1. Background

The COVID-19 pandemic will certainly be considered the gravest public health crisis the world has faced in the past century. Beyond its human toll, it has had far-reaching social and economic impacts, the full extent of which are yet unknown. Doubtless, it is the most consequential viral disease outbreak since the 1918 influenza pandemic, and one of the most important turning points in global culture.

Although governments around the world seem to have been caught by surprise by scale and magnitude of the crisis, scholars from various fields have long anticipated a viral pandemic and reflected on its wide-ranging societal ramifications. Their works have included analyses of the (geo)politics and decision-making processes during previous outbreaks including the 2002–2004 SARS outbreak (Huang, 2004), the 2009 swine flu pandemic (Baekkeskov, 2016; Chambers et al., 2012), and outbreaks of MERS-CoV in the 2010s. Among the insights in these works is the observation that pandemics exhibit ‘common features across jurisdictions … first, the nature of the epidemic itself and its social and economic consequences; second, the range and type of participants involved; and third, a common context of multi-level, global governance structures’ (Christensen & Painter, 2004, p. 23) and are thus amenable for comparison of decision-making processes. However, there is a paucity of works that interrogate the responses to pandemics by individual political actors.

In this paper, I use the concept of medical populism, defined as ‘a political style based on performances of public health crises that pit “the people” against “the establishment”’ (Lasco & Curato, 2019, p. 1) to reflect on the politics of COVID-19 in Brazil, the Philippines, and the United States. Despite their varied geographic, economic, and cultural contexts (for which they were chosen as illustrative examples in this paper), leaders in the three countries exhibited similar responses: simplifying the pandemic, dramatising their responses, making knowledge claims, and forging divisions – both ‘vertical’ and ‘horizontal’ (Lasco & Curato 2019, p. 3) – between the ‘people’ and dangerous ‘others’. In engaging in this exercise, this paper aims to contribute to the literature that characterises the politics and governance of pandemics and anticipates how political actors might react to similar health crises in the future, notwithstanding their seemingly-exceptional nature.

2. Pandemics and populism

The politics of pandemics and infectious disease outbreaks have well documented in various disciplines (Leach & Tadros, 2014; Salajan et al., 2020), and is rooted in the political nature of public health itself (Foucault, 2014). Furnishing a contemporary context of how this politics plays out, Harper and Parker (2014) highlight the complex interplay of actors – from national government and NGOs to philanthropic funds and international agencies, while Chambers et al. (2012) call attention to the ‘event-making’ that takes place when bureaucratic, often securitised, responses take a life of their own in response to infectious disease outbreaks. Avoidance of blame figures prominently in the politics of crisis management among those who hold office (Boin et al., 2009), while their political opponents ‘may highlight leaders’ mistakes and downplay their successes’ (Baekkeskov, 2016).

In a framework that builds on some of the above themes and calls attention to the politicised nature of pandemics, Lasco and Curato (2019) introduced the concept of medical populism as a political style often used in health emergencies. Acknowledging the risks inherent in using in an concept that ‘has reached the status journalistic cliché and political epithet’, they aligned their notion of populism with that of Moffitt, whose definition of populism as a ‘style’ (i.e. ‘the repertoires of performance that are used to create political relations’) has lent conceptual clarity and paved the way for points of empirical analysis. In contrast to viewing populism as a ‘thin-centered ideology’ (Mudde, 2007), a ‘political phenomenon’ (Müller, 2014), or a political logic (Laclau, 2005), Moffitt (2016, p. 45) defines it as ‘a political style that features an appeal to “the people” versus “the elite”, ‘bad manners’ and the performance of crisis, breakdown or threat’. As Lasco and Curato (2019, p. 2) contends, this definition is ‘broad is enough not to be tied to definitions of populism that connect it to substantive worldviews (e.g. nativism, tribalism, nationalism) but specific enough to characterise a political practice distinct from other responses.’ One of these ‘other responses’ – which they contrast with the populist style – is the ‘technocratic style’ ‘where state or other decision-makers seek the expertise of the medical establishment and expert communities to take over the situation to soothe public anxieties.’ (Lasco & Curato, 2019, p. 2).

