Trade offs and free lunches in pandemic policy

As the author of a book on opportunity cost, I might be expected to be enthusiastic about the idea that trade-offs are always important in economic and policy choices. This idea is summed up in the acryonymic slogan TANSTAAFL (There Ain’t No Such Thing As A Free Lunch). In fact, however, a crucial section of Economics in Two Lessons is devoted to showing that There Is Such A Thing As A Free Lunch. It is only when all free lunches have been taken off the table that we reach a position described, in the standard jargon, as Pareto-optimal[1].

If a policy is not Pareto optimal, it’s possible to find one that is better in every respect. In the jargon, the first policy is dominated by the second.

That observation is relevant in a couple of crucial contexts. Lots of climate deniers want to claim that there is a trade off between reducing carbon emissions, through investment in renewables, and improving the living standards of poor people, by building coal-fired power stations. In reality, renewables are cheaper and more reliable than coal, and millions of poor people living near coal-fired power stations die every year from particulate pollution. Even without considering global heating, coal fired power is a dominated option.

Exactly the same is true in relation to pandemic policy. Any policy which leaves R > 1 (the pandemic keeps spreading) is dominated by stricter policies that ensure R < 1. The first policy will not only lead to continuing deaths, but it can never be relaxed. So, it will entail more economic losses in the longer run. By contrast, once the prevalence of the disease is reduced to zero, the stricter policy can be relaxed (to be slightly more realistic, it may need to be reintroduced on a temporary basis to deal with local outbreaks).

In this context, it’s striking that none of those talking about an R > 1 policy in Australia are prepared to spell out the trade-offs they envisage. That’s because any attempt to do so would expose the bankruptcy of their reasoning.

fn1. I also point out how Pareto’s economic analysis foreshadows his embrace of Fascism.

37 thoughts on “Trade offs and free lunches in pandemic policy

  1. Obviously R>1 policies can be relaxed – they do so automatically when the switch to R < 1 occurs automatically as herd immunity approaches. R 1 outcomes with unexpected outbreaks of the virus as have occurred in a major way in Singapore. Indeed, in the absence of a vaccine, R < 1 policies without perfect eradication because of chance virus explosions, involve an ongoing and costly guerilla war with the virus.

    Thus there are significant tradeoffs here. Short-term policies that target eradication but which impose long-term economic costs without a vaccine and without costless ways of permanently preventing reinfection. Policies of the Swedish type involve more rapid convergence to herd immunity (now a few weeks away there), more deaths now but probably almost none later, lower economic costs now and no ongoing economic costs once herd immunity prevails.

    I don't back either approach – the information isn't sufficient to do so – but simply claim there are clear tradeoffs here. One advantage of pursuing eradication is that we get time to think, to learn from others' experience (does herd immunity work, what severe secondary medical impacts of the virus arise) and to hope for a vaccine. The big cost is the economic destruction caused by the current shutdown and the possible long-term consequences of not be able to co-exist peacefully with the virus.

    It isn't simple. I think your "no tradeoffs" conclusion is based on the premise that virus eradication is possible and can be secured at a low cost. Just an assumption, not a conclusion.

  2. ” Policies of the Swedish type involve more rapid convergence to herd immunity (now a few weeks away there), more deaths now but probably almost none later, lower economic costs now and no ongoing economic costs once herd immunity prevails.”

    There’s some big *IF*s with that though. One of the big assumptions would be there to be no mutations or further strains – a likelihood that’s in some way related to the spread/prevalence of infection?

  3. Harry Clarke’s comment is completely wrong, herd immunity in a disease like this means (as i said in the other thread) everyone gets infected and 1% of them die, with corresponding economic costs. 1% of people in a high-income country die every year. Harry’s proposal is that we double that number for the purpose of saving a few dollars.

    John, I don’t think pandemic policy in general sees a situation where policies leading to R1. This certainly wasn’t true for HIV for most of its history (since it continued to spread) and definitely isn’t true for influenza, which still proceeds in every country with R>1. In fact for about 300 years it wasn’t even true for Smallpox even though a vaccine existed: Smallpox was only eradicated in the 1970s after the WHO convinced the entire world to work together to get R1 can “never be relaxed”. Why not? R is already above 1, why not relax it? If you’ve already made the political decision to keep allowing the virus to spread why would you not be able to relax it and allow it to spread further?

    Do you think the decision to allow influenza to spread every year and kill a couple of thousand elderly people is a sign of the bankruptcy of people’s reasoning? Or is it more complex than that?

