On 31 December 2019, the World Health Organization (WHO) was notified by the Chinese authorities that there were cases of pneumonia of unknown origins in the city of Wuhan in Hubei Province (WHO, 2020a), By 3 January 2020, the Chinese authorities reported 44 cases of whom 11 were seriously ill and that the suspected source of the outbreak, a live-animal food market, had been shut down (WHO, 2020a). In an update on 20 January, the WHO (2020b) reported that the Chinese authorities had identified the cause of the outbreak, a novel coronavirus initially called 2019-nCoV (WHO, 2020b) and subsequently renamed SARS-CoV-2. Chinese scientists had established the genetic sequence of this virus and made it available to other countries. The virus was spreading in China and had spread to three other countries: Thailand, Japan and the Republic of Korea (WHO, 2020b). In early March, the WHO Director-General, Tedros Adhanom Ghebreyesus, announced that the disease caused by the virus, COVID-19 (Coronavirus disease 2019) had spread so far and so fast that it had become a global pandemic (Ghebreyesus, 2020a).
In early 2020, COVID-19 was a new disease. Policy makers needed to assess its risk, especially whether it could spread between humans and, if so, how rapidly and the dangerousness of the illnesses caused by such infection. At the start of the pandemic, it was difficult to assess such risks as there was no evidence.
Public health campaigns are designed to make the public aware of specific risks and change collective behaviour to minimise such risks. These campaigns often use emotions, such as anxiety, fear and guilt, to foreground and attract public attention to the specific risk and the associated collective behavioural change needed to mitigate it. This approach has underpinned campaigns such as the UK’s regular ‘don’t drink and drive’ campaigns (The Telegraph, 2020) and was evident in the 1980s with the ‘don’t die of ignorance’ HIV/AIDS campaign (Burgess, 2017).
Public messaging needs to achieve a balance between creating enough anxiety to engender the desired change in behaviour, but not too much as this may result in undesirable changes such as panic. Quigley (2005) examined the ways in which governments in the US and UK sought to manage one major risk, the so-called Millennium Bug: the danger that at midnight on 1 January 2000, computer systems would crash as many used a two-digit system that would not be able to differentiate 2000 from 1900. Both governments engaged in public awareness campaigns but these were so successful that by the end of 1998 the US government was seeking to reduce public anxiety and avoid panic reactions such as hoarding (Quigley, 2005, p. 288).
The specific concerns of policy makers and health promoters need to be converted into messages that can be understood and can be acted on by their target groups (Alaszewski and Horlick-Jones, 2003).
Risk played an important role in shaping policy makers’ choices and they used it to justify their decisions. However, risk does not make decisions. It provides the knowledge that can help policy makers and others make decisions or to understand and explain why certain decisions were made. Thus, failure of policy makers in some countries to recognise, communicate and effectively control COVID-19 was a result of bad choices and a failure to understand and use risk effectively.
In early 2020, SARS-CoV-2 was a novel virus and therefore there was no evidence on which to base risk assessments. At the start of the pandemic, policy makers had to find a way of making sense of the threat posed by COVID-19 and the different ways in which they did this shaped the success of their subsequent policies. Countries on the western Pacific Rim mostly framed the new disease in terms of SARS, a highly infectious and lethal virus but one that could be identified and controlled using strict public health measures such as quarantine and track and trace. Countries in Europe and North America generally framed the new virus as a form of seasonal flu. Seasonal flu is difficult to control but, apart from vulnerable individuals in the population, most people only have a mild short-lived illness. Since it is difficult or impossible to control the spread of seasonal flu, it is usually managed by protecting the vulnerable sections of the population by vaccination and/or ‘cocooning’, advising these people to limit their social contacts. The virus is allowed to spread
Intellectuals in the 18th century were optimistic about the future, arguing that the accumulation of human knowledge through science would enable humanity to control and exploit nature and create just and rational societies. In France, there was a project to bring together all human knowledge in a single document or encyclopaedia. This encyclopaedia subtitle, ‘a reasoned dictionary of science, arts and crafts’, was perhaps the most visible part of the Enlightenment or Age of Reason, an intellectual movement which aimed to liberate humanity from the fear engendered by ignorance, superstition and religion through rational and critical thinking based on scientific knowledge (Duignan, 020). An important element of the Enlightenment was the growth of public discourse in learned societies, academic journals and newspapers, which provided a space where knowledge and ideas could be exchanged and tested (Habermas, 1989, pp. 36–7).
Science and scientific knowledge still command substantial prestige and support in contemporary society as symbols of modernity and progress, but the optimism is now tempered. Science and technology can stimulate fear and anxiety. As Perrow (984) observed in his study of high-risk technologies, scientific knowledge enables modern societies to build sophisticated and complex systems that are also highly risky and prone to accidents, resulting in human harm. The most obvious example of such systems are nuclear power stations. Hospitals are also prone to such ‘normal accidents’.
Risk has emerged as a key mechanism for controlling the future and learning from past misfortunes.
How did risk influence policy makers’ responses to COVID-19? How will they be judged for their decisions?
