How much should we worry about pandemics?

Brett Stephens isn't that worried:

In other words, despite all the processes of globalization that are
said to be leading us toward nature's great comeuppance, trend lines
indicate we are better equipped than ever to minimize the effects of a

Why? Because wealthier people tend to be healthier people, and
because wealthier societies have more to invest in medicine and
research, and because a higher standard of living tends to correlate
with more personal space. Also, because globalization means information
sharing across boundaries, and rapid adoption of best practices, and
greater transparency.

I say think probabilistically, a concept not prominent in his piece.  A one percent chance of one hundred million deaths is, in expected value terms, one million deaths and that is a big deal.  Probably the United States is less vulnerable than it was in 1918, but how many people would die in China, India and many other locales?  How much disruption to trade, travel, and the world economy would take place?  Even in the United States, our public health systems would break down quickly and render many modern medical advances useless (e.g., when would the Tamiflu run out?).  Having lots of living space is wonderful, but it pays off only if people stay home from work and that means dealing with massive absenteeism.  Not pretty.  Better safe than sorry.

Oddly Stephens never mentions that we are living in a raging epidemic now, namely AIDS, which has run for several decades.  For all the virtues of retrovirals, the modern world was quite slow in combating or even checking the disease and still many people, including U.S. citizens, engage in very risky behavior.  Our collective response was not terribly impressive.  Greater wealth does help, but greater wealth also means we should spend more to limit the problem.

Going back to the flu, I was struck by this passage:

In each of the four major pandemics since 1889, a spring wave of
relatively mild illness was followed by a second wave, a few months
later, of a much more virulent disease. This was true in 1889, 1957,
1968 and in the catastrophic flu outbreak of 1918, which sickened an
estimated third of the world's population and killed, conservatively,
50 million people.

I should add that we're not yet "out of the woods" on this wave, since there is a reasonable probability of sustained human-to-human transmission starting in at least one country.  And a virus which lives in many people is a virus which can mutate.

The main thing we should do — invest in public health infrastructure — is in any case a good idea with many possible payoffs, whether a pandemic comes or not.  It is a better investment of money than pursuing the ideal of universal health insurance coverage.  I might add that one of the better arguments for universal coverage is simply that it could lead to better monitoring of some public health issues.


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