This study aims to examine and understand South Korea’s (S. Korea) COVID-19 response operations, a notable case for other countries to emulate, and suggest some practical implications for other countries struggling with coping with the current pandemic.
To examine the case, the authors propose a new theoretical framework based on concepts of the whole community approach in the emergency management field and on co-production in public administration studies, and use the theoretical framework to analyze the details of S. Korea’s whole community co-production for COVID-19 response.
The findings demonstrate that the successful pandemic response in S. Korea is attributable to a nationwide whole community co-production among multiple actors, including government, various industries, sectors, jurisdictions and even individual citizens, within and across relevant public service and public policy domains.
This study suggests a new theoretical framework, whole community co-production, which contributes to the conceptual advancement of co-production in the field of public administration and a whole community approach in the field of emergency and crisis management. The framework also suggests practical implications for other countries to integrate whole community coproduction that may transform current response operations to cope with COVID-19.
Yeo, J. and Lee, E.S. (2021), "Whole community co-production: a full picture behind the successful COVID-19 response in S. Korea", Transforming Government: People, Process and Policy, Vol. 15 No. 2, pp. 248-260. https://doi.org/10.1108/TG-05-2020-0088
Emerald Publishing Limited
Copyright © 2020, Emerald Publishing Limited
Since the first outbreak in Wuhan, China in December 2019, the novel coronavirus (COVID-19) became a pandemic in about four months (ALA, 2020). As of August 3, 2020, there have been more than 18.3 million infected cases and close to 700,000 deaths in 215 countries and territories around the world (Coronavirus Resource Center, 2020). The surge has overwhelmed health care and emergency response systems around the world in just a few weeks from the World Health Organization’s pandemic declaration in March 2020. Medical professionals have been burnt out dealing with the steep rise of cases (Weible et al., 2020). Treatment equipment and facilities have reached capacity. Protective gear for medical workers has become scarce.
Facing devastation, most of the world’s governments have focused on flattening the curve, meaning a gradual increase of COVID-19 infection rate over time. The flattened curve is to prevent overtaxing critical infrastructure and resources. Affected countries have implemented various measures to flatten the curve, including social distancing, travel restrictions and various forms and levels of lockdown. Still, many countries struggle to flatten the curve regardless of the mass efforts, reaching a grim new record of death tolls and confirmed cases every day (Regencia et al., 2020).
Amid the hopelessness, the Republic of Korea (S. Korea) has been recognized as a notable model to emulate (Normile, 2020). While on February 29, 2020, it recorded the world’s highest number by far of confirmed cases (909 new cases) outside of China, S. Korea has been flattening and reversing the curve, rapidly reducing the total number of confirmed cases and maintaining fewer than 100 daily new cases without going through a strict lockdown (Beaubien, 2020; Kim, 2020).
What has made such a difference in S. Korea? Often, effective leadership and a well-established public service and health-care system have been praised for S. Korea’s current promising outcome (Beaubien, 2020; Kim, 2020). Some have pointed out cultural and contextual differences such as strong collectivism, citizens’ conformity to authority or citizen’s preference for safety over their privacy rights (Borowiec, 2020). Each of these factors has been an important contributor to the country’s current successful response to the pandemic. However, at a meta-level, what resulted in such a difference in S. Korea has been an active nationwide co-production across diverse actors from different sectors, jurisdictions, industries, organizations and even individual citizens.
In response to increasing needs for a successful model to emulate, this research examines the case of S. Korea’s successful COVID-19 response operations, asking “how has nationwide whole community co-production across diverse jurisdictions, sectors, units, industries, and actors in S. Korea resulted in effective and efficient pandemic response?”. To answer the research question, the authors analyze the case and propose a new theoretical framework that is built based on co-production in public administration studies (Ostrom, 1972, 1996; Alford, 1998, 2009; Nabatchi et al., 2017), and the “whole community approach” in emergency management literature (Waugh and Streib, 2006; Nowell and Steelman, 2015). From the case study, the authors suggest some practical implications for other countries to consider in their own response to COVID-19.
