Emek Yılmaz [1]

20 August 2021

 

The first announcement of the COVID-19 virus as a global pandemic led to different and unforeseen experiences in life. At first, everyone perceived it differently: some did not take it seriously, while others became paranoid or hygiene-obsessed, cleaning constantly and washing almost everything brought from the market. There was no global action plan against a worldwide pandemic. Authorities introduced new regulations, different for every country, depending on the severity of cases. Italy, Spain, and France entered strict lockdowns. In Türkiye, a trial to agree on proper regulations was, and apparently, still is underway. Within a short period of time, face masks, hygiene, and social and physical distancing became the standard almost everywhere in the world. Some countries emerged as models, while others managed the situation surprisingly poorly, causing higher death rates due to incompetent intervention.

South Korea has been identified as a model in many studies on pandemic management (Dighe et al. 2020; Lee et al. 2020; Park and Chung 2021). This article briefly explains how the process has been managed in South Korea and discusses the cultural, economic, and political factors behind its success.

As of August 18, 2021, the global cumulative total number of COVID-19 cases is 210,352,699, and the global cumulative total number of deaths due to COVID-19 is 4,410,505. As shown in the chart, Singapore and South Korea indicate a low level of total COVID cases, illustrated by a flattened curve.

 

The first COVID-19 case in South Korea, Patient 1, was reported at Incheon International Airport and had travelled to Wuhan, China, on January 20, 2020. Following this announcement, the country moved quickly to implement measures defined in 2015 MERS-CoV (Middle East respiratory syndrome coronavirus – hereafter MERS). Until January 16, all COVID-19 transmission cases had been contained among families and friends, and the known total number of cases was 30 (Shin et al. 2020). A cluster of virus transmissions occurred at the mass of Shincheonji Church of Jesus in Daegu via Patient 31, and within a month (March 25, 2020), the number of positive cases increased to 5,080 people (out of 9,137 total cases in Korea) all with connections to the church (Shin et al. 2020).[2] Transmission of the virus was no longer contained within close circles.

Health management protocols

The Korean Center for Disease Control (KCDC) developed civic partnerships and recommended and defined self-isolation protocols and social distancing regulations for both indoor and outdoor areas (Lee et al. 2020). The KCDC also implemented case-based interventions following detailed protocols divided into four phases: 1) investigation of whereabouts of the patient during a specified period, 2) exposure risk assessment, 3) contact classification, and 4) contact management (quarantine and symptom monitoring) (Dighe et al. 2020). Testing was free for all Korean citizens, and foreign residents were not involved in the plan. The public-private partnership (PPP) for testing, tracking, and treating (3T) COVID-19 positive cases was another important and innovative step in controlling the pandemic (Park and Chung 2021). While many countries went under lockdown, Korea did not have to follow strict lockdown protocols (Lee et al. 2020). Public and private companies manufactured test kits, and Korean communication applications adapted with COVID-19 notices (South Korea 2020).

To carry out efficient 3Ts, central and local governments opened testing points in the city and applied the below protocol of the Ministry of Interior and Safety (2020).  The PPP works as follows: during the case investigation phase, information collected from traditional patient interviews is supplemented using GPS data on mobile phones, credit card transaction logs, and CCTV recordings in order to identify the geographic locations of contact tracing. For identified contacts, people with severe symptoms are immediately isolated in hospitals, while those with mild symptoms are asked to quarantine at home or be transferred to designated quarantine facilities. Regardless of their symptoms, contacts are placed under “movement restriction” via a mobile app developed by the Interior and Safety as part of a public health order (Dighe et al. 2020).

