Author: Benjamin Tak-Yuen Chan, Open University of Hong Kong
The COVID-19 pandemic has affected 187 countries and territories, with urban regions bearing most of the brunt. A staggering 60 per cent of all confirmed cases in China are in Wuhan and close to 35 per cent of US cases are in the state of New York. Metropolises generally register a higher caseload due to their large population size and density as well as the prevalence of testing.
This pandemic is being fought in urban centres across the world. In Northeast Asia, major Chinese cities with extensive international linkages like Beijing, Shanghai and Guangzhou together with Hong Kong, Taipei and Seoul have slowed the spread of the disease. Many capital cities in ASEAN countries continue to stay under total or partial lockdowns.
Asian countries’ responses to the pandemic have been mixed. Experiencing the SARS and bird flu outbreaks and being where two out of the four worldwide influenza pandemics originated, Asian metropolises are on the frontline and are natural testing grounds for innovative response measures.
A group of international public health researchers recently published a study calling for cities to invest in epidemic preparedness, quoting a funding gap of US$4.5 billion per year. This represents a good investment against projected pandemic costs of US$570 billion per year. It echoes the World Economic Forum’s suggestion of setting up a ‘pandemic preparedness index’ for cities.
The experience of Asian cities in containing the spread of the virus clarifies three salient issues: the importance of coordination between local and central governments, the key role of technology and the value of inter-city coordination.
Local and central governments are not always in step. Jakarta declared a state of emergency two weeks before the Indonesian health ministry sanctioned large scale social restrictions. Major Japanese cities like Kyoto and Nagoya, which were not included in the first round of the national state of emergency declaration, appealed for an extension of the emergency to their cities or declared one themselves.
Public health concerns and economic considerations do not always align, particularly in capital cities which are centres of economic activity, which can lead to central governments overriding local ones in pandemics. Tokyo’s business closure plans were tempered by central government pressure, as urban leaders had insufficient authority to institute their preferred response measures.
Japan typifies weak central coordination, leading to calls for it to emulate the central coordination model. The successes of central coordination models in South Korea and Taiwan in fighting the COVID-19 pandemic have overshadowed countries with weak central coordination, like the United States, where city and local governments have been forced to step in.
Technology is also a vital part of an urban pandemic preparedness plan. It has been utilised to track COVID-19 carriers, reduce transmission and deliver essential items.
Capitalising on the ubiquity of smartphone usage, local governments in South Korea employed an emergency messaging system to warn citizens when they come into close proximity of a confirmed case and inform them about the development of active cases. Cities have used robots to disinfect, monitor temperature, deliver goods to households, communicate with patients and elders in isolation, remind people about social distancing in public places and enforce lockdowns in the streets. Drones have been used to dispatch medicines to vulnerable communities in Ireland and were used in Chinese cities for transporting medical samples for coronavirus tests.
Asian cities can learn from one another to improve their responses to COVID-19.
ASEAN countries are moving towards a common action framework by setting up a COVID-19 response fund and by sharing information. It is essential for city and local governments to get involved in these collaborative efforts through platforms such as the Asian Mayors Forum, the ASEAN Mayors Forum, the United Cities and Local Governments Asia-Pacific and the World Association of the Major Metropolises. The issues confronted by cities are unlikely to be given enough attention at the national level, making such forums vital for metropolitan pandemic responses.
Even with an effective central coordination model in place, city leaders are indispensable. They are the ones to set social distancing guidelines, regulate civic activities, ensure food security, provide essential services, recruit volunteers, take charge of risk communication, allocate health resources locally and coordinate disaster management within their administrative boundaries. Public health researchers have found that a whole-of-society approach involving the state, local government, non-state institutions and the public is better than the traditional state-centric epidemic response. The success of South Korea is an example of this.
City officials must learn quickly about public health and emerging technology. They must plan, conduct risk assessments and mitigation strategies from the smart city concept and leverage technology to share data with neighbouring cities. Investing in the enhancement of local capacity and infrastructure to gather local disease surveillance data can assist national-level strategies. Robots and drones are particularly helpful in addressing the challenges of implementing city-level responses. The adoption of these technologies is generally within city officials’ authority unlike tracking apps which rely on national-level data and involve national legislation concerning personal privacy data protection.
The 2019 Global Health Security Index produced by Johns Hopkins University ranked countries on their pandemic preparedness. Yet the index and its metrics have been proven lacking during the COVID-19 crisis. The call for action within Asia must therefore be supported by locally relevant research that translates into meaningful strategies for deployment in Asian metropolises.
Benjamin Tak-Yuen Chan is Dean of the Li Ka Shing School of Professional and Continuing Education at the Open University of Hong Kong. He is a Fellow of the Royal Society for Public Health.
This article is part of an EAF special feature series on the novel coronavirus crisis and its impact.