24 March 2020, COVID-19 Narrative Ten

By Dr David Nabarro, Strategic Director of 4SD, Special Envoy of World Health Organization Director-General on COVID-19 and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London


By Dr David Nabarro and John Atkinson.

COVID-19 presents us with a complex and rapidly changing environment. We see leaders’ positions changing by the day, not necessarily because they are making mistakes, but simply because the situation is rapidly evolving. How do leaders make sense of what is going on in the face of such messiness in order that they might make choices on policy and implementation that last? How do they get a sense of foresight that offers some comfort in the complexity that they are facing?

We think a critical attribute for leaders is their ability to learn fast, to learn well and to apply their learning wisely. Fuelled by a relentless curiosity and willingness to challenge and question, good leaders are ready to adapt and are constantly providing frames of understanding that help others to adapt as well.

We are sharing some of our learning in the current context, through the lens of our experience of trying to shape rapid adaptive change in different settings over the preceding decades.

Where the virus seems to explode within communities, what have we seen? In all cases responses could have been more rapid, robust and rigorous.  But delays do not mean that the people involved were trying to harm. In fact, quite the opposite. They were caught in a realm of conflicting information, responsibility and emotion that made robust forward-looking decisions really difficult.  Now leaders have more information that enables them to act wisely and with foresight.

Here are some of the factors that might have deterred them from instituting robust action at the start of COVID-19 outbreaks:

  • Some leaders have been anxious about being seen to over-react.
  • They have tried to maintain public confidence through not giving scary messages knowing they would need that confidence for later.
  • They have been unsure about how to mobilize support for dramatic interventions when the effects of the crisis were not apparent to the public.
  • They were cautious of acting on incomplete data.
  • They were anticipating clear guidance from higher authorities in order to not take unsanctioned risk.
  • They were anxious about acting outside their jurisdiction and formal accountability.
  • They do not want to become unpopular given their focus on opinion polls and ratings.
  • They are being faced with choices that challenged their values and beliefs about the world.

As a result, we saw leaders making choices that did not have the effects they intended. We have seen insufficient attention to ensuring unified action between national and local jurisdictions: sometimes responses have not been joined up.  We sense leaders trying to get a grip of their domestic situations before focusing on the regional or global challenge. This is all understandable.  But leaders of countries with early outbreaks will do well to learn what was done to contain outbreaks (in China, South Korea and Singapore) as well as what seemed to let outbreaks expand dramatically.  Applying these lessons reduces the load on health services and saves lives.

We must learn from our experiences not to blame but to do better.  We must learn fast because a rapidly accelerating global challenge, doubling in scale every three days, needs an urgent, connected and well led global response.  Nothing else will bring us all through without massive irreversible damage to the human fabric.   

Leaders are quick to realise that responding to outbreaks is complex and brings inter-related challenges. Responding to COVID-19 requires well organized public health services in communities.  That is where the war is most intense.  Without it, transmission cannot be broken, outbreaks cannot be contained, then suppressed.  If outbreaks expand, they quickly impact on society and the economy because there is a need for action to reduce opportunities for transmission.  That means physical distancing, and movement restrictions – to help people keep apart from each other – are vital.  Hence the need for aspects of life to change – fewer gatherings and meetings, more time staying put and avoiding contact with others.  This is not easy to implement as these decisions have unintended, if not always unforeseeable, consequences.

This is a complex situation, unprecedented and without parallel.   A global crisis.  But with every person acting responsibly and following the examples from South Asia conveyed in clearly communicated guidance stemming from the World Health Organization, the crisis can be brought under control, and life can return to a new normal, within months.   The alternative is unthinkable. 

So, now is the time for us to be led by those who are comfortable with offering direction and making sense in a rapidly emerging new situation. 

So, now is the time for us to be led by those who are comfortable with offering direction and making sense in a rapidly emerging new situation.  These leaders are everywhere among us, not just at the top of governments, companies or institutions.  They are to be found at all levels in communities, companies, counties, cities and countries. We recognize them.  They see a direction even amid complexity.  They are clear that they do not know everything and adapt to new information.  They connect with others and work through multiple networks.  They bring them along and help them to adjust quickly.  And they always remember that responding to complexity is – for all of us – a struggle with multiple stresses.  At times we cannot believe it, sometimes we are disoriented. We will be sad, angry, frustrated and fearful.  So, the leaders we need now feel as they speak, sense the multiple emotions, and communicate sensitively and with consideration. 

