On April 10th, 2020, the Building State Capability program at Harvard University hosted our third virtual discussion with Prof. Matt Andrews, who answered audience questions on Leading Through Crisis.
Read BSC's Public Leadership Through Crisis blog series: https://bsc.cid.harvard.edu/public-leadership-through-crisis
Leading Thru Crisis event April 10, 2020
Katya Gonzalez-Willette [00:00:04] Hello and welcome to Building State Capability at Harvard University's Podcast Series. On April 10th, 2020, the Building State Capability Program at Harvard University hosted a third virtual discussion with Professor Matt Andrews, who answered audience questions about leading through crisis.
Salimah Samji [00:00:25] Thank you. So, Matt, let's begin with some introductory words first before I ask you the questions.
Matt Andrews [00:00:31] Hi, hello. Nice to see everybody.
Salimah Samji [00:00:34] Great. So I'll start with the first question that we had in the chat window from last week. And the question is - How do you best gain community buy-in to a response strategized and enforced by institutional and government actors?
Matt Andrews [00:00:50] I think it's an important question. But my belief in governance generally is that you want community buy-in to things because you're serving your community. I'm hoping that Mark Moore is going to join at some point in time because I was having a conversation that was kind of similar to to this with him the other day, talking about organizational structures and the idea that in a crisis you have a threat to the collective group. And so the interests of that collective are why you're doing this. So the interests of the community are the reason why you're mobilizing and why you're acting. So you really need to engage the community. And the first thing I'd say is you need to engage the community not only as recipients of what the government is doing, but as the sources of information as to what the threat looks like and how the threat is impacting people. So there needs to be a two way engagement here. And actually I'll say three way. In one way, we are kind of trying to work out what to do for you in the community as the government. We also trying to listen to you to find out what is needed. And governments frequently do that very poorly, just to say. And in times of crisis, I think you see governments do that even worse than other times because they think that they need to act quickly so they can't possibly engage with citizens and find out what citizens and communities are talking about. So the first thing is we're doing things for you and we want to do the right thing. The second is we are listening to you and we want to hear properly so we can know what to do and also so we can bring you in. The third thing is that you want to mobilize citizens. Citizens are an important part. Community is a part of your capability. Right. So, you know, one of the things we've been saying along is that government structures are probably not going to be enabled at this moment. You're gonna have to find new capability, and capabilities or new abilities authorized in different ways and empowered in different ways to be mobilized. Now, your citizens and your communities are gonna be a key part of your community. So it's not only that you're going to act towards them, they're going to act towards you. You're gonna have to mobilize them in this crisis, for instance, to do contact tracing in every place where you see contact tracing working. The contact tracing is done through communities. In the aftermath of terrorist attacks, which are another kind of crisis, communities are often mobilized to be the eyes and ears of security forces to determine if there are any other threats. So communities are very, very important. You think about how communities get mobilized in other natural disasters to help with cleanup, etc.. So you have to work out how to mobilize those communities. Now, how do you do that? As I said before, governments are not very good at this. Yesterday I was actually having a conversation with Penny and Tim and we were talking about potentially what kinds of changes might governments undergo through this that I would hope would be permanent. And one of them would be governments need to talk to their people more. And what I would say is when you're creating this organizational structure, this snowflake that we're thinking about, make sure that in your snowflake you include community groups, make sure the you include community representatives, whether they are at the beginning from chambers of business, whether they are from religious groups, whatever, whatever, bring them in. When you bring them in, you're not only bringing the individual in as a representative, you bringing them is as a connector. You want them to connect you to their communities. Very, very important in Peter's interview that went up this week. You'll notice that we talked a little bit about communities and communities and communication. And one of the things that he was stressing was all countries have got organic communication processes that work through communities. Sometimes these are going to be through religious communities. Sometimes they're going to be through unions, sometimes they're going to be through other organic mechanisms. And what you want to do in government is you want to start to map those out. You want to start to think about how are people influenced, how are people engaged? How are people connected? What are those mechanisms that exist in my society? And you want to piggyback on them. Now, all I'm saying here is is different. Everything that I'm saying is quite different for many governments, especially if you're overly hierarchical, you don't want to shift, you don't want to change, you don't want those structures to be invaded by communities. But what we're saying here is that in a time of crisis, you have a sense of urgency and new things might be possible. And if there's one new thing that you really do, it would be engage with your community so that you can hear from them so that you can mobilize them. Very, very important. So those are some of the mechanisms. Bring them on to your teams, bring representatives onto your teams, map out what the existing structures are, and then try to go to flow into those structures. I hope that that answers the question.
