Covid-19: Increased responsiveness helps South Korea legitimize authoritarian pandemic response measures

Covid-19: Increased responsiveness helps South Korea legitimize authoritarian pandemic response measures

Despite the South Korean government’s authoritarian Covid-19 measures that have sparked concerns over the possible violation of personal rights, no public protests against the government’s response have been witnessed thus ...

Covid-19 | Gender and ICTs in fragile refugee settings: from local coordination to vital protection and support during the Covid-19 pandemic

Covid-19 | Gender and ICTs in fragile refugee settings: from local coordination to vital protection and support during the Covid-19 pandemic

ICTs are changing how marginalized communities connect with each other, including those in fragile refugee settings, where ICTs have been used to share information and organize in collective enterprise. This ...

COVID-19: Should Europe embrace frugality?

The Covid-19 pandemic, emerging in the aftermath of the recent global financial crisis, could potentially further shake the confidence that Europeans have in their institutions. Rigid and slow decision-making processes and an excessive institutional reliance on super-specialisation and protocol-driven scientific evidence can at least partly explain why Europe finds it so difficult to predict disruptions and why it adapts its institutional machineries so slowly. Greater flexibility, including space for experimentation and improvisation, can help Europe to adapt more quickly to future contingencies, write Saradindu Bhaduri and Peter Knorringa.

Drawing of doctors wearing masks

Europe has offered a historically unprecedented degree of stability, prosperity, comfort and reliability to most of its citizens in recent decades. Many of its citizens have grown to take these benefits for granted, even when all this makes Europe a very high-cost economic system. Two recent disruptions, the earlier financial crisis and the Covid-19 pandemic, are unprecedented in the history of Europe, at least since World War II. The pandemic has caused more than 150,000 deaths so far, with a mortality rate in Europe far exceeding that of countries outside the continent. Potentially, these two events could shake the faith of people in the institutional mechanisms of the continent developed brick by brick over the last half a century, especially if such disruptions are expected to recur more frequently in the future.

Understanding the European system

Few would disagree that the present European production and innovation system, inter-country variations notwithstanding, relies extensively on the super-specialisation of work and an overwhelming reliance on strongly protocolised ‘hard scientific evidence’. Together, they are supposed to uphold quality and transparency in economic decision making, even at the cost of being expensive and sticky, i.e. slow in its ability to adapt to changing circumstances. While specialisation and protocols are in themselves indispensable and desirable elements in a modern economy, too much of it creates its own challenges.

In this blog we argue that the excessive institutional reliance on super-specialisation and protocol-driven scientific evidence in all its decision-making processes can, at least partly, explain why Europe finds it so difficult to predict disruptions and is not able to quickly adapt its institutional machineries in the face of a crisis1. A remedy in our view lies in reducing over-formalisation in its decision-making processes and creating more space for experimentation and judicious improvisation. These steps can help Europe to adapt quicker to future contingencies2.

A discourse which has begun highlighting the importance of such experimentations and judicious improvisations is the one on frugality and frugal innovations. They suggest ways to re-introduce such experimentations and improvisations in innovation processes to reduce ‘over-engineering’ and costs while maintaining basic functionality and affordability3. A concurrently emerging discourse on frugality in policy making emphasises the need for improvised decision making based on seasoned, practical, context-specific experience and the importance of ‘experimenting while deciding’4.

Does Covid-19 challenge protocolised hard evidence-driven decision-making?

Indeed, the pandemic struck, and struck hard while the system often continued to wait for a ‘formal go-ahead’ informed by ‘hard evidence’ to be gathered by ‘super-specialised’ actors and processes, to take policy decisions on (i) whether to test ‘asymptomatic patients’, (ii) whether ‘to wear a mask’, (iii) whether it is okay ‘to use hydroxychloroquine’, or (iv) whether ‘to impose a lockdown’. Waiting for ‘hard evidence’ has often been given a priority over also making clever use of readily available ‘soft evidence’ by seasoned practitioners, presumably also not to disturb the comfort of its citizens 5,6,7,8. Moreover, this denial to act upon soft evidence is not specific to the context of the current pandemic; it is rather the routine. Incidentally, later more systematic studies seem to validate the soft evidence of wearing masks, and practising social distance9.

Is the system adapting?

Going beyond ‘super-specialised actors?’

