In early 2020, a novel coronavirus spread from Wuhan, China, to almost every corner of the globe. COVID-19 caused devastation in every country where it gained a foothold and was allowed to spread through the population. When the first cases hit New Zealand at the end of February and beginning of March, Prime Minister Jacinda Ardern moved decisively by adopting a “go hard, go early” lockdown strategy to stop the virus from spreading across the island nation. Behind Ardern stood a small cadre of civil servants and infectious disease experts who studied the rapidly evolving science of pandemic response—and the virus itself—and made policy recommendations to Ardern and her cabinet. Behind that response team stood a battalion of police, healthcare professionals, and other essential workers ready to implement the policies. And behind them stood everyday New Zealanders—whom Ardern referred to as “the team of 5 million”—who gave up personal freedoms for the greater good during a mandatory national lockdown. A far-reaching and comprehensive communication effort drove strong public acceptance as the government shifted health directives and policies in response to the fast-changing situation. After May 1, the country went 102 days with no locally transmitted cases of the virus. However, a new outbreak of cases in August plunged Auckland, New Zealand’s largest city, back into lockdown and made clear that extreme vigilance was necessary to protect New Zealanders from the pandemic raging abroad.

Blair Cameron drafted this case study based on interviews conducted in Wellington, New Zealand, in July and August 2020. Case published September 2020.

In the early 1990s, scientists discovered that the city of Seattle faced far severer seismic hazards than previously known. Their findings showed that a devastating earthquake would occur—perhaps tomorrow, perhaps next year, or maybe not for decades. In any event, the coastal city—the largest in the Pacific Northwest region of North America—was gravely unprepared. The uncertainties surrounding the timing and extent of such a disaster worked against the case for immediate, significant, and unified government action. Beset by more-pressing priorities, elected officials were reluctant to commit significant tax dollars, extensive amounts of time, and substantial political capital to the issue. Municipal emergency managers and community organizers took on much of the responsibility and tried to address important aspects of how to respond to the population’s immediate needs amid the devastation a massive earthquake would cause. They worked especially hard to build networks of organizations and people that would strengthen the city’s preparedness and resilience. Still, organized efforts directed toward two other elements of preparedness—mitigation and recovery—lagged. Seattle’s effort to grapple with those problems spotlighted a bigger question: How should a society prepare for a high-consequence disaster of uncertain timing?

Gordon LaForge drafted this case study based on interviews conducted in Seattle, in July and August 2019. Case published October 2019.

In October 2014, Prime Minister Narendra Modi of India declared a new national campaign to eliminate open defecation within five years. An estimated half of all Indians—mainly those living in rural areas—still defecated in the open, as humankind had done for centuries. Because India’s past programs had focused on building toilets, achieving little success, this time the emphasis was on motivating behavioral change. But exactly how to approach the challenge was left to each state. Ajoy Sharma, a veteran Indian Administrative Service officer, took on the task of implementing Modi’s plan in northern Punjab state in January 2015. To change long-held public acceptance of open defecation, Sharma developed an innovative pilot program that integrated sensitization and social mobilization at the individual, family, and community levels with financial subsidies to support toilet construction. The success of the program and its acceptance in five districts gave Sharma the evidence he needed to apply a similar template across all districts in his state. By September 2017, the project had successfully certified 11 districts—half of the state—as Open Defecation Free, a total of nearly 6,000 villages. This case study offers lessons for governments interested in altering social norms and expectations on a large scale to bring about long-term societal change.

Tini Tran drafted this case study with the help of Asha Brooks and Arpita Tripathi based on interviews conducted from April to October 2017. Case published November 2017.

When Ebola crossed into Liberia in early 2014, the West African nation had few defenses. Because no effective vaccine was available at the time, the only way to limit the spread of the viral disease was to restrict physical contact with those who were infected, what they had touched, and the bodies of victims. But that advice countermanded the most basic of human instincts: to comfort a sick child, hug an ill relative, or shake hands with a friend or coworker. The challenge of changing human behavior was especially difficult because Liberia was still recovering from a long civil war. Public distrust of government, persistent rumors, linguistic diversity, and limited communication capacity hobbled efforts to send a clear public message and win citizens’ cooperation. After top-down tactics—including forcible quarantines of whole communities—failed to stem the rate of infection, a small team of Liberian officials, supported by international partners, realized that effective steps to contain the disease would require active participation by citizens themselves. The officials engaged Liberians in developing an information campaign and recruited people throughout the country to visit their neighbors door-to-door, explain the steps people could take to protect themselves, and respond to questions. Although the complexity of the Ebola response and the volatility of the outbreak had made it hard to measure the success of the social mobilization effort in reducing new infections, an analysis of timing together with anecdotal evidence strongly suggested that the effort helped save lives and contributed to the disease’s decline during the final months of 2014.

Leon Schreiber drafted this case study based on interviews conducted in Monrovia, Liberia in April and May 2016, with guidance and additional information provided by Jennifer Widner and Beatrice Godefroy.

Princeton University’s Health Grand Challenge supported the research and development of this case study, which is part of a series on public management challenges in the West African Ebola Outbreak response.

Timeline: West African Ebola Outbreak (poster infographic)

Timeline: West African Ebola Outbreak (page version)