  4. >Do you think the decision to allow influenza to spread every year and kill a couple of thousand elderly people

    But that’s not the policy. The government subsidises flu vaccines and encourages people to get vaccinated. Some people choose not to be vaccinated (a small number can’t be). That’s why there’s a couple of thousand flu deaths every year.

  5. I wish I could be confident that once Covid-19 is completely eradicated, it can be kept out of the country. If all the world were to adopt eradication as the policy, we might succeed. However, there are governments that think gradual herd immunity (acquired over many years) is a reasonable policy.

    If we think of Covid-19 as an alien invasion, then we would respond by ramping up our health defence capabilities. Seeing that we can’t seem to get out of secular stagnation, why not spend big on our health defences, and both: (i) prevent deaths (despite R>1), and (ii) end secular stagnation.

    Spending big on health (including government funded research) could also make us more resilient to future pandemics.

    Is this a “free lunch”?

  6. The free green lunch point is reinforced by the desperation of the bad faith attempts to discredit EVs with tales of child cobalt miners in the Congo and impending shortages of lithium. (The child miners are real, but they are there because the DRC government doesn’t work. Companies that audit their cobalt supply chains can avoid exploiting children at little cost).

  7. Smith9 it is the policy. To achieve herd immunity (actual herd immunity, not the jumbled mess everyone is repeating here) with influenza vaccine you need about 65% coverage, but because it’s not 100% effective actually required coverage is higher. But the government doesn’t try and achieve that coverage (to do so they’d need it to be mandatory as other vaccines are). Instead they push it as a personal protective choice (vaccinate yourself to protect only yourself) for vulnerable groups and healthcare workers. There is no coherent strategy to push R<1 for influenza. To do so would require a comprehensive (essentially mandatory) vaccination campaign and, if the vaccine turned out to be hte wrong one, a month of lockdown to stop its spread. But they don't do either of those things. So I want to know if John thinks that indicates the bankruptcy of the health services' reasoning, or if there is some other factor in the calculation that makes this decision sensible.

  8. faustusnotes,

    Herd immunity does not and cannot arise if immunity to the pathogen fades within 6 months to 2 years (the usual decay time). This is the case unless a vaccine exists and is applied annually to something like 80% or more of the population. At this stage it is unknown if immunity to SARS Cov2 (the pathogen which causes COVID-19 disease) is lifelong or fades, possibly within 6 months or less. It seems quite possible that life long immunity will not occur given the general characteristics of some other coronaviruses.

    At this stage it is also unknown if a vaccine can be developed. The technical difficulties to developing a vaccine for a pulmonary viral pathogen are very considerable. The technical difficulties to developing a vaccine for coronaviruses are also very considerable. No vaccine currently exists for any coronavirus except one for an enteric coronavirus which infects dogs. No vaccine exists for any pulmonary coronaviruses in any animal including humans, dogs and cattle, as examples.

    Large research resources are now being thrown at the problem of developing a vaccine. This might get us over the line. Let us hope so if the human immune system does not develop long term immunity to COVID-19 following an infection.

  9. JQ, you write: “If a policy is not Pareto optimal, it’s possible to find one that is better in every respect. In the jargon, the first policy is dominated by the second.”

    In the post 1950s literature a Pareto optimum is defined as there does not exist an alternative allocation of resources, one for each individual, such that the alternative allocation is preferred by at least one individual and it is at least as preferred by all other individuals.

    A Pareto improvement (this is what I believe you are getting at) is defined as allocation A dominates allocation B if A is strictly preferred by at least one individual and it is at least as preferred by all other individuals.

    So, I don’t understand the “is better in every respect”.

    Further, it seems to me the crucial reference is the literature on incomplete markets with the strong result that competitive private ownership economies with incomplete markets are generically Pareto inefficient (sub-optimal). There are no (negative) market prices for air pollution (coal) and atmospheric pollution (climate change), i.e. incomplete markets.

    Furthermore, the concept of strictly convex preferences, defined on dated commodities, would come in handy to argue that everybody wants to avoid dying from Covid-19 because strictly preferring consumption today and tomorrow and the day after and…., implies that a) only people who are alive matter and b) they want to live another day and another day, … , . So, if people argue about a trade-off between ‘the economy’ and ‘lock-down’ measures to save lives, then I would like to see their theoretical model of ‘the economy’ (a market economy to be precise) where a sufficiently large number of people have appropriate preferences. Thereafter one can do empirical research on the alternative hypothesis regarding people’s preferences.

