COVID-19

Richard McGregor: The war within the war on COVID-19

Richard McGregor is an internationally recognized expert on the Chinese political system and a senior fellow at the Lowy Institute.

McGregor’s book, The Party, on the inner-workings of the Chinese Communist Party is considered the pre-eminent text for understanding the CCP and was called a “masterpiece” by The Economist and a must read” by the Washington Post.

A former Bureau Chief for the Financial Times in Beijing and Washington D.C., Richard has been published in the Wall Street Journal, the New York Times and The Sydney Morning Herald and The Australian. He is also a regular commentator on the ABC, CNBC and Bloomberg TV.

Misha Zelinsky caught up with Richard for a chinwag about the COVID-19 crisis and what this means for the world, including the escalated US-China rivalry and who is winning, how Xi Jinping is using the crisis to his advantage, how fake news is making the problems worse in the west, how democracies are struggling under the weight of the challenge and losing soft power, the pivotal battle underway in the pacific and why its critical we engage the Chinese diaspora in western values.

Episode Transcript:

Misha Zelinsky (host):

Welcome to Diplomates I’m your host, Misha Zelinsky. I’m joined today by Richard McGregor. Richard, are you there?

Richard McGregor:

I’m here. Thanks for having me on.

Misha Zelinsky (host):

Thanks for joining us. Of course, we’re doing this live from both of our socially distant bunkers, vice the beauty of Skype, which everyone’s now very acquainted with over the last couple of weeks working from home, those who are. But thanks for joining us and obviously your expertise is in foreign policy and in particular the Chinese communist party. But given we had been talking about all things COVID, I thought an interesting place to start. You’re an expert in the CCP and you’ve written a book about the workings of the party. What does the handling of the virus tell us about the way the party does or does not function? And how did that impact on the, I suppose early stages of the outbreak in the Wuhan province.

Richard McGregor:

Well let me start at what might sound like an old place. But there’s a phrase in the US politics, it’s called the permanent campaign and that comes from the late 60s when politics basically got out of the old ways and old boroughs and things like that. Got into the hands of professionals and politics became a permanent occupation. Parties were running for election permanently in many respects. And I think that’s a good way to explain how the communist party in China works. And it’s one reason by the way, that why Western countries struggle to keep up with it. They are like a political organization running for election 24 hours a day, seven days a week, every day of the year. And so they’ve got remarkable skills and faults. We’ll come back to that as a result of that. So look at the COVID crisis is a bit of a classic case.

Richard McGregor:

The start of this, China mishandled it, however you want to put it. They lied. It was the virus in its early stage was covered up. This is not just Western propaganda, it’s all on the record in China. The outbreak and the spread of the virus would not have been nearly as bad in China and then to the rest of the world if it hadn’t been covered up in Wuhan initially. But look what happened, once they acknowledged it. They basically locked down first a city of 11 million people, Wuhan. Then they locked down a province of about 50 million people in Hubei. And after that they locked down the country.

Richard McGregor:

One of the funny things about this is, we’ve all come to know a lot of epidemiologists on TV and radio and the like, and they’ve become household names and none of them said, quarantining the source of the disease is basically a textbook way to handle it. But I guess, the textbook didn’t quite envisage quarantining about 760 million people, which was probably had the idea of a medieval village in France, but the CCP had the capacity to do it.

 

 

Richard McGregor:

Because they don’t just have a strong central government when they get their act together, they were able to exercise their power right down to every neighborhood committee and street and keep people indoors. So that’s state in genuine power state capacity. The second point on this is look how quickly they’re able to turn on a dime. We can come back to the issue about whether the latest Chinese figures are right on that, but once the Chinese got the spread of the disease under control and there were much fewer new infections.

Richard McGregor:

It is just amazing to me how quickly they turned on a dime and then their focus was outward propaganda. In other words, we want to tell the world not how we covered up the virus, but how we beat the virus. And we are now in this process now where China is running an incredible global campaign as a good global citizen to underpin public health. And you can only do that if you’ve got a political organization which is both top-heavy but flexible and fleet of foot, not bound by any law, can turn on a dime and that’s what we’re witnessing at the moment. So that’s what I mean by the sort of the permanent campaign.

Misha Zelinsky (host):

Now that’s actually a perfect way to turn to I suppose the war within the war. I mean, we’ve got the war against the virus itself, but there’s this I suppose the contest that’s underway and it’s perhaps another front for a contest that’s already been underway between the United States and China. Do you think that this is going to be a decisive battle between the U.S and China or is this just a skirmish of a broader play? Because there’s a real big focus now in the United States about blaming China, then China is now of course putting out misinformation suggesting that the disease came from the United States military. How do you see that war within the war at the moment between two superpowers?

Richard McGregor:

Now I think just about everything is a contest between the U.S and China in many respects. There’s very little cooperation at all and it’s not just a contest between two countries, it’s a contest between two systems. Because China benchmarks itself against democracies, for its own citizens it demonizes democratic system. What’s the most important democratic system in the world? And that’s the United States which sadly at the moment it’s doing very poorly in handling this crisis. Now, as you and I know there’s many different democracies and there’s many different types of democracies.

Richard McGregor:

And many democracies in the world Taiwan, South Korea, Japan to some extent, Singapore, which we might call a guided democracy. Maybe Australia we’ll see how we go there have handled this crisis in a very different fashion and relatively speaking, touch wood successfully. Not the U.S though, so China is focused on the U.S. Both sides have stepped back a little from the rhetorical war, but it was only about two weeks ago that an official Chinese foreign ministry spokesman as you alluded to, started tweeting out that this virus had probably not originated in China but it had probably been bought to China by a U.S military serviceman, a woman actually.

Richard McGregor:

There’s no basis to this, it’s the product of fettered conspiracy sites, one in Canada, some in America, all around the world. And this was quite a remarkable thing for the foreign ministry to do. Now I think there’s been a split in China within the foreign ministry over these tactics. But nonetheless, the fact that an official foreign ministry spokesman was authorized to do this tells you that the system in China is hardening up against the U.S. They wouldn’t have done this 10 years ago, they wouldn’t have done it five years ago but they are feeling pretty confident now and pretty involved in and pretty assertive and aggressive all under Xi Jinping. And so they are willing to take on the U.S in any form possible and that includes spreading fake news almost from the very top of the system.

Misha Zelinsky (host):

So I’m curious just to dig into that about this total campaign or this information war by China and the Chinese Communist Party. I mean, one of the things that I think the difficulty there is that the system tended to reward, or at least at the beginning was that misinformation or managing perceptions rather than truth. Where people in Wuhan doctors were arrested and journalists were arrested for reporting on it almost at the beginning for political reasons. I mean, is it possible do you think that China is going to be able to position itself as a savior globally, and can we really believe the narratives of the infection rates, the mortality rates out of China? And is that something that’s going to be effective for them?

Richard McGregor:

Yeah. Well the jury is still out on that. I would say not completely effective, but there might… I’d say two things. It might be more effective than we think or would like, and remember all this propaganda is also internally directed to the Chinese people themselves. The Chinese people have just gone through an absolutely brutal experience with a really tough quarantine. You think of yourself how much you might be sort of champing at the bit at the moment, after a few weeks-

Misha Zelinsky (host):

I’m climbing the walls here mate.

Richard McGregor:

Well, right. You think of Wuhan you weren’t allowed out at all, if you were you were severely punished, people were dying all around you and like. So there’s been a lot of civil unrest in China since then at various different places, you can see it on the internet. They were for example, outside the provincial headquarters, sorry the city headquarters of party organization this week. There was a massive protest calling for rent relief, something that people in Australia are going to be sort of angst that they will be very familiar with very soon. So going back to the start as you alluded in Wuhan and the origins of this and whether that really undermines China’s claims to soft power.

Richard McGregor:

I mean, I think it does overseas but let’s see how it plays out. For example I think one of the major battlegrounds right now is Europe. We’ve got terrible situations in Spain and Italy to France and also the UK, and China has been making extremely high profile air lifts of masks and protective equipment and gowns and that sort of thing for the use of medical professionals. And this has really caused quite a stir. If you look at Macron, president Macron from France recently he’s had to make very statement saying well, “Look, we’ve given as much to other countries in Europe as China has, stop this propaganda.”

Richard McGregor:

So it might work in a superficial way at the start, but I think it really alerts the leaders of other country like Macron who’s been thinking deeply about China. That they’ve really got to wake up to themselves and just see the attention and focus of what China is doing and they have to respond. We’ve been through this same debate in Australia, so the coronavirus has been important in that respect. I should say one other thing though, that on the figures you mentioned. Look, the quarantine was brutal in China but there’s no doubt it worked to a degree. Now, is it true, as they were saying a week or two ago that there were no new cases in China? Obviously that’s not true.

