EXAMPLE

Covid-19

In the early months of the Covid-19 pandemic, governments from low-, middle-, and high-income countries alike were scrambling to control its spread. Of course, what we know now-and did not know then-was that a significant portion of the virus's communicability was due to asymptomatic spread. Without the guaranteed onset of recognizable symptoms-and in less-severe cases, those symptoms that do exist are often no different from those of the common cold-one thing became clear: if governments were going to contain the virus, they would need a massive rollout of testing capacity, and fast. The solution, as determined by many governments, lay in engaging the private sector.

WHO's April 2020 "Covid-19 Strategy Update" called for a "whole-of-government, whole-of-society approach," in which governments should, "re-purpose and engage all available public, community and private sector capacity to rapidly scale up the public health system to find and test, isolate, and care for confirmed cases (whether at home or in a medical facility), and identify, trace, quarantine and support contacts."62

It was a unique circumstance. Rather than turning to PPPs for marginal advantages in efficiency, or cost-savings, governments were looking to the private sector for increased capacity, and an expeditious rollout of essential services. With public-sector lab capacity quickly overwhelmed, the private sector needed to be engaged. Was the private sector up to the job?

In South Korea, the answer was undoubtedly "yes." At an urgent, late-January meeting, the South Korean government engaged 20 companies in a race to find a suitable test, promising to cut through red tape and authorize an expedited approvals process. By February 12, the government had already approved two tests, and were able to cover the cost of testing for anyone with symptoms (asymptomatic citizens wanting a test could pay 150,000 won, or about 125 dollars. Concerned that the expedited approval might negatively impact the accuracy of the tests, the government decided to cross-check the fast-tracked tests to ensure they were working.

The gamble paid off. South Korea's swift action on the pandemic is now world-famous. At its peak, the country's rate of new cases per day exceeded 1,000. By April, that number was in the single digits.

Of course, PPPs were not employed to great effect everywhere. The United States, too, employed PPPs to increase its testing capacity, partnering with pharmacies and testing firms like CVS, Walgreens, eTrueNorth, and Quest.63 But the U.S.'s much-maligned testing strategy was, indeed, woefully slow. Was this due to inefficiencies in the private sector? It would seem not. According to Reuters, faulty government-produced tests from the CDC, and a slow, five-week FDA approvals process left the United States significantly behind the curve. In other words, it seems that it was government mismanagement, and not private-sector involvement that resulted in testing shortages across the United States.