If the CDC really wanted to prevent pandemics and epidemics it would advise not raising or using turkeys, or any other animal product. Stop them at the source.
Frankly, it is hard to worry about how we might prepare for the next pandemic when we are mismanaging this one so badly. It's not as if logistical problem have led to grotesquely costly measures to slow the spread of the virus (closing schools instead of daily testing), the lack of a cheap, rapid test available as scale, delays in approving the vac schools cines (refusal to use HCT), use data from other countries trials, failure to have changed the vaccine recipes for Delta (I'll wager Omicon will be the dominant strain before the recipes is changed).
Matt is using a framework for comparing importance that just doesn't work at all.
The fact that we spend more on something does not mean that it is more important. Not at all. I spend more on my dumb hobby than I do on clothes, but that doesn't mean that my hobby is more important to me than clothes are. No, I am quite aware that if I could only choose one, I would choose clothes. And I would forgo spending on my dumb hobby until I had adequate clothes. I spend more on internet and media than I do on electricity, but I know which is more important.
This stuff is evaluated on the margin, not in totals or averages. To pretend otherwise is facile and misleading.
Is national defense important? Of course national defense is ENORMOUSLY important. It is not that I think our military is not important, but rather that I think that we spend far more on it than we need to to meet our needs.
Now, it is easier to point at simple disparities in numbers and make some facile point. It clearly is much much harder to evaluate whether sufficient money is being spent to meet the real needs of these various issues. That takes diving into the weeds. That takes doing the INCREDIBLY difficult work of evaluating what the real needs are and of the challenges (e.g., logistics) of meeting them. Sometimes more money helps. Sometimes there simply isn't the capacity to make use of that money at this time.
To be fair, I don't think that acknowledge me any of this is absent from what Matt wrote. But somehow he returned to this facile (and meaningless) logic. Yes, Matt, the disparities are galling. They SEEM wrong. But you've not made the case that the money can be effectively spent at this time.
Btw I was hoping that you'd point out that the anti-viral drugs are super important because they enable challenge testing of vaccines, which I know you're a big proponent of.
I wonder if there is too direct a relationship of the solution to the problem, here. We just had a pandemic, and so it seems like a great idea to build the mechanism to prevent future pandemics. But the problem with this thinking is that a. it doesn't acknowledge what we did have that enabled the more successful parts of our response (building vaccines) and b. it's building something very specific that isn't particularly reusable for other crises.
Pandemic are bad, but they happen rarely. But pandemics are just particular diseases, which are bad but happen all the time. Similarly, massive crises happen all the time - earthquakes, fires, cyclones, pandemics, etc. Any particular one of these can be relatively infrequent. Public health communications need to happen all the time, but only rarely are these about a pandemic.
For my money, to use a gaming metaphor, I'd like a deck that I'd use in a variety of situations, rather than building the super card to trump this particular situation should we see it again.
Incidentally - are doses genuinely scarce right now? I've been under the impression that most African nations currently have more doses than they are able to administer, and the bottleneck is on the administration side. If they really can administer more, then we absolutely should be getting more doses to them, but I had been under the impression that there have been at least a few million doses gotten to most countries, and the difficulties involve logistics, supply chain, people to do the injections, etc. It would be good to be clear on this to know where the most help is needed.
In Kenya, doses are not scarce currently, the main two issues (as I understand them) are demand and logistics. Just like in the US, there are plenty of people who have heard the wild misinformation about the vaccine and do not plan to get vaccinated. Also, plenty of people live far from the hospitals and clinics where vaccines are available, so the government needs to set up more efforts to run mobile clinics that can reach more remote populations.
The piece that I'm not sure about is cost. I believe that the shot is free, but patients still need to pay a nominal fee for the doctor's time. Even if the shot is completely free, people are used to the hidden costs that come with "free" (in "free" primary education, parents still have to pay for school uniforms, books, meals and various other fees that are tacked on), so might be wary of what it will really cost them (in addition to transportation and potentially, a day of lost wages from vaccine side effects).
