I have some problems with Julie Sunderland’s determination at Project Syndicate that we are overreacting to the coronavirus outbreak in China:
Every few years, humanity succumbs to mass hysteria at the prospect of a global pandemic. In this century alone, SARS, H1N1, Ebola, MERS, Zika, and now the coronavirus have all generated reactions that, in retrospect, seem disproportionate to the actual impact of the disease. The 2002-03 SARS outbreak in China (also a coronavirus, likely transmitted from bat to human) infected 8,000 people and caused fewer than 800 deaths. Nonetheless, it resulted in an estimated $40 billion in lost economic activity, owing to closed borders, travel stoppages, business disruptions, and emergency health-care costs.
Such reactions are understandable. The prospect of an infectious disease killing our children triggers ancient survival instincts. And modern medicine and health systems have created the illusion that we have complete biological control over our collective fate, even though the interconnectedness of the modern world has actually accelerated the rate at which new pathogens emerge and spread. And there are good reasons to fear new infectious diseases: the Coalition for Epidemic Preparedness Innovations (CEPI) estimates that a highly contagious, lethal, airborne pathogen similar to the 1918 Spanish flu could kill nearly 33 million people worldwide in just six months.
Nonetheless, the fearmongering and draconian responses to each outbreak are unproductive.
She wants to
- Increase presumably public investment in “science and technology”
- Reinstate the National Security Council’s unit for coordinating responses to pandemics
- Have a “coordinated global response”.
Let’s start with the last one first. If she wants a coordinated global response, she’s addressing the wrong audience. The article should be in Chinese. How is such a response possible when the country in which the pandemic if it is one originated and in which there are several orders of magnitude more people with the disease and more mortality refuses to allow external observers to come to their own assessment of the scale of the risk? Giving those who believe in world government the benefit of the doubt, I think their intentions are good. However, if there is one thing we should have realized over the last 30 years it is that there is no global consensus either about means or ends, there are very few common values. Without some sort of consensus about values world government is unworkable.
I have no opinion about the NSC’s unit for coordinating responses to pandemics. I can’t make a determination as to whether it was a titanic boondoggle and waste of money or a vital contingency factor. It was probably some of both.
As to the first the federal government alone spends over $1 trillion per year annually on health care with the states spending nearly as much. Health care reached the point of diminishing marginal returns to incremental spending decades ago. Every penny of that is spending on “science and technology”. Presumably, that’s not what she means.
However, if she means research, the same argument applies. The numbers are just smaller. There is at this point essentially zero evidence that more spending on medical research will produce more results faster. It might or it might not. What I will predict is that the biggest effect of a lot more research spending all at once will mostly be giving raises to researchers without producing more results faster. The supply of researchers with the appropriate knowledge, background, and credentials just isn’t that elastic. Substantially increasing medical research in a productive manner will require a gradual effort taking place over many years.
There’s something else she doesn’t seem to understand. The money to spend more, as she appears to want to do, must come from somewhere. What is it that she doesn’t want to do that we are presently doing?
There are really only a handful of candidates. We can spend less on pensions, we can spend less on health care, or we can spend less on our military. Our military is already underfunded relative to the tasks we’re asking it to perform. What missions does she think should end?
Finally, I don’t know how one can determine whether we are overreacting to the outbreak in China, responding exactly as we should, or drastically underreacting. I think something depends on what’s actually happening in China and the truth is we just don’t know. I think it matters whether there have been 1,000 fatalities in China or 50,000. It might be that we are overreacting to the facts as we understand them but drastically underreacting relative to the risk. We just don’t know.
Videos now coming out of China show some level of panic. People suspected or accused of being ill are chased and carried off by authorities in hazmat suits. Carried off to hospitals? Confinement? Ovens? Try to imagine that was the scene you see from your home window. They are making the problem worse.
Reports are some 3 million people left Wuhan for new years holiday after the virus surfaced and before it was reported. Probably cannot be contained at this point.
What do ill patients gain if they make it to the hospital? Fluids? Oxygen therapy? Exposure to lots of sick people for sure.
Quarantine of a large population brings up so many issues of supply that I can’t see it working for long.
The good news if there is any is that the virus will mutate over time to a less virulent strain. That’s no help to the victims I know.
First, I think you should realize it is difficult to know how to handle a new outbreak of a new disease. Look at how God awful our response was to AIDS. How many thousands died who didnt need to die?
So no one knows how to respond initially to an outbreak of a new disease, but what we do know is that they will occur. That is why we need to have an infrastructure prepared to handle this. You are correct that we can’t suddenly create experts in this field. That is why it is so important to have a standing organization.
“The money to spend more, as she appears to want to do, must come from somewhere. What is it that she doesn’t want to do that we are presently doing?”
Homeland security budget or Defense budget. We are much more likely to face deaths from a pandemic than we are terrorists. Take a few billion out of the nuclear weapons budget. We might only be able to destroy the world 7 times over rather than 8, but we have a better chance to save lives from disease.
“There is at this point essentially zero evidence that more spending on medical research will produce more results faster.”
There is no prospective, double blind study to prove this so you are correct, but then we will never have such a study. What we do have is evidence from other situations. With Ebola these had been government investments in developing a vaccine (Canadian). That meant we could develop a vaccine much faster. Or take the AIDS epidemic. It took us along time to recognize it existed since we didnt have a good structure to do so. Then we had research delays because it affected gays and AIDS came from sinful behavior. Then we had to build up the research infrastructure.
“Substantially increasing medical research in a productive manner will require a gradual effort taking place over many years.”
Measuring productivity will be difficult since pandemics dont come on a regular basis. Should probably be metrics similar to what we use for defense initiatives.
Steve
So, why not spend $1 trillion per year on preparedness? Why not $10 trillion? The obvious answer is there are other, more immediate priorities and you can’t spend as much as you might like on everything.
I think you will find that the savings to be obtained from reducing our spending on our nuclear deterrence are far, far smaller than you seem to assume. If we eliminate our nuclear deterrent entirely, we could realize something like $15 billion per year. Almost all of that is just maintenance.
I agree that we should cut defense spending. The cuts will need to come from operations. We need to do less than at present. Even then I’m not sanguine about getting the amount of money that would be required while still maintaining a viable military.
I suspect that if we’re going to start preparing for this sort of contingency we’ll need to cut back on other health care spending.
One sure way to spend less on health care is to outlaw health insurance. Under Obamacare, the rules on “loss-ratio” required of insurers virtually guarantees that the insureds pay $1.25 in premiums for every $1.00 of actual health care. Look it up.
Jimbino:
I suppose there’s a scorched earthed path to solve any problem, but there’s a reason we don’t do it, and that reason is ….. elections.
China can try any old policy, we can’t.
” why not spend $1 trillion per year on preparedness? Why not $10 trillion? ”
Strawmen. Why dont we spend $10 trillion a year on national defense. Why dont we ask those who do this stuff for a living and then make a risk assessment. We do that all of the time. Make a best guess.
Steve
Why not distribute latex gloves to the third world? It’s too big of a job. Or Is it?
It’s done with mosquito netting and condoms. It’s a good start and after this episode the Chinese might be on board.