Ideas Blog

Few in the public sector foresaw Covid-19, what are we not seeing next?

Image: Nine Koepfer (Unsplash)

Aotearoa/New Zealand needs structured foresight, but a well-resourced foresight and risk ecosystem must be funded to support public sector CEOs in producing newly mandated long-term insights briefings.

Long-term insights briefings

The Public Service Act 2020 requires every departmental chief executive to publish a long-term insights briefing (LTIB) independent of ministers every three years, starting in 2022. These LTIBs should include medium and long-term risks.

The briefings are to be tabled in Parliament so all political parties will have access to their content. Public consultation and extensive feedback is expected. The briefings should be think-pieces that can enhance public debate.

On 1 September 2021, Professor Girol Karacaoglu of Victoria University of Wellington chaired a webinar discussion on these LTIBs. Speaking were:

  • Wendy McGuinness (founder and CEO of the McGuinness Institute)
  • Roger Dennis (foresight and innovation consultant)
  • David Skilling (founding Director of Landfall Strategy Group)

Wendy McGuinness

McGuinness outlined the history of foresight in Aotearoa/New Zealand, noting the previous existence of a Commission for the Future (disestablished in 1982), which she would like to see returned.

She spoke of the purpose of long-term briefings, they should:

  • Include foresight and learnings from hindsight
  • Be filled with curiosity
  • Question the status quo

But McGuinness also highlighted ways in which the LTIBs could fail to deliver their intended benefits. CEOs can be busy, shy, humble, uncertain, not foresight experts, risk averse, and desire political safety. Such traits could obstruct the process.

The briefings might be delegated downward, thereby failing to tap into CEOs insights. They might be postponed, rushed, lack sufficient consultation and collaboration.

Roger Dennis

Roger Dennis noted the volatile, uncertain, complex and ambiguous (VUCA) nature of the world. This state of affairs generates a lot of noise which we must distil.

Past clear examples of inattention blindness underscore the importance of foresight:

  • Nokia had one billion customers in 2006, but failed to attend to the threat of the iPhone.
  • The World Economic Forum’s ‘top 10’ global risks did not include pandemic disease

David Skilling

David Skilling highlighted some small developed countries that have good foresight processes. Aotearoa/New Zealand could perhaps learn from Singapore, Denmark, or Finland.

New Zealand is a unique context, but we don’t have to reinvent the wheel at every step and we should approach LTIBs as an international learning and collaboration exercise.

Skilling distinguished three time horizons, the immediate term, the 5-10 year term and the decades-long term, arguing that the medium horizon is of crucial importance, but the right questions must be posed.

Crucially for LTIBs to succeed, Skilling believes there needs to be Ministerial demand for the insights. Though webinar audience members thought demand could and should come from the public, iwi, DHBs, NGOs and so forth.

In contrast to McGuinness, Skilling thought we should avoid relegating important foresight work to a Commission, and we should build strategic capability across government agencies.

My interpretation

There are many reasons why LTIBs (and similar foresight processes) are essential. Such processes can help identify black elephants (a mix between a black swan and the elephant in the room – think COVID-19), they can help guide big important policy decisions to which they relate.

This is particularly important where there are irreversible decisions, such as decisions pertaining to environmental capital. They can help identify and mitigate large-scale risk (think risks as diverse as climate, biodiversity, biological threats, cyber threats, AI, demographic change, antibiotic resistance, workforce, even volcanism at global choke points), provided they are accompanied by a map of broad strokes solution space to scaffold debate and action.

However, LTIBs will not emerge that are fit for purpose unless there is a sufficient eco-system of foresight resources available to CEOs to aid in their production. Additionally, the LTIBs will not have the desired impact unless they can be digested, aggregated and issues prioritised by a sufficiently competent and apolitical central entity.

Such an entity needs to be deeply involved in the process, guiding CEOs with expertise and providing resources so that LTIBs are aligned with current foresight methods, cover appropriate time horizons, include relevant risks, and are sufficiently creative and curious, or we will merely end up with more of the same. Public, transparent consultation with diverse experts in academia, industry and the NGO sector is of absolute importance.

Part of the aim of such consultation should be to ensure the right questions are indeed being answered. The World Economic Forum’s risk report that omitted pandemics prevented the right questions being asked moving forward.

As Roger Dennis noted, an approximate answer to the right question is better than certainty on the wrong one. People tend to refine what they already know rather than casting the net wider. Swiss emergency management demonstrated this during the cold war with more and more precise models of nuclear fall-out, and an infrastructure programme obsessively focused on underground shelters:

[W]hen looking back at the broader civil defence programme of the period, it is evident that such calculative fastidiousness did not extend to weighing which threats to its security the Swiss nation should pay attention to in the first place. Absent at this point in time are explicit calculations weighing the risk of nuclear war against a plurality of risks. Where evidence of comparative assessment is to be found, the calculative practices at play appear rather loose, and the object of comparison rather limited” (Deville 2018).

Such myopia is dangerous, as New Zealand’s influenza-only pandemic plan demonstrated through 2020, along with a risk register focussed on short time horizons. What is New Zealand’s plan for volcanism at a global logistics choke point? Logistics are a hot topic in a post-Covid world. Or something much more certain and inevitable like the Superannuation burden of our demographic trajectory?

Such fundamental decisions as what to include and exclude from LTIBs must not prevent appropriate public debate on resourcing and prioritisation. I say include it all, in iterative fashion if the task is too great in a first pass. And then facilitate expert debate and prioritisation of the highlights.  

Marketing needed

A programme of marketing is now needed. Stakeholders should be actively primed to give input to the LTIBs, we should expect to be asked. The briefings themselves should be open to wide peer review.

Wendy McGuinness identified five major foresight think pieces that already exist in the public sector, but that these often fly under the radar. Publicization of the LTIBs when they emerge is critical. Ideally, they should be living documents, with a web-portal where stakeholders can leave feedback in ongoing fashion for the next iteration.

It is my view that without critique, peer-review, public input and societal authorization, these reports may simply serve the status quo.

Moral assumptions should be explicit

The reports should explicitly state the values framework within which they are operating. Why were some future possibilities prioritised for elaboration and not others? They should be accompanied by appendices of topics and themes not included, with an explanation of why not. It is one thing to fail to foresee, but to foresee but ignore must be justified to the public. This is a major shortcoming of one of the existing tools for management of future risks, the National Risk Register, which is classified and not open to scrutiny.

An ecosystem is needed with central aggregation

Unlike other countries, New Zealand lacks a surrounding ecosystem of think-tanks, universities, and large companies developing long-term views on a range of subjects.

For the LTIBs to be done well, to overcome siloed orthodoxy and cognitive biases, support for CEOs will be needed. This support needs to be central and apolitical. Commissions are not sufficiently central to the fundamental mechanics of the public sector, can be ignored, poorly funded or disestablished. Central entities such as DPMC, though apolitical in name exhibit features of politicisation, and a lack of transparency.

A Parliamentary Commissioner, with a well-resourced office of talent, answerable to Parliament (with Select Committee oversight), could be tasked with supporting foresight and risk aspects of these processes. Given the major decisions, some irreversible, about the future that could follow the aggregation of LTIBs, there is value in investing in this capability.

The first round of these reports should be written by experienced multidisciplinary teams, include the possible impacts of extreme risks, as well as a search for as yet unidentified problems. High-level mitigation strategies should be proposed for the public to debate.

LTIBs could be a step towards a very positive future for Aotearoa/New Zealand, but only if executed well.

Covid-19 was no black swan, but a paradigmatic black elephant

Photo by Parsing Eye on Unsplash

In the wake of the Covid-19 pandemic, everybody now knows that:

  • Warnings about pandemic disease had been touted for decades
  • Myriad organisations had called for increased health security funding
  • The world ignored all these warnings
  • SARS-CoV-2 emerged in 2019 with dire consequences

The fact that all these warnings were known, yet action was scant, remains difficult to comprehend. Although somewhat perversely, we even knew we would ignore the warnings. Psychological research has shown that these kinds of rare but devastating events are exactly the ones humans tend to overlook. As if to drive this point home, I noted in the news today that a resident of Westport (a New Zealand town flooded by a ‘1 in 100 year event’) even stated that he knew the area had flooded, but thought “the last one was it”.

