Countries with the highest Covid-19 related death rates have one thing in common: a seriously deteriorating quality of government over the last 20 years.
The Covid-19 pandemic is turning out to be one of the deadliest events to have devastated Western societies over the last 100 years. Apart from war and major earthquakes, the death rate of this global pandemic has been unparalleled in recent history. To put things in perspective, according to the ‘The New York Times’, the September 11 attack increased the overall death rate in New York City by 61% in relation to previous September months. The 1918 Great Flu led in October 1918 to 297% more deaths than in a normal October. The Covid-19 pandemic has been far deadlier than these two events, as it has multiplied the mortality in New York City by 5.8. The Paris heatwave of August 2003 doubled the number of deaths with respect to previous months of August. Covid-19 has multiplied the death rate by 2.6. In Madrid the pandemic has provoked 14,000 excess deaths between mid-March and mid-April 2020, that is a rise of 357% relative to previous years. And in Bergamo, the hardest hit place so far in relative terms in the world, the number of people dying in March 2020 was multiplied by 6.67.
It has become almost commonplace to say that a pandemic of this size could not have been foreseen in the developed world in the 21st century. It has also been frequently argued that all places where ill-prepared to face such a colossal challenge. Yet, not all places and not all countries have been hit in the same way. Counting the number of dead – which should be a relatively simple exercise and has been done by all developed countries accurately for decades – has suddenly become a political issue. No country wants to top the league of Covid-19 induced or related deaths. Often national statistics related to Covid-19 have been or become untrustworthy. That is why there is a need to look for alternative sources of information to assess the true cost of the pandemic in lives. The most reliable source has been assessing how deaths in the months of the outbreak compare to previous years in order to calculate the excess mortality in the first few months of 2020. This is what John Burn-Murdoch has been doing for Financial Times for the twenty countries where excess mortality can be calculated in a comparable way.
In the latest release of this calculation, including data up to 10 June, the differences among countries are striking. Whereas countries such as Iceland, Norway, Israel, or South Africa record no excess deaths in the first five months of 2020, excess mortality in the United Kingdom (UK) and Spain are respectively 64,200 and 44,000. The number of dead in Italy increased by 46,700 and in Belgium by 8,900. The overwhelming majority of these excess deaths were concentrated between the months of March and April 2020. The UK, Spain, Italy, and Belgium are the four countries with the highest incidence of excess mortality in the developed world, with rates of 946 additional deaths per million in the UK, 941 in Spain, 772 in Italy, and 768 in Belgium. In Portugal, by contrast, excess mortality has been – at 294 per million – less than one third that of its only neighbour, Spain. And in Germany, with a rate of 101 per million, excess mortality is less than one-ninth that of the UK and Spain and almost one eight of that of Italy and Belgium.
What are the explanations for such marked differences among countries that, in principle, can be considered similar? Many explanations have been put forward in order to explain these cross-country differences in mortality during the pandemic. Levels of international connectivity and the density of the major cities have been pointed as two of the major causes. Major airport hubs in large and open cities like New York, Paris, London, or Madrid have been key diffusers of contagion. The sheer concentration of population in high densities in what are large cities has made the rest. But the truth is that not every city and every country with a large international airport hub has been a focus of contagion. Amsterdam or Frankfurt host respectively the third and fourth largest airports in Europe, but the incidence of the pandemic in both the cities and their respective countries has been far lower than in Spain, the UK, or France.
Pollution has been signalled as another fundamental culprit of the incidence of the disease. High levels of pollution in places like Milan, Madrid, or Paris may have led to a greater concentration of respiratory diseases, rendering these places more vulnerable to the impact of the virus. Yet, cities with far higher pollution levels, such as Beijing, have been less affected by Covid-19 mortality.
Age structure is considered another fundamental reason for high Covid-19-related mortality. Ageing populations have been targeted by the pandemic. And, indeed, Italy has the second highest share of population aged over 65 in the world. France and Spain are also in the top 15 countries fight ageing. Nevertheless, Japan, the country with the largest share of over 65s has weathered the Covid-19 storm far better, despite being closer to the initial Wuhan focus and having reported cases far earlier than European countries. Moreover, Germany, Portugal, Finland, Bulgaria, or Greece all have a greater share of elderly population than France or Spain and yet the impact of the pandemic has been far lower.
[Escuche el ‘podcast’ de Agenda Pública: ¿Qué pasa con la solidaridad en la Unión Europea?]
Differences in the degree of personal interactions between Mediterranean and Northern European countries have also been identified as a potential reason for variations in mortality. But while this factor may, to a certain extent, apply to the division between countries in northern and southern Europe, it does not explain the gap in the impact of the coronavirus pandemic between Italy and Spain, on one hand, and Greece and Portugal, on the other.
There is, however, one important factor that the countries worst hit by Covid-19 per capita share and that has remained unnoticed until now. The UK, Spain, Belgium, and Italy are not only the countries with the biggest incidence of excess deaths in 2020, they are also those that have witnessed the biggest relative decline in government effectiveness, as measured by the World Bank, over the last 20 years. By contrast, Portugal, a country that has weathered the pandemic far better, government quality has increased during the same period. Similarly, other countries that has managed the health emergency far better, such as the Scandinavian countries, France, Germany, or the Netherlands, have also performed better in terms of their long-term change in government effectiveness.
The prolonged deterioration of the overall quality of civil service and bureaucracy and its weakening independence from political pressures has over time created a situation in which the capacity of governments to design and implement efficient public policies has been greatly compromised. Moreover, the credibility of governments to commit to policies has been greatly diminished in the eyes of the citizenry. Years of flagging government efficiency have therefore left these countries ill-prepared in comparison to many of their neighbours to fend off the challenge posed by the virus.
Hence, the reaction by these four countries has been slower than that of many others in Europe. They have struggled to adopt decisions to prepare and respond to the pandemic, as well as when trying to garner the necessary political consensus leading to taking tough decisions. At least in the cases of Spain, Belgium, and the UK, which had additional time than Italy to prepare for the hit of the pandemic, it also limited the capacity to learn from and react to what was happening in Italy. Additional consequences of weaker governments and bureaucracies have been frequent changes of direction and criteria in the policies adopted, the chronic lack of personal protective equipment for health and social workers, and a manifest incapacity to coordinate effectively the public procurement of medical and protective equipment. This has resulted in an every man/woman for himself/herself type of strategy that has not only undermined an effective and co-ordinated response when the virus struck, but has also failed to instil the necessary trust to bring the population on board. The results are well known: higher infection rates, higher level of infections among front-line health workers, and, sadly, a far higher share of excess deaths.
The coronavirus pandemic has been an event that has caught most countries around the world by surprise. But some have been far more effective dealing with it than others. Although there is a need to further analyse why this has been the case and what can be done in the future, it is becoming evident that the long-term decline in government quality has cost many countries that have allowed their political systems and civil service to deteriorate dear. Long-term decline in government effectiveness has had a price-tag in lives. And, unless something is done in order to redress this long-term relative government quality deterioration, the capacity to deal with any relapses will be further jeopardised and the recovery from the pandemic’s economic consequences far more steep.
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