Salimah Samji [00:05:21] Thank you. The next question that we had from last week was - Given how long this crisis is expected to last, what advice and strategies would you recommend to prevent burnout among leaders?
Matt Andrews [00:05:36] So that's a really, really, really important question. And actually from our first webinar a couple of weeks ago, I said, if anybody wants to help, put your hand up, sent me an email and one of the people is actually doing a PhD on precisely this topic right now. So next week, I'm going to be doing an interview with him on what would his ideas would be. I don't have great answers to that question right now. It's what I'm looking for. Right. Let me give you the answers that have come out of the interviews that we've had. So one of the interviews with Shruti Mehotra, where at the end of every single interview, the question that I'm asking people is, "What would your advice be to people personally to look after themselves to run the course?" And Peter is on and I'm going to ask him in a second what his thoughts are. But Shruti basically said her first answer was, "I did not do a good job of that." And I think that I would say for everyone that is aware, if you think that burnout is something to worry about, but maybe not for you, think again. You do need to be very careful about this. She mentioned sleep. She said you must make sure that you sleep. She said make sure that you eat well. Try to make it so that you are not working all the time. One of the things that you might want to do is you might want to have shifts. So people are working for eight hours on, eight hours off, whatever that may be, because you're working 24 hours at a time. When Hamad AlMalki, who is doing this work right now in Bahrain, it was interesting when I asked him that question. His first comment was sleep. It sounds like a very simple thing. But, you know, one of the things we find is that oftentimes people who are especially supervising the process, they constantly want to be in the action. I think in a place where you're seeing a significant amount of hurt and a significant amount of distress. And I think of the idea of taking time out and actually sleeping is something that might almost seem anathema at this time. It might seem something that you can't do. Everyone that I'm speaking to is saying do that. You must sleep, you must pace yourself. I would also say that people who are in the decision chair, you are not meant to be acting. So those people who are making the decisions, they are meant to be quiet. They mean to be preserving that decision making muscle. Don't overwork yourself in other areas. Look after yourself. Hamad also had some very good ideas. He said you really should get a little team around you that you can express your pain to. And he said in his words in the interview, he said, you need people that you can cry with because you need to cry sometimes. And I think sometimes it's sort of raw exhaustion and sometimes it's sort of what you see and what you're engaging and just you're seeing very, very difficult things. You're engaging in very difficult things. This is an abnormal time and the time of crisis is always abnormal. Make sure you have people around you that you can engage with. He also said you need to engage with your loved ones. And I think that he is in the middle of this. And I would encourage everyone go and read, go and listen to him, because, you know, we had this interview last week there in the middle of this in Bahrain. He said this is really hard because, you know, his parents. They can't see them. You know, we're separated from them. And if you are on the frontlines also and you're in a public health crisis, you can't be seeing everyone all the time because you are at the frontlines. So he said if you're there, you need to master technology very quickly so that you can connect with your loved ones. But Pete joined us and you also answered this question, which is kind of how do you look after yourself in this case? How do you make sure that you don't burn out? And I think the question is particularly important, because this is going to be a marathon, we are in the early stages now. I think that compared with many crises, this is so full of unknowns, even the unknown of kind of like how long do we need to kind of be separate? I think, you know, people are still revising that all the time. thinking about kind of how we get out of this into the next phase, not into normalcy, I think is difficult. And then I think that thinking about the economic impacts, this is going to take a long time. There's going to be a huge amount of uncertainty that is going to be very, very difficult to manage. So how do you think about that burnout? Pete?
Peter Harrington [00:09:33] Yeah. Hi, everyone. Thinking back to when we had our conversation, Matt, I think I agree with everything you said that your colleague from Bahrain said about really having people around you that you can share with them and be supported by and support. I mean, the other thing that I think I've been reflecting on, because it's taken me back remembering what the Ebola situation was like. I think it's really important just to recognize the psychological and emotional effect that being in the midst of this crisis has. I think even just really noticing and acknowledging it is extremely important. So we all get very pulled into the kind of day to day, the firefighting, you know, the business. But this whole situation is incredibly new for everybody. One of the things that was really striking about Ebola, which reminds me of today, so I'm in lockdown solo, and many of you will be in lockdown with loved ones, with family. But for those people who are solo, this is reminiscent of Ebola or even if you're not in lockdown solo, human beings are really social creatures. And just that thing of not having any physical contact with people that you would normally shake hands with or clap on the back or hug. It may be that you're continuing to do that with family, but even outside your house, if you know in your work, this is deeply alienating. On a very deep emotional level for us as humans. And I think it's really important to acknowledge that and recognize that. And think about, spend a little bit of time reflecting on what that does and trying to work a little bit harder to keep those human connections, because these are really unspoken, intangible things which are almost in our deep in our kind of reptile brain. You know, these aren't terrible things that occupy our minds in the way that the crisis occupies our minds at that deeper emotional level. The effect this has, I think, is really important not to forget about that and to not let it, even though it's quite alienating, to try and sort of compensate for that a little bit in the way you interact with people and the way you direct care towards yourself.