    (I observe, the only negative prices I have observed so far is the price of ‘money’ and on oil futures; both are financial contracts.)

    (Your opportunity cost approach runs into difficulties, IMHO, because without going to individuals’ preferences, the trade-off – the opportunity cost – is not defined. It seems to me, using a social utility function would require a result on similarity of preferences.)

    And,
    “I also point out how Pareto’s economic analysis foreshadows his embrace of Fascism.”

    I do recall your post in which you make the above point. I understand your point is based on your historical analysis, which I take as given. However, I would argue this historical point ought to be treated separate from the contemporary concept of Pareto Optimality. (Allowing a link between fascism and theoretical models competitive private ownership economies would be absurd.)

  10. I have a general question. Do or should the preferences of foolish or uneducated people matter as much (be ranked as important as) as the preferences of intelligent and educated people?

  11. Ernestine, in the standard welfare economics model of private goods, all that matters is preferences, so (ignoring issues of strict vs weak rankings) “preferred by everybody” is the same as “better in every respect”. For the problems we are looking at, there isn’t an allocation across individuals to compate, so I mean “better regardless of your preferences over the public good (health/climate) and private goods:”

  12. Faustusnotes, as I’ve been saying since 2005, policy should aim for universal vaccination against influenza. https://johnquiggin.com/2005/07/22/planning-for-pandemics/

    I support free vaccination for everyone, compulsory vaccination for health care and aged care workers, and lots of encouragement for everyone else. Also, as I said on Twitter yesterday, universal sick leave and a prohibition on coming to work with flu-like systems. Add in handwashing and track and trace, and there would be a reasonable chance on holding R below 1 for flu. With open borders, some cases would still come in, and there would be local outbreaks, but we could greatly reduce deaths.

  13. My above post was shortened for some reason, probably by a mistake I made. Here is the full intended post.

    I have a general question and a possible answer. Do, or should, the preferences of foolish or uneducated people matter as much (be ranked as important as) as the preferences of intelligent and educated people? The answer to this question matters for both election voting and spending and investing in markets, since we allow people to “vote” with their money except in the case of proscribed good sand services.

    We recognize this principle in that we presume, by drawing an arbitrary line, that people below the age of 18 do not have full competence (intelligence and experience) to vote. We had a debate about this a while back on this blog. I would argue for people over the age of 15 (say) to be allowed to vote upon application and a 500 word application in their preferred language written in simple supervised test conditions (a school room test would do) on why they should be given the vote early. If the submission demonstrated at least an average intelligence and literacy for age then they should get the vote early.

    For people 18 and over I would not advise this strategy. All should be permitted to vote without a competence test or any test, including convicted criminals if they wish (which is not the case now). For people 18 and over, we should tackle the problem from the other end, ensuring everything from nutrition, upbringing, care and education are sufficient to develop everyone to their full potential intellectually, ethically and physically.

    We need a well educated citizenry in a democracy. High school education should include as well as STEM type subjects and the other standards, a compulsory subject with basic philosophy (epistemology, ontology and ethics but without the big words up front), comparative religion, comparative ideology and comparative political economy. This could be rolled into one subject called Knowledge and Belief with discussions all the way through about what we can know, how certain we can be about that and what perhaps more clearly are probably beliefs or faiths rather than knowledge (certain or probable). The problem to my mind is that most people in our society cannot think clearly about science (empiricism) and beliefs/ethics and the relationship between the two in our overall socioeconomic context.

  14. John Quiggin, I’m sure your policy on influenza is great (it certainly sounds great to me) but do you think that government decisions not to pursue that policy are a sign of bankruptcy of reasoning (your term) or do you think there might be some other calculation at work? And if that other calculation applies to influenza, why do you think it’s different for covid-19? I agree with you that the governments letting this disease overwhelm them are guilty of a bankruptcy of reasoning, but I think you have the wrong origins of their stupidity, which is why I’m asking about this. (Hint: it’s not based on economic logic)

    Incidentally, as far as I know the WHO does not want to eradicate influenza at this stage. I can’t find a single WHO page on this but it appears that they are pursuing eradication of Yaws, dracunculiasis (sounds great!), malaria, polio and hookworm. I think they have also nominated measles for eradication though I don’t know if they’ve given up on that plan in the past few years. It’s really a humiliating fact for every rich nation on this planet that measles still exists – with appropriate coordination and funding we could be done with that disgusting disease in a year or two if we tried. But I can’t find anything about influenza eradication (the WHO’s influenza strategy is here). I hope you don’t think that the WHO has a bankruptcy of reasoning? Because it appears to me that their primary focus is on eradicating diseases that have a high burden in low income countries, and that seems like a nice priority to me. Also it’s possible that the science of influenza makes eradication impossible, and implies that your preferred policy would be an expensive waste of time.

