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We must take very seriously the responsibility to judge our leaders' policies. When they fail us, we must act as leaders ourselves.
In a pandemic it is natural to wish for decisive leadership from big government authorities guided by the best science and medical expertise. It is tempting to set aside democratic niceties—questioning authority, raising alternative perspectives, vigorous debate, disagreement, and experimentation—in favor of trusting leaders and experts. Echoing this widespread notion, the political scientist Francis Fukuyama wrote recently in the Atlantic that “what matters” to success in dealing with COVID-19 is “whether citizens trust their leaders, and whether those leaders preside over a competent and effective state.”
Despite many deep flaws in the U.S. response to coronavirus, active democratic citizenship has driven some of our most important positive achievements so far.
But the idea that we must sacrifice our democratic impulses in favor of strong central authority is dangerously misguided. Maintaining a robust participatory democracy is the best way for Americans to contain the COVID-19 pandemic and to rebuild our society in its wake. In a vibrant democracy, citizens oriented toward the common good do their part to make society work well. In this pandemic, that means that each of us needs to do our part to stop the disease and to help figure out the best ways for our communities to move forward.
Even as we recognize our mutual interdependence and work to come to agreement, though, we often disagree with one another because we bring different perspectives, experiences, and values. We hope to have good leaders at the top, but we prepare for bad ones. We seldom have authorities as wise, accurate, and just as we wish. As a check on their power, a participatory democracy of advocacy, contestation, adversarial journalism, and bottom-up leadership can generate collective wisdom and press our leaders to serve us better. We ought to take the responsibility to judge our leaders and their policies very seriously, even harshly. And when they fail us, we must act as leaders ourselves in our homes, workplaces, laboratories, communities, and states, because our lives depend upon it.
And in fact, this has already been happening. Despite many deep flaws in the U.S. response to coronavirus, active democratic citizenship has driven some of our most important positive achievements so far. Stopping this pandemic requires all of us to act: to hold our leaders accountable, advocate for social justice, correct experts’ mistakes, and innovate and lead locally. Those who wish for more decisive central government action should recognize these many accomplishments and call for the kind of federal action that fosters and learns from democratic action rather than subordinating or quashing it.
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First, democratic accountability makes leaders work harder to protect society. Writing in the New York Review of Books, the Nobel Prize–winning economist Amartya Sen observes that the people of India ceased suffering famines after they cast off British rule to become the world’s largest democracy. Though very poor, democratic India avoided the famines that killed millions in China, Bengal, Soviet Russia, and Kampuchea in the middle decades of the twentieth century. Why? Sen surmises that under the popular checks of democracy, “Any government keen on staying in power would have had to avoid such starvation deaths taking place at any cost.” Reversing Fukuyama’s thesis, Sen argues that persevering against existential social threats depends less on citizens’ trust in leaders than on the capacity of democratic citizens to punish leaders who fail to protect basic goods such as food security.
Public judgment and pressure may have moved some leaders to more vigorous action.
Although democracies cannot avoid COVID-19, public judgment and pressure may have moved some leaders to more vigorous action. In the United States, many took the disease more seriously and much earlier than President Trump did. Incessant questioning and criticism from journalists, public health advocates, and governors—and ultimately the prospect of having to defend his pandemic policies in the 2020 election later this year—may have contributed to his shift in tone and policy. (At the same time, the coming election seems also to figure in to the president’s agitation for reopening the economy.)
Similarly, the British Prime Minister Boris Johnson and his government abandoned its let-COVID-take-its-course “herd immunity” theory late in the day after mounting public criticism and scientific pressure. This is not to say that elections themselves ensure responsible governance. Myopic electoral considerations—coming from either politicians or voters—may yet lead to decisions that set off future waves of viral spread or suppress economic activity without sufficient government support for those jeopardized by the downturn. Elections cannot guarantee good policy, but they give citizens a chance to punish those who preside over catastrophes.
• • •
In this pandemic as in other times, decision-makers in government and industry can be inattentive or indifferent, sometimes hostile, to the needs of vulnerable workers and communities who bear the greatest burdens of COVID-19. Contentious agitation from community organizations and vulnerable individuals can draw attention these problems and press for more just policies.
In many parts of the United States, infection and death rates from COVID-19 are much higher among African Americans and LatinX people. Reverend William Barber of the Poor People’s Campaign has called for policymakers to recognize that the unjust burden of the disease stems from a long history of policies that have produced unequal health outcomes. Other activists have pressed for racially disaggregated data about COVID-19 to illuminate racial disparities and create knowledge and social pressure to address them.
