How can South Korea turn its COVID-19 control success into a successful soft-power asset for health diplomacy? The RAND Center for Asia Pacific Policy hosted a public webinar to convene a multidisciplinary group of public health professionals, international relations experts, and academics to engage in a high-level discussion. It was designed to promote the sharing of innovative ideas and best practices.

Transcript

Jennifer Bouey

Here we are. We are all here. Good morning and good evening to everyone. On behalf of the Center for Asia-Pacific Policy of the RAND Corporation, welcome to the webinar on "Can South Korea Help the World Beat the Next Pandemic?" Given our panelists are from Seoul, Geneva, and Washington, D.C., we had to choose a time that's quite early for Washington, D.C., on a rainy day and quite late for Seoul and impossible for the West Coast. Therefore, we are recording this session, and we will send the video to everyone that's registered for this event.

So my name is Jennifer Bouey. I'm an epidemiologist and a policy researcher at RAND Corporation. I'm also serve as a department chair for Global Health at Georgetown University.

Well, now, as the world is emerging from this devastating COVID-19 pandemic, we are acutely aware of the fragile public health and global health system that we are in. So we see the stark inequalities in public health capacities and lack of regional and global strategies facing these devastating crisis. So now is the time for both countries and international organizations to consider how to build a safer environment and for effective defense. So in this context, our team at RAND has recently published a research report titled Public Health and Soft Power: The Republic of Korea's Initial COVID-19 Response and Its Implications for Health Diplomacy. So during the early days of the COVID-19 disease's pandemic in 2020, the ROK, South Korea, had one of the highest success rates in adopting an effective defense, especially with the non-pharmaceutical interventions to counter the sudden assault of COVID-19. Without a national lockdown, the South Korea's government, their very practical strategy for adopting these interventions, has received the global attention for its success. So today's webinar is really to summarize some of these success and see whether other countries can adopt these strategies and understand how South Korea built its capacity and pandemic response capabilities. We are also discussing, asking the question, What is soft power and to what advantage, limitation, and risks are associated with building soft power on a public health success? And we are asking whether South Korea's successful pandemic response and foundations can be turned into soft power assets for South Korea and doing so, what are the limitations we should keep in mind, and what are the common risks associated with health diplomacy and the lessons we have learned from this?

So today we have three distinguished panelists to join us. They are the experts in many of these areas that we have talked about, and we have posted the full bio, a little longer bio, on our event site, on the RAND website, and sent to everyone who has registered. And here, given the time limits, we will just do a very, very short recap. So we have Ambassador Kathleen Stephens, who is the president and the CEO of the Korea Economic Institute. She will have— she has a long and distinguished career in diplomacy from 1978 to 2015 and served as the U.S. ambassador to South Korea from 2008 to 2011.

And we have here Dr. Youngmee Jee. Dr. Jee is the chief executive officer of Institut Pasteur, Korea, and also served as the special representative for health diplomacy at the Korea Foundation. Dr. Jee has brought experience in collaborating with WHO and international public health partners. And currently, Dr. Jee is a member of the WHO International Health Regulation Emergency Committee on COVID-19 and of the WHO Scientific Advisory Group for the Blueprint on Research and Development on Preparedness. Actually, she's right now in a conference with WHO, so she has to leave a bit early today.

And finally, but not last, Professor Tikki Pang. Professor Pang has been a visiting professor at the Lee Kuan Yew School of Public Policy at the National University of Singapore since 2012. He was previously the director of research policy and cooperation, evidence and information for the public policy cluster of the WHO in Geneva. And he's joining us from Geneva today.

So with no further ado, we will start the panelists's statement, and then hopefully we'll have enough time for a discussion. So I will invite our panelists to start with Dr. Jee. Maybe you can say a few words about your understanding of the strengths and weaknesses that relates to the public health system, to COVID-19, South Korea. And then I will invite Ambassador Stephens and Professor Pang to comment, to give your statements. Please, the floor is yours, Dr. Jee.

Youngmee Jee

Thank you, Jennifer. First of all, I want to thank RAND Corporation for inviting me to this event together with distinguished panelists. And, of course, Korea's success, especially the early success, was based on our government's very strong will for prompt responses, based on a very painful experience of MERS outbreak in 2015. So if I can, list of, these are the main factors. So number one, the early detection of cases using emergency use–authorized PCR kit starting from early February of 2020. Number two, tracing, tracking of the movement path of the cases using smart tracking system. That was actually collaborative efforts among different ministries and agencies. And we think that this allowed us to open our society throughout the pandemic. And number three, a well-coordinated treatment system depending on our patients' severity of symptoms. Number four, a private and public partnership and innovative ways to responding to COVID-19, such as walk-in and drive-through testing centers and community treatment centers for mild cases. Five, the government's huge efforts for risk communication and transparency. And in fact, the media briefing was done twice a day by the government for almost one year, and this was actually resulting in public's good trust in government policies.