In this paper, I engage with the above literature to make sense of the politics of COVID-19 in three countries – Brazil, the Philippines, and the United States – by looking at how political leaders in those countries constructed and responded to the COVID-19 pandemic in their respective countries. In particular, I identify the following features of medical populism as a style by political leaders in times of pandemic:

1. Simplification of the pandemic. Lasco and Curato (2019, p. 3) observe that ‘health emergencies create latitude for populists to make a case for the swiftest possible response … offering of “common sense” solutions to complex issues.’ In the case of pandemics, these include downplaying the virulence or severity of the outbreak (e.g. ‘It’s just like the flu’), promising quick fixes like an effective drug (e.g. hydroxychloroquine) or a forthcoming vaccine, or making simplistic arguments that pit liberty and the economy against public health. As Brubaker (2017, pp. 18–19) notes, populists ‘[devalue] complexity through rhetorical practices of simplicity, directness, and seeming self-evidence, often accompanied by an explicit anti-intellectualism or “epistemological populism” that valorises common sense and first- hand experience over abstract and experience-distant forms of knowledge.’

2. Dramatisation of the crisis. Brubaker (2017, p. 18) observes that ‘populists dramatize – and often of course exaggerate and distort – the threats from which they claim to offer protection. And when in power, they dramatize their response to crisis.’ While leaders have tended to downplay pandemics in its initial stages, they nonetheless make a spectacle of it through their use of the language of conspiracy, or through the language of emergency and war (see Flusberg et al., 2018). Political actors also dramatise the pandemic itself as an exceptional threat as a pretext to gain ‘emergency powers’, while simultaneously casting dramatic measures of ‘lockdown’ and declarations of ‘war’ and ‘emergency’ as commensurate and valid responses to safeguard public safety.

3. Forging of divisions. Put simply, medical populism involves a ‘dichotomic division of society into two camps – one presenting itself as a part which claims to be the whole’ (Laclau, 2005, p. 83), pitting ‘the people’ against ‘others’ cast as a public health threat. As Lasco and Curato (2019, pp. 2–3) note: ‘Medical populism works by creating a shared imaginary of “the people” as aggrieved parties, if not victims of diseases due to the system's neglect. While other forms of populism build on cultural and economic insecurity, medical populism emphasises the threats to public’s health and safety.’ As with other forms of populism, the ‘others’ against which the public is pit include powerful elites such as pharmaceutical companies, supranational bodies, the ‘medical establishment’ (i.e. ‘vertical divisions’) but they may also include ‘dangerous others’ like migrants that are blamed for the crisis and cast as sources of contagion (i.e. ‘horizontal divisions’).

4. Invocation of knowledge claims. In order to simplify and spectacularise crisis, and forge divisions, political leaders resort to making knowledge claims. In the case of COVID-19, these have included assertions about the virus’ origin (e.g. ‘It came from a laboratory in China’), true epidemiology and patho-physiology, proposed cures and solutions, as well as projections of and prognostications about the future. While some of these claims go against established scientific facts and verge on fake news, they may just as likely involve invocations of ‘science’ and ‘public health’.

3. Illustrative examples

Three case studies are presented in this paper – Brazil, the Philippines, and the United States, beginning with brief narration of the COVID-19 pandemic as it unfolded in the political sphere in the respective countries and then describing the political leaders’ responses according to the framework identified above. Following the approach of populism scholars of using a combination of official, journalistic, and scholarly sources as empirical material for comparative research (Mudde & Rovira Kaltwasser, 2018; see also Lasco, 2020a; Moffitt, 2015), political discourses and actions related to COVID-19 from January to mid-July 2020 in all three countries were monitored and reviewed by doing online searches and manual reviews of official government websites, social media accounts, and pertinent news coverage in each country from newspapers of record and major media outlets, with particular focus on the three countries’ heads of state – Jair Bolsonaro, Rodrigo Duterte, and Donald Trump – as well as their close associates. The multiple data sources served to ensure reliability and relevance, while news reports on specific events were cross-checked with other sources to ensure accuracy, with priority given to official transcripts and social media accounts, followed by local news sources and international reports. All the above textual material were gathered in an NVivo 11 database, using the elements of medical populism to guide coding and thematic analysis.

