Leadership in a pandemic

In the course of most publishing projects one encounters a problem that seems beyond solution. When one of my books faced an apparently insuperable obstacle, I used to tell a story from the Falklands/Malvinas war. When the British task force reached the islands, two groups of soldiers were to land and attack Port Stanley.

RFA Sir Galahad at Port Pleasant

One group was to land in At Port Pleasant and march to the capital, the other, at a greater distance was to board helicopters waiting for them on shore. The Port Pleasant contingent arrived to find that the correct landing craft had not. Their commander decided it was not safe to use other vessels, and while he waited the Argentinian air force bombed the ship. That group never reached Port Stanley. Meanwhile, the other contingent found that their helicopters had not arrived. Their officer decided not to wait, so they walked over rough terrain and defeated the Argentinian army. The unlucky leader at Port Pleasant, concerned for the safety of his troops, made an honest decision that proved disastrous. The other commander, who changed his plan in adversity, triumphed.

Now, lacking a knowledge of epidemiology and public health, I cannot judge the decisions made by experts in these unprecedented times. But it seems to me that we can judge national leaders. We watch particularly Mexico, where our son Chris lives and we have dear friends, the USA (more friends) and our own UK.

Mexico has excellent medical professional and others with relevant expertise, but is disadvantaged by two critical factors. The public health system is under-resourced, and of insufficient scale, to cope with the current crisis. Still more critically, political power tends to be exercised in very personal ways. The population tends to defer to its political leaders. Questioning the President is not easy, especially in the case of the current incumbent who controls most levers of power.

Miguel Barbosa recommends lemon juice to protect against Covid-19

Thus, the quality of decision-making at senior political levels is especially critical. In this respect the country’s government is still more ill-equipped than its health system. A particularly egregious example is Miguel Barbosa, the governor of the populous state of Puebla, who explained that the wealthy, who can afford international travel, get sick. The poor are, therefore, immune.

The President, Andrés Manuel López Obrador (AMLO), has expressed similarly quixotic opinions, while delaying preparations until nationwide action was taken on 30 March. AMLO has declared that Mexicans will be protected by their millenarian culture. This is a reference to the country’s cultural heritage from its ancient civilizations, as opposed to the Spanish imperialists, much reviled in official history.

AMLO's amulets

At one of his mañaneras (morning speeches-cum-press conferences) AMLO declared that he was protected from the virus by his “shields”. He then produced from his lectern a number of “amulets”, among them a Sacred Heart of Jesus pendant, a four-leaf clover and an American two-dollar bill. AMLO continued to hold mass meetings at which he gave abrazos (“hugs”) to large number of citizens. Social distancing did not trouble him.

Meanwhile, some state governors started to take decisions in the absence of federal measures. For example, about two weeks ago the governor of Jalisco state ordered all bars and restaurants to close. This left the girlfriend of our son unemployed (she works in a bar in Jalisco). However, the governor of Nayarit, where they live, did nothing. Indeed, on 21 March, Juárez Day, a national holiday to honour one of Mexico’s past presidents, our son attended a farm machinery and livestock show, funfair, rodeo and dance. Finally, on 30 March, AMLO instructed Mexicans to stay at home for two weeks unless they worked in certain essential sectors of the economy. On 4 April, the Mexico City metro, a large and crowded system, closed half its ticket windows and announced measures to avoid crowding at certain stations.

Since many Mexicans earn very little, and since many make a scanty living informally on the streets (cleaning windscreens, juggling or fire-eating at traffic lights, selling sweets, fruit-flavoured waters, or food), this measure may be very difficult to enforce. Many rely on their daily earnings to buy that day’s meals . They have to decide whether to stay safe at home or starve.