And all these actions were possible because of our MERS outbreak experience in 2015. And after this outbreak, government changed and established many things. So government established a dedicated emergency operation center and laboratory surveillance and analysis center and risk communication team and more. And these new structures played a very crucial role during COVID-19 pandemic, especially the Laboratory Surveillance and Analysis Center coordinated the laboratory diagnosis of not only public sector laboratories, but also private sector, including emergency useauthorization process. And also the government amended infectious disease prevention and control law to allow Korea CDC and government authorities to use personal information such as movement path to protect other people from risk of exposure to virus. And this was done because of very strong demand from the public asking for right to know those information to protect themselves. So therefore, those information was collected from CCTV footage, credit card use, and movement tracking with the mobile phone in collaboration with different ministries and agency by Korea CDC, and anonymized information was shared with the public. I know still there was some privacy issues raised, saying that those information could be too specific and public might be able to identify who they are. So Korea CDC actually again provided the guideline to minimize such a risk, and movement path information was collected for 14 days' period. And later, those those information on public domain should be removed regularly. So thersefore, I would say, there was a kind of consensus from the public to collect and use such personal information for public health purpose.

And the government, namely the Laboratory Surveillance and Analysis Center, was ready to take a very prompt actions after the news of new coronavirus in Wuhan, China, and Korea confirmed the first case on 20th of January 2020. So the government met with about 20 companies to discuss emergency use authorization on 27th of January 2020, before WHO even declared the public health emergency on 30th of January. So all these prompt actions were taken because of MERS outbreak, as I mentioned. So the thought was if we missed very early cases, then you might have some superspreading events in hospitals like we have seen with MERS, because this was big issue during MERS outbreak. So there was excellent collaboration, partnership between public and private sectors and government made on on that day, 27th of January. Government made the promise for EUA, and the companies were able to produce the kits, those kit very quickly by early February 2020. So those key bodies distributed quickly to cover the whole country. And. So, I— Can I still talk about it little more? Because I want to join my meeting, after my statement.

Jennifer Bouey

Yes, Please go ahead. Yes.

Youngmee Jee

So Korea has a quite comprehensive national health insurance and health care system. So everyone is covered and everyone has very easy access to medical services. So for COVID-19, everything was free. The testing and the treatment. And all private hospitals, which is around 96 percent of hospitals in Korea, also operated within national health insurance's system.

But one thing I should mention here, I think, Korea increased the number of ICU after MERS, but still, this was not enough for COVID-19. It's because we have never seen such scale of the patient. And after MERS outbreak, from 2016 to 2019, before COVID-19, those new centers I mentioned earlier, those centers of the Korea CDC and control tower system with other related ministries under the prime minister, was newly established. Also, although created by strong public health system, before MERS outbreak, there were some gaps, obviously, and those gaps were improved after MERS and played significant roles during COVID-19.

And also, in addition, Korea had WHO IHR join the external evaluation in August 2017 as a chair country of steering group of Global Security Agenda initiative led by U.S. And I was deeply involved in this evaluation process and coordinated about ten different ministries and agencies to prepare for this joint evaluation. And this evaluation process also provided excellent opportunity to show how Korea was able to improve the public health emergency preparedness and response system at the national level after most outbreak and evaluation research showed actually that Korea was quite well prepared and received high score for most areas. Still I think the Korean government did not make full efforts to work globally to support low and middle income countries.

But now after COVID-19, I think, Korea is more ready to work regionally and globally to support global health and health emergencies. And although Korea is not one of the G7 countries, maybe one of G10 or G11, there is a consensus that Korea should play some role and provide support towards the very ambitious goal of 100 Days Mission to develop vaccines and therapeutics and diagnostics for newly emerging pathogens in the future. At the regional level, Korean Ministry of Health provides voluntary contribution to the WHO Western Pacific region to support specific programs such as emergency program and health systems and immunization program in the region, and also quicker to create International Cooperation Agency and KOFIH, Korea Foundation for International Healthcare, support bilateral project with low-middle–income countries and multilateral project also with the international organizations, including WHO. And recently, government increased the bond contribution to CEPI and Global Fund. Especially our president during U.N. assembly promised four times increase of our contribution to the Global Fund in 2023. So it was from 25 million to 100 million U.S. dollars.

