Countries around the world responded to news of the spread of Covid-19 differently. Some countries hit first by the pandemic, such as South Korea and Singapore, moved effectively to contain the pandemic. Others, like the United Kingdom and Brazil, delayed containment and mitigation efforts even with more information and time to prepare. Popular analyses frequently attribute this puzzling variation to political systems (authoritarianism or democracy) and societal norms (collectivism or individualism). But these sweeping generalizations ignore the critical role of experts and expertise in mobilizing states and societies in moments of crises.“We compare the experiences of China, Hong Kong, and the United States, focusing on the role of public health experts and the specific types of expertise they deploy to persuade policymakers and the public to act.”
In our ongoing study, we compare the experiences of China, Hong Kong, and the United States, focusing on the role of public health experts and the specific types of expertise they deploy to persuade policymakers and the public to act. To trace the role of experts, we collected over 15,000 articles for in-depth reading and content analysis from six popular news sources with contrasting audiences: in China (Caixin and Global Times), Hong Kong (South China Morning Post and Apple Daily), and the United States (New York Times and Fox News). Caixin is known for its critical investigative reporting, while the Global Times is a state sponsored newspaper that is known for its nationalist views. SCMP is an English-language newspaper read largely by the business community, and Apple Daily is a tabloid publication known for its sensationalist anti-establishment views. The New York Times (NYT) is a liberal leaning newspaper, and Fox News is a conservative news TV channel. It is notable that despite ideological differences, we still found similar treatment of experts and expertise between the respective pairs of news sources.
We understand these expert statements in the press as acts of interventions aimed at swaying different audiences,1Gil Eyal and Larissa Buchholz, “From the Sociology of Intellectuals to the Sociology of Interventions,” Annual Review of Sociology 36, no. 1 (2010): 117–37. such as through “pandemic prophecies”2Oakland, CA: University of California Press, 2015More Info → and “evidentiary charisma.”3Ann H. Kelly, “Ebola Vaccines, Evidentiary Charisma and the Rise of Global Health Emergency Research,” Economy and Society 47, no. 1 (January 2, 2018): 135–61. Our preliminary analysis suggests that the types of expertise and the social and political context in which experts were embedded impacted how societies responded to Covid-19.
To distinguish between types of expertise, we draw on Lakoff’s distinction of actuarial devices and sentinel devices in global public health.4Andrew Lakoff, “Real-Time Biopolitics: The Actuary and the Sentinel in Global Public Health,” Economy and Society 44, no. 1 (February 2, 2015): 40–59. By actuarial devices, Lakoff refers to the use of data of past events to calculate future risk of disease and death across space and time, exemplified by the use of forecasts and phrases like “flatten the curve” in US media. By sentinel devices, Lakoff refers to the monitoring of events indicative of a coming catastrophe, where there is clear uncertainty. The health surveillance systems that flagged reports of “pneumonia of unknown etiology” in China and Hong Kong are examples of sentinel logic, which warned of impending disaster unless the disease of unknown origins was tracked down and contained. Furthermore, following Eyal,5Gil Eyal, “For a Sociology of Expertise: The Social Origins of the Autism Epidemic,” American Journal of Sociology 118, no. 4 (January 1, 2013): 863–907. we differentiate between experts and expertise, or to put it simply, the scientists and the pronouncements they make about public health.
In the following discussion, we briefly examine (1) how the experiences of experts shaped the forms of expertise that were deployed in response to Covid-19; and (2) how these forms of expertise interacted with policymakers and the public in our three cases.
Experts, past experience, and expertise
Covid-19 experts’ experiences with past outbreaks shaped how the media portrayed them. Mainland Chinese and Hong Kong experts prominently featured in the press were “SARS Heroes,” those with past experiences with the 2003 severe acute respiratory syndrome (SARS) outbreak, which cost both places hundreds of deaths, triggered widespread panic, and damaged their international images. These experts were seen by the press, policymakers, and the public as having the relevant expertise for the current crisis.
