Intended for healthcare professionals

Feature Christmas 2020: House of God

The covid-19 yearbook: world leaders edition

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4728 (Published 16 December 2020) Cite this as: BMJ 2020;371:m4728
  1. Mun-Keat Looi, international features editor
  1. The BMJ
  1. mlooi{at}bmj.com

In times of crisis, great leaders step up. So how did the class of 2020 fare?

Most likely to misinform

Donald Trump, president of the United States

What to say about the man who first claimed covid-19 would “disappear,” then blamed China, then withdrew from the World Health Organization, then told citizens to inject bleach, repeatedly tried to discredit his own infectious diseases lead, and caught the virus himself only to continue to flaunt his refusal to adopt prevention measures? Trump has made the pandemic a partisan, political issue in the US, hampering public health efforts. Soon to be former president of the United States, to the relief of many.

Most likely to claim to be “world beating”

Boris Johnson, UK prime minister

The decision to lock down later than the rest of Europe left the UK with one of the highest death rates in the world. In November it became the first country in Europe to pass 50 000 deaths, although the NHS has coped admirably, and initial problems with PPE seem to have been ironed out. However, confusion over constantly changing rules, a struggling “world beating” test-and-trace system, and allegations of cronyism in key appointments and the awarding of contracts to private companies for pandemic services—not to mention overlooking the incident of Dominic Cummings’s trip to Barnard Castle—have severely eroded public trust despite Johnson earning early sympathy after a serious bout of covid-19.

Most likely to approve a vaccine

Vladimir Putin, president of Russia

Long carrying one of the biggest covid-19 caseloads, Russia’s infections have soared throughout 2020, yet deaths per capita are relatively low, despite reports of a healthcare system struggling with ageing equipment and hospitals almost constantly near capacity. Putin put restrictions in relatively swiftly but refused to lockdown and is pinning hopes on his country’s own vaccine development. He has spared no opportunity to laud Russia’s progress and flabbergasted the world by approving one vaccine candidate before phase III trials had reported any results. He claimed it was safe because his own daughter had been administered it, though not yet himself.

Most likely to understand the science

Angela Merkel, chancellor of Germany

One of the few world leaders with a scientific background, Merkel quickly grasped the situation when the novel coronavirus hit Europe. Germany’s efficient public health system and clear communication with its state governors, as well as neighbouring countries, meant it has coped with alarming infection numbers1 with a robust test-and-trace system and clear effective prevention measures. Not everyone is happy, of course—protests by far-right anti-mask groups continue—but Merkel, together with Emmanuel Macron of France (see below), have been prominent in steering Europe through what is still a highly turbulent time.

Most likely to impose a stringent lockdown

Xi Jinping, president of China

From original concern to almost full normality, China is both reprobate and role model to the world in how to handle an epidemic. Chinese officials have been accused of covering up initial signs of the infection, but they were quick to impose an unprecedented lockdown on the Wuhan region. It was stringent and perhaps not replicable elsewhere, but Xi Jinping’s decision, as well as zero tolerance follow-up measures (including invasive surveillance, mass testing of the entire Wuhan region, and clamping down on any cluster outbreaks), has meant China is one of the few countries in recovery (health-wise and economically) in the world.

Most likely to eliminate the virus

Jacinda Ardern, prime minister of New Zealand

Universally lauded for being one of the few countries to achieve effective elimination of covid-19, some may argue that New Zealand’s Ardern benefited from a relatively remote and sparsely populated country, making closed borders and restrictions easier to enforce. But there’s no doubt that her decision to follow scientific advice and aim for the “zero covid” strategy that other countries rejected as unachievable has allowed New Zealand to return to normal. Ardern’s reassuring yet firm demeanour and swift action in response to subsequent cluster outbreaks have won admirers abroad and at home, helping her to an absolute majority in New Zealand’s 2020 election.

Most likely to deny everything

Jair Bolsonaro, president of Brazil

A man who is at least consistent. Even when he himself caught the virus, Bolsonaro maintained his dismissal of it as “the little flu.” His blatant disregard for masks, social distancing, or any kind of preventive measures led to clashes with, and the eventual dismissal of, two health ministers in the space of three months, and it ran counter to regional governors’ attempts to get the world’s third largest outbreak under control. Brazil still suffers, particularly with an underfunded universal healthcare system,2 but Bolsonaro remains defiant: “All of us are going to die someday . . . We must stop being a country of sissies,” he said in November.

