COVID-19: Overcoming controversies and achieving a more predictive form of crisis management

This article is based on the research carried out by Groupe URD’s COVID-19 Observatory[1] and the conclusions of the Autumn School on Humanitarian Aid. It aims to identify some of the main factors that are prolonging the crisis and its negative effects all over the world, given that the objective is not to stop the pandemic but to control it more, and to move from crisis management to predictive management.

Twelve months after the start of the COVID-19 epidemic[2], with hundreds of millions of people locked down and billions of dollars invested in the response[3] [4], we may have hoped that the end of the crisis would be in sight, at least in the Global North, with its apparent advantages in terms of financial and material resources. However, the number of countries that have currently reimposed lockdowns would appear to indicate the opposite. COVID-19 is still on the front pages every day, controversies continue to rage on social networks and in the media, and the decisions made by the majority of governments are continually changing. A major disaster for many… Faced with such general confusion, and control measures that, until recently, were limited to dictatorships and countries at war, the exasperation of the public and the politicisation of such measures is understandable.

Controversies of different kinds

Before discussing specific actions that would allow the response to be managed in a more organised manner, it might be useful to analyse how a myriad of controversies has prevented a consensual action plan from being established. We have been confronted with an unprecedented ‘infodemic’. This term, which combines ‘information’ and ‘epidemic’, describes the widespread propagation of both accurate and inaccurate information about a topic, for example a disease. As facts, rumours and fears get mixed up and spread, it becomes difficult to obtain only reliable information about a problem. There have been five main types of controversy connected to COVID-19:

1. A first group of controversies are linked to information that is false from the start. Errors, lies and fraud, whether institutional or not, are widespread and existed well before COVID-19. Control measures exist to protect ourselves from these. However, the desire to know everything immediately about this new virus, which is made worse by our hyper-connectivity, combined with interests of all kinds, has countered several of these procedures, either voluntarily (through misinformation[5]), or by accident, in the form of misinformation. This has even affected some of the most respected bastions of technical information. For example, reputed scientific journals have found themselves having to withdraw articles about controversial subjects like hydroxychloroquine, despite their review procedures[6]. A similar case of information that, on the face of it, was highly credible, came from a Nobel Prize winner known for his work on AIDS: he claimed, without sufficient evidence, that COVID-19 had been fabricated in a laboratory, which of course encouraged conspiracy theories[7]. This false information is all the more toxic as the algorithms used by social networks mean that their users are principally exposed to information that confirms their pre-existing beliefs, thus reinforcing their convictions, even for the most implausible ideas. Laudable efforts to counter this do exist, such as fact-checking websites and software that classify sources based on their qualities, or corrective institutional[8] or legal[9] measures, but their impact remains very limited.
2. A second group of controversies come from accurate information that is taken out of context. In this case, the scientific data is cherry-picked to support interpretations that the public – who are desperately hoping to find ‘THE’ solution to this deadly virus – want to hear. An example of this approach is the much-discussed documentary ‘Hold-up’, a collection of untruths which has become viral via social networks. Several newspapers, including Le Monde[10], rapidly refuted its claim of a conspiracy behind the pandemic, but the damage has already been done and it takes a long time for the fact-checking to make an impact. It is therefore important to take action before misinformation appears. This, for example, was what happened regarding the idea that a vaccination would allow us to get the pandemic rapidly under control. Very different sources, such as international bodies, virologists, private foundations who are funding the vaccinations and pharmaceutical companies all explained that it was impossible to obtain a vaccination immediately due to the complexity of the production, distribution and administration processes. For now, despite the brouhaha, this has generally been accepted. This will probably change when the competition between pharmaceutical companies, on the one hand, and producer countries, on the other, becomes too fierce to be limited to editorials. Ensuring that scientific discussions are accurate outside their scientific context requires long-term action, as does educating the public to be critically minded, and teaching journalists and scientists to be skilled in communication.
3. Controversies related to psychosociology. Many people who are presented with different sources of information will prefer the promises of a healer than statements based on established facts. In Afghanistan, for example, the authorities had a great deal of difficulty in convincing the population that there still was no direct treatment for the virus and that the miracle cure being sold by a so-called healer was a fraud. The laboratory confirmed that the concoction contained opium, papaverine, codeine, morphine and herbs[11]. What is more, these reactions lead to an even greater challenge when they are exploited by interest groups. Of course, there have been proposals made to detect and prevent these manipulations but they remain voluntary good practice codes. For example, Google, Facebook, Twitter, and more recently TikTok, signed the first set of self-regulatory norms in the world to fight against disinformation[12].
4. Differences of opinion that come from the distribution of sector-based responsibilities. The public health sector knows what the relative effectiveness of the proposed measures is from a medical point of view, but does not have the expertise to calculate how they might affect each sector of society. On the other hand, representatives of trade unions and the financial sector are better placed, for example, to determine the impact of certain measures on employment and stock exchange values, but do not have the expertise needed to know how an epidemic is going to evolve over time. Taken individually, these sector-based recommendations frequently appear contradictory because they have different objectives. The public therefore should be informed about the key points of these discussions and why they are being carried out in relation to the specific impact of the proposed recommendations on each section of society. The multi-sector composition of national COVID-19 commissions should help to overcome this difficulty by training their members more effectively in risk communication because there is always an element of mutual learning over time. By keeping the same sector representatives, mutual understanding gradually grows and allows the group to concentrate on stable and predictable control measures.
5. The fifth group of controversies are the result of a shift in the centre of gravity of authority. Institutional authority, and confidence in systems, even democratic systems, are increasingly criticised. As a result, individuals feel that they can decide for themselves, going as far as to believe that they are stronger than the virus and refusing to change their behaviour in order to protect others. This self-centred attitude can be seen very clearly in countries like Brazil and the United States, who are still unable to establish a national policy. What is more, no global mechanism has received the necessary endorsement to establish international strategies. The United Nations Security Council, the G20, the G7 and other major institutions were activated at a very late stage and have not made any significant decisions in this respect. Certain criticisms of the WHO may well be justified, but trying to undermine a neutral and global structure of this kind without proposing any alternative has maintained the pandemic at catastrophic levels. Only a global agreement will allow us to defeat this disease, or at least allow us to live with it, as it is a disease that can affect anyone and which is transmitted due to contact between individuals. If not for this pandemic, then for another one.

