Coronavirus: five failures in leadership
The coronavirus pandemic has revealed triumphs and failings of leaders like few other calamities in modern times.
Whichever way we measure the impacts of the pandemic, be it deaths, case numbers, or ruined finances and livelihoods, these measures reflect the decisions of leaders grappling with an unprecedented contagion.
Across the world, few leaders in government or public health institutions have met the challenge perfectly. But the leadership of those who’ve had qualified success has been markedly different to those who’ve had less success in controlling the spread of the virus and its consequences.
Many have lauded Jacinda Ardern, New Zealand’s prime minister, for her swift and decisive approach to the crisis. Under her leadership New Zealand first went into lockdown on March 25, establishing a four-stage alert system beginning at level four, where most businesses were shut, schools closed and people told to stay at home.
Today New Zealand has one of the lowest number of deaths and case rates in the world and has set the stage for re-opening its economy in what could be an international model in a post-COVID world. At the time of writing, New Zealand has just 4 new cases and has recorded 23 COVID-related deaths since the beginning of the pandemic.
By contrast, the United States administration has 28,550 new cases and has recorded 181,961 deaths. On March 16, President Trump issued a set of ‘Coronavirus guidelines’ to apply for 15 days and asked people to stay at home to slow the spread of the virus, but never order a nationwide lockdown.
In the long term, history will assess what leaders got right and wrong as they sought to control the pandemic. In the meantime, here’s five policy-actions that distinguish leaders who are winning and losing the battle with the coronavirus.
Not following expert advice
This has been a common failure at all levels of government leadership, from national to state, to city and local government.
It needs to be said that those best qualified to lead and provide expert advice to government on how to control a pandemic are public health professionals in the fields of epidemiology, infection control, biostatistics, health policy and global health. Public health has a long history and record of success in controlling infectious disease outbreaks dating back to the birth of modern epidemiology in the 1850s when Dr John Snow traced the source of a cholera outbreak in Soho, London to an infected water supply.
Countless lives have been saved through public policies informed by public health expertise. These successes include the control of HIV and AIDS, the control of vaccine-preventable diseases like smallpox, measles, diphtheria, the prevention of dental caries through the fluoridation of drinking water, and massive declines in tobacco and alcohol related deaths.
In US, The Centers For Diseases Control and Prevention is one of the world’s foremost public health institutions. Well-funded, well-staffed, and well-led until recently, it has long been a beacon of public health expertise and success.
But in few other high-income countries have political leaders ignored or departed from public health advice as frequently as the US Trump administration. At various times since the pandemic began, President Trump has said the virus wasn’t serious, predicted it would disappear, spent weeks questioning the need for masks, encouraged states to reopen even with large and growing caseloads, and promoted medical disinformation. [i]
His administration’s scattered response to the virus has contributed to many failures and missed opportunities, including a lack of effective travel restrictions, repeated breakdowns in testing, confusing advice about masks, and inconsistent messages from public officials.
As a result, the American death toll is of a different order of magnitude than in most other countries. With only four percent of the world’s population, the United States accounts for 22 percent of coronavirus deaths.
Failing to act quickly
Failing to recognise the spreading virus and to act quickly caused preventable suffering and deaths across the world, particularly among older people and especially in those living in aged care facilities.
In the Unites States, 41 percent of all coronavirus deaths have been linked to nursing homes and long-term facilities. At least 68,000 elderly residents and working age carers in these settings have died from the coronavirus. As of August 13, the virus had infected more than 402,000 people in some 17,000 facilities.
This figure jumps to 58 per cent in Israel and Norway and 66 per cent in Spain. Canada has the highest proportion in the world, with 81 per cent of all COVID-19 deaths in aged care centres.
In Australia, COVID-19 related deaths among elderly people in residential aged care facilities are among the highest in the world. By August 9, more than 68 percent of all COVID-19 deaths across the nation were among residents of aged care facilities.
