Prompt 5: Top-down or bottom-up approaches?

     An example of a top-down approach in response to the COVID-19 pandemic is nationwide lockdowns.  Most communities around the world experienced some form of a lockdown, but the strictness and length of lockdowns varied from country to country.  The United States had "stay at home" orders implemented at the state level but never experienced a national lockdown. The first lockdown was put in place on March 17, affecting cities in California.  These measures were effective only slightly. Many people had to continue to work to keep up with bills and other expenses. Lower-income communities were disproportionately affected by COVID-19 and lockdown policies as they could not stay home for extended periods.  In New Zealand, the country took a tough stance on COVID-19 lockdowns. The entire country was on lockdown, and it effectively limited the transmission of the disease. All luxury or nonessential activities are closed overnight (restaurants, sports, schools, pools, and playgrounds), leaving only the essentials open (gas stations, hospitals, and supermarkets). These measures were highly influential.  According to the New England Journal of Medicine, New Zealand had declared the pandemic to be over only 103 days from the first positive case.  Compared to other top-down approaches across the globe, this is a remarkable feat.  

In my personal opinion, bottom-up approaches work better for individual communities.  In a pandemic, this can look like public health operations looking at individual counties and making decisions for their community.  For example, suppose a county is struggling with an outbreak. In that case, officials can encourage individuals to participate in their health, making their decisions more impactful for their community.  In the United States, some pockets of people believe that their individual liberties come before protecting people, leaving vulnerable and immunocompromised people to suffer. Suppose we can provide local resources to these people and have their health be their decision. In that case, it could change the responses and behaviors of all communities. After all, top-down approaches cannot work if the individual doesn't respond to them. If the government gave all citizens a vaccine, but no one took it, the whole is still unvaccinated. 

Others, D. Mevorach and, et al. “Successful Elimination of Covid-19 Transmission in New Zealand: Nejm.” New England Journal of Medicine, 6 Oct. 2021, https://www.nejm.org/doi/full/10.1056/NEJMc2025203.