Many of the reported counts of Covid19 cases and deaths now better reflect reporting variations rather than actual health data. These charts indicate the new stories that are increasingly falling under the international media radar.

I show both the ‘bigger countries’ (with populations of more than half a million), and ‘all countries’. The latter are important in that they tend to reflect new waves of contagion in those small countries which receive many travellers relative to their domestic populations. (We in New Zealand note Cook Islands, Samoa and Tonga.)

The obvious new story –generally well-reported – is that of North Korea (see second chart for its full count for the week). Its case numbers (about one in 15 of the country’s entire population) will be exaggerated in one respect, in that many relate to infections incurred well before last week. But in another sense, these numbers may be understated, given that the authorities in North Korea (officially listed as the ‘DPRK’) really have no idea how many people have Covid19.

The important covid story that has gone under the radar is Taiwan, which is now undergoing a New Zealand-style outbreak. (This can also be called a delayed South Korea style outbreak.)

We also note that Australia and New Zealand have been near the top of the covid league table for a few months now, and will probably not be dropping off the table for several more months.

When ranking the countries by reported covid deaths, again we see many tourist-oriented smaller countries. Iceland is probably an anomaly, with a substantial backcount ‘spike’ of deaths of people with Covid19.

Finland is an interesting case; it is a country that has been slow to report its total deaths, so it has been hard to get a sense of whether Finland has truly suffered many covid deaths recently, or whether the reported deaths are mainly people who would have died regardless of covid.

Taiwan’s covid outbreak is still very recent, so death numbers there will rise in coming weeks.

While some countries close to Ukraine show up on the last of these charts, others – especially Poland, Romania, and Moldova – do not. While Russian excess deaths are usually at least double reported deaths, Polish and Romanian reported covid deaths better reflect the true picture. Their absence suggests that the increased movement of people arising from the Ukraine War has had little impact on Covid mortality so far. (We might note that, even in those historical wars with the highest military casualty rates, deaths from disease have generally been higher than deaths from weapons. While the war in Ukraine may turn out to be unusual in this respect, testing specifically for Covid19 will be well down the priority list in Ukraine.)

We should also note that many countries in Africa and some in Asia have not been the best at reporting covid data, and also do not register most of their non-covid deaths. Demographers struggle with these countries; even more so for countries which are experiencing conflicts or famine.

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Last week I published charts for six countries showing excess deaths triggered by all seasonal and respiratory maladies, not just Covid19. The other main conditions that show up in excess deaths are epidemic influenza and the group of endemic viral infections commonly known as the ‘common cold’. Here I look at four more countries.

I finished by speculating that countries which show the highest rates of seasonal mortality are more likely to be those countries with the highest statistical life expectancies.

Israel

Israel is such a country, with a life expectancy of 83, and which experiences winter mortality rates typically at 40 percent above summer rates.

Israel’s mortality generally peaks in January, where in every pre-covid January except 2018 and 2020, mortality rates were 40% or more above the summer mortality norm.

It looks like endemic respiratory conditions trigger winter mortality rates around 30% above summer norms. In Israel, this may be exacerbated by Jewish cultural norms which see many socialisation events in winter. Most particularly, these deaths happen in winter because comparatively few deaths happen directly from heart conditions, strokes, and cancers.

The biggest Covid19 mortality wave in Israel – in January 2021 – is much like a bad flu wave. The other two waves of covid deaths peaked on October 2020 (original variant) and August 2021 (delta variant).

Re Omicron in Israel, see my Covid Omicron in Two High Immunity Countries, and this chart in particular. Omicron hit Israel well after its Delta wave was over. Excess deaths were falling at a time that covid cases, and people dying with covid, were rising dramatically. The context of ‘excess deaths’ in January 2022, however, is that of normally high January epidemic and seasonal endemic deaths. In the chart above, we see the Omicron covid wave matching the influenza wave of January 2019.

Israel is the best known country to offer fourth vaccination shots. It’s hard to judge their success, because Omicron deaths were high; as high as flu deaths would have been in another year. But there was no flu season in Israel this winter.

Norway

Norway is unusual in that it shows no classic covid mortality wave. This is largely due to effective public health measures. Nevertheless, Norway saw substantial excess mortality during the Delta period, in large part older people dying then who, in more normal circumstances, would have died in the winter of 2019/20 or the winter of 2020/21.

Norway was highly affected by Omicron, and, earlier than most other countries, getting high numbers of Omicron cases at a time when when there were already large numbers of Delta cases.

Excess deaths in Norway have fallen markedly during the Omicron period in Norway, despite massive numbers of cases. Indeed, excess deaths in January 2022 are well below those of previous Januarys.

United Kingdom

The United Kingdom was among those countries really stung by the first European wave of the novel coronavirus infection that we call Covid19. It then followed the second European wave in the late autumn of 2020, with deaths peaking in January 2021.

In United Kingdom, we see four years where seasonal influenza drove January death rates to in excess of 40 percent above summer mortality norms; 2015, 2017, 2018 and 2020. In January 2016 and January 2019, the seasonal mortality peaks will have been mainly due to endemic ‘colds’. The common cold is a fatal illness, though typically like ‘the straw that broke the camel’s back’.

As noted by Dr Chris Smith on RNZ (Saturday Morning, Covid-19 science news) last Saturday, excess deaths during the Omicron covid wave are similar to those of a comparatively good influenza season.

The United Kingdom had a Delta problem comparable to that of Norway, though the factors causing death were probably more complex, including more ‘younger’ people with comorbidities. Norway generally has a healthier population than does the United Kingdom.

Note that, more than any other country, the United Kingdom has ‘blips’ in its reporting of deaths around the ‘festive season’.

South Africa

South Africa is more complex, in part because it was home to the dangerous Beta strain of Covid19. Also, South Africa went through an extraordinary set of lockdowns and other measures in early 2020 which left its population highly vulnerable to the next wave of covid, which came in the summer of 2020. Delta hit South Africa during an intense Beta wave. Thus, Delta’s impact was originally muted.

Delta’s main impact in South Africa was in December 2020, the same month that Omicron – probably from Botswana – became a thing. This wave of Delta caught South Africa unawares, with few recorded Covid19 deaths. It was probably most prevalent in some of the poor townships where most covid victims died at home, undiagnosed.

Excess deaths fell rapidly in South Africa, just in the weeks that Omicron rapidly overtook Delta as South Africa’s most prevalent variant.

We see that South Africa’s four death waves were basically six months apart, each mid-winter and each mid-summer. The last wave – the Delta death wave – was significantly lower than the previous three wave, no doubt due to raised levels of natural immunity. There was no Omicron death wave.

South Africa is clearly a country that was heavily vulnerable to Covid19; far mor than those countries that encountered Covid19 just after their winter flu and cold seasons. Also, interestingly and unusually, South Africa is most vulnerable to influenzas and colds in June, early in winter.

South Africa’s experience is not unlike that of Colombia, though South Africa has a much lower life expectancy than Colombia. Both countries appear to have had inherent vulnerabilities to a novel coronavirus; vulnerabilities substantially exacerbated by their similar experiences of stringent public health mandates in the early months of the pandemic.

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

A team of four experts from China have arrived in Honiara for on-site feasibility studies on two projects amid the surging case of covid-19 in the Solomon Islands.

The experts are here at the invitation of the government for studies on the upgrading of the national referral hospital and a new water plant.

They have arrived as Prime Minister Manasseh Sogavare made a national address at the weekend saying there were now 2790 cases of infection in the country.

Sogavare said this was within 20 days of the country’s first case of domestic transmission of the virus, reports RNZ Pacific.

He said that on Friday alone, health officials had identified 430 cases.

Sogavare put the official death toll at 32 but other deaths are believed to have occurred at home.

The prime minister said all but three provinces have reported cases, and transmission was now widespread in the capital, Honiara.

Many of the local lockdowns that had been in place has been lifted but a curfew from 6pm to 6am will still be enforced.

Movement out of Honiara is not allowed.

The prime minister has repreated calls for people to get vaccinated.

Boost for bilateral relationship
The arriving Chinese expert team said in a statement: “Hopefully our arrival can help Solomon Islands strengthen infrastructure construction, improve medical conditions and livelihood, and boost development of bilateral relationship.”

The team, which has strictly complied with Solomon Islands’ quarantine procedures, said its arrival, work and persistence would promote the country’s anti-pandemic work and improve the public medical environment and infrastructure.

In the spirit of “Umi togeta against covid-19”, the team vowed to deliver its best in the fight against the pandemic in Solomon Islands.

“Our team will stand firmly with our friends in Solomon Islands, defy difficulties and dangers, work hard, and build a modern diagnosis and treatment place with advanced technologies for Solomon Islands with the latest construction technologies in the foreseeable future,” the team added.

Robert Iroga is editor of SB Online. Republished with permission.

