What are the smart COVID-19 containment options for developing countries? Adnan Q. Khan (LSE) writes that the pandemic has pushed policymakers there into an environment of great uncertainty. Not surprisingly, many governments have been emulating the policies of other countries before them. However, while continuing with blanket enforcement of lockdown measures may temporarily stop the spread of the virus, it could quickly generate a new kind of crisis in the form of a rise in non-COVID diseases, deprivation, and hunger, especially in the developing world.
Following the herd is often perceived as less politically costly rather than announcing an independent response, though it may be seen as signalling competence and control. However, many governments have discovered that uniform policy responses are not delivering and, in fact, generate unintended consequences and resentment. Furthermore, they have realised that their hands are tied since they neither have the fiscal space, nor the state capacity to undertake grand, expensive plans that the developed countries have been able to undertake. This is all the more reason why developing countries should adopt policies that tailored to different local contexts, and that are effective yet feasible.
The pandemic has forced leaders to confront two untenable options – lockdown and risk livelihoods, or open up and spread the disease. With many already living on the edge of subsistence, and with a range of pre-existing health issues, the likelihood of adverse health consequences as a result of the response to the pandemic may be comparable to the pandemic’s morbidity itself. The trade-off for developing countries is not just lives vs the economy, but lives versus lives.
We argue the choice when it comes to containment does not have to be all or nothing. We propose a ‘smart’ containment approach for developing countries that is underpinned by active learning and a data-responsive graded response that tailors policy responses to different local contexts within countries with policy flexibility but it will have to be supported through the intense use of data in policy design and implementation.
Within a framework of active learning, even governments with limited capacity can develop localised smart containment policies. Once operationalised, these plans will help generate further evidence for policymakers to learn from, and lead to better contextualised and sustained policy responses. This is how we can escape the curse of a binary choice between lockdown and no lockdown.
A ‘smart’ containment strategy
First and foremost, a smart containment strategy should be underpinned by data. Most countries do have existing administrative data that can be drawn upon to help determine initial estimates of different health and risk profiles. This needs to be bolstered by regularly collecting data on health outcomes – both COVID prevalence, as well as health morbidity due to lockdowns – and socio-economic outcomes to provide a powerful evidence base to support decision-making in uncertain times.
Second, this data can be used to better understand prevalence and risk across different geographies, sectors or even age cohorts and thus employ targeted, graded approaches. This allows for flexibility and the ability to tailor the containment response to the needs of a locality. Furthermore, operationalising such an approach is far less economically costly as unaffected sections of the economy can continue working. And for those affected sectors, data should be used inform the lifting of lockdowns as soon as the risk profile has changed.
Finally, it is important to recognise that each policy response will generate new data and learnings. Responding to this evidence by continuously evaluating the need to impose and lift measures in specific places is core to a smart containment policy. This process of active learning, involving the adaptation of strategies, is key to ensure any containment measures mitigate the economic consequences whilst still prioritising health considerations.
To operationalise more graded and localised policies, clear, transparent, and regular communication will be needed to coordinate actions among different actors and to leverage the agency and self-efficacy of citizens. Effective community messaging and compassionate enforcement are critical to ensure voluntary compliance among citizens. As the positive outcomes are realised, this will further increase trust in authorities, popular understanding, and support.
Continued blanket enforcement of lockdown measures may temporarily stop the spread of the virus, but could quickly generate a new kind of crisis in the form of a rise in non-COVID diseases, deprivation, and hunger. A functioning economy, especially in highly vulnerable communities, is crucial to population health. As we move forward in the next few months, it is critical that containment options are tailored to local conditions. This is not easy but can be done by exercising adaptive leadership, by bringing expertise from different disciplines, by empowering local actors and communities, and by trusting citizens. If developing countries are to succeed, they should learn from others but importantly, chart their own way based on data and evidence.
This post represents the views of the author and not those of the COVID-19 blog or LSE. It is based on policy proposals described in more detail in the following documents – “Policymaking in uncertain times” and “Smart containment with active learning”.