The ‘unforeseen’ Covid-19 surprise

International organisations such as the UN, WHO, World Bank, and organisations such as the US National Academy of Sciences had made explicit warnings to governments across many years about pandemic and emerging infectious disease risk.

The human and economic impact of pandemic disease had been detailed, and estimated at half a trillion dollars per year (Fan 2017). The measures the world needed to take to detect, prevent and respond to infectious disease had been widely circulated and all the States Parties to the International Health Regulations had committed to implementing them (few contributed substantial resources and few had succeeded by the time Covid-19 struck).

No country was adequately prepared for Covid-19 (Dalglish 2021). The risk of coronaviruses had not been appropriately understood by governments, and many pandemic action plans (New Zealand’s included) focused solely on influenza.

A coronavirus pandemic simply wasn’t foreseen many would cry. We were struck by a black swan.

Covid-19 was no black swan

Black swans, are outlier events that comes as a surprise, have a major effect, and are inappropriately rationalised after the fact (Taleb, 2007).

However, coronavirus pandemics had been identified as a ‘time bomb’ after SARS 2003, and had been specifically workshopped in 2019 at the ‘Event 201’ pandemic exercise. This exercise involved leaders from a number of public and private global organisations contemplating how to deal with a coronavirus pandemic that kills 65 million people.

This table-top exercise took place in New York on 18 October 2019, when plausibly the first cases of Covid-19 were emerging half a world away. Within six weeks a handful of concerning cases were being discussed with alarm by experts on the ProMED bulletin board.

None of this fits the ‘surprise’ aspect of a black swan.

In the face of Covid-19 New Zealand lacked public health infrastructure (Baker, Wilson, & Woodward, 2017), lacked surge capacity (Skegg, 2021), and decision-makers had not previously contemplated the most effective measures ultimately deployed. These turned out to be border closure and comprehensive managed isolation.

In fact, as far back as 2017 two New Zealand academics (the author included) had started modelling the threshold criteria for when border closure for pandemics might be economically rational (Boyd 2017, 2018, 2019, 2020). We approached individuals at the Ministry of Health with a research proposal only to be told that border closure in a pandemic would never be a policy option and as such no funding could be provided to explore the policy in more detail.

Had these ‘left field’ organisms (coronaviruses!) and mitigation approaches (border closure) been pre-contemplated, then ‘off the shelf’ solutions, or at least solution outlines, might have been available at the time the pandemic struck. Appropriate border policies enacted in time might have prevented the mind-bogglingly expensive lockdowns New Zealand endured, and appropriate MIQ protocols might have prevented the second Auckland lock-down.

Historical myopia slowed New Zealand’s border control action leading to a troubled and porous approach amid inadequate legislation and the deficient public health infrastructure (Skegg, 2021).

Shortcomings were not unique to New Zealand and structural and textual failures in guiding regulations and processes at the international level, namely the International Health Regulations, and the World Health Organization generally, had been criticised, and continue to be criticised (Boyd & Wilson, 2021).

We knew the threat and we knew there would be a striking lack of global coordination. Covid-19, and its global ramifications, was no surprise, and therefore no black swan.

The black elephant

Indeed, the Covid-19 pandemic was a paradigmatic black elephant, a catastrophe that was extremely likely and widely predicted by experts, but ignored or simply unspoken (Asayama 2021).

Gupta describes a black elephant as:

‘an event which is extremely likely and widely predicted by experts, but people attempt to pass it off as a Black Swan when it finally happens. Usually the experts who had predicted the event – from the economic crisis to pandemic flu—go from being marginalized to being lionized when the problem finally rears its head’ (Gupta, 2009).

Knowledge about human cognitive biases explains why we ignore these kinds of risks (Gluckman 2021).

Overall, and painfully, not only was the threat of Covid-19 known, but we also knew that we would ignore it. There existed a myopic focus on day-to-day health needs, health policy that considers only the health sector, a reactive, response-focused approach, and lack of attention to future welfare. In general, a reluctance to address catastrophic risks, yet these kinds of risks harbour almost all the harm.

Escaping black elephants

By definition, information about black elephants is widely understood. To properly prepare for them governments must look both outwardly and inwardly.

Governments must engage experts not just policy wonks

Looking outward, we need to see crowd-sourced solutions, the power of superforecasters must be harnessed, and governments need to enlist assistance engaging in problem-finding, rather than mere problem-solving activities. These tasks will require close engagement with:

  • experts in academia
  • industry leaders & technical experts
  • non-government sectors
  • creative sectors

Although sensible plans might already be in place, there is always the possibility (or in the case of coronaviruses, probability) that reality will fall beyond the scope of established plans. Red-teaming approaches are needed, experts should be engaged to try to break existing plans. This requires openness and cooperation.

A percentage of preparatory investment should go to diversifying approaches to outlier events, especially when they are inevitable, as is the case with many black elephants. These days a few tens of millions of dollars thrown at understanding these problems, in order to draw the possibility space of mitigation measures, now looks trivial.

Public sector departments must self-critique

Perhaps more important than looking outward is looking inward. Governments must engage in institutional self-reflexivity and this is a process that must be supported from the outside.

Some of the greatest threats are the processes of governance themselves. These processes can become stuck through entrenchment, inertia, historical myopia, status quo, lack of imagination, ignorance, adherence to ‘best-practice’ and corruption by vested interest.

There must be a continual process of self-evaluation and self-critique. In a world of rapidly accelerating technology and human impact, the days of government departments simply justifying post-hoc their pre-formulated plans must end. A radical revision of risk and responsibility is needed, with diverse inputs and ‘crazy ideas’ articulated in detail and held on file for when they are needed.

National and global catastrophic risks must be the purvey of the population not merely the secret notebooks of Cabinet and DPMC spooks.

References

Asayama, S., Emori, S., Sugiyama, M., Kasuga, F., & Watanabe, C. (2021). Are we ignoring a black elephant in the Anthropocene? Climate change and global pandemic as the crisis in health and equality. Sustainability Science, 16(2), 695-701. doi:10.1007/s11625-020-00879-7

Baker, M., Wilson, N., & Woodward, A. (2017). The Havelock North drinking water inquiry: A wake-up call to rebuild public health in New Zealand.  Retrieved from https://blogs.otago.ac.nz/pubhealthexpert/2017/12/20/the-havelock-north-drinking-water-inquiry-a-wake-up-call-to-rebuild-public-health-in-new-zealand/

Boyd, M., & Wilson, N. (2021). Failures with COVID-19 at the international level must not be repeated in an era facing global catastrophic biological risks. Aust N Z J Public Health, Feb 23. doi:doi: 10.1111/1753-6405.13082

Boyd, M., Baker, M. G., & Wilson, N. (2020). Border closure for island nations? Analysis of pandemic and bioweapon-related threats suggests some scenarios warrant drastic action. Aust N Z J Public Health, 44(2), 89–91. doi:10.1111/1753-6405.12991

Boyd, M., & Wilson, N. (2019). The Prioritization of Island Nations as Refuges from Extreme Pandemics. Risk Analysis, 40(2), 227–239. doi:10.1111/risa.13398

Boyd, M., Mansoor, O., Baker, M., & Wilson, N. (2018). Economic evaluation of border closure for a generic severe pandemic threat using New Zealand Treasury methods. Aust NZ J Public Health, 42(5), 444–446.

Boyd, M., Baker, M., Mansoor, O., Kvizhinadze, G., & Wilson, N. (2017). Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention. PLoS ONE, 12(6), e0178732. doi:10.1371/journal.pone.0178732. eCollection 2017.

Dalglish, S. L. (2020). COVID-19 gives the lie to global health expertise. Lancet. doi:10.1016/s0140-6736(20)30739-x

Fan, V. Y., Jamison, D. T., & Summers, L. H. (2017). The Loss from Pandemic Influenza Risk. In D. T. Jamison, H. Gelband, S. Horton, P. Jha, R. Laxminarayan, C. N. Mock, & R. Nugent (Eds.), Disease Control Priorities: Improving Health and Reducing Poverty. Washington DC: The World Bank.