Richard McGregor:

Is it true that the death rate in Wuhan was as low as they suggested a few thousand? I think there’s no doubt that under counts the death rate. But having said that, I treat the Chinese figures to a degree like I treat Chinese GDP figures. They’re not right to the decimal point, but they’re broadly right as to the trends because I think with the virus, it’s something you simply you can’t sort of cover up for good. And another way of judging it is an old thing with China, don’t watch what they say, watch what they do. Now Xi Jinping has been out and about, he was into Zhejiang yesterday the province near Shanghai. He’s been to Wuhan. There’s no way they would put Xi Jinping out in public unless they were pretty confident that they’d made massive progress in containing the virus.

Misha Zelinsky (host):

Yeah. So just turning to Xi Jinping, your essay recently the backlash essay, you’ve written that Xi was under pressure internally and that perhaps China isn’t an unstoppable monolith that we sometimes perceive it to be. What to your knowledge has been the response in China by Chinese people? Are they buying the narrative from the government that things have been well handled by the Chinese Communist Party? And is this information war, you mentioned some of it’s being projected externally for soft power reasons to manipulate the global narrative, but a lot of it is for the domestic audience. How much is that of confidence as how much is that of fear in your mind?

Richard McGregor:

Yes, that’s a very good question and hard to be definitive in answering it. Before the coronavirus I had a very simple crude rule of thumb and emphasis on crude, and that was that the people, the citizenry liked Xi Jinping, the elite disliked him. Now why would I say that? Xi’s anti-corruption campaign is highly popular amongst people because that’s something that people have been angry about in China for a long time. Saying public officials get rich at their expense so bringing these people down works for him. The elite it’s a bit different. There’s a lot of criticism of him for his management of the economy, favoring the state over the private sector.

Richard McGregor:

You obviously upset a lot of powerful people with an anti-corruption campaign. Most of all I think the elite technocrats are absolutely furious with him about making himself president or leader in perpetuity, that was really the turning point. I don’t see at the moment, there’s no way at the moment Xi Jinping has his hands firmly on the levers of a power in every sector, nobody’s going to knock him off or anything that. It’s very hard to mobilize even elite opinion against him because you can’t. If you form a group to criticize him or a ginger group against him you’ll be shut down, you might be arrested and the like. Look at what’s happened in recent weeks after Wuhan.

Richard McGregor:

In the initial stages of the virus in Wuhan, we had an extraordinary display of public opinion on the internet criticizing the government, mourning the death of doctors who tried to speak out and like. Citizen journalists going around giving us fresh reports daily about what was happening on the ground. Well, that’s all stopped. The system’s got his act together, those citizen journalists are basically in detention. Other people who criticize Xi recently, most famously a big time Beijing property developer who was always a bit of a rat bag commentator but he was well-connected. He’s been detained.

Richard McGregor:

So anytime there’s any outbreak of criticism against Xi before it can take grip, before it can gain an audience at the top, before it can embolden people, he shuts it down and that’s what’s happening now. Whether the impact on Chinese people, people in China haven’t gone through a deep recession before, they probably about to go through one now. So we’ll see. The system will be tested but the propaganda system will also be working over time to convince people that they did the right thing with a lockdown. China did better than other countries, particularly America and they should stick with Xi and they should stick with the CCP.

Misha Zelinsky (host):

Yeah, that’s interesting. You sort of touched earlier on the contest between systems and that’s very much evident now. I mean, it was emerging before, but we’ve now got a full blown struggle between democracy and authoritarianism. And we talked about the limitations around why the authoritarian regime might’ve led to a cover up at the beginning, but the ability to turn on a dime as you said. I mean, what is the response to the crisis tell us about democracies struggling to get the balance right between I suppose, the repression of people and rights of individuals and the suppression of the illness?

Misha Zelinsky (host):

And the other thing I think is perhaps troubling people that are in favor of democracies as I am. When you look at the United States response to some other democracies in Europe, basic competence appears to be in question here. I mean when you look at the United States, a lot of their soft power came from being the country that put the man on the moon and being the global leader. They’re certainly not stepping up in a global leadership capacity, but also in basic competence capacity there’s certain question marks there.

Richard McGregor:

Well that’s right. When you let the state wither, and when you attack the state for decades, and when you load them up with all sorts of things that the bureaucracy in America is loaded up with by Congress, you undermine the effectiveness of the state. Whatever you say about China, they’ve got enormous state capacity. They can mobilize resources, they can mobilize people, they have a extraordinary ability, logistical ability to get suppliers here or there. That sort of thing has been corroded over many years in the U.S. We could go on about that about that tribal political culture. You’ve seen a bit of sclerotic democracies in Europe as well struggling at the same time.

Richard McGregor:

And this is all grist for the Chinese mill. I mean, the context for the Chinese is, the turning point of the Chinese confidence in their system compared to America was obviously first of all in the global financial crisis in 2008. The Americans had been coming over and lecturing the Chinese about how to run a modern financial system and the like. Then of course, we had the GFC and the Chinese saw okay, thanks America no more lectures from you on how to run banks and the like, we’ll do that ourselves. After that, that was the start of Chinese hubris after that under Obama and American made a bit of a comeback. You can criticize Obama, but the economy did start to recover and that Chinese notice that.

Richard McGregor:

I think this second point of Chinese hubris was the election of Donald Trump. The Chinese have always said we’re meritocracy and look you’ve just selected as your new president, a real estate celebrity developer from New York. So thanks very much, we’ll stick with our meritocracy. Now, I think that came off again because Trump in his initial stages really destabilize the Chinese, they didn’t know how to handle him. I think they got a better grip on him as of about last year. But now I think we’re getting maybe to a third point of Chinese hubris. In other words, if America really suffers and it looks they’re going to from this virus, both economically, societally and the like.

Richard McGregor:

All the holes in the health system, all the impact on poor people and the like in U.S. The way that the rich will be able to protect themselves in the U.S and poor people won’t. Well, that’s going to be another high point of Chinese hubris and this is at a time when compared to 2008, they’re a really powerful country. Their economy 2/3 the size America’s, their military I think they’ve got a bigger Navy these days than America’s, untested obviously. So we’re getting to a point where China will feel even more assertive and they’ll feel their able to be more assertive because the U.S more so than in 2008, will be really turning inward angrily. We hope not, but that’s the direction it’s heading in.

Misha Zelinsky (host):

And so just turning to you mentioned I suppose, China in the context of its military and forward projecting foreign policy. How worried should we be about the Pacific during the pandemic? I mean every country at the moment is grappling with the COVID-19 outbreak. We’ve gone through a big focus where we’ve done the Pacific step up because we took the view, we’d taken our eyes off the prize with our Pacific partners. And China had been doing a lot of soft power, a lot of debt diplomacy through it’s a belt and road initiative there. I mean, how worried are we generally right now about the Pacific? And should we be more worried about China’s activities there during the COVID-19 situation?

Richard McGregor:

Well, I think we’re worried about it. To be fair we are focused on it, whether we’ve got the capacity to remain competitive it remains to be seen. But let me give you one story. About three weeks ago I was actually in Papua New Guinea giving talks on China and the like and this was just when the situation was starting to turn in China, in other words they thought they were getting on top of the virus. And at that point the Chinese convened a teleconference with the entire cabinet of P and G and I think the Solomon Islands, to give them a talk about how to handle COVID-19. And I thought that was just remarkable. They were so fast, they’d barely drawn breath from battling back the virus and they’re on the front foot in this propaganda campaign.

Richard McGregor:

And it was obviously a global campaign because the Pacific Islands are important, but they’re not the biggest front for China’s global push. And there they were convening the entire cabinet and the Solomon Islands to in an exercise of what we might call soft power, teaching them about the virus. Now since then, for example Solomon Islands tests for the virus where were having to be sent to Australia. The Chinese said, “Oh, we’ll come and do them for you.” As a response to that, Australia has actually sent the Solomons their own test kits so that they can be done there. So, yeah there’s definitely a contest going on. In Port Moresby you can see Chinese construction sites everywhere, that they look just the construction sites I used to see Beijing.

Richard McGregor:

For good reason they’ve got the exact same signs outside them, the same companies, the same sort of safety signs in Chinese and bad English. And of course, Chinese workers were drawn and imported at the expense of the locals. I asked many of the Papua New Guinea friends up there why do you allow this? What about you’ve got massive underemployment in your country. And they said that well, the Chinese just insisted on it. So yeah, it’s a big contest in the Pacific and fundamental one for Australia. I think the federal government has done the right thing to focus on it. The problem with Australia I think often is we have excellent well-meaning policies, but then the execution falls away. And China isn’t going away from the Pacific so we’ve got to stick with it for a long time.