The many different sources of contradictory and conflicting information that exist show how difficult it is to ensure that everyone has access to rapidly available, accurate information, without compromising individual freedoms, and also how difficult it is to channel collective energy towards the effective management of the crisis. A global problem requires a global solution and significant funding. Though COVID-19 is a huge problem, solutions do already exist, but are incomplete. It is fundamental therefore to evaluate the reasons for this infodemic and to establish the basic principles of a global mechanism to prevent and treat it.

How can this crisis be managed more effectively?

Until the infodemic returns to more acceptable levels, which will take some time, there are already a number of ways to manage the COVID-19 crisis more effectively, as its social and economic side-effects are currently becoming worse than the direct impact of the virus.  We feel that the main objective should be to make the way it is managed more predictable. Three principal aspects are essential to achieve this:

1. An empathetic approach by the authorities has been an essential factor in controlling the transmission of the virus in democratic countries. Such an approach needs to be based on authenticity, which helps to build trust. But trust was eroded – particularly in democracies – because people thought that the measures implemented by the authorities would quickly allow them to get back to a certain form of normality. It is true that the speed with which the scientific community has acquired knowledge about this new virus is unprecedented. But as impressive as this may be, our knowledge is still too incomplete, even today, to allow us to really return to normality. To avoid misunderstandings and false hopes, scientists, journalists and politicians should systematically begin their public interventions with a reminder about the degree of uncertainty when decisions are being made. Such humility would also help to avoid ending measures too soon before all the necessary checks have been made to ensure that the ‘new normal’ is in place. For the majority of people, over and above the different sacrifices related to lockdowns, it is the apparent incoherence of the information coming from the many different sources that is difficult to bear. Being transparent about what the level of certainty and uncertainty behind the different decisions being made would help people – those of goodwill, at least – to adhere to these choices that have an effect on all of our lives.
2. A combined approach: No epidemic can be stopped by a single protection measure, in the same way that building retention walls on only three sides of a field will never protect it from flooding. A disease will continue to be transmitted for as long as there continues to be a gap in the defences. Protection measures, which have been discussed in detail for months, are all effective in their way, but if they are not applied together, the door is open to an increase in cases, as we saw at the end of 2020. The good news is that the opposite is also true. With current knowledge and existing tools, several countries with very different political and administrative systems have shown that it is possible to control this second wave by combining four main measures[13], which can be summarised as follows:

