The return of the state? The role of government in managing the pandemic

Mar 23, 2022
Corona virus
Learning from the mistakes of COVID-19 will be critical as pandemics become more common. Image Pixabay
Many countries with very high rates of COVID infection and pandemic deaths had governments reluctant to intervene to protect public health because of a strong belief in small government.

Since UK Prime Minister Margaret Thatcher and US President Ronald Reagan in the early 1980s ushered in aneconomic reform program that rolled back the role of government, neoliberalism has defined policy making in a majority of western countries. It continues to drive conservative thinking about the state with the notion that government is the problem, not the solution.

A re-evaluation of neoliberalism is long overdue. This is particularly relevant as COVID restrictions ease or are scrapped entirely in many countries and it is now possible to reflect on what allowed some countries to be more successful than others in holding off the worst of COVID-19. It is clear that the countries with the best responses relied heavily on strong government intervention, a commitment to a collective approach to public health that protected the most vulnerable and a willingness to quickly respond based on the best available science and public health advice.

The success of island countries like NZ and Taiwan can be largely attributed to the speed and scale of government intervention seen throughout the worst of the pandemic and the comfort of the population with this. Taiwan had the highest mortality rate in the world in the 2003 SARS outbreak. Since then, it has kept in place key parts of government health infrastructure needed to respond effectively to public health emergencies – something that should be emulated globally following the satisfactory control of this pandemic. President Obama had established a $200m early warning program designed to alert it to potential pandemics. President Trump decided to end this program just three months before the start of the COVID-19 Pandemic.

The comfort of these countries with government intervention measures including mask mandates and track-and-trace protocols in response to COVID-19 also needs to be noted when the global response to the pandemic is reviewed. In contrast the countries that had some of the highest rates of death and infection from COVID-19 include the US, UK, Brazil and India. These nations continue to follow neoliberalism and have leadership, particularly Brazil’s Jair Bolsonaro, that explicitly rejected science and public health advice. Within these countries the collective didn’t seem to matter. Only individuals mattered. Their response to COVID-19 emphasised the responsibility of individuals as opposed to government in managing the crisis.

Put simply – countries with a small government approach had larger epidemics and countries more comfortable with government interventions had smaller epidemics.

An additional indication of this small government, anti-collective approach is the failure of nations that continue to adhere to neoliberal policy settings to help low-and-middle-income countries (LMICs) to vaccinate against COVID-19. Low vaccination rates in LMICs is likely to prolong the pandemic unnecessarily as more variants of the virus are likely to emerge in these largely unvaccinated populations.

Learning from the mistakes of COVID-19 will be critical as pandemics become more common. This now seems almost inevitable as the world’s population continues to grow and more people come into contact with new zoonotic sources of infection. A number of factors will exacerbate these developments including climate change, deforestation and growing food insecurity.

Countries need to learn from the mistakes made from the global response to COVID-19 to help prepare for the next pandemic. We have to identify what public health infrastructure has to remain to be able to more effectively respond to any future crisis. Part of this means embracing the role of the state in maintaining good public health and rejecting the neoliberal commitment to the individual at the expense of the collective. As COVID-19 continues to demonstrate – no one is safe until everyone is safe.

A Royal Commission into Australia’s response to COVID-19 represents a critical first step. Australia’s mixed response to COVID-19 contrasts strongly with its remarkably effective federal and state management of HIV which still benefits Australia. In response to HIV Australia introduced needle-syringe programs, developed targeted national plans to reduce HIV transmission and provided direct assistance to communities who were the most at risk from HIV including men who have sex with men, sex workers, people who inject drugs and Aboriginal and Torres Strait Islander people. All these measures remain in place to this day as a part of an ongoing strategy to manage HIV infections within Australia.

The fact that countries that had a strong focus on government intervention in managing COVID-19 had better health outcomes represents a significant challenge to the neoliberal consensus. It is now the duty of governments globally to step up and better understand their role in maintaining good public health and the infrastructure required to fight any future pandemic. Neoliberalism could not manage the COVID-19 pandemic and will be even less able to manage the succession of pandemics which now unfortunately seem very likely to follow.


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