Misha Zelinsky (host):

No I think it’s absolutely critical, it’s one area hopefully that there’s bipartisan support. I mean the Pacific essentially is Australia’s geopolitical neighborhood so it’s something that we need to keep an eye on. I’m curious about your take on criticism of the CCP regime by those in the West. Clearly at the moment Donald Trump for the reasons we’ve already discussed, that Macron story but also he’s domestic political reasons he’s been calling COVID-19 coronavirus and calling it the China virus. I mean, where do you see the differences between criticisms of the Chinese Communist Party, China as a nation state? What’s fair and what delves into racism? Because often you have a situation where the regime, the CCP very quickly come out and say any criticism amounts to racism. Which is clearly untrue, but where is the line there and how do we manage that when we’re looking at both our domestic politics but also geopolitically in this contest between democracy and autocracy?

Richard McGregor:

Yeah, it’s a bloody hard question. In Australia, we have a very sort of racist history in Australia at the gimps, that’s obvious to anybody. We had an anti color bar in immigration till about ’65 or ’73 or however you decide to define it. Since then I think we’ve opened up remarkably and I’m sort of a glass half full on all this, but we’re being tested right now. I guess there’s two things to mention here. It’s very painful to see all the headlines in papers in Australia now about Chinese profiteers on masks and this, that and the other as though the only carpetbaggers in the world are Chinese and not of any other race or color.

Richard McGregor:

I have some sympathy for the Chinese companies in Australia, which sort of bought up all the masks and the PPE equipment in January and sent to China. Well, there was an emergency then, they’re now bringing it back here. I don’t know whether they’re price gouging or not, and if they are price gouging then something should be done about them. But it’s just seems a really easy, cheap, free kick in the tabloid and newspapers and maybe sort of you know prodded on from his sick bed by Peter Dutton. And I think we have to be really careful about that because we end up with people of Asian descent no matter where they’re from, being screamed at on the streets and the like and that’s bad all round.

Richard McGregor:

On the issue of the so called China virus, Chinese virus or Wuhan virus now look, I would never call it that and I don’t know whether it’s racist on not I mean. But I’m a little bit reluctant to allow the Chinese to play the victim card on this account. We have Japanese encephalitis, that’s what it’s called in Chinese newspapers. We had the Middle Eastern respiratory syndrome, We had Spanish flu, which by the way started in Kansas in America, not in Spain.

Misha Zelinsky (host):

It is that right? That’s interesting.

Richard McGregor:

Yes it is. It was only sort of came up and was reported in Spain. But the WHO I think because the Japanese complained about Japanese encephalitis I think tried to encourage people as of a few years ago, not to attach geographical names to diseases and fair enough. I think. But it is funny or interesting I should say, not funny. If you look at Chinese papers from say five weeks ago The Global Times, some of the headlines there talked about the Wuhan virus. And guess what? They’ve gone back in recent weeks and changed the headlines on the online stories and they are no longer calling it the Wuhan virus.

Richard McGregor:

But personally, we should speak truthfully don’t shy away from the fact about where this started and the problems of the initial cover up. That’s all fair game, but trying to use this as some sort of political cajole as U.S Secretary of State Mike Pompeo did recently at the G7 meeting. He wouldn’t agree to a communique until the word Wuhan virus was in there and of course there wasn’t a communique as a result. I think that’s pointless and not the main game and unnecessarily stigmatizing.

Misha Zelinsky (host):

So I mean, one of the things I think we’re grappling with here. I mean, traditionally people sending I suppose goods back to their homeland probably not an uncommon event in Australia’s history. The difference I suppose here is we’ve never had a situation where we’ve had an authoritarian regime which seeks to control its diaspora in other nations. So I mean, I’ll be curious to get your take on how worried we should be by CCP interference in Australia’s institutions, the United Works Front Department which is the propaganda wing of the CCP. How worried should we be about that when you’ve got former ASIO head saying look, “Essentially we’re being overwhelmed.” I mean, how concerned are you about things that? And then how do they play into things where you have seemingly China on a global scale, not just from Australia using its it’s diaspora networks to essentially source goods from beneath the nation states.

Richard McGregor:

Yes. Well once again, it’s a really difficult issue. On the issue of diaspora network sourcing goods, sometimes that can be great for trade. I mean, people have complained, I’m sitting in Sydney as I talk to you and Michelle and I listened to Alan Jones and Ray Hadley in the morning, the shock jocks, and they’re often complaining about the so called diagos the people who grab milk powder off the shelves here and send it back to China knowing that they’re getting a higher price. Now that’s no good price gouging but the other way of looking at it, these people have established what could be a lucrative trade for Australia.

Richard McGregor:

So instead of sort of demonizing why don’t we take them over? Why don’t we use it? Why don’t we make ourselves a base for which the Chinese would be dependent on to buy these things? So I kind of think in some respects we approach it the wrong way. Now onto your bigger point of how we handle the diaspora issue, it’s a really difficult issue. A lot of Chinese in Australia feel singled out over a lot of heavy press reporting in recent years about overseas Chinese and infiltrating the Labor Party and the Liberal Party of course.

Richard McGregor:

And not being loyal to Australia and that’s extremely hurtful thing to be told. But the truth is the problem starts in many respects in China, in the CCP with Xi Jinping because they’re very experienced at this kind of work. Saying that to these people your Chinese, your first loyalty should be to China. So how do we respond to that? It muddies the waters, it makes it very difficult for Australian institutions to manage when the CCP is quite openly targeting these people to support China. So it’s a day to day proposition and a very hard one to get right on every single day.

Misha Zelinsky (host):

The other difficulty of course is essentially the CCP has been very good at infiltrating all the I suppose the ethnic groups, the Chinese ethnic groups and taking control of those institutions. I mean, how do we push back on the independence of those institutions including things the Chinese language media in Australia, which a lot of it is a mouthpiece straight from the party? How do you see that challenge?

Richard McGregor:

Yes. Well the Chinese community in Australia is actually extremely diverse, some have been here for decades. The 70s we got a lot of people after the Beijing crackdown in 1989, we’ve had waves in more recent years. We’ve got rich people, we’ve got poor people, a lot of the Chinese middle class as well, very varied. A lot of the evangelical Christians and the like. So it’s a diverse community but as you say, the community groups which represent them and the newspapers which speak to them are not diverse. They are almost entirely pro PRC and the newspapers in fact basically censor themselves along PRC lines. Now, I want to make an important distinction here. There’s nothing wrong with being proud of China’s success since 1980, that’s quite natural.

Richard McGregor:

That doesn’t make you a CCP student and we’ve got to be careful about that. But nonetheless as you say, the control of the key groups or the mollifying of them if you like, is really striking. So we’ve got to be very aware of that. Where it’s a problem, we’ve got to be very open about it, sunlight helps. Everybody needs to understand how the Chinese political system works so we can get a bit of, a hate to say this, nuance into the debate. We can make judgments about whether something is in the interests of Australia and whether it’s not. But don’t target the entire community with a single brush because the community is diverse and we would like them to stay diverse in both their political opinion, especially I would say in the political outlook.

Misha Zelinsky (host):

I think that’s a really critical point. I mean, I think one of the mistakes we make in the debate is treating “the Chinese community” as a monolithic group. So I think it is very important, but it is also kind of that challenge between that pointy end that seems to be controlled by the CCP and how we navigate around that. The other question I want to ask you and sort of going back to some of the things we were talking about earlier relating to a repression and use of information in this total campaigning both globally and domestically. How do you see technology now seemingly… Once upon a time we thought technology and information was going to favor democracies. Now it seems democracy is being overrun now by misinformation, challenging of sources, impossibility of working out what truth is. The Chinese are very good at it, the Russians are excellent at it. I mean, how do you see that challenge and how do democracies push back against that?

Richard McGregor:

Yeah, very good question because you can make sure that the Chinese are pushing on all fronts. They’ve got their domestic internet locked down. They want to at the same time I would say transform or reform in their words, their global internet governance. They’ve got this thing called cyber sovereignty. In other words, they resent the fact that the internet having been set up mainly by the U.S and Western countries has been sort of governed by NGOs set up by those countries at the time. China wants to change that.

Richard McGregor:

Twitter is a great example of how China has it both ways. Inside China Twitter is banned outside China the Chinese government through its various ambassadors use Twitter remorselessly to promote their cause and spread all sorts of information. That same kind of access to Chinese citizens on Chinese social media, on Weibo and things that, the Twitter equivalent is not available. One of the big things you touched on there of course is Western countries being awash with misinformation and not much of it comes from China and Russia.

Richard McGregor:

And I think one of the big tasks is particularly to if not reform ourselves, is to get better ourselves. To make sure our institutions are protected and resilient, that we have a free and open media that is both sort of independent and healthy. In other words, that should, not entirely help crowd out as much misinformation as possible. And if we’re successful our rivals will be less successful. That applies particularly to America, but it certainly applies to Australia as well.