But I still think we should further strengthen our capacity, especially within the government sector, if we want to lead a global public health and hope Korea would be able to learn from existing initiatives and play more roles in the region and also globally. And during COVID-19, as you probably know, Korean government also tried its best to support low-middle–income countries and also some high-income countries as well by sending facial mask, diagnostic kits, and PPEs. And some Korean experts were dispatched to support COVID-19 responses in some countries. And after MERS, the Korean government strengthened the, as I mentioned, emergency preparedness and response system but never expected such big scale as we've seen with COVID. Therefore, the Korean government is trying to further increase number of ICUs in both public and private sectors and number of medical human resources and how we can fully utilize medical resources in private sectors to cope with public health emergencies in the future.

And I want to mention one thing. Korea was designated as a new WHO biomanufacturing hub to support low-middle–income countries to produce vaccines and other biologicals in February 2020. So starting from June this year, we are already providing some biomanufacturing training for personnel from LMICs and also Korea. So since Korea actually has the second largest capacity to produce biomedical products in the world, I heard that 600,000 liters per year. So government is also investing for hands-on training facilities in multiple locations in Korea, including also in Songdo and Andong. With this draw, I believe Korea can contribute to LMICs' equitable access to medical tools and products. So I hope to Korea would be able to play more and more international roles for global health emergencies with those roles, with those capacity building for the region and globally. And we definitely need to work together with other countries in the region and globally.

So I greatly appreciate RAND's Cooperation Center for Asian and Pacific Policy for producing very comprehensive paper and organizing a webinar like today to promote and evaluate Korea's COVID-19 responses and propose a way forward for future pandemics and emergencies. And my biggest apology, but, well, I have to leave. I cannot stay for the rest of this webinar, but I would be happy to answer any questions by email. And thank you so much.

Jennifer Bouey

Thank you so much, Professor Jee. Your comprehensive review of the strategy and the public health preparedness work done by the South Korea government is really welcomed, too. It's very informative. And I especially appreciate your updates on the ongoing improvement for the health system as well as the government's will to help the regional and the global pandemic preparedness. Thank you so much also for bringing this time. I know you are in the very important WHO meeting right now, even though it's quite late in Seoul. So I hope you the best.

And for the audience, please, if you have questions, put it in the Q&A session and we'll record those and then also send to our panel, all of our panelists for questions. Thank you. All right. So thank you for joining us. So next, so can I invite Ambassador Stephens to comment and maybe talk about your experience when you were in South Korea and also during COVID-19. What's your thought about South Korea government's response to COVID-19?

Kathleen Stephens

Well, thank you, Dr. Bouey. And I feel a little intimidated, but very honored to join you and my fellow panelists, because you are all experts. And I think Dr. Jee has laid this out so well. You— I think the question you posed for our conversation was, can South Korea help the world beat the next pandemic? And I think what we've heard from Dr. Jee is an answer, which is yes. And in fact, it's working to do so now. So I think this is a very important conversation to continue. And I also want to congratulate you on your paper, Public Health and Soft Power. And I do have a couple of observations about that from the point of view of a of a diplomat, a former diplomat, and someone who experienced a bit of the pandemic, both in South Korea and here in the United States. So I thought maybe I'd tell you something from kind of my perspective, my much more pedestrian perspective, if you like, on Korea's experience and on South Korea's role going forward. And again, I think Dr. Jee has laid out very comprehensively, so I can be brief and perhaps lea— perhaps rather rather anecdotal.

One thing that I was struck by, and what Dr. Jee said, was her repeatedly referring to the MERS experience, the outbreak, in South Korea some years earlier. I heard this, too, from my Korean colleagues throughout, that that was a searing and difficult experience, obviously, as a public health crisis, but it was also regarded as a failure, a failure of governance and of health policy in the way that it was responded and the way that the response was handled at that time. And there was a clear decision to learn lessons from that. And that was, so I was struck that Dr. Jee was again emphasizing that. And I think that really underpinned the degree to which South Korea was prepared, and when it wasn't prepared, that it tried to respond proactively as the COVID-19 pandemic began.