Matt Andrews [00:11:26] Peter, thank you for sharing that. And I'm going to call you afterwards, my friend. We're gonna talk about rugby or something completely innocuous. But Harry is the one who put his hand up and said he's doing this PhD. So, Harry, what ideas do you have for people managing burnout.
Harry[00:11:39] So the most useful model that I've come across is called the Job Demands Resources Model and saying job demands are the things that stress you out. And job resources are the things that engage you in your work. Can you make those balance or can you have the resources to compensate for the job demand? So question one is, can you reduce or rework the demands that are on your whoever it is - your doctors, your social workers, whoever? Maybe you can maybe you say we can't. We're in the middle of a crisis, but it's probably worth thinking, like, are they the right demands that are being put on them? Like if a doctor is ending a shift, really stressed. Is it because they had to see 80 patients? Not a lot we can do. Or is it because they had to spend like 20 minutes trying to make the photocopier work? So just hearing from them like what are the things that are stressing you out? What can we do about that? And then the flipside is we know that good resources buffer the effect of stress. So you can be in a high stress situation. But if you feel like you're in a really good team and being ready when looked after, actually people manage that. They don't burn out and they they sort of thrive. They do their best work at that point. So if we're saying we can't do anything about the demands, we can't take anything that we want away from people, what resources can we provide them with? And some of the resources that seem to be really, really important, one is social supports or feeling like other people have got your back. Another is giving people like feedback information, making sure that they understand what's going on. Another is giving them a sense of control, so like are there more decisions that you can devolve and obviously this is the kind of thing you'd be saying anyway, Matt. Another is like a sense of meaning or full of appreciation. So is it like if you're you're giving hospital patients their discharge papers, is there a slip at the bottom you can just tear off and say thank you to the doctors and things like that. And this is another thing that like, oh, it has to be social support, it has to be control. But a collection of those things seems to really help people to manage their demands. So the question I'd ask is, one, can you shift or change the demands? But too, can you provide people with more resources and a really light touch, easy way to remind them why this matters and help theem to keep going.
Matt Andrews[00:13:38] Wonderful. Thank you. That's great. I think that a lot of it comes down again to the organizational structures that you have and how you move those organizational structures. One of the things to clear also is when you are moving people into your crisis management structure, make sure that you don't also require them to do their usual day job. And that is one of the areas that we often see is that, you know, people are put into this kind of 24/7 crisis response, but they still have the other boss saying, by the way, we need this, this or this, or can you send this email out? No. You need to move people over. You need to give them clear tasks, but you need to manage what those tasks are. And I think it's important even the idea of putting people on shifts is a little bit of this. You're gonna say, "OK, you're gonna be working for eight hours. At the end of eight hours, you stop, someone else takes over. Maybe there'll be a 20, 30 minute rethink period. But at that point, we want you to go, right." I think that they're are a lot of ways of structuring the work and then structuring the support. And I think those were great ideas. Harry, thank you very much. When you listen to Hamad what was interesting to me is I said, "Tell me, what do you need to do to manage this?" And he said, sleep. He said he has a story. He said early on the crown prince came to me and he said, "Are you sleeping?" Now, the crown prince is like the president of the country, but probably just more important if you're from Bahrain. So it's really important also that the people who are in leadership are the ones who are telling their people to look after themselves. So if you are in leadership, make sure you're one of those people. If you know people in leadership, advise them that they need to be the ones who are reminding their people to look after themselves because they may not do it on their own. They may not feel that they have the permission or even the right to. They are in this situation. You need to regulate their work for them. Thank you, Heidi. That was great. Thank you.
Salimah Samji [00:15:27] The next question we have is - Usually pandemics last for years. We cannot have highly restrictive government measures for too long. Already the economic damage has been huge. What would the governments likely to be doing after the current rounds of lockdowns and restrictions to tackle this?