Drawing on case studies from the UK, China, Japan, New Zealand and the US, this original text explores policy responses to COVID-19 through the lens of risk. The book considers how different countries framed the pandemic, categorised their populations and communicated risk. It also evaluates the role of the media, conspiracy theories and hindsight in shaping responses to COVID-19.
As we reflect on the ‘first wave’, this book offers a vital resource for anticipating future responses to crises.
Risk plays a role in explaining and accounting for the past, especially individual and collective misfortune, focusing on why the misfortune happened, who was responsible and how it might be prevented in the future (Bernstein, 1996, p. 48; Douglas 1990, p.5). Policy makers would like COVID-19 to be seen as an ‘accidental’ natural disaster. However, as Green (1999) has argued, with the development of improved science and technologies by the late 20th century, governments could reassure their citizens that ‘[m]ost accidents are preventable’ (Department of Health, 1993, p. 9). If this is the case, then accidents such as COVID-19 ‘are the outcome of poorly managed risks, rather than the inevitable misfortunes that we must all suffer from time to time’ (Green, 1999, p. 25). Given that COVID-19 has affected different countries in different ways and the ways it spread and affected human populations was shaped by human decisions, it can be seen as a man-made disaster, especially in those countries with high infection and death rates.
Risk can be used as a way of identifying failings and allocating blame. It underpins the development of a ‘blame culture’ in which every misfortune is someone’s fault. As Douglas (1992) observed, ‘under the banner of risk reduction, a new blaming system has replaced the former system based on religion and sin’ (p. 16). In the case of collective disaster, there is pressure to identify why the risks were not foreseen and mitigated.
All societies need ways of managing the uncertainties of the future and accounting for the misfortunes of the past. In pre-modern societies, such as small-scale intimate societies or historic societies in Europe, religion and supernatural beliefs, such as those in witchcraft (Alaszewski, 2015), provided the basis for prediction of the future and allocation of blame for misfortune. In the modern high-income countries with developed health care, these systems have been (partially) replaced by rational ones, especially risk, in which human actions are based on reason and evidence. Indeed, for sociologists such as Anthony Giddens (1991), this drive towards rationality is the hallmark of modernity.
The emergence of risk as a framework for rational decision making can be traced back to the emergence of mercantile capitalism in the 17th century. Merchants managed the risk of shipping accidents and loss by sharing the risks through insurance. Lloyd’s of London was founded by Edward Lloyd in a coffee shop in London in 1686 and still functions as market place in which insurers pool and spread risk. The mathematical underpinning of risk, statistics and probability developed in the 17th century out of studies of games of chance and gambling (Bernstein, 1996). In the 18th century, the study and use of risk was stimulated by the Enlightenment, a social movement committed to the development of secular knowledge aiming to replace ignorance, superstition and religion with rationality based on science.
In modern global societies, events happening in distant places can affect our lives in unexpected ways and we gain knowledge about such events from various media. Towards the end of 2019, a new virus spread in the Chinese city of Wuhan and the first reports were on social media; for example, Dr Li Wenliang’s message on a Chinese chatroom on 30 December 2019 about the quarantining of SARS cases alerted infectious disease specialists worldwide that there was a new virus (Honigsbaum, 2020, pp. 261–3).
As Greg Philo and his colleagues at the Glasgow Media Group (1996) have observed, the mass media play a key role in shaping representations and understanding of risk. In a study of the media representation of mental illness, they found that individuals gained most of their understanding of the dangers and risk of mental illness from media representations. When such media representations clashed with their own personal experiences, individuals tended to accept the media representations even if they knew they were fictional, for example in television soap operas.
In democratic societies, the mass media is a key source of information. The earliest newspapers were published in the 17th century, The Oxford Gazette, first published in 1665, was one of the first regularly published newspaper (Mairal, 2011, p. 68). Mairal argues that the modern reporting of risk started in the 18th century with accounts of natural disasters and pandemics. These marked the shift ‘from the attribution of disaster to divine wrath to its treatment as a public catastrophe’ (Mairal, 2011, p. 69).
Risk can be defined as the probability of one or more outcomes. Probability uses knowledge derived from the observation of past events to predict similar events in the future. There is a strong technical and objective reality to probability. In contrast, outcomes are more subjective and relate to personal and collective values.
The difference between probability and outcomes can be seen when individuals choose to bet on a horse race. They are taking a risk. If their horse loses, they lose their stake but if it wins then they win. The size of their winnings depends on the horse’s ‘odds’, that is, the probability of the horse winning based on evidence from previous races. The choices individuals make depend on their personal preferences and values. If they value certainty, they will not bet. This means that they can be sure they will not lose money but they will also forego the chance of winning and the excitement of betting. If they value risk taking and the chance to make a big win, then they will back a ‘long shot’.
Where choices are made on behalf of others and the outcomes affect different social groups, it is no longer just a matter of personal preference but becomes one of collective values. This can be seen in the process of triaging, a way of prioritising and allocating scarce resources. Triaging can be defined as.