Just, you know, I was actually in Korea on a visit in February 2020, just at the time when reports were coming out of Wuhan. And I remember, if I can be just a little bit of a story, I guess, leaving New York, Washington and New York, and people saying, Oh, are you going to Korea? Because Asia was considered, of course, was the epicenter, and we were all right here in, you know, fortress, North America. Wasn't I nervous about going to Korea and getting to Korea? And over that two weeks that I was in Korea, the situation really beginning to change, and coming back to the U.S. to also find, as we were in those days and just a few days later, of course, some of those travel restrictions and lockdowns beginning. But what I also remember is, as I left Seoul on that occasion, and left late February, a Korean friend of mine, not in health services, just a civilian friend, as Koreans were wont to do, gave me a little, a little gift bag at the— as I was going to the airport, you know, usually it's something like maybe some Korean cosmetics or something. It was filled with K-94 masks. And she said, "Here, you're going to need these." It had about a dozen masks in it. And I have to say, when I got back to the United States, and we had no masks. And of course, there was also an aversion, and masks, like many things in the United States, became very politicized. And here I had this little bag of masks and I shared that with people. And I also shared something about Korea's experience.

So, I mean, maybe that's an example of almost soft power at the civilian level. But I'm also going to tell, I guess, now another story about masks which make us— You know, here in the United States, things became so politicized. And I think one of the questions to ask about the Korean experience is also, was that avoided and if so, how?

But with respect to masks and with respect to the topic of your paper, Dr. Bouey, soft power. As Korea was certainly having its hands full, managing the pandemic within Korea itself, it recognized that one thing it was doing was producing a lot of masks and it, through the Korea Foundation, I believe, began to send masks to other countries, including developed countries, including my country, the United States. And the Korea Foundation, for example, sent out something they called COVID-19 care packages. This may sound a little superficial in the day when, I mean, you know, horrific things were happening, but it actually served a very serious purpose, again, in terms of mask diplomacy and kind of spreading the word that there is science behind this, and also we can help each other.

So for example, former Peace Corps volunteers— I was a Peace Corps volunteer in Korea, you know, 40, 50 years ago, back when the United States was sending health volunteers to Korea. But all of us who were former Peace Corps volunteers received a COVID-19 care package filled with masks and, you know, a little bit of tea and some other things. And the message was you helped us, then we're going to help you now. And again, it wasn't only so much of a matter of a kind of a soft power of where Korea is now on reestablishing ties. But it also was saying something about— which helped, I think, a lot of Americans think about— the utility of masks as an important part of the public health measure, which unfortunately had become so politicized and irrational in this country.

But with respect to Korea's early response, which I think we're focused on, and COVID-19 within Korea itself, I mean, Dr. Jee laid it out in great detail, far greater detail than I could. But what really struck me as someone who's watched Korea and it's kind of, if you like, political and social structures over over the years, I think it benefited not only from the sense of lessons learned from MERS, but this very strong public health system that had been established. I mean, it certainly has its problems, but comparatively speaking, quite strong. A respect for expertise. And again, Dr. Jee touched on this, a respect for the civil service.

You know, and I remember also that— and the fact that this all helped the issue in Korea is also a politically polarized places in many ways. But during that, for a long period of time, the issue did not become politicized. And I think there were some really smart things, some specific to the Korean cultural context, but some that I think others, including my country, could learn from. You know, they had one figure. We had a figure, too, Dr. Fauci, and he suffered a great deal. There was a figure and a leader in South Korea, Jeong Eun-kyeong, who was not a politician. She's a medical doctor. And she was up there every single day briefing. And, you know, I heard so many of my Korean friends say, I don't listen to what anybody else says, but I listen to what Dr. Jeong says. You know, she had that credibility. She was the face at a time when people were very worried. And I think that this was a great steadying influence that we can all kind of learn from. We may not have the same kind of, you know, person, sometimes, or political structure, but we need to learn from that kind of lesson. This needs to— The politics needs to be drained away from it to the extent that that's possible.

And one thing that was very admirable to me during that time, too, was the holding of a national assembly election. I think South Korea was the first democracy or the first country, really, at the height of the pandemic, I think it was April, May of 2020, which held an election. And it had a very large turnout, without a spike in cases, and results that were respected. And in fact, it did benefit the government in power. But again, this was managed in a way that retained the legitimacy, if you like, and the separation of of science and politics. I— you see, I keep coming back to that theme.

But in the early days, certainly some things that you focus on in your paper, that Dr. Jee mentioned, the testing, the contact tracing, the awareness that one needed to balance privacy issues—and although that was not always done in ways that everyone approved of—but privacy issues with public health needs. And I think the conversation that I heard, and with Koreans, over that period about the contrast mostly with China, that, you know, that maybe there are some lessons we can all kind of learn. Understanding the risks that are involved in some of these more intrusive measures. But maybe Korea points the way— different cultures, different contexts will approach with a different way, but there are some lessons that we can learn from it.