Misha Zelinsky (host):

Yeah. I wanted to get your take on… I mean, China and the CCP will have to focus a lot of the debate when in discussions about the economic benefits to relationship with the Chinese state. I mean, how critical do you think the issue of human rights is? It’s dropped away now with COVID-19, but the way your issue was certainly getting a lot more attention probably in 2019. How do you see the importance of continuing to challenge China’s human rights record? A lot of countries shy away from it. Do you think it’s important that we continue to step up in that space?

Richard McGregor:

Well, it’s certainly important, but I do think Australia’s ability to lead on this is limited. Unless other bigger Western countries are taking the lead, then it’s going to be very difficult for us to do that. The Chinese don’t even bother to have the bilateral dialogue with Australia on human rights, which we conducted for a number of years. They steadily downgraded the level of representatives they would send to it, now they don’t bother with it at all. In the case of the Uyghurs for example, yes we should continue to pursue that, particularly in where Australian citizen involve, we should continue to publicize it.

Richard McGregor:

The media should continue to write about it. Think tanks like mine should continue to have events about it as well. But we don’t want to have too much expectations about what we will be able to achieve other than keeping it on the agenda. Now I may sound a little bit not as tough as some people would like, but this is not a new issue. China when it was much weaker and poorer didn’t respond very much to what pressure we were able to mount then and what pressure of course the U.S was able to amount then. And I’d say that’s even more the case now.

Misha Zelinsky (host):

But certainly, I mean and I think it’s really troubling that use of the technology in repression of Uyghurs in particular with at least one million people locked away it’s something I think we need to keep striving to draw attention to. But you’re right, it is extraordinarily difficult certainly from Australia on its own, but even from a global coordinated effort. Lastly, I just want to ask your opinion. I mean, we’ve got this big contest, you’re an expert in the CCP and its workings and it appears like this perhaps and it’s of their narrative to project themselves as a irrepressible monolith. But are you confident or an optimist when it comes to democracy prevailing in this contest or are you bearish at the moment in terms of us getting our act together and prevailing?

Richard McGregor:

I’m a little bearish. I do think China’s going to have many more problems than people appreciate or not every… For example, demographics. They’re going to get old very rapidly before they’re rich in a per capita basis. They’ve got enormous environmental problems particularly with water. The economy will not grow even at 6% a year for too much longer. So they’ve got enormous problems, but they’ve had enormous problems for years and they keep exceeding expectations in their ability to manage them. So in that respect, I don’t underestimate them and I think we shouldn’t underestimate them. So then it comes back to your question, can we get our act together?

Richard McGregor:

Well, if the U.S doesn’t get its act together, then it’s a whole new world. We’re already sort of part way down there in Australia by trying to establish much more regional multi-lateral partnerships, tighter relationships with Europe perhaps as well. That is going to be a whole new ball game once the Ex-Americana doesn’t so much fall off the cliff, but no longer becomes the dominant force in the region. This is a once in a two or three generational change in our foreign policy situation, and this it’s going to be a tough struggle I think some decades to come. So I just hope Australians can step up to the mark really and be prepared for it.

Misha Zelinsky (host):

Do you see the election in 2020 in the U.S in November as critical to that then? Given that second Trump term could really lock in a lot of those trends you just discussed?

Richard McGregor:

I totally do. I’m sorry to say, but if Trump is re-elected that is a disaster. I’m not saying everything he’s done is bad, but he’s just corrosive for U.S institutions, the importance of at least some level of truth and transparency in a democracy, in stability, in using expert advice. I don’t know what’s going to happen in 2020. I’ve always thought he’s going to lose actually because I think there’s so many Americans, you can look at all sorts of elections which have taken place, the democratic primaries, the midterms two years ago. So many people want to vote him out, it’s just a matter of the candidate who the Democrats field on the day, most likely Joe Biden we’ll see can get those people out. But I think you won’t undo the damage that Trump has done quickly and I should also say of course, Trump might be a symptom as much as a cause. He didn’t land in American politics a spaceship, the circumstances, the soil had been tilled for many years making way for him. But if he gets another four years then I think that will be devastating for global democracies.

Misha Zelinsky (host):

Well, Richard on that very happy note, I’m going to switch to our final question that I ask every diplomates and I was trying to find something positive to switch us to, but you’ve defeated me. But I’ll get across there in an enormously clunky Segway, but three people coming to a barbecue or foreign guests coming to a barbecue at Richard’s place in Sydney. You’ve noted that you’re in Sydney, so who would they be and why mate?

Richard McGregor:

Okay. I guess we want a Chinese guest. Let’s get Deng Xiaoping along with an interpreter because of his sheer sense, the arc of history of his life is quite remarkable. I think he would be terrific. I would like, and this is by the way I’m not saying all these three people would get along. I’m just telling the people I think-

Misha Zelinsky (host):

It might make it more interesting-

Richard McGregor:

More interesting. I think this is a great man of the old elite foreign policy, but a great thinker was a Harry Truman’s Secretary of State Dean Acheson who was pivotal in setting up the post war world. And a third person who I think might be a good peace maker amongst those or somebody who could step in when the conversation froze would be the late Kofi Annan from the UN, a great African diplomat. Many people would criticize him over many different things. He was in a job where he was never going to please everybody, but I think he also had a fantastic career as well. So he’d be my third guest.

Misha Zelinsky (host):

Well, they’ll be fascinating conversations around that table. So we’d love to get a podcast of that one mate so make sure you record it if you do happen to get everyone on.

Richard McGregor:

That’s true, yeah. I’m sorry to sound so gloomy, I’m really sounding gloomy these days and maybe it’s been locked up inside and I can’t exercise enough.

Misha Zelinsky (host):

What is that? In fairness Richard, we are in the middle of a global pandemic so you are entitled to be a little gloomy right now in mate.

Richard McGregor:

Yes. Well, next time I’ll be happier, I hope.

Misha Zelinsky (host):

Indeed. But look, thank you so much for joining us. You’ve given a lot to think about and I really appreciate the chat. So thank you so much.

Richard McGregor:

Thank you very much for having me on. I appreciate it.

 

 

 

Dr. Alexandra Phelan: Tackling the COVID-19 pandemic and you should know

Dr Alexandra Phelan is a faculty member at the Center for Global Health Science & Security at Georgetown University School of Medicine, and Adjunct Professor of Law at Georgetown University Law Center.

A global expert in pandemics, Misha Zelinsky caught up with Alex to talk about all things related to COVID-19, including the nature of the threat we face from the virus, the challenges coordinating government responses, the vital role universal healthcare plays in stopping pandemics, why the Chinese Communist Party’s delays at the start were so costly and what Australia and the world should be doing right now.

As a serious note please make sure you are listening to authorities and taking the most up to date advice as this crisis unfolds. The situation may have changed by the time you have listened to this. 

EPISODE TRANSCRIPT:

Misha Zelinsky:

Welcome to Diplomates. This is Misha Zelinsky. I’m joined today by Dr. Alexandra Phelann from the United States. She’s Australian but she’s joining via the magic of the internet, which is not yet crashed with all the traffic that’s on it. Alex, can you hear me? Welcome to the show.

Alexandra Phelan:

I can, Misha. Thanks so much for having me.

Misha Zelinsky:

Oh, pleasure’s all mine and the listeners. I might start, there’s a lot of places you can start with this topic relating to, we’re obviously going to be talking a lot about coronavirus or COVID-19, which is much more sinister-sounding name. Firstly, maybe you could just start by explaining what exactly the virus is. I mean, a lot of people say it’s a bad flu, it’s a killer virus, is it somewhere in between? Maybe you could start there with a short definition.

Alexandra Phelan:

Yeah, absolutely. So, I’ll firstly start with sort of two terms. We’ve got COVID-19 which describes the disease, so when people are ill and then we have SARS-CoV-2 which is the name that has been given to the virus itself, the coronavirus and you might here in there that SARS-CoV-2, so SARS coronavirus two, is because it’s closely related to the coronavirus that we saw in the SARS outbreak back in 2002, 2003, but it is a different new novel coronavirus.

Alexandra Phelan:

There are four coronaviruses that normally circulate during the year. They’re sort of a type of virus, a coronavirus, and they normally cause mild illness, so like mild colds, but we do know of two before this virus, more serious forms of coronavirus and that’s SARS that I mentioned and MERS, Middle East Respiratory Syndrome, is caused by the MERS coronavirus. And those are two viruses that showed us that the coronaviruses can actually cause this serious disease and this third novel coronavirus, so this sort of severe coronavirus is another example of a coronavirus that can cause quite serious respiratory illness being COVID-19.

Misha Zelinsky:

Right. Okay. And so in terms of the next question I think’s useful to get, as long as we’re doing a quick round of definitions. A pandemic. What is a pandemic and how do we define one?

