationships between policymakers and public health leaders during a crisis. In many countries, this relationship has been fraught with tension from the outset. For example, the UK government repeatedly insisted early in the pandemic that its decision-making was ‘following the science’, but questions were raised about the degree to which this was the case, and about the politicization of scientific advice. The membership of the UK’s Scientific Advisory Group for Emergencies (SAGE) was initially heavily criticized for inappropriate involvement of government advisers, lack of transparency and under-representation of public health and other relevant communities, with one high-profile commentator claiming the relationship between scientists and government had become ‘dangerously collusive’. In May 2020, a separate self-appointed group of 12 leading scientists established the ‘Independent SAGE’, which held weekly public online briefings and offered scientific advice.
In the US, the Trump administration consistently rejected the role and value of science in decision-making, and questioned the trustworthiness of leading public health experts and agencies. Unlike the legal protection afforded to the NCDC, the Trump administration was able to sideline and undermine agencies such as the US Centers for Disease Control (CDC), including through making political appointments to them. For example, in May 2020 the Trump administration blocked the Director of the National Institute of Allergy and Infectious Diseases, Dr Anthony Fauci, from testifying on the pandemic response in front of the House of Representatives.
The alienation of the scientific and public health communities exposes the lack of collegiality, mutual respect and support between policymakers and these communities, at the expense of national unity. Indeed, in a 2020 survey on national responses to the pandemic, 54 per cent of UK respondents and 52 per cent of US respondents thought their government was handling the pandemic poorly, compared with only 25 per cent of respondents in Italy, 14 per cent in South Korea, and 6 per cent in Australia. In fact, across the 14 countries surveyed, the majority of respondents believe that their own country has done a good job handling the pandemic, with the exception of the UK and the US.
Population buy-in with the national response
The relationship between government and the population is a crucial determinant of national unity, linked to a number of interrelated factors including equity; social cohesion and community mobilization across different population subgroups; and the trustworthiness, clarity and consistency of risk communication and public health messaging.
Equity
Even in countries where policy responses to the pandemic have prioritized both lives and livelihoods, the pandemic has exposed and exacerbated the underlying inequities in society, with devastating impacts on marginalized and vulnerable communities worldwide. Neglecting those groups has prolonged – and will continue to prolong – the pandemic.
While initially praised for its decisive public health action and roadmap to economic resilience, Singapore failed to include and prioritize low-wage migrant workers living in overcrowded and unhygienic dormitories. As of December 2020, 93 per cent of all positive cases recorded in Singapore were among migrant workers. Interviewees recognized the government’s ongoing efforts to address migrant worker vulnerability, but credited civil society and community mobilization with acting fast to protect and advocate for better healthcare.
Singapore is just one example. Similar tragedies have been evident in the Gulf Cooperation Council (GCC) countries, where Asian migrant workers suffer disproportionately high rates of COVID-19 infection. In Saudi Arabia, for instance, Asian migrant workers were found by one study to account for 70–80 per cent of all new cases. Almost all countries provided inadequate support to important vulnerable groups. Nearly every HIC has failed to protect residents of care homes, while knowing they were at the highest risk of dying from COVID-19. A survey of 21 countries found that 46 per cent of all COVID-19 deaths were among care home residents. Similar trends are apparent in infection and death rates among people of colour. In the UK, according to the Office for National Statistics, males from a black African background had a death rate 3.8 times higher than that of white males. Even taking account of geography, socio-economic characteristics and health measures, including pre-existing conditions, the rate was still 2.5 times higher than that of white males. There are many other examples of inequitable policy responses that fail to take into account the differential impact of the pandemic across social stratifiers including age, gender, ethnicity, income level, education and professional status.