In Mainland China, Zhong Nanshan, China’s top public health expert and government advisor, was known for defying the Chinese government in 2003 as he rushed to the frontlines to treat patients, and he was featured prominently in press reports. While Zhong was reluctant to compare Covid-19 to SARS, he understood the gravity of the situation, having been involved with public health reforms in the aftermath of SARS. As he said to a Caixin on January 20:
I have seen the patient’s symptoms, leukocytes, chest radiographs, so in this sense, the new coronavirus and SARS have commonalities. However, the infection with the new coronavirus has just begun, and is still in the climbing stage. So compared with SARS, the infectivity is not so strong, and the toxicity is not so great. As for what will happen in the future, the current case fatality rate cannot be comprehensive, it depends on its development… we still have to be vigilant.
Hong Kong experts, on the other hand, were more eager to compare the novel coronavirus with SARS. Warnings about “not repeating the mistake 17 years ago” were commonplace in news reports from Apple Daily. Reports in early January also latched onto the finding that the new virus was “80 percent the same as SARS,” stressing the need to be vigilant, but that the virus did not seem to be as deadly as the 2003 outbreak. Yuen Kwok-yung, an infectious disease expert at the University of Hong Kong and a government advisor, noted on January 21 to the SCMP that he was worried about the potential for local transmission of the virus:
Now we can see infections of family members and in hospitals. What we are worried most about is a large outbreak in the community that may cause a situation like what we experienced during SARS… We are worried that the super-spreading event might have occurred already… we need to see if sustained human-to-human transmission has happened.
Experts belonging to the Hong Kong government’s Covid-19 advisory committee—which includes Yuen, as well as David Hui and Gabriel Leung—also had critical experiences with SARS. Drawing from these experiences, the experts advocated measures such as mask wearing, setting up isolation wards in public hospitals, and border health checks, which were effective during the 2003 outbreak.
While experts in Mainland China and Hong Kong were mostly physicians or epidemiologists who were intimately involved with the SARS outbreak, experts in the United States that were featured in news coverage came from a wide range of disciplinary backgrounds, ranging from psychologists to microbiologists, as well as experiences with various public health emergencies, ranging from Ebola to the recent Swine Flu outbreak. This diversity also meant that it was hard for a coherent message to emerge. In spite of this, a distinct difference in the framing of the disease was the idea that Covid-19 was comparable to the flu, and experts created models that compared the spread of Covid-19 to the flu. For example, Michael Osterholm, director of the Center of Infectious Disease Research and Policy at the University of Minnesota, stated to the NYT on January 29:
I think we have to revisit which model we’re really using, and I think we really over the past week and a half have come closer to the influenza model… Trying to stop influenza in a community without a vaccine is like trying to stop the wind. I don’t know how we’re going to stop this… The only thing operating in our favor is at least it doesn’t appear to be as severe as SARS or as MERS.
When it became clear that the flu was not the best point of comparison for Covid-19, experts adjusted their models and stressed the need to “flatten the curve” by enacting social distancing measures. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, warned in testimony to the House Oversight committee on March 11 that “People always say, ‘Well, the flu does this, the flu does that.’ The flu has a mortality of 0.1 percent. This has a mortality of 10 times that.” Fauci also warned that, “The gentler curve results in fewer people infected at this critical moment in time—preventing a surge that would inundate the healthcare system and ultimately, one hopes, resulting in fewer deaths. What we need to do is flatten that down.” The phrase “flatten the curve” can therefore be thought of as a vernacularization of actuarial devices that became popular with public health experts in the United States.
In contrast, discussions of models and projections, from our reading, were largely absent in Hong Kong and Mainland China during the early months of the outbreak. The only instances where modeling was deployed was in Hong Kong in late January, largely to estimate the extent of the spread of Covid-19 in Mainland China at the time, rather than projection. This is largely due to policymakers and the public’s shared understanding of the need for vigilance and the consequences of the unchecked spread of Covid-19.
Expertise, publics, and the state
The different relationships between experts, state, and the public, meant that the deployment of these sentinel devices differed drastically. For experts in Mainland China, sentinel warnings were directed at top policymakers who were able to take drastic and unprecedented action, by locking down Wuhan and the rest of Hubei Province, the epicenter of the outbreak. Expert committees were consulted and Zhong was admitted as a member of the Chinese Communist Party, to signal the trust of top policymakers in his judgement and vice versa. Convincing the public of the need to take the outbreak seriously was less of a concern for experts, as many operated on the assumption that public health advice would be followed by the public and supported by the state apparatus. This can be attributed to the careful co-optation of scientific elites into the state through advisory committees and party membership, the overall of China’s public health and disease surveillance system, as well as the “patriotic hygiene campaigns” implemented after SARS that provided familiar repertoires of action for the public to follow during the initial phase of the outbreak.6Yanzhong Huang, “The SARS Epidemic and Its Aftermath in China: A Political Perspective,” in Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary (Washington, DC: The National Academies Press, 2004), 116–136. Furthermore, even while Wuhan municipal and Hubei provincial leaders lost credibility, the public largely trusted the central government to contain the spread of Covid-19.“The public mobilized to pressure policymakers to do more to fight Covid-19, as the public perceived the local government to be too afraid to take a stance against Mainland Chinese authorities.”
