Lessons From COVID-19 Responses in East Asia: Institutional Infrastructure and Enduring Policy Instruments

Abstract

Existing commentaries on government responses to COVID-19 have focused on such factors as competent leadership, policy instruments, or cultural dispositions. Yet, few have provided a synthesis that examines how these factors relate to each other. This article fills this gap in the debate by comparing COVID-19 responses among five advanced economies in East Asia: Taiwan, Hong Kong, South Korea, Singapore, and Japan. Although agile actions and competence of top leadership are necessary to confront an unprecedented crisis, they are by themselves insufficient. Equally critical is whether a society has the necessary institutional infrastructure in place when a crisis strikes. Policy instruments are more likely to succeed when existing institutional infrastructure supports their administration and implementation. For an instrument to generate enduring impact, it must be compatible with a polity’s underlying culture; instruments that accommodate the underlying cultural orientations are more likely to elicit public cooperation and voluntary compliance over time. Policy instruments must also address equity issues by reaching marginalized groups across all layers of the population. Progress in emergency management may be visible in mainstream society but masking brewing problems among marginalized groups. A comparison across the five advanced economies in East Asia yields several implications for comparative research and policy.

Keywords

crisis management institutional infrastructure policy instrument culture social equity COVID-19

Introduction

As a pandemic, COVID-19 has hit almost every country on earth. Policymakers and public managers worldwide have been put to the test on their crisis management capability. From January through May 2020, divergent emergency management approaches have been adopted worldwide. Yet, it has become increasingly controversial as to what policy instruments are more effective, in both the short and the long run, and whether instruments that work in one region can be used in others.

To confront an unprecedented crisis, agile actions and competence of top leadership are necessary (Moon, forthcoming) but are by themselves insufficient. Equally critical is whether a polity has the necessary institutional infrastructure in place when a crisis strikes. Policy instruments are more likely to succeed when existing institutional infrastructure supports their administration and implementation. We further argue that instruments that generate enduring impact must be compatible with a polity’s underlying culture; instruments that accommodate the underlying cultural orientations are more likely to elicit public cooperation and voluntary compliance over time. Hence, the set of feasible policy instruments is inherently constrained by culture and must be adapted to it.

Besides, policy instruments must address equity issues by reaching marginalized groups across all layers of the population. During a crisis, marginalized groups can easily be forgotten or neglected by policymakers. Low-income foreign workers, for example, are isolated from the mainstream culture and can easily be excluded in policy discourse. Progress in emergency management may be visible in mainstream society but masking brewing problems among marginalized groups.

The critical role of institutional infrastructure and cultural compatibility in the fight against COVID-19 is evident in five advanced economies in East Asia—Taiwan, Hong Kong, South Korea (“Korea” hereafter), Singapore, and Japan. The first four polities¹ have taken aggressive actions from the start of the COVID-19 pandemic; they have been relatively successful in containing the spread of the virus, except for Singapore, which experienced a surge in infections after an initial period of success. What explains the polities’ early, sustained, as well as halted success? Many commentators have attributed the four Asian polities’ successes to aggressive and comprehensive policy instruments themselves or a culture that supports public cooperation and voluntary compliance. Less attention, however, has been given to the institutional infrastructure they have established before the COVID-19 pandemic and how it has subsequently shaped the choices and effectiveness of policy instruments, given each’s cultural and social conditions.

The first four polities share experience in fighting similar infectious respiratory diseases, namely, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). After experiencing the challenges of responding to these diseases, all of them overhauled their public health systems and relevant regulatory procedures in preparation for the next round of epidemic. This pre-established institutional infrastructure has better prepared them to respond to COVID-19, compared with most other countries. By contrast, Japan experienced the swine flu (H1N1) pandemic in 2009 but has not built relevant health infrastructure. As a result, Japan had to bear the brunt of the COVID-19 pandemic over time.

To be effective, any policy instrument requires public cooperation and voluntary compliance. Policy instruments that infringe on individual freedom are more feasible and sustainable in East Asian culture that emphasizes collectivism. The culture governs social behavior with strong social norms and rules, is less tolerant of deviant behavior, and emphasizes the sacrifice of individual freedom for the collective good during a crisis. In western culture, by contrast, where individualism prevails, stringent policy instruments may not be sustainable over a long time when public cooperation and voluntary compliance dwindle. Hence, policy instruments that work in East Asia may not work well in other countries.