    I don’t think there’s a lot wrong with global pandemic policy. The problem is that people in certain countries are ignoring it, and when a disease occurs in China they don’t care because 5000 dead Chinese don’t register as worth anything to them. We’ve all seen how that worked out!

  15. Faustusnotes, I disagree with the government’s policy on influenza (obviously), but I wouldn’t necessarily use as a strong a term as “bankruptcy”, which I find appropriate in the case of the “let her rip” advocates on Covid. In the case of flu, it’s more a matter of unwillingness to push hard on an issue which is bound to generate a lot of resistance (eg compulsory vaccination for health workers), rather than confidently advancing an analysis that doesn’t stand up to scrutiny, then refusing to correct or retract.

  16. Just as an aside, my workplace offers free flu vaccination every year which I always take up. I’m surprised by the number of people who pass up the offer. I don’t think that my colleagues are anti-vaccination, but they have a few vaguely expressed reasons for not getting it – “I never get it”, “I will leave it up to my immune system” or “I heard x got sick with a mini flu after getting the jab”. I wonder if it’s something to do with a lack of decisive peer behaviour – or a subtle opt-in barrier. It would be interesting to know if there was any increase in the take up of free flu vaccination this year.

  17. In SA at least, early take-up of flu vaccination by the main C-19 risk group (the old e.g. me) was higher than usual, according to early morning ABC news (don’t recall date) and anecdotal contact with GPs etc.

  18. I have not gone for a flu shot as we are in hard lock-down in our house. So our chances of catching a flu are next to nothing anyway. We don’t go anywhere with a few very minor exceptions (pharmacy and father-in laws house – he is 90 and also in hard lock-down. And even then we take stringent precautions which of course greatly reduce flu risk as well as COVID-19 risk. All our food is delivered. We only purchase items which can be safely washed in food-safe detergent. We stocked up on meats and tinned and packaged non-perishablesmonths ago. We knew this was coming (in all probability) as early as mid to late January and acted accordingly.

    I wash every grocery item for 20 seconds and leave immersed for at least another 20 seconds and then rinse. We never permit any non-household person to come with 3 meters of us never mind the inadequate 1.5 meter rule. What cannot be washed (goods in careboard packets and non-perishable) is left in the delivery box for three days before being handled.

    Of course, as retired people we have the opportunity to take these hard precautions.

  19. Faustusnotes
    I doubt influenza eradication is viable. It came out of birds in China. If eradicated, it would eventually return to humans again. Unless you eliminate avian flu, it won’t go away.

    Quiggin’s flu policy sounds grand, because based on Dan Andrews criterion of: “no (name your activity) is worth some ones life” without something like it ee should be in a lockdown every winter in order to deal with seasonal flu.

  20. The flu example is a good one. As Michael Kottek points out, elimination is unfortunately not an option. So therefore we go for suppression and/or mitigation. Vaccination is helpful but it is not all that effective, especially for older people, as our thymus glands are pretty much kaput. There are 290 000 – 650 000 flu deaths per year and most deaths occur among people aged over 75 years, and in the world’s poorest regions, though there are lots of deaths among children, especially in poor countries, and children are very efficient spreaders of flu. https://www.who.int/news-room/detail/14-12-2017-up-to-650-000-people-die-of-respiratory-diseases-linked-to-seasonal-flu-each-year
    Our experience with COVID-19 seems to indicate that we can radically slow the spread of influenza by strict social distancing, good hygiene etc. (Flu/cold syptoms in Australia currently are 1/10 of the normal rate). So it is therefore a live option for us to consider severe social distancing restrictions next flu season, along with other control measures, as a way of reducing the damage from the flu.
    I have no idea what the optimal decision is for our society in the case of flu, but I can’t see any way of making the decision without weighing up tradeoffs across the different domains of wellbeing. And this will be with a disease which has a reproduction rate greater than 1.

  21. I think we need to start thinking of COVID for years, not months, which makes lockdown a more formidable phase.

    So get your flu shot, let the docs manage the logistics.

