Did WHO just Lock in the Cratering of the Global Economy?

What they should have said: First, do no harm

The World Health Organization (WHO) declared in a press briefing that decisions loosening lockdowns must be based “first and foremost on protecting human health.”

It sounds reasonable.

Except that it’s not.

It is often said that “health or economy” is a false dichotomy, as it is, yet statements prioritizing either perpetuate the dichotomy. They also influence actions favoring one over the other, and risk immense harm.

As explained back in March, there doesn’t need to be a tradeoff:

It is possible to achieve optimal health AND economic outcomes. Here are two examples — one offering the prospect of better economic and health outcomes, the other (as I understand it), better economic outcomes and likely no worse health outcomes:

Another is Sweden’s “low-scale” approach (with large gatherings banned but most schools and businesses operating). Australia is also trying a balancing approach — which carries risks that might, or might not, eventuate.

However, pushing the health message as “first and foremost” risks favoring the uni-science health solution of “lockdown” as “the” strategy, over multi-disciplinary diversity of thinking for solutions enabling better health AND economic outcomes.

Unsurprisingly given such messaging, many countries appear to be using the blunt instrument of lockdown to halt virus transmission (which it does well), with seemingly little interest in alternatives that might deliver better economic and public health outcomes.

Some countries (notably, island nations with small, dispersed populations, good healthcare systems and functional politics, like New Zealand, Ireland, Iceland, etc) might even eradicate the disease during lockdown. That would be a good result, and leaders will be lauded, yet reinforcing perceptions of “lockdown” as “the” strategy unwittingly risks worse health and economic outcomes.

That is because:

• Even if eradication succeeds in a few countries, “lockdown” is such a blunt tool that it won’t be known for some time whether the virus has been eradicated, and many businesses will fold long before ‘victory’ is declared.
• If eradication fails, the “lockdown” strategy locks in worse health and economic outcomes than complementary alternatives, because later pulsed lockdowns will be triggered by rising transmission rates — and their natural corollary: more cases, and deaths.
• In both cases, however, complementary strategies which offer better health and economic outcomes are missed. When WHO pushes “health first” rather than “health with” economic outcomes, lockdowns — the primary ‘health science’ strategy — retain their primacy, despite potentially better alternatives from a wider multi-disciplinary, multi-science health/economy perspective.

The result is that lessons from the initial policy failure to pivot fast appear to remain unheeded, with countries equally slow to pivot from lockdown thinking.

Only a month or two ago (several ‘years’ in coronatime) — the failure of most countries to switch strategies as soon as it became clear that asymptomatic transmission was not rare but the main means of transmission — from an initial focus on travelers and symptoms, to fast and effective widespread testing instead to locate and destroy the virus where it really was— might have avoided lockdowns altogether.

(Only a few nations, like Taiwan and South Korea, acted courageously with outcomes-oriented thinking broader than WHO’s narrow health-focus and slowly-emerging data, to try to get ahead of the virus).

Likewise, now. Future analysis with the clarity of hindsight might find that countries steadfastly maintaining lockdown as “the” strategy — despite the fundamentally altered science (from WHO’s initial belief that asymptomatic transmission was rare, now known as the primary means of spreading, combined with the virus’ long incubation and high lethality) — may be the critical stress point differentiating leadership across a spectrum between:

• Unwavering groupthink, with tightly controlled ‘messaging’ fixated on lockdown as strategy, with a range of outcomes from “terrible” (many deaths, wrecked economies) through “poor” (subsequent pulsed lockdowns, more deaths, wrecked economies) to “good, but” (fewer deaths, virus eradicated, wrecked economies); and
• Leadership for optimal outcomes, enabling the apparent chaos of unlimited imagination and diversity of multi-disciplinary thinking to forge the best possible results for health and economic outcomes.

In drawing such conclusions, future historians and leadership scholars might ask, for example, why leaders rejected options, already well-known and widely circulated, that could have produced better economic outcomes (earlier re-opening of shuttered economies, with greater certainty) AND better public health outcomes (fewer deaths) than “lockdown” and “seek and destroy” strategies alone.

Prepare to move over, famous O-ring, as classic groupthink exemplar.

However, WHO’s pronouncement also offers hope that optimal health AND economic outcomes may yet overcome the headlong rush into a health-centric mindset that risks locking-in the cratering of the global economy (and, ironically, possibly worse health outcomes).

The Director-General, Dr Tedros Adhanom Ghebreyesus, concluded with a call for “global solidarity”. That is precisely what alternative solutions require.

For some countries to conduct full-population testing, for example, with data benefiting all countries, may require global solidarity, or at least WHO’s encouragement, and international support.

That is because the type of countries that can conduct fast, effective, full-population testing for the benefit of all nations may need logistical support, and (as explained here) because full-population testing may not be viable in some big countries. (It takes too long, and countries like South Korea and Germany should get sufficient benefits for their own citizens earlier).

In practical terms, New Zealand (or another country with similar characteristics) should be able to conduct full-population testing in cycles of 7–10 days. Nor is this fanciful. First, it’s been done before, on a smaller scale. Researchers conducted a full-population study in an Italian town. The virus was eradicated by the second 9-day rotation. Second, scaling up is possible. Even at Germany’s rate of 200,000 tests per day, New Zealand could test everyone in about 3 weeks (compared with 14 months in Germany and 4.5 years in the US). But a UK researcher reckons it’s possible to undertake 10 million tests per day, by post. With just 4.8 million people in New Zealand, a 7-10 day rotation looks positively relaxed.

With the virus’ own GPS system delivered to the world, the medical experts at WHO and 193 countries would gain unprecedented insights, showing just how SARS-Cov-2 gets around. That would be immensely valuable. It would also help vaccine development.

But, while countries like New Zealand dither with a vague hope-based strategy that lockdown might eradicate the virus, the best data currently comes from Iceland, another island nation that’s already tested 10 percent of its population, more than any other. The data could be so useful — helping Iceland eradicate the virus with more certainty for its citizens’ health and its economy, and giving every nation the virus’ GPS map — as to be Nobel prize worthy. But Iceland has fewer than 400,000 people, so all-population data from one or two ‘big’ small countries would help. A joint Nobel prize also connotes collaborative effort for a joint cause; humanity.

As WHO says, global solidarity is vital.

But can we please just get over this “health or economy” stuff, and focus on optimal public health and economic outcomes?

— — —