Matt Andrews [00:15:46] So my answer to that is - there's just a gigantic amount of unknowns here right now. There's a lot of countries that I think are thinking about this. You know, people are saying, how long is this going to last? When is a cure going to come in? There are many, many questions. I do think that some countries are experimenting with this. And one of the reasons why I put the Bahrain example up is that Bahrain is experimenting with an approach where they suppress for two weeks and they release for two weeks. They suppress for two weeks and they release for two weeks. And it's an interesting approach because part of their rationale is we are not completely sure how long this is going to be. And we don't want to get ourselves stuck in a place where we can't be open. Now,they got it early. They started three weeks before they had their first case, so that when they had their first case, they could very effectively track every single case. And I think that what you are going to find in most places where there is an effective medical response or public health response, it's going to not only be treating people, it's going to be developing information systems whereby we know exactly where people are. We know we can track those people. And there's a way in which we can isolate people who have this. And I think that that's going to be a very important part moving ahead. I think the question of kind of when do we be open is one that is everyone is thinking about. As I said, the Bahrain example is we don't want to fully close. We'd rather be closed for two weeks, open for two weeks, closed for two weeks, open for two weeks. I think they also feel that that kind of model is something that they can work around. From a public resource perspective, thinking about things like subsidizing pay, subsidizing small business, etc. But I also think the thing that is powerful about it is that helps people manage the uncertainty of the situation. They kind of know how things are going to be. Now it's an experiment. So let's see how they do, I don't know. Other places, I think, are thinking about opening their economies in waves and perhaps moving to I know that there is some thinking in Pakistan at the moment from some thinkers, I don't think it's in the government yet, of potentially structuring the country where you will look at where the outbreaks are. You will look at where the hotspots are. You will look at the vulnerabilities of different hotspots and you will basically give each place a different rating. Again, this is very information intensive. You need huge amount of information and you will open some places, close other places.
I think other places are thinking about just kind of like extend the lockdown for a period of time and then have one grand opening. Here's the thing. We don't know. We don't know. We don't know. And one of the things that I think that as policymakers we should resist is we should resist pretending that we do. The only thing that I would encourage everybody is to reach out immediately to the people who are most affected and who we are most worried about through this crisis. So, you know, if you think small business is going to need a lot of help, instead of sitting in your office and determining a support program to small business, get on the phone and ask small business what's going on. Ask them how long they can manage. Ask them how connected they are to the people they hired. We don't know if people who have been laid off are still in the minds of small business people. And what they are looking for is just when the day opens, we are going to rehire them again. The one thing I can say for sure is that small businesses, big businesses, medium sized businesses, community organizations are thinking as hard as any policymaker is about how they are going to come out of this. So this comes actually back to the early question, which was kind of mobilizing your community. Policy should not be developed by a set of policy makers who are not communicating with the community. Get people on the phone, find out what their ideas are. Mobilize those ideas as much as you can. Because when we come out of this, we are going to need to experiment with lots of ideas. And those need to come from lots of places and they need to be done by lots and lots of people.
[In an interview with Mark Moore, Mark was saying we need to resist the urge to have one big answer and we need to resist the temptation to think that chaos is bad. We don't know how to come out of this. So there is going to be some chaos. What we need to make sure of is that the chaos is a lot of different people working to do what needs to be done or what they think needs to be done. And if we can energize a lot of actors in a lot of action and we can make sure that those people, when they bump together, say sorry to each other and then carry on their way. And I'm channeling Mark when I give you it's fabulous. That action, that activity, that noise will generate the ideas and will generate the solutions. And he uses the example of an anthill. And he says when he was younger, his father knocked over an anthill and all the ants went crazy and it appeared that it was complete chaos. And he said as an organizational scholar, he looked down and he said those ants could do with some coordination. He said he came back a couple of hours later and everything was sorted out and the ants were completely gone and they'd moved to a new house. And he said all of that craziness of this ant grabbing this baby ant to this ant grabbing that baby ant then scurrying away and bouncing over each other, it looked like chaos. But what it was, was urgency. And he said that the combined urgency of many people basically is what we need right now. It's that energy, because that is what's going to show us how to get out of this crisis. This is not going to be a designed exit as much as we want or designed movement towards something new because we don't know what nothing new looks like. This is going to be a structured release of energy from lots of actors, allowing those actors to try things and then see how that works. That's my view. That's my opinion. But what I've been saying is we don't know anything. So that's my opinion based on how I think you need to get out of deep states of uncertainty, which is I think where we are in thinking about getting out of this.