The federal government was too slow to recognise the problem. Even as late as mid-August the government was “failing to provide the same health response to residential aged care that was delivered to the rest of Australia,” said highly-regarded geriatrician Joseph Ibrahim of Monash University. He said the failings included insufficient funding for staffing, slowness in acknowledging the importance of masks, and delays in establishing co-ordinated infection control and response to outbreaks. [ii] An aged care workforce retention bonus was not paid to workers until July even though it had been promised in March. [iii]
“The system is broken. And what we’ve seen with COVID is that the system is broken at a high level because it’s not the aged care workers that have failed us in this. It is our people who are in governance roles — and I’m not going to call them leaders because they’re not leading — the people in governance positions who are accountable for what happens is where we have failed,” Ibrahim said. “They have not recognized the magnitude of the problem staring them in the face.” [iv]
In mid-August, after mounting pressure and days of damaging evidence presented to a royal commission into aged care, the Australian Prime Minister Scott Morrison apologised for his government’s failings. He said he was “deeply sorry” for failures in the aged care sector during the coronavirus crisis, but quickly defended the government’s overall response and backed officials who disputed many statements made to the royal commission.
The head the Commonwealth Health Department, Professor Brendan Murphy, accused the aged care royal commission’s lawyer (Peter Rozen, QC) of using misleading statistics to criticise the Government’s response to COVID-19. Counsel assisting the royal commission Peter Rozen, QC had repeatedly stressed the fact that aged care residents were over-represented in Australia’s COVID-19 death toll.
“Presently, 68 per cent of all COVID-19 deaths in Australia relate to people in residential aged care,” he said in his opening remarks to the royal commission on August 10.
A few days later Professor Murphy told a Senate committee that using those figures to suggest Australia was performing poorly was an “extraordinary interpretation of statistics”, labelling the conclusion “ludicrous”. When you have a very, very low death rate generally, then the aged care death rate as a proportion is high,” he said.
“Every death is an absolute tragedy and it’s been an awful situation, but to interpret a percentage of an extremely low death rate as an example of poor aged care management is simply not defensible.”
In the United States there was a similar failure by leaders at the Centers for Disease Control and Prevention to act quickly and decisively.
The CDC made early testing mistakes that contributed to a cascade of problems that persist today. It failed to provide timely counts of infections and deaths and it hesitated in absorbing the lessons of other countries, including the dangers of silent carriers spreading the infection. [v]
The agency struggled to balance the competing needs for caution while moving quickly as the coronavirus ravaged the country, according to interviews with federal officials, public health experts and medical workers. Further, in communicating to the public, the CDC’s leadership was barely visible, its stream of guidance was often slow and its messages were sometimes confusing.
“It’s not our culture to intervene,” said Dr George Schmid, who worked at the agency off and on for nearly four decades. He described it as increasingly bureaucratic, weighed down by “indescribable, burdensome hierarchy.”
This culture has locked some into a fixed way of thinking, former officials say. And it helped produce the CDC’s most significant failure in the crisis: its inability early on to provide state laboratories around the country with an effective diagnostic test.
The CDC developed a successful test in January designed to be highly precise, but it was more complicated to use and turned out to be no better than versions produced overseas. And in manufacturing test kits to send to the states, it contaminated many of them through sloppy lab practices. That, along with the Trump administration’s failure to quickly ramp up commercial and academic labs, delayed the rollout of tests and limited their availability for months.
As a result, the CDC couldn’t produce accurate counts of how many people were being tested, compile complete demographic information on confirmed cases or keep timely tallies of deaths. “That specific, granular data has huge implications,” said Julie Fischer, a professor of microbiology at Georgetown University who studies community preparedness for emerging diseases. “We lost precious time in decision-making and putting public health resources to use.”
As the virus spread from China across the United States between late January and early March, large-scale testing of people who might have been infected didn’t happen due to technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels. The result was a lost month, when the world’s richest country squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.
Creating fear, confusion and division
Like US President Donald Trump, the Mexican President Mr López Obrador minimised the pandemic early on, questioning the science behind face masks and did little to establish testing. He has consistently undermined medical experts and sown political division.