Despite early success in containment, Singapore experienced at a later stage a rapid surge of infection among foreign workers. The case of Singapore provides two valuable insights into the design and administration of policy instruments. First, the sudden rise in infection occurred right after the government relaxed its stringent policies. Considering Singapore’s collectivist orientation, the public could have remained cooperative even if the government were to maintain its initial stringent approach. A premature departure from such an approach has reversed the country’s early success in containment, suggesting that policy instruments that tap into the core of underlying culture should be consistently exercised during a pandemic crisis. Second, policy instruments must address social equity and reach all corners of the population, including marginalized groups such as non-citizen immigrant communities.

In the remainder of this commentary article, we first provide backgrounds on the East Asian polities’ COVID-19 management performance. We then explain how each overhauled its health and regulatory system to build institutional infrastructure and capacity before the COVID-19 pandemic arrived at their doorsteps. The ensuing section compares policy instruments adopted by each economy and assesses how such choices were compatible (or incompatible) with their equity, social, and cultural contexts. Japan and other western countries are briefly reviewed as comparison cases whenever appropriate. We conclude by discussing research and policy implications.

COVID-19 Pandemic Crisis Management in East Asia

A polity’s approach to managing COVID-19 can be assessed from several vantage points: (a) To what extent stringent policies were adopted in the first 30 days of the outbreak (i.e., preparedness for early actions); (b) case occurrence trends over time (i.e., management trajectory); and (c) total cumulative cases, tests, and deaths (i.e., overall performance).

Column 2 in Table 1 shows the extent to which a polity has adopted stringent policies in the first 30 days after the first confirmed COVID-19 case. The index, developed by a research team in the Blavatnik School of Government at the University of Oxford (Hale et al., 2020), assesses the stringency of government responses in the following areas: closing schools, workplace, and public transportation; canceling public events; restricting mass gatherings, internal movement, and international travel; stay-at-home requirements; and public information campaigns.

Table 1.

COVID-19 Pandemic Management Indicators.

Country/Polity	(1)GDP per capita (in 2019, nominal)	(2)Government response stringency index 30 days after the first case	(3)Cases 30 days after	(4)Total confirmed cases	(5)Total confirmed cases per 1 million population	(6)Total tests done per 1 million population	(7)Total tests done per total confirmed cases	(8)Total deaths per 1 million population
Singapore	$63,987	26.59	89	22,460	3,839	30,016	8	3
Hong Kong	$49,334	55.95	69	1,045	139	22,448	161	0.5
Japan	$40,847	13.89	30	15,663	124	1,676	14	5
Korea	$31,431	31.35	46	10,874	212	12,949	61	5
Taiwan	$24,828	30.56	24	440	18	2,807	152	0.3
USA	$65,112	5.56	15	1,347,309	4,070	26,943	7	242
Sweden	$51,242	0	13	25,921	2,567	14,704	6	319
Germany	$46,564	15.88	21	171,324	2,045	32,891	16	90
France	$41,761	13.50	12	176,658	2,706	21,213	8	403
UK	$41,030	11.11	23	215,260	3,171	25,461	8	465
Italy	$32,947	64.44	1,128	218,268	3,610	41,584	12	503
Spain	$29,961	11.11	66	262,783	5,620	52,781	9	566
World Average	$14,660			19,343	526	NA	NA	36

Note. The numbers in Columns 4 through 8 are those measured as of May 10. Columns 2 and 3 were extracted from Hale et al. (2020)’s data, which is available at www.bsg.ox.ac.uk/covidtracker. Columns 4 through 8 were retrieved from the Worldometer at https://www.worldometers.info/coronavirus/. GDP per capita data were extracted from the International Monetary Fund’s World Economic Outlook Database, October 2019. The world average is of 192 countires in the report. GDP = gross domestic product.

