Home > Uncategorized > Dealing with a pandemic as if human lives mattered

Dealing with a pandemic as if human lives mattered

from Dean Baker

It’s fair to say that the U.S. performance in dealing with the pandemic has been disastrous. With the effort led by Donald Trump, this is not surprising. His main, if not only, concern was keeping up appearances. Preventing the spread of the pandemic, and needless death, was obviously not part of his agenda.

Unfortunately, many other wealthy countries, like France, Belgium, and Sweden, have not done much better. They don’t have the excuse of having a saboteur in charge who was actively trying to prevent the relevant government agencies from doing their jobs.

Anyhow, I thought it would be worth throwing out a few points about how we should have approached the pandemic. While some of this is 20-20 hindsight, I was making most of these points many months ago. I should add, I claim zero expertise in public health, but I do have some common sense, in spite of my training in economics. Of course, if anyone with expertise in public health wants to correct or expand on any points here, I welcome the opportunity to be educated.

I will break down the discussion into three key areas:

  • Measures to reduce spread;
  • Efforts to develop effective testing, vaccines, and treatments;
  • The distribution of vaccines

The United States has failed horribly in all three areas, but many other countries have not done much better.

Containing the Spread

When I look back at what I have been wrong about since the pandemic started, my biggest mistake was in thinking that we could get the pandemic under control after a two or three month shutdown. (I also expected that we would make more progress in treatment. Unfortunately, the ratio of deaths to infections has not changed much since the summer.)

The idea that the shutdowns, followed by effective containment measures, could control the spread should not seem far-fetched. Several European countries did get their infection rates down to very manageable levels after their shutdowns. For example, Denmark, a country with a population of a bit less than 6 million people, had their daily infections below 20 in the summer. At this level, it is possible to do effective contact tracing and arranging for those who have been exposed to be quarantined and/or tested. Several countries in East Asia, such as Japan and South Korea, did even better.

Unfortunately, Denmark, like other European countries, allowed its people to travel freely over the summer. This resulted in many people becoming infected, and then spreading the virus when they returned.

Anyhow, the idea that we would have shutdowns (which can be much better targeted with what we now know) and then have containment measures and testing in place to prevent large-scale spread is clearly a possibility. We completely failed in this effort in the United States, both because we did not implement containment policies and also because we had grossly inadequate testing.

As far as containment, this would require the Centers for Disease Control (CDC), the Occupational Safety and Health Administration (OSHA) and other agencies giving clear guidance and ideally being able to enforce their rules. This mostly did not happen because the Trump administration did not want it to happen. The most important example here was when the CDC tried to produce rules for safe school re-openings, which Trump administration officials then rewrote because they complained that they required too much work.

In a similar vein, OSHA produced guidance for safe practices in meatpacking plants only after widespread reports of infections and deaths in a number of facilities. Incredibly, it was only last week that OSHA issued general guidance for workplace safety in dealing with the pandemic.

Going along with better guidance on the safe operation of workplaces and businesses, we should have had more aggressive efforts at testing and contact tracing. While some states have taken this effort seriously, the Trump administration was often openly hostile to the idea of more frequent testing. As Donald Trump said on several occasions, if we have less testing, we will identify fewer cases. In an administration in which public appearance was the main priority, not controlling the pandemic, there was little interest in pursuing a policy that would show the problem to be bigger.

In terms of what difference better control can make, Germany has had just over half the death rate (relative to its population) from the pandemic as the United States. Denmark has had less than one third the death rate. Governments that knew what they were doing and took the pandemic seriously kept people from dying.

Open-Sourcing Research on Testing, Vaccines, and Treatments

To my view, the biggest failure of policy in the pandemic has been the fact that we gave patent monopolies to the companies developing new tests, treatments, and vaccines. This has led to higher prices and needless shortages of the essential tools for containing the pandemic. This practice is even more frustrating since, in many cases, the government picked up the tab for much or all of the development costs.

arguedbeginning back in March, that we should see the pandemic as a great opportunity for experimenting with open-source research in a context of international cooperation. The idea is that we would negotiate some commitment of funding from each country, based on their GDP and wealth, which would go to support research on developing tests, treatments, and vaccines. All the research findings would be fully open, as would be the results of clinical trials. And, all patents would be in the public domain so that anyone with the necessary manufacturing facilities could produce any of the items developed.[1]

In principle, this would allow for the most rapid progress possible. It also would remove the incentives that patent monopolies give companies to lie about the safety and effectiveness of their products. And, it means that everything that was developed – new tests, treatments, and vaccines – would be cheap. These items are rarely expensive to manufacture, they are only expensive because drug companies have patent monopolies or other types of government protection.