Alexandra Phelan:

Great question. A pandemic is actually is not necessarily a legal term or a specific technical click, it’s more a descriptive term. A pandemic is simply a way of describing an outbreak or an epidemic that has gone over the entire world. And there are different definitions that people use to describe what is over the entire world. Some definitions are simply that it’s to two or three continents. Some definitions say everywhere except Antarctica. But essentially, it describes the spread of disease, rather than the severity of a disease, and as we look at the cases around the world of coronavirus, it’s quite clear that this is a pandemic. Now when the WHO confirmed that this was a pandemic the other week, it didn’t necessarily change anything from say an international law or a governance perspective. There maybe some contracts around the world that might have the word pandemic in them and that’s a triggering event or some pieces of domestic legislation that have pandemic as a triggering event, but as a term, it’s more a descriptor rather than any sort of significant legal designation.

Alexandra Phelan:

There is a term that is significant legally and that’s a public health emergency of international concern or PHEIC and that was declared on January 30th by the World Health Organization director-general under international law.

Misha Zelinsky:

And say that we’re now officially in a pandemic and we’ve got this rather severe version of the coronavirus, I mean, it’s hard to be how worried to be. I mean, can you give a sense to me, because there is so many different projections and people making various calculations as to mortality rates based on data out of China and other places. How worried should people be because it seems that early sentiment, certainly in Australia and I think around the world was people were relatively sanguine about it. How worried should people be and how concerned should we be about the various projections?

Alexandra Phelan:

Yeah, so worry versus being informed is a difficult one. I work in pandemic preparedness. This has been my life for the last 10 years and so for me, the idea of worry is not necessarily a good one. I think though how seriously should we take this is very seriously. And the reason being is, I mean models are models and there are limits to what models can actually demonstrate and what models can factor in and there are lots of different models that are being used for this outbreak, but what we are learning based on the observed data and I guess the consistency we’re seeing a range of different models that are coming out of this is that this is going to have beyond what it already has, a significant human health and life impact. If we start to compare it to other, comparisons can be useful to get a sense of things, right?

Alexandra Phelan:

If we compare some of the data that we do have, and again, this is just observed and this is likely to change, we do have some early, what we call case fatality rates. They’re a form of mortality rates that look at out of everyone who gets the disease, how many people actually die and this is being updated because every country in every situation will change the factors that cause whether people die or not die. And so there’s an average case fatality rate of about 3.4% and there’s out of everyone that gets it 3.4% will pass away, but that changes based on the situation. In Italy it’s looking like the case fatality rate is sitting up at that sort of higher-end, maybe 3.4%, perhaps even a little bit higher, but in other countries we’re seeing in say South Korea, we’re seeing it at sort of the lower end, sort of closer to 1%. Now that being said, that number, 1% is still significant.

Alexandra Phelan:

If we compare to past outbreaks and obviously this is the first time we’ve had a COVID-19 outbreak, this is a new type of coronavirus, if we look at say influenza pandemics, and they’re perhaps the most useful comparison, but you can’t really compare them exactly because they’re different diseases and different circumstances, but if I said, we’ve got this 3.4% global case fatality rate, we look at say seasonal influenza. Seasonal influenza each year has around a 1% case fatality rate typically, I mean it sort of changes a little bit, and that does a significant health burden. If we look at say the H1-9, so 2009 influenza pandemic, swine flu, which people may remember, that was about 0.1%. So, if we go from 0.1% to about 1% and then we’re looking at that’s between 1% and 3.4% or so depending on the circumstances, we’re looking at a pretty significant global health burden.

Alexandra Phelan:

The 1918 Spanish flu, just sort of think back to that, which killed more people than both wars combined, had a case fatality rate of about 2%. So, if we’re hovering at around that 2% and we get global spread and we get that 2% globally, and again, it depends all on the situation in each country, what measures countries take to protect their citizens and protect the health of their citizens will affect it, but if we’re looking at those sorts of figures, then we are in this, this is going to be a marathon, this is not going to be a sprint, the global impact and the health impact of this outbreak is currently expected to be significant.

Misha Zelinsky:

Well, that’s certainly sobering those statistics as compared to the Spanish flu which killed 10s of millions if not 100s of millions of people. So, just curious, you talked about the kind of the responses and sort of the impact. One of the things that people are talking about a lot is sort of this flattening of the curve, which is essentially governments trying to reduce the speed of the rate of infections, how much can that impact on how the health system responds and preventing the health system being overrun and not having access to respirators et cetera. How critical is that to the response?

Alexandra Phelan:

Yeah, so this is what makes this virus particularly concerning is the ability to overwhelm health services. Because when you do have the severe form of illness, which still appears to be only about 20% of everyone who gets it, gets this severe form, because that’s a really important point to make, it looks like 80% of the population will have a mild illness as 20% who are severe, but if we’re seeing 20% of the population with severe illness, that is guaranteed health care system overwhelm. And what we’re seeing in Italy for example, what we saw in Wuhan specifically, not necessarily in other parts in China, but in Wuhan, in Italy, and we are likely to see in other countries around the world, the intensiveness and the severity of care needed is what makes that health care overwhelm. So this flattening the curve, the idea here that is a term that those of us in pandemic preparedness have worked with and it’s wonderful to see this is rolling out and people understanding it, but what it’s worth understanding is whilst it’s about reducing the number of people with the severity of the illness over time, so reducing from being everyone overwhelming the health care system at once and trying to spread it out and delay the people who are getting the severe illness as long as possible so that the health care system can cope.

Alexandra Phelan:

One of the things that’s not reflected in a lot of those graphs is health care services are already overwhelmed in most places in terms of our ICUs, in terms of our beds. Around the world, governments have consistently under-funded health systems or non-nationalized health systems, and so we’re already kind of at health care capacity or very close to. So, even if we are doing this mitigation, this flattening of the curve by focusing on slowing, but necessarily stopping the spread of an epidemic, we’re still likely to meet that sort of peak health care demand at that level, it’s just about mitigating that as much as possible. So that’s where those mitigation strategies are really key.

Alexandra Phelan:

But then the other strategy that we’ve sort of talked about is this idea of suppression, which is not just about mitigating and reducing the impact but also actually stopping the spread to people. So, that’s where we start to talk about things like social distancing, which we can get into. The idea of social distancing is you try to prevent people who are infected from coming into contact with people who are susceptible, and that includes people who may not have severe illness but could then pass it onto people who are vulnerable, which includes older populations. We say older, we’re looking at maybe over 65 as the data again is coming in, but also people with underlying medical conditions that make them more at risk, and again, a lot of this data is observational and on the fly, and so it’s likely to change and that has to inform government policy as well.

Misha Zelinsky:

And so that’s really kind of critical then how the government responds. Can you give a sense, I mean, you’ve mentioned Italy a bit, maybe what Italy got wrong and maybe some of the countries that seemed to have maybe tackled the challenge. I mean, China had a very aggressive response essentially locking down Hubei province and then having people essentially report to fever clinics et cetera. Are you able to give a very kind of high-level delineations in who’s doing it well and who isn’t and what the key factors there are?

Alexandra Phelan:

Yeah, absolutely. I mean, let’s start with the good example. The good example is South Korea, and they’ve been touted as a good example, and this may change over time. But to date, South Korea have appeared to reduce the spread, have a health care system more able to cope, and have managed to start to reduce the cases going forward from here. What South Korea implemented was a bit of this multi-pronged strategy that looked at both mitigation and suppression. So, what they did is implemented significant testing processes whereby individuals could essentially access tests, to get tested to check if they were infected regardless of their illness and their symptoms, or their travel history, and South Korea was able to run 20,000 tests a day at some point. And that included things like drive-up car testing facilities, as well as actively testing individuals.

Alexandra Phelan:

Now if an individual tested positive in South Korea they were essentially put into sort of a self-isolation and there were a range of different measures that the South Korean government used that helped implement that, which may or may not transfer to other places. So they used extensive mobile phone surveillance and monitoring to help enforce that, which I think that depends on the acceptability of an entire population because, at the end of the day, public health requires public trust. You don’t want to be doing anything that undermines peoples willingness to engage with the government. So, they implemented that testing and surveillance, and so it meant the people that were infected were taken away like they were at home, they took themselves away from the potential risk of spreading it to other people. And coupled with broad social distancing, meaning that people weren’t necessarily going out to restaurants and bars and people were working from home, engaging those sorts of policies so even if someone hadn’t got a test, you’re reducing the opportunities for transmission before someone knows whether they are sick or not. So, the testing coupled with the social distancing measures were incredibly effective.

Alexandra Phelan:

If we now look to say Italy. Italy started its surveillance and testing significantly too late. The social distancing that were put in place were put in place probably two weeks too late and the thing to I guess think about with pandemics and when we do this pandemic preparedness, we say that when you think it’s too early, you’re probably just about to get too late. The whole point of these social distancing measures is to have it in place before you have transmission occurring because remember when you actually are doing a test and you’re finding people are turning up and they’re sick, so you’re doing a test based on them being sick, not like South Korea where they’ve just got testing happening, if you’re waiting for people to get sick, you’re probably two weeks down the track already. There’s been two weeks of … We still don’t know exactly the details of pre-symptomatic transmission, like how long before people show symptoms, can they transmit it, that’s still getting that precise data, but it appears to be an element here. Once people are showing up and they’re sick, it’s already a bit too late.