Economic policies

Preventive and control measures for COVID-19 impacted supply and demand and caused a worldwide economic and financial crisis. South Korea implemented financial support packages during different time periods. One interesting movement called the “Nice Landlord Movement” was voluntarily initiated by property landlords, who reduced or froze rents so that businesses could overcome difficulties caused by COVID-19. Central and local governments offered property tax cuts and tax credits to “nice landlords” to support the local economy (MoIS 2020). The movement began in February 2020 in Gwangju Hanok village in Gyeonggi-do province and spread across the country.[3]

Local governments also provided compensation to small businesses who were forced to close due to social distancing; these included businesses such as sports centers, cafes, PC bangs (PC rooms), norebangs (singing room or karaoke). New tourism patterns were introduced. Increased use of the rent-a-car system was expected to reduce the inconvenience caused by social distancing and “contact-free natural attractions” were promoted. Local governments shared the status of confirmed cases, medical facilities, and information via text messages and their websites (MoIS 2020).

The above graphic compares out-of-pocket (OOP) spending on health expenditure. According to the Organization of Economic Cooperation and Development (OECD), South Korea reports one of the highest shares of OOP consumption allocated to medical care across OECD countries. They claim that “OOP spending may create a barrier to health care access and use” and that “overall, 37% of health spending in Korea is financed directly by households” (OECD 2016). The World Health Organization recommends that this number should be less than 15-20 % of total health spending (World Bank Group 2020). The Korean government, therefore, terminated all out-of-pocket costs associated with COVID-19-related health services (Dongarwar and Salihu 2021). This investment to control and prevent COVID-19 is significant because it is understood that the pandemic creates a political crisis and places an economic burden on the health care system and economy. Globally, economies were expected to lose around -3.5 % of their gross domestic product (GDP) in 2020 (IMF 2021). However, thanks to the successful management of the COVID-19 crisis, South Korea was able to keep its 2020 GDP loss at 1 %, mostly due to exports (Kim 2021).

Political factors

The MERS experience and its political repercussions helped Korea to positively impact the world’s pandemic management. The Park Geun-hye government of 2015 applied basic precautionary measures, but the disease control policies were perceived by Koreans as sluggish, causing the supposed already-corrupt presidency to lose popular support and creating a political backlash eventually leading to the president’s impeachment (Park and Chung 2021).

Park and Chung (2021) compared Gallup Korea opinion polls for Park Geun-hye’s and Moon Jae-in’s government performances in pandemic governance performances. According to the authors, President Moon Jae-in, who came to power after Park Geun-hye, learned from the MERS experience, took the COVID-19 pandemic seriously, and acted quickly. These interventions received a positive reaction from the population, helping Moon Jae-in win the April 15, 2020 elections (Park and Chung 2021). President Moon Jae-in’s government, who understood the importance of transparency and information exchange with the public, elevated the KCDC from a Center to an Agency (the Korean Disease Control Agency –hereafter KDCA) on September 12, 2020 (Park and Chung 2021).[4] This change gave the center independence in controlling the pandemic on behalf of the president. The KDCA behaved more transparently than allowed at the time of MERS and carried out daily live online briefings with Q&A sessions, that continue to provide updated information and prevent misinformation (Park and Chung 2021, Lee et al. 2020).

Social and cultural factors

Why are Asian countries (in this case South Korea) successful in managing the pandemic? Some papers argue that civic awareness and voluntary cooperation are considered important in maintaining self-isolation, hygiene, and social distancing measures. Other articles state that Korea’s authoritarian and Confucian culture (not people’s voluntary behaviors) led the masses to follow pandemic control measures. In my opinion, both are valid arguments. In the case of mask-wearing, it is already a common practice in Asia during winter, as well as at times of high pollution.[5] In Asia, people do not hug or shake hands to greet each other. In addition, Korean society has become contact-free, carrying out economic activities via mobile apps and self-service kiosks called untact (a combination of the prefix un and the word contact) (Lee 2020). Nevertheless, it is also hard to rule out Neo-Confucian and authoritarian values, that are deeply rooted in Korean history. Confucianism is characteristically patriarchal as a political ideology and stresses three bonds: the relationships between father and son, ruler and minister, and husband and wife (Kim 2015), the former being superior to the latter. The superior must care for inferiors, be benevolent, and must regulate inferiors by propriety rules.