There is no way that any company with a fiduciary responsibility to shareholders is going to build up a bunch of unused capacity and spend to keep it functional but not making any money. That's just not how capitalism works.
It is possible that government agency can do this, but it also suffers from the short-termism that the human species has. Someday there will be an emergency or a political crises and the funding will be diverted to something else. It's a nice idea, but utopian.
The US has pretty much been at war continuously since WWII. But I see what you mean. Almost all of the capacity is unused.
All we need to do then is build some public-private partnership that can rake in the dough supporting this and doing nothing but practice and then talk the public into thinking that this is a great idea and we are set!
Sarah B asked some very very good questions. And I'd like to add a few. I will begin by observing that the people who babble about liberating patents have almost certainly never read one. Or understand what they do and do not do. Nor do they understand the transnational nature of patents as they would apply to the supply chain. Right down those chains are also many companies whose products are also patent protected. They are often unique purveyors of equipment or chemical precursors or QC equipment or any of the numerous elements that you need to build a manufacturing facility for ANYTHING. All of these things have lead times for delivery and when it comes to manufacturing pharmaceuticals or vaccines I do not believe it is possible to anticipate what you will need.
The logistics of watching a scale up from pilot plant to full production is something amazing to observe. As is refitting a given production facility to, say, switch models at an automotive manufacturing plant. Which generally involves ripping almost everything out and replacing it with completely different equipment. It takes years of planning and competent system integrators to make it all work. and then you retrain the workforce to use it.
I love your ambition but I do not think it is in any way practicable to try and produce generic plants to make anything like these products. Nor is it in any way practicable to staff such a facility with the array of personnel needed to operate such a facility when they don't know what they will be making and have them sit around waiting to find out.
There are things you could do though. And the principal one is identifying the equipment and supplies you will likely need for a broad array of vaccines and invest in removing bottlenecks and reducing delivery lead times. Much can be stockpiled and these can be maintained current with projected life expectancy and expiration date. Given the very strict environmental controls these sorts of plants require you could also prebuild empty facilities ready to be equipped with what you do need in terms of large scale production for any given pharmaceutical. Agility is the goal.
The big thing to be avoided at all costs is to have some sort of stampede for a specific vaccine production and have a whole bunch of dilettantes trying to milk the same supply chains for the same necessities. That cure is worse than the disease and it never works out. It is a much better strategy to let any organization that does know how to do anything scale up their own production. Just provide the tools they need.
I'm 100% in favor of a much bigger pandemic response.
But it shouldn't be part of the BBB. You could almost certainly get bi-partisan support for a big pandemic program. But of course they don't want that, they want to tie it into the highly partisan BBB so probably nothing happens.
IMO, you want to reform the CDC so it's only job is infectious disease. Don't get distracted on lifestyle diseases, leave that for someone else.
And provide steady long term funding in the bill so we can protect the future.
That should include capacity funding for testing, PPE, and vaccine production. Possibly with extra workers being trained in the national guard, or army reserve to staff the extra production when needed
For as much as I agree with parts of this post, there are so many flaws.
Begin with the skewed priorities of BBB: "But even perfectly worthy ideas like larger maximum Pell grants ($11 billion), expanding the Low-Income Housing Tax Credit ($12 billion), or electrifying the federal vehicle fleet ($9 billion) are not three or four times as important as reducing the odds of future pandemics."
Yes, they are. They're addressing concrete issues with practical solutions that will yield actual benefits. A future pandemic is theoretical, especially one on the scale of the Spanish flu or COVID. It's hard to prepare for theoretical risks, especially when there's no assurance that the funds you put in now will yield benefits later. And we have lots of equally dangerous "theoretical" threats.
