What can differences in the effectiveness of various countries’ responses to COVID-19 tell us about the social and cultural determinants of pandemic vulnerability and resilience? What effects do differing degrees and forms of trust, solidarity, and social capital across countries have on their respective capacities to cope with public health crises and to put in place effective disease containment strategies? How can a deeper understanding of these differences help those in the fields of health policy, epidemiology, and disaster response to improve present and future public health outcomes?
In this first phase of our research for PATH-AI, we have been thinking a lot about the social, cultural, and political nuances of the public heath responses to COVID-19 in Japan and the UK. With the caveat that any international comparison is complex and requires equal measures of caution and contextual sensitivity, we think that a comparison between Japan and the UK can help inform answers to these questions. Japan has a population of 126 million, and (as of 28 November, 2020) has recorded just over 142,068 infections and 16.4 cumulative deaths per million persons due to COVID-19, while the overall death rate for 2020 so far this year is lower than in previous years. In the UK, with a population about half the size, there have been 1.59 million infections and over 847.8 cumulative deaths per million recorded within 28 days of a positive test for COVID-19, while the excess death rate so far in 2020 has been an alarming 18% higher than previous years.
Photo taken by Jérémy Stenuit.
The reasons for Japan’s relative success in avoiding high rates of infection and deaths have been the cause of much speculation, with commentators pointing to a range of cultural differentiators including less interpersonal physical contact, and high levels of hand-washing and general hygiene. But these analyses can seem superficial, and the image of Japan that emerges is often simplistic and occasionally essentialising, seeming to preclude further analysis or the potential to learn lessons from its success. The caricaturing view is of a socially and ethnically homogenous, groupist society moving in lockstep, with a frictionless relationship between government mandates and citizen compliance – a societal model that seems to hold little relevance to countries such as the UK. The reality is far more complex.
In its early stages, our PATH-AI research has been focused on interrogating what sociocultural characteristics can tell us about the resilience or vulnerability of Japan and the UK in the face of the challenges presented by COVID-19. Such characteristics include levels of trust in government, interpersonal trust, and social capital – the bonding and bridging relationships between people that enable a society to function effectively – as well as practical orientations to reciprocity, social duty, and civic engagement. If we consider trust in government, popular opinion in Japan has reflected high rates of dissatisfaction with former Prime Minister Shinzo Abe’s response to the pandemic despite the relatively low death toll. Abe himself was widely seen as out of touch and remote during the early stages of the pandemic, and was forced to deny claims that the government was intentionally understating cases in order to try to salvage the 2020 Tokyo Olympics when this still seemed possible. The outbreak of COVID-19 on the Diamond Princess cruise ship led to around 700 positive cases, and was widely perceived as mishandled. When broader policy action was subsequently introduced, it was criticised as incompetent, with inadequate levels of testing and hopelessly outdated infection reporting methods. Abe’s policy of sending two face masks to every household, at significant public expense, drew widespread ridicule. While the Japanese government has focused on the importance of a vaccine, it is also worth noting the central government’s history of supporting a domestic anti-vaxxer.
Photo taken by Kevin Grieve.
In the UK, things have not been much better. From the outset of the pandemic, the central government has been continuously critiqued in much of the media for its indecisiveness, opacity, public engagement deficits, lack of effective testing, tracing and tracking regimes, and politicisation of public health decision-making and messaging. Though these aspects of miscarried COVID-19 response can be seen as accelerants of waning public confidence in political institutions, the dynamics of distrust, in the British case, run much deeper. A broader crisis of public trust has tracked the decade-long rise of the so-called “post-truth” era. The increasing polarisation of society along socio-economic and political lines has developed apace in tandem with an escalation of the perceived and actual politicisation of science – both accelerated by the echo chamber effects of social media, which have also served as catalysts for misinformation and COVID conspiracy theories.
Longer term trends in the UK toward expanding wealth-poverty gaps, decreasing social mobility, and the siphoning of socio-political discontent into social media silos have created an ever more widespread ethos of societal distrust. The public’s withholding of trust in government is, of course, not necessarily always a bad thing. As we have seen so far in the pandemic, there is a need to be critical of rules imposed with an apparent dearth of evidence-driven forethought, little public consultation, and insufficient financial support for those negatively affected by them. This kind of critique is indicative of a salutary public scepticism that demands a continuous suspension of unreflective trust in government in order to strengthen the resilience, accountability and trustworthiness of public sector institutions. Where well-informed and wide-reaching, critical attitudes of this sort can bolster generalised trust among citizen through the airing of reasonable gripes and expectations. But deeper roots of societal distrust in socioeconomic precarity and polarisation have led, in the UK context, to an evisceration of this kind of generalised expectancy. When the affective appeal of misinformation and conspiracy theories trumps the motivating force of evidence-based reasons, and when practical thinking becomes predominantly atomistic and emotively charged, this ends up doing harm to the everyday truths and intersubjectively shared experience that might otherwise function as critical social adhesives during public health crises. A generalised loss of good faith in the actions of fellow citizens is a likely consequence.
