Is it Possible to Prepare for a Pandemic?
In a new paper, Robert Tucker Omberg and I ask whether being “prepared for a pandemic” ameliorated or shortened the pandemic. The short answer is No.
How effective were investments in pandemic preparation? We use a comprehensive and detailed measure of pandemic preparedness, the Global Health Security (GHS) Index produced by the Johns Hopkins Center for Health Security (JHU), to measure which investments in pandemic preparedness reduced infections, deaths, excess deaths, or otherwise ameliorated or shortened the pandemic. We also look at whether values or attitudinal factors such as individualism, willingness to sacrifice, or trust in government—which might be considered a form of cultural pandemic preparedness—influenced the course of the pandemic. Our primary finding is that almost no form of pandemic preparedness helped to ameliorate or shorten the pandemic. Compared to other countries, the United States did not perform poorly because of cultural values such as individualism, collectivism, selfishness, or lack of trust. General state capacity, as opposed to specific pandemic investments, is one of the few factors which appears to improve pandemic performance. Understanding the most effective forms of pandemic preparedness can help guide future investments. Our results may also suggest that either we aren’t measuring what is important or that pandemic preparedness is a global public good.
Our results can be simply illustrated by looking at daily Covid deaths per million in the country the GHS Index ranked as the most prepared for a pandemic, the United States, versus the country the GHS Index ranked as least prepared, Equatorial Guinea.
Now, of course, this is just raw data–maybe the US had different demographics, maybe Equatorial Guinea underestimated Covid deaths, maybe the GHS index is too broad or maybe sub-indexes measured preparation better. The bulk of our paper shows that the lesson of Figure 1 continue to apply even after controlling for a variety of demographic factors, when looking at other measures of deaths such as excess deaths, when looking at the time pattern of deaths etc. Note also that we are testing whether “preparedness” mattered and finding that it wasn’t an important factor in the course of the pandemic. We are not testing and not arguing that pandemic policy didn’t matter.
The lessons are not entirely negative, however. The GHS index measures pandemic preparedness by country but what mattered most to the world was the production of vaccines which depended less on any given country and more on global preparedness. Investing in global public goods such as by creating a library of vaccine candidates in advance that we could draw upon in the event of a pandemic is likely to have very high value. Indeed, it’s possible to begin to test and advance to phase I and phase II trials vaccines for every virus that is likely to jump from animal to human populations (Krammer, 2020). I am also a big proponent of wastewater surveillance. Every major sewage plant in the world and many minor plants at places like universities ought to be doing wastewater surveillance for viruses and bacteria. The CDC has a good program along these lines. These types of investments are global public goods and so don’t show up much in pandemic preparedness indexes, but they are key to a) making vaccines available more quickly and b) identifying and stopping a pandemic quickly.
A final lesson may be that a pandemic is simply one example of a low-probability but very bad event. Other examples which may have even greater expected cost are super-volcanoes, asteroid strikes, nuclear wars, and solar storms (Ord, 2020; Leigh, 2021). Preparing for X, Y, or Z may be less valuable than building resilience for a wide variety of potential events. The Boy Scout motto is simply ‘Be prepared’.
Read the whole thing.