Article by AsiaPacificReport.nz

The first chart starts with three small countries, two of which are affluent British territories. Other British territories also are on the chart: Channel Islands, Isle of Man, and the United Kingdom itself. And Ireland. The Cayman Islands, premier super yacht and tax haven, reminds us that Covid19 started in Europe as a disease of the rich – including the super-rich. And French Polynesia is back in the picture.

When we go to the second chart, which omits countries with less than 500,000 people, we immediately see Central Europe, plus the Low Countries. East Europe is there, too. But affluent Central Europe dominates. We note that, roughly, the more affluent the country, the lower are the deaths relative to cases. Note that Slovenia is at the top of the table, just ahead of Austria.

Looking at the ‘league table of deaths’, clearly East Europe dominates. Commonwealth Caribbean nations also feature markedly, as some have for the last few months.

When we drop the small countries, we see that just about every East European country features. But a number of affluent countries feature for deaths; Austria, USA, Belgium.

Note that Bulgaria is at the top of the table. Bulgaria not only tops the present covid wave; it also tops the death league for the entire pandemic, with at least 1 in 140 Bulgarians (0.7%) dying from Covid19, if not of Covid19.

Slovenia, a close neighbour of Austria, is particularly worrying. Before October, it was catching covid from the south, from its former Yugoslavian neighbours. But something new happened in October, and it’s akin to what previously happened in the French Caribbean (and other) territories.

There is a large middle class, highly mobile, and very immunised population in northwest Europe. Many are connected to the governance of the European Union – see my Europia essay from last year (‘Europia’ and the Spread of Covid19, 16 April 2020). They travel a lot as part of their work, they are well paid, and they have generous annual leave entitlements. Also, as early vaccinees, their immunity has waned substantially. These people have all the characteristics of symptomless covid superspreaders. It’s such a shame that the process of revaccination is being so badly bureaucratically botched (Booster row ‘sabotaging’ Germany’s Covid-19 vaccine campaign, Irish Times, 22 November 2021).

In the first week of October, a major European Union entourage attended a major event in Slovenia, the EU-Western Balkans summit. Then, in mid-October, the number of Covid19 cases in Slovenia shot up. We see that the official death toll followed, with the usual lag. It’s still too early to know the actual death toll arising from this October 2021 covid outbreak. However, we see that in the earlier outbreak last winter, the excess deaths closely matched the official deaths. Slovenia keeps good records. (We might also note that the sudden Austrian outbreak may in part be due to the proximity – cultural as well as geographical – of Slovenia to Austria.)

Bulgaria, poor Bulgaria. Note that the scale of the Bulgaria chart is twice that (up to 60 daily deaths per million of its people) of the Slovenian chart. Bulgaria has an older, vulnerable population. Its best and brightest are living and working in other parts of the European Union.

At least until June 2021, its statistics all match in timing, although clearly its official covid case and death data are clearly understated. In June 2021, and especially from August, excess deaths – from covid – have climbed substantially ahead of recorded covid deaths.

This pattern, of excess deaths leading rather than lagging, is clear in most central and eastern European countries. It means that Covid19 has been significantly worse than we realise, in that part of the world that can now be called ‘covid central’. This will be due to a mix of undiagnosed covid deaths, and post-covid deaths arising from the damage earlier rounds of covid have inflicted on surviving victim’s bodies. This latter problem shows up in the preponderance of 65-74 year-olds among the undiagnosed post-covid deaths in Europe in June to October 2021 (see Germany in this chart, and a large proportion of Austria’s excess deaths in this period are people in this age group).

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Most countries in the Asia-Pacific region are on track to reach universal birth registration by 2030: an incredible achievement and a significant milestone in realizing human rights and equality. However, as the COVID-19 pandemic has exposed, many weaknesses remain in official recording systems, creating gaps in knowledge about the population and affecting how authorities respond to crises and reach those in greatest need.

Civil registration and vital statistics (CRVS) systems record births and other key life events such as deaths and marriages. Birth registration is fundamental for accessing a wide range of social services, benefits and rights. It provides an individual with a legal identity and a proof of age, which are often requirements to enrol in school, receive healthcare, apply for formal work, register to vote, inherit property, obtain a passport and social protection, or open a bank account. And often it is the hard-to-reach and marginalized populations that are least likely to receive official documentation, including those living in rural, remote, isolated or border areas; minorities; indigenous persons; migrants; non-citizens; asylum-seekers; refugees and people who are stateless or of undetermined nationality.

As regional leaders gather this week for the 2^nd Ministerial Conference on Civil Registration and Vital Statistics in Asia and the Pacific, the focus will be on regional and country-level achievements, obstacles and challenges in realizing the shared commitment that all people in the region will benefit from universal and responsive CRVS systems by 2024. It marks the midpoint of the Asia-Pacific CRVS Decade (2015-2024) and is an important milestone in the pursuit of creating national CRVS systems that are universal and responsive to the needs of entire populations.

Since 2014, more than 70 million more children in the region have greater access to education, health and social protection because their birth has been officially recorded and recognized through the issuance of a birth certificate. This is a notable achievement and testament to the resolve and commitment of governments to the shared goals made in 2014, the strength of regional cooperation, and the support of 13 development partners, including the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) and UNHCR, the UN Refugee Agency. 

Still, there is work to do. Robust and universal marriage registration systems are needed to prevent girls from being coerced into early marriage, which often threatens their lives and health. The region also has an opportunity to reduce the risk of statelessness and human trafficking, as well as to promote solutions for refugees and asylum seekers by documenting links to the country of origin. UNHCR’s work with national governments to strengthen and broaden civil registration systems to formally register people considered stateless or of undetermined nationality has led to profound policy changes across Central Asia and the legal recognition of every birth, irrespective of parents’ status.

Furthermore, as we have witnessed during the global pandemic, when civil registration systems fail to reach everyone in the country and not everyone is counted, a public health crisis intensifies. Whereas robust CRVS systems enable governments and health authorities to track the pandemic and respond quickly and in an informed manner, a poorly functioning civil registration system masks the true impact of a crisis: deaths go uncounted — especially among the poorest and most vulnerable — and individuals are unable to access humanitarian relief or benefit from financial stimulus measures and, more recently, national vaccination programmes.

Governments that are unable to account for the entire population face barriers to creating and implementing effective public policy and responding to a crisis in an equitable manner. A comprehensive approach to civil registration, with timely and accurate data that are put to the right use, has the power to benefit every individual and inform public policy simultaneously, including by reducing statelessness across the region.

Leaving no one behind through universal birth and death registration demands bold and ambitious outcomes from the upcoming ministerial conference. We have the knowledge, experience and technical ability to create registration systems that are responsive to the needs of the population and can guide us through current and future challenges. 

Armida Salsiah Alisjahbana is Executive Secretary, ESCAP

Gillian Triggs is Assistant High Commissioner for Protection, UNHCR

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Note: the 2^nd Ministerial Conference on Civil Registration and Vital Statistics in Asia and the Pacific will take place from 16 – 19 November. 

The first chart shows the three largest western countries: United States, United Kingdom, and Germany. The solid line plots represent quarterly average rates of excess death. It is clear that the United Kingdom copped Covid19 very early and very hard. The mid-June peak represents the period from mid-March to mid-June. It is important, however, to acknowledge the rapid fall in British deaths, after that peak. The United States had a much lower peak, and, for that same period, Germany hardly registers. The main issue here was the different abilities to protect the population aged over 80 from the ravages of the pandemic.

For Europe’s second wave, which represented the United States’ third wave, Germany was nearly as badly affected as United Kingdom; and slightly earlier, reflecting the continental European event that was most likely caused by late-summer tourism from the United States. (The later second peak in the United Kingdom reflects the Christmas New Year holidays; likewise, the United States whose peak was slightly earlier due to thanksgiving.)

The impact of the Delta variant barely shows on this chart, though we should note that Delta became predominant in the United Kingdom by 1 June (75% of cases), and by 1 July (just over 50% of cases) for Germany and the United States. The United Kingdom has lower deaths than the others in the most recent mortality data, probably due to more vaccinations, and despite rather than because of Delta.

The filled dots represent overall excess deaths, commencing with 24 May 2020, based on an assumption that the pandemic (outside of China) started to register in the death statistics from around 24 February 2020. And the unfilled dots represent annual average excess deaths; the first unfilled blue dot represents average excess mortality in the United States from mid-January 2020 to mid-January 2021.

We see that annual pandemic excess mortality is easily highest in the United States, due to its prolonged period of high Covid19 infection and death.

While overall excess deaths remain higher in United Kingdom than Germany, we see that annual excess deaths are now lower in the United Kingdom than Germany. Indeed Germany’s 2021 Covid19 outbreak, which roughly coincides in time with India’s big outbreak, is considerably more fatal than Germany’s first wave a year earlier. Germany’s 2020 outbreak – as shown through available excess death data – is too soon to be indicative of Delta.