Among several East Asian economies, during the first 30 days, Hong Kong adopted the most stringent responses (55.95), followed by Korea (31.35), Taiwan (30.56), Singapore (26.59), and Japan (13.89). Japan’s relatively low score is similar to most advanced western countries listed, with Italy being an exception as it adopted more stringent measures (64.44) than those of Hong Kong. Italy’s stringent responses were a reflection not necessarily of its higher preparedness but a relatively large number of cases (1,128) in the first 30 days, as compared with the double-digit numbers in the East Asian polities in question.

Table 1 also presents numbers of total cumulative cases, tests, and deaths as of May 10 as indicators of overall crisis management performance. To account for differences in population sizes, the indicators were calculated cases per million. Counting total confirmed cases per million (Column 5), Taiwan (18), Japan (124), Hong Kong (139), and Korea (212) all clearly show substantially lower numbers than western countries and Singapore, which recorded more than 2,000 total cases per million each. In contrast, the world average was just above 500.

Next, we look at the number of tests conducted. Since the virus infection may have hit each polity to different extents, we divided the number of tests by total confirmed cases. This measure indicates a polity’s testing capacity while accounting for the scope of the virus spread. By this measure, Hong Kong (161), Taiwan (152), and Korea (61) all show outstanding testing capacity. By contrast, Japan (14) and Singapore (8) are at much lower levels, similar to western economies. Finally, we compare the number of deaths per million. The measure indicates that Taiwan (0.3) shows the lowest fatality rate, followed by Hong Kong (0.5), Singapore (3), Korea (5), and Japan (5). By contrast, western countries’ death toll rates are far higher, ranging from 90 in Germany to 566 in Spain, whereas the world average was 36.

What do these numbers mean? They show that the five advanced East Asian polities have fared better than their western counterparts and the rest of the world in terms of early actions and overall performance. Yet, we still observe differences among them. First, despite its overall performance, Japan appears to be less prepared when compared with the other four East Asian economies. Second, despite aggressive early actions, Singapore’s overall performance indicators were far lower than expected, implying potential mismanagement of policy instruments. Figures 1 and 2 show the polities’ total COVID-19 cases per million over time between March 1 and May 10. Singapore experienced a switch from exhibiting a stable trajectory to a steep increase. When the other four East Asian polities are further zoomed-in (Figure 2), we can see that Japan’s cases have been soaring, whereas Taiwan, Hong Kong, and Korea have maintained stable trajectories.

Figure 1.

Total COVID-19 cases per million time series.

Figure 2.

COVID-19 cases per million time series among the four East Asian polities.

Prior Experience and Institutional Infrastructure Building

The four East Asian polities—Hong Kong, Korea, Taiwan, and Singapore—were able to take stringent actions early on because they had established an early warning system and put in place institutional infrastructure before the current virus outbreak. What prompted them to make such an investment? Table 2 shows that Hong Kong, Taiwan, and Singapore were among the hardest-hit polities by SARS in 2003. Although Korea suffered minimal damage from the same disease, the country became second to Saudi Arabia in terms of total MERS cases in 2015. Since then, all four polities overhauled their public health systems with a focus on preparing for the next round of epidemic.

Table 2.

Major Countries/Polities Hit by SARS, MERS in the Past.

SARS, 2003			MERS, 2015
Country/Polity	Cases	Deaths	Country/Polity	Cases	Death
China	5,327	349	Saudi Arabia	1,195	510
Hong Kong	1,755	299	South Korea	185	36
Taiwan	346	37	UAE	81	11
Canada	251	43	Jordan	25	8
Singapore	238	33	Qatar	13	5
Viet Nam	63	5	Oman	6	3
USA	27	0	Iran	6	2
Philippines	14	2	UK	4	3
Thailand	9	2	Germany	3	2
Mongolia	9	0	Kuwait	3	1
Germany	9	0	Tunisia	3	1
France	7	1	France	2	1
Australia	6	0	USA	2	0
Sweden	5	0	Netherlands	2	0
Malaysia	5	2	Italy	1	0
UK	4	0	Hong Kong	0	0
Italy	4	0	Taiwan	0	0
South Korea	3	0	Singapore	0	0
India	3	0	Sweden	0	0
Spain	1	0	Spain	0	0
Japan	0	0	Japan	0	0
World Total	8,096	774	Total	1,545	588