Alexandra Phelan:

And so this sort of a week and two-week timeframes we’re seeing sort of roll across the world, and so in Italy, once these measures were implemented, sure they might have assisted in bringing down the curve, but by that stage, the system was primed for overwhelm and that’s what we’ve seen in the Italian ICU units in the north of the country. There are some more nuanced sort of distribution of ICU beds within the country that could assist, but the overwhelm has occurred because these measures were put in too late and Italy was the first country in Europe to really be` hit, so it’s also not surprising that these measures were put in too late.

Alexandra Phelan:

I do want to sort of take a moment to mention Wuhan. In China, in other cities, in Beijing, [Shanghai 00:17:16], [Sichuan 00:17:16], et cetera, they implemented these sorts of social distancing measures very similar to what we saw in South Korea and that was very successful. Wuhan is a special category and I think it’s really important to distinguish the successful measures done in other China cities from Wuhan. By the time Wuhan implemented their lockdown, which is a phrase, and if we look at what it technically was it was a cordon sanitaire, which is not a quarantine, it’s essentially a geographic area that has a rope tied around it and said no one can come and no one can go. By the time that had been implemented, there was already significant local transmission occurring. The impact of the cordon sanitaire in Wuhan appears to have potentially delayed the spread, not within China, you know this was happening during Lunar Year travel periods, but perhaps could’ve delayed the spread internationally by a couple of days.

Alexandra Phelan:

Now the question is at what cost those couple of days because we don’t know how many people in Wuhan died from secondary causes as a result of the lockdown from the health care system overwhelm and the appropriate counterfactual would be what if Wuhan back when they had the first notifications from doctors at the end of December or during December and early January, if we’re being flexible with the timing there, if they’d implemented social distancing and extensive testing and gotten those diagnostic tests up and running in time and had that in place, could have it been a very different picture, and I think that is a counterfactual we’ll have to explore in the after reviews of this outbreak.

Misha Zelinsky:

You sort of touched there about the importance of quick response and not waiting too long, but as I think from an Australian point of view, we’re watching the world seemingly going into lockdown, is it inevitable that every country’s going to be lockdown in some way, or is that not inevitable. Because one of the things I’m struggling to understand just as a complete layman in this space is, is lockdown really the best and most effective way of dealing this in a social distancing way but in an almost complete social distancing sense or can it be measured and mitigated in different ways?

Alexandra Phelan:

So I think the first thing I’d say is the term lockdown is getting used to describe just relatively normal social distancing measures that we’d say are quite legitimate as well as very punitive, arbitral and authoritarian measures because the term lockdown doesn’t mean anything right? It’s a descriptive term-

Misha Zelinsky:

Well, for example in LA, right, they’ve just now closed restaurants and bars to the public. I mean, in Australia it was just said, it was no football games, but I think it was quite stark to see cities around the world now where they’re restaurants are shut, bars are shut, any sort of social event is shut.

Alexandra Phelan:

Yeah, so that’s happened here in New York as of tomorrow wherein all restaurants, bars et cetera closed. In reality that’s already been happening to some degree. So, if we’re thinking about that, so if we want to use lockdown to mean a few things. I think the measures that we want to be seeing are working from home policies, that should be implemented. It’s already here in New York, that is getting people working from home if they can because not everyone can and not every business can, but where people can work from home. No gatherings, I think the current, and please feel free to correct me was 100 people or 500 perhaps even, I mean that’s way too … 20 people versus 500 people that’s an arbitrary distinction, really it’s about removing people having contact, so I would say even getting the point where people aren’t meeting up with more than 5 people. I think that is what we need-

Misha Zelinsky:

Wow.

Alexandra Phelan:

to be sort of be reducing this transmission, right? Obviously in families, that’s not necessarily feasible, but I wouldn’t be having a dinner party. If they are going outside, making sure they’ve got that physical distance, but I think though when we start to think about things like schools, which this becomes tricky because it might seem counter-intuitive, schools and universities, universities I think there is more of a justification for moving classes to online and reducing that contact, but for schools, one of the things that needs to be consider in this process is the fact that if you cancel schools a parent has to be able to stay home and not all parents have jobs where they will be able to work from home and in particular the workforce that we are particularly concerned about are our health care workforce.

Alexandra Phelan:

One of the most direct ways to stymie say the US health care workforce, and I’m not as across the Australian data, is if single parents have to stay home and look after their kids because a significant number of health care workers, particularly nurses, are single parents with primary carer responsibilities to stay home and look after kids. And the alternative might be to be looked after by their grandparents who we know are a high-risk group, whereas children, thankfully, on the current data appear not to be high risk, so closing schools, particularly say primary schools, can have really significant negative impacts on your ability to respond. And so whilst it might seem counterintuitive, the closing of schools needs to be really well thought through and considered in regards who are the parents that might have to stay home to look after the kids, and that’s why as a social distancing measure, in a lockdown, that may not actually be the appropriate thing.

Alexandra Phelan:

There are lots of in-between, right, you can stagger recess, you can stagger arrival times, you can increase recess times, that’s why it’s a lot more nuanced than I think the discussion has been to date in a lot of the data in Australia, but certainly, mass gatherings, restaurants, bars. There is a social responsibility on all of us that if we take measures now, we could save our grandparents, our parents, and our friends and other loved ones who may be particularly vulnerable to this outbreak.

Misha Zelinsky:

And so this social distancing, or maybe it’s moderate lockdown or that this really like closing down of large parts of the economy, what’s not clear to me at least is how long will this last for and what the aftermath looks like? So I mean it’s 14 days, it’s eight weeks, but then at the end of that period, are we sort of through the worst of it, or can it sort of spike again? That bit’s not clear to me either and I think that’s causing a lot of confusion at least in my mind.

Alexandra Phelan:

Yeah, yeah. I guess from a pandemic planning point of view we always put upfront the economic costs of a pandemic and the reality is the more people who are getting sick and ill and if you don’t mitigate and reduce the spread the bigger the impact on the economy, so it’s like just accepting there’s going to be a loss, it’s just how much of a loss. So in terms of the timeframes and how that factors in, as I said, models are models and they’re not necessarily, you know, they’re not forecasts, they’re not Nostradamus or Cassandra.

Alexandra Phelan:

But some modeling that came out overnight from a group at Imperial and they’re work has been informative for the UK government response and other responses previously, is that we would likely need to be using a combination of mitigation and suppression, so social distancing as well as reducing peak health care demand until we have a vaccine and it becomes widely available and we know from other vaccines we’re probably looking at the 12 to 18 months. So, there has to be some sort of combination with both measures.

Alexandra Phelan:

Now how does that work in practice? Well, we saw that in South Korea, and also in parts of China, we’ve seen the ability to bring cases under control and get case numbers low enough that you can go back to perhaps the testing model of testing if someone’s sick and then isolating them and quarantining their contacts. So because suppression is possibly in the short term, if we could potentially loosen interventions and measures provided that we don’t see a rebound, so it all depends on how good the system in place is for that period in between. So, we could see these temporary relaxations in short windows, but it needs to be able to put the switch back on if we see case numbers moving again. And that can relatively disruptive obviously, but that might be a way of easing the economic and social costs of interventions that are being used over that period until we have a vaccine.

Alexandra Phelan:

A vaccine isn’t guaranteed. We do have incredibly a potential candidate of vaccines out there, but we’ve got to remember the only tool we actually have in our power right now, as humans together against this virus is our solidarity and our ability to act to socially distance and until we have a vaccine and it’s available it’s going to be our solidarity that is going to be what keeps us safe.

Misha Zelinsky:

Well, it sounds like people should be digging in for the long haul, so maybe switching now just to what maybe individuals should be doing social distancing. What should people be doing as of now, working from home clearly but are there specific measures people should be taking in terms of preparing themselves?

Alexandra Phelan:

Yeah, so I think some of the measures we’ve seen in Italy and what we’re seeing here in New York, closing of bars and restaurants and people working from home, but keeping grocery stores and pharmacies open so people can still go get food, and so there’s this sort of rush and panic to have a 18-month prep, that’s not necessarily be required. Having a stockpile of food to sort of get through the next two weeks is a good way of doing it, or having to get through in sort of periods and bursts and that way when people run out it’s sort of much more staggered and people can go to the shops and get groceries. In terms of other additional measures, I think the most important thing, and this is particularly for people who are not in high-risk categories, who are healthy, who are younger, so like under 60, is to realize that they have perhaps one of the most important role to play in stopping the spread of this outbreak and that that is more important than going to a bar with mates or having friends over, and we’re very lucky this has happened at a time where we have tools where we can chat with our friends through video and audio link and there is some really innovative and creative ways we can keep ourselves not socially isolated whilst we’re doing this social distancing.