The following section introduces a new theoretical framework, whole community co-production. The next section describes the methods, data and context followed by the descriptive findings from the case study. Then, the authors discuss the findings and suggest some practical implications. Lastly, the conclusion section summarizes the study with directions for future research.
Literature review: a whole community co-production for pandemic management
In public administration literature, “co-production” has been defined as both the processes and outcomes produced by multiple various actors collectively contributing to the delivery of relevant public services and achieving desired common goals (Alford, 1998, 2009; Nabatchi et al., 2017). Evidenced by a growing amount of research and programs, co-production has become imperative in transforming many public services and public policy domains such as budgeting (da Silva Craveiro and Albano, 2017), education (Sicilia et al., 2016; Wybron and Paget, 2016), environment (Association for Public Service Excellence, 2013), health (Penny et al., 2012; Realpe and Wallace, 2010), neighborhood safety (Alford and Yates, 2016) and transportation (Copestake et al., 2014).
Despite the increasing volume of research and programs on co-production, there have been ongoing debates on the level of co-production and who is involved in what domains of public service (Alford, 2014, 2016; Jo and Nabatchi, 2016). In general, existing literature categorizes the co-producers into two groups, state actors (government professionals) and lay actors (citizens producers), and categorizes the domain(s) of co-production as a specific issue or several relevant issues (Nabatchi et al., 2017). In their review of co-production studies, Nabatchi et al. (2017) propose typologies of participants, individuals, groups and collectives based on the scope of the role of the lay actor and the scope of the benefits of co-production to eliminate the confusion of the ambiguous boundaries of co-producers and the public service domain.
However, given the growing complexity and interdependence of public service domains in contemporary society, the boundaries of co-producers should be flexible and those of co-production domains should be permeable in practice (Alford, 2014, 2016). In the emergency management context, in particular, the types and numbers of co-producers need to be more inclusive than other ordinary public service domains. An emergency or and a crisis may affect all segments of society (Fisher et al., 2015; Sobelson et al., 2015; Zakocs and Edwards, 2006). For example, COVID-19 not only affects the public health service domain and infection control but also other health domains such as patients with pre-existing conditions or other surgical emergencies. Also, the response to the pandemic affects the domains of transportation, local economy, social welfare and information. Furthermore, a response in one public service domain affects other domains. For example, city lockdown affects the city’s local economy. Therefore, the co-producers of emergency management become everybody and anybody who is affected by the incidents (Khanlou and Wray, 2014).
In response to the flexible and wider scope of who co-produces what public services, the authors suggest a new theoretical framework, “whole community co-production” to increase the applicability of the concept of co-production in the public administration studies by combining the whole community approach widely used in the fields of emergency management and public health (Federal Emergency Management Agency, 2020). This study defines whole community co-production as the full engagement of the entire societal capacity – residents, emergency management practitioners, organizations across sectors, community leaders, professional associations, government officials and ordinary citizens, to transform relevant and interlocking public services to minimize damage from emergencies and to build resilience (Figure 1). The whole community co-production framework reflects the complex nature and the localness of any emergency or crisis, and the collective capability of communities to transform public services (Erkan et al., 2016; Leonard and Howitt, 2010; Sobelson et al., 2015). Hence, the approach focuses on initiatives and encourages transformation by diverse ranges of stakeholders who know the context and who have extra resources that can be used within affected areas (Kumar, 2019; Khanlou and Wray, 2014).
The whole community co-production approach is indispensable during large-scale disasters and extreme events such as the COVID-19 pandemic. The pandemic strains government capacities and asks communities to do more with less (Lee et al., 2020; Weible et al., 2020). Strong leadership and good public health systems are necessary. However, they alone are not sufficient to cope with a large-scale emergency (Boin and Hart, 2003; Comfort, 2007; Leonard and Howitt, 2010; Yeo and Comfort, 2017). While governments make policy decisions and implement programs to respond to the current emergency, they take inputs from their contractors, suppliers and partners to implement their decisions. Citizens are the general beneficiary of government programs, but their feedback reshapes both current and future emergency services, and they can participate proactively in public programs (Kumar, 2019). In the process, whole community stakeholders share information, resources, understandings and responsibilities (Comfort, 2007). The multifaceted sharing leads to a greater collective social outcome. It helps to identify best practices to organize and use strained resources, transform response operations and enhance community security and resilience in the face of emergencies and crises (Zakocs and Edwards, 2006; Comfort, 2007; O'sullivan et al., 2013; Sobelson et al., 2015).
