The Health Governance and Management Needs of the Global Economy
The pandemic we are living under will continue until medical technology is developed that either prevents or treats COVID-19. When that happens, the same economic and technological forces that created the global economy will reassert themselves.
Global supply chains are built on the differentiated advantages of local natural resources, culture, educational systems, social norms and skills. The quality and cost advantages of these supply chains dominate the savings in transport provided by supply chains limited by national borders. Just as the virus can’t be stopped by a national border, global capitalism is also quite clever at avoiding barriers to trade. Production efficiency and effectiveness are like rivers pulled by gravity and flowing toward the ocean. They have a momentum that is difficult to resist. This is because people like to buy higher quality and less expensive goods and services and corporations are designed to make money. Companies search globally for the best talent and supplies, which is why trade and immigration continue in the face of xenophobic and authoritarian propaganda. People also remain curious and want to visit places in the world that are different from the places they live. This is particularly true of young people. The global economy may be down, but it is not out. The low-cost communication and information system that makes images and information accessible to nearly everyone is the conceptual infrastructure of globalization and it is quite impervious to the pandemic.
The threat posed by this and future pandemics has some people predicting the end of global travel and commerce and an insular, rural world of human isolation and reduced commerce. Coupled with the reduction in global contact and commerce, many predict easing of requirements to protect the environment. To some, global travel and environmental protection are seen as luxuries of the “Pre-COVID” era. I don’t think so. Humans are social creatures who like to explore new places. People also like to breathe clean air, drink safe water and eat healthy, tasty food. Moreover, people and societies have proven to be quite resilient. I live in a place where hijacked airliners were flown into twin towers, killing thousands of souls and changing our way of life forever. September 11, 2001 was a sudden and horrific act of terror. And we will never be the same. But we are still here. We learned, we adapted. We spend a great deal of money securing our buildings, cities, infrastructure and transportation systems. Now, we will need to treat virus and disease transmission as the serious threat to our way of life it has proven to be. September 11 was a single, transformative day. COVID-19 is a slow-motion invisible enemy. But it too will prove to be transformative.
Once we gain control of this pandemic, we need to do a much better job of containing the next one. Each new disease must be studied to learn how to prevent and treat it. That means we must spend more on medical research — and the effort must be global and far better managed than the one we’ve seen with COVID-19. Second, when we identify a new virus, the traditional public health techniques of testing, tracing and isolation must be implemented immediately and aggressively. Until we have a way to prevent or treat a new disease, this must become as routine as a security line at the airport. This requires organizational capacity that is well resourced, competent, global and apolitical. That will not be easy to do. But trillions of dollars of costs have gone into COVID-19 response and impact and certainly preventing another one of these is motivation enough.
Money alone will not build the organizational capacity needed to protect us from future pandemics. New York City’s initial experience with contact tracing is instructive. It began with New York City’s Mayor removing the function from the city’s contact tracing experts in the Department of Health and Mental Hygiene and moving it to the Health and Hospital Corporation which had never built this capacity before. This move underestimated the difficulty of developing a contact tracing organization. An initial indication of the success of this effort was provided by New York Times reporter Sharon Otterman this past Sunday when she observed:
“New York City’s ambitious contact-tracing program, a crucial initiative in the effort to curb the coronavirus, has gotten off to a worrisome start…The city has hired 3,000 disease detectives and case monitors, who are supposed to identify anyone who has come into contact with the hundreds of people who are still testing positive for the virus in the city every day. But the first statistics from the program, which began on June 1, indicate that tracers are often unable to locate infected people or gather information from them. Only 35 percent of the 5,347 city residents who tested positive or were presumed positive for Covid-19 in the program’s first two weeks gave information about close contacts to tracers, the city said in releasing the first statistics.”
It may be unfair to judge a program after two weeks, but the point is that public health capacity must be built, and this takes time and expertise. It must also be shielded as much as possible from political influence. We need a more robust system of global, national, state and local public health organizations. Global institutions are particularly important, and if the World Health Organization can’t do better than it has done with this pandemic, then it must either be re-engineered or replaced.
In the post-World War II world, the development of such institutions benefited from American leadership. Even if America manages to rebuild its capacity for global engagement in 2021, it would be better if the new global public health system was led by a combination of powers including the European Union, China, India and other world powers. An effective system of global public health is a prerequisite for a thriving global economy. My hope is that people will come to understand our dependence on the science of disease in order to maintain and develop economic well-being. My further hope is that a deeper understanding of medical science will provide some of the scientific literacy needed to understand the science of climate change and environmental sustainability. We live in a complex, interconnected world and we will only be able to benefit from that complexity if we understand it and learn to manage its negative impacts.
The global public health system we need will not be pretty. Just as post 9-11 security was intrusive and inconvenient, health security will probably be worse. And one of the costs of that security will be yet another piece of our liberty. This is a real trade-off. Just as our cities and buildings are loaded with security cameras, and just as we are questioned when we enter airplanes and office buildings, we will soon find our bodies scanned not just for weapons but for disease as well. I am not happy about any of this, but the lockdown of the past hundred days has not been a picnic either.
Action on pandemics, ecosystem destruction and climate change needs to be seen as part of a redefinition of national and global security. Government’s fundamental function of providing for public safety requires far more capacity than that required to fight an opponent’s military attack. We can be attacked by disease, extreme weather, and a wide variety of threats to our air, water and land. As FDR learned during the Great Depression, we need an active and capable government to provide the foundation required to reap the benefits of capitalism. We don’t need a huge, unthinking bureaucracy, though. The organizational capacity we need can be steered by government but staffed by private and nonprofit contractors. But our security will cost money and tax revenues will be required to provide those funds.
The global economy is here to stay. The benefits far outweigh the costs and its economic and political power is derived from those benefits. We will see additional threats to human and environmental health. Our security and economic well-being depend on us developing and maintaining the institutional and organizational capacities to prevent and respond to these threats.