Editor’s Note: Jennifer Prah Ruger is Amartya Sen Professor of Health Equity, Economics and Policy and Founder and Director of the Health Equity and Policy Lab (HEPL) at the University of Pennsylvania. She is the author of Global Health Justice and Governance from Oxford University Press and served previously both as Health Economist and Speechwriter to the President at the World Bank. The opinions expressed in this commentary are those of the author. View more opinion articles on CNN.
President Donald Trump appears to have wavered on last month’s goal to have the US “opened up and just raring to go by Easter” as well as his warning on Twitter back then that “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.”
Larry Kudlow, the President’s top economic advisor concurred, adding “the President is right. The cure can’t be worse than the disease. And we’re going to have to make some difficult trade-offs.” He counseled that “[t]he economic cost to individuals is just too great.”
I agree that the economic costs of the Covid-19 pandemic are massive and growing. But the social and human costs are even higher and unequally distributed, hitting the vulnerable the most.
Whereas Covid-19 was a natural threat, the ensuing global pandemic and disruptions to the economy and our social way of life is a human-made calamity. We had a duty to prevent Covid-19 as economically as possible and we failed to fulfil it.
There is no paradox here. In 1948, Albert Camus wrote in “The Plague” that “everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky.” Pandemics are not preordained and the risks have always been sizable. A 2013 World Bank paper cited estimates that a single severe flu pandemic could cost $3 trillion or 4.8% of global GDP. The same paper cited estimates that if all countries developed and implemented systems for early effective contagion control that met specified international standards, annual spending would be moderate, costing “ten times less than the expected annual cost of inaction.”
Let’s face it, pandemic risk reduction was not a priority for the United States, or many other countries either, with an uneven focus on present-day patients rather than the prospectively sick. Pandemic risk reduction is a global public good, benefiting all countries. Reducing pandemic risk is a public service – a duty – which only governments, through the management and coordination of multifaceted sectors and local, national and global levels, can deliver.
National governments should anticipate and prepare for pandemic risks well in advance. The US and other countries have a duty of early detection, accurate diagnosis, and effective prevention and control of disease outbreak, both humanely and efficiently. Saving lives and safeguarding our economy are twin goals that are complementary, not contradictory, and the dichotomy some are presenting is a false one. Pandemic preparedness can have high economic returns.
I previously worked at the World Bank. I served as a health economist and then speechwriter to the World Bank president and led communications in the office of the president. Working at a development institution with a whole-of-society purview, it became clear that health risks are integrally linked to other types of risk, including our ability to work, to be educated and to engage socially with our friends and family.
Systematic economic shocks constitute shifts in demand and supply as well as social and economic disruption. Indeed, the Covid-19 pandemic is cascading across virtually every aspect of our lives; we have every possible reason to act humanely and efficiently.
Whole-of-society pandemic preparedness is a relatively low-cost set of activities that mitigates the high-cost impacts on human health, society and, yes, the economy.
What does cost-effective systemic resilience to pandemic impact look like? It’s multi-faceted and complex, of course, but select components of a rational and logical approach to health and the economy include the following:
First, we need scientifically-grounded risk assessments and response plans that are rigorously designed and tested. Governments should run intermittent simulations, honing and updating response plans accordingly.
Second, rational, truthful and transparent public communication in non-urgent as well as urgent times improves preparedness. That way, the public is primed to act based on motivation and factual information rather than fear and anxiety. Taiwan and Singapore’s public messaging following the SARS pandemic as well as during the rapid onset of Covid-19 are good examples of effective communication.
Third, governments should coordinate a centralized response, integrating national security and risk management systems, and set out clear, pre-defined roles among various departments and agencies. For example, Singapore had an inter-agency task force for years, which paved the way for a coordinated national testing, contact tracing, isolation, quarantine and communication strategy during the coronavirus pandemic.
The US was challenged in all of these necessary activities, leading to a scenario closer to bad than good – namely the rapid growth of cases. International coordination is also key, with allies, neighbors and, particularly, trading partners. For example, Taiwan visited China for a fact-finding mission, aiding its response.
Fourth, accountable and unified leadership at the highest levels – not just during crises, but between them – renders a country more prepared, resilient and ready to act swiftly and decisively.
Last, but certainly not least, underpinning all of these efforts is a strong One Health system, a local, national and global multi-sectoral collaboration focused on obtaining optimal health for people, animals and the environment. This system reinforces the bridge between veterinary and human health systems, for early, effective contagion control.
Both whole-of-society preparedness and One Health planning are relatively low-cost, high-return approaches to pandemic risk management. Developing and implementing a timely and effective pandemic preparedness system for all countries could cost an estimated $3.4 billion annually, while the expected annual benefit is an estimated $37 billion, according to the World Bank.
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Systematic prevention efforts will both reduce the risks of pandemics and produce considerable economic and health benefits.
Indeed, with pandemics, as with many areas of health, prevention is less costly than cure. With an estimated annual expected rate of return of roughly 50-123%, and benefit-cost ratio of roughly 11:1 for severe pandemic prevention, according to the World Bank, fulfilling our duty to prevent Covid-19 as economically as possible – had we done it – might just have been one of the most straightforward decisions of the 21st century.