  22. Years it may be, indeed. Good article concerning when and how to move out of lockdown in The Lancet:

    “About a third of the world is under lockdown as a public health measure to curb the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Policy makers are increasingly pressed to articulate their rationales and strategies for moving out of lockdown; the process of re-emergence is already cautiously starting in Austria, Switzerland, Denmark, Wuhan, and some US states. As the counterpoise between further disease spread and socioeconomic costs is debated, it is essential that policy makers in all affected countries have the best possible data and understanding to inform any course of action…”

    What policy makers need to know about COVID-19 protective immunity
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30985-5/fulltext

  23. Faustusnotes. You said

    ‘I agree with you that the governments letting this disease overwhelm them are guilty of a bankruptcy of reasoning, but I think you have the wrong origins of their stupidity, which is why I’m asking about this. (Hint: it’s not based on economic logic)’

    I give up. I can’t work out what you think the origin of the stupidity is. Please explain!

  24. John Goss, it’s just simple racism. They ignored the warnings they were being given because they had a mixture of idiotic beliefs about how it was bad for China because Asians are weak and dirty, China is developing, Chinese doctors are useless, the Chinese government is an incompetent authoritarian regime that can’t get anything right. On top of that they ignored the messages they were receiving because Asian lives don’t matter to whites, and they just didn’t care. They also don’t have Chinese people working in their public health academies or anywhere near government, and don’t have close enough connections to those people to know what’s going on. This is why the Imperial College team were assuming it is no more dangerous than normal pneumonia even though there were clear warnings it was much worse, then scrambled to change their model when the Italian data showed what was going on – they didn’t care about Chinese data but listened very quickly to Italians, which was already too late. This is why the Lancet published an editorial from their editor-in-chief, Richard Horton, criticizing the Chinese shutdown of Wuhan and demanding the WHO add “personal freedom” to its definition of health, just a few short weeks before the UK and Italy were forced to introduce exactly the same measures as China (which the Lancet now accepts as completely necessary when white people do it). This is why western governments didn’t start building temporary hospitals or even setting aside ground for them (unlike Japan, which had identified suitable sites in mid-February) and didn’t use the proven strategy of case isolation (which Japan was using in February). They just can’t listen to Asians. This is why we saw those incredible scenes of crowds in US airports when temperature testing was introduced, even though that stuff is completely normal in Asia and everyone knows how to do it. It’s like no one working in a US airport has ever been to Japan or China and thought “hey that’s a good idea we should try that!”

    There’s a great story from the USA of a supermarket chain in Texas that has a strong supply chain in China, who had the good sense to contact their Chinese counterparts in early February and listen to them, and began stockpiling supplies and preparing their staff for a lockdown, and who were able to survive and continue functioning as normal when other supermarket chains started to run out of supplies because of panic buying. None of what is needed to deal with this epidemic is difficult to understand, but it required white governments to listen to Asians. I think this is part of why Australia and NZ have handled it better – we have better relations with Asia and more Chinese connections, so we were better able to listen and learn. NZ, in particular, saw what China had to do and reacted very quickly to it.

    It wasn’t economic considerations that made the UK, US and Italy fail so badly. It was a simple inability to take Asians seriously.

  25. Fuastusnotes. Thank you for your explanation. I agree racism is a factor, especially for the US. But I wonder how strong. Richard Horton is really tight with the Chinese medical establishment so he would have known before most, exactly what was going on. And he has published lots of great research about COVID-19 by Chinese researchers.
    The differences (and similarities) in experience of the pandemic in the European countries really puzzle me. The UK, France and Italy have almost identical death rate curves despite different policies. And the variation within countries is very high.

  26. It’s more than simple racism, though racism plays a role. It is more a case of Imperial hubris. The West (the USA in particular but also Europe) suffers from a hang-over of Imperial pride. “We are the best, most knowledgeable, most ethical and most powerful people in the world and it will be ever thus.” That is a summary of Imperial pride.

    The Americans are being very foolish, the Europeans also but perhaps less than the Americans. We need the Americans and Europeans to become wiser. We need a balance of power to continue. The very reason for this is the dangerous increase in nationalism , expansionism and imperial pride in China. It would indeed be racist and historically inaccurate to say things like, “Only Westerners show imperial pride, only Westerners seek to create empires.” There are many historical examples of Eastern empires and of the oppressed becoming oppressors in their turn. The iron law of human power is that “Power corrupts and absolute power corrupts absolutely.” This is why I argue for democracy, not authoritarianism (nor for populism either). It is also why I argue for, and want to see continuing, a balance of power.

