In our coronavirus pandemic, consider the still developing outcomes in two large cities, both densely populated, globally connected, relatively transparent, and with first-world health care systems: New York City and Hong Kong.
By April 1, 2020 in Hong Kong (pop. 7.5 million) four people had died from the virus. In New York City (pop. 8.6 million) over 1,000 people had perished. How to explain this staggering difference?
Political scientist David Runciman recently observed that pandemics strip bare political power, especially the use of coercion. Political leaders make life and death decisions for their citizens.
He also correctly observes that national governments matter. In Sweden political leaders are experimenting with ‘herd immunity’, apparently also considered and discarded by UK’s Boris Johnson.
In China, political leaders adopted draconian and unprecedented measures, locking down tens of millions in Wuhan and Hubei province, that undoubtedly saved many lives. The leaders of nation states took these decisions on behalf of their people. In the process leaders have closed national borders and stopped global supply chains in their tracks.
Constitutions also matter. New York City and Hong Kong are local governments in two very different constitutional systems, one federal that shares power and provides more external space for politics, the other unitary, that centralizes power and contains politics.
Although other factors come into play (experience, planning, public health systems, and leadership, etc.), the constitutional arrangements are critical for explaining the number of deaths relative to the population in the two places.
China’s unitary system centralizes political power in Beijing. Hong Kong’s civil service-led government follows instructions from the central authorities. No partisan politics cloud the central government’s authority over Hong Kong.
Still, the central government has many priorities, including the survival of the Chinese Communist Party in power. These priorities may conflict with others at any one time. Thus, in December-January for political gain the party suppressed public information about the epidemic in Wuhan that could have saved more lives.
The US federal system gives state and local government responsibility for delivering most public health care. The central government can provide extra resources and does in emergencies.
The federal system gives greater scope for politics, especially when the relevant political executives come from different political parties. Democrats lead both New York City and New York state, while Republicans lead in Washington DC. Politics is undoubtedly involved in this 2020 presidential election year.
Federal systems provide space for political conflict that can undermine effective action in crises. Although the pandemic has been described as a war, it is a war with an unseen enemy. Accordingly, mobilizing and unifying against it become more difficult.
When the Chinese central government decides to act, it can do so swiftly, decisively, and effectively, as we saw in Wuhan. This benefited Hong Kong. The central government supported Hong Kong to effectively close its border with the mainland (beginning on 30 January and virtually complete by 25 March) – much too late, critics complained.
This action, with testing and quarantining new arrivals in Hong Kong, significantly reduced the risk of infection here. These actions were taken before community infection spread.
Hong Kong’s border with the mainland, policed by Hong Kong and mainland immigration and customs officials, is laid down in our constitution. Authorities in New York City did not (could not) close their border with the rest of the US, nor did they test and quarantine new arrivals to the city.
Other factors were also at play. Political leaders in the US sleepwalked into the pandemic, at first ignoring the problem although they knew about it. President Trump initially called it a ‘hoax’, and then denied that it was serious. New York City allowed community infection to take hold first before acting.
March 1 saw New York City’s first confirmed case, followed by a second on March 3, and from these the contagion spread. Only on March 6 did the mayor of New York order the extra equipment that health care workers needed, by then far too late. On March 7, the governor of New York declared a state of emergency. A shortage of tests and equipment characterised the period.
Political leaders in China, including Hong Kong, have experienced SARS, and were better prepared. Still, politics prevented them from taking early decisive action on the mainland and, thus, in Hong Kong. Hong Kong civil service-led government dithered.
With the threat clearly apparent, on 2-4 February hospital workers in Hong Kong went on strike to force the local government to completely close the border with the mainland, which authorities in slow motion eventually did.
On 25 January the Hong Kong government declared a state of emergency, and in subsequent days cut cross-border transport links, imposed various quarantine regimes on thousands of people, sent office workers home, and took other measures to stem the contagion.
This kept the number of cases down (although they are still growing) and significantly contributed to the lower death rate.
Hong Kong’s constitutional position as a local government in a unitary system played a key role here. The central government supported Hong Kong to close the border and test and quarantine relevant new arrivals. These were key decisions.
The US federal system has failed to support New York City. Rather partisan politics undermined the response to the crisis. In this case a city in a politically centralized unitary system outperformed a city in a politically decentralized federal system on one important performance indicator, the death rate from the virus.