The study adopted a qualitative case study method to explore S. Korea’s whole community co-production to cope with COVID-19. A case study method is appropriate given the research aim focusing on understanding current phenomena and the uniqueness of a situation rather than developing a concept or testing theories (Stenhouse, 1980) assessing complex social relations embedded in a case (George and Bennett, 2005), and suggesting some practical lessons based on findings from an in-depth analysis of an exemplary case of COVID-19 response practices in a specific context (Yin, 2003; McNabb, 2002).
Case: COVID-19 response in South Korea
For its rapid control of the spread of the disease, S. Korea’s response to COVID-19 has been recognized as an exemplary case. From the first case on January 20, S. Korea confirmed one or two cases on average in the subsequent days. However, after February 19, the number of cases exponentially increased because of multiple cluster infections (Ryall, 2020; Shim et al., 2020). S. Korea experienced its surge peak on February 29 with 909 new confirmed cases. Since then, the number of new cases has decreased significantly. In particular, since April 10th, the number of new cases per day has remained under 50 and even declared zero daily confirmed cases of domestic origin for multiple days.
Data and analysis
Applying the “whole community co-production” approach, the authors examine how the whole community (actors from varying scales and levels) has co-produced which kinds of public services to contribute to the country’s notable mitigation of and response to the pandemic. This study collects multiple qualitative data from multiple sources. First, the authors analyzed 242 documents and press releases published by government agencies and departments such as the Korean Center for Disease Control and Prevention (KCDC) and the Ministry of Economy and Finance, and multiple newspapers from January 31, 2019 to April 30, 2020. To collect information about changes in legislation and policies regarding S. Korea’s infectious disease control, the authors also reviewed minutes of the National Assembly published since the 2015 Middle East Respiratory Syndrome (MERS) outbreak.
The authors conducted a documentation review and a series of systematic content analyses of the qualitative data from multiple sources above mentioned. First, from the documentation review, the authors identified three domains, including institutional arrangements, incident command systems and response operations in practice. Second, the authors conducted content analyses to identify who were the whole community actors, how they were involved in response to COVID-19 and what types of public services were co-produced in each domain as well as multiple intersections of the domains. In particular, the authors analyzed minutes from the National Assembly and associated news articles to understand institutional arrangements supporting the whole community coproduction. The authors explored the incident command systems domain by analyzing documents and press releases by government agencies. News articles, government documents and press releases were analyzed to examine the contents of the response operation domain. When analyzing the contents of the response operation domain, the authors identified five emerging sub-domains. Each of the sub-domains has distinctive objectives for response operations but shares collective goals that support whole community co-production at the collective level. These sub-domains include massive testing and diagnosis, intensive contact tracing, information sharing, expansion of health-care system capacities and patient care and supply chain management.
Findings: multifaceted whole community co-production in South Korea’s pandemic response
This section presents how whole community co-production has operated which public service and policy domains in response to COVID-19 in S. Korea.
Whole community co-production for institutional arrangements
The legitimacy of S. Korea’s formal response operations to COVID-19 is supported by the Infectious Disease Control and Prevention Act, the Medical Service Act and the Quarantine Act. These acts define the incident commanders and guide detailed authorities, measures and methods for emergency operations to control infectious diseases.
The details of supporting articles in these acts have been added and/or amended since the 2015 MERS outbreak in S. Korea. After the outbreak, public opinion pointed out the absence of such an established system, lack of practical power of the incident commander and weak information sharing and collaboration across relevant organizations as the inhibitors of early and effective intervention to the previous infectious disease. In response to emerging public opinion over the past five years, a series of amendments have been made which have provided a fundamental steppingstone for the current promising COVID-19 response of S. Korea (Lee et al., 2020).