The failure to go this route is hitting home now that much of the world, including the United States and Europe, are facing shortages of vaccines. In the wake of these shortages, we are hearing the response that there is limited manufacturing capacity. This is true, but that is precisely the problem.

If Moderna or Pfizer can each build one or two factories to produce their vaccines, then it was possible to build ten or twenty. If there were inputs in short supply, we could have ramped up production of these inputs. This is why we have the Defense Production Act.

There is no reason that the United States could not have had stockpiles of 300 or 400 million of any vaccine that went into Phase 3 testing, by the time that it was approved. If we had capacity to produce another 100 million or so per month, we could ensure that supply would never be the limit on our ability to vaccinate people.

There is of course the risk that we would have produced 400 million doses of a vaccine that was not approved by the Food and Drug Administration, but so what? With the cost of production around $2 per shot, this would mean throwing $800 million in the garbage. In a context where the pandemic has cost us close to 500,000 lives, and trillions of dollars of lost output, the risk of wasting $800 million looks pretty trivial.

In fact, we should be thinking about the issue on a world scale. That means that we should have been looking to have 1-2 billion doses available when vaccines first were approved by regulatory authorities. This is where international cooperation really would be hugely valuable. In addition to the U.S.-European manufacturers, China, Russia, and India have also developed vaccines.

Two of China’s vaccines have been approved by other countries’ regulatory authorities. Russia’s vaccine has also been approved by regulatory authorities in a number of countries and a recently published article shows it to be highly effective. Russia is currently submitting for approval by the European Union’s regulatory agency. Germany has already expressed a willingness to use the Russian vaccine, if it is approved. Russia indicated it could provide 100 million doses to Europe in the spring.

It is great that these other countries have developed vaccines, but unfortunately, they have not been very forthcoming with their results. The Chinese vaccines seem to be less effective than the vaccines developed by Pfizer and Moderna, but they may nonetheless still be very useful in slowing the spread of pandemic, and perhaps even more importantly, preventing severe cases requiring hospitalization and possibly leading to death.

If we had gone the route of full open-source research, the trial data for these vaccines would be freely available to researchers and clinicians throughout the world. This would both allow governments to make informed choices about which vaccines might be best for their populations (several of the vaccines have the advantage of not requiring freezing, which makes delivery and storage far easier, especially in developing countries) and also for doctors and patients to weigh the relative risks and benefits of the available vaccines.

It is also important to point out in this context that we have a very concrete reason for wanting a quick and successful worldwide vaccine program. We know that the more the virus spreads, the more it mutates. There is a great risk that if the pandemic is allowed to spread unchecked in large parts of the world, that there will be mutations for which the current vaccines are not effective. Even if the vaccines can be adjusted to make them effective, as some scientists have claimed, this would still require the production and distribution of hundreds of millions of new doses of a revised vaccine, with the pandemic spreading widely in the meantime.

We really really do not want to be in a situation where we have to go through this thing a second time. That means we should be very serious about getting the whole world inoculated as quickly as possible, even apart from the humanitarian interest that we should not want to see preventable illness and death anywhere.

Distributing the Vaccines

Perhaps the most mind-boggling aspect of the policy response to the pandemic has been the failure of the vaccine distribution process. In the United States we have a fairly straightforward explanation: Donald Trump. Trump made it clear that, under his leadership, the federal government was taking no responsibility for distributing the vaccine. However, even without the leadership of the federal government, it is disturbing that states have not been better in stepping up and filling in the gap.

Even more striking is the fact that United States is actually doing better in its vaccine rollout than countries like France and Germany, which do have national health care systems and generally competent governments. It is astounding that they seem to have been unprepared to deliver vaccines once they had been approved by regulatory authorities. It is striking that these countries did not seem to have plans in place to quickly deliver whatever vaccines they had available.

This means having concrete plans to distribute the vaccine immediately after the regulatory authorities gave the green light. That would mean having stockpiles available near distribution centers. It means picking locations – nursing homes, hospitals, pharmacies, or mass inoculation points at sports stadiums or other facilities – and then ensuring that the necessary personnel are at the site.

We have heard reports of shortages of everything from syringes to personnel trained in giving the shots. We had all fall to ensue that we had plenty of syringes. If enough people had not been trained to administer the shots (we give two million flu shots a day during flu season), then we should have trained more people.[2]

It is truly incredible that states did not make these preparations. Again, having a federal government that was completely AWOL on the vaccine distribution effort was a big handicap, but it is still surprising how most states seem to have fallen down so badly.[3] And, it is very hard to understand how competent governments in Europe seem to have also been unprepared to quickly deliver the vaccine doses that were available.

Conclusion – The World Has Messed Up Big Time in Dealing with the Pandemic

It is hard to look at the track record over the last year and not conclude that governments failed badly in their efforts to control the pandemic. This is partly due to corruption and a failure of imagination, as in the decision not to open-source the development of vaccines, treatments and tests, and partly to a lack of competence, as in the failure to prepare in advance for the distribution of vaccines.

Some countries, especially those in East Asia, have done very well in limiting the spread of the virus and thereby minimizing deaths and economic damage. But few countries elsewhere have much to brag about. Donald Trump is of course a big part of the problem in the United States, but the failure goes well beyond Trump. There should be some real accountability once the pandemic is contained, which hopefully will be soon, if we start doing things right.

[1] I outline a system of publicly funded drug research in chapter 5 of Rigged.

[2] One of the amazing stories I’ve heard from public health people is that the coronavirus shots take longer to deliver because the shot giver has to make arrangements for a second appointment. If this is actually true, it is incredible that we would waste the time of a person giving shots, by having them make these arrangements, rather than having a separate person who checks people in doing this work.

[3] One explanation that I have heard is that states delayed making plans because they assumed there would be money for distribution logistics in the second pandemic rescue package that eventually passed at the end of December. The idea was that if they spent funds before the bill passed, they wouldn’t be reimbursed, but if they waited, they could then have the Feds pick up the tab. If this explanation is right, then it shows the enormous cost of the long delay in passing this bill.

  1. February 3, 2021 at 4:16 pm

    I’m looking at this from the UK, and seeing our PM wanting to preserve the UK’s “special relationship” with the US by wrecking the EU and becoming a poodle of Trump. The EU itself had been a European Economic Community that (whatever happened) was capable of feeding itself, which we got into because that is precisely Britain hasn’t been able to do for a couple of hundred years. Karl Polanyi in “The Great Transformation” ably explained the working out of Adam Smith’s “those who don’t work shan’t eat” morality with his story of goats and dogs on Robinson Crusoe’s island.

    If humans are merely animals and not children of God, then it is at least arguable that human lives DON’T matter. At least it appears that way to financiers interested only in making money. From my saying this it must be evident that I think they do matter, and that at age 84 I have nothing to lose by “speaking truth to power”. The powers incidentally include those who have learned population control from Malthusians and not had the imagination to seek alternatives from information-age control engineers.

    The point I started from was the USA, which can surely more than adequately feed itself, made no effort to contain the pandemic by sticking to feeding itself. If it caught the capitalist virus from the UK, that is no excuse for flying its most irresponsible citizens and sycophants around the world, spreading it along with their largely unnecessary business.

  2. February 6, 2021 at 1:02 pm

    USA, population 328,239,523, COVID-19 deaths 459000
    Vietnam, population 96,208,984, COVID-19 deaths 35. (figures as on Sat 6th Feb 2021)
    Vietnam has a 1300 km land border with China.
    Unfortunately, what act this drama is at is unknown.

  3. Ken Zimmerman
    February 27, 2021 at 1:05 am

    The relation between sickness, disease, and everyday life is complex in America. Boosterism, politics, and all out gamesmanship have always figured in a big way in these relations. David M. Oshinsky relates this story in his 2005 book, POLIO
    An American Story. (47-49)

    WHEN ROOSEVELT REENTERED POLITICS in 1928, he needed someone to replace him at the Warm Springs Foundation. The man he chose, his Wall Street law partner Basil O’Connor, was not exactly thrilled to be asked. In truth, O’Connor hadn’t the slightest interest in helping any “cripple” other than FDR. “My decision,” he recalled, “had no more emotional significance than taking over several file folders of unfinished business for a colleague who had embarked on a new project that would keep him overly busy.”11

    O’Connor, in turn, hired Keith Morgan, a fast-talking insurance salesman who had made a fortune in the booming bull market of the 1920s. Morgan’s job, as spelled out in a personal meeting with FDR, was to “sell” the concept of Warm Springs “to a lot of wealthy people who’ve never heard of it.” This seemed like a good idea since private philanthropy was still the province of the very rich. But Morgan came on board in 1929, the year the stock market crashed. All of a sudden there were fewer rich people with a lot less to give.

    With the Depression, Warm Springs almost went under. Contributions plummeted from $369,000 in 1929 to $30,000 by 1932. There was no money to pay the bills; new patients had to be turned away. In desperation, Morgan sought out a friend who had made a reputation as a rising star in the rapidly expanding field of public relations. His name was Carl Byoir.12

    The son of Jewish immigrants, raised in Iowa, Byoir lived by the motto, “A successful salesman is an attention getter.” In college, he had made a handsome profit selling yearbook advertising. At Columbia Law School, he had created a company, the House of Childhood, that offered franchises for a learning system developed by an Italian woman named Maria Montessori. (Byoir is credited with popularizing Montessori schools in the United States.) After that, he went to work for the Hearst chain, quickly reversing the decline of its flagship magazine, Cosmopolitan, by giving cash prizes to distributors who sold the most copies. When America went to war in 1917, Byoir joined the Committee on Public Information (CPI), which had the onerous task of selling Woodrow Wilson’s war aims to a divided nation. Known for its relentless boosterism, the CPI became a training ground for a pioneering generation of public relations men, including Byoir’s future partner, the legendary Edward Bernays.

    These wartime contacts propelled Byoir to the top of his field. In the early 1920s, he handled the public relations that helped establish the new Republic of Czechoslovakia, and followed that with a successful campaign to win U.S. recognition for Lithuania. To promote the sale of Blondex hair products, Byoir created the enduring image of the sexy “platinum blonde.” His most successful, and controversial, effort came in the late 1920s, when he worked with the corrupt dictator Geraldo Machado to increase American tourism to Cuba. “Carl Byoir may not have moved mountains,” said one observer, “but he definitely made a career of motivating people to do it for him.”13

    One of Byoir’s most important clients was Henry L. Doherty, founder of the Cities Service Corporation, the largest distributor of natural gas and electricity in the United States. Known as a master of strong-arm tactics, Doherty had hired Byoir to soften his ruthless public image. A well-publicized philanthropic gesture seemed a good place to start. When Byoir suggested a private meeting with Keith Morgan, Doherty jumped at the chance. There were rumors that the Federal Trade Commission would soon be looking into his sale of Cities Service stock on the eve of the great crash. Having a friend in the White House, he thought, might do him some good.

    Doherty agreed to finance a fund-raising campaign for the Warm Springs Foundation. At a brainstorming session, Byoir suggested a nationwide party to celebrate Roosevelt’s birthday. The first problem was getting the president to agree. Using his name could easily backfire. Some would see it is as a partisan move, allowing Democrats to pose as the protectors of crippled children. Others would question the participation of an industrial pirate like Henry Doherty. For Roosevelt, however, these were minor concerns. What mattered most to him was keeping Warm Springs in the black. “If my birthday will be of any help, take it,” he told Morgan. The party was on.14

    Byoir set up shop in Manhattan’s Waldorf-Astoria, which provided him a suite of offices free of charge. He had less than two months to prepare; the event was scheduled for January 29, 1934. From a public relations standpoint, Byoir had to connect an immensely popular president to a rare and mysterious “children’s disease.” The concept, as he saw it, was to extend the optimism of the early New Deal into the realm of philanthropy, allowing people to celebrate a leader who cared about the less fortunate and embraced the promise of better times ahead.
    The slogan “We Dance So that Others Might Walk” seemed to mirror the nation’s hopeful mood.

    As a former journalist, Byoir sent letters to newspaper publishers across the country, asking each to find a civic leader “who would feel honored in being appointed Director of the Birthday Ball in your city.” Specific rules were attached: “The Director will formulate the local committee, select the ballroom, direct the arrangements and manage the expenditures, so that from the sale of each ticket the National Committee will receive one dollar for the [Warm Springs] endowment fund.”15

    Byoir kept a close eye on the responses. Those slow to reply got a second letter inquiring about the delay. “Time is exceeding short,” it said. “Kindly wire us collect no later than December 28th and let us know what we may expect.” A week later, Byoir fired off telegrams to the remaining stragglers:

    PRACTICALLY EVERY CITY AND TOWN IN THE UNITED STATES IS GIVING A BIRTHDAY BALL IN HONOR OF THE PRESIDENT TO CARRY ON A NATIONAL BATTLE AGAINST INFANTILE PARALYSIS, WHICH EVERY YEAR CRIPPLES THOUSANDS OF CHILDREN. YOUR CITY IS ONE OF THE VERY FEW NOT YET ORGANIZED. IN VIEW OF THE SHORTNESS OF TIME, WILL YOU WIRE ME PERSONALLY?16

    By January more than three thousand local birthday ball committees had been established, a triumph by most yardsticks but a disappointment to Byoir. Expecting twice that number, he turned to those most likely to support the cause—local Democratic Party officials and patronage appointees (including Basil O’Connor’s brother James, the postmaster of Bangor, Maine). “No question about it. Our approach in those days was 90 percent political,” said a birthday ball planner. “It had to be. We had to work with our friends.”17

    To rally the troops, Byoir barnstormed the country with Wiley Post, the popular one-eyed pilot who had just set the speed record—7 days, 19 hours—for circumnavigating the globe. At each stop, Byoir held a press conference, lined up local Democrats, and spelled out the plan. For small towns, he suggested square dances, church suppers, and card parties. For large cities, he recommended union halls for the working classes and black-tie banquets for the financial elite. He got newspapers to run free advertising, phone companies to remind their subscribers to attend, and department stores to run window displays of the shoes, clothing, and hats to be worn at each event.18

    The night of January 29 was a smashing success. More than 6,000 parties were staged, from Puget Sound in Washington State to the southern tip of the Florida Keys. Skiers in Berlin, New Hampshire, formed a huge “R” for Roosevelt with exploding red flares. Fifty-two white doves were released in Grafton, West Virginia, to mark the president’s age. Schools and businesses closed early in Chicago, where dances were held in lodge halls, fight clubs, local taverns, church basements, and the major Loop hotels. Ticket sales were so brisk in Philadelphia that the premier event had to be moved to the 10,000-seat Convention Hall. From Browning, Montana, came word of a tribal dance on the Blackfoot Reservation.

    Nothing outdid the scene at the Waldorf-Astoria, where 5,000 people, crammed into four adjoining ballrooms, watched 52 debutantes in white evening gowns mount a multitiered birthday cake, 28-feet in diameter, as George M. Cohan, surrounded “by detachments of the Army, the Navy, and the Marines,” performed a “special ballad” he had written for the occasion, titled “What a Man.” As Cohan finished, at precisely 11:30 P.M., the president’s voice was heard over a nationwide radio hookup from the Oval Office. “This,” he said, “is the happiest birthday I have ever known.”19

    It took several months to total the contributions and pay the bills. At a White House ceremony on May 9, 1934, a committee led by O’Connor and Byoir handed the president a check for $1,016,443 [about $20.2 million today]. O’Connor had expected a profit of perhaps $100,000; Byoir knew better. When FDR turned to him and said, “Carl, I’ll bet you a good tie that you can’t top this figure next year,” Byoir took the wager. He saw even bigger days ahead.20

    [end of quotation]

    I would like to reduce the sting a bit, but that seems impossible. Democrats have lost both the sentiments and the competence to inspire a nationwide belief and commitment to anything. And Republicans can do it only for the cruelest, most venal sociopathic things. Democrats sometimes win, but only on the rebound.

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