Salimah Samji [00:21:39] With that, I'm going to open it up to everyone of you who is here, if you have a question or if you just want to share how things are going on, I know many of you are in different parts of the world. If you just want to share your experiences of COVID, how you're coping. A comment is totally possible as well. You can either raise your hand through zoom or you could just if your video is on, you can physically raise your hand. Allison would you like to ask your question, please?
Allison [00:22:05] Sure. Hi, thank you for welcoming me. So I'm in Massachusetts and there is concern that there's a significant drop in people who are experiencing partner abuse, domestic partner abuse reaching out for help. And it's mainly because oftentimes the way somebody would reach out for help is when they're on the way to the store, on the way to work. And instead, they're actually having to shelter with their abuser. And there's also been a marked decrease in reports of child abuse in Massachusetts, because those people who would otherwise have noticed - teachers, faith leaders, physicians are not seeing the children. And we heard a really compelling our Lieutenant Governor had a press conference yesterday and she actually spoke to people who are coping with violence. You know gave strategies for how to reach out for help. If you are having to deal with it and it was a really powerful press conference. But I just wondering, you know, for those folks who are dealing with real violence, how do you Matt or someone suggest getting their input into how to keep them safe?
Matt Andrews [00:23:03] Allison, I mean, if anybody else has any views on this, any ideas, please put your hand up. And we'll I'd love to get your thoughts on this, because I do know we have people on the line who are working in areas of kind of social service of different varieties. I know we have people who are working with elderly who are also kind of a vulnerable community in the sense and people who are working with the homeless, who I think they are also a lot of concerns about those communities being kind of abused and put in very, very compromising situations right now. So, you know, if anybody does have any views, please put your hand up and we'll come to you. I'm not an expert on this so I really wouldn't want to speak about it because it's a very serious issue. I do know that it is one of the issues that I have been kind of looking at from early on to see how different places are doing things. I watched on a tape the Lieutenant Governor speak yesterday, and I would say to people, go and see that, because I think it is full of good ideas. I do know that French authorities early on created and communicated a mechanism to people specifically suffering domestic violence. They developed a sign that people could use if they went to pharmacies or to grocery stores. So if there's someone who is suffering from domestic violence could go and they could ask a specific set of questions of people in those stores and that would signal that there is a domestic violence situation ongoing. So I think there are people who are thinking of ideas. I think every single idea is going to have problems to it. And, you know, if you're not going to the store and if you're in a domestic violence situation, you know, your partner may not be allowing you out of the house. I also do know that in some school districts in Massachusetts, because that's where I am, and I'm in touch with some school district commissioners. They have been working really hard with the teachers to identify lists of students that the teachers feel may be in compromising situations. And I think, you know, what you do find is that when people have been coming to schools for periods of time, I think teachers do get a sense of the students who they are worried about. And I think what they are doing is they are creating those lists and then they are trying very hard to engage with those students. So I know in one school district, for instance, they are still doing school lunch deliveries. And what they are doing is that they are making sure that those deliveries are actually going to the house itself. And so obviously there is a physical distancing. So they are not handing it straight to the kid. But I think in some cases they are making sure that they see the child physically collect the meal when the meal is being delivered every day. So there is at least some way where they are creating some avenue for at least information about the well-being of that child. In others, I think they are communicating with the children directly more through telephone, through whatever it can be. I think these are difficult times. And again, I think this is a time where what we want to do is we want to swarm the world with ideas on how to deal with these issues. We want 100 ideas and we want to try all of them, because that's the only way that we found a good one. But, Alison, it's a very, very difficult question.
Matt Andrews [00:26:03] If Susan had anything to say about the domestic violence situation and how to think about that.
Susan [00:26:08] Yes. Thank you very much. And I spent a couple of decades prosecuting elder abuse at the Department of Justice. And so elder abuse at that time is obviously really, really a critical issue. So I think there are many components to how to handle this. One is, you know, anybody who is experiencing elder abuse in any states can call adult protective services. In addition, the Department of Elder Justice Website has the ability to find the information and report ,that assumes that the person can actually, you know, make the call eventually. Also they have a screen over the safe screen where you can actually move quickly off that screen. If somebody comes in the room, I think the big issue, though, in order to encourage people to report. I mean, the bottom line is folks are not reporting that much as it is prior to COVID-19. I think one of the critical things is having enough PSAs and no wrong door information to identify what's going to happen after you report? So part of the fear is, oh my gosh, here we are in the middle of it, and if I report, what's going to happen to me? So the idea of giving people the information of where to report and confidence that there's a shelter and a place to go to get them out of the situation.