Whole community co-production for multi-tier incident command systems
Based on the Infectious Disease Prevention and Management Act, the KCDC became the nation’s first incident commander for infectious disease control on December 31, 2019. As the country experienced an abrupt surge of cases in early February 2020, the country declared an emergency alert level. Accordingly, the Central Disaster and Safety Countermeasures Headquarters (CDSCH) assembled under the Prime Minister’s office on February 23, 2020, to assist the KCDC. In the CDSCH, the Ministry of Health and Welfare has assisted the KCDC with public health capacities and the Ministry of the Interior and Safety has assisted the KCDC with its emergency management capacity (Figure 2).
Regardless of the confirmed number of cases in their jurisdictions and in accordance with the national incident commanders’ directions, the 17 municipal governments voluntarily assembled the Local Disaster and Safety Countermeasures Headquarters (LDSCH). Since then, LDSCH has been identifying critical information, requesting national assistance for local sites, assisting local public health facilities and sharing information with local citizens.
At the community level, multiple medical professional organizations, such as the Korean Society for Preventive Medicine and the Korean Medical Association, have promoted a social distancing campaign (Hong, 2020). With a couple of extreme exceptions, most individual citizens, as incident commanders of their own life, have voluntarily followed government recommendations such as self-quarantine and minimizing contact with other people. They also have continuously practiced safe health habits such as washing hands and wearing masks through out the incident (Yoon, 2020).
Whole community co-production for pandemic response operations in practice
Massive testing and diagnosis: S. Korea has taken the most aggressive testing strategy in the world (Yoon and Martin, 2020). As of August 3, 2020, a total of 1,579,757 people have been tested for COVID 19 in S. Korea (ALA, 2020) by 638 testing centers including 60 drive-through centers operated by 8,638 public health centers and medical institutions. Samples collected have been analyzed at 118 diagnostic centers (MoHW, 2020). The service is free of charge to all suspected, referred and/or confirmed cases. Currently, S. Korea can test and analyze up to 20,000 samples per day (3,000 in March 2020) (MoHW, 2020).
S. Korea’s testing and diagnosis capacity has been co-produced by the government, medical professionals and medical industries. First, KCDC, the Korean Society for Laboratory Medicine and the Korean Association of External Quality Assessment Service have developed and approved the current testing methods. Then, KCDC shared the information with manufacturers and assisted them to develop and mass-produce a commercialized version of the testing kit. The commercialized version has significantly reduced the time for the diagnosis from 24 h to 6 h (Kwon, 2020a). Since February 7, the manufacturers have supplied the testing kits to the testing centers, continuously supporting the massive testing capacities (Normile, 2020).
Intensive contact tracing: The S. Korean Government has been intensively tracing the possible points of contact of confirmed cases to identify potential confirmed cases and to prevent further disease transmission. The epidemiological investigation has been integrated as one of the services provided at the 638 testing centers. Upon arrival and registration at a testing center, the person is asked to provide recent travel histories (both domestic and overseas) to the investigators. If the person’s case is diagnosed as positive, then the person’s travel log is anonymized and shared with the municipal and national government to inform the public. If further information is necessary, the government formally requires investigation of multiple closed-circuit television recordings, the person’s mobile phone Global Positioning System data and credit card transactions based on the Infectious Disease Control and Prevention Act (MoEF, 2020). The functional operations of this additional data collection have been coordinated through multiple private service providers, such as mobile phone or credit card companies.
Information sharing: Information sharing has been the key to the response operation in S. Korea. KCDC first shared the information about the virus outbreak in China on December 31, 2019. COVID-19 information, such as symptoms, testing centers and protocols, has been shared through the official COVID 19 website (http://ncov.mohw.go.kr) and KCDC’s hotline 1339 (or regional code +120).