He generally speaks to the media without a mask and has said forcing people to wear masks could lead to “human rights abuses.” Mr López further played down the severity of the coronavirus’ threat early on by allowing soccer tournaments, concerts and preparations for the busy spring tourist season to continue even as neighbouring countries shut down.
In late March when case numbers started to rise, a lockdown went into effect, but by April the president had declared the disease under control. An analysis by The New York Times later found that the Mexican government was not reporting the virus’s true toll.
Adding to the confusion, political leaders in Mexico have sown doubts about the virus and the need to seek medical care. The popular president says he uses religious charms and his “clean conscience” to ward off the coronavirus, and he has advocated fighting the pandemic at home, with the help of families, rather than in hospitals.
Seeking to avert economic pain, the president has barely restricted travel. Under his watch, Mexico has the fourth highest coronavirus death toll worldwide. At the time of writing there have been at least 652,300 cases of the coronavirus in Mexico and 69,649 people had died.
In Australia, as elsewhere, there has been political division over when and how to lift tough lockdown restrictions and reopen an economy that has experienced its first economic contraction in 30 years.
Prime Minister Scott Morrison and many in his government have persistently undermined and criticised State Premiers that have enacted strict lockdowns on the advice of the chief health officers. This white-anting has provoked confusion and division in the community about the necessity and effectiveness of lockdowns, mask wearing, virus testing, contact tracing and protocols governing public gatherings. In doing so, the PM has undercut his own rhetoric of unity and wrecked the initial good will and effectiveness of weekly ‘national cabinet’ meetings involving the PM and the State Premiers to manage responses to the pandemic.
On September 7, Morrison took aim at the Victorian Government’s roadmap out of stage 4 coronavirus restrictions, saying he hoped the state would reopen more quickly than outlined.
Describing the Victorian plan as “hard and crushing news”, Morrison together with his treasurer and health minister issued a statement saying it was vitally important to “reopen our economy and reasonably restore the liberties of all Australians”. The statement also focused on the economic cost of maintaining stage 4 restrictions in Melbourne and stage 3 restrictions across Victoria.
The PM’s words gave comfort to business leaders that have pushed back against lockdowns that have hurt employment and business profitability.
The head of Victoria’s peak business organisation described Victoria’s roadmap out of coronavirus restrictions as “a road to nowhere”, while doctors said the plan will ultimately help the nation recover from the pandemic sooner. Victorian Chamber of Commerce and Industry chief executive Paul Guerra said he acknowledged the state’s second wave of coronavirus infections had to be contained, but the plan did not do enough to protect the business community’s future.
“We were hoping for a road to recovery. Today we have been delivered a road to nowhere,” he said.
“This does not deliver for the thousands of businesses that are trying to keep this state going and trying to keep their doors open.”
Political attacks on Victorian Premier Daniel Andrews from Morrison’s’ government continued for much of the week. “I am not interested in the politics of this,” Andrews said in response. “I am just not. It doesn’t work. It doesn’t work. Politics is of no use in the fight against this virus.”
Premier Andrews is holding his nerve but shouldn’t have to. Jurisdictions that have successfully eradicated or greatly reduced the incidence of coronavirus have shown unity in communicating and enforcing public health protocols. Disunity, political white anting and premature relaxing of restrictions have only sewn confusion and aided defiance against restrictions, producing second and third waves of the pandemic, causing more deaths, more rebound restrictions and consequent pain for employees, employers and business confidence.
Reopening the economy too soon
Among the litany of leadership fails that have emerged during the pandemic perhaps the greatest has been abandoning lockdowns and reopening economies before it was prudent to do so.
Remember the purpose of lockdown is to “crush the curve” — cut the number of infected people to a relatively low level. Then combine gradual reopening with widespread testing, tracing of contacts after an infected individual is identified, and isolation of those who might spread the disease.
Extended lockdown means a large loss of income for many workers and businesses. In fact, nearly half of the adult population in America and Australia, for example, lives in households that have lost employment income since early March. So lockdown had to be accompanied by disaster relief, especially generous unemployment benefits and aid to small businesses, to make lockdowns tolerable. It turns out that disaster relief has been more effective than is widely recognized.
