A Note by the Director
Summary
In October 2020, Ditchley held a ‘hybrid’ conference on the implications for the world if effective vaccines for COVID-19 remained elusive. The point of looking at the worst-case scenario was that it would expose dilemmas and lessons which might remain relevant even if things worked out much better than we dared hope, which, as of February 2021, they certainly have.
The conference rapporteur, Matthew Holehouse, wrote an excellent reflection on the conference that we published in January. We are publishing the full notes now and my own reflections, because, as we hoped, many of the insights remain relevant, even as a global vaccination programme progresses at pace, notably in the UK.
The conference brought together a variety of different areas of expertise and opinion, bridging divides in Ditchley’s usual way, including critics of a suppression strategy and lockdowns, as well as people working in the NHS which was already beginning to deal with the growing wave of cases of the second wave of the pandemic. A powerful feature of the discussion was that our face to face conversation benefitted greatly from virtual interventions from around the world, allowing us to compare directly the situation and strategy in different countries from first-hand accounts. This included China, Japan, Singapore, India, South Africa and the Democratic Republic of Congo, as well as North America and Europe. The contributions highlighted the primacy of culture and values in framing the decisions made in response to the pandemic.
China, for example, had combined its authoritarian system of state surveillance with strong social norms for defence of life at all costs in an approach that had successfully suppressed the virus. Much of inland China had already returned to life close to that pre-pandemic. Singapore’s strong civic leadership prioritised clear and sophisticated communications combined with strong controls over migrant workers and national borders, leading to effective control with very few fatalities – 29 as of October 2020. In Japan, strong peer pressure and respect for scientific expertise (over political leadership) had allowed the state to deal with the pandemic as a series of localised outbreaks, without having to resort to compulsory general lockdowns.
For India, Southern Africa and the DRC, COVID-19 was one more infectious disease among many to manage and the concept of lockdown was seen as misconceived, even unhelpful, for societies with young populations and that did not have national health systems to protect. Poverty, lack of development, lack of infrastructure and many preventable diseases such as malaria and diarrhoea remained the biggest killers. Famine from damaged economies, with reduced resources for emergency aid, was a growing concern for hundreds of millions. An additional fear was that liberal democracies, pre-occupied by pandemic response, would disengage from domestic debates within African countries on political reform, with a shrinkage in the world’s democracies the result.
In the US, the UK and across Europe, measures to control and manage the pandemic had revealed current weaknesses in democracy and made us question what it was about modern liberal democratic societies that made the pandemic so difficult to manage. For the US and, to some extent, the UK and other European countries, the process of striking a balance between reducing threats to life against curtailment of individual freedoms, civil liberties and economic well-being had become political and polarised. Pre-existing social and economic inequalities had both been made starker and worse. At the same time, opportunities were emerging which could be beneficial for whole societies. To survive this crisis and to build longer-term, there had to be a rebuilding in peoples’ trust in the basic competency of democratic institutions to deliver and function well.
Lockdown restrictions had taken societies both backwards and forwards. Inequalities had been exacerbated, precariousness increased, social mobility reduced, and we had seen a further retreat from multilateral leadership to national strongman politics. On the other hand, digital transformation had been greatly accelerated with businesses acquiring a taste for the future through online working; finding new efficiencies; and discovering that they need less hierarchy and more creativity in adapting to new environments. The same was true of many sectors in local organisation and in education. The move on-line had also accelerated on-line learning almost everywhere but was booming particularly in China.
Responses to the virus had put much on hold including the certainties in the ways the world used to work. For parts of the world that are finding new ways of working and continuously adapting, such as Singapore, there was no sense of returning to the old normal or even a new normal: “We’re existing in a ‘never normal’”. The COVID-19 pandemic was seen, in some ways, as an internal and international accelerant and validation of China’s current course, particularly as technology-based surveillance systems have been central to the country’s pandemic response and effective virus suppression.
Looking back at the discussion with the benefit of hindsight, a number of things stand out:
Globally, the endpoint with COVID-19 is likely to be endemic equilibrium, not permanent suppression or eradication. For many developing countries, COVID-19 is only one threat to life amongst many and there are many other things to worry about. There were huge chunks of the world where COVID-19 was likely already becoming endemic and would remain so. The real debate was about how to get to endemic equilibrium – what was an acceptable level of risk and fatalities for different societies to tolerate – not the endpoint.
Science triumphed. We may look back on this in a few decades’ time as a historical turning point when humanity entered a new stage in its fraught relationship with the natural world, with huge potential but also great risks lying in our growing technological capabilities. Effective vaccines provide a less deadly way to get to endemic equilibrium. If we did not have the vaccines, then we would be facing very hard choices right now about how long lockdowns and social distancing could be maintained in order to limit fatalities. The extraordinary scientific and technological achievement of developing and producing vaccines in such a short period of time has changed the game.
The pandemic has re-ordered the physical world and it will be hard to put it back together in its old form, even if we wanted to. The pandemic has created new categories of borders across different regions of the world and physical movement between them is likely to remain far from frictionless for some time to come. At the moment, the zones are largely individual countries with even EU states imposing border restrictions, but over time we are likely to see new zones of movement emerge. Extrapolating from the conference discussion, one can imagine:
A total suppression zone: this is where COVID-19 has largely been brought under control and cases are rare (and when they occur, are immediately isolated and controlled). This would include China, Japan, Singapore, South Korea and other Far Eastern states but also Australia and New Zealand. Let’s say three billion people.
A fully vaccinated zone where the disease is endemic but controlled. This was a hoped for but very uncertain prospect in October 2020 but happily much clearer now. This would be most of the western industrialised world. As money, infrastructure and now vaccines are available, there is a short term risk from bureaucratic delay but the longer term risk lies in anti-vaccination, anti-science and anti-government conspiracy theories. About a billion people.
A partially vaccinated and endemic equilibrium zone. This would be much of the developing world, including much of India, Pakistan and Africa but also some Far Eastern and Latin American countries. Another three billion.
These new divisions and points of friction are likely to be orthogonal to and cut across existing divisions, including within countries. In the developing world, vaccinated elites and capitals may be further separated from unvaccinated populations. China’s economic engagement with Africa may change shape as sending large numbers of Chinese workers abroad becomes no longer so attractive.