Since January 20, the day of the first case, the chief deputy of the KCDC has held a daily briefing at 2 p.m. to share information such as the number of new cases and mortality, and cases treated and recovered (Kwon, 2020b). During the briefing, anonymized travel logs of all the confirmed cases are presented for early identification and treatment of potentially infected cases, and prevention of further spread. The daily briefing records have been shared on the official homepage of KCDC, the official COVID-19 website, 17 municipal government websites and their social media webpages
The information shared by the government has been reiterated and redistributed by multiple channels. Both national and local media and broadcasting companies have been providing summaries of the information. The Naver, the major Web portal used by S. Koreans, has set up a banner on its main page to provide the most up-to-date information. Using the published information, ordinary citizens have developed free mobile phone applications that display all the travel logs of all the confirmed cases on a map and send alerts to users within a 100-m radius from the route. The first application was downloaded and used by 2.4 million people within about 20 days from its launch date on February 3, 2020 (Ha, 2020). All these private, nonprofit and individual’s efforts have contributed to citizens’ information accessibility and disease awareness.
Expansion of health-care system capacities and patient care: During the response, S. Korea has continuously expanded the health-care system capacity to prevent overtaxing of the core medical staff and facilities. A total of US$9.62bn has been assigned to the nation’s response to COVID-19.
Initially, 29 public hospitals were assigned as COVID-19 treatment facilities (KCDC, 2020). However, in the face of a shortage of hospital beds and emergency rooms during the surge, patients have been triaged based on their symptoms, and only severe cases have been admitted for hospital care to protect medical staff and provide needed care to all patients (Yoon, 2020). Meanwhile, 16 treatment support centers were opened to isolate and treat cases with mild symptoms. Initially, the government designated seven public employee training facilities to be used as treatment centers. Later, nine treatment support centers were added with the donation of space by several large corporations such as Samsung, LG, Hyundai Motors, Hanhwa, Kia Motors, a university and a Catholic church organization (CDSCH, 2020b). The confirmed asymptotic cases have been ordered to self-quarantine at home for 14 days and report their symptoms to designated officers of the district government through a “safety protection application” on their mobile phone (MoHW, 2020). With some exceptions, the majority of individual citizens who self-identified their possible contact with confirmed cases or traveled abroad have self-quarantined for 14 days.
Furthermore, tons of donations of medical supplies, goods, food and lodging have been provided to support medical staff on the front line of the response (Kang, 2020). Thousands of citizens, nurses, doctors, social workers, community organizations and nonprofits have volunteered for patient care and facility care at hospitals and treatment centers across the country (Kang, 2020). All these efforts together have eased the burden on the core medical staff and facilities and have contributed to raising the nation’s public health capacity to combat the disease (Kang, 2020).
Supply chain management: There have been no observable panic-buying behaviors or exceptional shortages of daily necessities or protective gear for medical staff in S. Korea. The only exception was the shortage of face mask supplies and the abrupt price increase of masks in early and mid-February. The government immediately intervened with the mask supply chain by producing state-sponsored KF 94 masks through 123 mask manufacturers. Each manufacturer has contributed 50% of its production to the government supplies (CDSCH, 2020a). In addition, the government halted unauthorized international export of masks and discouraged profiteers by imposing up to $5,000 fine or a two-year prison sentence. Violations are detected and investigated through coordinated investigations by the Ministry of Food and Drug Safety, the Fair-Trade Commission, the National Tax Service, the 17 municipal governments or individual citizens’ reports of violators and profiteers. As a result, the government was able to initially release 24,000 state-sponsored masks (US$1.2 per mask) through district post offices on February 27, 2020, and since then has been able to maintain national inventories that support stable mask supplies (2 per person weekly). Citizens have contributed to supply chain management at the local level by developing mobile phone applications updating mask inventories at district levels. The applications also contributed to managing social distancing between people wanting to buy masks.
S. Korea’s effective COVID-19 response operation is based on co-production by whole community actors in multiple public service domains including legislation, incident management systems, massive testing, intensive tracing, public health capacity, patient care, information sharing and supply chain management that all contributed to the notable COVID-19 response in S. Korea. Each of these public services is the output of co-production among multifaceted actors at all levels who have acted on their shared responsibilities. Furthermore, whole community co-production in one domain has supported co-production in other domains during the response period. Putting the people’s safety first, a wider range of actors have contributed to the pandemic response operations with respect, care and trust. The whole community’s efforts across multifaceted actors have resulted in S. Korea’s continuing effectiveness in COVID-19 response operations.
