While that statement is technically true (most experts thought it would be a flu virus, not a coronavirus), you can’t say we weren’t warned. Back in 2007 for example, the US Department of Health and Services conducted an audit of the federal government’s strategic stockpile, and found only 12,000 ventilators. Aware that this wasn’t enough for even a mid-sized pandemic, and with the memories of SARS and bird flu still fresh in their minds, they put out a tender for 40,000 new devices. The winning bid came from a small Californian company called Newport, who promised to deliver the entire order for less than $3,000 per unit.
This was innovation in action! The government would save time and taxpayer dollars, and Newport would gain the prestige of being a federal supplier, making up for any losses by selling the ventilators around the world. The contract was awarded in 2010, and initially, everything went perfectly. Prototypes were submitted, a design was chosen, all the approvals granted and then in 2012, just as they were about to start production, Newport was bought by a larger medical company called Covidien.
Almost immediately, the project stalled. The margins didn’t look attractive to the new bosses, and they worried that a cheap, portable ventilator would undercut their existing product line. By 2014, Covidien’s executives said they wanted out, complaining the contract wasn’t profitable enough. The government had to go back to the drawing board. This time they went for the safer, slower, less ambitious option, awarding the contract to Philips. It would be another five years before all the approvals were granted, and in December 2019 the government ordered 10,000 units, setting a delivery date for mid-2020.
The rest, of course, is history.
On the surface, the lessons of this debacle, so brilliantly reported by Nicholas Kulish, Sarah Kliff and Jessica Silver-Greenberg, seem obvious. In our last newsletter, we pointed out that the media is scrambling for narrative. In the early stages it was mostly ‘us versus them’ stories. Now though, it’s the human error angle that’s getting the most traction. The schadenfreude is irresistible. A gaggle of (mostly British and American) pundits is rushing forward to explain how their societies have been very foolish during their seven years of plenty. “We were warned again and again that this would happen,” they cry, “and yet we didn’t prepare!”
These are easy pickings; choose-your-own-adventure morality tales about the incompetence of bureaucrats/evils of capitalism/bravery of innovators/greed of overpaid fat cats. Unfortunately, in our quickness to judge, we’re missing a far more important lesson about the limits of our political and economic imaginations. To show you what we mean, we’re going to need to zoom out a little.
The COVID-19 storm has already ravaged several countries, while in others, it’s still approaching. Even as the peak recedes in places like Bergamo, Madrid and Paris, the coffins are piling up in New York, Tehran and London, and the black clouds are gathering over Delhi, Ankara and São Paulo. In Jerusalem, they’ve just closed the Church of the Holy Sepulchre. The last time that happened was in 1349, during The Black Death. Most countries have realised that in order to save lives, they need to keep their citizens at home.
This is obviously the right thing to do. A flattened curve however, is a longer curve, and the longer the curve, the greater the economic damage, since quarantines are contrary to the market’s need for mobility and dynamism. Policymakers are therefore faced with a second imperative: save livelihoods. In the short run, they’ve cobbled together unprecedented fiscal and monetary stimulus packages, but these are reactive measures, and not sustainable. The recessionary spiral is only just beginning, as the initial economic data reveals a cratering of trade, reined-in business investment, cowering consumers and surging unemployment that’s sparing few industries.
Far worse is expected in the days and weeks to come. According to Harvard economist, Kenneth S. Rogoff, it’s shaping up as the deepest dive for the global economy in over 100 years. “Everything depends on how long it lasts, but if this goes on for a long time, it’s certainly going to be the mother of all economic crises.” The world’s nations are walking across a knife edge between an epidemiological and economic debacle, and even if they make it through, they face problems down the line. Releasing lockdowns too soon risks triggering a second wave, as people harbouring the virus spill back into public. Places like Hong Kong and Singapore, having made it through the first wave, are already reporting sharp rises in infections as they loosen restrictions on businesses and re-open borders.