Strong quarantine restrictions on travel in and out of China may accelerate geopolitical separation of East and West, for example reducing the number of Chinese students abroad. Unanticipated consequences are likely to emerge over time. The emergence of new variants, not really discussed in our October conference, is likely to make reverting to a previously relatively frictionless international world very difficult.
Technology triumphed. Needs must: the pandemic compressed the cycle of the diffusion of innovations and we are all digital now, if we have the electricity and broadband connection. This has opened up the connected world and increased the frequency of global conversations as evidenced by our conference. Conversely, the unconnected are even more cut off with digital inequality exacerbated. Managing time zones is a challenge but it is incredibly powerful to be able to hear directly different views from around the world within the time frame of 24 hours.
What is striking is that the technology existed to do that before the pandemic, but we had not acquired the habit of taking advantage of it. It is worth asking what other technological possibilities are around us that we are not using to their full extent and how we can apply this newly acquired habit of sustained and serious global connectivity to address our common problems and to anticipate the next global threats.
Digital came of age and adult behaviour is now expected. The flip side of technology’s triumph is that everyone has now noticed that some technology companies are very powerful, big winners economically from the crisis, and not accustomed to playing by the rules that apply to everyone else. The backlash was already anticipated in our October 2020 discussion and is now coming to pass with an increasing focus by governments on the regulation of digital content and greater distribution of digital profits, not least to contribute to paying back the state’s pandemic debts. There is a balance to be struck in not overdoing regulation to the extent that it stifles innovation and reduces international competitiveness.
Democracies were severely challenged by the pandemic but now have an unprecedented opportunity to rebuild trust, pride and confidence. Looking back on our discussion, there is a sense that those of us living and believing in democratic systems were tortured by the contradictions in our response to the pandemic. It was those from authoritarian states who articulated most forcefully that the objective of the state’s response had to be to preserve life at all cost and at any age, with proud stories of COVID-19-surviving centenarians to illustrate this.
In the West, there was a tearing tension between the wish to preserve life and the desire to preserve freedom and so our responses were confused. The arrival of vaccines largely resolves this tension and opens up a way forward. An equitable, universal and well-executed vaccination campaign will do a great deal to restore trust, pride and confidence. A botched campaign will prolong the damage.
Are we going to look inwards or outwards for change? There is a huge pent-up desire for normality, a return to the best parts of the life we had before. We are exhausted, fed up, ready for a rest. We want government to step back, talk less, interfere less and allow us to go to the pub. At the same time, we, the same people as above, have seen what can be done with money, science and political will and we want government, corporate and citizen action to fix the things that we personally believe are wrong and unfair. We are going to have to decide how much action and intervention we want from our leaders across the challenges that confront us.
There is so much to do at home in democracies to address adaptation, education and inequality of opportunity. At the same time, we need internationally to take action on the climate and biodiversity crisis, address our relationship with China, and for the UK build a new relationship with Europe and the world beyond. The contentious debate over reduction of overseas aid in the UK is an early example of discussions and decisions to come.
The pandemic has taken a terrible toll: 120,000 lives in the UK, 500,000 lives in the US, so far. Other countries have fared better, but the global direct damage and indirect damage is enormous, personally, socially and financially. The pandemic, though, has also given us an emergent sense of purpose: to recover, to build back, to remake better what was wrong, to get ahead of future crises. The triumph of vaccines has given us a sense of possibility.
To take this opportunity, many in the conference felt that democratic countries must invest in infrastructure, particularly digital infrastructure. There has to be renewed investment in people and education and in ways that reach far more of the population. There is a need to revive basic tenets such as an ability to raise taxation and revenue with citizen consent and for democratic alliances to create global institutions. There must be clarity over regulation of technology and better processes for allowing local solutions and the means by which people can get their voices heard.
All institutions – schools, hospitals, government, the media – depend upon participation that builds trust. For the UK, updating the NHS and the underpinning social contract that supports it is now a priority. The benefits of digital transformation must have greater reach. This is the moment to re-invest in democracy and to recognise that reinvestment and renewal won’t be without struggle.
Full Report
Introduction
The coronavirus pandemic (COVID-19) has emerged as the greatest shock to the global economy and to our way of life since the Second World War. The economic and societal damage caused by the varying degrees of social and economic lockdowns and a global recession will have long-lasting consequences that are probably not yet understood.
An immediate response has been the unprecedented global effort directed towards the development of vaccines. In just seven months, some of this work is showing signs of success and there may be vaccine options as early as Spring 2021. But even with a vaccine, there are recognised logistical and technical challenges in inoculating the world and it may be that it is not possible to engineer a vaccine that provides lasting protection.
The coronavirus could end up as pervasive and varied as other coronaviruses that cause infectious respiratory illness, such as the common cold, but without losing its lethality for segments of the population – this was the scenario set for the Ditchley conference, Living with COVID-19: what are the implications for the world if a vaccine remains elusive?
This scenario is possibly the most difficult outlook for COVID-19 and requires the most adaptation from humanity. It deserves consideration – if things work out better, the insights explored may still apply to less negative scenarios.
What effects, then, would COVID-19 as a permanent feature have on the modern, integrated world? How would governments, institutions and individuals adapt and what are the capabilities they need? Political, moral and philosophical dilemmas have already been intensified; inequalities of every kind have worsened. Relations between the generations may already be changing as have relations between countries. But there are also opportunities to focus efforts on the change that’s needed and to accentuate the benefits that have already emerged.
This conference discussion explored three main areas:
• The implications for public health and public morality and questions of how to balance the rights, interests and priorities of different sectors of the population; the implications for longer-term reorganisation of our healthcare systems, and the wider moral framework for decision-making. Who should lead and make the decisions – health professionals and scientists, with greater knowledge; or elected politicians with greater accountability?
• The impact on the global economy and globalisation. What effects will debt, the prospect of reduced growth, slowdowns in the flow of goods, services and talent, changes in the location of manufacture and a shortening of supply chains as well as more reliance on technological remote connection through AR and VR have on the global economy? Changes to the delivery of education and an underlying shift in the business model of the universities is already underway. What new industries and jobs could emerge from the crisis? What economic and environmental problems could in fact be improved, and might the pandemic help us change course on the existential challenge of climate change?
