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Are Populist Leaders Creating the Conditions for the Spread of COVID-19? Comment on "A Scoping Review of Populist Radical Right Parties’ Influence on Welfare Policy and its Implications for Population Health in Europe"

Are Populist Leaders Creating the Conditions for the Spread of COVID-19? Comment on "A Scoping... Article History: Do populist leaders contribute to the spread of coronavirus disease 2019 (COVID-19)? While all governments Received: 22 June 2020 have struggled to respond to the pandemic, it is now becoming clear that some political leaders have performed Accepted: 4 July 2020 much better than others. Among the worst performing are those that have risen to power on populist agendas, ePublished: 14 July 2020 such as in the United States, Brazil, Russia, India, and the United Kingdom. Populist leaders have tended to: blame “others” for the pandemic, such as immigrants and the Chinese government; deny evidence and show contempt for institutions that generate it; and portray themselves as the voice of the common people against an out-of-touch ‘elite.’ In our short commentary, focusing on those countries with the most cases, we find that populist leaders appear to be undermining an effective response to COVID-19. Perversely, they may also gain politically from doing so, as historically populist leaders benefit from suffering and ill health. Clearly more research is needed on the curious correlation of populism and public health. Notwithstanding gaps in the evidence, health professionals have a duty to speak out against these practices to prevent avoidable loss of life. Keywords: Populism, Political Determinants of Health, COVID-19 Copyright: © 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/ licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: McKee M, Gugushvili A, Koltai J, Stuckler D. Are populist leaders creating the conditions for the *Correspondence to: spread of COVID-19? Comment on “A scoping review of populist radical right parties’ influence on welfare Martin McKee policy and its implications for population health in Europe.” Int J Health Policy Manag. 2021;10(8):511–515. Email: doi:10.34172/ijhpm.2020.124 martin.mckee@lshtm.ac.uk Introduction improving the health of their populations. This means that In the accompanying paper, Rinaldi and Bekker review the health consequences of policies only become apparent evidence that the ideology pursued by populist radical right long after the decisions that gave rise to them. Now, measures parties in Europe is harmful for health. Their analysis builds of health are leading the news. Heads of government in many on a small but growing body of literature on what has been countries are appearing, in some cases daily, to share the news 2,3 described as the political determinants of health. The on the progress of the pandemic with their people. Anyone can decisions that politicians make shapes the conditions in go to the Johns Hopkins website to track, in almost real time, which people live and the choices, many with consequences numbers of cases and deaths. A leading global newspaper, for the health, that are available to them. This is crucial the Financial Times, has become a key source of information during disease outbreaks, like the coronavirus disease 2019 on comparative COVID-19 data, discussing their strengths (COVID-19) pandemic, which requires politicians to set and weaknesses. These data make it possible for politicians aside ideology and act on a rapidly emerging and uncertain to be held to account for the ability to protect the health of body of public-health evidence. their populations in almost real time, in marked contrast to Here we extend the important work of Rinaldi and Bekker to the situation described above when the consequences of their ask, are populist leaders creating conditions which contribute decisions for health are only seen years later. to the spread of COVID-19? There appears to be a striking correlation between Before doing so, we first note that the COVID-19 pandemic countries led by politicians who support populist messages is unique in recent times in generating broadly comparable and the poor performance in responding to COVID-19. As data (albeit far from perfect) in every country in the world of June 25, 2020, the United States, Brazil, Russia, India, and with a delay of days or weeks at most. Historically, publication the United Kingdom occupied, in that order, the top five of health data, if it takes place at all, is often long delayed and, positions ranked by numbers of COVID-19 cases in the Johns in many cases, lacking the granularity necessary to provide Hopkins dashboard. Together, they account for 51% of all a detailed assessment of how countries are performing in cases worldwide but only 27% of the world’s population. Full list of authors’ affiliations is available at the end of the article. McKee et al There are four potential mechanisms for such a link between Mechanism 2: Contempt for Institutions populism and COVID-19 spread. We take each in turn. When the history of the COVID-19 pandemic