Public health: How politicians always get it wrong!

 The COVID-19 Virus

Thanks to COVID-19, public health has emerged as the top national security risk everywhere.  And it has triggered off a string of socioeconomic pandemics that no other shock before triggered:  There is rising; national debt; the collapse of economic activity; unemployment and surging incidence of poverty. The demand for governments to spend more to support the economy has never been so high!  

In the past politicians and technocrats have treated Public health as a low priority risk. Ranking low after defense and public service salaries in budgetary allocations. They were always wrong! Even when the pandemic came calling, the response was lethargic at first. Torn between averting an economic and a public health disaster, they stuttered. They were unprepared for a sudden shock and bungled the COVID-19 pandemic as they did a hundred years earlier during the Spanish Flu pandemic of 1918-19.

The scourge was sudden, extreme, and swift and there was no known cure. Epidemiologists recommended the closure of economies to contain it. That was in March 2020. We are now in September and still locked down. Millions have been infected, hundreds of thousands dead. Millions of jobs lost, and poverty has surged.

The only comparable pandemic outbreak was the1918-19 Spanish flu. Fear rules like the sword of Damocles: What would a second wave look like? The Spanish Flu was a vicious, efficient killer machine, the second time around: Would COVID-19 mimic its ancestor?  How long does the immunity last? What is the long-term damage to the heart, lungs, and brains of those who have recovered?  How long will the pandemic last? These are the unknowns stoking fear and uncertainty.

Writing about the potential for a future global pandemic, the December 2005 edition of Awake Magazine published by Jehovah’s Witnesses, described the Spanish Flu of 1918-19 as sudden, enormous, and swift.  News of the pandemic was suppressed due to news censorship during World War1, until Spain, a non-combatant, reported about a virus that was killing many people in different parts of the world, hence the name Spanish Flu. The character of COVID-19 pandemic mimics the 1918-19 flu.

 The Magazine with whose lead story was “The Next Global Epidemic -when?” reported that the medical profession had been warning about a future flu pandemic since 1919.  It cites an article in the medical journal, Vaccine of 2003, which was prophetic. The Journal accurately predicted that the next pandemic “will originate from China or a nearby country.”  It wrote: “It (the Virus) will spread rapidly throughout the world. Several waves of infection will occur. Morbidity will be extensive in all age groups, and there will be widespread disruption of social and economic activity in all countries… It is unlikely that health care systems in even the most economically developed countries will be able to adequately cope with the demand for health care services.” Does this sound familiar?          

In 1918, epidemiologists advised physical distancing, quarantines, wearing masks, and lockdown of public places. At that time, their advice was too little too late. The Spanish Flu was already ravaging the world.

This time around, they acted in time advising the same containment measures: Lockdowns, social-distancing, wearing masks, improved hygiene.  Politicians in some parts of the World dragged their feet. Some flat out rejected the advice allowing the virus to spread with dire consequences.  They did so in 1919.

 COVID-19 has exposed the World’s fragility and unpreparedness to deal with sudden shocks. It has exposed the exploitative human constructs that fuel the fires of a pandemic. It also deconstructed some business practices and public policies that dominate the economic and business landscape for half a century.  Among these is the pursuit of profit that treats public health as a commercial commodity. Governments retreated from the provision of universal health care, leaving it to the private sector. Public health services are therefore available to those who can afford and the infrastructure is fragile.

Wrong! Public health is a social good like security and national defense, COVID-19 has proven that beyond any reasonable doubt. Being a national security risk public health needs robust and resilient institutions and services. This places it squarely on the shoulders of the state. It cannot be subordinated to the whims of a few! It must be divorced from state capture by elite lobbies pursuing new avenues to make a profit. Its management must be an extract from the security stylebook.

Genevie Fernandes of the University of Edinburg, writing in IMF’s Finance and Development magazine lists five characteristics of a resilient public health system. These include; Vigilance, responsiveness, flexibility and adaptability, inclusivity, and equitability.  That is how national security works: always scanning the horizon for threats, responding early to any threats, dealing with threats at source or adapting quickly to deal with the threats, and finally, military responses protect all citizens. So should public health- and its budgetary allocation.

The Private sector, which is a poor producer of public goods, cannot be trusted with national security. Not to a sector that excels in the destruction of public goods.

The elevation of the private sector into the provision of public health is a product of what some prominent economists term Zombie ideas. One such idea is the efficient market hypothesis.  This hypothesis has not proven useful in the production of consumer goods.  It is a poor-fit in public health which demands resilient institutions. COVID-19 has proven that efficient markets do not build resilient institutions and economies. Lean and fragile government institutions were overwhelmed by COVID-19.

Life During Spanish Flu 1919 Our new normal

In the Holy Book, in 1 Samuel 15:22, the Prophet Samuel told King Saul “obedience is better than sacrifice.” The second lesson we have learned is; we must obey expert advice and discard misinformation and populism. Countries that heeded sound scientific advice early, experts say, have largely managed the spread of the virus.

 Africa is one such. Due to her weak public health infrastructure, Africa enforced containment measures such as lockdowns, quarantine, social distancing, wearing masks, and improved hygiene. Eight months down the road, Africa’s reported caseload is among the lowest in the world. With a population estimated at 1.2 billion, the continent reports only about 1.5 million infections and about 50,000 deaths. Compare that with the USA whose population is a quarter of Africa’s population. The USA rejected scientific advice, downplayed the pandemic, and is now the world leader in COVID-infections and deaths. So far, the US has reported a caseload of nearly 7 million infections and more than 200,000 deaths.

The third and important lesson, one that epidemiologists have learned quickly, is communicate your message far-and-wide. Epidemiologist are widening their reach away from publishing their works in Medical Journals and into such economic journals and IMF’s Finance and Development magazine. In the last three months, we have observed an increasing interaction between the economists at IMF and epidemiologists. IMF has emerged as the leader in supporting efforts to contain COVID-19

 The decision by epidemiologists to speak out on this platform is a masterstroke in that the IMF can leverage medical knowledge to push for the re-look at public health budgets in member countries.

Hopefully, this is the beginning of intellectual cross pollination as we deal with a myriad of potential threats including from climate change or another pandemic.