• How would a persistent pandemic interact with the other great trends in geopolitics and the technological revolution, such as growing competition and tension between the US and China, alongside the growing pace of change from technology? Could dealing with a persistent pandemic help build bridges over geopolitical tensions, or would the divides be deepened?
Perspectives on Living with COVID-19
Framing the discussion: routes to immunity
The hopes and expectations we had in spring 2020 that the COVID-19 pandemic could be short lived, that a period of lockdown would be followed by effective testing and tracing regimes to contain the virus, that society and economies would re-open and that it would be almost over by Christmas, have broken down.
The consensus and widespread adherence to government lockdown restrictions in the UK in March are fraying. A uniform approach presented as led by the science has been replaced by the more complex tiered response in which political choices are more explicit. The last several weeks have seen a realisation that the COVID-19 pandemic is not a short-term problem and that its implications are profound. What next?
This discussion was framed by a theoretical epidemiological perspective which suggests that the virus might settle down to follow the pattern of other coronaviruses: that is, enough of the population will become immune at any one time to prevent rapid and widespread infection. Although the disease will be never be eradicated, over time populations will reach a state of endemic equilibrium. Can the same be expected of COVID-19? And, how would we get there? A discussion of the way immunity might be achieved plays into the difficult moral and political choices to be made. Should there be a more explicit effort to achieve zero COVID?
There are serious implications to achieving what is otherwise termed natural herd immunity. For population level immunity to be achieved, a process of infection must take place. It was suggested that the virus would run its course in a period of 3-6 months and that those at greater risk of death could be protected for this time. But there are no certainties and such a course of action could result in unacceptable loss of life. It may not be possible to identify those at risk and protect them. Efforts to achieve immunity could also overwhelm health services in the short-term, and we don’t yet know enough about the longer-term effects of long COVID-19, which can afflict people of all ages.
An alternative to achieving immunity without a vaccine is virus suppression. To date, breaking the spread of transmission means keeping human beings apart. Measures such as closure of meeting places, social distancing and mask wearing must be made effective enough to keep virus levels acceptably low. These measures also bring harms: it was argued that these disproportionately affect poorer people, younger people and children, particularly in less well-off parts of the country and the economy.
For either scenario (suppression or acquired immunity) there is much that is still unknown: the longer-term effects of COVID-19; the percentage of the population that has been infected or that is asymptomatic; and the likelihood that better treatments, developed during the first wave, will reduce death rates in the second and third.
Whatever the route taken, over time we will have to live with an accumulation of immunity, naturally acquired or vaccine induced. Some believe that this can be achieved relatively quickly, whilst others, concerned about the risks of high numbers of deaths, argue that this must be a longer-term ambition built upon a sustained process of virus suppression.
These trade-offs are choices made by governments, and citizens. The dominant narrative led by government at the start of the crisis was apparently to suppress the spread of infection at all costs. The messaging was strong, following ‘the science’ and the population responded with levels of compliance greater than government anticipated. Since then, although the dominant approach has remained virus suppression, it has become messier and the political nature of decision-making more obvious and fraught, but the public discussion of the difficult trade-offs being made has been muted – COVID-19 has been a spectacle, not a discussion.
For many at this conference, living with COVID-19 required a better public discussion to create consensus over the painful and difficult trade-offs to be made – the process of how decisions are reached is as important as the decisions themselves.
Bad luck: sharing fortune and misfortune
Business is a mix of many enterprises: some sectors have been able, not just to survive, but to take strides forward operating digitally; whilst other sectors of the economy have all too obviously suffered. Those taking advantage have been catapulted into the future, gaining new insight into how to be innovative, creative and take opportunities for efficiencies. Some corporate companies are witnessing rapid changes in market sectors across multiple countries. Organisational cultures within companies were also said to be changing with companies pursuing more collaborative and flexible working regimes. Home working is not just a technological change, it has allowed some people to work differently.
These insights were said to be important for government. Businesses can see that they have new responsibilities: how should they proceed towards a future in which they need not employ as many people? Having glimpsed the future, the opportunity is to shape it and to do so in ways that benefit society as a whole. To do this, business and government had to find better ways to connect.
Governments, it was suggested, have not found ways to listen and taken advantage of business insights into changing economies and management practices. Business is seeking better collaboration with government to deliver easy wins, for example over training and retraining, flexible working, allowing volunteering and other socially beneficial initiatives. Effective collaboration will be needed for the necessary responses to climate change but the frameworks for better working between governments and business don’t yet exist.
The business view of this moment of ‘reset’ extended beyond COVID-19. The pandemic response had accentuated a number of societal fault-lines: societal inequality; the differential impacts of technology and AI on the economy; political polarisation and division; racial injustice; cyber security risks; and the climate and environmental crises.
This pandemic has seen winners and losers: technology companies have been lucky, piling on stock market valuations whilst others have suffered. Shouldn’t the bad luck be shared? A pandemic that is unlucky for the world has had unequal effects and there is no mechanism for sharing out the bad luck.
More bad luck
At the height of this global crisis, since March 2020, it was noted that wealthy people have become wealthier and power has concentrated further into fewer hands, while the economically disadvantaged have become poorer. The burdens of the virus have been disproportionately borne by those in insecure work without access to sick pay and with less money.
The move online for both business and education has deepened an already existing digital divide. In the face of global fragmentation, rising nationalism and a dramatic rise of misinformation, we’ve witnessed what was described as the most colossal failure of collective international action since the end of the Second World War. Global power contestation between the US, China and Russia is going unchecked with all three acting as disruptors.
Dissatisfaction with politics is from both right and left, creating deeper shifts, and divisions now difficult to bridge. The world has responded to infectious dangerous illness before with SARS, H1N1 and Ebola, the basics of how to deliver an international response is known and yet has stalled. What are the implications for an international response to migration and to climate change?
Time must change our perspective
As time goes by, virus suppression as the single most important priority in the pandemic response becomes harder to sustain. Other competing priorities crowd in. Not just the effects of short-term restrictions on individual freedom, on mental health, on local and national economies but also the slowing of the global economy and global migration. The UN has warned of increase in natural disasters and a risk of starvation of 130 million people in famine. Wider interests must inevitably take their place and change the basis of calculations of risk.