There is an alternative. The sociologist Charles Tilly famously argued that “war makes the state”— and that’s true of pandemics, too. Historically, quarantines have required navies, police and a monopoly on the use of force over a wide area. The 21st century equivalent looks like something out of the worst nightmares of Charlie Brooker: mandatory installation of apps that track your movement, digital surveillance, drones searching for people without face masks, CCTV cameras installed outside the homes of the quarantined, police arresting people for flaunting curfews.
This strategy of hitting the epidemic hard and fast, then seeking to curtail further outbreaks using enforcement and surveillance – ‘the hammer and the dance’ – is what China did in Wuhan, using an army of supervisors, monitors and paramilitary police. Scaled to the size of a city like London or New York, the equivalent would be 50,000 people in uniforms – something like the entire NYPD including auxiliaries – devoted exclusively to enforcing quarantine.
South Korea, Singapore and Taiwan have deployed more high-tech, less suppressive approaches, but ones which still feel deeply uncomfortable for anyone living in a liberal democracy. It’s an awful bargain; essentially, we’re being told we can save both lives and livelihoods, but only if we monitor and control the behaviour of the entire population, in individual and mass cases, at a scale and intensity never before seen in the democratic world.
Journalist Jeremy Cliffe calls this the coronavirus trilemma: we can pick two of three things, but we cannot have them all: save lives, save livelihoods, or uphold cherished civil liberties. We prefer to think of it as the bio-political straitjacket; it’s what happens when politics as usual is thrown out the window, and our woefully under-prepared leaders suddenly find themselves making life-and-death decisions for millions of people because someone chose the wrong time to eat a bat.
Once you understand the contours of the straitjacket, the panicked scramble of most politicians around the world makes far more sense. It explains for example, why we’re now seeing the imposition of measures that would have been unthinkable even a few weeks ago. Faced with a seemingly impossible dilemma, the easy way out is to start suspending civil liberties. This is a choice that’s been most clearly made in east Asia, but it’s starting to happen in other places now too.
The United Kingdom’s new coronavirus bill gives police and immigration officers the authority – in place for the next two years – to arrest and detain people suspected of carrying the virus. In Peru, over 21,000 people have been arrested and given a permanent criminal record for violating lockdowns. In South Africa, Kenya and Pakistan there have been numerous reports of police brutality, and in Rwanda anyone found flouting curfew is forced to sit for a day in the hot sun in an open stadium.
For authoritarians, the bio-political straitjacket is a gift. In the Philippines, President Rodrigo Duterte has issued death threats if lockdowns aren’t obeyed. “My orders to the police and the military is that if a commotion breaks out and they put up a fight that puts your life in danger, shoot them dead.” In the space of a few weeks, the prime ministers of both Hungary and Israel have effectively been given the power to rule by decree, without interference from courts or legislature. The first thing Viktor Orbán did with his fancy new pandemic powers? Strip away transgender rights. Likewise, Benjamin Netanyahu, who was twisting in the political winds, suddenly finds himself back in the driving seat, and Israel’s national security agency now has leave to access infected individuals’ phone records.
India, with an increasingly militant Narendra Modi at the helm, is drifting in this direction too. In Rajasthan, the government has made public the personal details of those under home-quarantine. In Karnataka, quarantined people are required to send selfies every hour throughout the day. Tamil Nadu is using a facial recognition app to track quarantined people. And last week, the Ministry of Electronics and Information Technology launched a contact tracing mobile app called Aarogya Setu, which live-tracks the location of the users.
Not all surveillance is inherently malign, and some of the new technology tools being deployed are helping. Within ten days of detecting their first imported case for example, Taiwan’s officials had created a phone tracking ‘digital fence’ system that now monitors more than 55,000 people. In South Korea, texts are sent to the public identifying potentially infected individuals and sharing information about where they’ve been. The UK, Germany, Austria, Italy and Belgium are all using data from major telecommunications companies to track people’s movement. It doesn’t have to be digital either – Cambodia has an analogue, phone-in system where all Cambodians report their diseases faster than almost any other place in the world.
These measures have, undoubtedly, saved lives. In the long run however, civil rights and privacy advocates are understandably worried that emergency measures may become permanent, so enmeshed in daily life that we forget their original purpose. That’s why strong, pluralist institutions matter. Civil liberties are less easily suspended in liberal democracies with a well-defined rule of law, and independence between the executive, legislative and judicial branches of government. Unfortunately, that means their range of choices is narrower too.