is written, it will be possible to identify many individual decisions by Mechanism 1: Blaming Outsiders and Victims politicians that influenced its course. Among them, and Rinaldi and Bekker examine the populist radical right, with its likely the most important, will be the timing of the decision combination of nativism (a policy of protecting the interests to impose restrictions on movement. Others will include of persons born in a state against those of immigrants) and choices about how and when to implement testing and authoritarianism (a policy favouring strict obedience to tracing strategies, how messages were communicated, and authority over personal freedoms). This is logical given the how the material necessary to respond to the pandemic was authors’ focus on welfare policy and health. However, when procured. However, underlying all of these we can identify seeking to understand responses to COVID-19 we believe two characteristics of populism that have contributed to the that it is appropriate to look at populism even more broadly. situation in which all of these countries have done especially In this respect, we additionally consider one mechanism badly during the pandemic. linked to a definition of populism proposed by Albertazzi The first is a contempt for the traditional institutions that and McDonnell, who see it as an ideology that “pits a are populated by the elites, sometimes described as “enemies virtuous and homogeneous people against a set of elites and of the people.” Populist leaders are reluctant to be bound by dangerous ‘others’ who are together depicted as depriving (or institutional constraints, such as constitutions and courts. attempting to deprive) the sovereign people of their rights, By switching between being president and prime minister, values, prosperity, identity, and voice.” This definition brings Vladimir Putin has managed to circumvent the constitutional together populist politicians on the left, such as Venezuela’s restriction on terms of office. Boris Johnson was found to have Nicolás Maduro, with those on the right, such as Brazil’s prorogued Parliament illegally. Jair Bolsonaro has spoken of Jair Bolsanaro, as well as those whose politics are influenced his desire to abolish the Supreme Court. It is, however, their heavily by nationalism or religion, such as Turkey’s Recep approach to public health institutions that are particularly Tayyip Erdoğan or India’s Narendra Modi. Others adopting important here. These are characterised by a combination of populist approaches include America’s Donald Trump, neglect, denying necessary funding or leaving key positions Russia’s Vladimir Putin, and the UK’s Boris Johnson. unfilled, or hostility. Thus, three months before the emergence The populist approach that these politicians have adopted of COVID-19, the Trump administration closed down the has involved appealing to groups in society that have been left USAID funded PREDICT programme, developed to provide 2 11 behind, for various reasons including the consequences of early warning of possible pandemics. In the UK the cabinet’s loss of traditional industries and who have struggled to adapt Threats, Hazards, Resilience and Contingency Committee to changing circumstances, often because of a lack of the was axed by Boris Johnson a few days after assuming office. necessary skills. Understandably, these groups have sought Jair Bolsanaro fired two health ministers within weeks. In someone to blame for the misfortune. Populist leaders have 2017 Narendra Modi cut the planned budget of the National seized upon their disaffection, developing a narrative in which Health Mission, India’s public health service, by 20%. their misfortunes are due to the actions of others. These are Donald Trump attempted to impose similar cuts on the often those who are identifiably different, for example because Centers for Disease Control but was blocked by Congress. of their dress or the colour of their skin. Thus, Donald Trump The organisation did, however, have to reduce substantially explicitly invoked COVID-19 as a justification for increasing its outpost in Beijing, established to provide information restrictions on workers coming from abroad. The populist on emerging viruses. The situation in Turkey was different. narrative continues by developing a worldview in which the There, the health system was weakened by Recep Tayyip circumstances that have allowed people to be left behind Erdoğan’s dismissal of tens of thousands of civil servants, have been created by a remote and unfeeling elite. Into this including leading virologists, following an attempted coup. situation, the strong leader emerges as the saviour of his (and In Venezuela the loss of institutional capacity was a result of almost always it is his rather than her) people. economic collapse due to mismanagement. This ‘insider-outsider’ narrative has served populist politicians well, attracting the votes of those who feel they Mechanisms 3: Denialism 8,9 have been left behind. The populist politician offers hope of The third, and related issue is rejection of evidence. Just as they a better