The second chart, of the same type, shows Sweden and New Zealand. It uses the same scale as the previous chart. The timing of Sweden’s first peak is the same as that for the United Kingdom, though deaths in Sweden were fewer, more confined to the oldest age group. Covid19 had no direct impact on excess deaths in New Zealand. Sweden’s second peak, while lower than Germany’s, was identically timed. It would appear to be derivative from the wave of covid cases that first appeared in Europe’s prime tourist destinations around August 2020.

While Sweden continues to have more excess deaths than New Zealand over the whole pandemic period, this has not been true for annual excess deaths for the year to the end of June 2021. Projecting these data forward, it is quite plausible that Sweden’s overall pandemic-period mortality impact may prove to be less than New Zealand’s by December 2022.

Some of New Zealand’s excess deaths may be indirectly related to Covid19. We might also note that New Zealand has some unusual demographics which may be showing an overstatement of excess deaths. Sweden, on the other hand, a neutral country in World War Two, almost certainly shows a more conventional population pyramid, at least for people aged over 60.

New Zealand and Sweden represent opposite ends of the policy spectrum, when it comes to addressing Covid19. The ideal policy is probably to take the best of both country’s approaches. There is no doubt that Sweden’s initial strongly non-interventionist approach was a failure; in particular in its initial refusal to test for Covid19 except for people already hospitalised, and in its unwillingness to at least have a ‘circuit-breaker lockdown’. However Sweden paid much more attention to the need to have a well-immunised population, with immunisation coming from a mix of natural and artificial (ie vaccination) means. Sweden, with much higher vaccination rates than New Zealand, falls considerably short of United Kingdom vaccination levels.

The final chart shows quarterly excess mortality for people aged 65-to-74 (my age group) for six countries, including New Zealand. In principle this age group catches a mix of those who are older and hence more vulnerable and those who mix and mingle in the community. This is the classic ‘boomer’ age group. For the countries given, New Zealand has the third highest boomer excess mortality, after Spain and Austria. We note that Austria was affected by the same early summer third wave of Covid19 that affected Germany. And we note that Spain, while never coming close to its original peak mortality, has been largely living with Covid19 ever since then.

Two of the other three countries – Sweden and Denmark – have had consistently negative excess mortality for the boomer age group in 2021. Further, for this age group, excess mortality has been higher in New Zealand than in Sweden for the last twelve months. While New Zealand may have a faster growing age 65-74 cohort than Sweden, Sweden has a considerably lower base mortality for this age cohort (ie Sweden has a higher life expectancy than New Zealand). So, the two sources of possible bias in the data somewhat cancel out. Denmark, which had a bigger per capita caseload than Sweden in their second covid waves, has consistently lower excess mortality for 65-74 year-olds than either New Zealand or Sweden. And Denmark was more adversely affected by World War Two than was Sweden. Denmark’s demographic idiosyncrasies for births in the years 1940 to 1955 are likely to be few; or at least something of an average between Sweden’s and New Zealand’s.

Finally, the United Kingdom, the only one of the six countries whose shown Covid19 death rates could have been influenced by Delta, had the lowest incidence of boomer deaths in the three months to mid-July 2021. This most likely reflects the prolonged (albeit easing) England lockdown, and will probably not be sustained. (I am guessing that we will see quarterly excess deaths in England hover at around plus five percent for the remainder of the year.)

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Keith Rankin, trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

contact: keith at rankin dot nz

The issues to watch out for now are the extent to which countries with high vaccination rates are (1) getting positive cases, and (2) getting Covid19 deaths. And one particular point to watch out for is the extent to which early vaccinator countries show signs of relapse, as immunity levels wane over time.

As for 2020, the tropical holiday destinations are well represented (and a significant number of these are not shown here, because their populations are less than 300,000 people). Important holiday destinations that do show are these French dependencies: Martinique, Guadaloupe, and Réunion. We also see popular Mediterranean holiday destinations showing up: Spain, France, Greece, Portugal, Morocco. Generally these have low death rates, but it’s still too early into August holiday month to declare that deaths will remain low.

Generally the places with the highest per capita cases of Covid19 are now quite dispersed, reflecting a mix of countries which experience high traffic at their borders, and other countries which have struggled to control domestic outbreaks.

Israel, Iceland, United Kingdom, Spain, Portugal, Greece all have very high full vaccination rates, high case numbers, but low death rates. All should be watched to see if death rates stay low. Of these, Israel and Iceland have had the most recent outbreaks. (Also, little Gibraltar has the world’s highest vaccination rate, at over 100%, and would be in about 6th place on the above chart.) We should also note Cyprus, which is coming out of a particularly bad outbreak, after having largely missed out on earlier covid waves.

I have also included Australia, for context. Australia’s lockdowns have clearly had a major impact on slowing down the growth rate of Covid19 infections. But low levels of immunity in Australia – both low from past infections and low from vaccinations – mean that it’s slow exponential outbreak may continue for a fearfully long time.

On deaths, we still see the impacts of the major outbreaks in Southern Africa, North Africa, South America, and South Asia. And Russia. And Iran. My hunch is that deaths will continue to fall in most of these countries, and will not appear in large numbers in the northern autumn as they did in 2020.

One country to watch is China. It has low levels of immunity; and reliance on draconian lockdowns and a vaccine that may have been the least effective so far. In other words – to use a forest fire analogy – it has by far the most ‘fuel’ to power an outbreak that may prove as hard as the Australian outbreak to contain.

In New Zealand, we now know that the speed of the vaccine rollout is the difference between life and death. The SARS-COV2 virus will reach an equilibrium in the Northern Hemisphere in a year or two – as did the virus that caused the ‘Russian flu’ pandemic around 1890. But it will kill many kiwis – sooner or later – unless we can achieve herd immunity through vaccination.

On 21 June 2021 I published this chart, showing high levels of excess deaths in Aotearoa, for all age groups. However, the source data provide a somewhat crude measure of excess deaths. The measure may be distorted by demographic changes; the rate of population growth, and changes to the age distribution of a country’s population. The data also represents excess deaths arising from falling living standards. (Or, where excess deaths in the beginning of 2020 are negative, rising living standards.)

Adjusting such crude data can be a laborious process, the importance of which is often not acknowledged. Here, because I want to compare different countries for which data is available on ourworldindata.org/excess-mortality-covid, I have to make some general assumptions that can be applied the same to each country.

First, I have averaged excess deaths for the first 10 weeks of 2020. Second, I have attributed half of this pre-covid excess (whether positive or negative) to demographic change, and half to changes to a country’s living standards.

Second, I have considered each age group to have been equally subject to changes in a country’s standard of living.

The result is that each country shown has a ‘counterfactual’ baseline, showing estimated changes in mortality arising from changes in living standards since 2017 (where 2017 represents the midyear of the second half of the 2010s’ decade). Excess deaths due to Covid19, or to Covid19’s wider epidemiology, exist where chart values are above the counterfactual baseline. Deaths averted as a result of Covid19 restrictions – and changing behaviours arising from these – are shown  by chart values below the counterfactual baseline.

The purple ‘dot’ at the end of March 2021 shows the annual average impact of the Covid19 pandemic on New Zealand’s mortality. It is below the counterfactual baseline, suggesting that deaths in the year to March 2021 are a little less than would have been the case had the pandemic not occurred.

New Zealand data suggests a three percent rise in mortality (corrected for demographics) for January and February 2020 compared to three years earlier. This represents a significant fall in New Zealanders’ living standards; a fall completely unrelated to Covid19.

For the remainder of 2020, death rates fell for all age groups, mainly I would presume because of the general absence of influenza.

2021 is a very different story, however. There are significant numbers of additional deaths, many of which may be classed as ‘postponed’ deaths arising from Covid19 restrictions. (Note that we have been hearing, but not responding to, a number of red flag stories such as this one. “The South Auckland hospital is hit by a huge winter spike in sick children”; I understand it’s not only children, and not only south Auckland. The story mentioned a general rise in “respiratory infections” in Aotearoa; so no Covid19 this year, but no shortage of covid-like trouble.)

Australia shows a similar pattern to New Zealand, though less dramatic. It is possible that an individual state in Australia would be closer to New Zealand, though I do not know which one. The main difference is that Australia had more deaths in early 2020 that appear to be covid-related, but could not be. Possibly stresses and strains arising from the that terrible bushfire summer took their toll; maybe smoke inhalation exacerbated pre-existing respiratory conditions. The other difference is that the pattern is New Zealand of excess excess-deaths in early 2021 is only minimally replicated.

Sweden, in June 2020, had the world’s worst official Covid19 death statistics. Certainly older Swedes ‘took one for the team’ (the team of ten million). Sweden’s early 2020 mortality rates indicate that its living standards were rising, unlike New Zealand and Australia. In 2021, Sweden has had no excess deaths, though, relative to Sweden’s covid counterfactual, Covid19 continues to have some impact on Sweden’s mortality.

