I recently started reading The Great Failure: What the Pandemic Has Revealed About Who Americans Protect and Who They Leave Behindby Joe Nocera and Bethany McLean. They had written the book before All the Devils Are Here: The Hidden History of the Financial Crisisthat I found one of the better books on the 2008 financial crisis, so when I saw their new book I was eager to dive into it. I expect I’ll have more to say about it in the future, but one thing stood out: In the early chapters, the mindset of government officials in the years leading up to the Covid-19 pandemic became clear to me, and of one person in in particular: Donald Ainslie Henderson. (Yes, I must confess that I deliberately made the headline of this post a bit click-baity, at least for the casual EconLog reader!)
In the wake of the Covid-19 pandemic, it was not at all uncommon to hear people protesting against the government for its unpreparedness and complete lack of planning in the event of a major pandemic. But Nocera and McLean point out that plans were in fact being worked on and drawn up for years before the arrival of Covid-19 in America.
Plans for dealing with a national pandemic began to be drawn up in 2005, after then-President George W. Bush read John M. Barry’s book on the 1918 flu pandemic, The great flu. After finishing the book, President Bush told his officials, “Look, this happens every 100 years. We need a national strategy.”
Although this was the moment when the government began to seriously formulate a national strategy, there were many who pushed for this step to be taken earlier, as Nocera and McLean write:
For decades, a small group of scientists tried to warn the government about the potentially disastrous consequences of a pandemic. The leader of the ad hoc group was an epidemiologist named Donald Ainslie Henderson, or DA Henderson, as he was known to everyone, including his wife.
And Henderson, shall we say, knew a little more than most about controlling the spread of disease:
In 1966, as a thirty-seven-year-old scientist, Henderson was loaned to the World Health Organization to lead a program with a seemingly impossible task: eradicating smallpox, one of the world’s greatest plagues. Henderson proved to be a remarkable leader, and in the span of ten years, he and his team succeeded.
Henderson was brought in to help develop a strategy: “By the time Bush began pushing his administration to come up with a pandemic plan, Henderson was seventy-eight years old. He had been dean of the Johns Hopkins School of Hygiene and Public Health for ten years, and had been in and out of government several times.” He joined the Center for Health Security when Bush began advocating for a pandemic plan. But because of his status, he was included in some government discussions. He wasn’t happy with what he heard.”
Why was he unhappy? Henderson differed from most health officials in one particularly interesting way. He was not what Adam Smith would call the man of the system, as described by Smith in the following way:
The man of the system, on the other hand, is apt to be very wise in his own conceit; and is often so charmed with the supposed beauty of his own ideal plan of government, that he cannot tolerate the slightest deviation from any part of it. He then proceeds to establish it completely and in all its parts, without any regard to the great interests or to the strong prejudices that may oppose it. He seems to imagine that he can arrange the different members of a large society with as much ease as the hand arranges the different pieces on a chessboard. He does not hold that the pieces on the chessboard have no principle of motion other than that which the hand imposes on them; but that on the great chessboard of human society each individual piece has its own principle of motion, quite different from that which the legislator would wish to impose upon it.
Henderson was well aware that people have their own ‘principle of motion’, and tried in vain to make other officials understand this. One of Henderson’s colleagues, Tara O’Toole, described his mentality this way:
“DA kept saying, ‘Look, you have to be practical about this,’” O’Toole recalls. “And you have to be modest about what public health can actually do, especially over longer periods of time. Society is complicated and you have no control over it.’ There was also the fact that DA and I had been in government. We had a pretty clear picture of what the government was and was not capable of.”
In particular, Henderson emphasized the importance of managing situations through decentralized, hands-on experiences rather than top-down planning. His ability to understand this was in no small part why his team’s efforts to eradicate smallpox were successful. When planning discussions, he would emphasize the importance of understanding that people are not just chess pieces that can be moved at will:
Henderson liked to say that there were two types of epidemiologists: those who used “shoe leather” – that is, they went out of the office and talked to people to learn about a disease and its spread – and those who used computer models. He was firmly in the shoe leather camp. During meetings to develop the plan, he made his position clear: he opposed the creation of policies based on hypothetical models – which, after all, were themselves based on hypothetical assumptions. “What computer models cannot incorporate are the effects that different mitigation strategies could have on population behavior and the resulting course of the epidemic,” he said. “There is simply too little experience to predict how 21st century populations would respond, for example, to the closure of all schools for periods of many weeks or months, or to the cancellation of all gatherings of more than 1,000 people.”
However, the leadership of the pandemic planning team had a very different mindset:
The two men leading the planning team were Carter Mecher, the gadfly at the Department of Veteran Affairs, and Richard Hatchett, an oncologist who had been Bush’s biodefense adviser since 2002. They were smart and dedicated, but neither had any experience with epidemiology. or pandemics.
Mecher and Hatchett did not share Henderson’s concerns about centralized, top-down plans based on hypothetical models. And that’s putting it mildly:
Ultimately, they embraced a model built by a high school student, Laura Glass, for a science project.
Ultimately, President Bush’s prediction came true: we had a pandemic that seemed comparable to the 1918 flu. And a plan was ready for Alex Azar, then Secretary of Health and Human Services:
Azar immediately began “marching through the pandemic playbook,” as he would later put it, which was written in the Bush administration and updated by the Obama administration. But despite all the man-hours spent drafting the pandemic plans, the documents were essentially worthless. Reality was very different from a simulation or a war game exercise.
It turned out that in practice the “plan” was at best worthless and in many cases actively harmful. While Mecher and Hatchett saw their roles as creating a playbook for everyone to follow, Henderson saw the goal as maximizing the opportunities for people to adapt and adapt in their own way. It’s worth thinking about how different the world might look today if policymakers had followed Henderson’s advice in the age of Covid-19 – or what the world might look like today if smallpox eradication efforts were said to have been carried out by people like Mecher and Hatchett.