Notes. Countries/Polities highlighted in italic are those mentioned or are the focus of this article. World Total also includes the cases of other countries not reported in the table. SARS cases were retrieved from the World Health Organization’s summary of probable SARS cases with onset of illness from November 1, 2002 to July 31, 2003, available at https://www.who.int/csr/sars/country/table2003_09_23/en/. MERS cases were retrieved from the European Centre for Disease Prevention and Control’s Epidemiological update: Middle East respiratory syndrome coronavirus (MERS-CoV), September 1, 2015, available at https://www.ecdc.europa.eu/en/news-events/epidemiological-update-middle-east-respiratory-syndrome-coronavirus-mers-cov-1-0. The cases numbers could be different from other sources depending on the timing they were measured. SARS = Severe acute respiratory syndrome. MERS = Middle East respiratory syndrome.

Specifically, they all created their Centers for Disease Control and Prevention (CDC)-equivalent emergency institutions. These centers were empowered with substantial staff, budget, specialties, and autonomy over the issuance of emergency guidelines to the public and policy advice to the top leadership. The four polities also invested in developing critical health infrastructures such as specialized medical centers and doctors, negative pressure rooms, intensive care units (ICUs), and public–private partnerships to augment existing medical capacity. Emergency manuals and guidelines were also overhauled; legislations were modified to streamline the approval process for test-kit development and clinical trials.

Notably, Japan and some western countries also had prior experience. Many nations, for example, experienced the swine flu (H1N1) pandemic in 2009. The country estimates of swine flu cases and deaths differ across studies (United States Center for Disease Control and Prevention, 2012). Still, in general, the death tolls were much higher among the advanced western economies listed in Table 2, compared with the SARS and MERS cases among the four East Asian polities. For instance, at least 8,800 were killed due to the swine flu in the United States, and the corresponding lower bound estimates for the United Kingdom and Japan are 1,237 and 198, respectively (Dawood et al., 2012). Yet, few had developed institutional infrastructure comparable to that in the four East Asian polities. For instance, the United States had the Global Health Security and Biodefense Unit, which was established in 2015 during the Obama presidency. The unit was responsible for pandemic preparedness, but the Trump administration abolished it in 2018 (Reuters Fact Check, 2020).

Japan exposed its vulnerability to the swine flu pandemic, with nearly 200 people killed (Japan Ministry of Health, Labor and Welfare, 2010). Scholars have consistently expressed an urgency for creating an independent CDC-equivalent unit or empowering the current National Institute of Infectious Diseases so that the country can be more pro-active in disease control and prevention. The government, however, focused on building the infrastructure for natural disasters that historically have posed more significant threats. In the Japanese context, these include earthquakes, tsunamis, typhoons, volcanic eruptions, and large-scale transportation accidents. The country has more than 700 disaster-based hospitals with medical assistant teams (DMATs) that specialize in these emergency responses, but they have not received proper training relevant to respiratory diseases (Egawa, 2020). Such a lack of preparedness was revealed when DMATs were dispatched to the Diamond Cruise ship and mishandled the inspection and quarantine of COVID-19 infected passengers (Schumaker, 2020).

Furthermore, the National Institute of Infectious Diseases has experienced budget and staff cuts over the past few years (Osaki, 2020). In the absence of a CDC-equivalent capability, a government’s public health actions are more likely to be shaped by political and international considerations (Egawa, 2020). These problems worsened as the Abe administration had persistently tried to host the Tokyo Olympic on schedule, resulting in sluggish responses to COVID-19 at the early phase of the crisis.

Our focus on system-level institutional infrastructure building is noteworthy given that previous public administration scholarship on emergency management has paid little attention to pandemic crisis management (e.g., Comfort et al., 2012; Kapucu, 2006; McGuire & Silvia, 2010) due to the absence of such events in recent decades. Most studies highlight the role of leadership, decision-making process, intergovernmental and organizational relations and networks, interagency communication, and information technologies. Few have underscored how larger-scale institutional infrastructure and system capacity shape pandemic crisis management (cf. Petak, 1985). The structural changes undertaken in the four East Asian polities can shed light on this question.