Overall, in the year to March 2021, Sweden had excess deaths at 8.5% (and covid-related excess deaths at 12% for the year). This compares to 1% and -2% for New Zealand. New Zealand’s recent problem is non-covid excess deaths, though the New Zealand health authorities and mainstream media appear to be very relaxed about this.

Like New Zealand and Australia, USA has had pre-covid excess deaths, suggesting falling living standards had already set in early in 2020. By March 2021, United States had 25.5% excess deaths, almost all of which were directly or indirectly due to Covid19. This is well in excess of Sweden’s covid toll.

The bigger surprise is that younger people fared as badly as older people, at least in proportion to normal death rates for their age cohorts. Further, in the US spring of 2021, it is the younger age groups who continue to be dying at 10% above pre-covid expectations. This means that huge numbers of American travellers (many without symptoms) had Covid19, and took it with them.

Of important interest is the role of younger people in perpetuating the pandemic in the northern summer of 2020. My analysis of Europe’s covid resurgence in the northern autumn, is that it was American tourists who brought Covid19 back to Europe in July and August. And, in terms of America’s political divide, almost certainly these American vectors of Covid19 were mostly ‘liberals’; Trump opponents rather than Trump supporters. This was almost certainly accentuated by Americans travelling to Israel.

My main comment here is to note that Israel’s peak covid death toll, in October, relates to the whole quarter-year period ending in October; that’s the average for August, September and October combined. This suggests that the outbreak in infections began in July 2020.

Compare Israel’s death toll for 15-64 year-olds with that of Sweden. It is clear that, in Israel, Covid19, transmitted by the young, really was the ‘boomer remover’.

When policymakers try to fix things, they often mess up because of the way the problem is formulated and the ways that subsequent policies are targeted. A classic example was the Closing the Gaps initiative in the early 2000s.

The problem – albeit simplified – is that some people are ‘advantaged’ and others are ‘disadvantaged’. In New Zealand, one of the groups that were (and presumably still are) disproportionately disadvantaged are Māori. (Another such group was, and is, Pasifika.)

One useful way of approaching the problem is that we can say as stylised facts:

• Seventy percent of non-Māori are advantaged, and thirty percent are disadvantaged.
• Thirty percent of Māori are advantaged, and seventy percent are disadvantaged.
• The socio-economic circumstances of advantaged Māori are comparable with the circumstances of advantaged non-Māori. And the socio-economic circumstances of disadvantaged Māori are comparable with the circumstances of disadvantaged non-Māori.

Closing the Gaps was meant to be about making the disadvantaged less-disadvantaged; or – better still – not disadvantaged at all. But the policymaking didn’t target the disadvantaged as such; rather it targeted Māori as the most prominent disadvantaged group. And it is true that if the median circumstance of Māori could be raised, given that the median Māori is disadvantaged, then the gap between a median disadvantaged person and a median advantaged person would close. Though many disadvantaged people – indeed the majority of disadvantaged people, who in New Zealand are not Māori – would not benefit

Today’s more modest equivalent of Closing the Gaps is the proposed creation of a Māori Health Authority. And, as in 2004, the National Party passionately opposes this as racially targeted policymaking. (I might note that Māori versus Pakeha constitutional issues have no more to do with ‘race’ than do issues in Northern Ireland between ‘Catholic’ and ‘Protestant’. In New Zealand’s case, the point of difference is that Māori are tangata whenua, not that Māori are ‘brown’; of course that doesn’t preclude the possibility that some people may be prejudiced against dark-skinned ethnicities, and thereby – knowingly or unknowingly – hold racist views towards Māori.)

Unintended Consequences

The problem with racially targeted policymaking of this sort is that it doesn’t address the actual problem (‘disadvantage’); instead such policies use ‘Māori’ as a proxy for ‘disadvantage’. (Other groups use other demographic proxies for disadvantage, such as ‘female’ or ‘working-class’ or ‘Muslim’.)

We are not yet clear as to the purpose of the Māori Health Authority.

Some believe that its purpose will be positive discrimination in favour of people with proven indigenous ancestry, especially in their ability to access health services. (Much as a Community Services Card discriminates in favour of cardholders.) If this is intended, it would be clearly problematic. Should a Māori family in Flaxmere or Kaikohe have more favourable access to services than their circumstantially identical Pakeha neighbours? Or should the community of Kaikohe be more favourably resourced than the community of Bluff?

The alternative interpretation is that the Māori Health Authority is an addition to the Health bureaucracy, that could only be justified – like other government bureaucracies – as a means to an overall improvement of health outcomes for all disadvantaged New Zealanders.

This is particularly problematic in today’s zero-sum fiscal environment. In a zero-sum fiscal environment, funding is from a fixed ‘pot of money’. This means that funding for one purpose comes at the expense of funding for other purposes (such as cancer treatment, or research on infectious diseases); and the policy issue becomes the ‘marginal health benefit’ that arises from this use of the money, as opposed to that use.

One of the most important refrains today is that Health is already over-bureaucratised, with far too great a proportion of funding going into ‘prioritisation services’; this being a euphemism for gate-keeping. Is an addition to the bureaucracy a more beneficial use of scarce resources than direct funding to train nurses, or to subsidise a greater range of life-enhancing drugs?

The concern that follows from this is the possibility that the principal benefit of the Māori Health Authority will be to provide enhanced career opportunities for the thirty percent of Māori who are not disadvantaged. And that the main people who will bear the opportunity cost of this benefit will be the presently disadvantaged, the majority of whom are the thirty percent of non-Māori who are disadvantaged.

The irony of this would be an opening of the gaps between the advantaged and the disadvantaged. Indeed, a dispassionate look at socio-economic outcomes in Aotearoa New Zealand since 2017 would be that it has been a period that could be described as an ‘opening of the gaps’.

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Keith Rankin, trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

contact: keith at rankin.nz

The past year is one that few of us will forget. While the impacts of the COVID-19 pandemic have played out unevenly across Asia and the Pacific, the region has been spared many of the worst effects seen in other parts of the world. The pandemic has reminded us that a reliable and uninterrupted energy supply is critical to managing this crisis.

Beyond ensuring that hospitals and healthcare facilities continue to function, energy supports the systems and coping mechanisms we rely on to work remotely, undertake distance learning and communicate essential health information. Importantly, energy will also underpin cold chains and logistics to ensure that billions of vaccines make their way to the people who need them most.

The good news is our region’s energy systems have continued to function throughout the pandemic. A new report Shaping a sustainable energy future in Asia and the Pacific:  A greener, more resilient and inclusive energy system released today by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) shows the energy demand reductions have mainly impacted fossil fuels and depressed oil and gas prices. Renewable energy development in countries across the region, such as China and India, has continued at a healthy pace throughout 2020.

As the Asia-Pacific region transitions its energy system to clean, efficient and low carbon technologies, the emergence of the pandemic raises some fundamental questions. How can a transformed energy system help ensure our resilience to future crises such as COVID-19? As we recover from this pandemic, can we launch a “green recovery” that simultaneously rebuilds our economies and puts us on track to meet global climate and sustainability goals?

A clean and sustainable energy is central to a recovery from COVID-19 pandemic.  By emphasizing the importance of the SDGs as a guiding framework for recovering better together, we must focus on two critical aspcets:

First, by making meaningful progress on the SDGs, we can address many of the systemic issues that made societies more vulnerable to COVID-19 in the first place – health, decent work, poverty and inequalities, to name a few.

Second, by directing stimulus spending to investments that support the achievement of the SDGs, we can build back better. If countries focus their stimulus efforts on the industries of the past such as fossil fuels, we risk not creating the jobs we need, or moving in the right direction to achieve the global goals that are critical to future generations. The energy sector offers multiple opportunities to align stimulus with the clean industries of the future.

The evidence shows that renewable energy and energy efficiency projects create more jobs for the same investment as fossil fuel projects. By increasing expenditure on clean cooking and electricity access, we can enhance economic activity in rural areas and bring modern infrastructure that can make these communities more resilient and inclusive, particularly for the wellbeing of women and children.

Additionally, investing in low-carbon infrastructure and technologies can create a basis for the more ambitious climate pledges we need to reach the Paris Agreement targets of a 2-degree global warming limit. On this note, several countries have announced carbon neutrality, demonstrating a long-term vision and commitment to an accelerated transformation to sustainable energy. Phasing out the use of coal from power generation portfolios by substituting with renewables, ending fossil fuel subsidies, and implementing carbon pricing are some of the steps we can take.

The COVID-19 crisis has forced us to change many aspects of our lives to keep ourselves and our societies safe. It has shown that we are more adaptive and resilient than we may have believed. Nevertheless, we should not waste the opportunities this crisis presents for transformative change. It should not deflect us from the urgent task of making modern energy available to all and decarbonizing the region’s energy system through a transition to sustainable energy. Instead, it should provide us with a renewed sense of urgency.

