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Post In Pandemics, Do Authoritarian Regimes Have Advantages?
Created by John Eipper on 03/25/20 3:24 AM

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In Pandemics, Do Authoritarian Regimes Have Advantages? (Sasha Pack, USA, 03/25/20 3:24 am)

John E raised the question of whether authoritarian regimes possess inherent advantages in the control of contagion. It is a fascinating question, and though this may be the first time it has come up on WAIS, it is a longstanding question in the history of medicine. The theory that authoritarian regimes are better prepared to handle outbreaks was proposed by the historian of medicine Erwin Ackernecht, a German Trotskyist militant who fled in 1933 and eventually landed in (my hometown of) Madison, Wisconsin, where he held the first chair in the History of Medicine at the University of Wisconsin in the 1940s.

Despite my having obtained a PhD in his department, I am only familiar with Ackernecht's work because I know more recent work that disputes his theory. Peter Baldwin's study, Contagion and the State in Europe, 1830-1930, published in 1999, argues that Ackernecht's model is far too simple. Examining case studies of smallpox, cholera, and syphilis in Britain, Germany, Sweden, and France (and others: it is a long book and I read it a while ago), Baldwin concludes there are too many other factors in the success of contagion control, and a country's putative political traditions (left/right, liberal/authoritarian) don't have much predictive value. In confronting cholera, Britain tended to favor sanitation over quarantine, which would seem like the liberal course, but then made smallpox vaccination mandatory at the same time that the authoritarian regime of Napoleon III made it voluntary. After the Bonapartist regime fell, the liberal Third Republic pursued mandatory vaccination for smallpox. This is one example I happen to recall, but the book goes through dozens of these and is pretty convincing that politics and political traditions are not too important in this question, at least in 19th-century Europe.

Extrapolating to today, I would add that liberal democracies, like autocracies, have all kinds of tools at their disposal to enforce quarantines, suspend public activities, order private manufacturers to produce needed goods, etc. It's too early to pass judgement about the handling of the current contagion, but it seems to me that the big difference between the US and China is that the US has a leader who takes everything very personally and is particularly sensitive to the cable news cycle. Through this lens, the epidemic has looked to him, at various points, like a hoax, like a form of Chinese biological warfare, and like a threat to his economy and therefore his reelection. Presumably the experts who are advising him and all other world leaders understand that public health is a subtle and interdisciplinary science, and have discussed rational ways of assessing the trade-offs to economic and social activity. The economy is not something that suddenly occurred to policymakers after the decision was taken to close everything. Some of America's state and local leaders seem far more capable of dealing with these ambiguities. I never thought I'd have much good to say about the governor of my state, Andrew Cuomo, but he is being an effective leader on this, imposing the draconian measures probably required while being as clear as possible about the endgame.

JE comments:  Sasha, you've addressed the question splendidly--dare I say with authority?  And you've succinctly summed up the challenges of public health policy:  it requires a subtle and interdisciplinary approach.  Democracies inevitably become more authoritarian in crises, particularly in times of war.  Any casual student of the US Civil War knows that the greatest leader in American history, Lincoln, suspended the writ of habeas corpus.  I suppose the crucial balance in pandemics is to instill the necessary "discipline" in the citizenry without silencing innovation and the vital flow of information.

We recall that this question arose from the Chinese physicians complaining about the Italians' lack of discipline in the crisis.  Here's another tricky question:  are some peoples just less disciplined than others?  Italy and Spain do have a very different national reputation than, say, Germany, Sweden, and Japan.


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