In the remainder of this section, we examine how specifically the public health and regulatory systems of the four East Asian polities were overhauled after experiencing prior epidemics and how these efforts have helped them act early on to handle the COVID-19 pandemic effectively. In doing so, we use Japan as a comparison case.

Creating a Capable Emergency Institution and Expanding Public Health Infrastructure

All four East Asian polities created CDC-equivalent emergency institutions for handling infectious respiratory diseases and granted them autonomy. For example, the chair of the Central Epidemic Command Center (a unit within the CDC) in Taiwan ranks the same as a government minister (Hille & White, 2020). During a public health crisis, all infectious disease specialists at medical centers across the country are managed by this central unit. Similarly, after a painful experience with MERS, Korea upgraded its CDC to be a deputy ministerial-level agency, increased its staff size, and expanded its professional specialties and autonomy (Moon, forthcoming).

The SARS epidemics in Hong Kong, Singapore, and Taiwan and the MERS outbreak in Korea exposed the vulnerability of their respective health care systems: overcrowded wards, poor ventilation, lack of adequate isolation facilities, and ICUs, among others (Hung, 2003; Kim, 2020). All four polities have taken steps to upgrade their health care facilities: more negative pressure rooms, ICUs, and infectious disease laboratories that can handle massive viral testing. Some have built logistical systems with stockpiles of essential protective equipment such as surgical masks. Notably, the governments did not work alone to improve their health care systems; they also partnered with the private sector to expand existing medical capacities. For instance, the Taiwanese government contracted with medical laboratories to quickly expand testing capacity during a national emergency (Hille & White, 2020).

Overhauling Regulatory Frameworks

Korea overhauled its regulatory system by introducing fast-track approvals for new test-kit development during an emergency. Thanks to the streamlined process, in the face of COVID-19, companies that developed new test kits were able to complete a whole process—from application to actual use—within a few weeks (Hille & White, 2020). Laboratories are also allowed to use unapproved in-vitro diagnostic kits during a public health emergency. Having learned from its initial mishandling of MERS information disclosure, the Korean government added disclosure provisions to the Infectious Disease Control and Prevention Act, which has served as a critical legal framework for COVID-19 crisis management (Kim, 2020).

The Taiwanese government forged the legal basis for limiting personal freedom during an epidemic, imposing fines on those who violate quarantine measures (Hille & White, 2020). Likewise, Hong Kong and Singapore imposed severe penalties for non-compliance. In contrast, Japan did not overhaul its regulatory system for public health emergency after the swine flu pandemic in 2009. Neither the Prime Minister nor the governors of its 47 prefectures have the authority to issue a national or local lockdown (Normile, 2020). Unlike leaders in Singapore, Taiwan, and Hong Kong, government leaders in Japan lack the legal means to impose any substantive penalties that limit personal freedom due to restrictions imposed by the current constitution (Trotter & Winsor, 2020).

Reorganizing Emergency Manuals

Korea bore the brunt of MERS, mainly due to a lack of emergency manuals regarding the isolation and treatment of patients during an epidemic. Emergency specialists initially ignored the danger of disease transmissions at health care facilities. About half of MERS cases resulted from transmissions between patients and health care workers within hospitals (Kim, 2020). After learning the lesson, the Korean government revised its disease control guidelines such that people with respiratory symptoms are advised to visit a specialist screening center first rather than hospitals (Hille & White, 2020).

Similarly, Hong Kong, Singapore, and Taiwan all experienced difficulties in isolating and escorting patients with suspected SARS, particularly at the point of admission and thereafter (Hung, 2003). Given the experience with SARS in 2003, these governments updated their emergency manuals. Notably, in the face of COVID-19, a central command in Taiwan immediately released a list of 124 action items, including border controls, school and work policies, public communication plans, and resource assessments of hospitals (Wang et al., 2020). Such a prompt release of comprehensive recommendations would have been impossible without having had updated emergency manuals ahead of time.

