Stalling Coronavirus efforts in UK and USA – a failure of policy

Like any keen resilience planner/disaster manager, I keep a close watch on the Coronavirus response here in the UK and other similar countries. Like many of you, I’ve watched with alarm as daily infections and deaths appear to be stubbornly refusing to substantially reduce in the UK and seemingly spiralling out of control in the USA.

In comparison, other western nations appear to have their epidemics under control and even close to eliminating the virus.

Source: Financial Times Visual & Data Team

So, what’s going on and why? This article explores how an apparent failure in government policy and communications has partly led to an environment that allows and encourages the virus to spread within the population.

Creating societal change through policy

To successfully implement any strategic policy that requires community action (for example influencing outcomes of a health emergency, such as epidemics), an alignment is needed across three key areas:

  • Government Policy – how the government intends to meet an aim or deal with the situation; shaping the intervention (e.g. the strategic response to a health emergency)
  • Professional/expert advice – providing objective guidance and advice to deliver the change. In this case expert guidance in understanding and reducing detrimental health impacts of the health emergency (such as scientific, medical and public health expertise), and
  • Public co-operation and trust in adopting required behaviours that will support a response.

When these elements are aligned, the policy intervention is likely to be successful and desired outcomes achieved, as long as those desired outcomes are achievable and realistic.

Recap on basics: What is policy?

Policy can be complex, but in its simplest form, policy is ‘how we are going to get things done’. It’s as simple as that

(I’ll do a more detailed article on policy and policy development at a later date).

Policy should be linked to an aspiration, final aim or outcome, even if that aim is to maintain the status quo. Policy is a general set of principles to achieve ‘a thing’ but doesn’t usually go into detail on how to deliver that thing (which is left to service design and delivery).

A more complex definition, policy is:

“…a set of ideas or a plan of what to do in particular situations that has been agreed to officially by a group of people, a business organization, a government, or a political party.”

Cambridge English Dictionary

In the UK the government’s Civil Service employs policy professionals to “design, develop and propose appropriate courses of action to help meet key government priorities and ministerial objectives.”

What’s happening?

With the infections from Coronavirus stubbornly refusing to drop within the UK, and rising at an alarming rate within the USA, something has gone wrong somewhere in the system.

UK daily infections and mortality, 13th June to 23rd July show a stabilising of 7-day average infections in the UK – figures courtesy of UK Gov.

We know both countries are testing at huge rates. At the time of writing the USA has completed 146,000 tests per 1 million population, and the UK 193,000 tests per 1 million (Worldometers.info, 19/07/2020). Both countries have excellent healthcare systems that, at the time of writing, are not overwhelmed or at capacity (apparently).

What’s gone wrong?

So, what is going wrong to cause infection rates to remain stubbornly consistent in the UK and rise at alarming rates in the USA?

Source: BBC News (22nd July, 2020)

Let’s explore this in terms those 3 key strategic policy elements: government policy, professional/expert advice and public opinion.

  • Government policy – in both countries, government policy has distanced itself from expert advice on infection control measures in favour of promoting a less effective political narrative of ‘individual responsibility’. This has limited and reduced infection control measures that have a perceived impact on personal freedoms such as restrictions on movement, mandating face-masks and bans on social gatherings, instead promoting a shared endeavour culture that allows people to choose to follow watered down guidance. Government policy appears to favour measures to protect and re-launch the economy, such as through encouraging returning to work, re-opening of bars, restaurants and shops and in some areas, sporting events.
  • Expert/professional advice – infection control and medical advice appears increasingly side-lined. Public rifts have appeared between health/public health experts and government ministers. The science community, which regularly struggles to communicate complex science to the public are finding their message increasingly diluted in government communications. Key public sector expertise appears increasingly side-lined or prevented from speaking openly in both UK and USA (such as Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases in the USA and Ruth May, England’s Chief Nursing Officer). As a result, the expert community is left without a unifying voice and appears increasingly conflicted by the range of differing and often conflicting alternative views and voices emerging.
  • Public opinion and trust – public confidence in the Government’s pandemic response has decreased to just 41% in the UK, the lowest in the world (YouGov, 8th June, 2020). The divergence between ‘the experts’ and politicians/political policy fuels a reduction in public trust in both, decreasing effectiveness of the diluted infection control measures and creating a perceived dysfunctional competition between ‘the experts’ and politicians. The Government’s repeated self-inflicted injuries, such as the Dominic Cummings breach of lockdown/quarantine in the UK has further damaged the public trust in the Governments response. As a result, the pandemic response finds itself in a dysfunctional competition between politicians, experts and often harming ‘alternative truths’ made prevalent through social media and ‘fake news’.
The UK and USA have created a gap between professional and expert advice, government policy and public trust needed for an effective intervention

The three elements required for successful policy implementation are increasingly distant, leading to a gap in the space for effective implementation of pandemic infection control implementation.

How do we regain control?

Deal with the situation before it becomes a crisis

One important lesson from the world of disaster management is to deal with the situation before it becomes a crisis. Deploy and use all the resources needed to bring the situation under control at the earliest possible opportunity. Anything less will prolong the risks and increases the strain on people and the system.

This current situation is an excellent example of poor crisis management, with half-hearted endeavours, mixed messages and varying policy imperatives. This has created an environment that leaves the epidemic to spread as infection control measures are relaxed; raising the risk that vulnerable people in the community will come into contact with the infection. In the longer term, this increases the likelihood that infection rates may quickly spiral out of control, as we have seen in the USA, or risking a second wave in the UK.

Considering how close the UK is to achieving extremely low infection levels, a period of focused and rigorous infection control activity, coupled with a powerful communications message to win the information battle and get the message to all vulnerable groups especially, may be enough to near eradicate the infection in the UK. This could include a pre-planned lockdown period of 2 to 3 weeks that severely limits opportunities for the virus to spread, followed by rigorous track and trace system to target individual cases.  

References

Woodcock. A, 2020, Coronavirus: Confidence in UK government’s handling of pandemic plummets to lowest in world after Dominic Cummings scandal, The Independent, UK, 08/06/2020, available online:  https://www.independent.co.uk/news/uk/politics/coronavirus-uk-government-confidence-dominic-cummings-boris-johnson-a9554946.html (viewed 23/07/2020)

Cambridge Dictionary, 2020, Meaning of ‘policy’ in English, Oxford University Press, UK, available online at: https://dictionary.cambridge.org/dictionary/english/policy (viewed 23/07/2020)

The Civil Service, UK, 2018, Working in Policy, Civil Service, Whitehall, London, UK, online at: https://www.civil-service-careers.gov.uk/professions/working-in-policy/#:~:text=Policy%20professionals%20work%20at%20the%20heart%20of%20the,definitely%20a%20job%20out%20there%20to%20suit%20you. (viewed 23/07/2020)

Worldometers.info, 2020, Covid-19 Coronovirus Pandemic: Reported Cases and Deaths by Country, Territory, or Conveyance, online at: https://www.worldometers.info/coronavirus/#countries (viewed 23/07/2020)

BBC, 2020, Coronavirus UK map: How many confirmed cases are there in your area? 22/07/2020 online at: https://www.bbc.co.uk/news/uk-51768274 (viewed 23/07/2020)

Financial Times Visual & Data Team, 2020, Coronavirus tracked: has the epidemic peaked near you?, Financial Times, UK, online at: https://ig.ft.com/coronavirus-chart/?areas=usa&areas=bra&areas=gbr&areas=fra&areas=deu&areas=esp&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&cumulative=0&logScale=1&perMillion=0&values=deaths (viewed 23/07/2020)

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