February 29, 2020


The unpalatable lesson of coronavirus: dictatorships can be effective: The discipline of public health inherently prioritises the collective good over individual freedom (Elizabeth Pisani,  February 28, 2020, Prospect)

Tedros has taken flack for his apparently contradictory stance: calls for transparency and solidarity on the one hand, praise for Beijing's authoritarian response on the other (roadblocks around major cities; potentially exposed people frog-marched to testing). Chinese social media is awash with images of him as the dog of President Xi Jinping. But his position highlights something we in the global health mafia do not admit: the discipline of public health inherently prioritises the collective good over individual freedom. Authoritarian regimes trample on individuals, but can also be good for public health.

Public and private welfare are not necessarily in conflict, and in the long run too much trampling is bad for everyone. But at the start of an outbreak, when resources are scarce and knowledge scarcer still, the authorities are never going to have the luxury of engaging in broad community consultations that might lead to a fair balance of interests. Their first concern is bound to be to avoid unnecessary public panic (the charitable view) and/or (more realistically) to save face and avoid damage to the economy. Hence the counterproductive early cover-up. When they can no longer close their eyes to the possibility that a new pathogen poses a real threat, however, those rare governments that care about the public good and have the clout to impose their will tend to do so rather rapidly. They'll do this even if it means sacrificing temporary freedoms, welfare or, in extremely unhappy cases, the lives of some individuals. Those sacrifices are emotionally devastating: witness the outpouring of fury over the injustice done to doctor Li--co-opted as a heroic whistleblower by the state only after his death, and long after it had tried to shut him down. But in terms of putting a brake on the spread of a pathogen of as-yet-unknown virulence, it behoves us to admit that they're probably quite effective. When Tedros says "in many ways, China is actually setting a new standard for outbreak response," he's not just flattering Beijing.

Tedros's two-faced messaging highlights another fact, too: the WHO can't impose its will on its shareholder states, and tiptoes especially carefully around the more powerful of them. China will play ball internationally if and when it suits its interests. Chinese scientists quickly shared eye-watering amounts of genomic data, for example, not just to show off the country's extraordinary capacity for sequencing, but also in the hope that others would use it to speed up the development of new diagnostic tests, therapies and vaccines. It has been stingier with clinical data, which is needed to predict the course of the epidemic, but which also tends to highlight weaknesses in local health systems. And there's not a damned thing the WHO can do to get that data.

There are already anecdotal stories about anti-vaxxers hysterical over the prospect of mandatory vaccinations.  Tough.  Such precautions are a simple function of human society.

Posted by at February 29, 2020 7:08 AM