Promoting Public Health Behavioral Practices

Since the country was hit by SARS in 2003, Singapore has regularly sent official messages to the public that encourage washing hands and sneezing into elbows or tissue papers during the flu season (Fisher, 2020). Likewise, citizens in Hong Kong and Korea are routinely asked to wear masks, wash hands, and take other precautionary actions such as avoiding crowded places and gatherings (Barron, 2020). These messages are parts of routine public information campaigns. In Korea, real-time precautionary alarms are sent to citizens through mobile texts several times a day during a public health emergency (Kim, 2020). For instance, the public are notified of the travel history of infected patients in their region. In all four polities, these messages penetrate daily life and can be seen on billboards, TV, newspapers, and social media. As a result, individual hygiene practices have become a part of community norms that support public health governance during a crisis.

Although wearing a mask was controversial in western countries, the four East Asian polities have long emphasized its importance at the individual and community levels. Some private enterprises (e.g., supermarkets) routinely require their customers and employees to wear masks. Over time, western countries have started to follow similar practices but only after considerable delays. By contrast, the four East Asian polities have recognized the importance of such hygiene practices as an essential part of public health governance (Griffiths, 2020). These hygiene practices are also common in Japan; yet, the country’s soaring COVID-19 cases show that such practices alone are insufficient unless other substantive policy instruments are in place.

Policy Instrument Choices: Tapping Equity and Social, and Cultural Dimensions

Choice Sets and Availability

Table 3 presents policy instruments that many governments have used to cope with COVID-19. These instruments include, for example, the coverage and costs of testing, mobility restrictions, border control, quarantine methods, school and business closure guidelines, and more. Although the list is far from comprehensive and it is beyond the scope of this article to examine all the details, a few points merit discussion.

Table 3.

Policy Instrument Types During the COVID-19 Pandemic.

Types of policy instrument	Instrument choices
Testing	Geography: comprehensive vs. cluster-focused (i.e., hot spots)
	Coverage: any individuals with suspected symptoms vs. specific individuals with serious respiratory-related symptoms
	Eligibility: citizens vs. non-citizens (i.e., immigrants without citizenships); non-criminals vs. criminals
	Cost: free (universal) vs. cost sharing
	Accessibility: designated centers or drive/walk-through sites vs. approval by doctors after consultation
Mobility restriction	Restriction degree: mandatory stay-at-home order vs. voluntary stay-at-home order vs. no restrictionGeography: national lockdown vs. local lockdownPlaces: home, workplace, public transport
Border control	Entry ban target: all countries vs. select countries (regions) in high-risk groups vs. no border control
Quarantine (and contact tracing)	Surveillance: monitored vs. voluntaryLocation: government facilities vs. hospitals vs. homeCost: self-pay vs. government assistanceMethods: in-person interviews and visits vs. app (GPS)-based technology vs. electronic wristbands
Priority group for treatment	Groups: citizen vs. non-citizen; insurance holder vs. non-holder; elderly vs. non-elderly
Social distancing and other hygiene practices (e.g., mask wearing)	Enforcement: mandatory (by law) vs. left to the private enterprises vs. voluntary
Public information campaign	Sources: mobile text message; newspapers; billboards; television ads; social media; government homepageMaterials: cartoons; words; videos
Business (and school)	Operation: businesses opened as usual vs. essential industries only allowed to open (i.e., non-essential closed) vs. all closed; school opened vs. temporary closure
Limits on mass gatherings	Threshold: universal number applied to the whole country vs. density-based restrictionType: all public gatherings banned vs. private gatherings banned as well

A comparison among the five East Asian polities indicates that the extent to which the government has established relevant institutional infrastructure may shape and constrain policy instrument choices and their effectiveness during a public health crisis. With enough personnel, cutting-edge information management technology, and adequate facilities, Hong Kong, Taiwan, and Singapore set out to conduct extensive contact tracing and strict quarantine measures to identify and isolate risk groups. The three also controlled their borders early on, even before the first cases were reported (Barron, 2020). Korea, by contrast, decided to keep its borders open but instead focused on comprehensive testing due to its massive capacity. In other words, the government anticipated that closing the borders was unnecessary as long as free testing was made universally available and widely conducted.