While Europe initially responded slowly to the arrival of Covid-19, we do now observe quite a few deviations from the routine reliance on ‘super-specialisation’ and formal protocols surrounding innovation, production, and validation. Such improvisations are particularly visible in products and services related to public health deliveries, arguably to ensure their timely and affordable access at the time of the pandemic. Examples include the open-source development of a ventilator, where so-called lay persons can also contribute and participate. Similarly, many informal organisations have sprung up across the continent to produce open-source medical equipment and protection gear for patients and healthcare workers10. These organisations are not taking the routine protocolised path of regulatory approval. Instead, in order to ensure timely affordable access, they are relying on the viewpoints of physicians and clinical administrators on ‘whether it works’ in the ‘actual’ environment of their use11.

Going beyond ‘protocolised’ hard evidence?

A sizeable section of physicians and clinical researchers of repute have vouched for including hydroxychloroquine (HCQ) in the treatment protocol of Covid-19 based, once again, only on soft evidence of clinical acumen, ‘prudent observations’, and targeted, non-randomised, small-sample clinical studies121314. While the opposition to rely on such soft evidence may be rational, the issue remains that we need fast decisions and therapies to deal with the pandemic, and ‘hard evidence’ of randomised controlled trials does not come fast, nor do they come cheap. Indeed, more than four months into the pandemic, we have conflicting evidence of its (non-) efficacy for advanced-stage treatment. While the WHO has stopped its randomised controlled clinical trial (RCT) citing ‘no benefit’[20], a recent ‘retrospective study’ by the Henry Ford Health System reports significant benefits.[21] For early-stage treatment or as a prophylactic, we are still guided by softer evidence of ‘clinical observations’ and ‘retrospective studies’15.

The evidence of low rates of mortality in places and countries using this therapy have triggered a diverse set of responses from scientists, politicians, and regulatory authorities16,17. Some of them have rejected it outright due to non-availability of ‘gold standard’ evidence from RCTs. Other responses have ranged from agreeing to conduct more elaborate studies (RCTs or otherwise), to continuing with the therapy based on ‘prudent clinical acumen’. Indeed, an emerging view in this context invites us to explore ‘doing while learning’ by integrating the urge of clinical practitioners to use untested therapies, while designing, if necessary, full-fledged protocolised clinical trials to evaluate efficacy of the therapy better18. These propositions challenge the sharp division of super-specialisations between clinical research and clinical practice: “clinical practice and clinical research are addressed by separate institutions, procedures, and funding”19. The crisis has underlined the necessity to adapt this structure.

So, is a new pattern emerging?

Many of the presently successful experiments can be defined as frugal innovations: they are affordable, retain basic functionalities, and are developed through extensive polycentric interactions, involving super-specialised experts as well as seasoned lay practitioners. Similarly, in line with the arguments of the frugality discourse in policy making, decisions are being made by localised, practical experiences of people in the field, focusing more on ‘what works’ rather than ‘what ought to work’, to ensure faster access to protective gear, medical equipment, as well as medicine therapies. Such a process of decision making arguably gives priority to arriving at ‘good-enough’, faster decisions, rather than waiting for a zero-error solution. Of course, we need to be careful here; most of these experiments show that results are contextual, local in their scope and feasibility, and difficult to scale up.

Still, an exclusive reliance on super-specialisation and protocols would hold fort only in an environment where lives and livelihoods are stable, prosperous, comfortable, and reliable. But now that the illusion of a zero-risk and fully controllable society is fading, we propose a more nuanced future orientation that creates space for experimentation and improvisation based on localised knowledges. Recent EU efforts to pay more attention to citizen science and frugal innovation, for example in a Horizon 2020 call, are promising stepping stones in this direction, i.e. to develop rigorous science that is also built on the bottom-up knowledge, practices, and the creativity of EU citizens. This will help make the society more resilient to future contingencies.