4. Discussion

Regardless of the absolute magnitude of the pandemic in each of the three countries, we can find similar features (see Table 1 for a summary). In terms of ‘simplifying of discourse’, most striking are the parallels in the way the leaders sought to dismiss the pandemic (e.g. ‘a little flu’), make therapeutic claims (e.g. quick cures and imminent vaccines), while, in terms of ‘spectacuarlising the crisis’, it is the language of war and conspiracy that figured in the three examples, mirroring the way politicians have responded to outbreaks like SARS in the past as a form of ‘symbolic reassurance’ and as a way of re-establishing legitimacy (Christensen & Painter, 2004, p. 44).

Medical populism and the COVID-19 pandemic

All authors

Gideon Lasco

https://doi.org/10.1080/17441692.2020.1807581

Published online:

11 August 2020

As for the core populist logic of division between ‘the people’ and dangerous others, we can also identify particular ways in which this was instantiated during the pandemic. First, ‘the people’ are imbued with various characteristics, biomedical and otherwise, from both Duterte and Bolsonaro claiming that their citizens are less susceptible to the virus, and Trump invoking American exceptionalism – ‘Americans are the strongest and resilient people on Earth’ – to reassure the public that the pandemic can be overcome. Such characteristics vary according to the context: While Duterte has invoked the discourse of collective discipline, implicitly making it a hallmark of the ‘virtuous citizens’ who make up his base, Trump has invoked the discourse of individual freedoms with a similar outcome. Meanwhile, given that the three leaders are already in power, the ‘establishment’ against which they pit the people against may involve some ‘higher’ geopolitical entity like the World Health Organization – or some familiar populist tropes such as ‘intellectual elites’ (represented by universities, academics, public health experts and journalists).

Finally, in terms of knowledge claims to support the above, what we find in common is a widespread deployment of scientific language and imagery – and a selective deployment of scientific consensus. For instance, by touting the promise of ‘chloroquine’ or other drugs, the three leaders made claims that involved biomedical products or terminologies – even as doing so pit them against biomedical experts.

These similarities support the view that medical populism as ‘not [an] episodic but a familiar response to medical emergencies’ (Lasco & Curato, 2019, p. 6). While other factors affect decision-making in pandemics, including legal structures, pre-existing policies, and conceptualizations of science, political considerations – and by extension, populist performances – play an undeniable role in influencing country responses (see Salajan et al., 2020).

They also raise the question of the global extent of ‘medical populism’ – and what other alternative styles we can identify. Building from Moffitt (2015), Lasco and Curato (2019, p. 1), p. 1) made a binary opposition between ‘a technocratic response which seeks to soothe public outcry by letting experts and institutions of accountability take over’ and ‘a populist response which further spectacularises the crisis and pits “the people” against the failed and untrustworthy establishment.’ Following these definitions and conventional characterisations, the leaders of Germany, Taiwan, South Korea, and Singapore may be classified as medical technocrats, given their governments’ ‘expert-driven’ decision-making.

However, such distinctions rest on what we mean by ‘experts’ and what counts as ‘science’ – both of which are, as the pandemic has made clear, highly-contentious questions. Moreover, as the illustrative examples show, one can invoke ‘science’ and still exhibit elements of medical populism. These definitional difficulties should temper the utility of typologising leaders as either ‘medical populists’ or ‘medical technocrats’ – without detracting from the usefulness of medical populism as a framework for analysing – and anticipating – politicians’ responses to health crisis. At the very least, the concept underscores the role of individual political actors in mediating the ‘dramaturgic form’ (Rosenberg, 1989) of disease outbreaks and constructing familiar scripts.