By contrast, Japan lacked pre-established institutional infrastructure, which has limited the range of available policy instruments and their effectiveness. Given limited testing capacity, for example, the cabinet and its health experts crafted a cluster-based strategy. The plan was to focus on specific clusters identified as hotspots so that limited resources and testing capabilities can be deployed efficiently. Dr. Shigeru Omi, the doctor leading Japan’s response to COVID-19 said, “We don’t have the capacity, and it doesn’t make sense,” in answering a question about whether the government planned to test citizens without severe symptoms (Harding, 2020). Although a cluster-focused approach might have worked in the past, in the face of a much larger-scale pandemic, the approach exposed the country’s limited capacity (Normile, 2020; Trotter & Winsor, 2020). Given the limited capacity, the Japanese government chose to focus on external factors such as border shutdown.

Equity and the Social Dimension

The East Asian polities’ COVID-19 experiences illustrate the importance of incorporating equity and related societal considerations into policy instruments. As shown in Table 3, key criteria in policy instrument administration concern whether testing, treatment, or quarantine should be made equally available to everyone regardless of citizenship, age, gender, class, and criminal records, and whether there should be some priority groups. For instance, the elderly are a significant risk group, and most governments have attempted to prioritize measures to protect this vulnerable group. Density patterns in public, residential, and commercial areas are also major considerations for mass contagion prevention.

As Ingram et al. (2007)’s social construction and policy design theory suggests, some groups may be excluded from policy benefits either due to their weak political power standing or due to their negatively constructed social images. These populations include low-income classes, ethnic minorities, the disabled, non-citizens, students, criminals, or those with intersectional group identities. A policy focus on mainstream societal groups may mask brewing problems among marginalized groups and ultimately ruin early progress on the fight against COVID-19, as has been the case in Singapore, where major outbreaks emerged among migrant workers after the country’s initial success in containing the spread of the virus. Until early April, which was about 2 months after the first case was identified in Singapore, the total COVID-19 cases were below 1,000. Since then that number exponentially soared up reaching to more than 22,000 cases in the next 2 months. Strikingly, it has been estimated that the migrant workers living in the government-run dormitories accounted for 88% of these exponentially increased cases (Cai & Lai, 2020).² The Singapore case shows the importance of considering the special needs of marginalized or vulnerable groups such as low-income foreign workers, who may require additional resources, such as free testing and additional government surveillance, to help remedy their disadvantaged circumstances. Such needs for equity considerations in the design and administration of policy instruments, especially in the absence of any preexisting legal requirements, resonate with the argument that social equity should be a major pillar of public administration not only for normative values but also for practical ones (Svara & Brunet, 2020; cf. Durant & Rosenbloom, 2020).

The Cultural Dimension

During a pandemic, many policy measures impose extraordinary demands on citizens. For these measures to succeed, public cooperation and voluntary compliance are needed. In addition, citizens need to accept heavy penalties handed out by the government to ensure close to universal compliance. With Korea being an exception, the other three polities—Taiwan, Hong Kong, and Singapore—have imposed heavy penalties against non-compliance (e.g., heavy police enforcement of quarantine rules).

Although these actions may look extreme in Westerners’ eyes, they are viable in East Asia due to its collectivist culture. In this culture, individuals are willing to sacrifice their freedom during a crisis for the collective good (Hofstede, 2001; Porcher, forthcoming). These Asian communities exhibit a long history of persistent threats from wars, natural disasters, and pathogens, which have shaped strong social norms and strict principles governing social behavior and desirability (Gelfand et al., 2011).

Policy instruments that tap into core cultural orientations need to be consistently exercised throughout the crisis. Singapore is a case of mismanagement on this front. The country once saw remarkable progress in the early stages of the crisis. Yet, after seeing initial success, the government relaxed its stringent stance, and the country experienced a surge of infections. Given its collectivist culture, Singapore could have continued to impose stringent measures and receive public cooperation and voluntary compliance from its population.

