Social protection is decisive to contain COVID-19, according to a study covering 77 countries

A project led by researchers at Getúlio Vargas Foundation in Brazil and the University of Michigan in the US produced a detailed analysis of the effects of public policies and government decisions on the response to COVID-19, highlighting the factors that influenced its success or failure in many countries and regions around the world.

By Maria Fernanda Ziegler  |  Agência FAPESP – All countries that obtained success in their response to COVID-19 did so in a similar manner; the countries that were unsuccessful made mistakes in their own way. Adapting the famous opening sentence of Leo Tolstoy’s Anna Karenina about unhappy families (“All happy families are alike; every unhappy family is unhappy in its own way”), this is the conclusion of Coronavirus Politics: The Comparative Politics and Policy of COVID-19, published at the end of April by the University of Michigan Press. The book is a compilation of studies by over 30 authors who set out to understand the effects of public policy, public health interventions and government decisions on the course of the pandemic. It covers 32 countries and regions in detail but discusses 77 countries all told.

The book’s editors, Elize Massard da Fonseca (Getúlio Vargas Foundation, Brazil), Scott Greer and Elizabeth King (School of Public Health, University of Michigan, USA) stress that social protection measures such as income support, special lines of credit for businesses, and tax breaks for the vulnerable should be implemented in conjunction with nonpharmaceutical interventions in order to halt the spread of the virus, avoid deaths and contribute to economic recovery.

Competent implementation of such measures had more decisive effects in this regard than public health capacity and per capita income. “The main finding of our study is that countries that paired nonpharmacological interventions such as social distancing, contract tracing and mask-wearing with welfare and income support programs designed to enable people to stay at home were successful in controlling the pandemic. This is true of low-, middle- and high-income countries alike,” Fonseca told Agência FAPESP.

The book, which was supported by FAPESP, analyzes comparative policy and politics in the first nine months of the pandemic (up to September 2020), when no vaccines were yet available. Chapters were written by 66 researchers covering single or multiple countries on all continents, some discussing an entire region.

The same researchers also wrote a paper on social policy and the lessons learned in combating COVID-19 in Brazil, Germany, India, and the US. It was published online on April 20, 2021, in Global Public Health.

When the World Health Organization (WHO) declared the pandemic in March 2020, the measures required to minimize or stop the spread of the disease were well-known. “We all learned very quickly about the risks, about how COVID-19 was transmitted, about how to avoid deaths, and about how to prevent health services being overwhelmed. The lessons were learned very fast compared with the AIDS epidemic, for example, when it took years to complete genetic sequencing of the virus and even to realize it was a sexually transmitted disease,” Fonseca said.

In the case of COVID-19, guidelines for dealing with the pandemic were rapidly developed by universities, research centers and the WHO. “True, the importance of wearing two masks wasn’t discovered until later, but we knew the disease was caused by a respiratory virus, and countries had enough information to implement a response and take steps to cope with the problem,” she said.

Even so, the responses varied enormously from country to country. While hospitalizations and deaths surged tragically in the US, Brazil, India and Spain, countries as diverse as Vietnam, Mongolia, Germany, New Zealand, South Korea, Taiwan and Norway were success cases. Like an interminable marathon, 2020 ended with the epidemic under control in China and Vietnam while Canada and Germany, for example, were forced to reintroduce lockdowns and other restrictions.

In this context, lack of coordination between public health and social measures was key to the negative performance not just of Brazil but also of several other countries. “Our health and economy ministries didn’t talk to each other, so the measures taken to address the problem weren’t coordinated,” Fonseca said. “The federal cash transfer program [income support for the poor, self-employed and furloughed] lifted many people out of extreme poverty for a while but unfortunately didn’t genuinely ensure they stayed at home. That’s a problem when lockdown or mobility restrictions are needed. It’s also important for communication campaigns to be part of the effort to get people to stay at home.”

The use of generous social programs disconnected from public health interventions was also disastrous for the US, the world’s largest economic power. India was on the verge of collapse in 2020 because tough public health measures were not accompanied by any welfare or income support programs at all. Germany was initially successful, with social protection measures alongside lockdown and good communication with the public.

Blame game

Another kind of lack of coordination can be detected in Brazil. “We’ve had very strong social policies, but the health measures lacked any coordination within the federal government and among states. In a country like Brazil, we need coordination not only among neighboring countries but above all among subnational units, because the virus doesn’t give a hoot about borders,” Fonseca said.

The response to the pandemic was merely palliative in Brazil because of this disconnect between health and social policies, she added. As in almost all countries, the president and state governors claimed the credit for any successes and blamed the failures on others.

The book notes that the Brazilian president claimed the credit for the income support program passed by Congress and blamed the unpopular mobility restrictions and social distancing measures on state governors and mayors. In the US, President Donald Trump did the same. According to the authors, populist leaders everywhere blamed the pandemic on China and praised themselves for their response, much of which was rhetorical and xenophobic.

“In Brazil, states all had their own social distancing policies. Some opted for lockdown, some didn’t. There was no coordination,” Fonseca said. “In early 2021, as cases and deaths surged again, state governors seem to have woken up and begun discussing coordination. The health ministry is supposed to coordinate public health policy in Brazil, but for several reasons, it has failed to do so during the pandemic.”

Politics matters

The study also discusses the political factors that helped or hindered responses to the pandemic, which varied considerably across countries and regions. According to the researchers, the institutional framework for the public health system, including staffing and hospital facilities, limited the effectiveness of the response in many cases.

“The question of presidentialism matters,” Fonseca said. “Presidents have constitutional powers to act, but some did little or nothing. In Brazil, [Jair] Bolsonaro used constitutional powers to appoint ministers who agreed with his ideas, disseminating a highly controversial and even eccentric agenda. His interference in the health ministry was unprecedented in the democratic period, influencing the presentation of data and the formulation of clinical protocols, and even defining essential activities by means of decrees.”

Other leaders also behaved in controversial ways on the basis of constitutional powers, although some were less eccentric. Examples include Sebastián Piñera in Chile, Donald Trump in the US, and López Obrador in Mexico, as well as Prime Minister Boris Johnson in the UK, where the strategy was nevertheless completely changed in mid-2020. 

“No matter how much public money was spent on field hospitals and new intensive care units, presidents used constitutional powers to implement agendas that served their own interests, and not necessarily to combat the pandemic,” Fonseca said.

In the US, Trump made light of the risks and effects of the virus and harshly criticized Anthony Fauci, the country’s top infectious disease expert and a prominent member of the White House Coronavirus Task Force. “Trump also set aside his capabilities as head of state to promote a controversial political agenda of his own,” she said.

Vaccination and a new round of research

The book analyzes countries’ responses to the pandemic during a period in which vaccines were not yet approved and only nonpharmacological interventions could be used to control transmission of the virus. “In this first book, we discuss the dynamics of the policies and programs that underpinned the nonpharmacological interventions. The first vaccines weren’t approved until December. Once vaccines started to be available, the politics of the pandemic changed significantly. New political factors came into play,” Fonseca said.

The group now plans to begin a new round of research, possibly launching a second book at the end of 2021 to analyze the period following the approval of vaccines and the onset of immunization campaigns.

A digital version of the book can be read online or downloaded at: www.fulcrum.org/concern/monographs/jq085n03q.