We must harness the capacity of sustainable energy to rebuild our societies and economies while protecting the environment in the pursuit of the 2030 Agenda for Sustainable Development.

Armida Salsiah Alisjahbana is Under-Secretary-General of the United Nations and Executive Secretary of ESCAP

Precis: This article takes the WHO as an example to examine the difficulties for some international organizations in playing their due roles and tackling with the security threats of international concern such as a public health crisis of COVID-19. It is believed that an in-depth institutional reform is necessary for international organizations including WHO to adapt to the reset of globalization, the ensuing global challenges, and the transformation of global governance in the post-pandemic order.

Confronting the public health crisis as COVID-19, the existing global governance system has fallen into a state of partial failure, which is embodied in slow response and action of international organizations, increasing difficulty in coordination and cooperation between big powers, and the lack of leadership. WHO is clearly unable to coordinate national actions or to regulate behaviour and change prevention and control measures of various countries amid this pandemic. In recent years, the impediments to globalization, the rise of populism, the revival of nationalism and unilateralism allude to the inherent conflicts between international organizations and sovereign states. Disease is a non-zero-sum non-traditional security issue as its threat to all is undifferentiated. Since everyone is facing a common threat, international organizations that are instrumental for communication and preventive solutions should take the lead. But why some international organizations failed to function and why can it be hard for countries to utilize such platforms and work together? This article analyses that there are several major dilemmas restraining the role of international organizations, which are unlikely to be resolved in the short run. The following takes WHO in the pandemic as an example to explore its plight.

Difficulties and Dilemmas Confronting International Organizations

Above all, the WHO faces constraints from the sovereign states.

The first hinderance is financing. The most common way for all parties to play games in WHO is to influence the WHO agenda through financial leverage. WHO’s funding comes from two main sources: assessed contributions and voluntary contributions largely from member states and other sources such as philanthropic foundations and private sector. Assessed contributions have been a declining share of WHO’s overall budget in recent years, so the organization is increasingly relying on voluntary contributions. The trick is that most voluntary contributions come with explicit requirements and restrictions on their use. The only fund that WHO really has control and can flexibly allocate is about US$500 million a year in assessed contributions. WHO has been struggling to both invest in global public health and to cover its own operating costs. Take the 2018-2019 biennial budget as an instance, the total planned amount was US$4.422 billion (the actual implementation was US$5.3 billion), of which the assessed contributions were only US$957 million. As the biggest contributor to WHO, after President Trump announced a suspension for US funding on April 14, 2020, Director-General Tedros indicated that the US move would leave the organization with a financial gap that could interrupt the efforts to stop the coronavirus pandemic. When the greatest power takes an example, it is hard for others not to follow suit, particularly under the situation where all economies are suffering heavy losses.

The second is the recognition. As an intergovernmental organization, WHO has the legitimacy and capacity to act only based on state empowerment and authorization. In a broad sense, this “authorization” is also a recognition. A recognition of the existence and effectiveness of international organizations. Given the limits of human knowledge of various communicable diseases, WHO remains torn between taking initiative and being cautious in the event of an outbreak. After the outbreak of influenza A (H1N1) in 2009, WHO coordinated countries to take proactive measures and declared a “pandemic”, but was accused of “overreacting”. This was because H1N1 had been spreading all over the world, but the fatality rate was low. A joint report by the British Medical Journal and the Parliament of the European Commission criticized WHO for exaggerating the pandemic, causing panic among the public and triggering a global rush to buy vaccines for pharmaceutical companies to profit. After the Ebola outbreak in West Africa in 2014, WHO was accused of poor early warning, ineffective prevention, and slow response. Critics claimed that the first Ebola patient was infected in Guinea in December 2013, but WHO did not officially declare an outbreak until three months later, when the virus had spread to neighboring countries. In this recent crisis, WHO’s status and value have been further weakened. During the present anti-pandemic process, the Trump administration continuously accused WHO of acting too slowly to sound the alarm about the coronavirus. A great power refuses to admit the role of WHO is parallel to not recognize and distrust the organization, which will inevitably impact the international organization’s authority and capability to act in its field. Facing public health threats, particularly from unknown viruses and emerging infectious diseases, WHO seems to be caught in a paradox: taking aggressive action to stop outbreaks before the situation becomes serious will be criticized as overreacting; and taking cautious attitude would be blamed for failing to contain the pandemic. The anarchy of international system makes international organizations have no coercive power in implementing measures. One of the authoritative sources of them is the level of expertise rest on knowledge. They hold the “power” to master data, publish information and set standards by virtue of their knowledge. Therefore, if a country questions its expertise, it can affect a range of the organization’s actions. If countries no longer use that knowledge as a standard, the authority of the organization will be undermined.

Secondly, the WHO is influenced at the systemic level.

First of all, international organizations are the product of globalization and multilateralism. In theory, the deepening of globalization should become a hotbed for the development of international organizations. In reality, nevertheless, globalization has deepened the antagonism between countries. We are witnessing more clearly the gap between countries and the changing political landscape within them. Some countries have risen in the process of globalization, while others have been divided in the process. Rising nations are more insistent on globalization, while declining nations only want to retreat. International organizations seem to become a burden no longer needed, living in the tension between the cracks. As a sub-agency of the UN system, WHO seeks to place health goals above power politics. But as an intergovernmental organization, WHO cannot avoid the shades of power game and geopolitics. As early as its establishment, the Constitution of the World Health Organization was delayed by the ratification of member states due to the confrontation between two camps of the U.S. and the Soviet Union. It was not until the outbreak of cholera in Egypt’s Suez Canal area that countries realized the importance of establishing a global public health organization and passed the Constitution in 1948. With the launch of the Marshall Plan, the eastern and western camps entered a period of fierce confrontation. In 1949, the Soviet Union led the Eastern European countries withdraw from WHO. In order to maintain the integrity of global public health system, then Director-General George Brock Chisholm retained the membership of the Soviet Union and other countries on the ground that there was no opt-out clause in the Constitution, so that the Soviet Union was able to rejoin in 1958.

Second, the new world pattern is evolving, and some countries are inclined to politicize global issues. The alleged politicization of health issues refers to use health issues as a tactic to pursue political goals. The introduction of political issues into WHO by some countries led to the dysfunction and overloading of the mechanism beyond WHO’s jurisdiction and weakened its original purpose of promoting public health. When Trump halted funding for WHO, he also expressed his dissatisfaction and anger at WHO’s repeated praise for China’s anti-epidemic efforts. He believes that the U.S. is investing a lot of money, but WHO is ultimately standing up for China. International organizations do not necessarily choose sides, but their support for one country in a certain area may be regarded as a preference to be resisted by the other party. WHO, in this case, is unwittingly entering the political gap between China and the U.S. Mutual recriminate and stigmatization, transfer domestic contradictions as well as shirk responsibility for the poor response to the pandemic aggravate the conflicts and frictions that already existed among member states, thereby result in the inefficient operation of international organizations. In this climate of mistrust and disunity, it is hard for all parties to act in concert.

Third, non-neutral rules of global governance are impacted. The current global governance system mainly relies on the rules formulated by western countries. However, these rules are non-neutral in the light of non-western cultures. That is, the meaning of the same system varies to different groups, and those who benefit from the established system or may benefit from some future institutional arrangement will strive for or maintain institutional arrangements that are favorable to them. Global governance rules exist upon intersubjectivity and only play a normative role if they are accepted by the majority. Non-neutral rules are difficult to promote consensus between western and non-western cultures. One consequence of this non-neutrality is that in the practice of global governance, the actual benefits or losses brought by different mechanisms to sovereign states are inequivalent. In an era when the developed economies dominate in the global governance system, such non-neutrality, while has always existed, is not as prominent as it is today with more and more non-western economies rise and enter the global governance system. This is illustrated in the case of COVID-19 striking big powers, as non-western actors are bringing their own practical experiences into the existing governance system, thereby shaking the governance structure dominated by the Western instrumental rationality. The concepts, principles and approaches of global governance begin to fall short in attuning to the reality of rapid development of globalization and the emergence of global challenges.

Lastly, the WHO has self-deficiencies in terms of operating rules and mechanisms.

First, WHO is already the largest and most authoritative international agency for epidemic prevention in the world, but it is still unable to play a leading role in this crisis. This is because international organizations and states are distinct in nature. States have sovereignty, while international organizations do not. Management personnel in international organizations are dispatched by member states, and there are no individuals independent of the state and belong exclusively to an organization. This makes it impossible for international organizations to operate in complete isolation from states. Additionally, an international organization is a platform where member states gather for discussion, vote to reach a resolution, and implement it. Basically, the consensus of major powers becomes the resolution of the international organization. That is, a balance exists between the views expressed by the representatives of member states within WHO. Leaders of international organizations has only the power to implement the policy. Taking the position of chief balancer, Director-General Tedros may be viewed as a consensus-maker instead of an authoritarian decision-maker. International organizations, whether intergovernmental or non-governmental, are coordinating bodies. Their decision-making power is limited. Whether member states, especially the big powers, have shared interests, common needs and collective policy orientation determines how much role the international organization can play.