Many of those who work in critical sectors that provide health care, food, and transportation face higher risks of infection because job conditions prevent them from social distancing. In many of these workplaces employers cannot or will not take measures that protect workers from infection. For example, some 350 workers—mostly immigrants—at a single Smithfield Foods pork processing plant in South Dakota tested positive for COVID-19 in this month. Those cases amounted to 40 percent of all cases in South Dakota at the time. In the past few weeks, workers have protested such conditions and called for occupational and health protections at places like Walmart, Amazon, and Instacart using digital organizing tools and platforms such as coworker.org.
Contentious agitation from community organizations and vulnerable individuals can draw attention to problems and press for more just policies.
In the coming weeks, states across the country will make critical decisions about how to reopen the economy and control subsequent outbreaks. Georgia’s Governor Brian Kemp announced that restaurants, bowling alleys, and some other businesses may re-open in the last week of April. But activists such as LaTosha Brown, founder of the Black Voters Matter Fund, fear that his policy will jeopardize the health of black and working class people who lack the capacity to protect themselves through social distancing and other measures while others—professionals and knowledge workers who can better protect themselves—reap the greatest gains from early economic re-opening. She and her colleagues plan to press Kemp and other decision-makers to provide protective equipment to workers, test and trace COVID-19 in low-income communities and communities of color, expand Medicaid, and implement other measures to protect vulnerable people in Georgia.
We should listen to these social justice activists because vigilance and advocacy are more reliable routes to protecting the least advantaged from being smothered by the burdens of this pandemic than trust in benevolent authority.
• • •
Expert Mistakes and the Whole Truth
Some think that if the politics of Westminster and Washington are to blame for mismanaging the response, perhaps politicians and citizens alike should defer to public health experts, epidemiologists and other scientists. Many scientists have responded to this crisis with incredible speed, for example modeling COVID-19’s spread and impact, developing rapid testing methods, and fielding potential vaccines and therapies.
At the same time, scientists and experts rarely speak with one voice, and this pandemic is no exception. When some experts advocate moderate responses and others say shut it down, the choice for citizens (and leaders) is not between science and superstition, but which expert to heed. Experts make mistakes just like the rest of us; they are fallible. In a recent interview about the role of scientists in this epidemic, my colleague Sheila Jasanoff said that “Simple faith in experts is every bit as unwarranted as faith in angels. . . . None of us can claim to be prescient.” Democratic public deliberation and citizen engagement can help correct the errors of experts and get closer to the whole truth of this pandemic.
Indeed, they already have. The reversal of facemask guidance is the most obvious, embarrassing example of expert error and democratic correction. Out of some combination of scientific opinion and expert worries about panic-driven mask hoarding, the Centers for Disease Control (CDC) advised Americans that they should not wear face masks because they won’t help stop the spread of COVID-19. To some citizens, this advice seemed contradictory; the CDC said that masks would help health care workers but wouldn’t help ordinary people. To others, it was puzzling because in many countries that handled the outbreaks well—Taiwan, Hong Kong, Singapore, and South Korea—people seemed to wear a lot of masks. After substantial public skepticism and scathing criticism from contrarian non-Western public health experts who championed mask-wearing, the CDC reversed its position in early April.
Democratic public deliberation and citizen engagement can help correct the errors of experts and get closer to the whole truth of this pandemic.
Perhaps more tragically consequential, the logic of expertise at the CDC and Federal Drug Administration (FDA) seems to have delayed testing availability by several critical weeks in the United States. Out of a concern for quality, the CDC insisted on making its own COVID-19 test and distributing that to labs across the country. Unfortunately, as is now widely reported, the test they produced was flawed and unreliable. Acting on its charge to assure safety and effectiveness, the FDA was slow to permit state public labs and private labs to conduct their own COVID-19 testing in February and March of 2020. Democratic citizen action contributed to increased testing in two ways.
First, citizen action generated basic information about testing availability. Many other countries collect and report national statistics about the number of tests that they conduct, but the United States does not. Remarkably, our main source of information about testing availability comes not from public health experts or public officials, but from ordinary citizens who have joined together in a crowd-sourced reporting project called COVIDtracking.com. Created by Jeff Hammerbacher, Alexis Madrigal and Robinson Meyer, the project’s volunteers scour newspapers, press releases, and health department web sites to record how many tests have been given, how many came back positive, how many people have died, how many are hospitalized, and other information. They make their daily reports available electronically. Their database has been used by many news outlets including the Atlantic, Politico, the New York Times, and the Wall Street Journal.