future. It matters little that they often fail to deliver. are reluctant to be constrained by institutions and their rules, Any failure is always someone else’s fault, and particularly so they reject the laws of science, discovered and promoted those from the “other” group or the elite that protects them. by the elites, and their consequences. Rather, they adopted The difficulty arises when the threat is not from the “other” the tactics associated with denialism, including promotion group but, as with COVID-19, it is from a microorganism. Just of conspiracy theories, cherry picking evidence, citing false as, to employ a widely used cliché, viruses pay no attention to experts, moving goalposts, and employing a range of logical national borders, nor do they have passports or citizenship. Of fallacies. course, this did not prevent President Trump from blaming Even though the rapid growth of the pandemic was apparent the Chinese, or ‘Kung Flu’ virus, or Hindu nationalists from from early on, populist politicians were in denial about blaming Muslims. its potential effect on their countries. In early March 2020, Boris Johnson advised the public that “we should all basically 512 International Journal of Health Policy and Management, 2021, 10(8), 511–515 McKee et al just go about our normal daily lives’’ providing they washed Trump network, reduced propensity to comply with physical their hands frequently, and boasted of shaking hands with distancing measures across Zip codes in the United States. infected patients. Later in March, Jair Bolsanaro described Another study found that obtaining news from mainstream the pandemic, which by then had accounted for less than broadcast media, such as NBC News and the New York 20 000 deaths worldwide, as a “media trick.” Many populist Times, correlated with possessing accurate information about politicians have promoted treatments lacking any evidential the disease’s lethality, and accurate beliefs about protection basis, most notably Hydroxychloroquine, in a possibly unique from infection. The study also found an association between example of agreement Donald Trump and Nicolás Maduro. watching Fox News and support for conspiracy theories, such While there is a wealth of evidence that consideration of as believing that the CDC is exaggerating the seriousness of all the evidence leads to better decisions, populist politicians COVID-19 to undermine the presidency of Donald Trump. reject anything that challenges their beliefs. Hence, when the director of the US health department’s Biomedical Advanced Reverse Causality: Suffering and Ill Health From COVID-19 Research and Development Authority challenged Trump’s Increasing Support for Populism support for hydroxychloroquine he was fired. Of course, faced So far, we have considered the impact of populist politics on with a situation they cannot control, it is understandable that COVID-19, describing how it has inhibited the development populist politicians, used to spreading positive messages, will of effective responses to the pandemic. But what about the clutch at straws. Maduro had previously advocated drinking impact of COVID-19 on populism? Will those who once tea made from lemongrass and elderberry tea. However, in supported these populist politicians turn against them as they Trump’s case, it has become impossible to ascertain whether see their friends and families die prematurely? The United his increasingly bizarre statements reflect a deliberate attempt States offers an opportunity to find out. Between March and to create hope of a cure or whether they simply reflect his the latest data, as of writing this paper, there was a sustained profound ignorance of basic science, as when he commented fall in cases in states and counties that voted for Clinton in that the coronavirus “has gotten so brilliant that the antibiotic 2016 while the reverse happened in those that had voted for 23 28 cannot keep up with it.” Trump. Trump’s poll ratings have been falling but he still The prominent cases of populist leaders mismanaging the retains considerable support among his core vote. This may crisis described above is consistent with a recent quantitative be explained, at least so far, by the cognitive biases that shape study on political leaders’ responses to the COVID-19 how people interpret news, itself related to the news channels pandemic in 94 countries from around the world. The results they view. Thus, in late February 2020, early in the pandemic, of this analysis suggest that governments headed by populist 40% of Republicans were “not concerned at all” about a leaders delivered a weaker response to COVID-19 than non- coronavirus outbreak in their communities, falling to 25% in populist ones by implementing fewer closures and less robust mid March. In contrast, among Democrats the figure started health countermeasures during the onset of the crisis. Thus it at just over 5%, falling even further over the same period. would seem that the consequences of apparently idiosyncratic This gap was corroborated by other data, including evidence circumstances associated with populism for