This hierarchical social order clearly exists in Korea. In my experience, one of the most obvious examples is that of supervisors in the workplace defining subordinates’ timetables without any legal regulation. Those who hold power positions in the public sector are respected, and protocol is usually accepted without question. I believe this is an important factor in the pandemic prevention and control process. Citizens respect the KDCA’s briefings and follow agreed procedures. Can this be considered volunteer participation, or is it due to the way people are educated in the family, school, and culture of the institutions they work in? I believe it is the second, which results from a strong, hierarchical, and Confucian culture. Respecting and following the order of authority is ingrained in the culture, and the Shinchonji Church case is one of its results. The KDCA (or government) authority is replaced with the authority of the head of the church, so the church mass caused the fast spread of the virus.

Does this mean we need to always obey authority? Shall we allow authorities to surveil us at all times? Perhaps what we need is “intelligent obedience.”[6] Koreans do not necessarily heed all that comes from authorities, which explains democratization movements and the impeachment of the Park Geun-hye government.

Currently, the world is undergoing a period of vaccination, as well as a rise in new COVID-19 variants. Countries began administering vaccines early this year, beginning with elderly and at-risk populations, but whether due to successful management of COVID-19 infection levels or the slow development of their own vaccine, South Korea  lags behind in vaccination among OECD countries (Our World in Data 2021).[7] The COVID-19 Delta variant is fast spreading among the unvaccinated population in Korea. As of July 30, 2021, only 14% of the population has been vaccinated, and the KDCA aims to vaccinate over 70% of the population with at least one dose by September 2021 (CNA 2021).

To conclude, pandemic management demands detailed and long-term planning involving scientists, policymakers, local governments, and potential stakeholders. Building mutual trust, transparency, and information exchange are considered essential. The lack of a global action plan created uneven and uncoordinated intervention across the world, causing a seemingly never-ending pandemic with the emergence of new COVID-19 variants. A global action plan against the pandemic is essential, and the Korean management model sets a good example.

 

Notes

[1] Ph.D., Visiting Researcher at KUASIA for 2020-21. emekyilmaz@gmail.com

[2] This news piece titled “How a South Korean church helped fuel the spread of the coronavirus” is presented as a graphic design and explains the day-by-day cluster spread of the virus.

[3] The “Nice Landlord Movement” reminds me of another voluntary movement that took place in the 1997 economic crisis, during which people joined a campaign and contributed to the IMF debt payment by donating their golds to the government because the national currency had lost value in the international market. It was seen as a national embarrassment, and people acting on it was considered a “public self-sacrifice” to save a troubled economy. In BBC World Analysis. 1998. “Koreans give up their gold to help their country.” Available at http://news.bbc.co.uk/2/hi/world/analysis/47496.stm on January 21, 2021.

[4] The center was renamed the Korean Disease Control and Prevention Agency (KDCA).

[5] In Korea, for example, during the period of yellow dust that comes from the west, many people wear masks to protect themselves from respiratory problems.

[6] As opposed to the book title Intelligent Disobedience: Doing right when what you’re told to do is wrong by Ira Chaleff 2015.

[7] The variable time span is December 2, 2020 – August 18, 2021.

