These kinds of analyses are generally a waste of time, because the people performing them have no idea about how outbreaks are identified and controlled. They have good intentions, but outbreak control isn't a simple linear world where you know all the variables and you can work with averages. As a result, these estimates tend to have little basis in reality.

Take the numbers from Berstein et al - they're patently ridiculous! "$19 billion to close down China’s wildlife farming industry". Never mind the credibility of the $19bn figure... who's going to tell China to shut down anything? Who think's the CCP are just going to do what they're told? What kind of a plan is this??

If you want to do a cost/benefit analysis, you need to do it by strategy. And there are lots of different strategies.

For example, what's the cost/benefit of a rapid elimination strategy? What's the cost/benefit on having wastewater / sewerage / environmental / random testing in major international ports of entry? What's the cost/benefit of investing in rapid testing manufacturing capacity? Or of training HCWs to implement the strategy?

If you respond quickly, you can reduce the size of the problem by orders of magnitude, and therefore reduce the costs of resolving it by orders of magnitude too. So where does that appear in the analysis? Nowhere, because these kinds of analyses don't allow for it. Instead, they just make vague assumptions about reducing healthcare costs, which is totally unsatisfactory.

I've tried to explain this before...

https://forum.effectivealtruism.org/posts/utE4WqYjjmYDwoiuJ/pandemicriskman-s-quick-takes#u2JxaKrmfJF4hbfh5

Hi Oisín, thanks for getting in contact. Yeah, I’d definitely be interested in joining the chat. Were you guys ever based in Dogpatch? I remember seeing some EA Ireland stuff in there a while ago.

Pandemic Prevention: All Nations Should Build Emergency Medical Stockpiles

All nations should have stockpiles of medical resources e.g. masks, PPE, multi-purpose medicines and therapeutics, and various vaccines (smallpox, H1N1, etc). At the slightest hint of danger, these resources should be distributed to every part of the country. There should be enough stock to protect the people for as long as is required to get resupplied.

The Australians have a national medical stockpile and they started distributing masks from it in January 2020 in response to the Covid-19 outbreak. The French used to have a national stockpile of masks, but they decided it would be more ‘efficient’ to get rid of it, reasoning that if there was an emergency, they could just buy masks from China. Sacre bleu!

Stockpiling is a general-purpose risk management technique which also works for other emergencies such as terrorism, fires, nuclear fallout, and war. If you want to survive in the long-run, you need to build stockpiles!

Interesting. That makes sense. The military are often 'guinea pigs' for testing and experiments.

I expect the cost of this testing would fall over time as our technology improves and we become more precise and efficient in our use of it. But, that is an assumption.

I also think that if we can put these policies in place in the developed world then fewer of these pandemic-potential pathogens will reach the developing world. Had the EU and the USA reacted faster and more competently to Covid, the likes of India and South America could have been spared a lot of cost and suffering.

Pandemic Prevention: We Need Comprehensive Surveillance Testing At All Major Airports

If a Pandemic-Potential Pathogen is to spread internationally, it will have to pass through a national port of entry. If it does, then it will likely leave a trace. Since the air travel network is the major risk for spreading PPPs, we should test airports regularly: wastewater, sewerage, surfaces, and (voluntarily) passengers. Major nodes such as Heathrow, Schipol, Changai, and Dubai should be especially vigilant. If all developed countries were performing comprehensive surveillance testing at their main ports of entry, we could find novel PPPs much quicker and before they had established themselves overseas. This would greatly reduce the risk of all future PPPs, and for pennies in the dollar (if even) when compared to the cost of a pandemic.

Hello! My name is Dermot and I’m from Ireland. Pandemics (and how to stop them) have brought me to the EA Forums.

My professional background is in the financial markets – I am an investment risk manager by trade – so I have none of the skills or training one would normally associate with infectious disease and outbreak control. But, like a lot of people, I started to take an interest in Covid-19 during the first lockdown (what else was there to do?). My initial reaction was that we had screwed this one up, but the long-term question remained: how do we make sure a catastrophe like this never happens again?

Over the following weeks and months (and years, now), I tracked the Covid-19 outbreak through the datasets and the research papers. I reached out to journalists, politicians, and Covid activists to discuss policy reform. I wrote articles for the news media. For a few months, I found myself working on a policy proposal with a group of prominent Irish academics. As an outsider on the inside of academia, it was an enlightening experience.

Over the course of my journey, I became increasingly confident that pandemics were the kind of problem that could be solved – completely and permanently. Unfortunately, that solution would require perspectives and skillsets which seemed to be rare among the prevailing pandemic policy-making establishment… which brought me to EA. Within EA there is a focus on long-term thinking and existential risk management, and these are exactly the kinds of perspectives we will need to solve a problem of this nature.