the spread of that those living in Democrat supporting areas were more COVID-19 in three of the worst affected countries, the United likely to search online for hand sanitizers. States, the United Kingdom, and Brazil, are representative of COVID-19 may also shape the underlying forces that the broader developments in the world, especially considering precede and correlate with populist sentiments and support. that in that multi-country study the results are adjusted for First, in addition to the devasting effects on population countries’ economic capacity, demographic composition, health, the pandemic has also precipitated an economic earlier experience with pandemics such as severe acute crisis. One recent well-publicized study found crisis-driven respiratory syndrome (SARS), the level of democracy, and unemployment to be a substantial driver of political distrust time elapsed since discovery of a country’s first confirmed and the subsequent rise in populist electoral support across COVID-19 case. Europe. Second, COVID-19 is intensifying the spread of 27,31 online disinformation, which may further erode trust in Mechanism 4: Suspicion of Elites experts and mainstream institutions, fuelling support for anti- While perhaps less direct than the key mechanisms establishment and populist narratives. Third, consistent with highlighted above, it is also important to highlight the historical linkages between epidemic threats and xenophobia, intersections between populist rhetoric, the media, and emerging evidence suggests that the COVID-19 pandemic 33,34 COVID-19. Populist politicians commonly position the has triggered anti-Asian and anti-immigrant sentiments, media—particularly outlets that criticize their policies or views that align with populist rhetoric promising to protect a messaging—as members of the ‘corrupt elite,’ or the “enemy pure and (ethnically) homogenous people. of the people,” in the case of Donald Trump. Yet, during a Although we will not know the actual implications of the pandemic, experts must rely heavily on mainstream media pandemic for populist political parties and their leaders for platforms to generate public health awareness and articulate some time, until votes in the next rounds of elections are the steps that must be taken to mitigate risk. counted, and these ramifications will be likely shaped by the This dynamic creates an insidious pathway through which human toll and the length of the pandemic, past experience populism may facilitate the spread of COVID-19. 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Are Populist Leaders Creating the Conditions for the Spread of COVID-19? Comment on "A Scoping Review of Populist Radical Right Parties’ Influence on Welfare Policy and its Implications for Population Health in Europe"

International Journal of Health Policy and ManagementJul 14, 2020

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Abstract

Article History: Do populist leaders contribute to the spread of coronavirus disease 2019 (COVID-19)? While all governments Received: 22 June 2020 have struggled to respond to the pandemic, it is now becoming clear that some political leaders have performed Accepted: 4 July 2020 much better than others. Among the worst performing are those that have risen to power on populist agendas, ePublished: 14 July 2020 such as in the United States, Brazil, Russia, India, and the United Kingdom. Populist leaders have tended to: blame “others” for the pandemic, such as immigrants and the Chinese government; deny evidence and show contempt for institutions that generate it; and portray themselves as the voice of the common people against an out-of-touch ‘elite.’ In our short commentary, focusing on those countries with the most cases, we find that populist leaders appear to be undermining an effective response to COVID-19. Perversely, they may also gain politically from doing so, as historically populist leaders benefit from suffering and ill health. Clearly more research is needed on the curious correlation of populism and public health. Notwithstanding gaps in the evidence, health professionals have a duty to speak out against these practices to prevent avoidable loss of life. Keywords: Populism, Political Determinants of Health, COVID-19 Copyright: © 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/ licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: McKee M, Gugushvili A, Koltai J, Stuckler D. Are populist leaders creating the conditions for the *Correspondence to: spread of COVID-19? Comment on “A scoping review of populist radical right parties’ influence on welfare Martin McKee policy and its implications for population health in Europe.” Int J Health Policy Manag. 