Most likely to misfire

Narendra Modi, prime minister of India

Modi can’t win. Not against this opponent. Imposing one of the world’s largest and most severe lockdowns failed to flatten the curve, and SARS-CoV-2 infection is still running rampant throughout India with a caseload the second highest in the world and a death toll expected to rise sharply now that the virus has reached rural areas where healthcare is severely lacking. Criticised for mis-timing his “biggest gun” of lockdown (possibly just for a dramatic show of authority), the lack of warning and transparency over decision making, official pandemic figures, and limited testing mean that the worst fears for India’s beleaguered public health system seem to be coming true.

Most likely to learn from the past

Moon Jae-in, president of South Korea

South Korea had a scare in 2015 when MERS unexpectedly reached its shores. Never again, it declared, and Moon’s response has been impressive: prompt lockdowns and restrictive measures, universal surveillance using the latest in tracking technology to warn of infected contacts, and one of the first deployments of mass (including drive-by) testing. South Korea still has cluster outbreaks (notably in the capital, Seoul), faces a shortage of hospital beds, and saw around 16 000 intern and resident doctors strike over plans to boost the number of doctors.3 But on coronavirus, the public and president seem aligned.

Most likely to act first

Tsai Ing-Wen, president of Taiwan

If there’s a leader who did everything right, it’s Tsai. The first to take preventive action over SARS-CoV-2, she ordered health screenings for all flights from Wuhan from 31 December 2019 and in January mobilised the Central Epidemic Command Center to coordinate the response. She introduced travel restrictions, began quarantining high risk travellers, and limited the number of people allowed at gatherings. Aided by a robust healthcare system and universal health coverage, Taiwan has a strong track, trace, and isolate programme after lessons learnt from the SARS epidemic in the early 2000s.4 Tsai’s government even produced its own masks, partnering with the country’s private companies to keep stocks high and prices affordable for hospitals and the public and donating 10 million to other countries at a time of global shortages and international division.

Most likely to be caught between a rock and a hard place

Pedro Sanchez, prime minister of Spain

Few governments will emerge from this crisis unscathed, but Pedro Sanchez has had a particularly difficult time in territorial Spain. He has been severely criticised for his government’s overly centralised and heavy handed response to the first wave, when the country emerged alongside Italy as the centre of the European outbreak, the horrific 20 268 deaths in care homes,5 and the imposition of one of the longest lockdowns in the world. He has taken a more delegated approach since the summer, but he still finds himself caught between regional leaders who oppose more restrictive measures and a weary, straining healthcare service, all while infections continue to climb.

Most likely to give a clear and measured national address

Emmanuel Macron, president of France

Nationally broadcast addresses can be double edged swords, but Emmanuel Macron has wielded them with some skill. They’ve proved crucial in communicating two strict but necessary lockdowns and numerous curfews and restrictions on French citizens, balancing his country’s teetering economy, racial tensions, and the world’s fifth biggest coronavirus burden. His leadership domestically as well as on the continent has earned him credit, but, as France’s hospitals struggle with a second wave already worse than the first, he will need to offer more than reassurance in the months ahead.

Most likely to refuse to wear a mask

Andrés Manuel López Obrador, president of Mexico

“You know when I’m going to put on a mask? When there is no corruption,” said López Obrador in July. He has repeatedly broken physical distancing guidelines and continued to travel even as Mexico rocketed up the caseload rankings over the summer. With austerity foremost on his agenda, he has kept testing and tracing at a minimum and forgone any mandatory national lockdown, instead focusing on an expansion of hospital beds. The result is one of the highest caseloads and mortality rates per capita in the world.

Most likely to stay in the background

Stefan Lofven, prime minister of Sweden

For much of 2020, the public face of Sweden’s pandemic response was not a government minister but Anders Tegnell, the state epidemiologist at the Public Health Agency. But Tegnell’s controversial “soft” strategy—refusing harder restrictions to spare the economy and avoid the inevitable spike that follows any lockdown—delivered a death toll of 6000, higher than all of its Scandinavian neighbours combined.6 Cries about failures in care homes, testing, and the refusal to change tack are now deafening, and regional governors took matters into their own hands, with Uppsala becoming the first to introduce its own “local lockdown” in October. Lofven, for his part, has become more vocal, admitting in November that “we are moving the wrong direction,” and in a rare Sunday night national address he warned that “too many people have been careless about following the recommendations.” Sweden is now starting to introduce more stringent measures, such as restricting public gatherings to eight where it was previously 50.

Footnotes

  • Correction: We amended this article on 18 December 2020 to correct misspellings of Jacinda Ardern, Jair Bolsonaro, and Xi Jinping.

  • Provenance and peer review: Commissioned; externally peer reviewed.

References

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