The leadership needed now requires rapid learning because everything is new.  Strategies are important: they show the direction and steps to take.  How can we help leaders come together and adapt their strategies in the light of such rapid and constant change?  We call it ‘Adaptegy’.  And it is the leaders who pay attention to multiple sources, including their critics and foes, who find themselves best able to work with others for effective action.  The best of them can help groups of actors adapt what they do quickly, seamlessly and in synchrony. 

We have seen how the countries affected by the 2003 SARS outbreak learned the lessons from that time. For COVID-19 they have acted swiftly, decisively and thoroughly, working rapidly to set up large scale testing, effective contact tracing, tough physical distancing regimes and community-based solidarity. In Europe where this learning had not been experienced and societal norms were different, more gradual responses have led to the European countries becoming the epicentre of the epidemic. Fast forward a few weeks and things look difficult for North America.

Leaders in countries yet to be as severely affected are deeply anxious. They can see what is coming at them and in many places, they lack the resources of the large, well-funded Western European health systems that are currently being overwhelmed. They wish to prepare but are lacking capacity. Acting early and thoroughly will be critical to establish the best possible public health responses.

So, there is another lesson that leaders across the world need to learn from our experience of previous epidemics. A virus such as COVID-19 has shown us quite brutally that in a global economy it has no regard for national borders. A global problem will require a global response and it is in everyone’s interest to look beyond parochial needs and think globally. The help and aid from China, South Korea and Singapore to Europe is our example to learn from. If we don’t, we risk successive waves of outbreaks around the world and into the future.

A virus such as COVID-19 has shown us quite brutally that in a global economy it has no regard for national borders. A global problem will require a global response and it is in everyone’s interest to look beyond parochial needs and think globally.

It is a requirement of leadership in this complex environment to take responsibility and to act with audacity and accountability. Regaining our equilibrium will require collective action if we are to minimise long term disruption. Particularly, leaders need to learn five things;

  • Learn that working in a complex environment means becoming comfortable with uncertainty. Linear models of causality do not resolve complex problems, they make them worse. Learn rapidly from history and reality, connecting to multiple sources of information to see the wider perspective.
  • Learn to work with amplification. Break patterns of activity that are rapidly amplifying things we don’t want such as chains of infection or unhelpful social behaviour. Encourage patterns of activity that amplify things we need such as telling the stories of the great things people are doing already to foster local solidarity.
  • Learn to provide frames through which people can see the events around them in a new light. Learn to constantly test these frames, adapt them as you see how people respond to them so that they connect with how people everywhere are making sense of what is going on in their lives. That way, they adjust their behaviour in ways that are helpful.
  • Learn to work through networks, directly and indirectly. To beat this virus, we can think like a virus in the way we infect people with our thinking, our understanding and our belief about what needs to be done. Find the super-connectors and messages that people relate to.
  • Learn that nothing happens in isolation, that health, social, economic and environmental systems are all entirely inter-related. Learn how changes in one affect all the others and use that for the best. Connected and seamless working is the only way to tackle existential crises.  None of us can expect to tackle this one alone.   

Above all we ask that as you learn, you learn to act with audacity and accountability.

Act, act now, act for everyone.

There are many great sources of advice for governments and healthcare systems and the people who work in them, particularly the World Health Organization website. This is the trusted source for clinical information. Please bookmark it and keep checking it as it is updated.

On 21 February 2020, Dr David Nabarro, Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London and Strategic Director of 4SD, was appointed as one of six Special Envoys to the World Health Organization (WHO) Director-General on COVID-19.

In this role, David provides strategic advice and high-level political advocacy and engagement in different parts of the world to help WHO coordinate the global response to the epidemic.

The COVID-19 Narratives are being written by David and peers to share with those who want more information about the situation and to help raise awareness and readiness of all actors.

Snapshot from WHO COVID-19 Situation Report – 63, as of 10:00 CET 23 March 2020

→ WHO Risk Assessment Global Level VERY HIGH
→ 332,930 confirmed cases (+40,788 new in the last 24 hours)
→ 14,510 deaths (+1,727 in the last 24 hours)
→ 3 new countries/territories/areas has reported cases of COVID-19 in the past 24 hours (Syrian Arab Republic, Grenada, Mozambique)
→ WHO has updated the Laboratory Testing Strategy Document (find all technical guidance here)
→ WHO Regional Office for Europe has published interim guidance on how to deal with COVID-19 in prisons and other places of detention
→ World Water Day celebrated the essential role of hand washing

1 Comment
  1. Totally agree with the 17 objectives of sustainable development and more,human capital to develop a new learning system to innovate in education and business, we ourselves are the cure , for having a good future.#SDGs #DecadeofAction #Agenda2030 #TeachSDGs #EliteSDGs #GlobalGoals


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