Leadership in the USA, which has traditionally had superb expertise in public health, has left the country ill-prepared as the severity of the epidemic increases. When I lived and worked in the USA in the 1970s, I admired its civic life and the competence of its governmental structures. Now, I observe an administration that values self-interest, political dogma and prejudice above capability, fact, science, expertise and knowledge. The principal criterion by which an action or statement is judged is whether it increases the popularity and adoration of the President. Denigration, spite and insult have become the common currency of politics. The very values and decency of American government have been undermined.

Critically, in this crisis, the consequences are not just that decisions at the top are corrupted by these values, but also that government has been deprived of expertise and infrastructure, much needed in this time of crisis. The Obama administration eliminated the White House Health and Security office, responsible for planning for global matters, but after the Ebola epidemic of 2014 established a Directorate for Global Health Security. President Trump’s National Security Adviser, John Bolton, who focused principally on the USA’s state enemies and terrorism, merged this health office into a directorate in which global health was seen as an aspect of defense. The medically qualified director of the Obama unit was replaced with an official whose expertise is North Korean nuclear proliferation. The Trump administration’s slow response to the pandemic may in part follow from the submersion of epidemiological expertise and priorities into a larger unit, focused on other matters.

Similarly, the budget of the Centers for Disease Control and Prevention (CDC) has been reduced, and some offices closed. This is part of a pattern of the undervaluing of science and expertise. For example, although the federal government employs scientists who research climate change, federal employees are forbidden from using the term. In preliminary meetings between UK and US trade officials, the USA has insisted not only that climate change issues cannot form part of the negotiations, but that the term may not even be mentioned.

It is not surprising that, in this culture, Mr Trump has hindered and delayed effective action to address the pandemic. Initially, he dismissed the virus as little more than ordinary flu. He has declined to implement a national effort to combat the virus. This has been left to state governors who vary in the resources at their disposal and the vigour with which they have addressed the matter.

Brian Kemp. Note lack of distancing

For example, Brian Kemp, Governor of Georgia, declared as late as 1 April that he had not implemented a stay at home policy because he had only just learned that the virus can be transmitted by people who have no symptoms. One consequence of limiting the federal government’s participation in attempts to control the disease has been competition between states for equipment such as ventilators, which has increased the price.

A number of Mr Trump’s comments have contradicted or undermined the advice of his own administration’s officials and medical advisers. For example, on 3 April the CDC recommended that all Americans wear a cloth face covering in public to help restrict the spread of Covid-19. President Trump announced not only that he would not wear such a mask, but that the American public need not wear one if they did not wish to.

Two anecdotes illustrate the focus of the administration and its supporters on enhancing the reputation of the President. Dr Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases, an expert on immunoregulation who has advised six presidents on global health issues, has, on a number of occasions clarified or contradicted statements made by the President that were not entirely accurate consistent with federal advice. As a result, he has been criticised by Mr Trump’s supporters, although not by the President himself. The American Thinker, for example, described Dr Fauci as a “Deep-State ­Hillary Clinton-loving stooge." He has been given a security detail because of threats to his safety. Some of Mr Trump’s press conferences have focused on praising him for his handling of the crisis, rather than on communicating clearly the public health message.

Mike Lindell

At one such conference, the President appeared with businessmen who support him. Mike Lindell, CEO of MyPillow, told the reporters that Mr Trump is the greatest President in US history and added that “God gave us grace on November 8, 2016, to change the course we were on”. God had been “Taken out of our schools and lives, a nation had turned its back on God.” At a time when Americans face the deaths of tens of thousands of their fellow citizens, the President devoted a national communication into a fan club event.

In the UK, the government’s approach has been very different. Government ministers assure us, as if the phrase were pre-recorded, that everything they do is “led by the science”. The Prime Minister or Health Secretary appear at a daily press conference with two experts at either side – at a safe social distance. The government has lots of experts: the Chief Medical Officer, the Chief Scientific Officer, their deputies, the CEO of the National Health Service (NHS), the CEO of NHS providers, and so on. The impression is that ministers simply do what these wise men and women instruct them to do, based on science. This, of course, is not really the case. As a behavioural scientist adviser stated in an interview she contributes her advice, which is combined with advice from other specialists, for ministers to make decisions.  She knows what her advice was, but has no idea of the overall picture.