1. See for an elaborated account of Europe’s early response to COVID -19 ‘Coronavirus Europe failed the test’, Politico.Last accessed on 1 June 2020.
2. See ‘Better luck next time? How the EU can move faster when disaster strikes’,Sciencebusiness
Last accessed on 10 June 2020.
3. Knorringa, P., Peša, I., Leliveld, A. et al. Frugal Innovation and Development: Aides or Adversaries?. Eur J Dev Res 28, 143–153 (2016). https://doi.org/10.1057/ejdr.2016.3 . Last accessed on 1 June 2020.
4. Patil, K., Bhaduri, S. ‘Zero-error’ versus ‘good-enough’: towards a ‘frugality’ narrative for defence procurement policy. Mind Soc 19, 43–59 (2020). https://doi.org/10.1007/s11299-020-00223-7 Last accessed on 1 June 2020.
5. ‘Italy, Pandemic’s New Epicenter, Has Lessons for the World’, New York TImes, especially the section on local experiments. Last accessed on 1 June 2020.
6. ‘Report on face masks’ effectiveness for Covid-19 divides scientists’, The Guardian Last accessed on 6 June 2020.
7. ‘In one Italian town, we showed mass testing could eradicate the coronavirus’, The Guardian Last accessed on 6 June 2020.
8. ‘Up to 30% of coronavirus cases asymptomatic’, DW Last accessed on 6 June 2020.
9. ‘Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis’  Last accessed on 6 June 2020.
10. Digital Response to COVID-19Last accessed on 3 June 2020.
11. ‘Open-Source Medical Hardware: What You Should Know and What You Can Do’, Creative Commons
12. ‘Hydroxychloroquine for COVID-19: What’s the Evidence?’, Medscape Last accessed on 1 June 2020.
13. ‘Hydroxychloroquine prophylaxis for high-risk COVID-19 contacts in India: a prudent approach, The Lancet’. Last accessed on 1 June 2020.
14. See ‘He Was a Science Star. Then He Promoted a Questionable Cure for Covid-19’, The New York TimesLast accessed on 1 June 2020.
15. ‘Preventive use of HCQ in frontline healthcare workers: ICMR study’, The Indian ExpressLast accessed on 10 June 2020.
16. ‘A Look at COVID Mortality in Paris, Marseille, New York and Montreal’, Covexit.com
Last accessed on 10 June 2020.
17. ‘Coronavirus: How Turkey took control of Covid-19 emergency,’ BBC. Last accessed on 10 June 2020.
18. ‘Chloroquine and hydroxychloroquine in covid-19′, the BMJ. Last accessed on 1 June 2020.
19. ‘Optimizing the Trade-off Between Learning and Doing in a Pandemic’, JAMA network. Last accessed on 1 June 2020.

20. https://www.who.int/news-room/detail/04-07-2020-who-discontinues-hydroxychloroquine-and-lopinavir-ritonavir-treatment-arms-for-covid-19

22. https://www.henryford.com/news/2020/07/hydro-treatment-study

This article was originally published by the Centre for Frugal Innovation in Africa (CFIA). This article is part of a series about the coronavirus crisis. Read all articles of this series here.

Saradindu BhaduriSaradindu Bhaduri held the Prince Claus Chair in Frugal Innovation for Development and Equity (2015-17) at ISS (EUR). He is Associate Professor at the Centre for Studies in Science Policy, at JNU New Delhi, and the Coordinator of the proposed JNU-CFIA Transdisciplinary Research Cluster on Frugality Studies.Saradindu Bhaduri

Peter Knorringa is a Professor of Private Sector & Development at the International Institute of Social Studies (ISS) at Erasmus University Rotterdam. Since 2013, Professor Knorringa is the academic director of the Centre for Frugal Innovation in Africa (CFIA).

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COVID-19 | How COVID-19 exacerbates inequalities in academia

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The COVID-19 crisis has brought to the fore gendered and racialised aspects of precarity that were steeping in academia long before the virus emerged. The increased burden of unpaid care ...

COVID-19 | Ephemeral universalism in the social protection response to the COVID-19 lockdown in the Philippines

Since March 2020, the Philippines has implemented one of the world’s strictest and longest lockdowns in response to the COVID-19 pandemic, which has caused severe disruptions in peoples’ livelihoods. The government’s emergency social protection response, the ‘Social Amelioration Program’ (SAP), has also been notably massive, introducing one-off near-universal income protection. It is an insightful case given that the country’s existing social assistance system has been celebrated as a model for developing countries, even though it has been mostly bypassed in the emergency response. Moreover, the country’s highly stratified and fragmented social policy system has resulted in implementation delays and irregularities that have fostered social hostilities and undermined the potential for such momentary universalism to have lasting transformative effects.