Second, WHO has an “institutional inertia”. Its reform of governing structure lags behind the development of global health governance with its influence on the decline. Since 1999, the principle of zero growth has been introduced into the budgeting process of WHO. Consequentially, WHO is increasingly dependent on voluntary contributions and has shown a bilateralism in promoting projects, since most contributions are earmarked for specific purposes by donors. As some scholars note, voluntary contributions militate against multilateral governance and decentralize the authority of international organizations to donor countries.

All in all, from the perspective of internal factors, academics generally believe that WHO’s organizational culture is strongly functionalist, conservative, and increasingly corrupt in recent years. The failure of strategic planning and the over-decentralization of WHO’s structure render its internal system increasingly rigid. Moreover, there are issues of impartiality within WHO. As more and more information about WHO’s internal decision-making is exposed by the media, the fairness and transparency of WHO’s work are increasingly questioned. Many scholars agree that the financial interests of the medical experts who advise WHO on decision-making are intertwined with multinational pharmaceutical companies, making WHO difficult to be objective and neutral.

To date, no substantive breakthrough and sustainable progress have been made in any area of governance, terrorism, financial crisis, transboundary disasters, and climate change, etc. COVID-19 represents yet another failure of global governance. The root cause is the lack of international cooperation. In recent years, with the strong backtracking of populism, unilateralism, and power politics, international relations are shifting toward geopolitics, the sense of international responsibility and the trust of international community are declining. It seems that everyone knows the theory of win-win cooperation, however in reality, the spirit of cooperation is easily concealed, forgotten, and even deliberately abandoned.

Some Recommendations on Institutional Reform in the Post-Pandemic order

In the post-pandemic world, international organizations and multilateral mechanisms will face greater tests. Only through constant institutional reform can they adapt to a changing world order.

The first is to boost the leadership and appeal to perform the leading and coordinating role to full potential in global governance. The authority and expertise of international organizations are mainly reflected in the fairness and effectiveness of promoting international cooperation and solving global issues. This depends on the sufficient cooperation and support of member states on the one hand and on the strategic vision, leadership, and professionalism of international organizations from officials to staff, on the other. In response to global challenges like COVID-19, the UN needs to make corresponding reforms and adjustments. This would include convening relevant meetings at the earliest possible time to convey confidence to the world, unifying the goals of all parties, and drawing up global action roadmap. Specialized agencies under the UN need to carry out separate actions around their respective themes, update their own rules and norms in real time. WHO could be more empowered to upgrade the global public health governance system. The international community has had conducted some effective bilateral and local cooperation and gained positive experiences in the fights against SARS, H1N1 influenza and Ebola, but there is still a long way ahead to achieve global, sustainable and closer cooperation. It is necessary to improve the overall status of public health governance and reinforce WHO, so that it has more rights and higher international status similar to that of the IMF and the World Bank to organize experts and focus on scientific research, vaccine development and data sharing as well as help developing countries with weak health infrastructure to improve their response capacity. The international community has generally been underinvesting in public health. As of February 29, the U.S. was still more than half behind with its 2019 dues and US$120 million is defaulted for 2020. After the outbreak, the COVID-19 Solidarity Response Fund has been created by the UN Foundation, the Swiss Philanthropy Foundation and WHO, but similar efforts should be more institutionalized in future. Meanwhile, WHO must strengthen the institutional construction, such as build a global infectious disease monitoring, early-warning and emergency-boot mechanisms, further elucidate the rules and norms of public governance, formulate guiding principles that all countries must abide by, unify standards, and improve the control and binding force on relevant behaviors of various countries, but not limited to report information, temporary research and judge the situation. For now, though the role and status of WHO in global public health governance has been weakened to a certain extent, as the largest international health organization and one of the larger specialized agencies within the UN, WHO still has broad responsibilities to combat infectious diseases based on the Constitution of WHO and designated by its accession to the UN, as well as has the only authorization of leading and promoting effective development of international health law. Therefore, it is crucial to carry out effective reform of WHO. The direction is not “reprimand and denounce” by some member states targeted others and counteract each other’s efforts. Instead, it should be further enhancing the power of existing multilateral mechanisms, increasing financial support, and expanding bilateral or small multilateral public health cooperation to larger regional domain. For this purpose, the established China-Japan-ROK joint prevention and control mechanism and the public health cooperation within the ASEAN framework should be consolidated and then upgraded to the Asia-Pacific region. The European Union and the African Union should also act together and promote the integration of public health, and then on this basis, form the regional cooperation between Asia and Europe, among Asia, Europe and Africa as well as in a wider range.

The second is to strengthen the authority and expertise of international organizations. Globalization has never been entirely positive as a single-dimensional process. International organizations is the central force and the primary driver for global governance. The multilateral cooperation mechanism should include at least two functions: political leadership and advisory implementation. In the current international system, it is unrealistic to require specialized agencies to perform core political leadership because they do not have corresponding political authority and power resources. However, for multilateral organizations with rich expertise in a specialized field, it is the fundamental obligation to provide intellectual support and technical implementation for political decision-making. For example, the political leadership of G20 and the advisory implementation of WHO could converge and form a global action model to counter security threats more actively in global public health. WHO can gather information, propose professional suggestions, and provide a concrete scientific basis for the G20 to put forward global action plans. In this regard, G20 could be continuously elevated from short-term crisis response mechanism to long-term governance mechanism.

Conclusion

International organizations have accrued deep malpractices in managing global affairs. In the current COVID-19 and previous international public health emergencies, there are various difficulties in the operation of international organizations, confining them to take conductive actions, which in turn reducing the effectiveness of problem solving. The world seems to lack a consistent and coherent response in the face of a common enemy. A path of transformation should be explored. Only through constant change can international organizations be reinforced in the new order, otherwise it will be eliminated or replaced. However, we must also be aware that some curtailments are beyond the scope of international organizations and concern the whole international community. The reality of the COVID-19 has put the international community at a crossroads once again. Is it to turn the crisis into an opportunity and make the pandemic a driving force for community building through strengthening all-round cooperation and multilateralism? Or to reject international cooperation, shrink into a corner, and deepen the division of the world? Or to expand the conflict and make the outbreak a pusher of the law of jungle? The rational choice is certainly cooperation. COVID-19 is an acute crisis that not only takes a heavy toll on global public health safety, but also creates global threats to varying degrees in other fields through its spillover effects. Institutional reform needs the solid support of political will and cooperative consensus. Multilateralism is by far the most reasonable approach to global governance, and multilateral cooperation is the most democratic way to combat global threats. Whether global consensus can be reached and cooperation mechanism can be built out of the crisis will not only directly affect the success of anti-pandemic battle, but also have a far-reaching impact on the international relations and world order after the pandemic.

In the fight against COVID-19, success has so far been defined by responses in Asia and the Pacific. Many countries in our region have been hailed as reference points in containing the virus. Yet if the region is to build back better, the success of immediate responses should not distract from the weaknesses COVID-19 has laid bare. Too many people in our region are left to fend for themselves in times of need. This pandemic was no exception. Comprehensive social protection systems could right this wrong. Building these systems must be central to our long-term recovery strategy.

Illness or unemployment, pregnancy or old age, disability or injury should never be allowed to push people into poverty. During a pandemic, social protection schemes facilitate access to health care and provide lifelines when jobs are lost, rescuing households and stabilizing economies. This has been recognized by governments in the face of COVID-19. Over three hundred new social protection measures have been taken across forty countries in the region. Existing schemes have been strengthened, ad hoc packages rolled out and investment increased.

This recent appreciation for social protection is welcome. It must be maintained, because the most effective responses to COVID-19 have been from countries which had robust social protection systems in the first place. The logistics of taking measures during an unfolding crisis are complicated; setbacks and delays inevitable. Well-resourced social protection systems built over time are just better placed to deal with the unexpected. However, these systems still do not exist in many of parts of our region.

A recent report by the International Labour Organization (ILO) and the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP), The Protection We Want, finds that more than half the region’s population has no coverage whatsoever. Only a handful of countries have comprehensive social protection systems and public spending in this area remains well below global average. In many countries in South Asia and the Pacific, public expenditure on social protection is as low as 2 per cent of GDP.

Where social protection systems do exist, their coverage is riddled with gaps. The youngest, least educated and poorest are frequently left uncovered by health care in the region. Many poverty targeted schemes never reach families most in need. Maternity, unemployment, sickness and disability benefits are the preserve of a minority of workers in the formal economy, leaving 70 per cent of workers locked out of contributory schemes. Lower labour force participation among women accentuates gaps in coverage. Population ageing, migration, urbanization and increasing natural disasters make social protection ever more urgent.