Second, citizen-generated information about the paucity of testing in the U.S. empowered citizens, journalists, and activists to hold national and state level officials accountable. Many articles and social media posts have used this crowd-sourced information to press for more testing. The president, many governors, and many public health commissioners have felt the heat of democratic pressure to expand testing. And testing has increased, though much more needs to be done.
Experts should strive to benefit from the corrections and insights of democratic citizens and to increase public trust. Doing so requires transparency and humility, and there are at least four guiding principles they should implement. First, they should be completely transparent about their assumptions, data, and uncertainty. Ignorance is no cause for embarrassment in an unprecedented situation. Second, rather than trying to present a united front, experts should be honest about their differences and disagreements with other experts. Third, experts should exercise humility by being open to criticism and acknowledging errors. Fourth, they should treat members of the public with respect by never pandering, trying to manipulate, or hiding the full truth (don’t tell the “noble lie” that masks won’t help in order to manipulate people into not hoarding masks).
• • •
Local Leadership and Innovation
Although many call for decisive central action to stem the pandemic, local innovation and leadership from citizens, civic, and private organizations—sometimes in the face of centralized obstruction—have often shown the way so far.
Local innovation and leadership from citizens, civic, and private organizations—sometimes in the face of centralized obstruction—have often shown the way so far.
In many states, for example, private and non-profit organizations acted more quickly and paved the way for states, and then eventually national government, to implement social distancing measures. In California, for example, Apple and Facebook recommended that their employees work from home on March 5. San Francisco Schools closed on March 12. Governor Gavin Newsome issued California’s facilities closure and shelter in place order on March 19. In Massachusetts, my employer, Harvard University, announced on March 10 that students would be sent home and gave them until March 15 to move out. The public schools that my children attend closed their doors on March 12. One week later, governor Charlie Baker ordered all of the state’s schools to close. If these civic, private sector, and local government leaders had waited for these state leaders to act, they would have all acted much more slowly. If we had waited for a social distancing order to come from Washington, we’d still be waiting.
The Supreme Court justice Louis Brandeis urged us to think of U.S. states as “laboratories of democracy.” Some states and cities have managed the pandemic in ways that others can learn from. Though we are still early in the crisis, the state’s response offers some innovations and lessons for the rest of us. In terms of outcomes, both the number of recorded COVID-19 cases and deaths has grown more slowly in Washington than in just about any other state.
One reason for its success is that Washington has been a leader in testing. Through most of March—until it was overtaken by the massive New York outbreak—Washington had a higher testing rate than any other state. A big reason for this leadership lies in the state’s strong public institutions—in particular the labs at the University of Washington—and an independent mindset. On March 4, when very few tests were available in the country, the school’s virology lab announced that its lab had developed the capacity to run 1,000 samples per day.
When most public health surveillance and federal government efforts were focused on keeping the COVID-19 out of the United States, medical researchers in Washington State were exploring the possibility of spread inside the country. The first U.S. case of COVID-19 was discovered there in late January. Helen Chu, a Seattle infectious disease expert, suspected that COVID-19 might be spreading inside the state undetected. In February she sought permission from state and federal regulators to repurpose her Seattle Flu Study to search for the novel virus.
Out of ethical concerns for subject confidentiality (evidently moral concerns about the harms of pandemic were discounted) and because she operated a research rather than a clinical lab, Dr. Chu was unable to gain permission. Feeling the urgency of a looming health emergency, she and her team proceeded without approval. In late February her team discovered the second case of COVID-19 in Washington: a high school student with no known relevant travel history. Chu’s team thus discovered the second known case in the state with the nation’s first COVID-19 outbreak by operating in defiance of regulatory authorities who did not give her the permission she requested to look for it.
After their discovery, Seattle medical researcher Trevor Bedford analyzed sequenced genomes from the first and second Washington cases. He inferred that they were connected, that COVID-19 had been spreading inside Washington for the prior six weeks, and that perhaps several hundred people were infected but undetected. Just two days earlier, CDC official Dr. Nancy Messonnier had said, in what was regarded as a heroic wake-up call on COVID-19, that “our containment strategies have been largely successful. As a result, we have very few cases in the United States and no spread in the community.”