Nation-states have responded to COVID-19 with unprecedented short-term economic support for their own economies but the factors precipitating acute food insecurity around the world, that pre-existed the pandemic and are linked by some to climate change, have not elicited the same level of global response. Instead, the situation may have been worsened by both by the pandemic and by the effects of national responses.
Inequalities previously tolerated have been exposed. Is there not an imperative now to take a broader perspective and to control the virus in the context of wider objectives – social and economic – to restructure economic systems differently? The opportunities for transformational approaches to inequalities are felt but not yet defined. There are points of inspiration for politics, for climate change, economic change, tax reform and devolution of power. The response to Black Lives Matter, the brief glimpses of reduction in pollution and CO2, the furlough schemes and the recognition that the lucky tech companies had benefited disproportionately have opened up the possibilities for change.
Cultural differences in approaches to public health
The different national approaches to dealing with the virus reflect national cultural differences. Briefings given to this conference from China, India, Singapore, South Africa and the DRC show the range of different contexts and responses to the pandemic. Specificities of culture and context determine responses. There was criticism of the WHO both for applying generalised guidance and for not co-ordinating risk assessments in support of border re-opening. Across the world a mix of virus suppression or processes of infection spread are playing out according to the values and conditions of particular places.
The Swedish approach, it was argued, should be understood in the broader context of Swedish society. Social cohesion and redistribution are important values in Swedish society. In effect, Sweden’s response to the virus (for better or worse) was a decision made decades ago.
A crisis of language
We were, it was suggested, suffering from a crisis of language and a limited vocabulary to discuss responses. The language of triumph, war and certainties was said to limit our understanding and elements of the debate had become highly polarised, making it hard to discuss the balance of individual, collective and public interests. The popularity of films such as The Crazies, Invasion of the Body Snatchers, The Survivors and many others at the start of the crisis suggested an interest in exploring scenarios, empathies and response narratives.
The approach taken in the Singapore government’s communication strategy included an explicit and deliberate understanding of how to reach segments of their population with the use of different communication mediums, careful use of language and good timing.
The media strategy is an important element of Singapore’s overall response. There was reflection on a series of metaphors used to discuss COVID-19, its impacts and societal responses. These include metaphors associated with fighting and protecting against the virus. These have been prevalent since the start of the crisis and will likely remain to accompany strategies of track and trace, distancing and mask wearing. For business, language is associated with rebound and openness to travel. As time passes, ecological metaphors express the nature of interdependence, that we are all connected. Finally, metaphors associated with resilience have been important in creating a common bond both in enduring the crisis but also in the potential for future societal change.
The term vulnerability is one often applied to others. Who decides who is vulnerable? Is it a byword for certain kinds of discrimination, for example over age, health, ethnicity or working roles (a matter of life and death in the application of Do Not Resuscitate Orders)? And what happens to a person’s sense of self to be labelled that way? The NHS was obliged at times to prioritise COVID-19 patients with repercussions for others with serious illness. There was concern that deferred access to treatment may also lead to unnecessary suffering and death. Such a situation will surely raise difficult questions for the future of the NHS. Should the health system restructure to create separate facilities for infectious respiratory disease? Should the NHS refocus its remit? Has sustained underfunding fundamentally undermined the health system? What will the relationship with the wider care sector look like? The deaths amongst elderly people in UK care homes is increasingly recognised as a system failure. There was nothing these people could have done individually to protect themselves. They were exposed to the virus by care and health systems.
Managing pandemics in a democracy
Does the management of the COVID-19 virus present specific challenges to liberal democracies built on market capitalism? In determining the common good, liberal democracies have to balance the rights of individuals and different parts of society, including healthcare, education and social care with the demands of the economy. There also needs to be collective trust amongst citizens that democratic governments are able to deliver, whatever the common good is agreed to be. Part of the equation for modern democracy is the management of technology and data. The Chinese state has deepened its commitment to following an authoritarian surveillance model using technology and data. What alternative models are there for democracies? The US was described as following a laissez faire market-based approach, whereas the EU was characterised as more highly regulated (India will develop its own model).
Democratic management of the pandemic requires trust in the competency of institutions. An open media, shared values, social cohesion, education and trust in science are part of the functioning of democracy. There are strengths in the openness and messiness of democracies, in conflict and debate. Democracies should be able to expose and punish policy failure such as failing to protect healthcare workers, the elderly, the poor and disadvantaged. Democracies also depend upon an ability to raise taxation and revenue with citizen consent. Basic competency and better decision-making processes can strengthen democracies.
Communication strategies have not worked well enough. Governments have followed hierarchical approaches to communications – headmaster like – rather than consensus building. If there is a difference in women’s leadership to this crisis it may be in the modes of communication.
Where do we go from here?
The pandemic has accelerated changes that would have otherwise taken much longer to break through: remote working; remote delivery of education and changed opportunities for all the stakeholders – students, teachers, parents; digital payment; remote health consultation and new uses of data. A shift is underway. The world is reordering priorities and there is no agreement on what they should be.
But there will be differential effects of people in society. There are winners and losers: younger people and women have lost out. Uneven broadband and internet access are creating new inequalities within and between countries. Underdeveloped internet in Africa is holding the continent back. A review of globalisation is inevitable: are there opportunities to identify and pull back from its negative aspects?
Transformation cannot simply refer to technology but to all the processes behind it, to building local solutions and to finding ways for people to get their voices heard. The benefits of digital transformation have to have greater reach and use data differently. We must get some clarity over regulation of technology and data use. There has to be a redistribution of power within the tech ecosystem. This is a moment to re-invest in democracy.
Country reports on pandemic response
Country briefings
China
China has, to date, suppressed COVID-19 with a combination of strong tech-based surveillance and authoritarian state control. The Chinese approach has been to save the majority at the expense of the tiny few: ‘People first and life first’.
The following points were noted:
• Traditional and family culture are strong. Respect of the elderly is high and older family members often take care of children so parents can work. Families are intergenerational and integrated.