Korea chose a different mix of liberal policy instruments (e.g., an open economy, no border control, and a comprehensive testing strategy), but the more stringent actions they undertook later, such as using government tracking apps for quarantine and mandating rule-breakers to wear wristbands, are supported by its collectivist culture. Policy instruments that worked in East Asia may not be equally effective in other parts of the world. Instead, policymakers must consider which elements of a policy instrument are adaptable given their cultural contexts to elicit public cooperation and voluntary compliance.

Research and Policy Implications

First, the polities that have performed well share some similarities. They all had prior experience of failed responses to past epidemics. Fostered by experience, the governments overhauled their health care systems and put in place relevant institutional infrastructure, which has prepared them well to guard against the brunt of COVID-19. Second, pre-established institutional infrastructure has shaped the set of viable policy instruments. Third, a policy instrument may create sustainable impacts only if it is compatible with the underlying culture and if policymakers pay attention to the needs and risks disadvantaged communities face.

Future research may extend these lines of inquiry by examining countries in other parts of the world. Future studies, for instance, may investigate whether and how much other countries built institutional infrastructure; if they did, whether it was triggered by events other than prior epidemic experience. In doing so, researchers could extend the geographic focus beyond East Asia and conduct cross-continental studies.

The commonality of robust institutional infrastructure among the four East Asian polities also offers insights into the debate about the measurement of government quality. Since La Porta et al. (1999), who equated good government with “good-for-economic development,” scholars have questioned what constitutes quality of government in a broader sense and how to measure it. From a conceptual point of view, for example, Rothstein and Teorell (2008) argue for the importance of impartiality in the exercise of public authority. Recently, Porcher’s (forthcoming) empirical work shows that culture may also be such a determinant. The World Bank provides various governance indicators, but perhaps the most comprehensive and refined index comes from the Berggruen Institute, which combines 25 sub-indices over 14 years for 38 countries (Anheier, 2019).

Yet, no one has considered crisis management capability as a measure of government quality in general and of public administration in particular, despite recurring epidemics and natural disasters worldwide. Given that the whole world has been hit by COVID-19, academics may begin to incorporate this dimension into the index. Indeed, increasing numbers of data sets on governments’ responses to COVID-19 worldwide and public health infrastructure may be utilized in future studies.

Our ongoing research has extracted data from the Institutional Profiles Database 2016 and started looking into these questions by examining relevant indicators on public–private cooperation as well as coordination and collaboration within each administration. We have documented that the four East Asian polities all showed higher scores on a composite index than did Japan and most other Western countries, except for Sweden, the United Kingdom, and the United States. Such patterns may reflect the East Asian polities’ crisis management capability, but the patterns also suggest the need to revisit questions of measurement and theory. For instance, can we specify what indicators predict a country’s crisis management performance?

Also, paradoxical findings by Porcher (forthcoming)—that culture shapes government quality more than formal and political institutions worldwide, but not in Asia—may be reconcilable when viewed in the context of our analysis. In other words, policy impacts on wicked problem-solving is a function of the interactions between culture and policy instrument choices, constrained by institutional infrastructure and capacity. It may be further constrained by the inherent design of a country’s governance and intergovernmental system (Tang & An, 2020). In future research, public policy and administration scholars may embark on more systematic and comparative studies that can tease out these nuanced influences in Asia and beyond.

In the past, a pandemic emergency was considered a rare occurrence. But the COVID-19 pandemic has taught us that the price is too high to pay if a country is not ready to act when the crisis strikes. Drawing on the experiences in advanced East Asian polities, this article has provided insights into the importance of building institutional infrastructure and how it shapes the set of viable policy instruments. Policy instruments must be designed with the underlying cultural and societal conditions in mind.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

Author Biographies

Brian Y. An is currently assistant professor in the Department of Political Science at The University of Tennessee, Knoxville. His research examines urban policy, public finance, and broader governance and social equity issues in public administration, focusing on the role of institutions in shaping policy effectiveness. Beginning from the fall 2020, he is joining the School of Public Policy at the Georgia Institute of Technology as assistant professor of public policy.

Shui-Yan Tang is Frances R. and John J. Duggan Professor in Public Administration and the Chair of the Department of Governance and Management in the Price School of Public Policy at the University of Southern California. His research interests include institutional analysis and design, environmental politics and policy, and governance reform.

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