Whole community co-production should not be unique to S. Korea. Many countries have established policy frameworks that encourage a whole community approach in emergency management practice. In addition, co-production has been an imperative part of public service around the world. In many countries, there is strong involvement in COVID-19 response by citizens, professions and communities, as well as co-production between governments and companies, industries and nonprofit organizations (Weible et al., 2020; Yeo, 2020). Yet, as the situation demands everyone to do more with less, it seems the previously taken-for-granted whole community approach has not been incorporated well with the co-production operating in practice. In this situation, co-production has become something to be reintroduced or reintegrated into the whole community response operation in practice. It is, also possible that COVID-19 might have been recognized as just one of many public health issues. Thus, emergency response systems for COVID-19 have operated differently than for other types of hazards, such as natural disasters, that could immediately mobilize a whole community co-production. Furthermore, facing the wicked nature of the novel virus, societies might have been easily distracted by nonessential issues (Weible et al., 2020) such as fighting about wearing masks or scapegoat hunting. Such distractions could encourage defensive routines in relevant public organizations that were expected to take lead in response to the situation (Comfort et al., 2019; Weible et al., 2020). Meanwhile, issues, problems, systems and people might be more segmented and isolated, thereby wasting limited information and resources that could be used in COVID-19 response.
Concerning these possible impediments, we suggest several ways for other countries to reintroduce or reintegrate whole community co-production into their response to COVID-19. The authors suggest it is important to approach the pandemic as a large-scale emergency, just like other hazards, which needs a whole community approach for effective responses (Yeo and Comfort, 2017; Comfort et al., 2019; Weible et al., 2020). In addition, countries may establish an ultimate goal for the situation, putting the people and saving their lives, first. This goal cannot be stressed enough to develop distributed cognition on collective pandemic response across all segments of society. Lastly, connectedness among all the issues and needs in the current situation can be iteratively communicated with everybody and anybody who are currently or potentially affected by the pandemic to establish shared responsibilities of stakeholders at all levels. Government agencies and policymakers may transform current communication from one-way – government push information down to the public, to two-way – the public and government directly exchange information (Houston et al., 2015). The transformation may be achieved by using information and communication technologies and social media (da Silva Craveiro and Albano, 2017; Malawani et al., 2020).
This study aims to introduce a new emergency management approach, whole community co-production, to current pandemic management practice by examining how the approach has worked and resulted in the successful COVID-19 response practice of S. Korea. Findings indicate that S. Korea’s effective COVID-19 response operation is based on co-production among whole community actors in multiple public service domains including legislation, incident management systems, massive testing, intensive tracing, public health capacity, patient care, information sharing and supply chain management.
Whole community co-production may not sound very new in all-hazards emergency management as either a whole community approach or co-production systems might have operated well in the past. However, given the complexity of disease control and subsequent social and policy issues, government, society and communities may not relate their existing whole community emergency response capacities to managing the novel type of public health crisis. The lack of whole community co-production might be attributable to ongoing struggles to flatten the curve in many countries. Concerning possible impediments for pandemic management, this article suggested several implications to encourage or enhance whole community co-production.
Despite the contributions of this case study to theory and practice, this study has limitations to be addressed in future research. This is an exploratory single case study of whole community co-production for pandemic response systems in a single country. Therefore, to expand our discussion and findings, future research may use different methodologies or data sources to examine the same case. Through surveys or in-depth interviews, researchers may measure factors or conditions that facilitate whole community co-production in the country or examine the impact of whole community co-production on pandemic response performance. Furthermore, to expand theoretical implications and understanding for the whole community co-production, future studies may apply the theoretical framework, whole community co-production, to analyze or access the pandemic response systems of other countries. Or they may conduct a large case study by either comparing similar cases or contrasting different cases.
A whole community co-production framework for pandemic management (adapted from Alford, 2014)
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