• Whilst travelling out of China, including to Hong Kong, is out, travelling within China has returned to pre-pandemic levels. External travel requires 14-day quarantine periods for all entering China.
• China is a hyper-mobile society with an extensive transportation infrastructure. 3.66 billion people travelled by rail last year and 660 million flew within China. There are 200 million private cars (around 38 million in UK).
• China is able to control outbreaks with the existing ecology of surveillance technology. The virus has allowed the state to extend surveillance and the social credit system.
• A big shift of education online – 300 million students online. 72% of families say they’re supporting students studying online. Many companies are moving into hardware and software to support online education. Digital content generated by 300 million people spending days online has created a new digital data asset.
• There has been an increase in people working from home combined with workforce reductions. Chinese companies realise they don’t need so many people working. Manufacturing has also slowed because global trade has slowed.
• Internet provision of services and goods is growing. Purchasing power has moved online with online currency and payment.
• Herd immunity was said not to be feasible in China. Even with a low infection rate, the health system could be overwhelmed as a consequence of population size. China is prepared for a second wave. But China will not be immune and will have to stay vigilant. China is confident about vaccine development and production.
China has to relink itself to the world and it must negotiate to connect again to the world while guaranteeing its peoples’ health. It has concerns over currency, slow rates of export and food security. Globalisation was weakened under lockdown. Meanwhile, business is getting a sense of greater efficiency with fewer workers. The last six months have helped China think about the future economy.
Japan
Japan has suppressed the COVID-19 virus by suppressing transmission and managing clusters of outbreaks. A state of emergency was used for a short period between April and May. Japan is still finding between 200-500 cases a day and this is seen as too high, but transmission is being managed by mask wearing, social distancing and avoidance of public and crowded places.
• There have been 1,600 deaths in Japan but there is no discernible correlation between death and social and economic disadvantage (although some elderly refuse intensive care). There has been some discrimination against infected people.
• Technology has not played a major role in Japan’s approach to managing the virus. Less than 20 million people (out of a population of 126 million) installed the mobile app – not enough to be effective.
• There is some use of the QR code in bars and restaurants but not huge take-up. Privacy is an important norm in Japanese society.
• There is no crowding on trains and transport is not a site of virus transmission. People are working remotely.
• Mask wearing is very common. 99% of people wear masks. There is strong peer pressure within Japanese society. Ventilation within buildings is also part of the approach.
• People are generally following scientific advice. The Japanese listen to scientific advice and expert panel members were active in promoting the guidance.
• All measures are on a voluntary basis. The aim is to interrupt transmission and to protect elderly, care homes and nursing homes. Outbreaks have tended to be in entertainment venues and nightclubs, but transmission more widely has been controlled by managing clusters.
• Japan is trying to open borders but is concerned by a lack of international risk assessments and frustrated by a perceived lack of WHO co-ordination over risk assessment on travel between countries.
COVID-19 may become a human virus with seasonal outbreaks and the view from Japan anticipated a significant impact for several years to come. The question of how to establish a safe society for elderly people was uppermost with concern over a further threat from pandemic influenza.
Internationally, globalisation and urbanisation has made us all less resilient – we have to consider how to build about a safer world in the future and this may mean a reconsideration of globalisation and the meaning of a good society.
Singapore
Singapore started with a small number of cases and several spikes with imported cases from China and then from the US, Europe and Singaporeans returning from abroad. The highest number of cases were found in the migrant worker populations (often associated with the construction industry) and specifically in foreign worker dormitories.
• Overall Singapore has recorded 57,000 cases of COVID-19 and 28 deaths. High quality medical care and treatment of symptoms has been effective in reducing deaths. The network of community hospitals was important, but these are mostly staffed with community health workers. Singapore also demonstrated an ability to move manpower, for example by deploying airline staff to police social distancing.
• Singapore had learned from SARS in 2003 and H1N1 in 2009. The government had a framework ready for containment and control which included border checks and controls, rigorous contact tracing at speed, safe entry QR and the sharing of geophysical data, quarantining, restricting gatherings to no more than 5 people, homeworking and lockdowns in foreign worker dormitories or isolating foreign workforces.
• The media strategy was an important part of Singapore’s response. The aim was for clear communication across multiple platforms, print and posters as well as broadcast and digital (Facebook/YouTube) with messages targeted at particular audiences (including the elderly and migrant workers).
• Singaporeans received regular and timely information updates: 1.5 million people registered to receive messaging directly via WhatsApp. These updates were often then shared with wider family and friend networks. The regularity and predictability of the information flow was said to be central to its success. It was important, for example, that information messages went out at the same time each day. This strategy involved close working by government with private companies (Apple, Facebook, Google) which required effective technical capacity on the part of government to negotiate with major private providers.
• Singapore has already seen some transformation in processes for e-invoicing and e-payments in moves towards a cashless economy and delivery-based enterprises.
• Singapore’s finance department has supported the economy with 100 billion Singapore dollars on supplementary supports to avoid a 5/6% contraction of GDP, said to have saved around 155,000 jobs. The aim is to preserve the economy and retaining capacity (to include retraining for greater digital capacity).
Singapore’s communications strategy was directed towards all parts of society and reaching out to senior citizens for example to include them in digital transformation was said to help support resilience within the whole community.
India
This pandemic should remind us that we as human beings are not invincible – extinction is a threat to be taken seriously. The long tail risks of pandemics and COVID-19 has exposed weaknesses of government around the world and in particular countries like India that are not well prepared for healthcare crisis or vaccine distribution.
• There was a plea for vegetarianism – a step individuals can take in exercising their own agency. COVID-19 was a by-product of our eating habits. Human food choices and the poor management of animals was a clear factor and one that can reoccur.
• There have been 7.7 million confirmed cases of COVID-19 in India and 100,000 deaths. But huge uncertainty is an everyday reality for Indians. Compared to other deaths, COVID-19 deaths are low and under a 10th of total deaths. India has a tolerance for infectious mortality. In a normal year 1,100 people a day die from tuberculosis. Diarrhoea still kills 2,000 people a day.
• Vaccines may make a difference in the Western world but not in India because people will have to pay. The pathway for India with or without the vaccine may not be very different. The COVAX system may help. H1N1 infection is still current in India. More people are said to have died in 2017 of H1N1 than in the 2009 pandemic itself.
