Why are Governments finding the new plague so hard?

Posted on Friday, March 20, 2020

Author: Dr. Nigel Cameron

Dr. Nigel Cameron
Senior Fellow, Institute for Science, Society and Policy

We’ve all observed the halting and surprisingly diverse approaches of governments around the planet to the emergence and spread of SARS-CoV-2 - the official name of the virus causing the coronavirus disease COVID-19. (And yes, it would help all of us if WHO could take the advice of the weather services and come up with simple names for these things.) We’ve been asking why their approaches have been so different – in timing as well as focus – in dealing with exactly the same problem.

Each country has its own story. Once we’re done with SARS-CoV-2 - and once it’s done with us – there will be a grim accounting, nation by nation. Decisions and deaths.

Some things (bad things) are already obvious. It’s clear that in the crucial first days and weeks both China and the U.S. took deliberate steps that had the effect of delaying their respective countries’ response. It’s also apparent that, perhaps uniquely, the UK seems deliberately to have encouraged the initial spread of the disease – bizarrely resigned to the inevitability of mass infection. Despite a much-heralded U-turn, it is still holding back from the lock-down policy adopted by much of Europe. Canada has followed others’ lead and closed its border to most non-citizens, and now partial closure of the Canada-U.S. border is being planned.

Meanwhile, China claims that its belated but draconian quarantine policy has worked; and in Hong Kong and South Korea and Singapore we seem to have examples of less drastic but also surprisingly successful efforts, in more democratic though very orderly societies. What these examples will mean for Africa and other less-developed regions, where there has been little testing and where healthcare systems are far from adequate even in normal times, remains to be seen. Especially in a world newly shorn of American leadership.

There are four core policy challenges facing every government.

  1. Plainly, to contain the spread of the disease.
  2. To manage the healthcare needs of those who succumb.
  3. To handle the macroeconomic impact.
  4. To address the potentially enormous fallout for individuals and small businesses as contracts fall off, hours and jobs are lost, and (especially in countries with modest social provision) workers need to be encouraged not to go to work if they are sick.

Some comments on each before we go further.

1. Containment. It’s plainly been simpler for China, with its centralized decision-making and compliant citizenry, to take the dramatic actions that have apparently contained the outbreak. Of course, all states reserve powers of an “autocratic” nature to deploy in emergency. Perhaps the most striking example among the democracies is that of Belgium, a country that is notoriously difficult to govern - with three provinces, two warring language communities, confusing “shared competencies” between federal and provincial governments, and often with no actual national government at all (as in the past year). Last week the “interim acting prime minister” Sophie Wilmes – regarded as a lightweight transitional figure – was suddenly vested by the King with the power to rule for six months by decree. By contrast, it is hard not to conclude that the British government has shifted, under serious criticism, from a policy of essentially enabling the spread of the disease for a period in an effort at treatment flow control, to one of high-profile dithering. Johnson uses his daily press conference to tell people not to go to pubs and restaurants, devastating their trade without stopping many of their customers. (The owners are angry: if he ordered them closed, many would have insurance support.)

2.Treatment. We’ve watched China erect whole 1,000-bed hospitals in a matter of days; and also watched as Italy’s healthcare system - and funeral system - have been overwhelmed. We’ve watched a succession of doctors in assorted countries including the UK, with its much-vaunted NHS, bewail the lack of PPE (personal protective equipment). We’ve noted that the crunch need in every jurisdiction has been the availability of critical care beds and ventilators. According to reports, Italy actually has twice as many, per capita, as the UK (which is second to bottom of the European ladder); the US has seven times as many, but hardly enough. Hence the desperate effort in many countries to slow the progress of the disease so there is no sudden spike – and to keep open the hope that there will be no spike down the pike.

What’s more, over time both the human and physical resources of the healthcare system will be degraded. Doctors and nurses develop the disease, others decide to protect themselves and their families by pulling out – especially if there are equipment shortfalls. While a strategy may work for a week or a month as things get going – will it work if the virus is still on the loose, and there are many, many more patients, in three and six months’ time? This is where the improvidence of decision-makers is so telling and may prove so disastrous – the failure to maintain a stockpile of very basic PPE equipment, and to plan for a rapid scale-up of critical care beds/ventilators. Emergency actions to manufacture the needed supplies may or may not prove sufficient. We’re already weeks into the crisis and little has been done.

Despite the fact that it has the best-resourced healthcare system in the world, the U.S. has been scrambling. One report states they have only one per cent of the 3.5 billion masks needed to fight the pandemic for a year. Most masks are made in China, which is now producing 116 million every day - and has been sending supplies to several suffering countries. Another report suggested the U.S. was trying to buy a German company working on a vaccine.

3. Macroeconomics. It appears that President Trump’s initial reluctance to take the threatening pandemic seriously stemmed from his desire not to spook the markets. Now that the markets are thoroughly spooked, the US and everybody else is pouring money into efforts to prevent widescale bankruptcies and attendant layoffs. Quite apart from the problem of stabilizing market indexes in time of uncertainty, it’s plain that economies will shrink, perhaps dramatically, as economic activity slows. And this is all happening at the same time as the exogenous shock of Saudi Arabia’s destabilizing oil price war with Russia.

One issue that will be weighing with political leaders is whether the vast and potentially ruinous economic disruption involved in encouraging or enforcing stay-home policies is “worth” the savings in human lives that result – especially if those lives are (mainly) those of the elderly and the chronic sick. One depressing truth is that these are two groups who already cost healthcare systems a lot of money. What about the unthinkable – essentially, plan for a cull and cut the risks to the economy?