Alexandra Phelan:

I think the other sort of very individualized measures are clearly washing your hands often and properly, I think people are getting that message. If you do feel sick to contact the relevant hotline that’s made available or health care service to check with them. If you do have any symptoms, to stay home. The reality is, is we say mild illness, up to 80% of mild illness, that still can include pneumonia, so you can still get pretty sick and pretty unwell, but you’re not necessarily at the point of hospitalization and needing the health care service, and so I think there’s going to have to be an understanding that it’s not going to be pleasant for everyone that gets it and has a mild form. Some people will just get a sniffle, some people will get quite sick, but what we need that is our ICUs and our hospitals are available for people who are going to die without that support. So, I think that individual recognition of what is serious and what’s not serious.

Alexandra Phelan:

And I think the final thing is we all have a part to play in protecting the most vulnerable members of our community not just in our behaviors but also ensuring that they’re not socially isolated. Our elderly population or people with disabilities, or other members other community, just anyone in the community might not have the social connections and/or the support systems to be able to go get groceries and do things like that, so I think ensuring that we’re protecting those individuals. And that includes things like ensuring that sick leave is not a limit on people’s ability to stay home. Ensuring that casualized workforce in Australia have access to sick leave and have access to payment protections. There are lots of models around the world where the government’s actually gave hand-outs, gave amounts of money, and not just sort of what we’ve seen in Australia so far, but a broader range of people, and I think those sorts of measures we really need to be thinking about our restaurant workers, our casualized workforce, that need to be part of this because we need to be safe and staying home and not feel the economic individual economic pressures to have to be going to work.

Misha Zelinsky:

I absolutely agree with you around the issue around insecure work and the lack of access to health care. Certainly a concern in Australia, and I know it’s a bigger concern in countries like the United States. In terms of reassuring people, I mean we saw, I think at first everyone was having a bit of a laugh about the toilet paper crisis that seemed to have started in Australia and has spread around the world, but the prospect of panic buying is now very real. We’re seeing queues for things around the world and in the United States, people are queuing for guns, which is concerning, do you think we’ve done enough to reassure people? Because there’s a balance between scaring the bejesus out of people and also making sure they’re properly aware of the facts. So, how have you got that [crosstalk 00:32:09]?

Alexandra Phelan:

Yeah, it is a really challenging example of science and political, and governance communication. There are people who are experts at this, right, people who are experts in how to communicate that tension-

Misha Zelinsky:

Like Twitter, right?

Alexandra Phelan:

… I think if we saw government engaging these experts, in fact in our pandemic plans that is right up there in our top-10 priorities is have expert communicators for this exact issue. So, what people should be doing is having enough food and supplies that they feel that they can stay at home for the two weeks, in case they are sick and they stay at home for that entire period. And recognizing that hoarding is … You know, you see these posters during WWII, hoarding is unpatriotic, we’re kind of in that sort of period, right, where this is take only what you need to keep you and your family safe, and you might need to change some behaviors to be able to take less than what you would normally need. And I think that’s where there’s also a role for government in communicating what’s going to happen in terms of supply chains and logistics about access to food and how those supply chains are going to be kept active so people know that hey in two-weeks’ time when I’ve served my period of isolation, I need to go out and get some more supplies, get some more food and whatever that they know that they can.

Alexandra Phelan:

In New York, a number of restaurants have shifted to go and delivery so that they can keep their staff on board and can continue to provide food and done in a way where it’s pick up and drop off so you don’t have any individual contact between the people delivering and people who are at home. And so in facilitating those sorts of supplies and facilitating a much clearer communication is really key to addressing that balance. It’s a hard one but it’s possible.

Misha Zelinsky:

What’s the role here? So, how concerned are you as someone as an expert, I mean I was half-joking about Twitter, it seems to me that every single person’s now an expert in infection rates and global health policy, but how concerned are you about the role of social media in driving fake news and being able to distinguish what’s happening and what’s not happening? And also, I think, it’s very difficult for people as well with the flood of information from around the world, not just in their own jurisdiction, how do you see those challenges in amongst all this?

Alexandra Phelan:

Yeah, so I think there are two elements here. The first element is accuracy of information and the second element is mental health. So, the accuracy of information is we’ve become accustomed to receiving information from multiple sources, reliable and unreliable, and over the last four years, in particular, there’s been a lot of discussion about how do you stop unreliable information and where do you get reliable information. One of the advantages of a public health threat is we do have already established authorities on public health and that’s the World Health Organization, that’s the Center for Disease Control for the US, that’s the different public health departments in Australia, and I think I haven’t been up to date on what the Victorian Department of Health has been communicating. WHO and CDC have lots of really shareable memes on social media, they’re not actually memes they’re just images, but really shareable ways of communicating accurate information. So, if you are using Twitter and Facebook, I would make sure you’re following WHO and your state, as well as the federal health department, because they have been engaging in really active and proactive communication on those tools and I would limit where you get your information to those sources as much as possible, partly because of the first reason, for getting correct information, but also the second reason is mental health.

Alexandra Phelan:

A pandemic is a scary thing. There’s a lot of uncertainty and in that uncertainty, we can get worries and fears, as well as misinformation. There is constant information coming from other countries, accurate and not accurate, there’s constant levels of panic and fear and people telling other people not to fear and not to panic and dismissing what are quite legitimate concerns in many respects, so I think if you are not working on the outbreak directly, and it’s not necessarily directly relevant to what you need to be doing in your day-to-day apart from what you are doing to protect yourself and your family and your community, limiting the information you get to perhaps once a day. Maybe it’s the news broadcast at night or even radio at a certain time of day, or to the WHO or CDC or where ever you’re getting your news and limiting it, because I can tell you from someone who’s been following this outbreak since 31 December 2019, it can very quickly because overwhelming and very quickly that sense of lack of control, like what can you do as an individual. So I would focus on those steps that we spoke about and limit your time on social media in so far as you can while staying connected with your friends and family and loved ones.

Misha Zelinsky:

Staying off social media generally is good advice, so [crosstalk 00:37:56]. So, yeah you talked a lot about governments and the important role that they play here, I mean unfortunately in some instances we’ve seen I think rather poor leadership. I mean how helpful or unhelpful do you think the political class has been around the world on this issue? Who’s doing it well, who’s not, and what should they be really doing to restore a sense of calm to this?

Alexandra Phelan:

I think one of the best examples that we’ve seen in terms of political communication and political messaging and leadership is in Singapore, we saw the Singapore government very early come out say what they’re going to do, very clear messaging, balanced, and I think there’s a couple of rules for political and health communication that we try to follow. You say firstly, what do you know, what you don’t know, what you’re doing to find out and when you’re going to speak with people next? I’ve seen the state of Victorian Premier Andrews do exactly that framework in a number of the messaging and I’m sure there are plenty of other examples within different levels of government in Australia as well. So, I think clear messaging and leadership upfront and early is really key and that Singapore is a great example.

Alexandra Phelan:

We look at WHO, I’ve openly critiqued them on a number of different issues with this outbreak, particularly on human rights and international law norms, as well as public health messaging, but to their credit, one of the most incredible things WHO and the Director-General Tedros and others have been doing these daily updates to press, really clear messaging, again, what we know, what we don’t know, what we’re doing to find out, and when we’ll be back and I think those are some really great examples of communication. And it really shows how communication is so central to leadership and when people don’t hear from their leaders, they get worried. And I think having clarity of messaging is one of my biggest concerns with the current outbreak back in Australia and how it’s being dealt with. Yeah.

Misha Zelinsky:

Just expanding on the Australian response, it seems that we are at least somewhat behind the rest of the world maybe by fortune of our geographic isolation, ability to control our borders, I mean what would your advice be to Scott Morrison and the rest of the authorities that are responsible for this, what should we be doing urgently?

Alexandra Phelan:

So, the first thing I would say actually is to push back a little bit on that. Pathogens don’t respect borders. So, the fact that Australia’s a little bit behind in terms of timing is not a factor of border security, in fact at one point, we can maybe at another date how border enforcement can actually make things worse, or perceived border enforcement. But it is potentially a fact of our geographic isolation in terms of just number of travelers from the relevant parts of the world that has made a big, big step. Sorry, I got so distracted with making a particular point I forgot the rest of your question, Misha.

Misha Zelinsky:

That’s okay, it’s an important point to make and as I said, I’m more than happy to be corrected on this topic, I do not claim to be an expert.

Alexandra Phelan:

No, no, no.

Misha Zelinsky:

No, no, so what would you be advising the government in Australia to be doing if for whatever reason we do seem to have some time still up our sleeve?