The San Andreas fault is going to go some day, busting the California aqueduct and depriving southern California of water. Should we put in spare desalination capacity to replace all that flow? The New Madrid fault is going to go again some day, with up to a 50% chance of up to a 7.0 magnitude in the next 50 years (and maybe a 10% chance of an 8.0). That will bring down every bridge in the Midwest (and probably every tall building). (https://www.sccmo.org/705/About-the-New-Madrid-Fault) Should we be reinforcing all ~3500 bridges in that part of the country? Terrorists may get MANPADs and be able to shoot down airliners. Should we install anti-missile warning devices on all planes? And maybe chaff dispensers or IR spoofing devices?
Oh, and asteroids crashing into the earth as well.
It's so easy to waste money on preparing for low probability/possibly distant events. "We need huge amounts of excess capacity in vaccine manufacturing. . . " No, we don't. Because it will not be kept up. Oh, maybe for five years or even ten. But trust me, more than ten years from inception to need will lead to decrepit, unusable facilities, as no one wants to pay to keep them up after COVID has become a distant memory. Should we do R&D on super vaccines? Sure! Scientists are great at R&D. But otherwise: nope.
And lastly, as someone who worked military logistics for decades, I appreciate the callout to that old expression about amateurs and professionals, but perhaps more telling and appropriate to the discussion is what is known as "the logistician's lament":
"Logisticians are a sad embittered race of men,
very much in demand in war, who sink resentfully
into obscurity in peace. They deal only with facts,
but must work for men who traffic in theories. They
Exactly. *Some* day (soon, I hope), we'll be entering the "peace" of the post-COVID world, and we'll return to the land of theories, which very much will not have any time or resources for maintaining the infrastructure for the next huge pandemic, may it come not soon at all.
Southern California absolutely *should* have *some* sort of backup system, but I assume the cost-effective version is a few big reservoirs that can store several days (weeks?) of water until a repair is available.
On the New Madrid thing, there are some bridges that *should* be reinforced to ensure they can survive such a quake (I would particularly prioritize the Eads Bridge and the I-40 bridge and some others), but not *every* bridge.
I think it's absolutely a good thing that NASA is spending some amount of money learning how to divert an asteroid (https://www.nasa.gov/planetarydefense/dart), though given the amount they've spent cataloging all the near-earth objects and showing that there aren't many that pose a threat, they don't need to spend a lot on this.
We shouldn't spend unlimited amounts on pandemic mitigation, but it's almost certain that any bit of effective spending would produce more good over the next 50 years than electrifying the federal vehicle fleet before the current vehicles get replaced anyway.
Sure, you can't take care of every possible contingency, and rational cost-benefit calculations should drive you to doing those things of greatest value, as you note. But we aren't doing those things, while we sit here discussing massive preparation for the next great pandemic. Why? Because of the availability heuristic. It's important to spend lots of money on the next pandemic because we're in the present one. But the last big LA earthquake was 1994,(*) and New Madrid was 1812. Yawn.
And in 10 years pandemics will be a big yawn as well, so any requirement for continued large-scale spending will be buried by new "availability heuristic" priorities.
And meanwhile, I think electrifying the federal vehicle fleet is a great idea.
(*) Right after the Northridge earthquake, everyone was convinced another big earthquake was imminent (many moved away; others did their one-time emergency prep). But geology doesn't care about the availability heuristic.
Are we not doing those things? Does Los Angeles not have substantial capacity in its reservoir system? Are all the bridges in St. Louis seismically unsound? I assumed these things had been done, even though we haven't done the maximalist versions you were mentioning.
(1) No. We don't have enough to get through a drought. Also, there are few reservoirs in the LA area; we're reliant on out of area reservoirs and other sources (like the Colorado river).
(2) It's been a while since I drove through the New Madrid fault area, but the last time I did, I was struck by the spaghetti-thin poles holding up the bridges (compared to California Hulk-like supports). From my reading (e.g., https://www.nehrp.gov/pdf/SeismicWavesMar08.pdf) some work has been done, but only preliminary (e.g., Emerson Bridge) and only up to some level of a big earthquake. If it's above 7.0, good luck for the I-40 bridge. And that may be the smartest thing to do! You can't cover every risk. Which is my point on future pandemic spending.