Matt Andrews [00:27:15] Great. Wonderful.
Salimah Samji [00:27:16] I wonder if Hassan can actually ask his question because he had put it in the chat window.
Hassan[00:27:22] Right. I'm in Singapore and work for Save the Children. So for us, the big worry is what's going to happen with countries like Bangladesh, Afghanistan, Pakistan or sub-Saharan Africa. They already are dealing with very fragile economies. At the same time, if this thing grows they cant.. those governments have very limited capability and capacity to deal with this. And if the outbreak goes beyond their capacity and also the measures to contain it become economically not feasible for these countries. So then they are in a very impossible situation. We are seeing different responses from different countries. So I think it would be good, too, if you could share some thoughts on what policy options these countries have. Should they just let the virus spread as much as it can and focus on economy or forget the economy and then focus on containing the disease?
Matt Andrews [00:28:24] So let me get my thoughts on this. I think that there's two important questions and they're related. One is - given that we haven't seen the same impact yet in the developing world as we have in the developed world. I don't know, North-South, whatever you want to do. Right. There's no good way to speak about those two different places. But this is where the question is, what does that mean? That's the first question. Does that mean that this is a developed world pandemic? Could be that there's a warm climate, cold climate thing. Not really sure about that. It's happening in Australia. It's happening in Singapore. Not really sure. And I think, again, I'm not sure. Is it because, yes, maybe there are some of the treatments for things like malaria have helped. I don't know. It could be. Is it because the degree of globalization is less and what you do find in the early stages at least is this is a pandemic that was flown into countries. this flew into countries. So then the internal transmission then began. And that's when you get into trouble. Is it possible that because many countries in Africa, even Latin America, even South Asia, to an extent, or some regions might be less globalized, less connected, that it took longer for the virus to get across their borders? And so then when they started to close things up that actually they stopped the spread, that could be the case. Is it possible that we're not testing so we don't know? It's so difficult to know. And one of the things I would also say is in many of the countries, you know, people are dying of all sorts of things, whether it's Tuberculosis, whether it's HIV, whatever it may be. And we could start to see in a year's time that the death rates in respect of those things starts to grow. But those people are out in rural areas or we just didn't catch it. So the first question is kind of is this something that really everyone should be worried about? Because maybe it's kind of, you know, this is a rich person's disease. I don't know. My answer to that is what we are seeing in places where this is going out of control, that it isn't just a public health thing, it's a gigantic economic catastrophe. I was listening to Julia Frank yesterday, who is the former Minister of Health in Mexico. He was the former Dean at the Harvard School of Public Health and currently the President at Miami, University of Miami. And Julia was saying, you know, it's a false tension between public health and economics. He was like, you know, the number one reason why people suffer from bad health outcomes is because they have bad economic conditions. And the number one reason in every country that countries go through bad times is when people actually are not healthy. So these things go hand in glove. And because of that, I would say if you are in a poorer country, if you're in a country where you're kind of scratching your head and saying, is this going to be a bad thing? What I would say is I think that you need to be contingency planning, which is we can't afford to see if we are right or wrong on this. Because in some of these countries, if you say let's just let this virus go and if it does go, it will decimate the country. Right. What you are finding in the US right now is that this virus can affect anybody here. But the people who are in poorer communities and who have worse health systems are the ones who are dying and they are dying en masse. And I don't know any developing country right now that has a health system that I would call robust. So if this does get out of control in a country, firstly, I think that country's economy is going to be in big, big, big trouble. And I think because you don't have great borders between any of these countries, it will it will go crazy. This is, again, my view. I don't think that the right idea is to say, let's just see how this things goes. I don't think that we can afford the downside if the downside comes. I think it does require us to ask, though, given the resources we have given the context we are in, given the values that we are concerned about, they are public health values, they are economic values, there are values towards the poor. Given all of those different things, I think we need to work out strategies that are balanced and we need to look for as much balance as we can have. And every country needs to be doing that in its own way. I am really, really worried that I see on both the public health measures and the emerging economic measures, many developing countries seem to be doing what we call isomorphic mimicry. Let's look to see what they are doing in other places and we just copy them. You know, I was working with a country in Latin America recently and that country literally developed a set of economic measures that look exactly like the measures that are included in the congressional acts in the last few weeks in the United States. And my first question is, how can you afford that? You can't afford that. It's not possible. So I think to answer Hassan's question, it's one of those areas where I think we want to get a lot of heads together. We want to get a lot of people thinking about this. I don't think people should just look at what the developed world are doing in response and copy them. I also would really, really say to people, please don't just grab hold of a consulting firm and give the first piece of advice or an external adviser, even if that external adviser comes from Harvard or is me or is my colleague Ricardo Hausmann. Ricardo is the smartest guy that I know. But you know what? No one knows what to do right now. So you must take multiple pieces of advice. You must do that, whether you're talking about the public health response or whether you're talking about the economic response. You must do that because we don't know what we're doing. I see that there's some hands that are up, but I see that Mark Moore has joined us as well. And I want to see if I can bring Mark in. Mark, I was telling people a little bit about the conversation we had about the ants and about chaos. And if we have urgency right now and when we have urgency, let's use the urgency to mobilize as many people doing as many things. Let's bring the information around those people together. But let's not think that we can plan our way out of this and control our way out of this. I wonder if you would share some of your thoughts and ideas on this for us. Everybody, Mark Moore is a colleague of mine at the Kennedy School. He is a wonderful professor who writes a lot on public value. I want to thank Gonzalo Leone, who is on her as well for telling me last wee, "We need Mark Moore and we need Creating Public Value. So, Mark, if you can give us your thoughts on just this idea of entertaining chaos a little bit.