2021;10(8):511–515. Email: doi:10.34172/ijhpm.2020.124 martin.mckee@lshtm.ac.uk Introduction improving the health of their populations. This means that In the accompanying paper, Rinaldi and Bekker review the health consequences of policies only become apparent evidence that the ideology pursued by populist radical right long after the decisions that gave rise to them. Now, measures parties in Europe is harmful for health. Their analysis builds of health are leading the news. Heads of government in many on a small but growing body of literature on what has been countries are appearing, in some cases daily, to share the news 2,3 described as the political determinants of health. The on the progress of the pandemic with their people. Anyone can decisions that politicians make shapes the conditions in go to the Johns Hopkins website to track, in almost real time, which people live and the choices, many with consequences numbers of cases and deaths. A leading global newspaper, for the health, that are available to them. This is crucial the Financial Times, has become a key source of information during disease outbreaks, like the coronavirus disease 2019 on comparative COVID-19 data, discussing their strengths (COVID-19) pandemic, which requires politicians to set and weaknesses. These data make it possible for politicians aside ideology and act on a rapidly emerging and uncertain to be held to account for the ability to protect the health of body of public-health evidence. their populations in almost real time, in marked contrast to Here we extend the important work of Rinaldi and Bekker to the situation described above when the consequences of their ask, are populist leaders creating conditions which contribute decisions for health are only seen years later. to the spread of COVID-19? There appears to be a striking correlation between Before doing so, we first note that the COVID-19 pandemic countries led by politicians who support populist messages is unique in recent times in generating broadly comparable and the poor performance in responding to COVID-19. As data (albeit far from perfect) in every country in the world of June 25, 2020, the United States, Brazil, Russia, India, and with a delay of days or weeks at most. Historically, publication the United Kingdom occupied, in that order, the top five of health data, if it takes place at all, is often long delayed and, positions ranked by numbers of COVID-19 cases in the Johns in many cases, lacking the granularity necessary to provide Hopkins dashboard. Together, they account for 51% of all a detailed assessment of how countries are performing in cases worldwide but only 27% of the world’s population. Full list of authors’ affiliations is available at the end of the article. McKee et al There are four potential mechanisms for such a link between Mechanism 2: Contempt for Institutions populism and COVID-19 spread. We take each in turn. When the history of the COVID-19 pandemic is written, it will be possible to identify many individual decisions by Mechanism 1: Blaming Outsiders and Victims politicians that influenced its course. Among them, and Rinaldi and Bekker examine the populist radical right, with its likely the most important, will be the timing of the decision combination of nativism (a policy of protecting the interests to impose restrictions on movement. Others will include of persons born in a state against those of immigrants) and choices about how and when to implement testing and authoritarianism (a policy favouring strict obedience to tracing strategies, how messages were communicated, and authority over personal freedoms). This is logical given the how the material necessary to respond to the pandemic was authors’ focus on welfare policy and health. However, when procured. However, underlying all of these we can identify seeking to understand responses to COVID-19 we believe two characteristics of populism that have contributed to the that it is appropriate to look at populism even more broadly. situation in which all of these countries have done especially In this respect, we additionally consider one mechanism badly during the pandemic. linked to a definition of populism proposed by Albertazzi The first is a contempt for the traditional institutions that and McDonnell, who see it as an ideology that “pits a are populated by the elites, sometimes described as “enemies virtuous and homogeneous people against a set of elites and of the people.” Populist leaders are reluctant to be bound by dangerous ‘others’ who are together depicted as depriving (or institutional constraints, such as constitutions and courts. attempting to deprive) the sovereign people of their rights, By switching between being president and prime minister, values, prosperity, identity, and voice.” This definition brings Vladimir Putin has managed to circumvent the constitutional together populist politicians on the left, such as Venezuela’s restriction on terms of office. Boris Johnson was found to have Nicolás Maduro, with those on the right, such as Brazil’s prorogued Parliament illegally. Jair Bolsonaro has spoken of Jair Bolsanaro, as well as those whose politics are influenced his desire to abolish the Supreme Court. It is, however, their heavily by nationalism or religion, such as Turkey’s Recep approach to public health institutions that are particularly Tayyip Erdoğan or India’s Narendra Modi. Others adopting important here. These are characterised by a combination of populist approaches include America’s Donald