Let’s hope that the omicron variant of covid-19 is indeed the omega, more or less, the marker of a transition from pandemic to endemic illness.
I am at this point more concerned about the next pandemic, the next global-scale crisis (or the other one that is as pressingly continuous right now: climate change).
I’ve read a few “what we have learned” articles, a few “let’s apply what we have learned to the next pandemic” essays, and most of them seem to be as much a symptom of the problems with the global response to covid-19 as they are solutions. I’m not surprised by that, because most of the lessons are the kind that the human species is profoundly unready—and possibly incapable—of acting upon.
Review for a moment the kinds of sober, thoughtful, specific policy recommendations that well-educated and knowledgeable specialists in epidemiology and public health will be making with great seriousness of purpose and expert insight over the next months and years:
Tighter global identification and regulation of potential zoonotic reservoirs: restrict access to habitats of animals known to pose high risks of zoonosis (bats, pangolins, etc.); monitor livestock populations known for zoonotic potential (pigs, fowl); tightly regulate wet markets for cleanliness and separation between species available for sale.
Revision of laboratory safety protocols for labs working with coronaviruses, rhinoviruses and other pathogens known for rapid mutation and risk for epidemic spread; encourage global transparency including global inspection teams for such facilities.
Standardize global protocols for containment of epidemic spread of diseases, especially restrictions on movement of people and goods, and improve procedures for acknowledging that a disease has become a pandemic.
Educate publics about the importance of public health measures like masking, distancing, and vaccination.
Improve global-scale infrastructures for vaccine and pharmaceutical production, encourage more equitable distribution of vaccination and drug therapies, increase public investment in health care world-wide.
And more in that vein. I can see the parade of earnest and completely reasonable workshops, conferences, white papers, party platforms, think-tank reports and so on stretching out in front of us like a stairway to the future that we all used to believe was possible.
Maybe it still is, but we’re not climbing to it on those kinds of steps. There’s another climb to make first, and it’s up a steep cliff with only a few handholds.
Anybody who is serious about implementing all those kinds of measures is going to have to reckon honestly with what will keep them from being anything more than suggestions that will only be implemented in a handful of European social democracies.
First, that the existing international order is 100% opposed to the kinds of coordination, mutual trust, and transparency that these measures would require, and that these are measures which have to be implemented consistently all around the world to have any hope of helping with global-scale problems. An individual nation-state can have a completely sensible and well-administered policy framework for managing education, for provisioning health care, for reducing industrial pollution by facilities within its own borders, for promoting alternative energy production. No nation can implement management of large-scale epidemics or pandemics on its own. Too many experts in too many fields continue to make recommendations of various kinds that presume we have an international order that it capable of doing more than pantomiming its sober acceptance of these recommendations. It’s a corrosive pretense that undercuts trust all around the world.
Second, key players in implementing many of these kinds of recommendations are able to evade, ignore or sidestep the authority of any governmental or regulatory system that might command them to follow revised procedures. That scales all the way down to groups of poachers or hunters who will continue to enter protected habitats or interact with zoonotic risks and all the way up to the biggest pharmaceutical companies. This isn’t just a matter of enforcement, either: it is also about the incentives that drive small groups of people to take risks and that lead pharmaceutical companies and health care systems to make their own decisions about profit-seeking and allocation of services against wider public interest. Inequality and uncontrolled capitalism make coordinated global responses to worldwide emergencies impossible.
Experts and policy-makers might justly reply: screw you, these are massive transformations of the human status quo that you’re describing as preconditions of good policy-making and that’s not fair or practical. True enough. But none of us would think well of a policy-maker who recommended that we distribute nanotechnology that destroys all pathogenic viruses across the entire planet, or that make a magic serum that heals all diseases instantly, because those aren’t possible solutions. The same goes for all those sober recommendations as long as the world is the way the world is.
Still, making every problem into something that can only be tackled if peace, equality and justice ring out everywhere from Andorra to Zimbabwe is a recipe for fatalism and surrender. There are things that public health officials, epidemiologists, and policy-makers can do now that will improve their responses to the next epidemics and pandemics that fall under the heading of “physician, heal thyself”. If we cannot change the world simply by wishing it were so, we can at least do some self-work.
First, experts and officials focused on epidemics need to stop using the last epidemic as the model for the management of the next one. That crippled the early stages of reaction to covid-19 because many early responses assumed it was more or less identical to MERS and SARS, which seemed like relative success stories in global management: coronaviruses with relatively high mortality that almost always produced rapid symptoms in the infected. It took far too long for experts to acknowledge that people infected with the disease could frequently be asymptomatic and that there was aerosol transmission. We may yet discover as we look back on the early pandemic that this was suspected or even understood quite early, but if so, nobody told the public until much later. The same issue that bedevils everyday diagnosis (that specialists tend to discount patient testimony or clinical evidence that doesn’t conform to their own specialized knowledge) is in play here too—that novelty and idiosyncrasy in a given outbreak get misrecognized or misunderstood because of a strong push towards conventional wisdom and standardized measures.
Second, far more importantly, everybody involved in public health and epidemiology desperately needs to add qualitative social scientists and humanistic thinkers to their working groups. The failure to understand how politics and culture actually work has always been a problem for technocratic authority, but we have arrived at a moment where it is a crippling shortcoming. The problem is made worse by the fact that most experts and policy-makers live within societies where there is ever-increasing social distance between publics and communities whose livelihood and worldviews rest on very different bases. There is almost nothing that brings a Ph.D. epidemiologist making low six figures who works in a research lab affiliated with the CDC in contact socially with many of the people their recommendations may momentously affect. It’s not something you fix by dutiful mingling (or if you do, it’s not up to individuals—it’s another structural transformation beyond the power of any one group to affect on their own). But you can ameliorate the problem some by understanding that you cannot manage epidemics or public health crises unless you understand politics and culture better and respect it as a material limitation on your proposed solutions. That includes better judgments about where and when picking a fight with political leaders is required and where sucking up to them works better—but it also includes an ability to imagine how people are feeling and thinking that doesn’t just treat those people as something to be cajoled or nudged or managed into a state of mind that makes them pliant to expert authority. Experts have to understand their own political and social location and the limitations of that location. That isn’t just the US, it’s everywhere.
Third, somewhat relatedly, proposed measures to control epidemics and other public health crises have got to include a much wider and more sensitive audit of the costs and risks involved in their implementation. If what you’re proposing involves serious damage to a particular kind of small business or involves dramatically intensifying certain kinds of risks to mental and emotional health, that has to be in the initial assessment of the policy and that assessment has to be public, transparent and serious. We talk about testing vaccines or drugs and about where the side effects make the treatment too dangerous, but almost no expert was seriously talking at the outset of most of the measures taken to control covid-19 about what the other risks to health and welfare might be—which egged on many people who adopted those measures rigorously to be preemptively dismissive or hostile to those who felt the costs were too high. There should have been a massive underwriting of mental health care at the outset of social isolation, an investment in creative approaches to reducing its emotional harms, a far smarter grasp of the relatively small risks of small gatherings outdoors, etc; there should have been a very quick targeted strategy for compensating particular kinds of small businesses (restaurants, nail salons, etc.) that were inevitably going to take a hit. If there is at some point a serious risk that cannot be managed or offset that begins to be as consequential to many people as the disease you’re trying to stop, there has to be an honest conversation about the point where those two measures cross over. It’s no good stopping a pandemic if the means you adopt profoundly damage the lives or mental health of many of the people you’re saving. Part of what made this conversation especially hard this time around was the pre-existing social distance between the people who were able to follow all the recommendations and the people who just couldn’t, e.g., who could go on Zoom and have everything delivered and still pull down the same comfortable salary and who could not.
Fourth, in many countries, we’re going to have to have some form of searching and difficult conversation about how and when we value life. Almost everywhere on Earth where there are elder care facilities, people in those facilities died very disproportionately from this disease. We mostly haven’t reckoned with that so far because reckoning with it can’t just be limited to “oh this disease kills old people”. It kills old people in elder care facilities because in the EU, the US and other nations, elder care facilities are badly run and are often in poorly maintained buildings. Everybody has a problem here. Many of us horrified by the death toll of covid-19 tolerate or ignore potentially preventable mortality from other sources. Many who proclaim themselves “pro-life”, like American evangelicals, have demonstrated profound indifference to mass death from covid. We need to consider a new reckoning of weights and measures, all of us, to decide when we will do almost anything to save a life and when we will conclude that some other principle has a greater hold on us.
So there are things to do in preparation for the next epidemic that are possible—and that need to begin right this minute, while the lessons are freshly visible in our hearts and minds.
Photo by Yohann LIBOT on Unsplash