Another example of effective local action comes from San Francisco, where Mayor London Breed has been rightly credited with acting early and effectively against COVID-19. When asked why San Francisco might have been relatively well-equipped for this pandemic, she said that the city learned crucial lessons from the AIDS crisis of the 1980s: “the federal government was absent and didn’t want to support our efforts in any way. We were . . . left alone to manage this public health crisis. . . We emerged as a model for addressing HIV/AIDS.” Prior painful experience of the indifference the federal government, occurring almost forty years before the Trump administration, made it clear that the city’s fate depended on the quality local initiative and leadership.
What moral are we to draw from these examples? For many Americans, it is tempting to blame President Trump’s administration for being uniquely incompetent. And perhaps it has been. In this pandemic as in normal times, it would be wonderful to have sure-footed, highly competent, central government to save the day. But where are the examples of successful big government action that some in the commentariat wish for? The United Kingdom and France have centralized government, but are testing at rates lower than almost anywhere in the United States. Few look to either as models to imitate. Central government responses in Italy and Spain seemed slow.
The importance of learning from local successes will increase as we face the more complex challenges of managing localized outbreaks and adapting our lives and work to the reality of this ongoing disease.
Germany may be the exception that shows the importance of decentralization. Federalism there was thought at first to hamper effective central government response, but some now think its federal structure may have been a key to early effectiveness. In India, we should look to the state of Kerala, not Modi’s national government, for effective pandemic leadership. Chinese leaders would like to be able to argue for the superiority of authoritarian technocracy, but as Yasheng Huang has argued in these pages, its autocracy may have prevented early action and may now be suppressing the true extent of the disease and its effects. South Korea, Taiwan, Hong Kong, and Singapore are rightly held up as examples of early success, but their victories may derive from complex mixes of prior experience with SARS, greater collective orientation to enable social mobilization, competent expertise, among other factors.
It is tempting for those in big central government to think that they know better and so try to develop the best policies, the best plans, the best forecasts, the best tests and impose them on the states and localities. If they had done that in Washington State, more of its residents would have gotten sick and died. Instead, they should strive to support the efforts of citizens and localities with resources and learning.
The importance of learning from local successes will increase as we face the more complex challenges of managing localized outbreaks and adapting our lives and work to the reality of this ongoing disease. What are the best ways to identify the infected, trace their contacts, and isolate them? Should we use apps, armies of contact-tracers, or some combination? Should we isolate people in their houses, in hospitals, or in hotels and gymnasiums away from their families? How should we alter our workplaces, schools, and parks to minimize threats of infection? If additional shutdowns are required, what are the triggers for when to start and indicators for when they can be relaxed?
The best answers to these questions should come from inventions and discoveries in workplaces, communities, cities, and states. It would be a grave mistake to rely on big central government to develop one blueprint that we should all follow. In situations of high stakes and high uncertainty, it is better to attempt many strategies and learn from experience rather than placing one big bet. Furthermore, this pandemic raises many challenges of public health, welfare, economic security, even technology and privacy. We need hands and minds—and many different resources—from all over the countries, from many disciplines and backgrounds, to develop the answers to meet these challenges. Efforts such as the partnership between Massachusetts state government, Partners in Health, and an array of civic and private entities to distance, trace, test, isolate, and treat seem promising. Finally, local circumstances matter; the best answers for Dallas, San Francisco, and New York City may well be different.
Instead of trying to know better, the federal government and other central authorities should seek to discover and understand deeply what is working best in states and localities and spread that widely so that we can learn and improve together. It is very promising in this regard that last week, ten Northeastern states formed a regional council to help each other learn and move through this crisis together. Western coast states formed a similar council. “None of us has ever gone through this before,” Rhode Island Governor Gina Raimondo said of the council, “and I am confident that by working together and sharing our best ideas, we are much more likely to get this right.” Those councils, and perhaps eventually federal agencies and the White House itself, can become hubs of learning that bring the very best efforts emerging all across the country to bear on controlling this pandemic and revitalizing our society.
...we need your help. Confronting the many challenges of COVID-19—from the medical to the economic, the social to the political—demands all the moral and deliberative clarity we can muster. In Thinking in a Pandemic, we’ve organized the latest arguments from doctors and epidemiologists, philosophers and economists, legal scholars and historians, activists and citizens, as they think not just through this moment but beyond it. While much remains uncertain, Boston Review’s responsibility to public reason is sure. That’s why you’ll never see a paywall or ads. It also means that we rely on you, our readers, for support. If you like what you read here, pledge your contribution to keep it free for everyone by making a tax-deductible donation.
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