Thus, the experience, judgement, and general calibre, of ministers is critical. The current government has been in power since the Conservative party ejected Mrs May from its leadership, and installed Mr Johnson as Prime Minister. He promptly began to exclude rivals and those who were not fervently anti-EU from office, and in some cases from the party altogether. The Conservative’s large majority in the December election, took this process further. Every minister had to swear to focus exclusively on our exit from the EU on 31 December this year. Those who swore loyalty, were also required, as an audience in a pantomime responds to the villain’s “Oh no I didn’t” with a loud “O yes he did”, to respond to Mr Johnson’s “What are we going to do?” with an enthusiastic “Get Brexit done”. Rivals and experienced ministers were removed from the cabinet. The Prime minister felt secure enough to take a two-week holiday, funded by an unknown donor, with his new fiancée, on Mustique, the holiday retreat of the extraordinarily wealthy and of royalty. While he relaxed, large numbers of fellow Britons were flooded from their homes in the north and in Wales. This did not trouble him enough to return to the UK.

Now, a government composed of a faction of the Conservative Party with a single unifying objective, finds itself dealing with an unforeseeable crisis of an unprecedented nature. Those who hold the most important offices of state are new to their roles, or of untested talent.

Jeremy Hunt, when Health Secretary

The former Foreign Secretary and Health Secretary, Jeremy Hunt, whose contacts and experience might have been invaluable, is consigned to the backbenches as a mere MP (although he chairs the Heal and Social Care Select Committee). The former chair of that committee, Dr Sarah Wollaston, who has experience of scrutinizing health policy and was a practicing doctor, was driven out of the party and is no longer an MP. The same applies to Dr Phillip Lee, another former minister and medical practitioner. Matt Hancock, Health Secretary since July 2018, has not been entirely convincing to date. When confronted with serious problems, he assures us that “I am working incredibly hard”, but does not offer convincing solutions.

Matt Hancock

Boris Johnson showing how not to distance socially

 

 

 

The Prime Minister’s career is based on the carefully constructed, artificial Woodhousian personality, of the ever optimistic dishevelled toff, a jovial rhetorical style that makes it respectable to appeal to prejudice and unpleasant instincts, on the grounds that this is “Just Boris being Boris”.  It is hard to think of any occasion in his previous career when he has had to take hard decisions. As the virus crisis began to gather pace, he was slow to act, and then action was not terribly decisive. The government hesitated to order a “lockdown”, preferring instead to focus on “containment”. Then, with great regret for violating the inalienable right of the British citizen to go to the pub (typical rhetoric), he merely requested that we avoid certain gathering places, including clubs but not restaurants. This request stood the test of events for a matter of days, when a more rigorous shutdown was ordered.

Meanwhile, Mr Johnson and his ministers have not yet shed their campaigning style to become leaders of the entire nation. Ministers are overly fond of the first person pronoun, as in “I am working incredibly hard”. On 2 April Mr Johnson informed us by video that “I am massively ramping up testing”. Exactly how he is personally accomplishing this remains unclear. In “Boris being Boris” style, at one point he suggested, adding in Woodhousian style, that he is often accused of being too “boosterish”, that in three weeks we might “turn the tide”. Mr Hancock, asked what the Prime Minister meant by “turn the tide”, clarified that he meant precisely that: “turn the tide”. The Prime minister’s lack of precision is characteristic of his ministers, who appear confused about what we may and may not do, and at times contradict one another. They also failed to practice the social distancing they were urging their subjects to adopt.

In a crisis, learning fast is essential, as is developing sound judgement in extraordinarily difficult circumstances. I hope for us all in the UK that our ministers rise to the challenge. I believe that we have a better chance of that happening than my friends in Mexico and the USA can hope for.