Several interviewees recognized that solidarity is not just about having a common purpose and consistent approach to the pandemic, but also about focusing on those most vulnerable to infection or to the socioeconomic fallout of the pandemic, who risk being left behind. Many argued that the solidarity movement has failed to advance health equity in a meaningful way, or to redress the exposed inequities. As one interviewee stated, the pandemic has not been a great equalizer, because ‘the most disadvantaged or marginalized in our societies are the ones who are most at risk of infection and who will suffer the longer-term socioeconomic effects of both the virus and the economic fallout’ (RI-033). Another interviewee reinforced that view:
Policy responses and interventions introduced to address the pandemic must be accompanied by the appropriate provisions and protection mechanisms to facilitate public cooperation. As WHO implored on several occasions, this needs to include support for isolation, quarantine and lockdowns, to create an enabling environment for all people to participate in and benefit from the response, as part of the social contract between government and the public. Where social protection is not afforded to the population, research suggests that the impact of national lockdowns on both income loss and risk of exposure to COVID-19 is regressive. However, the past three decades of growing inequality and income insecurity have eroded trust in public systems and institutions, and progressively weakened social cohesion. Indeed, many countries entered the pandemic with a tenuous social contract. Although to date nearly all countries and territories have responded with a combined total of 1,622 social protection measures, interviewees did not perceive there to be sufficient, comprehensive or sustained action at a policy level to prioritize marginalized and vulnerable populations; redress the disproportionate suffering; and remove or mitigate structural barriers to adopting healthy behaviours and accessing healthcare.
Social cohesion, community mobilization and trust
How the individual relates to the community, and the strength of that relationship, was perceived by several interviewees as a key difference between solidarity at a community level in the Asia-Pacific region compared with that in Europe and North America. According to interviewees, individuals in the latter regions tend to be less socially and economically dependent on the community, which, in turn, weakens social cohesion and mechanisms for collective action that are critical to achieving solidarity with the public health response efforts.
By contrast, in many communities across the Asia-Pacific region (and other parts of the world), as well as in Indigenous communities, as highlighted by one interviewee, individuals rely heavily on the community for various aspects of daily life and subsistence. There is a more developed sense of social, cultural and community responsibility and duty that transcends individual rights and freedoms. This leads to an almost habitual practice of trust, mutual support and recognizing interdependencies – all factors that have characterized solidarity in response efforts. Recent studies have similarly observed the protective effect of collectivist societies compared to individualistic ones, in terms of their COVID-19-related health outcomes.,
In addition, how society responds to regulations and public health guidance often also reflects the level of public trust in government and its institutions, especially when used to justify restrictions of individual liberties. Overall, interviewees perceived trust in political leadership to be important in achieving social cohesion and unity between government and the public. Concerning Thailand, one interviewee observed that, although the public may disagree with political decisions and policies, there is a greater trust in government specifically when it comes to protecting the safety, health and wellbeing of people – perhaps as a result of the collective memory of the threat posed by the 2003 SARS outbreak and the need for public cooperation in countering it. However, trust in political leadership is not necessarily a deciding factor in national unity. In Hong Kong, for instance, historically low public trust in government triggered community solidarity and a strong civil society response. The 2019–20 protest movements in Hong Kong pivoted organizational capacity and civic infrastructure to conduct COVID-19 surveillance, distribute masks and install hand-sanitizer dispensers, focusing on impoverished and vulnerable communities, including the elderly., Similarly in Brazil, where political leadership undermined solidarity, grassroots bodies organized to mobilize resources, communicate hygiene guidelines and dispel mis- and disinformation.
Risk communication and public health messaging
Credible and effective risk communication and public health messaging are crucial for building public trust and solidarity with the response. Indeed many countries communicated their pandemic response responsibilities in terms of solidarity. For example, New Zealand’s Prime Minister Jacinda Ardern reinforced health messaging through various media channels and explained how values such as solidarity, teamwork, kindness and collective action justified public health interventions. Interviewees argued that it helps to create a common and collective understanding of the problem, and of what is required from society to cooperate and contribute. As one interviewee put it:
In many countries in the early stages of the pandemic, the lack of transparent, timely and effective risk communication by health authorities failed to catalyse collective action such as physical distancing, lockdowns and appropriate use of PPE. In the absence of effective official risk communication, rumours and misinformation are able to proliferate. The unintentional spread of false information (misinformation), or the deliberate circulation of fabricated information (disinformation), undermined solidarity by distorting public health messages, misleading individuals and communities, and splintering public trust. There was an overwhelming sense that the actors forging a solidarity movement were disastrously unprepared for the vast, rapid spread of disinformation. In Thailand, this ‘infodemic’ was tackled by the Prime Minister’s Office calling on all major media organizations to cooperate to produce a consistent message, coordinate public health communication and reduce the risk of misinformation.