Trump, neglect, denying necessary funding or leaving key positions Russia’s Vladimir Putin, and the UK’s Boris Johnson. unfilled, or hostility. Thus, three months before the emergence The populist approach that these politicians have adopted of COVID-19, the Trump administration closed down the has involved appealing to groups in society that have been left USAID funded PREDICT programme, developed to provide 2 11 behind, for various reasons including the consequences of early warning of possible pandemics. In the UK the cabinet’s loss of traditional industries and who have struggled to adapt Threats, Hazards, Resilience and Contingency Committee to changing circumstances, often because of a lack of the was axed by Boris Johnson a few days after assuming office. necessary skills. Understandably, these groups have sought Jair Bolsanaro fired two health ministers within weeks. In someone to blame for the misfortune. Populist leaders have 2017 Narendra Modi cut the planned budget of the National seized upon their disaffection, developing a narrative in which Health Mission, India’s public health service, by 20%. their misfortunes are due to the actions of others. These are Donald Trump attempted to impose similar cuts on the often those who are identifiably different, for example because Centers for Disease Control but was blocked by Congress. of their dress or the colour of their skin. Thus, Donald Trump The organisation did, however, have to reduce substantially explicitly invoked COVID-19 as a justification for increasing its outpost in Beijing, established to provide information restrictions on workers coming from abroad. The populist on emerging viruses. The situation in Turkey was different. narrative continues by developing a worldview in which the There, the health system was weakened by Recep Tayyip circumstances that have allowed people to be left behind Erdoğan’s dismissal of tens of thousands of civil servants, have been created by a remote and unfeeling elite. Into this including leading virologists, following an attempted coup. situation, the strong leader emerges as the saviour of his (and In Venezuela the loss of institutional capacity was a result of almost always it is his rather than her) people. economic collapse due to mismanagement. This ‘insider-outsider’ narrative has served populist politicians well, attracting the votes of those who feel they Mechanisms 3: Denialism 8,9 have been left behind. The populist politician offers hope of The third, and related issue is rejection of evidence. Just as they a better future. It matters little that they often fail to deliver. are reluctant to be constrained by institutions and their rules, Any failure is always someone else’s fault, and particularly so they reject the laws of science, discovered and promoted those from the “other” group or the elite that protects them. by the elites, and their consequences. Rather, they adopted The difficulty arises when the threat is not from the “other” the tactics associated with denialism, including promotion group but, as with COVID-19, it is from a microorganism. Just of conspiracy theories, cherry picking evidence, citing false as, to employ a widely used cliché, viruses pay no attention to experts, moving goalposts, and employing a range of logical national borders, nor do they have passports or citizenship. Of fallacies. course, this did not prevent President Trump from blaming Even though the rapid growth of the pandemic was apparent the Chinese, or ‘Kung Flu’ virus, or Hindu nationalists from from early on, populist politicians were in denial about blaming Muslims. its potential effect on their countries. In early March 2020, Boris Johnson advised the public that “we should all basically 512 International Journal of Health Policy and Management, 2021, 10(8), 511–515 McKee et al just go about our normal daily lives’’ providing they washed Trump network, reduced propensity to comply with physical their hands frequently, and boasted of shaking hands with distancing measures across Zip codes in the United States. infected patients. Later in March, Jair Bolsanaro described Another study found that obtaining news from mainstream the pandemic, which by then had accounted for less than broadcast media, such as NBC News and the New York 20 000 deaths worldwide, as a “media trick.” Many populist Times, correlated with possessing accurate information about politicians have promoted treatments lacking any evidential the disease’s lethality, and accurate beliefs about protection basis, most notably Hydroxychloroquine, in a possibly unique from infection. The study also found an association between example of agreement Donald Trump and Nicolás Maduro. watching Fox News and support for conspiracy theories, such While there is a wealth of evidence that consideration of as believing that the CDC is exaggerating the seriousness of all the evidence leads to better decisions, populist politicians COVID-19 to undermine the presidency of Donald Trump. reject anything that challenges their beliefs. Hence, when the director of the US health department’s Biomedical Advanced Reverse