Yes we actually should be preparing for unlikely but catastrophic events. Or at least do some kind of cost-benefit analysis. But human beings are terrible at planning for the future. At least we are good at adapting to the present.
That wouldn't make it more persuasive, though, because that's not the sticky part of the argument. Nobody is disputing that if there was a surefire way to avoid another similarly deadly, costly pandemic by spending $100 or $500 billion it would be worth it. But on that, the devil really is in the details, that's the difference between a good use of money and a wasteful boondoggle that absorbs huge amounts of resources to shadowbox against a threat that may not materialize or may occur anyway.
On a slightly related note, I do not understand why so many people were so quick to jump to the "equity" point regarding Omicron...
First of equity proponents argue that equitable distribution is the best way for rich countries to protect themselves from variants. However, even if given perfectly equitable distribution (i.e. no boosters until the first course gets to everybody) to everyone who wants one, the anti-vax population is easily sufficient to be a breeding ground for new variants. So people in rich countries are clearly better off taking the boosters.
From a moral perspective, it clearly is "wellness optimizing" to prioritize old people in developing countries over kids in rich countries. However this is not the way calculations are performed for anything else... nobody blames people in the UK for getting much better cancer treatment than someone in Niger. In fact, the "Left" argument is that the US is a terrible country for not paying for its own citizens to get better healthcare, but there is no similar push to distribute more resources to Mozambique or whatever.
I think from a political perspective the reasoning here is obvious... from a station of abundance rich people and rich countries will spare relative scraps with developing countries. But if they are asked to make a real resource sacrifice it's not going to happen. Some journalists and public health people seem to have somewhat lost their minds on this though and are arguing that it's feasible to convince rich countries to sacrifice their own health and their kids health (even a little bit) for the sake of people an ocean away. Again, this is probably not a morally defensible position but its how basically every country has operated forever.
If we want to help people in developing countries we should try to get to a position of abundance.
I think it was people who were saying several months ago that the US (and other wealthy countries that had more than enough vaccines) should be making more of an effort to get vaccines into arms in poorer countries since that's where variants were more likely to emerge.
Unrelated to the topic of the post, which is very good and important, Matt, have you read Daniel Immerwahr's *How to Hide an Empire*? I think you'd like his stuff about logistics.
It's amazing even in a war (like Iraq) how much financial controls guided logistics outcomes and even more how coding issues in logistics software tended to have dramatic impact on the performance of the entire logistics system.
This stuff is depressing. If we couldn't beat back Covid due to people not wanting masks or a few antivaxxers, we could just blame it on them. However, this all seems entirely solvable by Democrats. Fix the funding mechanisms, maybe do what the Reagan Administration did in the 80's and yell at the CDC and FDA to cut it with the parochial, overregulatory bs, message to the public that actual technological fixes are coming, make tests as cheap and easy to get as in Europe, and talk about ventilation. The last one especially gets me. It seems like no mentions it much, even though good ventilation and filters can do a lot, but instead it all leads back to masks and idiot anti-vaxxers.
Spot on re: ventilation. We're in a liberal area and our school superintendent talks about frequent bathroom cleanings, handwashing, and masks, but no HEPA air filters.
"The CDC ... advises you to overcook your turkey"
If the CDC really wanted to prevent pandemics and epidemics it would advise not raising or using turkeys, or any other animal product. Stop them at the source.
Frankly, it is hard to worry about how we might prepare for the next pandemic when we are mismanaging this one so badly. It's not as if logistical problem have led to grotesquely costly measures to slow the spread of the virus (closing schools instead of daily testing), the lack of a cheap, rapid test available as scale, delays in approving the vac schools cines (refusal to use HCT), use data from other countries trials, failure to have changed the vaccine recipes for Delta (I'll wager Omicon will be the dominant strain before the recipes is changed).
Matt is using a framework for comparing importance that just doesn't work at all.