In the US, the UK and Australia conservative governments who prize balanced government budgets found themselves with no option but debt-financing their economies with generous unemployment packages and payments and loans to employers to keep workers on the books. Governments have been able to fund these payments by issuing government bonds on very favourable terms — government borrowing costs are the lowest in a century.
So conservative economic ideology gave way to economic reality. Conservative governments that were shuttering their economies had to bankroll the economic storms of their own creation. Despite this, conservative ideological obsession with balanced budgets soon reared its head and in America, the UK and Australia, the economic rescue packages were soon being wound back, worsening the plight of people who had lost their jobs and creating the threat of an economic cliff as consumer spending stalled again.
However, it’s now clear that without continued support, high unemployment will remain and consumption will falter, hurting profits and threatening the survival of many businesses. Like it or not, massive budget deficits must remain for governments to ensure people’s livelihoods and economic recovery.
But with a presidential election looming in the US, the Republican party is increasingly putting all its hopes on a rapid reopening of the economy, even though that prospect terrifies health experts, who warn that it could lead to further waves of infections and many more deaths.
Back on March 25, Donald Trump inexplicably said he wanted to reopen “large sections of the country” by Easter. This put himself on collision course with his own health experts, claiming without evidence that the shutdown would cause more deaths than the coronavirus itself.
“I hope we can do this by Easter,” Trump told reporters at a White House briefing. “I think that would be a great thing for our country.”
Asked if that timeline — 12 April — was realistic, he replied: “We’re going to look at it. I just thought it was a beautiful time, a beautiful timeline, it’s a great day.”
Now Republicans claim the government can’t afford to keep providing a safety net, because it means incurring too much debt. This is both bad economics and disingenuous says Paul Krugman, a Nobel Prize-winning economist.
“After all, soaring budget deficits haven’t stopped Trump officials from considering, yes, more tax cuts,” he says.
Why are Trump and his allies so eager to run the risk of a much higher death toll?
“The answer, surely, is that they’re reverting to type,” says Krugman. “In the early stages of this pandemic, Trump and the right in general downplayed the threat because they didn’t want to hurt stock prices.
Now they’re pushing for a premature end to containment because they imagine that it will boost stocks again.
“They won’t say this explicitly,’ says Krugman, “and they’re throwing up various disingenuous explanations for what they’re doing, but their basic position is that thousands of Americans must die for the Dow.”
Poor communication
Leaders’ ability to communicate effectively has been essential since the beginning of the pandemic.
New Zealand Prime Minister Jacinda Ardern’s two-minute address to the nation announcing a four-week shutdown of New Zealand from Wednesday — “Kiwis, go home,” she said — was clear and unequivocal. The four-stage alert system in New Zealand was simple to understand.
Level four meant people were instructed to stay home, schools and universities would shut, all non-essential businesses close, air travel and public transport are only to be used to transport essential workers and freight. Also, there would be no weddings, parties, gatherings of any sort. Essential services such as supermarkets, GPs and pharmacies would remain open.
But it was Ardern’s tone that mattered as much as the substance. She acknowledged these were the “most significant restrictions on movement in modern history”. But without them, “tens of thousands of New Zealanders will die. There is no easy way to say that.” She ended as she often does: “Be strong and be kind.”
If Ardern’s credibility as leader was strengthened by her response to the Christchurch terrorist attack last year, the credibility of Australia’s prime minister, Scott Morrison, was weakened by initial errors in the response to the unprecedented scale of the nation’s summer bushfires.
People value transparency, and most will forgive missteps in such a fast-moving and unprecedented crisis, but the contradictory messages in the early days of the coronavirus bred confusion. Morrison’s statement on 13 March that he would still go to a rugby league game after announcing that all gatherings of more than 500 should be cancelled after the weekend, was his first misstep.
Asked whether it was responsible to attend a rugby league game on the weekend in light of the state and federal governments agreeing to cancel gatherings of more than 500 people across Australia, Morrison said on 13 March; “The fact that I would still be going on Saturday speaks not just to my passion for my beloved Sharks; it might be the last game I get to go to for a long time.”