The Philippine government first imposed its ‘community quarantine’ on 15 March, which has since been extended until 30 June. Thus far, the pandemic has not been severe relative to evolving global indicators, with 302 confirmed infections per million people and 11 confirmed deaths per million people as of 25 June (although at only 5,760 tests per million people, these confirmed rates are likely to be significantly underestimated). However, as elsewhere in the Global South, the lockdown has thrown the country into an employment crisis given that more than 60 percent of its workforce is informal, most in precarious situations even when earning above the official poverty line.

In response, the government rolled out the ‘Social Amelioration Program’ (SAP), comprising at least 13 different schemes and with an estimated total budget equivalent to as much as 3.1 percent of the country’s GDP [1]. The largest scheme is the Emergency Subsidy Program (ESP), which has been allocated 200 billion Philippines pesos (PhP; about 3.5 billion euros), more than three times the combined budget of all the other schemes.

The ESP was initially intended to cover 17.9 million households, while the other SAP cash subsidy schemes were to target more than 5.2 million individuals. Assuming that none of these overlapped (e.g. only one subsidy recipient per household), the SAP would have covered over 23 million households, or more than 96 percent of the roughly 24 million households in the country. This extent of coverage is effectively universal, representing an attempt to provide basic income support to all but the richest five to ten percent of households.

The ESP initially sought to provide cash transfers to low-income and vulnerable families during the months of April and May, the projected duration of the lockdown. The transfers range from 5,000 to 8,000 PhP per month (about 90 to 140 euros), depending on the minimum wage of the region of residence. This is notably more generous than the existing poverty-targeted conditional cash transfer programme, the Pantawid Pamilyang Pilipino Program (hereafter Pantawid), which provides families with at most 3,450 PhP per month (approximately 60 euros). The 4.4 million Pantawid families have nonetheless been included in the ESP and the amount they receive has been topped-up to the ESP amount.

Despite these ambitions, the SAP has already been faltering. Based on our research [2], a number of problems can be discerned:

Delays and backtracking in the distribution of the ESP. While the ESP was supposed to be paid in two monthly tranches in April and May, the first tranche was yet to be completely distributed as of 15 June [3]. It was later announced that the second tranche, whose distribution only began on 11 June, would only be distributed to beneficiaries living in communities where the lockdown conditions had not been eased – about 8.5 million families – as well as to an additional five million ‘waitlisted or left out’ families, or, as explained by the DSWD, those that did not make it to the list of first tranche beneficiaries [4]. It is not clear whether either of these numbers include the Pantawid households mentioned above or why there would have been ‘left out’ families from a programme that was ostensibly universal.

Vague and fragmented selection guidelines. In addition to this lack of clarity at the aggregate level, the guidelines in the selection of ESP beneficiaries have also been vague and fragmented, which subjects them to different interpretations and discrepancies on the ground. There is no single document that describes the process in detail or provides even an overview. The social registry that is used for poverty targeting in the Pantawid – the Listahanan – was not used for the identification the non-Pantawid families, who constituted 75 percent of the ESP target beneficiaries in the first tranche. Instead, the government reverted to reliance on village-level government functionaries, who have proven decisive in identifying ESP beneficiaries and distributing assistance. This has re-politicized the administration of social protection after years of supposed attempts at depoliticization by means of the Listahanan and the Pantawid.

Failed attempts at overcoming residualism. The SAP reflects an attempt to overcome the limitations of the country’s polarised and fragmented social protection system, even while this system has rendered almost impracticable its universalist impulses. The existing system notably excludes close to half of the population at the middle of the income distribution – often referred to as the ‘missing middle’ [5]. This refers to the 40 percent of employed people working in the informal sector who are not covered by the contributory social insurance designed for those formally employed, which covers about 40 percent of employed people, while at the same time they are not covered by the Pantawid, which covers about 21 percent of the population. The Pantawid beneficiaries are presumed to be the poorest people, although there have been serious concerns regarding its accuracy of targeting, meaning that it excludes many of the poor, while including many who are not (at least, not according to the poverty lines used by the programme) [6].

Social hostilities in the face of systemic confusions. The confused and fraught implementation of the SAP has therefore exacerbated fundamental schisms entrenched within the existing social protection system, including confusions about who is in fact targeted by the ESP and contestations by local government officials over the number of beneficiaries set for their respective cities or municipalities [7]. In particular, given the perception that Pantawid families are prioritised by the ESP (in the sense that they are automatically eligible for the programme), they have drawn public attention and scrutiny, even though they only accounted for about 25 percent of targeted recipients of the ESP in the first tranche. As a result, anti-poor sentiments have proliferated on social media since the distribution of the first tranche [8].