The fact that we spend more on something does not mean that it is more important. Not at all. I spend more on my dumb hobby than I do on clothes, but that doesn't mean that my hobby is more important to me than clothes are. No, I am quite aware that if I could only choose one, I would choose clothes. And I would forgo spending on my dumb hobby until I had adequate clothes. I spend more on internet and media than I do on electricity, but I know which is more important.
This stuff is evaluated on the margin, not in totals or averages. To pretend otherwise is facile and misleading.
Is national defense important? Of course national defense is ENORMOUSLY important. It is not that I think our military is not important, but rather that I think that we spend far more on it than we need to to meet our needs.
Now, it is easier to point at simple disparities in numbers and make some facile point. It clearly is much much harder to evaluate whether sufficient money is being spent to meet the real needs of these various issues. That takes diving into the weeds. That takes doing the INCREDIBLY difficult work of evaluating what the real needs are and of the challenges (e.g., logistics) of meeting them. Sometimes more money helps. Sometimes there simply isn't the capacity to make use of that money at this time.
To be fair, I don't think that acknowledge me any of this is absent from what Matt wrote. But somehow he returned to this facile (and meaningless) logic. Yes, Matt, the disparities are galling. They SEEM wrong. But you've not made the case that the money can be effectively spent at this time.
Btw I was hoping that you'd point out that the anti-viral drugs are super important because they enable challenge testing of vaccines, which I know you're a big proponent of.
I wonder if there is too direct a relationship of the solution to the problem, here. We just had a pandemic, and so it seems like a great idea to build the mechanism to prevent future pandemics. But the problem with this thinking is that a. it doesn't acknowledge what we did have that enabled the more successful parts of our response (building vaccines) and b. it's building something very specific that isn't particularly reusable for other crises.
Pandemic are bad, but they happen rarely. But pandemics are just particular diseases, which are bad but happen all the time. Similarly, massive crises happen all the time - earthquakes, fires, cyclones, pandemics, etc. Any particular one of these can be relatively infrequent. Public health communications need to happen all the time, but only rarely are these about a pandemic.
For my money, to use a gaming metaphor, I'd like a deck that I'd use in a variety of situations, rather than building the super card to trump this particular situation should we see it again.
Paxlovid. Paxlovid is the name of the effective antiviral from Pfizer.
Incidentally - are doses genuinely scarce right now? I've been under the impression that most African nations currently have more doses than they are able to administer, and the bottleneck is on the administration side. If they really can administer more, then we absolutely should be getting more doses to them, but I had been under the impression that there have been at least a few million doses gotten to most countries, and the difficulties involve logistics, supply chain, people to do the injections, etc. It would be good to be clear on this to know where the most help is needed.
In Kenya, doses are not scarce currently, the main two issues (as I understand them) are demand and logistics. Just like in the US, there are plenty of people who have heard the wild misinformation about the vaccine and do not plan to get vaccinated. Also, plenty of people live far from the hospitals and clinics where vaccines are available, so the government needs to set up more efforts to run mobile clinics that can reach more remote populations.
The piece that I'm not sure about is cost. I believe that the shot is free, but patients still need to pay a nominal fee for the doctor's time. Even if the shot is completely free, people are used to the hidden costs that come with "free" (in "free" primary education, parents still have to pay for school uniforms, books, meals and various other fees that are tacked on), so might be wary of what it will really cost them (in addition to transportation and potentially, a day of lost wages from vaccine side effects).
There is no way that any company with a fiduciary responsibility to shareholders is going to build up a bunch of unused capacity and spend to keep it functional but not making any money. That's just not how capitalism works.
It is possible that government agency can do this, but it also suffers from the short-termism that the human species has. Someday there will be an emergency or a political crises and the funding will be diverted to something else. It's a nice idea, but utopian.
I'm pretty sure that you've just proven that the US military couldn't possibly exist.
The US has pretty much been at war continuously since WWII. But I see what you mean. Almost all of the capacity is unused.