 

References

Amy Dighe, Lorenzo Cattarino, Gina Cuomo-Dannenburg et al. Response to COVID-19 in South Korea and implications for lifting stringent interventions. Imperial College London (29-05-2020). doi: https://doi.org/10.25561/79388

CAN. 2021. South Korea announces COVID-19 vaccination plan for 18- to 49-year-olds. Channel News Asia, July 30, 2021. https://www.channelnewsasia.com/news/asia/south-korea-announces-covid-19-vaccination-plan-for-18-to-49-15338142

Daejoong Lee, Kyungmoo Heo, Yongseok Seo. 2020. COVID-19 in South Korea: Lessons for developing countries. World Development. Vol. 135

Dongarwar, Deepa and Salihu, Hamisu M. 2021. Implementation of universal health coverage by South Korea during the COVID-19 pandemic. The Lancet Regional Health – Western Pacific. Vol. 7. https://doi.org/10.1016/j.lanwpc.2021.100093

Frankopan, Peter. 2020. Past pandemics exacerbated disadvantages – what we can learn from them about the coronavirus recoveryhttps://theconversation.com/past-pandemics-exacerbated-disadvantages-what-we-can-learn-from-them-about-the-coronavirus-recovery-141254.

Heisook Kim. 2015. Confucianism and Feminism in Korean Context. Diogenes. Vol. 62(2) 41– 47.

IMF. World Economic Outlook Update. 2021. https://www.imf.org/en/Publications/WEO/Issues/2021/01/26/2021-world-economic-outlook-update

Jaewon, Kim. 2021. South Korea limits COVID damage to 1% GDP contraction in 2020. https://asia.nikkei.com/Economy/South-Korea-limits-COVID-damage-to-1-GDP-contraction-in-2020#:~:text=South%20Korea%20limits%20COVID%20damage%20to%201%25%20GDP%20contraction%20in%202020,-Led%20by%20chip&text=Bank%20of%20Korea%20data%20published,5%25%20from%20the%20previous%20year.

June Park, Eunbin Chung. 2021. Learning from past pandemic governance: Early response and Public-Private Partnerships in testing of COVID-19 in South Korea, World Development. Vol. 137.

MoIS. 2020. Ministry of Interior and Safety- Local Government’s Response to Covid-19 in Korea.  https://www.preventionweb.net/files/72481_localgovernmentsresponsetocovid19in.pdf.

Lee, Julie Yoonnyoung. 2020. The South Koreans left behind in a contact-free society. https://www.bbc.com/worklife/article/20200803-south-korea-contact-free-untact-society-after-coronavirus.

OECD. 2016. OECD Health Policy Review: Health Policy in Korea. https://www.oecd.org/korea/Health-Policy-in-Korea-April-2016.pdf.

Our World in Data. 2021. https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=latest&facet=none&pickerSort=desc&pickerMetric=total_vaccinations_per_hundred&Metric=Vaccine+doses&Interval=Cumulative&Relative+to+Population=true&Align+outbreaks=false&country=AUS~AUT~BEL~CAN~CHE~CHL~COL~CZE~DEU~DNK~ESP~EST~FIN~FRA~GBR~GRC~HUN~IRL~ISL~ISR~ITA~JPN~KOR~LTU~LUX~LVA~MEX~NLD~NOR~NZL~POL~PRT~SVK~SVN~SWE~TUR~USA~CRI

Sangmi Cha. 2021. Quarter of S. Koreans get at least one vaccine dose ahead of schedule. Reuters, June 16, 2021. https://www.reuters.com/world/asia-pacific/quarter-skoreans-get-least-one-vaccine-dose-ahead-schedule-2021-06-16/

Shin et al. 2020. How a South Korean church helped fuel the spread of the coronavirus. Washington Post, March 25, 2020. https://www.washingtonpost.com/graphics/2020/world/coronavirus-south-korea-church/.

South Korea. 2020. Tackling COVID-19: Health, Quarantine and Economic Measures of South Koreahttps://ecck.or.kr/tackling-covid-19-health-quarantine-and-economic-measures-of-south-korea/.

World Bank Group. 2020. Economic Impact of Covid-19 Implications for Health Financing in Asia and Pacific. Discussion Paperhttps://openknowledge.worldbank.org/bitstream/handle/10986/34572/Economic-Impact-of-COVID-19-Implications-for-Health-Financing-in-Asia-and-Pacific.pdf?sequence=5&isAllowed=y