Gluckman, P., & Bardsley, A. (2021). Uncertain but Inevitable: the expert-policy-political nexus and high-impact risks. Retrieved from: https://informedfutures.org/high-impact-risks/

Skegg, D. (2021). The Covid-19 Pandemic: lessons for our future. Policy Quarterly, 17(1), 3–10.

Taleb, N. (2007). The Black Swan: Random House.

The ‘trivial’ US$165 billion cost of global health security

WHO have launched an intelligence hub which will be a global platform for pandemic and epidemic intelligence.
Unsplash: Martin Sanchez

G20 report shows global pandemic resilience is within reach, but developed countries like New Zealand need to pay our fair share

The G20 Independent Panel’s report ‘A Global Deal for Our Pandemic Age’ finds that US$15 billion per annum could provide some pandemic resilience through interconnected global measures. Our findings suggest another $31 billion is needed annually to support country-specific measures. However, New Zealand’s contribution would be trivial considering it is yet to contribute the expected 0.7% GDP in overseas development assistance.

The world has long known that health security investment is needed

Prior to the Covid-19 pandemic several international organisations provided estimates of how much the world needed to invest in capability and capacity to prevent, detect and respond to biological threats and attain a minimum level of global health security.

These estimates ranged from the very low ($1.9 billion, the World Bank’s lowest estimate) to reasonably substantial ($100 billion for just 67 low- and middle-income countries, by the World Health Organization). Progress had been made through initiatives such as the Global Health Security Agenda (GHSA), via which the USA provided nearly $1 billion in support to 31 low-income countries.

Health security internationally was known to be poor

However, the countries of the world were still nowhere near attaining a minimum level of health security capability or capacity by the time of Covid-19. This was demonstrated by the average global country score of 40.2/100 on the Global Health Security Index (2019), which identified major persisting health security weaknesses, particularly in the domain of ‘health system’ and also with regard to biosecurity and biosafety.

Health security scores did not predict Covid-19 response

Unexpectedly, the distribution of impact of Covid-19 across countries was not explained by GHSI scores. Countries such as the USA and UK suffered greatly yet exhibited the highest health security scores. Other countries, such as Niue, with low scores, remained Covid-free.

Figure source: Baum et al 2021 (BMJ, 29 Jan)

Health security scores are correlated with fewer deaths from communicable disease

That said, our research found a correlation between the proportion of a country’s population dying from communicable diseases, and the GSHI score. This suggests an association with increased health security scores and the ability to deal with internal disease threats.

Figure source: Boyd et al. 2020 (BMJ Global Health).

Global coordination was lacking prior to Covid-19

However, the world as a whole clearly failed to coordinate with respect to Covid-19. There was a lack of integrated disease surveillance, which might have raised the alarm early, there were equipment shortages globally, coordinating global institutions lacked resources to adequately manage a response, and financing to rapidly deploy countermeasures where they were needed was absent.  

At least $15 billion per annum is needed for inter-country measures against pandemic disease

In the wake of Covid-19 the G20 commissioned an Independent Panel to report on financing needs that would adequately ensure preparation to meet future emerging disease threats. The Panel identified that the missing pieces of the puzzle are not internal measures by individual countries, but rather coordinating measures and global public goods. Notably, these inter-jurisdiction factors are not assessed by health security metrics such as the GHSI that score individual countries, and it is logically possible (and indeed was the case for many countries) that isolated high scores for GHSI mask a complete lack of international integration across countries’ preparedness measures. It is not surprising, with hindsight, that GHSI failed to track Covid response.

In broad strokes, the G20 Report found that the following measures should be financed:

  • Global coordination through high-level global governance systems
  • Global institutions that have adequate and secured funding fit for purpose
  • Global surveillance systems that are interconnected
  • Global public goods and financing mechanisms to ensure availability and distribution

The G20 Independent Panel estimates the cost of these measures (and some others) at US$75 billion across five years, or US$15 billion per year. They note that the cost of an event such as Covid-19 is 300-700x this investment. The implication is that the ROI is vast. However, this statistic muddies the picture because the cost of Covid-19 is per event, not per year. If we’re aiming to estimate the cost-effectiveness of an annual investment of $15 billion, we really want to know the annualised cost of (all) biothreats.

Health security investment is associated with increased health security scores and might further reduce death from communicable diseases

In previous research we performed two extrapolations. Firstly, we compared the GHSI scores of countries that had received a share of the United States’ contribution to the GHSA programme. We found that countries receiving this funding scored +6 points higher than matched controls on the 100-point scale. These additional points came at an average cost of US$4.6 million per point. If we aimed to raise all countries to a score of 75/100 this would cost $31 billion and given the relationship between internal communicable disease deaths and GHSI scores (the scatterplot above), this might reduce ordinary communicable disease deaths by 16.7%. Assuming 50% annual ongoing maintenance costs, this programme might cost US$90 billion over five years. We note that this figure is in the same ballpark as the WHO estimates prior to Covid-19.

Global coordination is still needed, and country-specific plus international measures could cost US$33 billion per annum

However, what we’ve learned from Covid-19, and I discussed above, is that the missing piece of the puzzle appears to be global coordinating mechanisms and systems for providing global public goods that can be deployed anywhere and everywhere they are needed, rather than leaving it up to each country to ensure self-contained preparations. This is where the G20’s estimate of a further $75 billion comes in. This requirement must be added to the costs of bringing each country’s internal preparations up to a minimum standard. The total cost might therefore be US$75 billion PLUS US$90 billion, which is US$165 billion over five years, or $33 billion per year.

The return on these investments in health security is likely very good

We can calculate the return on these investments as follows. Our research estimates the annualised cost of all biothreats (including pandemic influenza, SARS, MERS, Zika, Ebola) at US$622 billion. This is excluding Covid-19, which is estimated to cost tens of trillions of dollars, but the inter-covid interval is not clear, so it is hard to annualise the costs across, say a couple of decades. Other estimates have put the costs of biothreats at $1 trillion annually. If we assume even just a 10% reduction in the impact of biothreats due to the measures outlined (eg 1 in 10 pandemics is avoided, or the number of deaths from each is reduced by 10%, thereby saving $62 billion in annual harms) then the ROI is as follows:

(US$62 billion – US$33 billion) / US$33 billion = 88% ROI

If we reduce harms from biothreats by 50% then the ROI is:

(US$311 billion – US$33 billion) / US$33 billion = 842% ROI

The cost of a minimum standard of international health security measures is relatively trivial for developed nations

To put this in perspective, if only the richest billion people on the planet were tasked with paying for this, then New Zealand’s contribution would be $US165 million. Or 0.08% of GDP. Given that the UN recommends that developed nations contribute 0.7% of GDP in development assistance, and given that NZ (in 2019) contributed only 0.28% of GDP, adding this additional contribution is still well within the expectations of New Zealand as a global citizen.

Another way to look at this is at the level of individuals. $33 billion per annum globally is $33 per person for the world’s 1 billion wealthiest people. Health security measures are well within reach for an almost trivial investment.

What New Zealand can do

  • Advocate for global Heads of States meetings to agree to action on biothreats.
  • Act to commit the recommended 0.7% of aid internationally by at least doubling present ODA investments and add an additional 0.08% for pandemic preparedness measures, thereby supporting the G20 recommendations.
  • Enhance our local domestic capabilities and capacities to increase NZ’s and our Pacific neighbours GHSI scores.
  • Stop the endemic habit of public sector departments justifying status quo preparations, and instead cultivate a norm of engaging in continual problem and risk finding and solutions. Ask (of MIQ, health system, pandemic preparedness, vaccine programmes, public goods, global agreements) how can we make this better? Rather than constantly saying ‘our measures are in line with global best practice’. It should simply be obvious that ‘current best practice’ was inadequate.
  • Appropriately incorporate biothreat risk into our National Risk Register and publicly communicate the risks and problems to seek additional innovative crowd-sourced solutions.  

A minimum level of health security is well within reach globally and developed nations must rapidly finance the measures required. The next pandemic could begin at any time.

Why the Covid-19 lab-leak theory is a big deal

Spoiler alert: it has nothing to do with proving the origin of Covid-19, pointing the finger, apportioning blame, reparations, or US-China relations.