Investing in a basic level of social protection for everyone – a social protection floor – would immediately improve livelihoods. United Nations’ simulations across thirteen developing countries in the region show that universal coverage of basic child benefits, disability benefits and old-age pensions would slash the proportion of recipient households living in poverty by up to eighteen percentage points. The decrease in poverty would be greatest in Indonesia, followed by Sri Lanka and Georgia. Purchasing power would surge in recipient households supporting increases in per capita consumption in the lowest income groups.  In 9 out of 13 countries analysed, more than a third of the population currently living in poverty would no longer be impoverished.

These phenomenal development gains are within reach for most countries in Asia and the Pacific. Establishing basic schemes for children, older persons and persons with disabilities would cost between 2 and 6 per cent of GDP. It is a significant investment, but affordable if we make universal social protection systems a fundamental part of broader national development strategies.

Yet it is not only the level of funding that matters, but the way the funds are spent.  To achieve universal coverage, we need a pragmatic mix of contributory and non-contributory schemes. This would deliver a vital minimum level of protection regardless of previous income and support a gradual move to higher levels of protection through individual contributions.

New approaches to funding participation can extend social protection to workers in the informal economy. Schemes that reward unpaid care work and are complemented by subsidized childcare services can form a decisive step towards more inclusive and gender equal societies. And new technologies, including phone-based platforms, can accelerate delivery across populations.   

As we focus on building back better in the aftermath of the pandemic, our region has an opportunity to make universal social protection a reality. In so doing, we could bring an end to the great injustice that leaves the vulnerable in our societies most exposed. Governments from across Asia-Pacific will convene later this month at ESCAP’s Sixth Committee on Social Development to strengthen regional cooperation in this area. Let us seize the opportunity to accelerate progress towards universal social protection, and reduce poverty and inequality in Asia and the Pacific.

Authors

• Armida Salsiah Alisjahbana is the United Nations Under-Secretary-General and Executive Secretary of the Economic and Social Commission for Asia and the Pacific (ESCAP).
• Chihoko Asada Miyakawa is the ILO Regional Director for Asia and the Pacific.

Early Identification and Action

We are now learning, from Covid19, one thing above all else. With epidemics, it is early identification and action that matters. When our Prime Minister, Jacinda Ardern, says that New Zealand’s government approach is to “go hard and go early”, she is only partly correct. What matters is that by going early you may not have to go hard; and that having (and understanding) information both enables early responses to outbreaks, and makes it possible to go no harder than is necessary.

Radio New Zealand ran a story this morning (9:20am) “Is business support shifting away from government elimination goal?”. As is often the case, the headline missed the nuanced point being made by the interviewee, Auckland Chamber of Commerce CEO Michael Barnett. The point being made was that, to avoid repeated hard and disruptive responses to each epidemic outbreak, early and precise action was required – in particular, through smart-testing and smart-confinement.

Smart testing means: symptomatic testing of people whose lives involve significant close contact with other people, sample asymptomatic testing of people who work at or travel through international or quarantine borders, and follow-up genomic testing (for positive cases) and sample antibody testing (serology). This is the information component of a smart-response strategy.

Smart confinement means focussing on restricting the pathogen rather than restricting the people; in the case of Covid19, the pathogen is the coronavirus SARS-Cov2. The major tools here are contact tracing, the temporary mandatory use of face masks in sensitive environments until an outbreak is contained, and the temporary closures of sensitive environments for which mask use is not always possible (such as premises that involve eating or drinking, or singing). The general idea is that speedy containment should minimise the time for which such temporary mandates and closures are required.

With regard to contact tracing, having a smart public health app and a smart public health card are complementary. A public health card (a ‘Covid Card’, kept in the same place as one’s drivers licence or ‘hop card’), which logs offline records of contacts can complement an app that, when deployed, can trigger a notification of a casual contact or a place recently frequented by a possibly infectious person.

Bureaucratic Bungles

There is much chatter this month about the failures of managers to keep critical facilities safe; facilities such as ‘managed isolation and quarantine’ (MIQ), ports of entry into New Zealand, rest homes, and medical facilities.

This is a systemic problem that is due in large part to a tone-deaf management culture which emphasises financial/accounting ‘costs’ over economic costs, and largely underestimates benefits; indeed, economic costs include the foregone benefits of cost-cutting measures. (See RNZ’s Doctors pen warning to Christchurch over DHB, and my Counting the Cost of Government Action and Inaction.)

This management culture in New Zealand goes back to the 1987 Treasure Briefing to government, called ‘Government Management’. (This policy briefing of course reflected management practices that were already fashionable in some other countries.) By and large, all government in New Zealand since 1987 have been responsible for the creation of a bureaucratic culture that overemphasises financial and accounting costs, and deemphasises societal benefits. David Clark was a Minister of Health who epitomised and reinforced this culture.

In practice, it means that if a government asks its officials to implement a policy, but makes some aspects of that policy ‘optional’, then these bureaucrats will choose to save costs by not implementing those parts of the policy, or by implementing a scaled down version of the policy. Further, such managers in charge of stockpiled resources – such as personal protective equipment (PPE) – will be reluctant to deploy or relocate such resources; much as misers who ‘save for a rainy day’ refuse to spend their savings when it rains on the grounds that it might rain even harder tomorrow.

The problem is compounded by management structures, where Ministries act as intermediaries between ministers and operational managers, and where ‘spending ministers’ – such as the Ministers of Health and Education – are intermediaries between their ministries and the Treasury ministers. If the Prime Minister mandates some policy, it has to pass through a whole bureaucratic chain – a chain which may have multiple points of resistance. The chain is from Prime Minister, to Treasury Ministers (who authorise a pot of money, even when there may be no practical reason for capped funding), to spending Minister, to the Ministry, to – in the case of public health – the District Health Boards (DHBs).

DHBs’ managers may interpret and respond to the mandate they receive in different ways, depending on the different extents of culturation present in each institution. A good manager will have heard the mandate from the top, and will question any discrepancies between the spirit and the letter of their instructions. Tone-deaf managers will take their filtered instructions literally, and will try to comply by spending as little money as possible. One result which we are familiar with is the grudging minimalist approach by managers towards upholding the safety of clinical staff.

Economic Principle

The general economic principle that should guide action is that of economic efficiency, which enters public policy as cost-benefit analysis.

The principle is that, if the marginal benefit of a policy action exceeds the marginalcost of that action, then that action should be undertaken (albeit with the possibility that parties who would bear that cost should receive appropriate compensation). By marginal, we mean ‘additional’. For example, in our present context, there may be a proposal to add a restriction to a society which is currently at New Zealand’s epidemic alert Level Two. If the best estimate of the benefit of the additional measure is that it outweighs the (best estimate) cost of that measure, then the measure should be implemented. And if the marginal cost outweighs the marginal benefit, then the additional policy measure should not be implemented.

(This process of analysis also applies to proposals to remove a measure that is currently in force.)

The most difficult part of this process is to produce unbiased estimates of these benefits and costs. And, within that, the difficulty exists in both estimating and discounting long term benefits and costs. By ‘discounting’, we mean weighting immediate benefits and costs against expected future benefits and costs. What matters is that the cost calculus used to make such a policy decision is transparent – publicly available, and able to be challenged. It does not mean that policy action must wait until challenges are exhausted. Rather, the process of challenge is a process of learning, and refinement of the analysis in light of new information.

One way that we can attempt to estimate long run benefits and costs is to evaluate past comparable episodes. The past episode that I find to be interesting here, is that of tuberculosis. We note here that the classic tuberculosis ‘pandemic’ began in the eighteenth century and only ended in the mid-twentieth century with the development of an antibiotic effective in treating the tuberculosis bacteria. (With ongoing global poverty and antibiotic resistance, it has been argued – by Frank Snowden – that the world is already in a second tuberculosis pandemic.)

Pandemics and Society: the Long Term

Yesterday I read They say, ‘learn to live with Covid-19. Here’s what I say back, by scientist Siouxsie Wiles. The most interesting part of Dr Wiles’ article was its discussion of the harmful aspects of Covid19 infection other than the possibility of imminent death. In this regard, Covid19 can be usefully compared with tuberculosis.

In Frank Snowden’s 2019 book Epidemics and Society, the emphasis is on the social causes and social consequences of epidemic diseases. Tuberculosis was a reality of life for two centuries that people had to live with knowing there was no cure. An interesting story – told by Margaret Heffernan in Uncharted, how to Map the Future Together – is one about the history of economic forecasting. The three pioneers of this statistical art – Irving Fisher, Roger Babson and Warren Persons – were all diagnosed with tuberculosis. (Two of these lived beyond the age of 80, and may have been false positives.) It meant that they lived their lives under the cloud of considerable personal uncertainty, and that circumstance most likely contributed to their quests to minimise economic uncertainty.