Two weeks later, Morrison was worse, conveying a mass of contradictory and confusing messages.
On March 24 his press conference messages were stay home everyone, but if you have a job, you are an essential worker, so make sure you keep working. Go to school, but don’t go to the foodcourt. Five at a wedding, 10 at a funeral, 10 at a bootcamp, but no yoga. No waxing, but a hairdresser for 30 minutes is still OK.
As Guardian journalist Katharine Murphy observed, “a thread of logic ran through the various delineations — or some of them anyway — but holding onto that thread was really challenging. The dull thud that could be heard in the distance as Morrison spoke at a fiendish clip was the sound of a million Australian heads exploding in their lounge rooms.”
British Prime Minister Boris Johnson styles himself as the great communicator but he has been shambolic at best and dangerous at worst in the what and how he has communicated since the start of the pandemic.
He initially toyed with the idea of “herd immunity” — letting the virus take its course to a large degree. On March 14 at a press conference Johnson revealed that the UK would no longer try to track and trace the contacts of every suspected case, and it would test only people who are admitted to hospitals. In lieu of any major social-distancing measures, Johnson instead offered a suite of soft advice — people with symptoms should stay home; no school trips abroad; people over 70 should avoid cruises.
Almost immediately, the supposed plan came under heavy criticism, coupled with confusion that public-health and science advisers would recommend this strategy. Herd immunity is typically generated through vaccination, and while it could arise through widespread infection, “you don’t rely on the very deadly infectious agent to create an immune population,” says Akiko Iwasaki, a virologist at the Yale School of Medicine. Yet that seemed like the goal. In interviews, Sir Patrick Vallance, the UK’s chief scientific adviser made it sound like the government was deliberately aiming for 60 percent of the populace to fall ill. Keep calm and carry on … and get COVID-19. [vi]
It took a report from scientists at Imperial College to show Johnson that this laissez-faire strategy of letting the public take responsibility would have cost hundreds of thousands of lives, with the health care system overwhelmed and the worst affected patients left without treatment.
Later, after the seven weeks of lockdown that helped suppress the spread of the coronavirus, Johnson addressed the nation on the evening of Sunday 10 May to explain the next steps. Restrictions were to be eased, but moves would be tentative and contingent, checking for new outbreaks at each stage, with a possible return to more stringent measures if the virus took advantage of the relaxed rules.
The three biggest constraints resulting from the lockdown were to be eased: the limits on outdoor pursuits including regular exercise; not being able to get to work if you were unable to do your job from home; and school closures preventing parents leaving for work even if they wanted to. Thus “Stay at Home”, the previous headline advice, was qualified. The new slogan was “Stay Alert”, a very different sort of instruction.
“This was not the first time the government was accused of poor communications during the crisis,” said commentator Lawrence Freedman.
“As an exercise in communication this was not a great success. A lengthy document to help explain the new guidance and provide the scientific background was not published until the next afternoon. It was only then followed by a parliamentary session and a press conference when many of the issues raised could be explored. By this time confusion reigned and the government was accused of “muddled messages” that could be dangerous in their consequences.”
Dan Gaffney is a teacher and author. His book ‘Journey Home — Essays on Living and Dying’ was published in 2019.
[i] David Leonhardt, August 6, 2020. The unique US failure to control the virus, The New York Times
[ii] Professor Joseph Ibrahim, August 5, 2020, Precis of evidence to the Aged Care Royal Commission
[iii] David Crowe, August 12, 2020. Aged care operators were left waiting for promised financial aid, Sydney Morning Herald
[iv] Joshua McDonald, August 29,2020, Australia’s Aged Care Facilities Have Failed Amid the Pandemic, The Diplomat
[v] Eric Lipton, Abby Goodnough, Michael D. Shear, Megan Twohey, Apoorva Mandavilli, Sheri Fink and Mark Walker, June 3, 2020, CDC waited its entire existence for this moment. What went wrong? New York Times
[vi] Ed Yong, March 16, 2020. The UK’s Coronavirus ‘Herd Immunity’ Debacle, The Atlantic