The lab leak theory

The lab leak theory, as is now widely understood, is the hypothesis that Covid-19 invaded the human population, not as a result of some ‘natural’ animal-human interaction, but as a result of a coronavirus making its way from laboratory samples directly into the world. The most likely place this might have occurred is at the Wuhan Institute of Virology.

To be clear, the lab-leak theory does not rest on there being malicious intent, or gain-of-function research, or negligence. It is enough that a dangerous pathogen might have accidentally emerged from a high security laboratory to wreak havoc on the world. The lab-leak hypothesis does not depend on human engineering of a virus. A naturally occurring (though no less dangerous) virus could still leak from a lab.

A friend of mine expressed the feeling many people have about Covid-19 origins when she said: “I don’t think it really matters. Pandemics will arise from a variety of sources, what’s more important to focus on if how can we learn (from this experience) how to respond better when they do?”

This is part of the crucial point. But our best response to a pandemic is to prevent them. If we are dismissive of a laboratory origin, then our prevention strategies will overlook prevention at laboratory sites. If the laboratory hypothesis is reasonably plausible, then we ought to invest a reasonable amount in securing laboratories. If we are ever able to elucidate the actual origins of Covid-19 and it was in fact a sequence of events involving a laboratory, then our investment in prevention should specifically target that sequence of hazards.

I personally doubt that we will ever find conclusive evidence of a lab leak. This is partly because the leak may have been a leak of a naturally occurring organism, and partly because any hard evidence in supporting a lab leak has almost certainly been destroyed. We should keep investigating, just in case, but I’m not holding my breath.

The probability of a lab-leak

Without conclusive evidence we must take a probabilistic approach. Authors of one account derived the probability of the Covid-19 pandemic being the result of a lab-leak by imputing known published probabilities across a range of key causative variables. On this principled probabilistic account, the probability of a naturally occurring SARS-like community outbreak originating in Wuhan is 1 in 1000 years, while the probability of a lab-leaked community outbreak occurring in Wuhan is 1 in 833 years. Given that there was in fact a SARS-like community outbreak in Wuhan, one of these must have occurred. This means the probability of a lab-leak origin is 55% and a natural origin is 45%. Even under very conservative assumptions these authors still find 6% probability for the lab leak hypothesis. This is the correct approach to reporting on the origins of Covid-19.

We shouldn’t be pitting one theory against the other to determine certainty, which we may never find, we should be determining probability, which can then guide resource allocation.

Hence the reason why the lab-leak theory is a big deal, and it is a very big deal, is simply because it is plausible, and not only plausible, but perhaps equally likely.

Irresponsible representatives and media

There is almost no greater threat to humanity than a global pandemic. This means that we must avoid them at all costs. Unfortunately, getting to the bottom of the issue has become a partisan football. This is clear when former US President Trump spoke of the ‘China virus’, or through the combative imagery, tone and rhetoric on Sky News Australia when that channel reports on the lab-leak hypothesis.

Much media coverage of the Covid-19 origin story is not helping us prevent future pandemics. In fact, it is probably raising the risk. Too many media outlets are running an attack campaign on China. The effect of this kind of approach is likely to push Chinese officials into defensive mode, counter-offensive mode, and secretive mode. None of this helps us achieve a transparent investigation of the facts. This is a lose-lose strategy, and media outlets running this approach will have the blood of future pandemics on their hands.

Other media outlets are running the opposite campaign. They are minimising the lab-leak theory with faulty logic such as ‘there’s no conclusive evidence for a lab-leak’ (when there’s no conclusive evidence for a natural origin either), or ‘Leading biologist dampens his “smoking gun” Covid lab leak theory.’ Which misses the point that a lab-leak of a naturally occurring organism might not carry a ‘smoking gun’ genetic signature. None of this is helpful.

High-reliability industries and system safety

Many industries depend on ultra high-reliability functioning. These are industries where one failure can have dire consequences. The rate of error needs to be as low as one in a million, or even less. We don’t want any more than one in a million patients to die due to anaesthesia, or one in a million planes to crash, or one in a million nuclear control rods to jam. Ideally the failure rate is even less. In surgery, these are the ‘never events’.

These high-reliability industries, provide a template for the way to investigate causal factors when disaster (or near miss) happens. The process must be a robust, dispassionate, no blame approach. People are error-prone, this is simply a fact of our psychology and biology. Therefore, systems must be engineered to make failure impossible. It is inadequate systems that cause catastrophe because the systems have not adequately protected against error-prone humans.

In laboratory science we never want a dangerous highly communicable organism to infect a human. In fact, the downside is so great (potentially millions if not billions of lives at risk) that we should aim to have complete knowledge of any situations where a laboratory safety failure might possibly have occurred, or is predisposed to occur, or has occurred with 50% probability!

If the lab-leak theory is equally likely to the natural origin theory, then we should assume that there was a lab-leak and spend a decent amount of resource conducting a no-fault investigation into how-possibly it might happen. What causal factors could lead to a lab-leak. This kind of process should draw upon the well-established principles of root cause analysis and failure modes and effects analysis from engineering, as well as human factors principles deployed in high-reliability systems. If any flaw in the laboratory system is identified, then this must be addressed, and the learnings shared with all other labs and also with regulators. All this should occur whether or not we ever find conclusive proof a lab-leak happened.

There should be no witch hunt, there should be no talk of fault and blame and reparations. In fact, there should be a guarantee that no fault will be determined. We want cooperation, transparency and access, but sadly the approach to date has been combative and finger pointing. Representatives’ comments fuel headlines and headlines fuel the agenda of representatives in a vicious cycle. Each actor in this system whether editor or politician has a responsibility for nurturing the conversation in a direction more likely to save future lives than cost them.

Greatest threat to humanity

Covid-19 is, thankfully, a serious but not catastrophic pandemic. Next time we might not be so lucky. An engineered virus, possibly the result of gain-of-function research, could escape a laboratory. It could cause another global pandemic, it could kill a billion people. All this makes the threat from bioengineering a greater, or at least more immediate risk than climate change, a risk equivalent to nuclear war, a risk potentially more imminent than a catastrophic failure of advanced artificial intelligence. Seen in this light the world ought to be far more interested in preventing the next pandemic, far more fastidious about identifying all ways that a virus ‘how-possibly’ might have escaped the Wuhan Institute of virology, and spending far less time and effort waiting for conclusive proof, and seeking to blame, effort that is preventing us preventing the next pandemic.

Even if the probability of a lab-leak at Wuhan is ‘only 6%’, but especially if it is 55%, then decision makers need to pay attention. There is no point waiting for a ‘smoking gun’. Biosafety and biosecurity should be ultra high priority policy domains moving forward.

There is in fact a blueprint for how to begin the process of preventing lab-leaks. The Global Health Security Index (GHSI) proscribes 140 things that countries can do to enhance health security. Many of these items pertain to biosafety and laboratory security, and almost no countries have implemented any of them to date. It is unfortunate that some measures of Covid-19 ‘success’ have not correlated with the GHSI, and hence some researchers have criticised the GHSI’s usefulness. If lab-leak is a live hypothesis, this mindset might mean throwing the baby out with the bathwater.

The Climate Change Commission in New Zealand has recently recommended that changes required to cut emissions to acceptable levels might cost 1.2% of GDP by 2050. At a global level this is US$1 trillion dollars per year. Appropriate investment in biosafety and biosecurity, including contributions to new and needed international organisations probably does not need come anywhere close to this, but such investments are an equal priority given the risks and probabilities involved. It just so happens that US$1 trillion dollars per year is the expected average annual cost of emerging infectious diseases.

Some first steps are obvious, and free. The world banned atmospheric testing of nuclear weapons, and we can ban gain of function research in virology.

SARS-CoV-2: A modern Greek Tragedy?

Cassandra: True prophecies that were never believed

Despite a WHO-led investigation, compelling evidence on the origin of the SARS-CoV-2 virus remains inconclusive. The WHO investigation concluded in favour of a natural origin, being satisfied that ‘asking whatever questions we wanted’ and obtaining answers to these questions ruled out a laboratory leak. Researchers at the Wuhan Institute of Virology stated that they do not keep similar viruses to SARS-CoV-2, and they have appropriate safety training (while not divulging actual laboratory records).