Alexandra Phelan:

Yeah, absolutely that’s spot on. So, what we have right now is that time up our sleeve. There is already local transmission in Australia and so we need to start recognizing that we need to have measures in place now that address social distance and for people to limit that local transmission. We can’t rely on trying to control who comes in and out of the country, it is already here, it is already in Australia. So, what is needed is, I think there should be a move to issue advisories about limiting all mass gatherings, so I would say, over 20 people. People should and this is advisory and I’m deliberately using the word voluntary and advisory here, we can sort of talk about mandatory and criminal in a moment. There should be a prioritization of testing. We’re already at risk of running out of certain re-agents as I understand in Australia, so I think guaranteeing and shoring up our supply chain to actually conduct testing and to continually proactively test anyone who is showing symptoms, regardless of their travel history and perhaps facilitating testing through things like drive-through testing, continuing to set up specified clinics and to have that testing for people who have symptoms or who are our contacts of people who have symptoms or are confirmed.

Alexandra Phelan:

We then also be needing to look at our own measures. We should be looking at an encouragement and people who can, working from home. If they can, work from home. I think the universities, makes sense also to be shifting to a university-from-home model, where applicable, where okay. The school closures, as I mentioned earlier is a little bit more tricky and a little bit more difficult and I think that should be thought through very carefully because of the risk it will have on our health care workforce and our vulnerable elderly populations if those measures are implemented. The next thing we need to be doing is preparing a health care system. We do not have enough ventilators in Australia to cope with this. We do not have enough ICU beds in Australia to cope with this if we have transmission what is modeled in other countries and what we’re seeing in other countries.

Alexandra Phelan:

What we need to be doing is can we increase those direct items, do we have ability to get more ventilators, and get more beds, and that includes being ready to … When I say ready, I mean within the next two weeks, if we don’t see any particular shift in transmission being ready to be able to have our hospitals in surge capacity, that includes cutting elective surgeries and getting ready to have our system and perhaps already depending on what capacity is like in hospitals now, already be switching to have our hospitals in crisis standards of care, which that’s when we’re determining who gets access to ventilators. We need to have those plans in place now because you don’t want to be making those ethical decisions on the fly. And to be having our hospitals ready and supported ready to go for when to surge does hit.

Alexandra Phelan:

We’re going to be seeing, I think the thing I would say to people is do not be surprised and alarmed as we see cases doubling or exponentially growing because that’s exactly what we’re expecting the virus to do. So, when you see breaking news cases have doubled overnight, or whatever, that is expected and what you see today is two weeks after the infection occurred. So, we need to be putting those measures in place now so we are stopping that spread and it may seem like it’s too early, but that’s exactly when we’re talking about a pandemic, that is exactly when you need to be putting these measures in place. I think the cancellation of mass sporting events I think they’re absolutely the right decision and I think we need to be moving to those measures now.

Alexandra Phelan:

Now I mentioned the mandatory and criminal thing. Something that has concerned me is, so I worked on these laws in my undergraduate law dissertation was on these laws in Australia, when you use punitive criminal laws, you push people away from the public health system. You push them towards the criminal system, you push people towards avoiding interaction with authorities, whether they be police or public health.

Misha Zelinsky:

Because you don’t want to admit that you have it so you’re better to hide from it.

Alexandra Phelan:

Absolutely. And that’s when it goes underground. That’s when we see transmission, right, because people don’t want to engage. I was deeply disappointed to hear the Prime Minister say talking about dobbing in your mate who comes into work to the police. That’s is a strategy for underground transmission in Australia that we cannot track and it is not the right message, because we are about to go into a pandemic most likely in Australia, well we are in an epidemic, we are mostly likely drawn into the scale that we’re seeing around the world to some degree, we may be able to flatten it and move it to a different trajectory if we act now. What we need right now is solidarity and trust in our authorities and trust in each other and it is much better than if your mate comes into work that you say, “Hey, you go home right now. You have to go home.” Than you’re calling the cops. We need to be in this together and we need to support each other, and support our most vulnerable populations and moving towards a criminal model, I can tell you now from someone who’s worked in this field for a decade. criminalizing anything to do with health will always make health worse.

Misha Zelinsky:

That’s a very strong message and I think that’s something we should absolutely take on board here and around the world. Now just one, as we get towards the end of this. I know you got important conversations to have and important work to do. You talked before about the Wuhan situation and the origins of this outbreak, I mean, you talked all about the government response information sharing, how big a stuff up, and would it have made a difference had the Chinese authorities sort of acted earlier rather than covering it up. I mean it’s all sort of been forgotten now in the flurry of activity, but of course, at the time doctors were being arrested for diagnosing the illness and things like of that nature, as essentially the system tried to manage up, to hide the problem emerging. How big a problem was that delay in the beginning to where we are today?

Alexandra Phelan:

I think we will get some really interesting counterfactual model or sort of post hoc models to look at exactly that, that if this was reported. Again, this ties into the point that I was just making, that we know that a system that shares information, that is transparent, that is based on public health principles and is based on human rights, including the right to health and the right for everyone to have their health protected by the government, we know that those systems are much better at responding to infectious diseases and so measures that discourage notification that penalize individuals speaking or reporting, or a bureaucracy that deliberately slows down the sharing of information upwards and the reactions out of concern of potential punishment, we know that already, we know that that makes health worse, so I think that it will be very unsurprising if we have after-action reviews that sort of look at if we had had action by the Wuhan government in early January. So, even when this was reported globally, but if Wuhan specifically, we’d seen action in early January, rather than keeping the lid on things whilst the regional meetings were being held, then I think they’re quite conceivably could’ve been an appropriate response that mitigated and contained the outbreak at a much earlier stage.

Alexandra Phelan:

The nature of exponential growth means that the earlier that you can get in the more lives saved and the economics, like the economics, aren’t really what’s going to be at play here, but that’s the early you intervene the less the impact. I don’t know how helpful that’s going to be going forward because we’re going to have a long way before we get to those sorts of after-action reviews, but yeah, I think that will definitely be a point of many, many PhDs to come.

Misha Zelinsky:

Sounds like you’ve got one in the making there for yourself, but how do we future proof ourselves against future pandemics. I’m sure there’s someone who’s thought about these for a very, very long time, probably been jumping up and down producing reports saying that we’re not prepared for pandemics, we’re not pandemics and being ignored. What are the things that, you know, we obviously need to control this outbreak now, but what are the real things we need to be doing to future proof ourselves against future problems like this?

Alexandra Phelan:

Yeah, we need a couple of things. The first is we need investment in strong domestic health care system. We’re incredibly lucky to have Medicare in Australia and we should not be cutting it, we should not be underfunding it, we should be supporting our systems. To be able to have the capacity to prepare for pandemics like this let along every day health of Australians and that’s around the world, universal health care around the world. So, ensuring that health care is affordable, it’s available, it’s acceptable and it’s accessible and it’s quality around the world.

Alexandra Phelan:

There are a range of different capacities as under the piece of international law called The International Health Regulations there are these core capacities that countries are obligated to implement. There is an external evaluation available of countries to assess whether they’ve met those requirements and so there are tool kits, there are frameworks, and there are legal obligations that already exist for pandemic preparedness. And yes, we have been jumping up and down for the last 10 years and longer, so investment in not just in our own countries but the investment in the health systems and pandemic preparedness of other countries around the world, because we’re interconnected. If this pandemic has shown us anything is an outbreak anywhere is a public health threat everywhere and rather than placing blame on countries it’s about building up their support and their capacity to prevent, detect and respond to these outbreaks in the future.

Misha Zelinsky:

Well, Alex, this has been a hell of a conversation. I’m certainly more informed, though I don’t know if I’m any less alarmed, but to bring some kind of levity to this conversation, I normally find some clunky way to segue and I can’t possibly think of one for the final question about a barbecue at Alex’s place with three foreigners. Now, it is three, which does make it under your number of small gatherings, so we can still go ahead, though you might need to buy some stuff ahead of time and I can’t guarantee everybody’s going to make it there, but who are the three foreigners at a barbecue at Alex’s and why?

Alexandra Phelan:

You know what? I might need you to ask this question again, Misha, at some point, because I have been so busy I haven’t been able to sit and think about who I would invite to my barbecue. I think I’m still in social isolation mode.

Misha Zelinsky:

Well, you know what? I’m going to let you off the hook. Ordinarily, I don’t let my guests out of here without answering the question but given that you’re fighting the good fight on behalf of Aussie’s in the global debate, I think I’ll let you off the hook, but-

Alexandra Phelan:

I appreciate it.

Misha Zelinsky:

… it’s been a fantastic conversation. Really appreciate your insights and good luck with the fight against not only this pandemic, but all future pandemics. Thank you very much.

Alexandra Phelan:

Thanks, Misha.