• The impact on education in India has been significant, particularly in deepening social divides. The 300 plus million children not connected to technology have been disadvantaged. On the plus side, some of the ways in which education has been over emphasised until now have been revealed. The cost of education was too high and the delivery of education must be rethought.
• The pandemic revealed weaknesses in the Indian economy especially over dependency on supply chains, for example over PPE. There were few testing kits or PPE available at home. India is the manufacturer of 60/70% of the world’s vaccines but all are exported. India exported significant quantities of HCL (hydroxychloroquine).
• The rise of Super Apps in India combines digital payments, ecommerce and education. Reliance (a digital shopping app) is now operating in conjunction with Facebook, another with Amazon, another with Walmart. The Super Apps are going to be the drivers of the digital economy.
There was hope that health might become a major pillar of the Indian economy and that government intervention in the health system could leapfrog other parts of the world with for example, telehealth.
Africa
Responses in healthcare were very different across Africa reflecting responses from poorer and richer Africa. In Nigeria and Kenya, the responses were said to have been better. In poorer countries, it’s a different story. In unpacking the co-morbidities of COVID-19, Africa had to face up to itself. Ebola/HIV have been far more profound in many African countries. Poverty is an overriding factor. The risk from dying from being economically poor are greater than dying of COVID-19. The prevalence and effects of TB are far worse.
• Weak governance was also said to be a major factor. The delivery of vaccines across African countries will require serious consideration of leadership. The role played by Sierra Leone’s President Ernest Bai Koroma, for example, was said to be important in that country’s better response to Ebola. Institutional capacity has to be built for scientific modelling and data use.
• Africa’s position in relation to education and skills has been intensified by the pandemic. Africa has a young population which means better resistance to COVID-19, but skill levels are poor. How can technology be leveraged to support education in Africa?
• The long-term economic challenge is dependency on China. It was argued that China has dumped cheap goods into Africa, inhibiting the opportunities for African nations to develop their own economies.
The basic infrastructure to transport food and water needs to be developed. There are opportunities for trade and agricultural markets, but these have to be supported by better infrastructure. Africa has to integrate into the global digital world.
DRC
In the DRC, there are 10,822 cases of reported COVID-19 and 276 deaths, a 2.5% death rate from confirmed cases. Unreported cases are likely to be much higher.
• The DRC is one of the poorest countries in the world with the majority of the population either unemployed or underemployed. People have to go out every day to earn money. The idea of a national lockdown was not feasible for the DRC. If the notion of lockdown is premised on protecting a health system from being overwhelmed, then for those countries without an established health system lockdown makes little sense.
• Restrictions were put in place – the Gombe business district in Kinshasa, for example, was put into lockdown.
• The lockdown had detrimental effects for business, as the digital ecosystem is underdeveloped. Internet costs are high. Business could not easily move on-line.
• COVID-19 represented one more disease to deal with alongside Ebola, typhoid, dengue and malaria. It reduced available resources for other diseases.
• Reduction in global demand for some raw materials had an impact. The government is reliant on exports of cobalt and coltan minerals and on cross border supply chains. Closed borders also had an effect on food supply. DRC relies food-wise with trade with other African countries. If trade is damaged, there is a knock-on effect in custom taxes for export and import. When the world shuts down, many countries were unable to access basic medicines.
• Poor governance is a big problem. Fears were expressed that external pressure on the DRC to improve governance may be lessened. A possible Cold War between the West and China will affect DRC. The DRC may align itself with China, which cares less about good governance.
• Education has been affected by the impact of the pandemic. Students and children were not able to access any kind of education. The DRC need solutions for e-learning in the future.
• DRC is going for herd immunity. Many people don’t believe COVID-19 exists at all. Many see it as a Western illness, a foreign disease only present in Europe or China.
• Alternative medicine in the DRC for infectious disease is an important sector. Roots medicines or homoeopathy are used extensively.
There was a plea for Western countries to stop politicising health. Responses in the UK were seen to have been highly politicised. This pandemic was said to have exposed some of the disadvantages of interconnectedness and interdependence that globalisation has brought Africa.
This Note reflects the Director’s personal impressions of the conference. No participant is in any way committed to its content or expression.
Conference Participants:
AUSTRALIA
Ms Carly Kind
Director, Ada Lovelace Institute, Nuffield Foundation. Formerly: Legal Director, Privacy International.
CANADA
Dr Lise Butler
Lecturer in Modern History, City, University of London; author, 'Michael Young, Social Science, and the British Left, 1945-70' (Oxford University Press, 2020); Programme Director and founder, City BA History and Politics; contributing editor, 'Renewal: A Journal of Social Democracy'; Archives By Fellow, Churchill College, Cambridge. Formerly: Lecturer in History, Pembroke College, Oxford (2015-16).
Dr Eric M. Meslin PhD, FCAHS
President & CEO, Council of Canadian Academies (2016-); Adjunct Professor, Dalla Lana School of Public Health, University of Toronto (2020-); Pierre Elliott Trudeau Foundation COVID19 Impact Committee (2020-); Genome Canada Canadian COVID 19 Genomics Network (CanCOGeN) steering committee (2020-); Senior Fellow, PHG Foundation, University of Cambridge (2019-). Formerly: Founding Director, Indiana University Center for Bioethics (2001-16); Executive Director, US National Bioethics Advisory Commission (1998-2001).
CANADA/FRANCE
Mr. Philippe Couillard MD
Senior Advisor, Dentons. Formerly: 31st Premier of Quebec (2014-18); member, National Assembly of Quebec (2003-18); leader, Quebec Liberal Party (2013-18); Quebec Minister for Health and Social Services; university professor and neurosurgeon.
CANADA/UK
Ms Ninjeri Pandit
Director, Office of the NHS Chairs, CEO and COO, NHS England.
DEMOCRATIC REPUBLIC OF CONGO
Miss Arlette Nyembo
Independent consultant in the international development sector, working on development projects across the Democratic Republic of Congo. Formerly: Oxford Weidenfeld and Hoffmann/Abraham Rausing Scholar; MSc Global Governance and Diplomacy (2019/20). Mandela Washington Fellowship for Young African Leaders (2018).