For most Western countries, the decision has been to save lives first, avoid stamping down too hard on civil liberties, and then save livelihoods using the state. Unprecedented programmes of government spending have been set in motion, with some even going so far as to write cheques directly to citizens. These measures feel like they’ve been made grudgingly though. The truth is that most of the world’s liberal democracies are so deeply biased towards financial values (as opposed to social, or environmental values) that the decision to save lives still feels like economic suicide.
After decades of being held hostage by the ideas of old, dead guys from the 1970s, we’ve internalised the belief that what motivates people best is not “the public good” but a desire to make a profit. We’ve spent so long being told that we have to compete savagely with others, that nobody else can be trusted, that the health and wealth of our own nation comes first, and that long-term, collective thinking is less important than individual survival, that we quite literally cannot imagine any other way of living.
Nowhere do these strictures seem more obvious than in the United States. Earlier this week, the Supreme Court of Milwaukee blocked the governor’s executive order to suspend in-person voting for the state’s primary. A judge had to quite literally order people to stand in line and risk their lives in order to vote. If that sounds ridiculous, it’s because it is. The bio-political straitjacket dictates that there are no good options. Given an unwavering commitment to civil liberties, and in the absence of either a social welfare system or public healthcare, policymakers in the US have to choose: save lives OR save livelihoods.
That’s why the politics of coronavirus revolve so strongly around the interplay between the death curves and what’s happening on Wall Street. The signal comes straight from the top. The man democratically elected by 47% of Americans to be their leader takes two things seriously: television ratings, and stock market performance. Every night, the press pack dutifully rolls over to help him broadcast another must-watch episode. Which states are gonna get the masks and ventilators? Who’s being nice and who’s being nasty? OMG check it out it’s a miracle drug!
Even as the bodies pile up, those around him are clamouring to re-open the economy, insisting they won’t let the cure be worse than the disease. Others have put it more crudely: sacrificing a portion of the population might be better than watching the stock market tank. The rest of us can only watch in horror. Too late, American citizens are being forced to reckon with Adam Smith’s basic insight, abandoned by liberal economics, that if markets are social institutions, then they must be moral institutions too.
This is what a pandemic does. It exposes people’s unsubstantiated beliefs in the superiority of their ways of living. South Korea and the United States discovered their first cases on the same day. South Korea now has 204 dead – a ratio of 4 deaths per 1 million people. The US death ratio (50 per 1 million) is 12 times worse, and rising quickly. The world’s richest nation, blessed with the most advanced medical technologies ever invented, is on a trajectory to suffer more sickness, more dying, and more economic harm from the coronavirus than any other developed country on Earth.
Which brings us back to our opening story, about how the US federal government tried to build a new fleet of ventilators, and failed. The moral of the story seems to be two-fold. The first is that American institutions charged with protecting public health are embedded in a bureaucratic culture that values control over effectiveness and outcome. Second, that we should beware of entrusting public health to the marketplace. Market forces might deliver extraordinary, mind-bending, innovations in medicine, but they don’t deliver cheap, accessible, life-saving public health care. That now seems abundantly clear, and hopefully the lesson will be heeded in every country in the world once the dust settles.
For us though, there’s a more important lesson, which is that our reactions to this story reveal our beliefs in a false binary. We too readily accept that there’s a trade off between the goals of the state and the goals of the market, between public good and private profit. That’s the real kicker in all of this – the bio-political straitjacket is not real. It’s a belief system, founded on outdated 20th century ideas about the best way to organise society.
The good news? There are ways out, approaches that allow us to escape the straitjacket, and they’ve been shown to us by two visionary economists: Mariana Mazzucato, with her research on the entrepreneurial state, and Kate Raworth, whose concept of doughnut economics is now being embraced by Amsterdam as a model to clean up the post coronavirus economic mess. After 2,489 words and two weeks of far too many open tabs however, our resident political economist’s brain is tied into a knot, so you’ll have to wait until our next newsletter for that.