4. Workers and small businesses. It is a special challenge for the U.S. (and of course less-developed nations) without strong social safety nets to expect sick employees to stay home – a crucial component in fighting the spread of disease. Workers who are contractual or part-time are easy to lay off everywhere, though they have some protections in European nations. The U.S. is according to reports planning any day to send upwards of $1,000 to every taxpayer, with discussion of further payouts later in the year. This will help them pay the rent and also stimulate crucial demand in the economy – and, perhaps, have potential political benefits. The fact that this initiative is bipartisan suggests no-one really knows where they will fall.

It’s a truism that governments find special difficulties in addressing policy issues that cut across multiple departmental areas of responsibility. Even fighting a war – the image being employed by various leaders, including Macron and Johnson – is basically the responsibility of one department of state. And while Secretaries of Defence need backup from colleagues across other departments, and may jostle with their head of government for pride of place, Secretaries of Health are much less able to commandeer such general responsibility – they are much more junior, and in need of even greater support.

It’s also a truism that every government includes a unit (perhaps several) working on “preparedness” and security threats like this one. While such units have plans in their files and have likely war-gamed this exact scenario, they invariably hold a lowly place in the hierarchy. This was strikingly illustrated by the decision of the Trump administration two years back to dissolve the pandemic preparedness unit in the White House National Security Council. Trump recently lied about not having been party to that decision. But at the time he had said “as a businessman” he didn’t consider the unit necessary until there was a problem.

Yet more significant, perhaps, is the culture of government; which brings to mind the management saying (attributed to Peter Drucker) that culture eats strategy for breakfast. And I am reminded of an initiative I was involved in a decade back that sadly failed for lack of funding – to develop psychometric tests for “future-mindedness” that could be applied to civil service recruits. The kind of people who lead bureaucratic departments tend to be, well, bureaucrats; well-suited to stasis and specialization.

Looking ahead

I’m writing this on March 19, when the latest statistics via Worldometers are almost a quarter of a million cases, and almost 10,000 deaths, worldwide. Italy has overtaken China. And in country after country assorted restrictions are being put in place – for the next two or three or four weeks.

No question in my mind, we need to think at least six months ahead before children start going back to school and anything like normal economic activity re-starts. And that’s making some optimistic assumptions.

For one thing, there’s not going to be a vaccine and for normal life to start up again the virus would need either to have swept through the population (likely causing hundreds of millions of people to be sick, and several million to be dead), or it will need to recede for seasonal reasons, like the flu does. Or – just possibly – we will have stopped it in its tracks as China may have done; though once China is back to “normal” the smart money is on further widespread outbreaks. And who in the West has the capacity to shut down huge cities and go door to door with thermometers for weeks on end?

And a vaccine? Whatever leaders may say (European Commission President Ursula von der Leyen foolishly suggested otherwise before being slapped down by her own experts) it’s a complex and very time-consuming business; promising candidates often don’t make it. Anthony Fauci, America’s top expert on infectious diseases, has warned that it will be 12-18 months before a vaccine is ready. The European expert agency has said the same thing.

Here’s the terrifying prospect. Look at what’s happening in Italy, where the medical system has been stretched to capacity by 40,000 cases, and under 500 deaths a day. Now imagine just 400,000 cases. The death-rate will increase much faster than the case-rate, because despite whatever manufacturing efforts can be rushed those vital critical care beds and ventilators and skilled nurses will be far fewer than are needed for treatment of the seriously ill. So death rates will go up, and the swamping of the healthcare system will also lead to a spike in deaths of people who don’t have the virus but something else. This will look very like hell on earth. See this stark report that apparently had a big impact on UK and U.S. policy.

It’s this prospect that has made governments take extraordinary measures to slow the infection rate and hope they can keep it down. But that will likely involve de facto quarantine for all of us except those in healthcare and other vital services (from food delivery to garbage collection) who will need state-of-the-art PPE. It will also involve our being able to keep the economy going (the global economy as well as our own household economies) for months on end, with most people working from home.

Have you seen the 2011 movie Contagion? It’s a disaster movie, of course, and they are rarely great cinema. But it’s well-regarded, since it is mostly realistic in its depiction. What is not realistic is the speed with which the vaccine is developed – and in the movie, the vaccine is the only way to stop the disease. So it’s possible that we really need to look 18 months ahead for a vaccine to come and save us, or those of us who are left – a scenario set out in a recently leaked report from the U.S. Government.

*****

Of course, pandemic SARS-CoV-2 can only have come as a complete surprise to the blinkered, the short-sighted, and the obtuse, though sadly our governments, democratic and autocratic, harbour plenty of women and men who qualify on one or more of those criteria. The SARS-1 (2003) and MERS (2012) outbreaks – both more deadly diseases that mercifully proved far less contagious than the latest – sounded loud, clear warnings to the global community.

As we scramble to fight this fire, legislatures need to make it a priority that there will be robust resources in place for next time. And – per impossible – our political (and bureaucratic) leaders need not to be blinkered, short-sighted, and obtuse.

Because there are plenty of zoonotic diseases out there, waiting in line. Anyone for Covid-20? 

Nigel Cameron is President Emeritus of the Center for Policy on Emerging Technologies in Washington, DC; in 2015-16 he was Fulbright Visiting Research Chair in Science and Society at the University of Ottawa’s Institute for Science, Society and Policy. He has written widely on technology, health, and ethics. In 2007 he was the U.S. Government’s (unsuccessful) nominee to be United Nations Special Rapporteur for the Right to Health. He is currently working on a biography of C. Everett Koop, U.S. Surgeon-General from 1981-89, who lead America’s response to the AIDS pandemic.

 

 

 

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