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The Role of the Administrative State in Times of a Possible Pandemic

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Teklemariam
March 8, 2020

When epidemiologist Abdel R. Omran first formulated the theory of epidemiologic transitions in 1971, it was linked to two main observed population transitions: 1) the distribution of a population from younger to older, and 2) the divergence of mortality rates and life expectancy relative to causes of death related to health and diseases. Omran’s proposition posits that mortality and disease patterns go through four stages: 1) pestilence and famine (i.e. dark ages); 2) receding pandemics (i.e. developing countries); 3) degenerative diseases (i.e. cardiovascular diseases and cancers); and 4) delayed degenerative & lifestyle diseases (i.e. diet and opioids).  

However, some medical analyst argue that the globalized world today is in fact in stage 5 of the epidemiologic transition, with possible reasons being attributed to either the evolution of microbes, poverty or increased connections. Perhaps the most convincing aspect of a global stage 5 of the epidemiological transition is the spread of the current novel coronavirus across the globe, which is directly linked to the interconnectedness of humans due to business, leisure, and generally increased travel across borders. No matter what stage we might be in at the global scale, one thing is for sure, how the administrative state reacts to a possible pandemic is essential for curtailing the possible deaths of hundreds, if not thousands of its citizens. How each country responds during each stage is a function of that government’s role as protector of its citizens, which is what Thomas Hobbs argued is the primary function of government.

While the first case of the coronavirus is believed to have originated in Wuhan, China in late 2019, at the time of this writing, the epidemic continues to rapidly expand with reported cases across 38 countries on every continent, except Antarctica. It has affected 85,000, and has killed 3,000 globally.

For public health administrators in the United States, as well as the global community, how governments are handling the crisis will be a study in contrast for many decades to come. For example, China’s early muzzling of information out of Wuhan during the early stages of the virus has been well reported, and it may have increased the spread of the virus across the globe. The unpreparedness of the Iranian government to deal with the outbreak due to limited capacity and not informing the public fully on the true scope of its spread has led to a wide number of infections and deaths.

In the United States, the slow process to create a complicated test for the virus by the Centers for Disease Control and Prevention (CDC), instead of the World Health Organizations test guidelines, has slowed down and led to loss of valuable time that could have been used to track its spread in the country. The limited number of testing in the United States had a to do with the disconnect between federal, state and local level officials ability to test and administer surveillance of possible cases; an obvious constraint of a federalist government. The central government of South Korea had tested close to 67,000, and Japan roughly 1,890, by the end February 2020. In contrast, the United States had tested less than 500 during the same time period. The ability and need to administer as many possible cases is evident when considering that in China’s Guangdong province, of the 300,000 surveilled and tested in fever clinics, about 420 were found to be positive cases. If you don’t look, you do not find, and that puts small and large communities at risk. 

So why does this all matter for the United States? Since 2018, the position for a pandemic specialist in the country was eliminated, as well as the senior director for global health security and biodefence, and the 2021 budget proposal includes a 16% reduction for CDC from the 2020 funding levels. In the wake of the current potential pandemic, the administration and Congress are working to authorize additional billions to supplement the funding. This is all good news, but can we as a developed society continue to wait until disaster strikes to catch up to the aftermath? In an era of extreme weather-induced disasters and an ever connected world that can lead to spread of new epidemics and pandemics, shouldn’t governments be using all their administrative capacity to mitigate, prepare, and respond to crisis?

If there is one thing that continues to become clear, it is that a deconstructed administrative state that curtails or eliminates its investment and role in public health and environmental crisis preparedness, mitigation, and response—and/or a top-down state that is willing to misinform or not be transparent to its public of an existing crisis—is one that will fail its citizens, and potentially its legitimacy. It is always easy to blame the bureaucracy in areas of superfluous mandates, however, the health of a nation is not one of them. Rather, this is one of its most important roles for its sustainability, if not to guard its own legitimacy and existence. Otherwise, one can imagine a stage 6 to Omran’s epidemiological transition, that which is one of isolation of nations due to never ending pandemics that are not controlled due to failure of states. 

Author: Nathan (Natan) Teklemariam is a third year Doctoral student at the L. Douglas Wilder School of Government and Public Affairs at Virginia Commonwealth University. Teklemariam is a 2018 ASPA Founders’ Fellow and a 2018 ASPA International Young Scholars recipient. [email protected]

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