GERMANY/UK
Lady Elisabeth Stheeman
Member of the Financial Policy Committee, Bank of England (2018-); External Member, Audit and Risk Committee, Asia Infrastructure Investment Bank (2021-); external member, Financial Market Infrastructure Board, Bank of England (2017-); Aareal Bank AG: Supervisory Board member; deputy chair, Risk Committee and member, Technology and Innovation Committee; non-executive director, Edinburgh Investment Trust plc; member, London School of Economics Council and Court of Governors; deputy chair, LSE Finance and Estates Committee. Formerly: Senior Advisor, Prudential Regulation Authority, Bank of England (2015-18).
JAPAN/UK
Ms Yoko Dochi
Managing Director, Global Head of Investor Relations, SoftBank Group Corp, Tokyo and London (2018-); Non-Executive Director, JPMorgan Japan Investment Trust plc; Trustee, Daiwa Anglo Japanese Foundation. Formerly: Principal Investor Relations Officer (Japan) and General Manager, EMEA Head of Investor Relations (London), Toyota Motor Corporation (2001-18); Investment Officer and other positions at IFC and IBRD, World Bank Group, Washington, DC (1996-2001) and the Bank of Tokyo (now Mitsubishi UFJ Financial Group), Tokyo (1987-96).
JAPAN/USA
Ms Shihoko Goto
Deputy Director for Geoeconomics and Senior Northeast Asia Associate, Asia Program, The Wilson Center; contributing editor, The Globalist. Formerly: correspondent for Dow Jones News Service and United Press International, Tokyo and Washington, DC; donor country relations officer, World Bank.
NETHERLANDS
Ms Arwen Smit
Author, "Identity Reboot" (reimagining data privacy for the 21st century) (2020); Independent Expert, Horizon 2020 Fund, European Commission (2020-); venture partner & mentor, Outlier Ventures (focused on IoT, AI and Blockchain) (2019-); lead blockchain strategist, MintBit (advising Fortune 500 C suite & governments) (2018-); history teacher, The Access Project (2017-). Formerly: EMEA lead, Mobility Open Blockchain Initiative (2018-20); co-founder, DOVU (2015-18), International Advisory Board, AIESEC (2016); mentor, Virgin Startup (2016-18).
Ms Catherine Vollgraff Heidweiller
Head of Quantum Computing Partnerships UK, Google, London; Strategy and Operations Manager (EMEA), Google, London; Prins Bernhard Fellow; Hendrik Muller Fellow.
NIGERIA/UK
Mr Ade Adeyemi MBE
Fellowship Director, Global Health Programme, Chatham House; Senior Manager, NHS England; Fellow, Royal Society of Arts; Senior Associate Member, Royal Society of Medicine. Formerly: Executive Board Member, Fabian Society (2013 18).
TURKEY/UK
Dr Pinar Emirdag
Managing Director and Global Head of Digital Client Services at Markets, JPMorgan Chase. Formerly: Senior Vice President, Head of Digital Product Development and Innovation, State Street (2017-19).
UNITED KINGDOM
Dr Jamie Bennett
Deputy Director, HM Prison and Probation Service; editor, Prison Service Journal; author, 'The working lives of prison managers: Global change, local cultures and individual agency in the late modern prison' (Palgrave MacMillan, 2015). Formerly: Governor: HMP Long Lartin, HMP Grendon, HMP Springhill, HMP Morton Hall.
Dr Edward Brooks
Executive Director, the Oxford Character Project; co editor, 'The Arts of Leading: Perspectives on Leadership from the Humanities and Liberal Arts' (forthcoming); author, 'What May I Hope For? Modernity and the Augustinian Virtue of Hope' (forthcoming).
Mr Paul Clarke CBE FREng
Chief Technology Officer, Ocado (2012-); member, AI Council; co-chair, Robotics Growth Partnership; advisory board member, National Food Strategy; member, Innovation Expert Group.
Dr Leon Danon
Senior Lecturer in Data Analytics, University of Exeter; member, Scientific Pandemic Influenza Group on Modelling (SPI M) (gives expert advice to the Department of Health and Social Care and wider UK government on scientific matters relating to the UK's response to an influenza pandemic (or other emerging human infectious disease threats).
Professor Sunetra Gupta
Professor of Theoretical Epidemiology, Department of Zoology, University of Oxford. Formerly: Principal Investigator, Oxford Martin Programme on Vaccines, Oxford Martin School (2010-15).
Ms Jan Hall OBE
Founding Partner, No 4 (2018-); Executive Coach, Tavistock Institute and Meyler Campbell; author, "Dementia Essentials" (2013, revised 2020) and "Changing Gear" (Feb 2021). Formerly: headhunter, working on CEO and Chairman appointments (22 years); Founder, JCA Group (2005-16); post-sale, UK Chairman and Co Leader of European CEO and Board Practice, Heidrick & Struggles (2016-18); Senior Partner, Spencer Stuart (1997-2005).
Dr Tom Hobson
Research Associate, Centre for the Study of Existential Risk, University of Cambridge.
Mr Matthew Holehouse
British Politics Correspondent, The Economist (2020-). Formerly: Reporter covering Brexit negotiations, MLex Market Insight (2016-20); Brussels Correspondent, Political Correspondent and other roles, Daily Telegraph (2010-16).
Dr Catherine Howe
Director of Communities, Adur and Worthing Councils (2020-); board of trustees, Centre for Public Scrutiny (2017-); Governor, The Democratic Society (2010-). Formerly: Director of Design, Delivery and Change, Cancer Research UK, London (2018-20); Digital Innovation Director, Capita (2015-18); Governor, Portslade Aldridge Community Academy (2011-17).
Sir Simon Jenkins FRSL FSA
Columnist: The Guardian (2005-); BBC Correspondent; author, 'Mission Accomplished? The Crisis of International Intervention' (2015). Formerly: Chairman, The National Trust (2008-14); Columnist, The Sunday Times (2005-08) (1986-90); Columnist, The Times (1992-2005); Editor, The Times (1990-92); Political Editor, The Economist (1979-86); Editor, The Evening Standard (1976-78).