Mark Moore [00:34:40] I apologize for being late. Let me say a word first about the idea of taking full advantage of the effect of the virus on motivating people to take other action in the public interest. Basically, it's only a complement to efforts taken for their own self-protection. And I think that, well, one of the great advantages of a crisis in any society that has some modicum of what I would describe as public spirit, which is a sense among individuals in this society that they have to be responsible for and concern to some degree about the welfare of others as well, and to use government as an agent for enacting actions that would benefit everybody. If we have a kind of public spirit like that that gets roused in the midst of a crisis and it increases the level of anxiety generally, but the anxiety does its usual thing, which is to produce a variety of different kinds of work. And an awful lot of that work might turn out to be misdirected. In the sense of being both inefficient and ineffective. And it might even be hostile and contrary to the interests of some people for the benefit of a few and a variety of different things like that. But it's an incredibly valuable asset to be able to take advantage of. And with a little bit of guidance and a little bit of support, that will inevitably end up being present as part of our response and ideally a constructive part of our response rather than non-constructive. And I don't think we have to worry too much about, quote, "efficiency" there, because as long as people what are doing has some desirable effect on the epidemic, the increase in the scale of the effort will begin to make a difference. And that matters a whole lot. All right. So I remember talking to some of my friends at the business school early on when we were teaching about public management. And one of their business school professors said to me at one stage, he said, "You know, Mark, businesses aren't efficient when they're approaching a new problem and they aren't even efficient when they're trying to solve a big problem or create something at scale. They overwhelm problems with massive amounts of resources." Right. And that's the often the role of capital. And that's one of the reasons why capital and the supply of capital is very important. And the same thing is true, I think, when we're working on big social problems, that in some sense, if you mobilize full amount of resources, you can get an effect without worrying too much about either the micro or even, for that matter, the macro efficiency of the grid as a whole. So that's that's the argument that I was making with Matt the other day. But may I add one thing Matt on the conversation you were just having? So as you know, at the outset of the epidemic, there were two dominant strands of expert advice that was emerging, and one of them was captured by the idea of test, test, test, test, test. Remember that? And the other was social distance, social distance, social distance. Now, in some respects, because the United States didn't have the capacity to test, test, test, test, test, it had to act as though the country as a whole was at risk. Because we were now not in a world in which we could do contact tracing because we were in a world of community spread. And so we had to act as though everyone was vulnerable. And we then shifted to a social distancing policy that came online relatively slowly, but not as fully as the test, test, test. And now what you hear people beginning to think, particularly with respect to the backside of the epidemic, where we begin to let people go back to work. And as we begin thinking about how to contain the more perhaps isolated, small-scale epidemics that break out in particular areas, people start thinking about taking a, quote, "more strategic approach." And what they mean by a strategic approach, I believe, is one that is targeted. That in some sense tries to identify the status of a particular community with respect to the threat of the epidemic and then tailors its level of anti epidemic spread and the mobilization of treatment capacity to the particular conditions and the state of the epidemic in that particular state. Now, there's a risk there, obviously, that with community spread, we have to treat every place as though it were vulnerable to a significant outbreak that could consume a large portion of the existing population and therefore use both the bluntest and most extreme form of public health prevention activities, which is to essentially try to reduce general contact as much as possible. But what that reminds us of is the testing is actually useful in four very different functions, and that if we have a limited capacity for testing, then we might have to decide which of these four capacities we are going to use it for or how we ought to allocate our total capacity for testing. Let me just name the different methods for using testing. The first one is we treat testing as essentially a consumer good and we say it's available as something for individuals to get for themselves when they feel like they need it. And of course, America, with its focus on markets and privatization, with its privatized, largely marketized medical system, is inclined to treat testing as an individual consumer good that people can go and get. But that doesn't help us very much in an epidemic. It does work for individuals, but it doesn't do much work for the collective. So then the second use of testing and part of the collective process is for