Causality: Suffering and Ill Health From COVID-19 Research and Development Authority challenged Trump’s Increasing Support for Populism support for hydroxychloroquine he was fired. Of course, faced So far, we have considered the impact of populist politics on with a situation they cannot control, it is understandable that COVID-19, describing how it has inhibited the development populist politicians, used to spreading positive messages, will of effective responses to the pandemic. But what about the clutch at straws. Maduro had previously advocated drinking impact of COVID-19 on populism? Will those who once tea made from lemongrass and elderberry tea. However, in supported these populist politicians turn against them as they Trump’s case, it has become impossible to ascertain whether see their friends and families die prematurely? The United his increasingly bizarre statements reflect a deliberate attempt States offers an opportunity to find out. Between March and to create hope of a cure or whether they simply reflect his the latest data, as of writing this paper, there was a sustained profound ignorance of basic science, as when he commented fall in cases in states and counties that voted for Clinton in that the coronavirus “has gotten so brilliant that the antibiotic 2016 while the reverse happened in those that had voted for 23 28 cannot keep up with it.” Trump. Trump’s poll ratings have been falling but he still The prominent cases of populist leaders mismanaging the retains considerable support among his core vote. This may crisis described above is consistent with a recent quantitative be explained, at least so far, by the cognitive biases that shape study on political leaders’ responses to the COVID-19 how people interpret news, itself related to the news channels pandemic in 94 countries from around the world. The results they view. Thus, in late February 2020, early in the pandemic, of this analysis suggest that governments headed by populist 40% of Republicans were “not concerned at all” about a leaders delivered a weaker response to COVID-19 than non- coronavirus outbreak in their communities, falling to 25% in populist ones by implementing fewer closures and less robust mid March. In contrast, among Democrats the figure started health countermeasures during the onset of the crisis. Thus it at just over 5%, falling even further over the same period. would seem that the consequences of apparently idiosyncratic This gap was corroborated by other data, including evidence circumstances associated with populism for the spread of that those living in Democrat supporting areas were more COVID-19 in three of the worst affected countries, the United likely to search online for hand sanitizers. States, the United Kingdom, and Brazil, are representative of COVID-19 may also shape the underlying forces that the broader developments in the world, especially considering precede and correlate with populist sentiments and support. that in that multi-country study the results are adjusted for First, in addition to the devasting effects on population countries’ economic capacity, demographic composition, health, the pandemic has also precipitated an economic earlier experience with pandemics such as severe acute crisis. One recent well-publicized study found crisis-driven respiratory syndrome (SARS), the level of democracy, and unemployment to be a substantial driver of political distrust time elapsed since discovery of a country’s first confirmed and the subsequent rise in populist electoral support across COVID-19 case. Europe. Second, COVID-19 is intensifying the spread of 27,31 online disinformation, which may further erode trust in Mechanism 4: Suspicion of Elites experts and mainstream institutions, fuelling support for anti- While perhaps less direct than the key mechanisms establishment and populist narratives. Third, consistent with highlighted above, it is also important to highlight the historical linkages between epidemic threats and xenophobia, intersections between populist rhetoric, the media, and emerging evidence suggests that the COVID-19 pandemic 33,34 COVID-19. Populist politicians commonly position the has triggered anti-Asian and anti-immigrant sentiments, media—particularly outlets that criticize their policies or views that align with populist rhetoric promising to protect a messaging—as members of the ‘corrupt elite,’ or the “enemy pure and (ethnically) homogenous people. of the people,” in the case of Donald Trump. Yet, during a Although we will not know the actual implications of the pandemic, experts must rely heavily on mainstream media pandemic for populist political parties and their leaders for platforms to generate public health awareness and articulate some time, until votes in the next rounds of elections are the steps that must be taken to mitigate risk. counted, and these ramifications will be likely shaped by the This dynamic creates an insidious pathway through which human toll and the length of the pandemic, past experience populism may facilitate the spread of COVID-19. 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