Until the end of the nineteenth century – when Robert Koch proved that tuberculosis was an infectious disease – the disease had ‘romantic’ connotations. (Indeed, the pale and drawn appearance of women with tuberculosis seems to have been the precursor for the widespread twentieth century preference for skinny models in the fashion industry.) In the ‘Romantic era’, tuberculosis was seen as an inherited condition that particularly affected creative white people (it was called the ‘white plague’). So, while suffering from tuberculosis would usually lead to an early death, there was no stigma attached to it. Tuberculosis escaped the attentions of the ‘sanitary movement’ of the 1830s to 1850s; the movement that attributed most other diseases to ‘filth’. (In fact, tuberculosis existed in poor and non-white communities, but was largely undiagnosed and unnoticed.)

After the 1880s, tuberculosis gradually came to be understood as a contagion – typically but not only passed from person to person – that caused substantial damage (scarring) to a person’s lungs and could also damage other organs. It was revealed to be a ‘tricky’ disease of remissions rather than cure; an ailment that might activate at any time in an infected person’s life, and an ailment that would typically and substantially reduce both quantity and quality of life. It was discovered that fresh air – preferably dry mountain air – and minimal stress could substantially extend tuberculosis remissions. More generally, it came to be understood that people benefited from remission from work. Tuberculosis may have played a large part in the perception from the 1880s to the 1930s that the most important improvements to living standards were increased leisure rather than increased household incomes; in those years productivity growth did not mean economic growth.

These points are very pertinent today, because the bodily damage created by SARS2 (Covid19) and SARS1 may be similar to that created by tuberculosis; ongoing though intermittent, and requiring affected people to lead less stressful and less precarious lives than the lives they might have been anticipating in 2019. We no longer live in a world – as we did in the later decades of the twentieth century – where young adults could believe that they could get infectious diseases with impunity, knowing that their diseases would either self-cure or be cured with drugs such as antibiotics.

Conclusion

Covid19 is taking us – in a way that cannot pass unnoticed (as SARS1 did) – into a new era of changing estimations of long-run costs and benefits. It is a disease that, while survivable for most, is a disease that nobody wants to get. Nevertheless – like tuberculosis in the nineteenth century – a substantial minority of the world’s population will have it, and will have their whole lives physically and psychologically affected by it. At the very least, this experience will modify the future economic choices that most of us make.

Today’s first summary chart looks at reported Covid19 cases and deaths over the seven days to 14 May. It is sorted into a Covid19 ‘deaths league’. Sweden now leads the world for acknowledged Covid19 deaths, closely followed by United Kingdom and Belgium. While Netherlands is showing well below Sweden and Belgium, Monday’s chart showed the large extent of the undercount of Covid19 deaths in Netherlands.

(Belgium continues to be the worst affected country in the world – excluding little San Marino – with three times the number of deaths per capita than the USA. Sweden has 33% more Covid19 deaths per capita than the USA. The regular news reports that the USA is the worst affected country from Covid19 are far from true.)

(This table omits a number of small mainly wealthy countries that have been excluded because of their small size: Bermuda [British], Andorra [Europe], Sint Maarten [Dutch], Mayotte [French], Channel Islands [British], Sao Tome and Principe [Portuguese-speaking Island nation off African coast].)

For deaths in the last week, Ecuador is fourth in the world, still well ahead of Brazil and Peru for Latin America; though Peru has many more new cases – per capita – than the other two. Mexico is now also making a significant showing.

While the chart is still dominated by the usual European suspects, there are relative newcomers from eastern Europe (Moldova, Bosnia and Herzegovina, Romania and Finland).

Also of great significance is the presence of an Arabian country – Kuwait – in the ‘deaths league’. Kuwait has so many new cases that it requires two columns.

Re Netherlands, I saw the following story on Al Jazeera this week: Hidden coronavirus tragedies: Dutch elderly advised against ICU. Netherlands is the country with the most ‘liberal’ euthanasia laws. It appears that, while elderly Dutch people have not really embraced euthanasia, government policy is to place subtle pressure on them: “In late March, the Dutch Federation for Medical Specialists advised medical professionals to be more selective in sending COVID-19 patients to the ICU”.

I have a sense that a variation of this ‘let the old die quietly’ approach is taking place in Sweden. Sweden is an overtly mercantilist country (as is Netherlands) that sees its economic purpose of life as “making money” (especially through exports), and where people ‘live to work’ rather than ‘work to live’. A nation with such underlying values places a lowish value on the lives of retired persons. I caught Paul Henry (on TV3) interviewing a senior public health official from Sweden. The Swedish official dismissed his country’s high death rate, claiming that the ratio of deaths to cases (what our Ashley Bloomfield calls the “positivity rate”) is unimportant because Sweden is not interested in knowing about “asymptomatic” cases of Covid19. It seems that Sweden’s strategy is to let the virus infect as many people as it can, treat the seriously ill, and not worry too much about elderly fatalities. At present, two in every thousand people in Stockholm have died from Covid19; not quite as bad as New York City, but certainly comparable.

One more country to note is Ireland, which has gone ‘under the radar’, but continues to have a serious problem. Being an island hasn’t helped Ireland very much.

Qatar – home of Al Jazeera, and one of the last airlines to keep flying around the world – has more than double the new cases of the second country, Kuwait. Bahrain, UAE, Saudi Arabia and Oman also feature on this chart. While only Kuwait has significant numbers of deaths so far, it seems likely that death rates in the other Arabian countries will pick up later this month. (We should also note that we are currently in the middle of Ramadan, which may have something to do with what is happening in these countries.) Qatar and UAE resemble Singapore in a number of ways; Singapore is, like them, a leader in new cases. Hopefully the Arabian countries will prove as good as Singapore in averting high death rates. Certainly, the age profile of the cases in the Arabian countries will be much lower than in Europe and North America, so that will help to keep their death rates down.

(Note that two countries were omitted from the second chart, again for being too small. These were San Marino and Mayotte.)

An important country for New Zealand to watch is Chile, which is in many ways like New Zealand, has winter coming, and has had a major outbreak of new cases after easing restrictions.

We also note the presence of Russia, now ahead of USA in terms of cases per person. Another country to note is Gabon, the first continental African country to show up. Gabon is a comparatively wealthy French-speaking country. Also, we see the Maldives, a popular tourist country in the Indian Ocean; a country whose main industry is high-end tourism.

Among the Anglo-Celtic countries, United Kingdom clearly leads the Covid19 mortality data. I think it’s clear that, in London at least, the virus spread too widely to be contained before any containment measures were implemented. Ireland lags the UK, but leads Canada. It is looking like eventual death rates from Covid19 will be much the same in Ireland, Canada and the USA.

New Zealand and Australia continue to look good. It appears that Australia has contained its recent upturn in cases. Winter is the challenge now, for the southern hemisphere countries.

Today’s chart shows (in grey) the estimated impact of Covid-19 on mortality rates in the selected countries. For most of these countries, the ‘excess death’ procedure provides an estimate of underreporting in underreporting countries compared to those with the most comprehensive reporting.

Some of these extra deaths may have occurred as an indirect result of Covid-19 – eg non-treatment for other conditions – and not themselves due to coronavirus infection. There is however evidence that deaths unattributable to Covid19 have reduced; for example, March would in other years have been a peak month, in these countries, for seasonal influenza deaths among the aged and others with comorbidity issues.

This exercise is comparable with my Smithometer exercise, where I was able to show that, for a two-week period in 1918 coinciding with the Black Flu, mortality was occurring at ten times the usual rate.

We see quite clearly that Belgium, Spain and United Kingdom have the greatest Covid19 mortality, closely followed by Italy, Netherlands and France. Netherlands appears to be the worst underreporting offender; it is much closer to its neighbour Belgium than the reported data suggest.

Sweden, which has one of the worst reported Covid19 death rates, at least reports its deaths in a comprehensive manner.

The data from Germany, Denmark and Norway suggest that there has been a decrease in deaths unrelated to Covid19. I means that in the worst affected countries, their lockdowns will have prevented a number of these other deaths (eg influenza deaths, accidents). So the actual number of deaths resulting from the Covid19 pandemic will have been higher in all countries than the grey columns in the chart indicate (as is clearly the case in Germany, Denmark and Norway).

In Norway, Covid19 has actually reduced the total number of deaths in that country in March, despite 161 people dying of Covid19. (Covid19 actually saved about 200 other lives in Norway!)

While the New York Times data does not give an estimate for the United States, it does estimate New York City’s mortality. New York City’s actual death rate from Covid19 is more than three times higher than that of Belgium, and is almost certainly higher than that of Brussels, Belgium’s most affected city. (While New York is unlikely to be as badly afflicted as Milan, it will be closing in on that Italian city.) New York’s officially reported deaths appear to be about 80 percent of all its deaths attributable to Covid19.

Working out an eventual death total for Covid19 may have to wait until the year 2030, because many indirect deaths will occur in later years. This exercise will be made more difficult, because, over the decade, there will also be many other deaths that will not happen, thanks to Covid19’s influence on our lifestyles.