Skeptics of the natural origin theory, on the other hand, say they wouldn’t trust the outcome of the investigation because it was closely overseen by China’s government. In fact a new report just published in the Bulletin of the Atomic Scientists argues in favour of the lab leak theory citing publicly available records of gain-of-function coronavirus research at the Wuhan Institute of Virology that specifically made use of ‘humanized’ mice, to enhance the ability of the virus to infect human cells. Furthermore, there is some indication that risky work was undertaken not in the strictest ‘BSL 4’ laboratory conditions, but in a more lax BSL 2 environment. The full report in all its forensic detail is available here.

So who is right? Where did SARS-CoV-2 emerge from? When there are competing uncertain hypotheses we might employ a principle of parsimony to infer the correct explanation, or we can use a principle based on prior knowledge of conditions that might be related to the event.

Parsimony: Ockham’s Razor

Ockham’s razor is the principle that when solving a problem (or explaining a pandemic), entities should not be multiplied without necessity. Basically, the explanation that posits the fewest moving parts is likely to be the right one. Did the existence of nature cause a pandemic? Or did the existence of nature AND a virus laboratory in Wuhan cause a pandemic. In this case, parsimony would lead us to conclude that SARS-CoV-2 emerged naturally, the simplest explanation.

Prior probabilities: Bayes’ Theorem

However, there is another approach. Bayes’ Theorem allows for conditioning probabilities on known data points particular to a case of interest, rather than merely on background probabilities. For example, the probability of a coronavirus outbreak across scenarios such as:

  1. in a random city
  2. in Wuhan specifically
  3. in Wuhan given the existence of an Institute of Virology
  4. in Wuhan given the existence of an Institute of Virology that is conducting work on how to modify coronaviruses so that they more easily infect humans
  5. in Wuhan given the existence of an Institute of Virology that is conducting work on how to modify coronaviruses so that they more easily infect humans, and in which it is known that laboratory safety protocols are being violated

We see that scenario (5) posits a lot more entities (an institute, a specific project, particular behaviours, etc) compared to merely ‘nature’ and therefore according to Ockham’s razor such an explanation is manifestly unnecessary to explain the pandemic. However, according to Bayes’ Theorem the base (‘prior’) probability of the pandemic being the result of a lab leak must be massively increased given the additional information contained in (5). Furthermore, if we do not find data points that we would expect to find were the natural outbreak theory true, such as evidence of rapid viral evolution in early cases, or evidence of a natural animal reservoir of SARS-CoV-2, then we must revise downward the probability that natural is the correct explanation (even if it is the most parsimonious).

But have details such as those proposed in the previous paragraph been borne out? The article in the Bulletin of the Atomic Scientists argues ‘Yes’. You can read the full article by clicking the link, but here are two key passages.

“No one has found the bat population that was the source of SARS2, if indeed it ever infected bats. No intermediate host has presented itself, despite an intensive search by Chinese authorities that included the testing of 80,000 animals. There is no evidence of the virus making multiple independent jumps from its intermediate host to people, as both the SARS1 and MERS viruses did. There is no evidence from hospital surveillance records of the epidemic gathering strength in the population as the virus evolved. There is no explanation of why a natural epidemic should break out in Wuhan and nowhere else. There is no good explanation of how the virus acquired its furin cleavage site, which no other SARS-related beta-coronavirus possesses, nor why the site is composed of human-preferred codons. The natural emergence theory battles a bristling array of implausibilities.”

These findings would push a Bayesian to downgrade the likelihood of a natural origin from whatever prior probability was favoured. And then, in research funded by the US National Institute of Health, taking place at the Wuhan Institute of Virology:

“Dr. Shi set out to create novel coronaviruses with the highest possible infectivity for human cells. Her plan was to take genes that coded for spike proteins possessing a variety of measured affinities for human cells, ranging from high to low. She would insert these spike genes one by one into the backbone of a number of viral genomes (“reverse genetics” and “infectious clone technology”), creating a series of chimeric viruses. These chimeric viruses would then be tested for their ability to attack human cell cultures (“in vitro”) and humanized mice (“in vivo”). And this information would help predict the likelihood of “spillover,” the jump of a coronavirus from bats to people… The methodical approach was designed to find the best combination of coronavirus backbone and spike protein for infecting human cells. The approach could have generated SARS2-like viruses, and indeed may have created the SARS2 virus itself with the right combination of virus backbone and spike protein… It cannot yet be stated that Dr. Shi did or did not generate SARS2 in her lab because her records have been sealed, but it seems she was certainly on the right track to have done so.”

These facts, along with evidence pointing to unsafe laboratory practices detailed in the Bulletin of the Atomic Scientists article raise the probability of the less than parsimonious explanation.

US Intelligence and Donald Trump

Furthermore, the laboratory project of concern was being undertaken in Wuhan, but was funded by the US NIH. This new knowledge explains some previously puzzling facts. The lab-origin theory (and possible early illnesses affecting lab staff in November 2019 as detailed in the Bulletin) is consistent with the US intelligence services claim that there were cases of SARS-CoV-2 prior to December 2019, as detailed here. President Trump then cited the lab theory as his favoured theory based on the intelligence he had received (see here), and he used a PR tactic of referring to SARS-CoV-2 as ‘the China virus’ repeatedly. This could all have been dismissed as it was at the time as Republican posturing. It seemed unusual at the time that if US intelligence or Trump had a smoking gun implicating the Wuhan Institute of Virology, then given their rivalry with China they would have revealed this to the world. As it transpires, the coronavirus project at the Wuhan Institute of Virology was funded by the US NIH. Had intelligence officials, or Trump himself in the interests of political point scoring made their information public, then the US would have immediately been implicated. The lab-leak theory now explains something that was previously unexplained. Explainability is another marker of a correct hypothesis.

Mitigation Matters

Why does it matter where SARS-CoV-2 originated from, given that it is now here, and everywhere on Earth? The list of plausible origin stories for a situation like COVID-19 has immense practical importance. Because to mitigate such events in the future, we must ensure that at least some of the measures we deploy target the actual sequence of events. If the ‘most likely’ explanation is a natural origin, and we target all future measures at reducing the probability of natural origin, and yet in fact, the origin was anthropogenic, then we may miss the opportunity to lower the risk of anthropogenic catastrophe in the future. Certainty and zealous defence of parsimonious explanation is an extremely risky policy strategy.

Prevention policy and the lose-lose square

In global risk reduction there are often difficulties getting buy-in for prevention, safety and preparedness measures because vested interests obstruct the process (think fossil fuels and carbon emissions). Some policies aimed at mitigation result in someone or some state winning and someone else losing. There may be fear of economic contraction or first mover disadvantage in some domain. Yet in the complex game-theoretic melee of international relations there are lose-lose positions, where no one wins from the status quo. This is where leverage might be gained to help reduce global catastrophic risk. There is a prima facie case, enhanced by the discussion above, that gain-of-function research on viruses capable of infecting humans sits entirely in the lose-lose square. By banning such research we can reduce the risk of technological catastrophe.

Science advances ‘Funeral by funeral’

The article in the Bulletin of the Atomic Scientists made me think of a quote by Max Planck. To paraphrase, ‘science progresses one funeral at a time’. Planck’s idea was that scientists are a dogmatic breed and the only way falsehoods vanish is through the death of their proponents. However, given today’s scenario, this maxim can be interpreted a different way. The ongoing litany of technological catastrophes (think the Bhopal disaster, Banqiao dam failure, Chernobyl disaster, recent ‘Irresponsible’ rocket debris) seem to indicate that death must occur for safety and wisdom to truly advance. It is the funerals of ordinary citizens, victims of hubris (or gain-of-function research), whose deaths may (or may not) lead to safer systems and more precaution. Science may well advance ‘funeral by funeral’.

Greek Tragedy

As one public health physician has recently put it: “The irony is that it was US-funded research, and like a Greek tragedy may have created the end it was seeking to avoid: a pandemic.” Whether SARS-CoV-2 emerged from a laboratory or not, we must be sure that we do not move forward creating the very ends that we seek to avoid.