All we need to do then is build some public-private partnership that can rake in the dough supporting this and doing nothing but practice and then talk the public into thinking that this is a great idea and we are set!
Sarah B asked some very very good questions. And I'd like to add a few. I will begin by observing that the people who babble about liberating patents have almost certainly never read one. Or understand what they do and do not do. Nor do they understand the transnational nature of patents as they would apply to the supply chain. Right down those chains are also many companies whose products are also patent protected. They are often unique purveyors of equipment or chemical precursors or QC equipment or any of the numerous elements that you need to build a manufacturing facility for ANYTHING. All of these things have lead times for delivery and when it comes to manufacturing pharmaceuticals or vaccines I do not believe it is possible to anticipate what you will need.
The logistics of watching a scale up from pilot plant to full production is something amazing to observe. As is refitting a given production facility to, say, switch models at an automotive manufacturing plant. Which generally involves ripping almost everything out and replacing it with completely different equipment. It takes years of planning and competent system integrators to make it all work. and then you retrain the workforce to use it.
I love your ambition but I do not think it is in any way practicable to try and produce generic plants to make anything like these products. Nor is it in any way practicable to staff such a facility with the array of personnel needed to operate such a facility when they don't know what they will be making and have them sit around waiting to find out.
There are things you could do though. And the principal one is identifying the equipment and supplies you will likely need for a broad array of vaccines and invest in removing bottlenecks and reducing delivery lead times. Much can be stockpiled and these can be maintained current with projected life expectancy and expiration date. Given the very strict environmental controls these sorts of plants require you could also prebuild empty facilities ready to be equipped with what you do need in terms of large scale production for any given pharmaceutical. Agility is the goal.
The big thing to be avoided at all costs is to have some sort of stampede for a specific vaccine production and have a whole bunch of dilettantes trying to milk the same supply chains for the same necessities. That cure is worse than the disease and it never works out. It is a much better strategy to let any organization that does know how to do anything scale up their own production. Just provide the tools they need.
This patent author and biopharma manufacturing research scientist says ENDORSE
I'm 100% in favor of a much bigger pandemic response.
But it shouldn't be part of the BBB. You could almost certainly get bi-partisan support for a big pandemic program. But of course they don't want that, they want to tie it into the highly partisan BBB so probably nothing happens.
IMO, you want to reform the CDC so it's only job is infectious disease. Don't get distracted on lifestyle diseases, leave that for someone else.
And provide steady long term funding in the bill so we can protect the future.
That should include capacity funding for testing, PPE, and vaccine production. Possibly with extra workers being trained in the national guard, or army reserve to staff the extra production when needed
For as much as I agree with parts of this post, there are so many flaws.
Begin with the skewed priorities of BBB: "But even perfectly worthy ideas like larger maximum Pell grants ($11 billion), expanding the Low-Income Housing Tax Credit ($12 billion), or electrifying the federal vehicle fleet ($9 billion) are not three or four times as important as reducing the odds of future pandemics."
Yes, they are. They're addressing concrete issues with practical solutions that will yield actual benefits. A future pandemic is theoretical, especially one on the scale of the Spanish flu or COVID. It's hard to prepare for theoretical risks, especially when there's no assurance that the funds you put in now will yield benefits later. And we have lots of equally dangerous "theoretical" threats.
The San Andreas fault is going to go some day, busting the California aqueduct and depriving southern California of water. Should we put in spare desalination capacity to replace all that flow? The New Madrid fault is going to go again some day, with up to a 50% chance of up to a 7.0 magnitude in the next 50 years (and maybe a 10% chance of an 8.0). That will bring down every bridge in the Midwest (and probably every tall building). (https://www.sccmo.org/705/About-the-New-Madrid-Fault) Should we be reinforcing all ~3500 bridges in that part of the country? Terrorists may get MANPADs and be able to shoot down airliners. Should we install anti-missile warning devices on all planes? And maybe chaff dispensers or IR spoofing devices?
Oh, and asteroids crashing into the earth as well.