The extent to which the impact of differing levels of both trust in government and trust between people within the UK and Japan accounts, in some way, for the fact that the COVID-19 attributed mortality rate in Great Britain is over 51 times greater than that of Japan is an important question, and it is one that our research has begun to broach. It is notable that, in Japan, public distrust of the government has, in both the past and the present, shown itself to be generative, stimulating alternative and compensatory forms of civic trust between fellow citizens. In the wake of the central government’s perceived poor handling of the Fukushima nuclear disaster in 2011, grassroots civil society groups sprang up in Japan to monitor radiation levels and to protest and force the closure of nuclear power stations. These manifestations of compensatory modes of civic trust are built on high levels of social capital, and the sense that other people in a shared society are also trying to do the right thing – even if the government is not to be trusted. While there may be little faith in the central government in Japan, there is a higher degree of trust in scientists and in the authority of their expertise. This is buttressed by generalised confidence in the capacity and motivation of citizens to follow scientific advice.
Photo taken by John Cameron.
In the COVID-19 context, these aspects of civic trust appear to have contributed to a widespread acceptance of science-led public health measures like mask-wearing and social distancing. They have also shone through in broadly adopted practices of so-called “self-restraint” (jishuku), which have allowed Japan, a country with few legal enforcement mechanisms to back up many of its public health measures, to rely primarily on people following its suggested guidance. Yet jishuku has also been critiqued as being socially coercive, mobilized by politicians but enforced by peer pressure, stigmatization, and bullying of people perceived as breaking with government advice or even of those who have tested positive for COVID-19. A top buzzword of 2020 has been “self-restraint police” (jishuku keisatsu), coined to describe those “policing” other people’s self-restraint – a contradiction in terms that seems to expose a flipside to Japan’s high level of generalised interpersonal trust, and that complicates our understanding of the societal operation of trust. The paradox of Japan’s widespread compliance with public health guidelines despite a lack of legal enforcement mechanisms highlights something about the way that trust – but also social coercion – operates in society. In Japan, the success of infection prevention measures has depended on people trusting each other to come together in confronting the novel coronavirus by their own rational, scientific, and solidaristic lights, but it has also relied on the subtle restraints of interpersonal policing.
In the UK by contrast, there seems to be far less civic trust, and jishuku does not exist in the British case in the same way that it does in Japan. Instead, in the initial stages of the pandemic, the key message of protecting the NHS was used to unite the country and to marshal social solidarity. This was highly effective during the first national lockdown. But as messaging changed in accordance with the shift in policy objectives toward restarting the economy and stimulating business, public health measures like local lockdowns and mask mandates seemed to grow less effective, leading to the necessity for a second lockdown as COVID cases continued to rise. The message of prioritising the NHS was replaced with one of prioritising commercial activity with new catchphrases like “eat out to help out” widely promoted; this and the mnemonic commands “hands, face, space” were far less motivating rallying cries. It soon became apparent that British citizens and subjects were not, in fact, “all in it together.” The disparate effects of the pandemic on ethnic minorities and vulnerable and marginalised groups became increasingly evident, amplified by the global anti-racism protests in June. Likewise, the gathering momentum of the anti-mask movement, anti-lockdown protests, and conspiracy theories about 5G and the global elite surfaced the high levels of polarisation and distrust of government that have characterised so much of the divisiveness of Brexit-era politics in the UK.
This ethos of distrust was only exacerbated by the top-down, “soft-paternalistic” public health approach taken by the government. Instead of supporting forms of public trust through community-involving social mobilisation, full transparency, and bottom-up public engagement, the UK government has often chosen a course of behaviourist nudging at scale, second-guessing public responses (as with the unattributed concept of “behavioural fatigue”), manufacturing and steering public sentiment, and hiding certain information (for example, the minutes and membership of SAGE, and the logic behind decision-making about when “the science” has or has not been “followed”). The nudge culture underpinning the UK government’s COVID response strategies has made it particularly vulnerable to post-truth narratives and conspiracy theories that posit a cabal of shadowy powerbrokers manipulating the public and “the science” behind the scenes. The politicisation of scientists has linked a significant part of their public credibility – and their authority – with that of politicians. In Japan, by contrast, the incoming Prime Minister Suga immediately sparked a bitter row and unusual levels of vocal public protest when he rejected the appointment of six scholars to a key independent science advisory panel, the Science Council of Japan. The separation of scientists from politicians has enabled the former to maintain their credibility and authority despite the perceived failures of the latter.
Photo taken by Ehimetalor Akhere Unuabona.
These preliminary observations have significant implications for the efficacy of different policy responses to the pandemic, as well as for the level of compliance with the current mass vaccination mobilisation. Above all, it is vital that we should start thinking now about how to rebuild and support forms of both interpersonal civic trust and trust in government as a public health priority in the British context. Part of this is about rebuilding the credibility of government and the trustworthiness of its policies through greater transparency in communication, less top-down manipulation and manoeuvring, and higher levels of perceived fairness (for example, ensuring that government officials and advisers do not break the government’s own rules). This could be facilitated by central and local governments supporting civic engagement initiatives, including public consultations and other modes of public participation that are listened to and given a prominent role. But we also urgently need to address the polarising engines of marginalisation and precarity, which are becoming worse in the UK with the end of the furlough scheme and rising unemployment rate.
As our PATH-AI research continues, and sharpens its focus on the role that digital technologies and AI are playing in these transformative sociocultural circumstances, both in state and corporate responses to the pandemic and beyond, we will zero in on issues of multi-level technology governance, on the relationship of privacy and trust in the context of health surveillance, and on the possibility for intercultural learning in the development of health policy that is more effective in mitigating the uneven damage to individual and community wellbeing done by the scourge of COVID-19.
