Less than two months after issuing a state of emergency, former Prime Minister Abe Shinzo declared victory over COVID-19. Abe was keen to suggest that a “characteristically Japanese way” was responsible for overcoming the pandemic. Other Asian countries utilized surveillance tactics and nationwide testing to bend the curve. The United States, on the other hand, struggled with containing the virus despite quarantine measures because it sought to avoid what it saw as the overly draconian and costly tactics found in success cases. This is perhaps best symbolized by the U.S. public’s refusal to wear masks and adhere to social distancing guidelines – behavior that may explain why every day since November 5, the United States has had more new COVID-19 cases than the total number recorded in China or Japan.
Asia’s success led some observers to argue that cultures of obedience, general cleanliness, and Confucian shared responsibility explain why it was more successful with containing the virus. Culture-based arguments are bound to invite criticism because the implications are unsettling. No one wants to conclude that success is unique to one region, and therefore not replicable. New Zealand and Vietnam’s successful handling of the crisis suggest that the special sauce is not limited to East Asia. Moreover, essentializing nations and people to base parts ignores the complexities and even failures of Asia’s COVID-19 response. Indeed, cases in Japan and South Korea are on the rise, albeit far below U.S. levels.
Yet the experiences, geography, and path-dependence that shape culture are far from simple and can explain why a country is unique while simultaneously dynamic. Several social science and humanities studies analyze culture comparatively. It’s common sense to say that cultures have unique aspects; hundreds of millions of people are driven to travel to diverse places every year by the urge to experience something different, after all.
Certain cultural practices in Japan and the rest of Asia, reinforced by recent experiences of other pandemics, have slowed down the spread of the coronavirus. The United States’ failures are its own, and the inauguration of President-Elect Joe Biden alone will not solve the COVID-19 crisis. Sound policy and strong leadership are important, but they are greatly assisted by practices and infrastructure that have developed over time.
Initial successes with containing the coronavirus were due to effective policy measures that had been informed by past experience fighting pandemics such as SARS and MERS. Based on those experiences, Taiwan, Hong Kong, and Singapore strengthened their healthcare systems and developed a playbook for future pandemics. Taiwan, for example, established the National Health Insurance Administration (NHIA) after the 2003 SARS outbreak. In the early weeks of the COVID-19 outbreak, the NHIA moved quickly to integrate its database with that of Taiwan’s National Immigration Agency, tracking citizens’ past 14-day travel history alongside their health record. Those identified as high-risk were put under home quarantine and monitored electronically through their mobile phones. Consequently, Taiwan also demonstrated its independent capacity to handle the novel coronavirus outbreak despite being cut off from WHO resources.
Unlike Taiwan, Japan’s creation of a robust healthcare system was not forced by regional politics, but its national health insurance system, established in its current form in 1961 (a successor to more limited forms that had existed since the 1920s), has been critical to ensuring potential coronavirus carriers are seen by healthcare experts despite the country’s limited testing strategy. Japanese citizens benefit from a well-developed healthcare infrastructure that provides routine health check-ups, either supported by employers or by national health insurance. Some have posited that Japan’s unique regionalized public health centers funneled COVID-19 patients to the appropriate resources – although the system was not immune to bottlenecking. Japan’s healthcare infrastructure also allowed the Japanese government to cast a wide safety net, which included targeting clusters and securing 27,300 beds and 23,000 facilities for potential patients.
Japanese citizens benefit from a well-developed healthcare infrastructure that provides routine health check-ups
The U.S. healthcare system is much more vulnerable, with many Americans unable to secure an appointment or afford coverage. The Trump administration, moreover, has continued to attack the Affordable Care Act, the closest thing to universal healthcare for Americans who do not qualify for Medicaid and Medicare. Although breaking on mostly party lines, one poll found that a little more than half of Americans support a Medicare-for-All plan, a number basically unchanged over the last six months of the pandemic. One would be hard pressed to find any poll in Japan measuring public interest in switching to a healthcare system modeled after that in the United States. The policies that the public is willing to follow and the infrastructure that the public is willing to pay for are expressions of cultural values.
Besides the increased awareness of large-scale epidemics that reinforced health infrastructures, high public buy-in was also built up by previous pandemics, and this blunted public concerns over the curtailment of individual rights for the purposes of public health.
South Korea, for example, failed to disclose key information regarding the tracing of infected patients, which left dozens of people unwittingly infected and infecting others during the 2015 MERS crisis. This episode led many South Koreans to accept the cost of their privacy in return for the gains of public safety. This compromise was reflected in the revisions made in public health law after the MERS outbreak. Under the amended Infectious Disease Control and Prevention Act, the state and local government have the right to “surveil and prevent the outbreak of infectious diseases.” The Minister of Health collects relevant information about potential and confirmed patients’ movement paths and “promptly disclose” it to the public.
Japan’s response to COVID-19 exemplifies how culture can immensely support public health policy. Despite there being no legal enforcement or penalties involved, the streets of major cities were noticeably less crowded a day after Prime Minister Shinzo Abe declared a state of emergency. Japan’s so-called “Three Cs” model – which calls on citizens to avoid closed spaces with poor ventilation, crowded places, and close-contact conversations – reflects cultural characteristics. In addition, the practice of wearing surgical masks for individual and community health is much more prevalent in Japan, as sick people regularly wear masks to avoid spring pollen or transmitting germs. Even the private sector stepped in, with Japan becoming a pioneer in fashionable masks. According to one poll, 83.6 percent of respondents wear masks when talking to others at a close distance. Americans also report high rates of mask use, but adherence varies wildly by activity.
The practice of wearing surgical masks is much more prevalent in Japan, as sick people regularly wear masks to avoid spring pollen or transmitting germs
Contact tracing continues to lag in the United States for a myriad of reasons, including lack of capacity and privacy concerns. The public also shows resistance to following best practices, with one poll finding less than half of Americans always wear masks outside the home despite CDC guidelines. Moreover, a sizable minority of the public is becoming increasingly vocal with their unwillingness to abide by shutdown orders. Despite California turning the corner on the mid-August spike, petitions and protests to recall state governor Gavin Newsom are growing after state orders closing amusement parks and extending the shutdown.
Prime Minister Abe’s “two masks per household policy” was a source of ridicule, with many arguing that it was too little and too late. By the time the masks reached most Japanese households, the worst of the pandemic appeared over. Nevertheless, the government-issued masks and a ban on reselling masks to prevent profiteering sent clear signals that masks were an essential component of combating the coronavirus.
The signals are far noisier in the United States. President Trump has not attended a COVID-19 task force meeting in months and continues to publicly criticize Anthony Fauci, the nation’s leading infectious disease expert. Despite contracting COVID-19 at a super spreader event that he hosted, Trump downplayed the consequences of the disease and promoted misinformation. The Trump administration’s attempts to overturn the 2020 election, and refusal to provide the Biden transition team critical resources, will only further complicate the US COVID-19 response.
There are no shortage of articles tying societal ills, such as gender inequality, suicide, and oppressive work conditions to Japanese culture. Yet, scholars prefer to tie coronavirus success cases to sound policy and decision-making, ignoring any cultural component. In reality the policies that are passed, and the capacity to see policies through, are profoundly influenced by culture. Some of the civic and democratic traditions Americans proudly advocate around the world provide the basis of a culture that is not conducive to fighting a pandemic. One can certainly argue that Japan’s health infrastructure is why it has mostly succeeded in controlling the pandemic – but it has helped tremendously that health experts and officials have not had to battle a recalcitrant national culture every step of the way.