5. Conclusion: Implications for global health

The four elements of medical populism identified in this paper offers some lessons – if tentative – for global health. The simplification of the pandemic and invocation of knowledge claims, for instance, raise questions of authority and trust. If an American president declares that injecting disinfectants can treat COVID-19, who can adjudicate such a claim? As it turned out in this particular instance, scientific consensus continued to carry some weight: when experts forcefully refuted such a claim, Donald Trump walked back from it, claiming that he was just being sarcastic (Higgins, 2020). Both Trump and Bolsonaro also eventually wore face masks after months not doing so – albeit in the latter case, as ordered by a judge (Gullino, 2020b; Wise, 2020). Although not all refutations lead to such retreats, they nonetheless further underscore the need for credible and trusted academic institutions that will be more difficult for populists to contest (Speed & Mannion, 2017). They also animate the question of whether social media platforms can – or should – vet, delete, or flag false or misleading knowledge claims, as Twitter has done for Bolsonaro and Trump. Moreover, as the recent retraction of a paper on the efficacy of hydroxychloroquine based on dubious data shows (Servick & Enserink, 2020), they also call for reconciling the need for rapid evidence with the imperatives of scientific rigour – as well as a deeper reflection on the ‘mediatisation’ of science in this age of preprints and ‘communicative abundance’. Specifically, great care must be placed on studies that touch on efficacy of cures and vaccines. As various scholars have warned, anti-vaccination movements can capitalise on the rush – driven by politics as much as public health – to develop a COVID-19 vaccine (Megget, 2020).

As for the spectacularisations of crisis, these may not necessarily detrimental. As Lindenbaum (1998, p. 39) notes, the ‘familiar dramaturgical form’ of epidemics may mobilise communities; this ‘common architecture’ may well include government’s performances, as when the technocratic Singaporean government distributed masks for all households even while stating that the consensus at the time was that masks were unnecessary. In that case, the face masks held ‘symbolic efficacy’ by empowering and reassuring the general public (Lasco, 2020b). On the other hand, it is also easy to see how dramatic actions like ‘total lockdowns’ and ‘mass testing’ can take political precedence over less spectacular measures like contact tracing and increasing health care capacity, undermining the efficacy of pandemic responses – and, as in the case of the Philippines, potentially exposing the public to abuses of power. In this case, too, public health experts are called to participate in public discourse, even as doing so exposes them to the risk of being cast as threats to public health themselves.

Which brings us to the forging of divisions between the ‘people’ and dangerous others. If medical populism is a familiar response to pandemics, then it anticipates further vulnerabilities on the part of those associated with groups politicians would cast as ‘ethnic’ or ‘foreign’ others (Keil & Ali, 2006). While scapegoating in times of epidemic has been around from ancient times to recent epidemics like the SARS outbreak (Cohn, 2018), its politicisation underscores the need for even more care in challenging the ‘geography of blame’ (Farmer, 2006) and offering more protection for migrants who are already being disproportionately affected by the COVID-19 pandemic (McAuliffe & Bauloz, 2020).

Finally, these constructed divisions also call attention to the political vulnerabilities of health institutions, including international agencies (Lasco & Larson, 2020). During the SARS outbreak, the WHO was a ‘major institutional actor ever-present’ in national governments (Christensen & Painter, 2004, p. 25) and ‘was generally praised for its role and the organization emerged with heightened prestige and legitimacy’ (Christensen & Painter, 2014, p. 39). During the COVID-19 pandemic, despite the fact that it is ‘not part of the domestic political game’ (Khemani, 2020, p. 3), the WHO has nonetheless figured in domestic politics as evidenced by our illustrative examples, with dire consequences to the global health agency as in the case of Trump’s decision – and Bolsonaro’s threat – to withdraw from it. If populism is a ‘mirror’ (Panizza, 2005) for democratic institutions, then so it must be for global governance bodies like the WHO (Reddy et al., 2018).

As the pandemic is still unfolding, it remains to be seen how it can call critical attention to leaders’ political styles, tilt future elections, and exact accountability from those who failed to act properly. Overall, however, the illustrative examples in this paper suggest that world leaders mobilise familiar patterns of action and rhetoric when confronted with health crises: patterns that can be anticipated for pandemic planning in local, national, and global levels. Exactly which kinds of leaders mobilise such styles, under which circumstances, and to which outcomes, remain germane questions in studying the politics and governance of health crises.