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Okay, onward!
Rahm Emanuel was famously against letting a crisis go to waste. Cynical, yes, but it gets to a deep truth: significant changes are often driven by crises.
For example, the Great Depression spurred creation of the Securities and Exchange Commission and the FDIC in the US. Edward Jenner invented vaccination because people were willing to try anything to stop smallpox.1 Astronauts reached the moon because the US and the Soviet Union were in a Cold War and willing to fund literal moonshots to come out on top.
Reforms are simply easier during and after a crisis: politicians may put aside differences and work together (so funding becomes available), people may be willing to make sacrifices they would never consider in normal times, and in general, lots of roadblocks and red tape that typically would slow or stall change are cleared away.
It can’t all be good.
True. Crises are also dangerous for the same reasons. It’s easier for a demagogue or dictator to seize power during an emergency. It’s easier for bad laws to pass and undermine the values a society previously held dear. And some of our crisis-driven inventions can prove terrifying, like nuclear weapons.
Whether danger or opportunity, it’s normal for crises to generate change at a faster pace than normal. We saw that during the COVID pandemic with rapid vaccine development and rollouts.
But we also saw something disturbing during and after the COVID pandemic, a sign of what I’ll call a failed crisis: the devolution of pandemic readiness, especially in the US but to some degree in some other countries, too.
Not just letting a crisis go to waste but letting a crisis leave the system worse off than before?
Yeah. I think the world is less prepared for a new pandemic than we were in 2019, for several reasons:
Polarization around the effectiveness of and approach to COVID lockdowns, vaccines, treatments, and masks
Emergent doubts about the CDC’s and WHO’s much-vaunted capabilities
Disparate impacts of COVID on different socioeconomic classes
Lingering questions about the origins of the pandemic
Individual burnout with regard to pandemics
Exhaustion of government and industry appetites for emergency spending
Let’s talk more about polarization and trust, which seem important in terms of why this crisis felt so difficult. I remember feeling, very clearly, that I was on my own in winter and spring 2020. Hospitals were overloaded, tests were scarce, information changed every week, and political interests polarized what should have been a straightforward scientific message. Institutional trust fell, sometimes for good reasons (as just one example, the CDC’s early test-kit failures and slow responses as the disease stormed across the US were shocking—but the CDC was also struggling to gain political support amid a global emergency, which is a bizarre position to be in).
So, it was a mess-and-a-half. What about the next time a pandemic arises?
If another pandemic happens anytime soon, there will likely be even more doubters than last time, and less readiness to open public funding coffers. Recent tensions would likely rise to the surface and ignite, immediately complicating the response.
Can we turn this around before another pandemic strikes? As I wrote in Emerging Risks and Smart Regulation, there are ways to build trust proactively—and if we need anything right now, it’s greater trust in our institutions and in each other. For pandemic preparedness, that could mean:
Strengthening communication among local, state, and federal public health departments and helping them proactively build trust with communities.
Cutting red tape for testing, reporting, and treatment of various diseases.
Setting up rapid-response channels designed to take early reports from doctors seriously and act fast to investigate.
Banning gain-of-function research (whether or not it contributed to the COVID pandemic, gain-of-function research poses significant risks that may not be worth the potential benefits).
We’re not destined to fail in the face of another pandemic, but we are less prepared than we were in 2019. That isn’t set in stone, though. The things that went wrong with COVID don’t have to define the future. That’s risk management in action: learning from incidents and addressing root causes to improve resilience for the next time.
Before Jenner’s breakthrough, lots of people used dried smallpox scabs or pustules for immunization and risked the disease itself for the chance to avoid it. That was called inoculation, and it was way worse than vaccination.
New Zealand was, on paper a lot less prepared than the USA. We still have some polarisation and presumably some burnout among healthcare workers, but nothing like at the level of the USA, so I'm not sure if we are better or worse off now.
One thing that fascinated me about the story of the smallpox vaccine was the fact that even after Jenner's vaccine, some people preferred the old approach using smallpox scabs. Also that there was plenty of anti-vaccine sentiment despite the massive risk of smallpox and the effectiveness and comparative safety of the vaccine.
This was well written. A little bit journalistic, a little bit of opinion. I wrote about Jenner and smallpox a long time ago from a different angle. Even after 225 years, our objective minds know vaccination is an amazing thing yet we still fight it tooth and nail! Not that different from very well educated people, despite enormous evidence, still wedded to a young earth. It doesn't seem to have much to do with what we know but rather what we were taught and have locked in our heads and identity. I genuinely believe crazy lefties led society to vaccine hesitancy. Once Trump was in office, magical thinking led to them changing sides. It was never what was objective, it will often reside in feelings and tribalism.