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 Healthy Governance, Healthy Responses:
Lessons from East Asia in Tackling COVID-19

Better Governance, Better Outcomes:
East Asian Experiences Tackling COVID-19

Up through January 2020, the US-China trade war dominated the headlines and oriented most of the discussion about East Asia’s economic trajectory. This issue has not faded in significance whatsoever, but understandably, everything is now taking a backseat to responding to the COVID-19 pandemic.

Because globalization is now truly comprehensive, it unfortunately is not surprising that a novel coronavirus that first emerged in central China has found its way to every corner of the globe. But what also stands out is that the extent and damage of the pandemic has varied dramatically from country to country, community to community. It is urgent that we identify these patterns and then explain them. If we can understand why some countries have intervened more effectively than others, this offers hope for those who have been less successful to gain lost ground. And it will also help the world better prepare for the next pandemic, which most assuredly will come. And better preparedness at home will facilitate more effective international cooperation, which has also been less than ideal in the current crisis.

The purpose of this post is to ask questions, first, by providing some initial figures on the basic patterns, and second, by speculating on some of the reasons for the variation we see. It will be up to others, mainly global the public health professionals, to answer these questions.

The Numbers

Data on the pandemic is widely available – we rely on Worldometer and individual jurisdictions – but they must be taken with many grains of salt. There is a real capacity challenge in identifying cases, and different jurisdictions also may use different standards in categorizing cases. Beyond this, local officials may intentionally hold back reporting on cases to national authorities, and national authorities may have an incentive to under-report cases publicly or internationally.

Salt consumed, here are what the available numbers show (as of May 26, 2020):

Looking globally at cumulative total cases (Figure 1), there is no doubt that the United States stands out, with by far the greatest number of cases. That said, a few others also stand out. They include all of the BRICS (Brazil, Russia, India, China and South Africa), but also more advanced economies such as Spain and Italy. Aside from China, in Northeast Asia both South Korea and Japan have had significant, even if isolated, outbreaks.

Looking over time (Figure 2), jurisdictions have had different paths. If we count from the day of the first case, some have risen quite steeply for an extended period, others with shorter times of growth, and then, variation in the pace in which the number of new cases declined.

Because the United States stands out when the data is presented in absolute form, viewing the number of cases in logarithmic scale (Figure 3) helps us see the variation within East Asia and a handful of other countries.

When attention turns from cases to deaths, the global pattern is somewhat similar (Figure 4). Again, the United States stands out, but this virus has wreaked havoc in all regions of the world.

That said, the fatality rate of COVID-19 varies widely. If we focus on a select group of notable places in East Asia and beyond (Figure 5), the highest rate is in Italy, at 14.3%. Within East Asia, China has a relatively high fatality rate, at 5.6%. By contrast, in Vietnam, where there have been 327 cases, there are no related deaths. And in Taiwan, despite extensive people-to-people ties across the strait, the island’s total number of cases and fatality rate have also been amazingly low, with only 441 cases and fatality rate of 1.6%.

One way to summarize the data in a way that helps generate a clearer analytical puzzle is to delineate across countries by both cumulative cases on a per capita basis and their fatality rate. Doing so (Figure 6) shows wide variation across locations, including the highlighted select group from the previous figure. One possible generalization is to place the cases into four groupings: some have a large number of cases per capita and a high fatality rate; others have a large number of cases but a lower fatality rate; others have a low number of cases but high fatality rate; and finally, some have both a low number of cases and a low fatality rate.

Possible Explanations

Understanding why regions vary in the number of cases and fatality rates is crucial to stopping this pandemic and effectively preparing for future ones.

One very important background factor in shaping experiences is demographics. The data show that countries with older populations tend to have higher fatality rates. That said, demography is not destiny. Countries with similar demographic profiles have fared differently because their societies have responded differently to the challenge. 

We would expect that regions that have high government capacity in general would be better prepared to deal with the pandemic. Responding effectively requires a highly coordinated effort involving officials, the media, the private sector, and the healthcare community. That said, the general data on government capacity are far from definitive. Using cross-national metrics from the World Bank and others, we found no correlation between metrics such as “government effectiveness,” “regulatory quality,” and “rule of law” with cases (either total or per capita) or fatality rates.

This lack of clarity may be a product of inaccurate data on the spread of the virus, but more likely it is because we need more precise metrics of responsive capacity that are more specific to public health. Using information from Oxford University, we compiled a table (Figure 7) on how a selected group of jurisdictions have responded in terms of four categories: closure and containment, travel restrictions, economic measures, and health systems. One sees a variety of strategies and tactics adopted. The data show that, like economic development, there is no single right way to respond to a pandemic. Some, such as China, have focused on limiting movement of people and isolating those who symptoms. Yet, it is notable that in two locations in Asia with very low cases and fatality rates (Vietnam and Taiwan), success has been achieved primarily by a combination of limiting international travel and steps to collect and provide information for healthcare system and the public, including public information campaigns, testing, and comprehensive contact tracing.

Because the data is still incomplete and the pandemic is far from over, these insights should be viewed as highly speculative and tentative. Yet they provide some guidance to where policymakers, the healthcare community and public can look for solutions that could provide lessons for everyone.

Scott Kennedy is senior adviser and Trustee Chair in Chinese Business and Economics. Shining Tan is research associate in the Trustee Chair in Chinese Business and Economics.