The inadequacy of celebrated models of poverty-targeted social assistance

These confusions and tensions show how the pursuit of genuine universalism within an existing stratified, fragmented and residualist social protection system presents major in-built challenges for advancing beyond moments of crisis. While the Philippines has been able to roll out a massive emergency social protection response to the COVID-19 lockdown, with near-universal coverage of possibly more than 90 percent of the population, reliance on the existing institutional infrastructure has had the effect of fostering social hostilities and potentially quelling support for such universalism among the population.

This is particularly significant given that the flagships of this infrastructure – the Pantawid and the Listahanan – have received huge support from international financial institutions and successive governments for 13 years prior to the pandemic and have been promoted as models up to the crisis, yet they have proven to be utterly inadequate for identifying systemic vulnerabilities at such a crucial time as the pandemic. The enormity of need engendered by the COVID-19 crisis evidently pushed the government to go beyond its conventional focus on poverty-targeted social assistance. As it scrambled to do this, it mostly bypassed the targeted system that had been so carefully groomed and adulated by donors, which has been neither fit for the purpose of actualizing universalistic aspirations, nor politically facilitative for their perpetuation.

[1] https://www.officialgazette.gov.ph/downloads/2020/03mar/20200328-JOINT-MEMORANDUM-CIRCULAR-NO-1-S-2020.pdf

[2] This work builds on our ongoing research that we have been conducting since 2015 into the political economy surrounding the institutional evolution of the Philippine social protection system, as part of ERC-funded research project entitled ‘Aiding Social Protection: The Political Economy of Externally Financing Social Policy in Developing Countries’ (grant agreement No 638647). Our current research on the COVID response has been based on deskwork ¬– by necessity given that all three authors have been in lockdown in Europe – and has involved the collection and analysis of official documents (including relevant laws, presidential reports, and other administrative edicts) and media coverage concerning the Philippine government social protection responses to the pandemic, and selective remote interviews with  social workers from the Department of Social Welfare and Development (DSWD) who have been involved with the COVID-19 response at various levels of government.

[3] https://public.tableau.com/views/SAPMonitoringDashboardforEmergencySubsidyunderAICS/Dashboard1?:display_count=no&:showVizHome=no

[4] See https://news.mb.com.ph/2020/06/11/1-3-m-4ps-beneficiaries-get-sap-2-cash-aid-reports-dswd/ and https://www.dswd.gov.ph/wp-content/uploads/2020/06/Annex-A.-Media-Based-SAP-FAQs-Part-3-ver-june-1-8pm-final.pdf

[5] Cf. Fischer 2018, 2020; ILO, 2017; Rutkowski, 2020.

[6] The rampant inaccuracies of the Pantawid are detailed in our forthcoming article currently under review. Also see Kidd and Athias (2019). 

[7] For instance, see https://www.rappler.com/nation/257316-reinstate-original-beneficiaries-metro-manila-mayors-dswd

[8] E.g., see viral posts on Facebook like this and this, and news reports like this.

This article is part of a series about the coronavirus crisis. Read all articles of this series here.

About the authors:

Emma CantalEmma Lynn Dadap-Cantal is a PhD student at ISS. Her dissertation is a comparative case study of the political economy of social protection in Cambodia and the Philippines, with particular emphasis on the role of external donor influences in shaping the social protection systems in these two countries.

Charmaine G. Ramos

Charmaine G. Ramos (c.ramos@luc.leidenuniv.nl) is a lecturer at Leiden University College, Leiden University, The Netherlands. Her current research focuses on analysing social policy and resource governance, as a means for exploring how political economy dynamics constrain and structure institutions for social transformation and productive expansion in developing economies.

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Andrew M. Fischer is Associate Professor of Social Policy and Development Studies at the ISS and the Scientific Director of CERES, The Dutch Research School for International Development. His latest book, Poverty as Ideology (Zed, 2018), was awarded the International Studies in Poverty Prize by the Comparative Research Programme on Poverty (CROP) and Zed Books and, as part of the award, is now fully open access (http://bora.uib.no/handle/1956/20614). Since 2015, he has been leading a European Research Council Starting Grant on the political economy of externally financing social policy in developing countries. He has been known to tweet @AndrewM_Fischer


Title Image Credit: Asian Development Bank on Flickr