Ms Gillian Keegan MP
Member of Parliament (Con) for Chichester (2017-); Parliamentary Under Secretary of State for Apprenticeships and Skills, Department for Education. Formerly: Parliamentary Private Secretary (PPS) to the Secretary of State for Health and Social Care in (2019); PPS to the Home Secretary (2019); MP Apprenticeship Ambassador (2019); PPS to HM Treasury (2018); Chief Marketing Officer, Travelport; Group Vice President of Multinational Customer Group, Amadeus IT Group, Madrid; Commercial Director, MasterCard International.
Professor Rakesh Uppal FRCS, FRCS(CT/h)
Consultant Cardiac Surgeon, Barts Heart Centre; Professor of Cardiovascular Surgery, William Harvey Research Institute, Queen Mary University of London; Director, Barts Life Sciences; Non-Executive Director Capital Enterprise; Chairman of the Board, Raphael Labs (biotech start up working on CV19 prophylaxis).
UNITED KINGTOM/UNITED STATES OF AMERICA
Ms Melissa Wong Bethell
Managing Partner, Atairos Europe.
UNITED STATES OF AMERICA
Mr Eric S. Braverman
CEO, Schmidt Futures.
Dr Helima Croft
Managing Director, Global Head of Commodity Strategy, RBC Capital Markets, New York; member, National Petroleum Council; Life Member, Council on Foreign Relations. Formerly: Managing Director and Head of North American Commodities Research, Barclays; Lehman Brothers; Council on Foreign Relations; CIA.
Ms Duyeon Kim
Senior Advisor for Northeast Asia and Nuclear Policy, International Crisis Group (2019-); Adjunct Senior Fellow, Center for a New American Security (Seoul based).
Admiral Michael S. Rogers, U.S. Navy (Retd)
CEO, The MS Rogers Group LLC; Senior Fellow and Adjunct Professor, Public Private Initiative, Kellogg School of Management, Northwestern University; advisory board member, Australian American Leadership Dialogue; advisory board member, NATO Cyber Defence Center of Excellence; board of directors, United States Naval Institute. Formerly: U.S. Navy, retiring as a four-star admiral (1981-2018); Director, National Security Agency and Commander, U.S. Cyber Command (2014-18); Commander, U.S. Fleet Cyber Command/U.S. 10th Fleet; Director for Intelligence, Joint Chiefs of Staff and U.S. Pacific Command.
Ms Gayle Smith
President and CEO, ONE Campaign (2017-). Formerly: Administrator, U.S. Agency for International Development (2015-17); Special Assistant to the President (Obama administration) and Senior Director for Development and Democracy, National Security Council; Special Assistant to the President (Clinton administration) and Senior Director for African Affairs, National Security Council; founder, sustainable security program, Center for American Progress; co-founder, ENOUGH project and Modernizing Foreign Assistance Network.
Ms Terri Taylor
Strategy Director for Innovation and Discovery, Lumina Foundation, Washington, DC (2017-). Formerly: Education Counsel (2011-17); English teacher, Kyrgyzstan (2006-08).
INVITED SPEAKERS
CHINA
Mr Michael Kuan
Founder & Chairman, Kuan Capital (2013-); founding council member, TEDx Global. Formerly: co-founder, CyberCity Investment, SIG Capital; Partner, GGV Capital; The China Ambassador, Pepperdine University; member, XPRIZE's Innovation Board.
Dr Tang Bei
Associate Professor of International Relations and Assistant Director, Centre for Global Governance Studies, School of International Relations and Public Affairs, Shanghai International Studies University. Formerly: Visiting Scholar, Columbia University (2014-15).
INDIA
Mr Gaurav Dalmia
Chairman, Dalmia Group Holdings; founder and Chairman, Landmark Holdings; co-founder, GTI; Board member, Brookings India; member of the Governing Board, The Institute for New Economic Thinking, New York; Chairman, Indian Advisory Board, Room to Read (a global education charity); op ed contributor to The Economic Times, The Times of India and Financial Times.
Mr Oommen C. Kurian
Senior Fellow and Head of Health Initiative, Observer Research Foundation, New Delhi.
Mr Pramit Pal Chaudhuri
Foreign Editor, Hindustan Times, New Delhi; Fellow, Ananta Aspen Centre of India; Senior Associate, Rhodium Group; Senior Advisor, BowerGroupAsia. Formerly: Member, National Security Advisory Board to India's Prime Minister (2011-15).
JAPAN
Professor Hitoshi Oshitani MD, PhD, MPH
Professor, Department of Virology, Tohoku University Graduate School of Medicine. Member, Japanese Government Subcommittee on Novel Coronavirus Disease Control.
SINGAPORE
Mr Aaron Maniam FRSA
Deputy Secretary (Industry & Information), Ministry of Communications and Information, Singapore; Adjunct Faculty Member, National University of Singapore. Formerly: Administrative Service, Government of Singapore: Director, Institute of Policy Development, Civil Service College; Head, Centre for Strategic Futures, Prime Minister's Office (2010-11); Strategic Policy Office, Public Service Division (2008-11); Singapore Foreign Service: principal coordinator for Congressional liaison and issues relating to the Middle East, Embassy of Singapore, Washington DC (2006-08); North America Desk, Singapore (2004-06).
SOUTH AFRICA
The Hon. Mmusi Maimane
Founder, One South Africa Movement (2020). Formerly: Leader of the Opposition (Democratic Alliance), National Assembly of South Africa (2015-19); Leader of the Opposition (2014-19); Democratic Alliance National Spokesperson.
UNITED KINGDOM
Professor Rana Mitter OBE FBA
Professor of the History and Politics of Modern China and a Fellow of St Cross College, University of Oxford. Books include 'Forgotten Ally: China's World War II, 1937 1945' (Houghton Mifflin Harcourt, 2013; UK title, ‘China's War with Japan’), winner of the 2014 RUSI/Duke of Westminster's Medal for Military Literature, named a Book of the Year in the Financial Times and Economist; and 'China's Good War: How World War II is Shaping a New Nationalism' (Harvard, 2020). Co-author, with Sophia Gaston, of the report "Conceptualizing a UK China Engagement Strategy" (British Foreign Policy Group, 2020). Winner, 2020 Medlicott Medal in History.