I recently started reading Fiasco: The pandemic reveals who Americans will protect and who they will leave behindby Joe Nocera and Bethany McLean. they had written the book before The devil is all here: The hidden history of the financial crisisI found this book to be one of the better books on the 2008 financial crisis. So when I saw their new book, I knew I wanted to read it. I’m sure I’ll talk more about this book in the future, but one thing caught my attention. What I wondered about in the early chapters was the thinking of government officials, particularly Donald Ainsley Henderson, in the years leading up to the COVID-19 pandemic. (Yes, I confess that I intentionally made the headline of this post a little clickbait, at least for regular EconLog readers!)
In the aftermath of the COVID-19 pandemic, it is quite unusual to hear people criticize the government’s unpreparedness and complete lack of planning in the event of a major pandemic. That wasn’t the point. But Nocera and MacLean point out that the plan was actually in place years before COVID-19 arrived in the United States.
Plans to deal with a national pandemic began to be put together in 2005 after then-President George W. Bush read John M. Barry’s book about the 1918 influenza pandemic. great flu. After reading this book, President Bush told government officials, “Look, this happens every 100 years. We need a national strategy.”
It was at this time that the government began to develop a national strategy in earnest, but as Nocera and MacLean write, there have been many calls for this step to be taken.
In fact, for decades, there has been a small group of scientists trying to warn governments about the potentially dire consequences of pandemics. The leader of the special group was an epidemiologist named Donald Ainsley Henderson (DA Henderson), who everyone knew, including his wife.
And let’s just say Henderson knew a little more about controlling the spread of disease than most.
In 1966, as a 37-year-old scientist, Henderson was appointed to the World Health Organization to lead a program that carried out the seemingly impossible task of eradicating one of the world’s great scourges: smallpox. Henderson proved to be an outstanding leader and over the course of a decade he and his team achieved success.
Mr. Henderson was brought in to help develop the strategy. “Henderson was 78 years old when President Bush began pressuring his administration to develop a pandemic plan. He served as dean of the Johns Hopkins School of Public Health for 10 years and was a leader both inside and outside of government. He joined the Center for Health Security when President Bush began to instigate a pandemic plan. However, because of his stature, he was forced to participate in some of the administration’s discussions. He wasn’t happy with what he was hearing. ”
Why was he unhappy? Mr. Henderson differed from most health officials in one particularly interesting way. he wasn’t like that adam smith He famously called the system man, as Smith described it:
Conversely, system people tend to be very wise within their own conceits. and is often so absorbed in the supposed beauty of his own ideal plan of government that he cannot tolerate the slightest deviation from any part of it. He continues to establish it completely and in all its parts, without any consideration of the larger interests or the strong prejudices that may be opposed to it. He seems to imagine that a hand can arrange the various members of the Great Society as easily as it can arrange the various pieces on a chessboard. He does not believe that the pieces on the chessboard have any principle other than the movements that the hands make on them. But on the great chessboard of human society, each piece has its own principles of motion, quite different from those that the legislature seeks to impose upon it.
Henderson was acutely aware that humans had their own “principles of motion” and tried in vain to make other officials understand this. Tara O’Toole, one of Mr. Henderson’s colleagues, explains his thinking this way:
“The DA kept saying, ‘Look, we’ve got to be realistic about this,'” O’Toole recalled. “And you have to be humble about what public health can actually do, especially over a long period of time. Society is complex and you can’t control it.” There’s also the fact that the DA and I were in government. did. We had a pretty clear understanding of what the government could and could not do. ”
Mr. Henderson particularly emphasized the importance of managing the situation through decentralized, hands-on, real-world experience rather than top-down planning. His ability to understand this was in no small part why his team’s efforts to eradicate smallpox were successful. When planning his discussion, he emphasizes the importance of understanding that humans are not simply chess pieces that can be moved around freely.
Mr. Henderson was fond of saying that there are two types of epidemiologists. Those who use “shoe leather” – those who go out of their offices and talk to people to learn about diseases and their spread – and those who use computer models. He belonged firmly to the shoe-leather school. At a meeting to flesh out the plan, he made his position clear. He argued against formulating policy based on hypothetical models – after all, the models themselves are based on assumptions. “What computer models cannot incorporate is the impact that different mitigation strategies have on people’s behavior and the resulting course of the epidemic,” he said. “For example, it takes experience to predict how people in the 21st century will react if all schools are closed for weeks or months, or if all gatherings of more than 1,000 people are canceled. There are too few.”
But the leadership of the pandemic planning team had a completely different mindset.
The two men who led the planning team were Carter Mescher, the governor of the Department of Veterans Affairs, and Richard Hatchett, an oncologist who had served as Bush’s biodefense adviser since 2002. They were smart and dedicated, but neither had any experience in epidemiology. Something like a pandemic.
Metcher and Hatchett did not share Henderson’s concerns about centralized, top-down planning based on hypothetical models. And that’s to say the least.
They ended up adapting a model made by high school student Laura Glass for a science project.
Ultimately, President Bush’s predictions came true and a pandemic appeared to rival the 1918 influenza. And there was a plan in place that then-Health and Human Services Secretary Alex Azar could implement.
Mr. Hazard immediately began “working out a pandemic strategy.” As he later said, it was written in the Bush administration and updated by the Obama administration. But given all the man-hours that went into putting together a pandemic plan, that document was essentially worthless. The reality was very different from the simulations and wargame exercises.
In reality, the “plan” turned out to be worthless at best, and in many cases downright harmful. Whereas Metcher and Hatchett saw their role as creating a strategy for everyone to follow, Henderson believed that the goal was to maximize the opportunities for people to adjust and adapt in their own way. I thought so. How might the world be different today if policymakers had taken Henderson’s advice in the age of COVID-19, or how the smallpox eradication effort would have been run by people like Mescher and Hatchett? It is worth thinking about how the world would be different today if this had happened.