It's so easy to waste money on preparing for low probability/possibly distant events. "We need huge amounts of excess capacity in vaccine manufacturing. . . " No, we don't. Because it will not be kept up. Oh, maybe for five years or even ten. But trust me, more than ten years from inception to need will lead to decrepit, unusable facilities, as no one wants to pay to keep them up after COVID has become a distant memory. Should we do R&D on super vaccines? Sure! Scientists are great at R&D. But otherwise: nope.
And lastly, as someone who worked military logistics for decades, I appreciate the callout to that old expression about amateurs and professionals, but perhaps more telling and appropriate to the discussion is what is known as "the logistician's lament":
"Logisticians are a sad embittered race of men,
very much in demand in war, who sink resentfully
into obscurity in peace. They deal only with facts,
but must work for men who traffic in theories. They
emerge during war because war is very much fact.
They disappear in peace because, in peace, war is
mostly theory."
(https://www.globalsecurity.org/military/library/report/1989/HGJ.htm)
Exactly. *Some* day (soon, I hope), we'll be entering the "peace" of the post-COVID world, and we'll return to the land of theories, which very much will not have any time or resources for maintaining the infrastructure for the next huge pandemic, may it come not soon at all.
Southern California absolutely *should* have *some* sort of backup system, but I assume the cost-effective version is a few big reservoirs that can store several days (weeks?) of water until a repair is available.
On the New Madrid thing, there are some bridges that *should* be reinforced to ensure they can survive such a quake (I would particularly prioritize the Eads Bridge and the I-40 bridge and some others), but not *every* bridge.
I think it's absolutely a good thing that NASA is spending some amount of money learning how to divert an asteroid (https://www.nasa.gov/planetarydefense/dart), though given the amount they've spent cataloging all the near-earth objects and showing that there aren't many that pose a threat, they don't need to spend a lot on this.
We shouldn't spend unlimited amounts on pandemic mitigation, but it's almost certain that any bit of effective spending would produce more good over the next 50 years than electrifying the federal vehicle fleet before the current vehicles get replaced anyway.
Sure, you can't take care of every possible contingency, and rational cost-benefit calculations should drive you to doing those things of greatest value, as you note. But we aren't doing those things, while we sit here discussing massive preparation for the next great pandemic. Why? Because of the availability heuristic. It's important to spend lots of money on the next pandemic because we're in the present one. But the last big LA earthquake was 1994,(*) and New Madrid was 1812. Yawn.
And in 10 years pandemics will be a big yawn as well, so any requirement for continued large-scale spending will be buried by new "availability heuristic" priorities.
And meanwhile, I think electrifying the federal vehicle fleet is a great idea.
(*) Right after the Northridge earthquake, everyone was convinced another big earthquake was imminent (many moved away; others did their one-time emergency prep). But geology doesn't care about the availability heuristic.
Are we not doing those things? Does Los Angeles not have substantial capacity in its reservoir system? Are all the bridges in St. Louis seismically unsound? I assumed these things had been done, even though we haven't done the maximalist versions you were mentioning.
(1) No. We don't have enough to get through a drought. Also, there are few reservoirs in the LA area; we're reliant on out of area reservoirs and other sources (like the Colorado river).
(2) It's been a while since I drove through the New Madrid fault area, but the last time I did, I was struck by the spaghetti-thin poles holding up the bridges (compared to California Hulk-like supports). From my reading (e.g., https://www.nehrp.gov/pdf/SeismicWavesMar08.pdf) some work has been done, but only preliminary (e.g., Emerson Bridge) and only up to some level of a big earthquake. If it's above 7.0, good luck for the I-40 bridge. And that may be the smartest thing to do! You can't cover every risk. Which is my point on future pandemic spending.
