31 Mar 2020 21:02 IST

Covid-19 is a massive failure of public health leadership

Why couldn’t those responsible for watching, planning and acting to prevent calamities avert the crisis?

While doctors, nurses, and other medical workers form the frontlines of the war against the coronavirus, risking their own lives, it makes sense for us to ask, “Why are we in this desperate situation worldwide?”

The short answer is that, as in every major global crisis in the last 30 years, the people whose job it is to watch, prepare, plan, and execute action to prevent calamities were either asleep at the wheel or not taking their responsibilities seriously enough.

The second Iraq war was a massive intelligence failure, when western agencies reported that Saddam Hussein had weapons of mass destruction. He never had any. The result was that trillions of dollars were needlessly spent and hundreds of thousands were killed or wounded.

The 2008 mortgage crisis happened because financial regulators and the big rating agencies never saw problems with subprime mortgages and sophisticated financial tools such as collateral debt obligations, although it was their job to be ahead of the curve. The result: trillions of dollars needlessly spent and millions of lives forever changed.

Failure of public health system

Covid-19 is a catastrophic failure of public health leadership. Highly-qualified people — from the World Health Organisation, the US Centres for Disease Control, the US National Institute of Allergy and Infectious Diseases, and eminent epidemiologists from institutions such as Stanford, Harvard, and Johns Hopkins — are offering regular updates on TV about what needs to be done. While viewers appreciate their expertise and measure of calm, billions around the world are now impacted by their collective failure to act and prevent this epidemic from happening in the first place.

Bill Gates, in a famous TED talk in 2015, predicted that the world is totally unprepared for a pandemic, and warned that countries have to mobilise. “Today, the greatest risk of global catastrophe doesn’t look like this,” he said, showing the image of a mushroom cloud created by a nuclear explosion. “Instead, it looks like this,” he said, pointing to a picture of the influenza virus. Why were public health officials not paying attention to Gates?

Every major country has a generous, dedicated budget for public health. Public health officials have been studying epidemics and pandemics for hundreds of years. After all, more people have died because of contagion from diseases like the plague or the Spanish flu than from war, and these experts have been combing through troves of data, often with the help of supercomputers, to find cures or vaccines for infectious diseases. Despite all the resources at their disposal, they are now saying that a Covid-19 cure is months away, and a fully-tested vaccine after clinical trials, perhaps a year and a half away. Didn’t they see something like this coming at all?

Shocked by intensity

Coronaviruses are not new — over 6,000 strains have already been catalogued by scientists. The current Covid-19 string is a variant but a few distinguishing features make it deadly. First, it seems to transmit faster between people and stay on surfaces for a long period, about 12 days. Second, it transmits from people who are asymptomatic, meaning that someone with no symptoms could still be carrying the virus and pass it along to others. Are we to accept that infectious disease experts — in all their modelling — never foresaw a strain with these deadly characteristics?

When Covid-19 hit, its intensity and resolve seemed to surprise and shock public health officials as much as the rest of us who did not even know what a coronavirus is. Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organisation, famously said in a February 10 press conference, “The overall pattern of cases has not changed. 99 per cent of the reported cases are in China and most cases are mild.” He announced that a WHO team was arriving in Wuhan the following day, nearly two months after the first patient had died in China. On February 28, rattling off numbers of cases and deaths, he upped the ante by saying, “The continued increases in the number of cases and the number of affected countries over the last few days are clearly of concern.” Ten days later, on March 11, the WHO called Covid-19 a global pandemic.

The WHO is not a reporting organisation — its mission is to improve people's lives, to reduce the burdens of disease and poverty, and to provide access to responsive health care for all people. Where, then, is its leadership? The old adage “Poor planning on your part does not constitute an emergency on my part” is clearly proving to be untrue as nations are forced to act with impunity, relying on spectacular emergency powers to shut economies down and save lives — all to cover up for the rather uncoordinated conduct of public health officials.

The Covid-19 outbreak started in China largely because of that country’s medieval practice of trading live animals in open markets. After numerous examples of similar diseases that originate from animals like the avian flu or H1N1 — one study said that 75 per cent of all new human infections come from livestock, including pigs, chickens, cattle, goats, sheep, and camels — why didn’t our public health experts press our political leaders to impress upon China to immediately put a ban on such practices in the interest of global public health? Why wasn’t China sanctioned by the global powers for continuing to endanger its own population, if not that of the world? Instead, we have watched the world’s leaders press China about issues like personal freedom, human and religious rights, and environmental pollution, which while important, are clearly not as important as the crisis the world faces today.

Unforgivable response

When the virus hit, China took action that is unconscionable for a country that is a major world power. The first response of the Chinese machine was to suppress scientific data that was coming out of Wuhan and then punish the very journalists and frontline healthcare workers who sought to shine a light on the problem. The WHO went easy on China and never brought about its weight to lean on China to be a better global citizen. Had China more openly shared its experiences and invited the world’s leading public health officials to Wuhan during the very first week of the outbreak, countries around the world could have been better prepared to fight the onslaught. And China, probably, wouldn’t have had to face so many deaths.