Island Refuges: How Australia and New Zealand could cooperate to protect humanity from catastrophic biological threats and nuclear winter

Image source: Google Maps

Key Points

  • Biological threats far worse than Covid-19 are possible, even likely.
  • Governments should consider worst case scenarios and contingencies.
  • Risks should be catalogued and published in a form that expresses expected utility loss (probability x impact).
  • In an existence threatening scenario, Australia and New Zealand are the island refuges most suited to seal borders to safeguard humanity.
  • Many practical steps can be taken to ensure that island refuges are a viable option of last resort if a catastrophic biothreat arises.
  • Island refuges in some geographic locations might offer additional resilience against nuclear winter.

It’s no longer surprising news that COVID-19 may be a warning shot that provides humanity the chance and the motivation to address some of the many catastrophic global risks. Our latest research paper explains the rationale and practicalities of island refuges as mitigation.

Biological Threats

Pandemic viruses with high case fatality could potentially infect a majority of the population. Deliberate biological events (DBEs) have occurred before (Millet & Snyder-Beattie, 2017a), will likely occur again, and could pose catastrophic or existential threat to humans. With rapidly advancing biotechnology it is conceivable that an engineered virus might combine features of very high transmissibility and very high case fatality. Multiple engineered viruses could conceivably be deployed simulataneously to achieve close to 100% fatality risk in human populations (Turchin & Denkenberger, 2018). Finally, new technologies such as artificial intelligence could amplify biothreats in many ways (O’Brien & Nelson, 2020).

The threat of a DBE could be partly driven by a search for ‘winter safe’ deterrence (Baum, 2015), or for cheaper alternatives (relative to nuclear weapon arsenals) to nuclear mutually assured destruction. These risks are amplified because the Biological Weapons Convention (BWC) has no verification system (Dando, 2016), and has been violated in the past (Gronvall, 2018). It would only take one unanticipated or accidental event for a bioweapon (or laboratory accident) to become a catastrophic threat.

These risks should ideally be expressed by governments in terms of expected utility loss (ie probability x impact). For example, hypothetically:

  • A 20% probability per annum of an Ebola outbreak that kills 10,000 people, for which the expected utility loss is 2,000 deaths per annum.
  • A 1% probability per annum of a catastrophic biological attack that kills 20,000,000 people, for which the expected utility loss is 200,000 deaths per annum.

Clearly the second threat would be the larger risk and at least some analysis and policy resources should be tasked with better understanding risks like it and how to mitigate them.

Resources could be allocated to risk mitigation in proportion to the expected utility loss, keeping in mind that some mitigation measures will address multiple risks.

We need options of last resort

No preventive or resilience strategy is foolproof. An anthropogenic pandemic of existential magnitude is probably more likely than a naturally occurring one, and the world ought to pursue technologies that ensure safety.

However, last lines of defense may be required, such as refuges. If an island nation closed its borders quickly enough, allowing no one at all in, it could keep the threat at bay, thereby protectively sequestering its population and preserving technological know-how.

Island Refuges

Image source: iStock

Many islands might unintentionally act as refuges where humanity survives, such as North Sentinel Island which harbours a population that vigorously rejects outsiders. However, many such islands do not harbour the materials and know-how to preserve a technologically flourishing civilisation.

Our new research paper poses the question, ‘which islands are most suited to safeguard a population of humans in order that a technologically flourishing global civilisation might be restored after a catastrophic pandemic?’

We explore this question in depth and determine it is Australia, New Zealand and Iceland, but that none of these three islands is yet fully prepared to play such a role in protecting human existence as we know it. Given Australia and New Zealand’s proximity and close relationship there is potential to cooperate on such a project, especially given there is redundancy with four potential island refuges (Australian mainland, Tasmania, North Island and South Island of New Zealand).

COVID-19 taught us that pandemics may reach many remote islands only after some delay, giving such islands a chance to successfully close their borders and keep the disease out. We also know that there were many disruptions to trade and that such disruptions would only be worse in a more severe pandemic. Disruption could be total in a catastrophic situation.

Preparations should be a mixture of specific anticipatory actions, and more generalist responses for all kinds of scenarios.

Refuge preparations

In order to ensure that an island can survive intact through the catastrophe a number of aspects of self-sufficiency and security need to be developed ahead of time. For example:

  • early warning systems
  • food security
  • energy security
  • essential services
  • health security
  • disaster resilience
  • psychological resilience
  • overcoming legal barriers.

Our research paper provides a table of additional possible preparations in the Supporting Material.

Governments should articulate these risks, and possible mitigation measures, crowdsource additional strategies, and begin to evaluate the rationale and priority of various preparations.

Effective military and/or police capability may be needed to repel those determined to try to reach the refuge (who might bring disease with them). This is a weakness many small islands face, however military technology is rapidly becoming cheaper, smaller, more versatile, and autonomous. Still, it would be more ideal for the global community to discuss and recognise refuges ahead of time, and coordinate, perhaps via a treaty or UN resolution, to leave the refuge island(s) alone should a catastrophic pandemic arise. The future of humanity could depend on it.  

Nuclear winter

Robbie Norman: Getty Images

Finally, some refuges might help mitigate nuclear winter. The threat of nuclear war persists. A small-scale war between India and Pakistan could have dramatic implications for global agricultural productivity threatening mass starvation (Toon et al., 2019). A limited nuclear war (<1% of the world’s arsenal) could disrupt the climate for 5-10 years, especially above latitude 30 degrees north (Jagermeyr et al., 2020). A larger nuclear war between the US and Russia could lead to below freezing summer temperatures over much of the northern hemisphere (Coupe, Bardeen, Robock, & Toon, 2020). Large scale nuclear war could be catastrophic with the possibility of human extinction, although there would likely be some survivors notably ‘in Australia and New Zealand’ (Robock, 2010). Supervolcanic or asteroid/comet impact winter may have similar effects (Rampino, 2011; Vellekoop et al., 2014), perhaps, too, a geoengineering catastrophe (Dykema, Keith, Anderson, & Weisenstein, 2014).

This means that it might be sensible for Australia and New Zealand to also consider what might mitigate nuclear winter situations as well. There may be some substantive overlap in resilience preparations for nuclear war and for catastrophic biological risks. This is because we can confront nuclear winter by increasing humanity’s resilience to it (Baum, 2016). In the context of a global nuclear war, island refuge status might be imposed involuntarily.

Island nations such as New Zealand could: stockpile food (including alternative sources) (Martinez et al., 2020), water, sunscreen, fuel, and medical supplies; shielding against UV radiation; and secure telecommunications against electromagnetic pulses or loss of cloud connectivity (Baum, 2016).

The reverse of winter scenarios, extreme global warming, is another catastrophic scenario (albeit probably over a longer timeframe), and if the process is reversible then Iceland could potentially harbour a population safely until the threat has passed.

Amplifying risk factors

There are many other considerations that might help or hinder the functioning of a refuge. The 2021 US Intelligence Global Trends Report, warns of the potential fragmentation of societies and the global order, with the possibility of international trade disruption, groups of countries creating online enclaves, and eroded civic cohesion. This is important because social factors such as the degree of societal ‘tightness’ or ‘looseness’ have been correlated with better and worse Covid-19 outcomes. Mechanistic modelling shows how tightness arises in high threat environments because it’s an advantage. Tight countries do better in threat situations and this only enhances the concerns raised in the US intelligence report. It seems some kinds of social structures and interactions are worth nurturing and other trends must be overcome.

Government action is needed

Governments should invest in teams analysing these very large scale threats and trying to determine with more certainty the expected utility loss. This would allow them to publish risk registers, invite crowd-sourced (public sector, business, civil society) input about mitigation strategies, and to rationally prioritise investment in the context of competing demands. Some necessary preparations might be intergenerational human resilience projects.

Risk and Resilience in Aotearoa/New Zealand

Photo credit: Edge2Edge Media

New Zealand should up its game in risk identification, analysis, and prevention. This is the key message from former GNS principal scientist Kelvin Berryman when discussing a new risks report. He told the Listener, ‘New Zealand is still creating its own disasters waiting to happen.’

The risks report in question was published in April 2021 by former Chief Science Advisor Peter Gluckman and co-author Anne Bardsley. It details New Zealand’s need to address ‘uncertain but inevitable’ risks. The report has garnered media attention such as RadioNZ’s coverage here, and the feature in the Listener available here (paywalled).