    The USA right now is a wounded beast. Surely, the Chinese have a proverb for it? Perhaps, “Don’t prod the wounded tiger.” Perhaps it is time for the Chinese to demonstrate their legendary wisdom and patience. It’s going to be a while before Americans learn some wisdom and patience again. As the Chinese could tell them, it sometimes takes a century of humiliation to learn that lesson.

  27. Akarog, Svante – 100yrs and counting. And a lab ‘mishap’.

    faustusnotes “Or is it more complex than that?” – it is certainly more complicated than your chosen blame debating point – racism. So is exceptionalism, paternalism, and many other isms. I have appreciated your input re herd immunity, yet avian-ism, and evolution are at play. As well as racism.

    And JQ, don’t hold your breath “policy should aim for universal vaccination against influenza”.

    “A new look at an old virus: patterns of mutation accumulation in the human H1N1 influenza virus since 1918

    OOPS! “This discontinuity reflects the extinction of the human H1N1 strain in the mid 1950s, followed by the re-introduction of the strain in 1976, presumably from a researcher’s freezer. ”

    “we document multiple extinction events, including the previously known extinction of the human H1N1 lineage in the 1950s, and an apparent second extinction of the human H1N1 lineage in 2009. These extinctions appear to be due to a continuous accumulation of mutations. At the time of its disappearance in 2009, the human H1N1 lineage had accumulated over 1400 point mutations (more than 10% of the genome), including approximately 330 non-synonymous changes (7.4% of all codons). The accumulation of both point mutations and non-synonymous amino acid changes occurred at constant rates (μ = 14.4 and 2.4 new mutations/year, respectively), and mutations accumulated uniformly across the entire influenza genome.”…

    “As a zoonotic pathogen, the influenza virus is able to infect multiple species. It is generally thought that aquatic waterfowl are a primary natural influenza reservoir [3], where there are usually no clinical symptoms [4], and where low level transmission probably perpetuates the viral pool [5]. All 14 influenza subtypes are maintained in waterfowl.”

    “Human influenza has such a high mutation rate that, even within a single host individual, the virus quickly becomes a genetically diverse “swarm” [61,62]

    “The greatest influenza threat, therefore, is the introduction of a non-attenuated strain from some natural reservoir. This suggests that a better understanding of the origin of such non-attenuated strains should be a priority [5]. Our findings suggest that new strategies that accelerate natural genetic attenuation of RNA viruses may prove useful for managing future pandemics and, perhaps in the long run, precluding the genesis of new influenza strains.”
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507676/?report=classic

    Influenza, an ever-evolving target for vaccine development
    https://evolution.berkeley.edu/evolibrary/news/130201_flu

  28. John Ross, Horton isn’t tight with Chinese researchers and was apparently furious when the first epidemiological reports were published in Chinese. His “offline” editorial excoriating the Chinese government for imposing a lockdown was breathtakingly irresponsible and indicated a complete lack of understanding of how serious this problem was. It was also arrogant and patronizing, and looked incredibly stupid within a few weeks. My Chinese colleagues were furious about that (and have been generally deeply disappointed in the Lancet’s contribution to this pandemic). The Imperial College team have very few if any Chinese staff members, and their models massively underestimated the spread of the epidemic (though to be fair to them this could reflect a general problem with early outbreak models, something that needs to be explored for future outbreaks). The decision to ignore Chinese data on the rate at which patients need to receive intensive care or intubation was a massive mistake, though it may have been driven by simple ignorance of the Chinese literature rather than a dismissal of Chinese information. But the political leadership who were running around dismissing this in March – that’s straight up racism from them. Also, obviously, imperialism is racism.

    ikonoclast, I think the Chinese are being very patient (not that they have much choice). But watch now as the same right-wing christians who brought us the war in Iraq begin beating the drums of war with China, telling us that their latest geo-political rival is hiding a weapon of mass destruction. And look how easily the Trump-curious left take the bait, hook line and sinker.

  29. That’s fascinating faustusnotes, about Richard Horton. I saw him in action at the 2015 Lancet-China Academy of Medical Sciences (CAMS) Health Summit in Beijing and he was very close to the CAMS academics at the time. There have been 5 successful Lancet-CAMS summits, and another one was scheduled for 2020. And the Lancet seems to have published a lot of work by Chinese academics in recent years.
    Maybe things have soured recently, or Horton has succumbed to hubris (or both!) But clearly he should have known better than to publish that editorial you referenced.

