In October 2019, a group of epidemiology boffins compiled the Global Health Security Index, which ranked countries according to how well prepared they were for a global pandemic. The US came top, and the UK second. As of early May 2021, there have been nearly 600,000 deaths in the US and 127,000 in the UK, compared with 10,000 in Japan, 1,800 in South Korea, and 26 in New Zealand. What went wrong?
What went wrong was that the US had a plan, but no one dared to use the plan until it was already too late. Michael Lewis, author of The Big Short and Liar’s Poker, has done what he usually does and turned a complex subject into a fluid intellectual thriller in The Premonition. The meat of the story happens before the Covid outbreak, following a motley gang of maverick doctors and scientists as they overturn the received wisdom – that nothing can be done about a novel flu epidemic apart from waiting for a vaccine – and write up a detailed playbook for the White House, before watching in disbelief as no one asks to see it, and scrambling themselves to pull together the threads of America’s fractured and dysfunctional health system.
As always with Lewis, the book is full of fascinating facts and personal angles: the idea that closing schools, if done early enough, can help stop an epidemic in its tracks came directly from a teenage girl’s entry in her school science prize. (Laura Glass built a clever mathematical model with the help of her programmer father.) The book’s heroine is a fabulously determined Californian public health official who glories in the name Dr Charity Dean, and about whom Lewis’s prose occasionally goes rather soft-focus. And there are villains, too: Lewis excoriates in particular the scientific bureaucrats who moved far too slowly, always intoning the mantra that there was not enough evidence. But of course there will never be complete evidence about a newly discovered pathogen. And when you’re fighting a fire, you don’t wait for perfect data.
Though the final part of Lewis’s book is a rather parochial, wonkish story about American institutions, there is a global lesson about political incentives. Lewis doesn’t mention it, but the much-misunderstood story of the Y2K bug is quite relevant here. In the years leading up to the year 2000, people realised that the legacy computer systems still used in aviation, power grids, and much else besides encoded the year in their internal clocks with only two digits. So after "99" the counter would flip around to "00", and cause unexpected and possibly lethal behaviours. People talked of planes falling from the sky as the new millennium dawned.
Of course, none of this happened, which is why Y2K is most often cited as an example of unsubstantiated "project fear". But what really happened was an awful lot of money and ingenuity was spent on successfully averting disaster by reprogramming thousands of systems. The problem with that kind of triumph, though, is that some bonehead can always claim that the fact no disaster occurred proves that no disaster was ever likely. So political leaders have little incentive to act quickly and decisively – because what if it worked? Then they would be blamed for all the downsides of lockdowns, school closures and so on, without getting any credit for averting the catastrophe that self-declared "sceptics" could later claim was never going to come anyway, even if it visibly happened in other countries.
And so Lewis leaves us with a troubling thought for the future. Is it possible that the world simply won’t have learnt its lesson this time? Despite three million deaths and counting, this arguably hasn’t been "the big one" that scientists have long known is inevitable, the really devastating disease that is as communicable as Covid but far more lethal – like the 2003 Sars outbreak, which had an 11 per cent fatality rate, around 10 times as deadly as current estimates for Covid-19. What if the big one comes when the airwaves and web pages are still clogged with bloviators claiming it’s no worse than the flu and that wearing face masks is an assault on their freedom of speech? In that case, our species might even deserve the coming cull.