Yes we actually should be preparing for unlikely but catastrophic events. Or at least do some kind of cost-benefit analysis. But human beings are terrible at planning for the future. At least we are good at adapting to the present.
re: this is a BFD -- would it kill you to footnote BFD with credible estimates of the death toll (17.5 million per https://www.economist.com/graphic-detail/coronavirus-excess-deaths-estimates) and of the financial cost (ranging from $7 trillion to $16 trillion per https://www.rand.org/pubs/research_briefs/RBA769-1.html and https://news.harvard.edu/gazette/story/2020/11/what-might-covid-cost-the-u-s-experts-eye-16-trillion/ respectively)? Thanks.
That wouldn't make it more persuasive, though, because that's not the sticky part of the argument. Nobody is disputing that if there was a surefire way to avoid another similarly deadly, costly pandemic by spending $100 or $500 billion it would be worth it. But on that, the devil really is in the details, that's the difference between a good use of money and a wasteful boondoggle that absorbs huge amounts of resources to shadowbox against a threat that may not materialize or may occur anyway.
On a slightly related note, I do not understand why so many people were so quick to jump to the "equity" point regarding Omicron...
First of equity proponents argue that equitable distribution is the best way for rich countries to protect themselves from variants. However, even if given perfectly equitable distribution (i.e. no boosters until the first course gets to everybody) to everyone who wants one, the anti-vax population is easily sufficient to be a breeding ground for new variants. So people in rich countries are clearly better off taking the boosters.
From a moral perspective, it clearly is "wellness optimizing" to prioritize old people in developing countries over kids in rich countries. However this is not the way calculations are performed for anything else... nobody blames people in the UK for getting much better cancer treatment than someone in Niger. In fact, the "Left" argument is that the US is a terrible country for not paying for its own citizens to get better healthcare, but there is no similar push to distribute more resources to Mozambique or whatever.
I think from a political perspective the reasoning here is obvious... from a station of abundance rich people and rich countries will spare relative scraps with developing countries. But if they are asked to make a real resource sacrifice it's not going to happen. Some journalists and public health people seem to have somewhat lost their minds on this though and are arguing that it's feasible to convince rich countries to sacrifice their own health and their kids health (even a little bit) for the sake of people an ocean away. Again, this is probably not a morally defensible position but its how basically every country has operated forever.
If we want to help people in developing countries we should try to get to a position of abundance.
I think it was people who were saying several months ago that the US (and other wealthy countries that had more than enough vaccines) should be making more of an effort to get vaccines into arms in poorer countries since that's where variants were more likely to emerge.
For example: https://www.slowboring.com/p/rochelle-wolensky/comments#comment-2209059
I would add that there appears to be a fanciful assumption that vaccines will be distributed quickly and equitably once they reach poor countries.
Hey now, "old-fashioned" affection for pure military history?
“Amateurs talk strategy, professionals talk logistics.”
Unrelated to the topic of the post, which is very good and important, Matt, have you read Daniel Immerwahr's *How to Hide an Empire*? I think you'd like his stuff about logistics.
From my experience working DoD logistics, I found this expansion sadly relevant:
"Amateurs talk strategy, professionals talk logistics, experts talk finances and gurus talk coding."
It's amazing even in a war (like Iraq) how much financial controls guided logistics outcomes and even more how coding issues in logistics software tended to have dramatic impact on the performance of the entire logistics system.
This stuff is depressing. If we couldn't beat back Covid due to people not wanting masks or a few antivaxxers, we could just blame it on them. However, this all seems entirely solvable by Democrats. Fix the funding mechanisms, maybe do what the Reagan Administration did in the 80's and yell at the CDC and FDA to cut it with the parochial, overregulatory bs, message to the public that actual technological fixes are coming, make tests as cheap and easy to get as in Europe, and talk about ventilation. The last one especially gets me. It seems like no mentions it much, even though good ventilation and filters can do a lot, but instead it all leads back to masks and idiot anti-vaxxers.
Spot on re: ventilation. We're in a liberal area and our school superintendent talks about frequent bathroom cleanings, handwashing, and masks, but no HEPA air filters.
It’s way easier to criticize identities and behaviors rather than come up with solutions and implement them!