Blaming it all on China is a popular parlour sport but is not fair either. Some of the wealthiest nations in the world never looked at their inventories for critical infrastructure, such as masks, gloves, and ventilators, to fight a global pandemic. The big powers of the world have thousands of atomic weapons ready to respond to a nuclear attack, but are low on critical Personal Protection Equipment, which costs a small fraction of a single nuclear bomb? This just doesn’t compute. Why didn’t our public health officials ask our governments to stock up on millions of PPE in government stores, ready to be deployed under such an outbreak?

Any modern company invests substantial resources on a practice called Business Continuity Planning — that is, how to continue a business when a disaster hits. Consider a data centre that whirls Internet traffic around the globe. Could one ever imagine that the big tech companies like Google, Facebook and Amazon would operate all of their data centres out of a single country? Even an entry-level Disaster Recovery Analyst would immediately flag such a proposal as unworkable and strike it down.

Yet the world's major hospital and healthcare chains, and device manufacturers relied only on China for all production capacity related to PPE and their critical components. Credit President Trump and Prime Minister Modi for launching ambitious plans and promising incentives to bring manufacturing back, but the commercial health industry never invested in a backup source of production capacity. When China got hit with Covid-19, China did what any country would do — hold its inventory labelled for export so that it could use it to serve its own populations first. And when Chinese factories shut down and workers stayed home, the efficient China supply chain miracle came to a screeching halt. With no backup production capacity, the world immediately faced a shortage of critical PPE.

Critical imports

American political leaders and some industry titans have said that they will start producing ventilators now. But it is not easy to set up a brand new production line and start shipping the product out instantly. In an irony, many western countries no longer have factories to make minor but critical components like screws, washers, and nuts most of which today are only made in China. This is why Jim Hackett, the Chief Executive of Ford, said in a recent television interview that the earliest that Ford could start shipping ventilators is in June. By this time thousands more may have died.

Now, our political leaders have little clue about the side effects of their actions because they are listening to the very public health officials and scientists that have let us all down. By executive fiat, the world has resorted to extremely inconvenient steps such as forced quarantines, contact tracing, and social distancing. As we watch, the only meaningful way in which this can be done is to shut off the entire economy of a country, causing irreparable harm to millions. How long should such restrictions be in place? What would we do if we declare victory but a few people who are infected but asymptomatic escape the net and begin re-infecting again? Neither our political leaders nor public health officials have a response. Hope, it seems, is the crucial strategy here.

Painful economic impact

History tells us that even during the worst periods of war, commerce goes on — halted only by sirens and bombings. Our brave frontline health workers have always cared for the wounded and tended to the dead. But in the case of the coronavirus, governments have taken decisions that are unprecedented. No war-torn economy has ever shut everything down. In a country like India where nearly 80 per cent of economic activity comes from the informal sector, no government leader is talking about addressing the pain of those impacted. Small temporary handouts of cash and rations are simply not enough.

Shutting down the economy is relatively easy but bringing it back to life is not. A small business generally generates enough free cash to survive for about a month without revenue. When employees are laid off, they have to decide how to prioritise paying their bills for the next month, and when they don’t pay bills, other small businesses will likely fail. When businesses don’t make rent payments, the landlord suffers. When the landlord fails to make a mortgage payment, banks and the securities markets that rely on real estate suffer. Governments around the world have pledged to pump in trillions of dollars of liquidity into corporations, small businesses, and banks to keep them half-alive so that they can return to regular commerce, but it is not clear how effective these pledges will be.

For wealthy countries like the US and Japan, which can borrow in their own currency and can print as much money as they want, these kinds of actions are possible. Indeed, the US Congress just passed a $2.2 trillion stimulus bill — the country’s largest in history — that would cover the costs of a Covid-19 response for the next four months. For every other country, printing money will cause rapid inflation and deplete foreign-exchange reserves. Asset values will plunge and currency values will fall against the dollar. How do these countries plan to restart their economies in such a grim situation?

It seems therefore that the Covid-19 battle will go on and off until a cure is found. Or until a vaccine is found. But we don’t yet have a clue as to what would happen if Covid-19 were to mutate into a new form that is able to circumvent these defensive mechanisms. Would we have to bring back these drastic measures again to confront a new Covid until another cure is found? How long will this go on?

Meanwhile, divisive politics continues to play a role even when thousands are dying. In Washington, people on TV and social media are criticising President Trump for anything he says and does — seeing an opportunity to bring down his presidency, which was largely predicated on the outstanding US economy before the pandemic.

All of which brings us to the seminal question: Who is responsible for putting all of us in this perilous situation? It's clearly not the world's political leaders who are being forced to play a tough hand. The inconvenient, and perhaps disrespectful, truth is that the so-called public policy experts, whose job it is to protect us from the next pandemic, never saw this coming even as they flew around the world, attending seminars and conferences, and lifting wine glasses in unison. It is their inaction, or inability to plan for a pandemic, that has brought the world to its knees and changed it forever.

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