  30. John Goss, I saw him at a public health conference in Singapore at about that time too. He gave a barnstorming presentation on how global health has failed, how it is another form of patronizing western interference in low-income countries, colonialism by another name, etc. and blaming everyone under the sun for this sad state of affairs. And I sat there thinking “you are the editor in chief of the leading global health journal, but you won’t take any personal responsibility for the direction global health has gone? Don’t you think maybe possibly your journal, as the lodestone of the entire field, might share a shred of the blame?” But he wasn’t up for introspection, that was obvious. Very disappointing. The entire field of global health is a disaster, this pandemic response has been (outside of Asia) absolutely shocking, and the Lancet has to take responsibility for their part in all of this.

  31. fautusnotes. I wouldn’t mind conversing off blog if you were interested. My email is the standard email format for the University of Canberra.

  32. Australia’s and New Zealand’s domestic responses to the pandemic have been very good. Australia and New Zealand were in what is termed Oceania, not Asia.

    The reasons why our responses have worked are complex and no doubt won’t be fully understood for some time. At the political level, the N.Z. government took an explicit attempted eradication path. In Australia, Scott Morrison was gazumped by the state Premiers leading their own path to at least implicit attempted eradication. The vanguard was formed by the Premiers of Victoria and NSW, closely followed by the Premiers of W.A., S.A. and Tasmania. The Qld. Premier came an un-creditable last in this push but at least not a distant gross-failure last, so Qld. too has fared well.

    Australia’s relative distance and disconnectedness from the world also played a role. Our worst infection clusters came from cruise ships, Australian tourists returning from the USA and American tourists themselves. I admit my own surprise that far fewer outbreaks are traceable to Chinese tourists and Chinese students. China mainly contained the outbreak to Hubei province and within that province to the city of Wuhan. Australia’s connections to Hubei might not be that great compared to our connections to China overall.

    Australia’s spread-out urban planning has possibly played a role. The mythical “quarter-acre block” (it’s usually smaller than that but still substantial) leads to distributed rather than clustered living. This sort of distancing seems to be good when we face pandemics. Australians commute by car a lot rather than public transport. This is bad thing of CO2 emissions but probably a good thing when it comes to pandemics. We have less (no?) slums compared to many nations and less apartment living. We also have perhaps less homeless.

    We had other factors which might have predisposed us to a large outbreak. We have a high proportion of elderly and some nursing homes which have not fared well in this outbreak. The take home message seems to be “Live in a detached dwelling. You will be better off, espeically in a time of pandemic.” Cruise ships, aged care homes and crowded apartment buildings and slums all seem to be the places not to be if you can help it.

    The correlation between neoliberalism and a poor response to the virus pandemic seems to be strong. Australia has adopted neoliberalism in a considerable number of economic arenas but Health and Welfare in Australia have been bastions of either resistance to this process or have been quarantined and preserved as it were from the “virus” of neoliberalism because of Australia’s strong social welfare tradition. Where the virus of neoliberalism has been resisted well, the virus of COVID-19 has been resisted well.

  33. Ikonoclast, that cruise ship SNAFU could have been a terrible disaster and I think a bit of luck fell Australia’s way in that regard.

    Also I’m not convinced the low-density living is the boon people think it is. Many young people in Oz live with their parents or in share houses, which can be overcrowded and unhygienic and don’t have the kind of social cohesion required to manage lockdown. In contrast here in Tokyo young people almost always live alone if they’re not with their family, because single-person apartments are plentiful and affordable. I think this might be part of the reason that Tokyo is doing better than London, where housing quality is poor and overcrowding very common. That plus of course Japanese public spaces are much more hygienic than British – I wouldn’t be surprised if you could sequence the Spanish flu from the crud you can scrape off a London Tube seat (disgusting!)

    I think Australia made a good judgment about timing of the lockdown, and also has a very good public health infrastructure, and that made a big difference to the speed of control. I would have liked to have seen Japan declare its state of emergency a month earlier, when there were still not many cases, and had that been done I think we could have got away with an easy one month lockdown, instead of what is now going to be 2. Early measures done well were key to beating this!

  34. Australia’s detached housing model can and did work well for most of the white population [1] from immediately post-WW2, until the rise of neoliberalism in Australia. I have had a lived experience of this era and model, if I cheat a little and add in a bit of family history from just before I was born. That system can and will work again today with its more welfarist and socialist policies.