I think, you know, another kind of lesson from the Korean experience is when it came to getting vaccines. South Korea is kind of, as I understand it, and you all are the experts here, it kind of made the— had not expected vaccines to come so quickly. So when vaccines were available, South Korea had trouble getting their hands on it. So, but again, I think this is maybe where as they look forward and look at now becoming more active as an international vaccine hub, more involved with the international organizations. I think that's another example of Korea trying to learn from where they think they had or where they did have shortcomings in the past, going forward. So in the aftermath, I do think that Korea has a lot of approaches that can be helpful elsewhere. I think that their public health program is going to be an increasingly important part of their overseas development assistance outreach, which the current government is increasing. And I think that these areas of vaccine cooperation is probably one that will increase. And I guess I would say maybe, kind of as a final point, there's also the issue of North Korea and whether or not health diplomacy and provision of health care services and vaccines with—by South Korea and in conjunction with international bodies—will allow some kind of opening of dialog or easing of tensions with North Korea. And something I think that I hope will be explored.

Jennifer Bouey

Wonderful, ambassador. Ambassador Stephens, thank you so much for a very comprehensive, you know, review of your own experience, as well as based on your expertise, basically answered a question of this mystery, which, you know, our reporter has also tried to tackle, and how, you know, South Korea with— It's, I think, at one time in February 2020 before we all understand what is COVID-19, South Korea has the second highest prevalence of the cases outside, you know, this is outside China. But then they can quickly, you know, conquered the first— taming down the first outbreak. That was very, very impressive. And how, you know, in April, just two months after the first outbreak, they had a large election. So you see that this can be done in a democratic country. And, you know, all these lessons that we see, that they continue to improve their public health system, crisis after crisis. So those are all the things that we can learn from many other countries around the world.

Now, let me invite Professor Pang, who also understands the Southeast Asia regional pandemic situations, as well as from the experts who worked closely with WHO and other international organizations on pandemic response, to ask your thoughts on Korea's response and how that can be, you know, can be helpful regionally and what would be the best way for South Korea to participate in this global alliance to— against the next crisis? Professor Pang, the floor is yours.

Tikki Pang

Yes, thank you very much, Jennifer, and it's a pleasure to join this panel. I'm going to try and address three questions that I think you've proposed that we try to address.

The first one is, what can Korea contribute? Are they in the context of a potential soft power asset for global health diplomacy, I think, as Dr. Jee has outlined. The country's sort of near-perfect response based on effective surveillance, tracking, tracing, monitoring, testing, treatment, and public communications that can certainly serve as a model for dealing with future public health crises. So that's the first question.

The second question is, does South Korea's successful management strategy have other potential benefits? And my response here is that it has both internal as well as external benefits. Internally, and I think Ambassador Stephens has mentioned this, it has resulted in an increased trust and confidence in government and in public institutions, in the health care and in the research spaces. So I think that's an important benefit. Externally, it relates to your other question of how can South Korea turn its COVID-19 control success into a soft power asset for health diplomacy? I think in relation to that question, it means that Korea can contribute to the global body of knowledge around pandemic control and, importantly, in sharing best practices in shaping future pandemic preparedness and response. And, as highlighted both by Professor Jee and Ambassador Stephens, importantly, to look outwards externally towards helping developing countries in the region. So that's obviously a part of a soft power asset.

With regards to contributing best practices, I'll just give you two examples. The first one is the ongoing discussion on the Financial Intermediary Fund for Pandemic Prevention, Preparedness, and Response. It has that terrible acronym of FIF PPR. As you know, this is currently being actively discussed and will be highlighted at a G20 meeting in November in Indonesia, my home country. So I think the learnings from the Korean experience can definitely have an important role in shaping what that fund should be trying to do in the future. The second example is something, you know, because I used to work for WHO, something I followed very closely is how the Korean experience will contribute to the revision and amendments of the International Health Regulations, which was tabled in May at the World Health Assembly and will, in the coming year or two, will result in some quite significant amendments to the International Health Regulations, which, as we all know, is the way— is sort of the guidance instrument, especially for developing countries, in dealing with pandemics. So that's sort of internal and external benefits.