In contrast, warnings from experts in Hong Kong were taken up by a public who did not trust neither the Hong Kong government nor Mainland Chinese authorities to be forthcoming. Reporting in Apple Daily was largely skeptical of information from Mainland China, stoking fears and anxiety about a SARS-like cover up. On January 4, Hong Kong authorities activated the “serious response level” in response to reports of the novel infectious disease, but policymakers still faced criticism for doing too little. A January 7 report from SCMP described panic buying of face masks and price gouging, because of widespread anxieties amongst the public of an impending outbreak in the city. The public mobilized to pressure policymakers to do more to fight Covid-19, as the public perceived the local government to be too afraid to take a stance against Mainland Chinese authorities. Alfred Wong, a spokesman for Médecins Inspirés, a doctors’ concern group, is quoted on January 19 in the SCMP, saying that Hong Kong needed to “stand firm and demand more information from China… This is a key period for Hong Kong to prevent the spread.” Thousands of medical staff represented by the Hospital Authority Employees Alliance and other allied unions and civil society organizations went on “anti-epidemic strikes” in early February, demanding the government close the city’s borders and for more personal protective equipment. This pressure from civil society helped convince policymakers in Hong Kong to adopt stricter border checks and quarantine measures for new arrivals. The public in Hong Kong therefore played a critical role in amplifying the sentinel warnings from experts.
In the United States, experts had to convince both policymakers and the public. While the anti-science stance of the Trump administration is well documented, the US response to Covid-19 was also hindered by debate over public health advice. The models used by experts to make arguments about Covid-19—as well as their data and assumptions—became open to criticism and became an object of public debate. Reporting in the NYT on March 13 on different models from the Centers for Disease Control and Prevention quoted Fauci as saying “all models are as good as the assumptions that you put into the model.” The same report goes on to quote Ira Longini, codirector of the Center for Statistics and Quantitative Infectious Diseases at the University of Florida:
We’re being very, very careful to make sure we have scientifically valid modeling that’s drawing properly on the epidemic and what’s known about the virus… You can’t win. If you overdo it, you panic everybody. If you underdo it, they get complacent. You have to be careful.
Fox News would also run segments like the one on May 5 that asked: “Are coronavirus models reliable enough to base policy off of?” A subsequent article on May 7 blamed the “hysterical culture” of “over-protecting our children, seeking safe spaces, announcing ‘trigger warnings,’ hyperventilating on social media” for what the writers perceived to be over-exaggerated projections of deaths in the United States. The actuarial expertise mobilized by public health experts, while somewhat effective at urging policymakers to act, became contentious when it encountered the public due to the tenuous relationship between expert warnings and the assumptions built into their models. Furthermore, in early March, Fox News commentators, such as Trish Regan, went further, attacking experts for peddling the coronavirus “hoax” and “scam” in hopes of hurting Trump politically. This dual attack on experts and expertise further constrained the United States in mobilizing effectively against Covid-19.“We hope that our work can further shed light on the critical and agentic role experts and expertise play in mobilizing publics and policymakers in times of crisis.”
This preliminary analysis sketches out some main differences between experts and the forms of expertise mobilized during the Covid-19 pandemic in China, Hong Kong, and the United States. Sentinel and actuarial forms of expertise shaped how officials and citizens recognized the threat of Covid-19, while prescribing different ways to combat the pandemic. This research is still in progress, and we intend to conduct a systematic content analysis of experts mentioned in these texts. Nonetheless, we hope that our work can further shed light on the critical and agentic role experts and expertise play in mobilizing publics and policymakers in times of crisis. Our multiple case comparisons also show the multiple pathways toward mobilizing effective responses to Covid-19 through activating institutional repertoires and collective memory.
The authors contributed equally to this work.