I just started learning The Great Failure: What the Pandemic Reveals About Whom America Protects and Whom it Leavesby Joe Nocera and Bethany McLean. They have written this book before All the Devils Are Here: The Hidden History of the Financial CrisisI found it to be one of the best books about the 2008 financial crisis, so when I saw their new book I was eager to dive into it. I expect I’ll have more to say going forward, but one thing I’ve come across. What stood out to me in the first chapters was the mindset of government officials in the years leading up to the Covid-19 pandemic, and one in particular – Donald Ainslie Henderson. (Yes, I will admit that I purposely made the title of this post a little clicky, at least for the average EconLog reader!)
In the aftermath of the Covid-19 pandemic, it was not unusual to hear people berating the government for its unpreparedness and complete lack of planning in the event of a major pandemic. But Nocera and McLean point out that, in fact, it had been worked on and developed years before Covid-19 arrived in America.
National pandemic response plans were first put together in 2005, because then President George W. Bush read John M. Barry’s book about the 1918 flu pandemic, The Great Influenza. After finishing the letter, President Bush told his officials “Look, this happens every 100 years. We need a national strategy.”
Although this is the first time the government has begun to develop a national strategy in earnest, many have called for this step to be taken earlier, as Nocera and McLean write:
Indeed, for decades a group of scientists had been trying to warn the government of the potentially catastrophic consequences of the plague. The leader of the ad hoc group was an epidemiologist named Donald Ainslie Henderson, or DA Henderson, as he was known to everyone, including his wife.
And Henderson, we might say, knew more than most about controlling the spread of disease:
In 1966, as a thirty-seven-year-old scientist, Henderson took a loan from the World Health Organization to lead a program with a seemingly impossible task: eradicating smallpox, one of the world’s greatest plagues. Henderson became a remarkable leader, and within ten years he and his team pulled it off.
Henderson was brought in to help develop the strategy: “When Bush started pushing his administration to come up with a pandemic plan, Henderson was seventy-eight years old. He had spent ten years as dean of the Johns Hopkins School of Hygiene and Public Health, and had been in and out of government many times.” He joined the “Center for Health Security when Bush began pursuing the pandemic plan. But because of his status, he was included in some of the administration’s discussions. He was not happy with what he heard.”
Why was he unhappy? Henderson was different from most health officials in one very interesting way. He was not what Adam Smith would famously call a system man, described by Smith as follows:
A person of order, on the contrary, is apt to be more intelligent in his own thinking; and he is often so attracted by the perceived beauty of his ideal plan of government, that he cannot deviate the least from any part of it. He continues to establish it wholly and in all its parts, without regard to any great interests, or powerful prejudices which may oppose it. He seems to think that he can arrange the different members of a large society as easily as a hand arranges the different pieces on a chess board. He does not consider that the chess-board pieces have no other goal of movement than what the hand insists on; but that, on the great chess-board—the board of human society, each part has its own principle of movement, which is entirely different from what the legislature may introduce to emphasize it.
Henderson was well aware that people have a “system of motion” all their own, and he tried in vain to make the other officers understand that. One of Henderson’s colleagues, Tara O’Toole, described her thinking this way:
“The DA kept saying, ‘Look, you have to use this,'” O’Toole recalled. “‘And you have to be humble about what public life can do, especially in times that are going on. Society is complex, and you cannot control it.’ There was also the fact that DA and I have been in government for a long time. We had a clear idea of what the government is, what it can do, what it can do.”
Henderson particularly emphasized the importance of decentralized, hands-on, real-world experience rather than top-down planning. His ability to understand this was not part of the reason why his group’s efforts to eradicate smallpox were successful. In planning discussions, he will emphasize the importance of understanding that people are not just chess pieces that can be moved at will:
Henderson liked to say that there are two types of epidemiologists: those who use “shoe leather” – that is, they go out of the office and talk to people to learn about the disease and its spread – and those who use computer models. He was firmly in the shoe leather camp. In meetings to speed up the program, he made his position clear: he was opposed to policy-making based on hypothetical models – which, in turn, were based on hypothetical assumptions. “The things that computers cannot include are the possible effects of various strategies to reduce human behavior and the effect of this epidemic”, he said. “There is very little experience to predict how the people of the 21st century will respond to, for example, the closing of all schools for weeks or months, or the cancellation of all gatherings of more than a thousand people.”
However, the leadership of the pandemic planning team had a very different mindset:
The two men who headed the planning team were Carter Mecher, an official at the Department of Veterans Affairs, and Richard Hatchett, an oncologist who has served as Bush’s defense adviser since 2002. They were smart and dedicated, but had no experience with epidemiology. or epidemic diseases.
Mecher and Hatchett did not share Henderson’s reservations about centralized, top-down systems based on hypothetical models. And that’s putting it mildly:
They finished hugging a model high school student, Laura Glass, built for a science project.
In the end, President Bush’s prediction came true – we had an epidemic comparable to the 1918 flu. And there was a plan, ready to go to Alex Azar, then Secretary of Health and Human Services:
Azar soon began “marching from the pandemic playbook,” as he later put it, which had been written in the Bush administration and revised by the Obama administration. But for all the man-hours spent putting together pandemic plans, the documents were useless. The reality was very different from simulating or practicing a war game.
It turned out that in reality, the “plan” was at best useless, and in many cases very dangerous. While Mecher and Hatchett saw their role as creating a playbook for everyone to follow, Henderson saw the goal as increasing opportunities for people to adjust and adapt in their own way. It’s worth thinking about how different the world might look today if policymakers had taken Henderson’s advice during Covid-19 — or what it might look like today if the effort to end smallpox had been led by people like Mecher and Hatchett.
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