The final question I wanted to address is the question that you asked. What are the limitations and risks involved in this transformation into effective soft power diplomacy? What should be avoided? My view here is that I think Korea should develop a proactive strategy which considers three factors. The first one is there is no one-size-fits-all kind of response. The second factor is that for health diplomacy to be successful, it is important to acknowledge that Korea's control success has to be seen in the context of other countries, in the context of their governance, political structures, their cultural and social realities, their available resources, and, of course, their technical capabilities, not just in the health care systems, but also, for example, in research and in manufacturing capacity that Ambassador Stephens alluded to. So that's the second factor. The third factor is avoiding a cookie-cutter approach and being sensitive and respectful of other countries' concerns and priorities and acknowledging that other countries also have much to contribute in terms of control success.

I'm based in Singapore, so I'm quite familiar with the Singapore success story, and I would be a bit of a devil's advocate to say that I think Singapore has been as successful as South Korea has in controlling the pandemic, and there are very interesting parallels between what happened in Singapore and what happened in Korea. How Korea learned from MERS, Singapore learned from SARS in 2003. Okay? The keystone of the effective Singapore response: government will and commitment. Absolutely central. Another factor: rapid responses. And importantly, and I'm glad Ambassador Stephens highlighted this: nonpoliticization of a health and medical issue. It was completely devoid of politics. As in Korea, the population had a lot of trust in government. The government, in its response to COVID, had strong social capital. In addition, of course, to having a robust healthcare system and a unified response across all sectors, not just the Ministry of Health, but many other ministries, including the Ministry of Communications. And I'm so glad that Dr. Jee and Ambassador Stephens highlighted this transparent, timely, accountable sharing of information with the public. Okay?

So though, those are the things— implicit in what I just said is some of the things that they should avoid, you know, not to come across as "we have the solutions to all your problems," but be respectful and be aware of different contexts and work with other countries in the region that have also done well and perhaps, you know, connect with countries that have not done so well. Indonesia, my home country, they didn't do so well because of reasons that we don't have time to go into. But I think there is sort of mutual learning possible here, that Korea can play a central role. So I'll stop there. Jennifer, if you, maybe some other questions there during the discussion. Thank you.

Jennifer Bouey

Wonderful. Thank you so much, Professor Pang. I'm so glad that you brought up the example from Singapore and about SARS. So I think overall, the East Asia in the first response is doing quite well in 2020. And we have, you know, there are case studies from Singapore, from Taiwan, from South Korea, from Japan. They all have been discussed. And what we have done for this report is really one of the case studies of that successful clusters. And as you said, that they have some common features. One is that the depoliticize of the public health issues and a public health system that has capacity, has confidence, and a workforce and strategies for these events.

So, you know, just given time, we have about 20 minutes for questions and answers. And I encourage all the— everyone in the audience to submit your questions in the Q&A. And we can ask those questions. But first, maybe I can ask Ambassador Stephens, maybe do you have any additional thoughts after Professor Pang's so wonderful recap about soft power. We know that Korea, South Korea, is known for its K-pop and technology. And I know, in many countries in Asia, South Korea is also a hub of higher education. Many people go to South Korea for postgraduate and graduate and college, for education. And how can, in that environment, to boost South Korea's best model, in terms of public health? I wonder, Ambassador, do you have any thoughts on this type of collaborations, regionally and globally, for the government?

Kathleen Stephens

Yeah. Well, I appreciate what Dr. Pang said about it's important for Korea as it tries to share some of its experience with the rest of the world, that it be understanding that we're at cultures and—these are my words, not yours—but that situations vary and to be adapted to those. I think that's essential. You know, I do find in the United States, not very scientifically, but I do get sometimes a reaction when I talk about the Korean experience with Americans. Yes, there's there's a different image of Korea now because of K-pop, because of, you know, Korea's technological success, and so on. But there's also sort of stereotypes, you know, that, well, that worked in Korea because it's a highly centralized, homogeneous place. And, you know, the stereotype is kind of everybody kind of goes in lockstep. So it must be easy. It's much harder in a place like the United States or Indonesia or— And, you know, it is different, probably is harder in some ways. But I think it is important that, yeah, that Korea be aware that— and Koreans as they— not play into these stereotypes but have the kind of cultural sensitivity and the awareness of circumstances in other places, as they increase their international development programs and so on to adapt to those things.