therapeutic purposes, individual therapeutic purposes. And that system tends to be one where we reserve testing to be used with people who have symptoms who've gotten bad. And we use it then to decide on what level of care we're going to give them and how we're gonna try to protect the people who are caring for them from the disease. So let's call that therapeutic use. The third use is what you could call the surgical preventive effort, which is we use testing for contact tracing and for trying to quarantine small areas from larger societies where that seems possible because we don't yet have community spread in those locations. The fourth one and the one that's most apt to be neglected is absolutely critica for the third use of testing is general representative sample of a population that we're trying to protect. Now, that could be a national population, and if we had had enough testing capacity, the United States would have benefited enormously from having a system in which we selected a representative sample of the population and didn't wait for them to ask, but simply went out to them, said, we are going to test you every day or every other day, regardless of your health status. Right. And we are going to continue tracking that over a period of time so that we can see where the hell we are with respect to the epidemic. And the size and character of that sample would have to do with the amount of granularity that you wanted to be able to use.
Do you want to be able to say what was happening in the nation or the state or at the county level or even the town level? But it seems to me that would have been great at the outset. But what we can use now is that we can maybe selectively use it in towns or in parts of the country where the epidemic hasn't yet hit and have both a general testing program in those areas and a use of testing for contact tracing and that particular kind of intervention. So I think we haven't yet quite wrapped our mind around the particular use of testing. And as I was listening to you discuss the response of poor countries in which the epidemic has not yet hit. I think it's possible that in those countries it might be possible. I don't know that this is true, but it might be possible to do some sort of more or less stratified representative sample that would give us an early indication. So that would be very important when we're coming out of the disease as well, because the truth is, is we're going to have to retain some degree of social distancing, almost for sure. It's the social distancing that's causing an awful lot of the economic impact as it is at the same time reducing the impact that would come from serious illness deaths. And so we would like to actually reduce at some stage in a way that's protective of the public health and other requirements for social distancing. And the only way to do that would be to have a differentiated sense of where we were. That differentiated sense would have to be based on data. It's not that different, actually, than what Trump and his guys were thinking about as a way of easing up in a strategic way or closing up in a strategic way. But the problemthere's a piece here that says testing and thinking about testing might be a critically important thing for people in countries where this has not yet developed badly.
Matt Andrews [00:43:52] I know we're over time, and I know we need to begin wrapping up. Just to say, I think even as you've been saying that even something like testing, there's multiple reasons why we do it. We need to think in a thoughtful way about these things. Yes. You don't say, well, they did it, so we're gonna do it. Why do you want to do it? What information? Where are you in the process? And I think the example of Bahrain was very interesting to me is right from the outset they started before they had their first case. And I think that when you are starting before this has become a hurricane, they are many, many things that you can do. They had three streams of work - they had an economic stream, they had a a social stream, they had a medical stream and in the medical stream they had a testing stream, they had a supply stream, they had a hospital organizing stream. So, you know, they basically had something like 16, 17 teams in operation at one stage, doing multiple, multiple things. And I think what they managed to do, they managed to develop that very early testing capacity. Random testing capacity, plus contact tracing. But they are like 1.6 million people. So you're basically talking about what you might think of doing in Dallas, in Philadelphia. You might think about doing this in that kind of area. They also only have one airport and they also are an island. And so for them, that strategy worked well. So this might be what you want to do if you're Madagascar, it might be want to what you want to do if you are Mauritus et cetera, et cetera. But different places are going to need different things because you're too far into it.
Salimah Samji [00:45:14] Great. Thank you very much. We really appreciate that you find this useful. We definitely are here to help. We'll save some of the questions from the chat window and begin with them next week. Thank you very much for all joining us.
Matt Andrews [00:45:27] Thanks, everybody. Thanks Salimah.
Katya Gonzalez-Willette [00:45:31] To learn more about the Building State Capability Program's public leadership through crisis, blog series, visit bsc.cid.harvard.edu/public-leadership-through-crisis. Thank you for listening.