The general thrust of ‘Uncertain but Inevitable’ is that governments are responsible for keeping people safe, the New Zealand government has developed a National Risk Register, which allegedly includes maximum credible threats, however this is kept secret when it ought to be public, and that much more institutional transparency and accountability of risk assessment are needed. There should be an apolitical focus on high-impact risks that overcomes three particular failures: (1) risk identification, assessment and communication, (2) human factors (especially issues of cognitive biases), and (3) policy/political dimensions.

I certainly applaud the efforts to improve the scale, scope and transparency of risk analysis in New Zealand. A few additional points warrant mention:

Firstly, it is very notable that the former Chief Science Advisor is critiquing the National Risk Register, one supposes that he was privy to at least some of its contents in his former official capacity, and if he feels the register and/or risk processes surrounding it in Aotearoa/New Zealand are inadequate then we should certainly take note.

Second, the focus on ‘uncertain but inevitable’ risks is surely too narrow. The Listener piece  states that a spokesperson for the Prime Minister said, ‘New Zealand had a good track record of identifying and managing risks and was committed to ensuring public discussion about nationally significant risks.’ However, New Zealand’s approach to risks has traditionally been a reactive one. Even forward-looking endeavours like EQC are designed for the aftermath. A track record, even a good one, is not necessarily good for unprecedented and unexpected risks. Notably, our ‘successes’ with Covid-19, the Christchurch earthquake and so on, were with regard to risks that were neither unprecedented, nor unexpected. What about emerging risks such as biological engineering, misaligned artificial intelligence, solar geoengineering, rising digital totalitarianism, newly discovered risks from space, and the established but unaddressed risks of nuclear, volcanic and asteroid/comet induced winters, let alone technological risks yet to be identified.

Thirdly, the Listener reported that the authors of ‘Uncertain but Inevitable’ believe it would be theoretically possible to have an all-encompassing risk register, however, they felt that such a register could overwhelm its audience, or result in generic or vague risks. I would counter this point by saying that the point of a risk register is to formalise analysis, to be sure the assessment is systematic and comprehensive. But the register needs to record dimensions beyond the traditional coarse ‘likelihood’ and ‘magnitude’ categories. By adding best probability estimates, best impact on life-years and the economy estimates, considerations of tractability, lists of possible interventions and best estimates of cost-effectiveness (all constantly updated as new information comes to hand), then risks can be ranked by expected annual utility loss. A risk budget can be determined, and this budget allocated to the highest priority risks. It may be that the most important risks are not those that we traditionally pour investment into, such as road safety or flood banks, but rather risks such as the next Covid-19 or a nuclear winter. That remains to be determined by the process just outlined. The register would not be overwhelming if we start by addressing the Top 10 risks.

Fourthly, Berryman is cited in the Listener article as saying that we need more and better science communication. There is plenty of knowledge and research about risks, but this doesn’t always find its way into public policy. This is something I completely agree with and at Adapt Research we hope to initiate a New Zealand Human Futures Forum (currently a funding application is under consideration), which would focus on nurturing discussion and information sharing about global catastrophic and existential threats in a way that is relevant to Aotearoa/New Zealand. This risk category is notably absent from almost all risk policy work. We have previously noted this omission at the level of the UN, and locally in the domains of artificial intelligence and catastrophic biological threats. And yet, when the approach taken in point three above is deployed, such risks may be the most rational ones to address.

“Green zones” pave the way to eradication of SARS-CoV-2

Image by x3 from Pixabay

Effective vaccines for COVID-19 raise the potential of disease eradication (elimination at the global level). Adapt Research contributed to a recent blog that considers the advantages and the challenges of eradication. Progressive expansion of “green zones” provide the best chance of eradicating COVID-19 and achieving the associated medium and long-term benefits. Full blog hosted externally, click here to continue reading.

Media commentary on the blog appeared in the New Zealand Herald on 18 March 2021.

The COVID-19 house fire and the unbearable silence of fire alarms

Key Points

  • The World Health Organization (WHO) needs a more proactive and transparent Emergency Committee to raise the alarm in health crises
  • Potentially catastrophic disease outbreaks must trigger a fire alarm, because humans resist action unless a piercing alarm is sounding
  • New international structures for rapid high-level propagation of the alarm are needed to ensure hasty responses
  • It will be necessary to have false alarms to ensure all true threats are detected
  • WHO pandemic advice should be tailored to contexts (eg island nations), rather than one-size-fits-all

WHO? The Emergency Committee

The international health regulations (IHR) provide for the Emergency Committee of the World Health Organization (WHO) to declare a Public Health Emergency of International Concern (PHEIC) in appropriate circumstances.

PHEIC is meant to be a signal to all countries that significant actions, aid and cooperation may all be needed. Critics have lambasted the late timing of PHEIC declaration for COVID-19 and also the opaque nature of the acronym.

The WHO Emergency Committee declared a PHEIC on 30 Jan 2020, not at its first, but at its second meeting, two months after searches for ‘SARS’ had been spiking on WeChat and one month after laboratory confirmation of a ‘SARS coronavirus’ in the context of dozens of cases of pneumonia of unknown origin.

SARS is specifically named in the IHR as a virus of significant concern. The world saw in 2003 how SARS coronaviruses can behave. Surely there was a strong argument for convening the Emergency Committee as early as 1 January 2020 and declaring a PHEIC immediately. We argue this point in our research letter published 23 February 2021.

Unfortunately, key information appears to have been suppressed in Wuhan during December 2019 leading to continued widespread travel in and out of the region throughout January.

With a more flexible decision-making process, able to countenance disparate and informal information sources (WeChat, Google, ProMed, Twitter), and with a mandate to investigate to verify concerning information, things might have been different for the Emergency Committee, and the world.

We need a fire alarm

Fire Alarm Sign

Entities like the WHO Emergency Committee are fearful of unnecessarily alarming the world, so they remain silent for too long. Their function is analogous to a fire alarm, they are supposed to warn us loud and clear of imminent emergency. But fire alarms don’t actually tell us when there is a fire, as Eliezer Yudkowsky has explained. More times than not when a fire alarm sounds there is no fire, and this is how it must be. The threshold for alarm must be set below the threshold for risk so that the alarm sounds for all actual fires. Missing even one fire ends in ruin. The WHO Emergency Committee clearly missed a fire all through January 2020.

The mere sight of smoke (think snippets of information appearing on ProMed, or WeChat, or sidebar news stories) is not enough to compel people to act. This is especially true in a crowded world because of psychological barriers such as the bystander effect (surely someone else will act! I don’t want to look silly…).

Fire alarms give permission to act. If the alarm sounds, it’s OK to leave the building. It’s OK to get the extinguisher. It’s OK to close borders to arrivals from a disease epicentre. It’s OK to put masks on in public. You’re not going to look silly, because the alarm is sounding.

Well-functioning alarms activate at a low threshold and early enough that the fire can still be extinguished. The alarm must be piercing enough that normal activity cannot continue until the alarm is off. Alarms can be switched off right away if there is no evidence of a fire, but the fire brigade has to have time to check the building first.

A case in point was Auckland in February 2021. The city was put into a three-day lockdown in response to three community cases of COVID-19. Some critics said, with hindsight, that it was a ‘false alarm’ and complained that the government was too hasty. But the sight of people suddenly wearing masks, social distancing, and getting COVID tests because of the lockdown ‘alarm’ shows that fire alarms have a purpose. The brigade checked the building, and the alarm was quickly switched off.

PHEIC and prejudice

The issues surrounding the failures of the PHEIC alarm system are discussed in more depth in a podcast published by Nature. In sum there probably should be:

  • More transparency around the activities of the WHO’s Emergency Committee, in particular have the IHR criteria for declaring a PHEIC been met? (we know that Emergency Committees have been inconsistent in this aspect)
  • More powers to investigate/respond to non-official data on outbreaks
  • A ‘traffic light’ system so that PHEIC isn’t simply ‘yes’ or ‘no’, giving the Emergency Committee more powers to raise alert levels early on.
  • An international Pandemic Treaty
  • Reduction in Incentives to NOT report outbreaks (due to fear of economic harm if hotspots are then avoided – perhaps a compensation system could be workable?)
  • Incentives for countries to WANT to set up long-term systems and care about monitoring
  • Incentives for countries to agree to do these things

An industrial inferno: Global catastrophic biological risks

COVID-19 is a serious smouldering house fire, needing constant vigilance to put out hotspots. The next pandemic could be an industrial inferno.