Because certainly, I mean, I have to just add, I mean, again, just visiting Korea now a few times over the past couple of years that I've been able to travel again is, you know, there's, within Korea, there's still a lot of debate. And I'm sure that's true in Singapore, too. I mean, people who think that, you know, people have— One, people have very high expectations of their government and the public health service. And, you know, they're very critical of the tardiness of getting vaccines. Many are, you know, too much, too much, too little. There's plenty of debate. So I think that's another one of the lessons that maybe Koreans, from their own domestic experience, can bring abroad. That you have to be ready for robust public discussion and debate about health policy, because it does touch people's most intimate parts of their lives and their families. So, yeah, I guess that would be, that would be my advice. I also kind of have a question, and that is, with both of you having so much experience in kind of the international area, I know that Korea is home to the International Vaccine Institute. Is that a sort of a platform for South Korea to do more in the vaccine area or— I'm sorry, maybe I'm overstepping my role to ask others questions. But I know that I've heard Korea's talk about the notion that Korea could be a vaccine hub. So this is, again, trying to marry, I guess, some of the scientific and business, you know, interests with its public health prowess.

Jennifer Bouey

Yes, I think that's a great question. You know, our report really focused mostly on the first response. You know, we even now we see, even though COVID-19 is a typical infectious disease that's very easily transmitted, and we are very surprised that the the successful vaccine can be created in less than a year. So that's all very inspiring. But, and, you know, for public health professionals, we are actually— we were surprised, and I think Dr. Jee mentioned that they were surprised that the vaccine can be produced in such a short time. So even with that, we see that the first year in 2020, we still very much relying on the nonpharmaceutical interventions. That means, you know, the masks, the social distancing. But how to, you know, work with these very traditional intervention and be aware of the economic setbacks that can cause, and with social suffering and political setback, as we can see in many of the countries. So those are also very tricky. But you're right, I think both Indonesia and Singapore and South Korea has capacities to build these to manufacturing the vaccine. And the question then again is, if a country has manufacturing capacity, you know, how the patent and the vaccine technology, especially with mRNA, which are very new technology, how that's shared around the globe and with the hub of the manufacturing centers. Yeah.

So we do have a question from the audience for now. So I have John Parachini, a senior researcher and leader in many of the national security studies from RAND, posted a question. John, can you just, since we, I put you on the spot here, can you ask the question? Just voice your questions here.

John Parachini

Yes. Thank you. Given that there are variations from country to country, are there metrics that we can use to evaluate the actual effectiveness of response to a pandemic. For example, per capita deaths or speed in sequencing, genetic sequencing of the disease or speed in the development of a vaccine or some measure of transparency of the government or the public confidence in the government's policy measures to address it. If there's some metrics that we can use that are consistent across countries that may identify for us those measures that are always going to be effective regardless of cultural difference. Thank you.

Jennifer Bouey

Thank you. That's, I think it's a really great question, and particularly the question that we're asking today. You know, I think Professor Pang mentioned there are— every country has its unique cultural, political, economic situation. And how do we measure a success? I have some thoughts, but I would maybe ask Professor Pang to respond first and then maybe Ambassador Stephens.

Tikki Pang

Yes. Thank you very much, John. Truly an excellent question. And obviously, moving forward, I think, you know, metrics are particularly important, especially in the context of the fact that many countries are going to be quite limited in their resources. So any future plans for a better response should have an evaluation component. I absolutely agree with you, and I think the metrics to be developed should go beyond just the usual medical and public health responses around surge capacity, number of doctors, number of ICU beds. But, given what we experienced in COVID, must also metrics, as you already mentioned, to include the level of trust in government. Metrics that include how transparent, how timely, how accountable have communications strategies been? Has civil society been involved? Has inequities been addressed in stigmatized marginalized populations, amongst the poor, amongst woman, amongst migrant workers, for example? The question is, who's going to develop these metrics? Now, I am pretty sure that the international health regulations, in the deliberations to revise and amend it, will be thinking along those lines. Because the answer is, at the moment, the IHR does have metrics that countries are being asked to report on. Okay? But Jennifer, this is over to you at RAND, okay. Perhaps it requires an independent think tank like yours to come up with this, let's say, draft metrics to then start the dialog thinking about it. Because it's a lot beyond just health and medical issues. So, yeah. Thanks. Thanks, John, for raising that issue of metrics.

Jennifer Bouey

Thank you, Professor Pang, and thank you for the charge that you gave to us. And I think that's a wonderful research and a very much necessary research we need to work on. Ambassador Stephens, do you have any thoughts on this?

Kathleen Stephens

Well, I just agree. I think over to RAND on this one. I mean, I— it seems to me that the experience of this pandemic, I mean, both in my own country, in the United States and elsewhere, has shown us that we approach this thinking about different metrics. And I don't think there is any agreement, if you like, on which are the ones that are going to matter the most. I mean, certainly in the United States, you know, early on in the pandemic, no one could imagine the levels, the numbers of deaths that we would see per capita. It's extraordinary. You know, and I think across the board. But as the pandemic has gone on, as it went on, the question of economic disruption, of interference with privacy or with personal choice, people have different metrics for this. And I think it's a fascinating and just an all-encompassing sort of analysis I think you'd have to do to think about that. And I think it will vary from country to country and from cohort to cohort.

Tikki Pang

Yeah. Can I just build on that? What Ambassador Stephens mentioned on personal choice? I think that is a particularly important metrics. Now, with apologies to my friends in the United States and in the Western democracies in general, I think the one big difference that I noticed with Southeast Asia, with Singapore, with Taiwan and Korea, that populations by and large are highly trusting of government. They're quite willing to follow what government recommend because they trust them in terms of technical veracity of their advice. You don't see people burning mosques in Singapore, in Taiwan, or in South Korea. This is all about personal choice. This is about the culture of individual freedom. I make my choice. Okay. Well, to me, pardon the expression, that's sort of the democracy gone awry. Okay. In an emergency situation, you need a firm hand like what we've seen in Korea, like what we've seen in Singapore. I better stop this diatribe right now.

Jennifer Bouey

Thank you. Thank you. I appreciate that comment. Yes, I— my thoughts on this, John, is ultimately, you know, in public health, we do look at indices, we look at overall mortality. But what's interesting to COVID-19 is that there are lots of deaths and the mortality not directly related to COVID-19. But if we have a society with lockdown, we see that many people with chronic diseases, with cancer, with heart diseases, that they cannot have access to their health care because of COVID-19. And there, that excess of mortality, I think, has been calculated in many countries, including Europe, U.S., the rate of excess mortality is also relevant. So as you, John, as you mentioned, what is the best number? It's probably not just the mortality on COVID-19, but overall life expectancy and the mortality for those during those periods.

And I can also attest to the importance of politics, political and economic discussions during COVID-19 that in the field of global health, that when we teach global health courses at Georgetown, we tap into many of our collaborators in Africa and Southeast Asia. And what I observe is an increasing interest about politics, and national security relates to health, public health, which in the past were not, you know, everyone assumed that health would be separate from politics, which, you know, we see definitely the counterevidence of that. So there might be a new discipline of academic and research on politics and health that I've seen very— you know, the other day the provost from a university of health, Allied Health, and asking us, you know, is there good resources in the U.S. and probably South Korea, too, about a discussion of academic work on politics and health? So those are in addition to the economic supply chain and global health.

All right. So with that, thank you very much for all the– I think we had just a wonderful, very inspiring discussions about Korea's response to COVID-19. And I would still like to promote one of the RAND report that we recently produced. It's for free, public, for the public. And you can find that report on South Korea COVID-19 response at early stage of pandemic on the RAND website. The link is also embedded in the RAND event page. So I would like to use the last minutes of this hour to thank everyone to join us at this hour. And thank you for all the questions from the audience. So, well, are there any other thoughts? The last words, I give it to Ambassador Stephens and Professor Pang, maybe one minute last thoughts.

Kathleen Stephens

Well, I've learned a lot. I'll just say, when you organize a session on health and politics, I'd like to be in the audience. But thank you. I do commend your report to everyone. I will share it.

Jennifer Bouey

Okay. Final words from

Tikki Pang

I think for my, yeah, My last word, perhaps, is that when you're looking into the future, and it goes back to the metrics that John raised, is don't forget the issue of the longer-term impact of COVID, what we all know as long COVID, because that clearly has go— will going to be very important impacts on financing of the health care systems, especially in developing countries. So I think that's another ball that we shouldn't lose sight of.

Jennifer Bouey

Thank you. So I think that to close this up, I hope that everyone in the audience, I know they are coming from many different countries. We can all learn from South Korea that they have strengthened their legal, public health, and political system through crises of MERS and COVID-19. And for the road ahead, we can still learn. We are still trying to add more contents to our to-do list. And I hope to keep in touch and with everyone interested in this topic. And please feel free to send us more questions and I will deliver those questions to our panelists. Our excellent panelists. Thank you very much.

Tikki Pang

Thank you.

Jennifer Bouey

Thank you. Take care.

Tikki Pang

Bye bye. Have a good day.

Jennifer Bouey

Thank you. Take care.

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