It has been claimed that the UK has been left ill-prepared for this pandemic because so-called austerity has hollowed out public services. But, writes Matthew Lesh, the head of research at the Adam Smith Institute in The Daily Telegraph, the countries that have been most successful at responding to COVID-19, the Asian tigers, have relatively low levels of healthcare spending. Singapore (4.5%) spends half as much as the UK (9.8%) as a proportion of the economy. Taiwan (6.1%), Hong Kong (6.2%), and South Korea (7.3%) spend less too.
Lesh writes that these countries were most at risk of a major COVID-19 outbreak, considering their proximity to China. But the results are striking: Hong Kong has had four deaths, Singapore and Taiwan have had six, and South Korea has had 208. The UK has already had over 9,000. Hong Kong, Taiwan and South Korea have not had to instigate lockdowns or close businesses. Singapore only shut non-essential businesses last week.
Lesh says that the success of the Asian tigers is because of meticulous planning after SARS in 2003, small but agile bureaucracies, and decisive early action. Singapore has an early warning system, isolation facilities in hospitals, a 330-bed infectious disease management facility, trained healthcare staff and stockpiles of personal protective equipment, medications and vaccines. They have also undertaken simulation exercises and public education about hand-washing, mask-wearing and medical treatment.
He argues that pandemic response requires good governance and strategy effectively executed. The most successful countries ramped up testing as quickly as possible, involving the private sector, and used technology to trace cases to prevent broad outbreaks.
Lesh writes that while this is all speculative – we won’t know for some time how different countries have handled this crisis – it appears British bureaucracy has been lacklustre. Despite years of pandemic planning, modelled on a less threatening H1N1-like flu outbreak, he said the UK has been slow to take COVID-19 seriously.
The body responsible for infectious diseases is Public Health England. PHE began testing in January, but limited testing to a single laboratory. It was not until mid-February that testing was expanded to the entire PHE network, and even later the National Health Service (NHS). PHE rebuffed offers from companies, universities, charities, and even animal testing labs, to help.
On 26 February, PHE announced there was “no current evidence to show that the virus is circulating in the community”. Lesh writes that in retrospect, an epidemiological impossibility.
He writes: “We just weren’t testing broadly. The UK, perhaps uniquely, has given up on testing and case tracing in the community. The government is only now involving pharma companies like AstraZeneca and GSK in testing, but this remains weeks away. In 2018/19, less than a quarter of PHE’s budget was directed towards protection from infectious diseases, the organisation’s raison d’etre. PHE has become best known for its nanny state concerns about sugary soft drinks and chocolate bars. Perhaps a refocus is in order.”
Lesh writes that when this is over, the key lesson must not be that the UK needs to spend “more” on healthcare.
He writes: “We could spend twice as much (like the US), but end up with the same dismal outcomes. Bigger leads to inflexibility. It will be far more important to develop an agile bureaucracy that is willing to work with the private sector.”
[link url="https://www.telegraph.co.uk/news/2020/04/12/smaller-countries-spend-less-healthcare-better-job-britain/"]Full report in The Daily Telegraph[/link]