Public Health and Pandemics in a High-Income Charter City

A closer look at the steps a successful charter city might take in the face of a pandemic.


In an earlier blog post, Mark Lutter noted that the response to a global health emergency in a charter city would look like the response to COVID-19 seen in South Korea, Taiwan, Hong Kong, and Singapore. Mark specifically discusses how better social technology, the ability to effectively coordinate large groups to achieve desired outcomes, would position a charter city to more effectively respond to a pandemic like COVID-19 than the host country otherwise would be. This post discusses what the public health infrastructure and response might look like in a successful, high-income charter city, where high-income means a GNI per capita over $12,376.

When a charter city is first established and in its initial growth years, the resources available to the city administration will be necessarily limited. This means that most health spending will necessarily be focused on developing a healthcare system that can deliver basic services at low cost, with a drive for universal access for city residents. However, as the charter city grows and incomes rise, the resources available for the city’s health infrastructure also rises. The same pattern is observed on an international basis. A more well-funded public health administration in a charter city can begin taking steps to prepare for future health emergencies by learning from past successes.

A successful charter city can start by looking at what low-income countries have done well in the face of public health emergencies. Nigeria’s highly effective response to the 2014 Ebola outbreak serves as a model case for the importance of developing the ability to quickly trace, monitor, and isolate individuals that have been in contact with an infected individual. Lagos is far larger than the hypothetical charter city, and it is also much poorer, yet it was able to prevent a major crisis. Senegal has also been lauded for its successful response to Ebola, the centerpieces of which were a world-class testing laboratory to identify cases and a separate health center dedicated purely to the Ebola response. These two cases demonstrate that an effective public health response to a crisis is achievable, even in a low-income setting.

High-income countries, notably Taiwan, Hong Kong, Singapore, and South Korea, also present model responses for a charter city to plan to be able to implement. As soon as China first reported a problem to the World Health Organization, Taiwan immediately began aggressive screening and monitoring of travelers from Wuhan, China. Travel from Wuhan was quickly banned, and widespread mask distribution was undertaken. Taiwan had already developed temperature screening at its airports after the 2003 SARS outbreak. Taiwan’s health system covered costs for those getting tested and their care, and widespread public information campaigns provided information on how to stop the spread of COVID-19.

Similar responses were taken in the other three countries mentioned. In Singapore, high levels of trust in the government helped make the response more effective, along with using simple cartoons as a way of disseminating information to the public. Singapore’s response has been so effective that a total lockdown has so far been unnecessary. Hong Kong, Singapore, and Taiwan all bucked the World Health Organization’s recommendation against restricting travel—their preference for precaution has likely saved hundreds or thousands of lives. Although South Korea has seen more cases than some of the other success stories, it was able to get its COVID-19 problem under control quickly with very widespread testing.

These responses can be replicated in a high-income charter city. Each year, some portion of the city budget can be allocated to developing a store of personal protective equipment for use by medical personnel and for public use. If the charter city has its own airport, temperature-taking infrastructure can be made standard and travel restrictions can be easily implemented. The widespread adoption of mobile phones throughout the Global South can make the dissemination of information particularly easy for a charter city health administration, in addition to other media channels. Charter cities that attract research universities or other advanced labs can become central locations for developing testing and the initial research into epidemics of unknown origin.

By laying the groundwork for a streamlined, but effective public administration that incorporate lessons from proven successes abroad, a high-income charter city would be well-positioned to respond to a public health emergency like COVID-19. It would possess the physical infrastructure needed to effectively respond, like reliable electricity and water, but also the administrative and public health infrastructure. Taiwan, Hong Kong, South Korea, and Singapore all learned from the 2003 SARS outbreak and successfully prevented COVID-19 catastrophes as a result. Charter cities can do the same.