    When my father returned form WW2, as an ex-serviceman, he was able, after being demobilized, to buy a housing commission house on what was then a northern outskirt of Brisbane (Chermside). Housing Commission houses, built by the Queensland Housing Commission were made available preferentially to returned servicemen and then to other young working families at less than what we might today term “market prices”. That is to say, the economic rents of private development and private land speculation were not part of the costs of these houses to the returned servicemen and the workers. It was a scheme with distinct socialist elements which of course is why it worked so well. The Commonwealth Bank ( a fully nationalized bank) provided low interest loans for mortgages on the housing commission houses with interest rates fixed until the end of the loan. The purchasers held full title to the houses, subject to the mortgage of course, until that mortgage was paid off. Then they held full title.

    These suburbs were healthy, open and well supplied with green spaces, parks, schools, roads, mass transit (the tram terminus was at Chermside on the crossroads of Gympie and Hamilton Roads, shops, dentist(s), recreation and sporting facilities, a large medical clinic and a hospital, all at least from the beginnings of my memories at 5 years old in 1959. Isn’t it amazing that a recovering post-War economy in the 1950s could do all this for working people and yet today young people cannot afford a (vastly over-priced) tiny flat? We know the answer to this. It is a factor of socialist or at least mixed economy measures (public and private) compared to the rent-seeking model of neoliberalism.

    My father would have been about 22 or 23 when he bought that house, with a 20 or 21 year old wife in her second pregnancy and dandling a one year old son on her hip. I was to be the third son so I was not then even a twinkle in my father’s eye. You see the strong ability for household formation which was conferred by the policies of the times upon a very young man not long back from war, with very few savings, with the expenses of growing family and living on one (at that time) basic wage. My mother was forced by the sexist policies of the times to leave her profession of state school teacher as soon as she married.

    Contrast this situation (whilst not forgetting the racism and sexism of that era) with the situation today. In a much larger economy with a much larger production per capita, where we cannot confer on very young people nearly the same capacity for household formation as we did sixty to seventy years ago, even allowing for hedonic adjustments (real and supposed improvements in the size and quality of houses). Indeed, in some ways those houses were better and more preferable to modern houses, albeit mainly in materials. The house was hardwood throughout in framing and weatherboard exterior cladding with good quality pine flooring. It was a very solid and sound house. The roof was fibro (not a good idea as we know now but fibro once manufactured at least fixes and renders more or less inert the asbestos fibres bound in the matrix material .The plumbing and wiring was adequate for the times and perfectly safe.

    It is the rates of profiteering from economic rents and of land speculation under neoliberal economic relations, along with the unemployment levels and casualized workforce typical of neolibealism which explain the inability of young adults now to form households. Tiny, poor quality flats now cost a greater percentage of the minimum wage than did good, basic houses even in 1984 when my wife and I bought our first house. Ours was more than basic. It was a very good, spacious 3 bedroom, 1 study house, with a large lounge room, and a large kitchen-breakfast room, in a suburb near Chermside . It had hardwood, chamfer board cladding, a hardwood frame, a superb hardwood (brush-box) floor and a large secluded slate courtyard facing north with slate steps to it up the side. It was actually an architect-designed home for the original owners in perhaps what might be called a 70’s “rectangularism” style. Excuse me, I don’t know my domestic architecture style terms.

    It was a very nice, spacious, well-lit, livable house and it cost A$66,000 at that time, This was about 2.5 times (at a guess) of the annual gross, minimum or basic wage at that time. In today’s dollars this is about A$200,000. What could you buy for $200,000 these days? I very much doubt you could get more than a tiny, one-bedroom flat in a brick “six-pack”, also hieing from the 1970s, and in the one of the worst suburbs in your city. This is a total disgrace, a rank economic injustice, foisted on the young people of Australia today by the greedy mongrels promoting neoliberalism.

    I know neoliberalism is one giant lie because I come from a time when the neoliberal lies did not hold sway and I have seen that those ways, though not perfect, worked much better than neoliberalism does for working people and poor people. It’s about time, indeed beyond time, that we crushed and abolished neoliberalism and all its rent-seeking parasites. But the path is democratic socialism NOT authoritarian communism. I must add that.

    Note 1. – Obviously the policies did not work well for black, indigenous Australians in what was still racist Australia at that time.

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