• limiting the importation of the virus. A control measure applied on its own has never prevented a virus from being imported. However, this measure has proven to be very useful if others are adopted at the same time. For islands, even large ones like Taiwan and New Zealand, it appears to have been a very important success factor. The boundaries involved can be those of a country, a city or even a university campus.
• limiting the number of contacts. Given that this virus will only be partially stopped by the first barrier, a second barrier needs to be raised by reducing the possibility that a non-infected person will find themselves somewhere where there is a high risk of transmission of the virus. To do this, any event where there is a high risk of transmission should be banned and individuals must only be in contact with the same, limited number of people, commonly referred to as a ‘social bubble’. Though this has not yet been explained scientifically, it appears that only 10 to 20% of infected people are responsible for 80 to 90% of transmissions.
• reducing contagiousness when people meet. Unfortunately, the two first barriers only partially reduce the risk of transmission. Given the large number of people who are asymptomatic, we have to limit the possibility of infecting or being infected by avoiding transmission via respiratory droplets: avoiding speaking loudly, shouting, reducing time of contact to less than ten minutes, wearing a mask, staying outside as much as possible, ventilating rooms, etc. The majority of this behaviour is acceptable if it is promoted as a means of prevention rather than individual protection. The psychological trauma of successive authorisations and bans is much greater than maintaining a reasonable preventive measure in the medium term. The example of car seat belts illustrates this situation perfectly as, nowadays, everyone wears them, even when they are driving at 30 km/h to the nearest shop.
• if a person has the virus, their contacts should be traced, tested and quarantined. This is the measure that is currently missing the most often, particularly in democracies. Allowing a few people to infect others places the whole system in jeopardy and makes a mockery of all those who have made sacrifices to respect all the other measures. By showing people the mechanisms that can protect an individual’s identity, this essential measure can be applied. Many countries, including the most transparent societies, have not yet established independent mechanisms that are acceptable to those who campaign to protect our privacy.

3. Engaging with the institutions:

1. • Multi-sector committees should make recommendations decided by consensus to promote measures to be applied by the population as a whole in the medium and long term, while respecting the four main control measures;
   • At the global level, a multi-sector system should be established as quickly as possible. WHO, as well as economic, social and development institutions should be involved to make sure that transmission rates are rapidly reduced, while preserving economic growth.
   • The same coordination principles and integrated, multi-sector vision have helped to protect local communities, both rich and poor, in countries where there is little global or national coordination (for example, local governments, community-based organisations, university campuses and businesses).

Conclusions

During this COVID-19 pandemic, an infodemic has proven to be the most serious barrier to effectively managing the response. Pointless discussions and controversies have distracted, and continue to distract, both the population and those involved in the response from the right behaviour and decisions.

Lockdown is an extreme measure of last resort that can only be justified to allow governments to establish an organised response that everyone is aware of. And yet, this is still not the case, even in countries that do not lack economic and scientific resources.

As several countries have shown, a ‘combo’ approach – which consists of simultaneously applying four main, interdependent measures – can help to get the pandemic under control. Negotiations regarding these measures should be as stable as possible, and the measures should only be relaxed when it is certain that the situation will not return to a state of crisis.

Though the new vaccines against COVID-19 might provide greater immunity than vaccines that have been produced for other viruses, they are still only one more measure to be added to the list of preventive measures. It is unrealistic to think that the arrival of vaccines will remove the need to establish genuine global coordination, whether for the current pandemic or for those to come. There is an urgent need to avoid repeating the errors of the past and to ensure that global coordination establishes prevention plans for future threats.

For the time being, the measures that have been adopted are not saving enough lives and are not protecting the economy sufficiently, despite the efforts of those who respect preventive measures, and the billions of dollars invested. While we wait for national and international mechanisms to be consolidated, we should begin with local aspects that are less complex to put in place. The pandemic is the responsibility of each and every one of us.

[1] https://www.urd.org/en/project/covid-19-observatory/

[2] The first formal notification of cases of pnumonia in Wuhan were made at the end of December 2019, and the pandemic was officially declared by the WHO on 11 March 2020.

[3] https://blogs.imf.org/2020/05/20/tracking-the-9-trillion-global-fiscal-support-to-fight-covid-19/

[4] https://www.covidmoneytracker.org/

[5] According to UNESCO, disinformation about COVID-19 creates confusion in relation to medical science which has an immediate impact on each person in the world and on all societies. As such, it is more toxic and more deadly than disinformation related to other subjects. This is why we use the term ‘disinfodemic’.  (https://en.unesco.org/sites/default/files/disinfodemic_deciphering_covid19_disinformation_fr.pdf).

[6] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31324-6/fulltext

[7] https://science.thewire.in/the-sciences/luc-montagnier-coronavirus-wuhan-lab-pseudoscience/

[8] https://www.foreignaffairs.com/articles/united-states/2020-11-19/how-defeat-disinformation

[9] https://scroll.in/article/929863/countries-around-the-world-are-criminalising-fake-news-why-is-that-bad-news

[10] https://www.lemonde.fr/les-decodeurs/article/2020/11/12/covid-19-les-contre-verites-de-hold-up-le-documentaire-a-succes-qui-pretend-devoiler-la-face-cachee-de-l-epidemie_6059526_4355770.html

[11] https://www.aljazeera.com/features/2020/9/3/the-afghan-herbalist-who-claims-to-have-a-cure-for-covid-19

[12] https://ec.europa.eu/digital-single-market/en/tackling-online-disinformation

[13] https://tomaspueyo.medium.com/coronavirus-the-swiss-cheese-strategy-d6332b5939de