There is a significant difference between a virus that causes fewer than 1% of those infected to die and one that causes 10%, 20%, 50% or more to die. Higher case fatality risk than COVID-19, or even higher than SARS (2003), poses the risk of a global biological catastrophe that overwhelms human systems and devastates society.

In our research letter, we argue that not only should PHEIC be declared much earlier, but that it should be declared ‘with-‘ or ‘without-‘ catastrophic risk. This might be the impetus for even stronger initial measures (such as Wuhan-style lockdowns, or border closure for island nations) right at the outset, with a realistic chance of eliminating the outbreak before it becomes a pandemic.

As successive instances of community transmission and the alert level system in several countries have shown, an initial overreaction can always be swiftly downgraded as information comes to light, but the reverse is not possible.

Pandemic advice: one size does not fit all

Initial and ongoing advice by the WHO following the PHEIC declaration was not context specific. For example, though possibly in line with evidence at the time for some contexts, advising against travel restrictions was completely inappropriate for small island nations. Perhaps even larger island nations such as the UK should have closed borders and pursued an elimination strategy for COVID-19. The UK faces obvious additional hurdles to the success of such a strategy, including dense connections to continental Europe, close proximity to other landmass making non-commercial sea and air access easy, as well as a huge logistical challenge and high probability of quarantine failures. That said, it may not be impossible and the debate was presented in The Guardian.

International cooperation is needed

Former New Zealand prime minister Helen Clark is leading an independent investigation into the global response to COVID-19. Speaking at the University of Otago, Wellington, on 1 Feb 2021, she indicated that a number of her recommendations, forthcoming in May, will centre around strengthening global institutions and connecting top-level decision makers. These connections will facilitate the functions that the world expects of these institutions.

A summary of her talk was published in The Conversation. Clark emphasised that nations must stop trying to go it alone. There is a strong case for multilateralism and the world needs to remove obstacles to a precautionary approach that were evident in China in December 2019, and within the WHO in January 2020.

At the Davos 2021 meeting, Ursula von der Leyen (President of the European Commission) delivered a speech noting that Europe is proposing a biodefense preparedness programme to sit within the new European Health Emergency Response Authority (HERA). The programme will scan for pathogens and prepare vaccines, with long-term predictable funding and public-private partnership. Earlier detection and faster scaling of response is needed. These are positive steps.

However, the solution, according to Helen Clark, must be global, and may need to include a high-level pandemic council consisting of the UN Secretary General, the WHO Director General, and the heads of the IMF and World Bank. This council can immediately agree on a course of action then use their influence to directly contact heads of state, finance ministers, and health ministers to coordinate a response. New Zealand could advocate for such a Council so that it is no longer a cork bobbing in the ocean of audacious whims of individualist global leaders, awaiting the sound of an alarm that will legitimise the necessary drastic action.

Valid Assessment and the Future of Health Security

Birth of the International Health Regulations

After the world failed to contain the 2003 SARS outbreak and it became a pandemic, the 2005 international health regulations (IHR) were born. The IHR included a mandate to report any cases of certain diseases (including SARS) to the World Health Organization (WHO) within 24 hours. Importantly the IHR requires all countries to be capable of preventing, detecting and responding to health emergencies.

Non-Compliance

Prevention and detection clearly failed at the outset for COVID-19. There is some evidence that a censured laboratory report identifying ‘SARS coronavirus’ emerged at Wuhan Central Hospital on 30 Dec 2019. Given the mandate to notify cases of SARS, and given the 2003 experience of a SARS pandemic, the WHO should have been able to declare a public health emergency of international concern (PHEIC) then and there. That did not happen. As it transpired a lack of Chinese transparency, politicisation, and reluctance to report the facts meant that the outbreak was not prevented, nor appropriately detected.

However, the IHR also mandates that countries ensure they are prepared to respond to global health threats. But once COVID-19 spread outside of China we saw how unprepared the world truly was.

This had been known for years. In 2012 only 42 of 194 States Parties to the IHR had self-reported compliance. This meant that 152 countries were not prepared to prevent, detect, or respond to significant health threats. Given the self-reported nature of the evidence, the reality may have been much worse. Two initiatives followed:

Invest and Measure

(1) the Global Health Security Agenda (GHSA) – a collaboration among many nations to enhance health security through investment and knowledge sharing, where notably the US invested nearly $1 billion in the health security of 31 developing nations.

(2) the Joint External Evaluations (JEE) with the WHO, whereby countries assessed their progress in conjunction with external teams, resulting in recommendations.

By 2018 only a minority of countries had yet undergone a JEE. Furthermore, it is apparent that many other factors contribute to health security beyond being prepared to prevent, detect and respond to outbreaks. For example, the quality of the health system and health workforce, the degree to which countries comply with international norms, and the risk environment. The world needed a universal and comprehensive measure of health security to identify gaps and target efforts.

The Global Health Security Index

The Global Health Security Index (GHSI) is such a tool and was used to measure health security capability of 195 countries across 140 items in 2019. The average global score was 40.2/100.

However, to be useful any measure of health security must be valid.

In a paper just published in BMJ Global Health, we report a validation analysis of the GHSI. Highlights are:

  1. The GHSI has face validity, being the culmination of a programme of work that began with a systematic search for factors that underpin health security.
  2. GSHI correlates strongly with measures of the JEE and so is useful for countries that have not yet undergone a JEE.
  3. GHSI correlates moderately with aggregate mortality from communicable diseases suggesting that increasing GHSI might improve disease outcomes.
  4. Countries that received US health security investments have higher GHSI (perhaps indicating the effectiveness of these investments).
  5. GHSI scores are typically higher for countries with past domestic cases of SARS (indicating that countries might learn from prior outbreaks).

Overall, we found that the GHSI is a somewhat valid measure of health security, that is perhaps best used by countries to identify gaps in health security that might warrant further analysis. This is exactly what the authors of the original GHSI report concluded in the same recent issue of BMJ Global Health: The value proposition of the GHSI.

Beyond the GHSI

However, the impact of COVID-19 makes clear that we need to address factors that the JEE and GHSI do not measure and perhaps cannot measure. Institutional knowledge, a sense of urgency, relationships established in living memory, cross-sectoral logistics and resilience, all these factors may be critical to responses, and difficult to measure.

Other overlooked factors may include: root cause analysis of laboratory accidents and near misses; gathering intelligence on biological threats; cyber-biosecurity practices; the capability to strictly manage borders and quarantine; the elimination of wet markets and wildlife trade; and the apparent negative impact of sanctions, federalism, the politicisation of media and misinformation and disinformation on social and mainstream media.

Enhancing health security needs to be one of the world’s foremost projects (in the vein of climate action). This is for a number of reasons:

  • The rising risk of accidental bioengineering disaster
  • The rising risk of powerful biological weapons
  • The rising risk of AI enhanced biological manipulations
  • The likelihood of future pandemics
  • The clear inadequacy of the present IHR to ensure protection
  • The obvious cost-effectiveness of preventing biological catastrophe

How Much Will it Cost?

The cost of bringing all countries up to a minimum level of health security is probably marginal in the context of COVID-19. We found some evidence that that the US investment of a mere $1 billion correlated with significantly higher GHSI scores on average across 31 countries (+6 points overall, +10 for detection & reporting). For context, $1b is only 1/2000th of the initial US Congress COVID-19 stimulus package. The WHO has estimated it would cost $100 billion to bring 67 developing countries up to IHR compliance. Given the stakes (trillions lost to COVID-19) this is a no brainer.

The Path Forward

More will need to be done, especially in light of COVID-19, including structural changes to the IHR, and the process by which WHO declares PHEICs. Developed countries should increase their overseas development assistance to the 0.7% of GDP recommended by the UN and target their own gaps in health security. Many critics have suggested paths forward, see the following links for examples: