Wednesday, March 31, 2021

Pandemic preparedness and public health

Charlie Pierce has this comment on the US and the COVID-19 pandemic, "We were less prepared for this pandemic than the Pacific Fleet was for an air attack on December 6, 1941 and we’ve only begun to dig for the answers why." (Dr. Birx's CNN Interview Brought an Enormous Temptation Toward Ungovernable Rage Esquire Politics Blog 03/29/2021)

I've been reading and hearing various news reports on the progress of national COVID vaccination campaigns. Like a large portion of the world's population have been doing.

I don't have any special insights to offer. But I will make what should be a banal observation, that countries need to prepare for medical emergencies involving epidemics and pandemics.

I know that in the US, Germany, and Austria, the federalist structure of epidemic response certainly look like its been a problem in various ways. The fact that those three countries have respective populations of 328 million, 83 million, and 9 million. But they all have encountered significant problems of coordination between national and state governments in coping with the pandemic.

Federal arrangements are one of many factors that affect the comparative effectiveness of different countries' responses. Sorting out which factors made how much effect on responses will be a challenging task for social scientists. Physical size of the country, population density, prevailing practices of socializing with friends and family, state of the national health care system, general political stability, and vaccine purchasing decisions will be among them.

Israel has gotten a lot of positive attention for its vaccination rate. Chile at one point was exceeding Israel's performance. (Chile löste Israel als "Impf-Weltmeister" ab Oberösterreichische Nachrichten 15.März 2021)

Israel has been in a relatively high state of military preparedness pretty much for its entire existence as a nation. Gil Murciano reported for the German Institute for International and Security Affairs on Israel's response to the pandemic in Covid-19 and the Securitization of National Crises in Israel’s Strategic Approach Dec 2020:
Israel’s first response to the Covid-19 crisis demonstrated a security-based approach to a non-military national crisis. Faced with a first-of-its-kind non-military crisis of national magnitude, the government reactivated a pre-established, well-rehearsed policy protocol. It assigned the security community with the operational management of the crisis and responsibility over key strategic roles. Israel’s reliance on this commu­nity is an outcome of both the health system’s weakness as well as an overarching mind­set – shared by both the leadership and the public – that perceives the security commu­nity as the optimal manager of national crises. This approach curtails the development of civilian crisis capacities and enhances future dependency on the security community in national crises. It bears consequences on Israel’s performance in future civilian crises: first, on its ability to devise an optimal response, second on its level of readiness to con­front security threats during such crises, and third on public transparency.
In the case of the COVID pandemic, Israel's response meant that they were able to distribute vaccines and perform the vaccinations rapidly.

During 2020, the US did a terrible job of getting vaccines out. But once the Biden-Harris Administration took office, they were able to get the vaccine distribution going rapidly. So I assume that were emergency plans of some kind around and obviously the capabilities were there. It's just that Trump didn't bother to do any of them. Among other factors, basic minimal competence at governance is helpful in crisis situations.

But it also tells me that a vigorous backup system for distributing medical supplies and vaccines in an emergency should be a baseline minimum for public health systems. And maintaining a sufficient supply of intensive-care facilities that will be "excess" in non-epidemic times. That is, that capacity has to be shielded from the pressures of short-term profit making. Because from the short-term profit viewpoint of a private company, public health considerations are economic "externalities," i.e., something that's not their problem to worry about.

And the US and the international community should become a lot more flexible about seizing private patents on vaccines needed in an emergency. Especially when they are developed with large amounts of public funds (Siva Thambisetty, Vaccines and patents: how self-interest and artificial scarcity weaken human solidarity LSE Blog 02/09/2021): "the pharmaceutical industry has assiduously worked to deny any public claim on patents that have grown from public money."

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