So, I am here to share my experiences and analysis, but I’m also here to learn from domain experts, to give and receive feedback on key ideas, and to discuss pandemic prevention and preparedness with people who have also spent a lot of time thinking about it. There aren’t many platforms where it is possible to have a rational, informed conversation about the Covid-19 pandemic, pandemic-potential pathogens, and global pandemic policy these days. I’m hoping that I can find that here.

Pandemic prevention is entirely achievable, and within our lifetimes (I’m a Millennial). We can permanently end the threat that PPPs pose to humanity, and I think there’s a lot of potential for the EA community to play a major role in that solution.

Dermot

“Surveillance is a very expensive ongoing cost”

1 Do you have any estimates for that? The cost of annual surveillance is surely a pittance compared to the cost of a Covid-19 pandemic every 20-30 years. We have an insurance industry for this reason. One would also expect the cost of that surveillance to fall over time, and the quality of the info it provides to improve too.

2 The cost of developing, trialling, manufacturing, and distributing 8bn doses of an unproven vaccine to every corner of the world every time a novel PPP is discovered (!!) would surely be more than the annual surveillance costs. It also offers worse health outcomes. Plus vaccines are our last line of defence. If we aim to defend ourselves there, then it is only a question of time before we lose. Global vaccination is, to be frank, an insane approach to pandemic risk management. This, thankfully, is starting to be understood by some prominent epidemiologists:

https://www.oecd-forum.org/posts/entering-the-age-of-pandemics-we-need-to-invest-in-pandemic-preparedness-even-while-covid-19-continues

“the actions you should take upon detecting a new microbe which could potentially be a pathogen are unclear”

First you alert the world to the fact that there is an unidentified / novel pathogen circulating. Then you implement your national pandemic prevention plans. Remember, this is not a scientific matter. Making decisions in uncertain environments is risk management, not science. Real world planning, preparation, resource management, and tactical decision-making in uncertain environments are required to protect humanity from pandemics, but they are not scientific skills. They are not taught to, or by, scientists, so the methods of science are of little value in a crisis. A scientist can tell you what a hurricane is, whereas a risk manager can tell you what to do about it. That's the key difference. But, that's also a major hurdle that we'll need to overcome, as scientists are very influential but also VERY unwilling to recognise the inadequacies of their methods.

“Have you got a more detailed version of why you think this?”

Speed. If an outbreak is growing at 3x per week, then every week saved in finding the outbreak cuts it in size by a factor of 3. The smaller the outbreak when we find it, the more local it will be, and the quicker, cheaper, and easier it will be to contain and eliminate it. Covid had at least a 10-week head start on us, and then we sat around for another month or two before we did anything substantial. The outbreak had increased by many orders of magnitude before we even got started with our responses. With better surveillance we could have picked it up in November 2019, it would have been 1/10,000^th the size when we responded, and the outbreak would have been over by spring 2020 with little disturbance outside of China and a few cities in the EU/USA. Surveillance is speed, and speed is our greatest leverage over PPPs.

Pandemic Prevention: Surveillance Has a Higher Return on Investment Than Vaccines

If you’ve got money to spend on pandemic preparation, put it into better global surveillance, not better vaccines. Surveillance is our radar for novel pandemic-potential pathogens ('PPPs'). The better our radar, the sooner we find the PPP, the smaller the outbreak will be at the time, and the quicker, easier, and cheaper it will be to eliminate it. Vaccines, in contrast, are one of our last lines of defence. If we are to protect ourselves from PPPs in the long-run, we'll need stop them long before we need to resort to global vaccination.

Could we use a supercomputer to model epidemics?

Could we create an epidemic ‘game’ and then trial different scenarios and measures to see which worked best? Something like an 'in silico' RCT for pandemic responses. If so, why have we not done it yet? It would be vastly superior to table top exercises, and seems like it would be as good a use as any for our finite supercomputer capacity.

"Do you have a particular solution to guarantee pandemic prevention that deals with the specific logistical complexities inherent to the task, that can be applied to every country on Earth without being resisted?"

I don't know what you mean by 'without being resisted', but otherwise, yes :)

The complexities are driven by the exponentiality of the variable. The exponentiality is resolved through speed, as I note in the piece. Exponential variables are exponential on the way down too.

"you state your solutions will come in later posts but I think it's better to do that upfront"

We must understand the nature of the problem we are trying to solve before we start designing solutions. Similarly, we lay the foundations before we buy the wallpaper. Patience young grasshopper.

"Given your title I expect to see a theory of change that attempts to address the overwhelming challenges involved"

I cannot speak to your expectations.

The key point of this piece, which is reflected in the title, is that pandemics are the kind of problem that can be solved, in contrast to a problem like hurricanes which we can only hope to endure better.

Having worked with senior academics and policy-makers in my own country I know that this distinction is not well understood among those in positions of the highest levels of influence. Hence, why I take my time in making the point.