COVID-19 and THE NOAH’S ARK PROBLEM

Published by Anonymous (not verified) on Fri, 01/05/2020 - 2:09am in

One of the things the COVID-19 lock up  got me thinking about was Noah’s Ark. Remember the original: God vowed to destroy mankind with  a great flood  because of its wickedness, but told Noah and his family to self-isolate themselves  in an ark – a substantial building with three stories – with enough food for a long stay; to bring in  two specimens of every living and creeping  thing;  and to  stay put till  the flood had subsided. Noah and his clan isolated themselves seven days before the flood started. The  flood peaked in 40 days. As the waters receded the lock-up instructions were gradually relaxed and in a further two months it was safe for Noah and his family  to go out again and resume their normal lives.  Everyone and everything on land  that had the ‘breath of life’ had  died.

Leave aside the striking parallels  which will convince all Jehovah’s Witnesses, religious fundamentalists  and omnes gentes that it’s ‘all in the Bible’.   Leave aside also one big difference, which is that so far at any rate the corona virus is much more forgiving that the biblical deity. Most of us will survive this particular flood of germs.

Nevertheless, the Noah’s Ark problem arises whenever rising demand presses on a fixed supply. In the biblical story the shortage was in the supply of salvation, which was strictly limited to the righteous Noah and his family.  

In today’s secular version, there is a fixed (in the short run)  supply of  medical goods, notably protective clothing, tests, ventilators, hospital beds, and so on. So these items have to be rationed.

On what
principle? The free market solution is to ration by price. The price of goods
in short supply goes up, leaving only the rich able to afford them. If we had a
free market in health care, they would be able to buy up  the lion’s share of  scarce medical goods. Eventually the quantity
of medical goods would rise to meet the increased demand, but in the meantime
the poor would have to do without.  

The
socialist solution is ration books or queueing. In the first case everyone is
allocated an equal share of the scarce resource; the second works on a ‘first
come first served basis’:  the people at
the heard of the queue get what’s in the shop, and the rest get nothing. Long
queues with nothing in the shops to buy was a well-known feature of late
communism.

But as
soon as we think of the problem in terms of life-threatening viruses and
medicines, we see that neither the free market nor socialist solution can be
made to work.

Any attempt to apply the free market  solution would lead straight to revolution. Socialism has severe problems too. Some medical supplies, like masks, can be successfully rationed, with everyone getting a fixed number. But hospital treatment can’t be rationed like, say, meat  and eggs  were in the war,  because it  can’t be divided up into individual portions. For example, it would make no sense to allocate a tenth of ventilator to everyone. The bottom line here is that though testing can be done on a random basis, treatment cannot be random.  

Evidently some different principle of selection  is needed. This takes us back to the biblical story.  God saved the virtuous; we have decided to prioritise the economically useful.  The old, the sick, the infirm, those with ‘underlying health issues’, will be left to live or die as they may under conditions of lock-up; the giant share of scarce  medical supplies will go to those with a viable future. Utility  replaces virtue as the highest value.

Given
that we have got ourselves into this particular shortage trap, it is hard to
see what other principle of selection is available. Allocating scarce medical
supplies to the medically and  economically
useful  is clearly the only sensible
thing to do.

But it
sits very uncomfortably with another principle to which the liberal world   is
committed: that each life is of equal value. 
It is in the name of equal rights to ‘life, liberty, and happiness’  that we ban all kinds of discrimination
against particular individuals and groups.  But in the situation we face today, someone is
going to have to decide that some lives are more valuable than others. Some
people will be selected for the Ark, and others will be left to face the future
as best they can till we develop a vaccine or  the virus has done its work.

The
conclusion seems clear enough. Given that we have no ethically accepted
principle of choosing between who is to live and who to die, we should take
exceptional pains to ensure that we do not face acute shortages of life-preserving
equipment.  It is a scandal that the
developed world was caught so short of tools to deal with the latest pandemic,
some countries more than others. For this there are a number of reasons.

The first is the policy of austerity, which now shines forth in its full wickedness. The evidence is strong that ‘pandemic planning became a casualty of the austerity years’. (Sunday Times, Coronavirus/Insight 19/04/39). As a result our government faced a very poor trade-off between medical intervention  and ‘herd immunity’. It may even be worse than we think as recent research has questioned the degree of immunity, so there may be more deaths than expected. Broadly speaking, the shorter we are of medical resources, the more drastic lock-up will need to be.

But
austerity is by no means the only culprit. A second, and more fundamental,
explanation for our lack of preparedness, is the business philosophy of ‘just
in time’. As health expert Alanna Shaikh, put it:  ‘Just in time ordering systems are great when
things are going well. But in a time of crisis it means we don’t have any
reserves. If a hospital or a country runs out of face masks or PPE equipment,
there’s no big  warehouse full of boxes
that we can go to, to get more. We have to order more from a supplier, we have
to wait for them to produce it, and have to wait for them to ship it, mainly
from China’.

This
criticism applies to much more than medical procurement. It challenges the
just-in-time orthodoxy generally prevalent in business.  Reserves, the argument goes, cost money.
Efficient markets don’t require firms to have inventories, just to have  enough ‘stock’  to satisfy the consumer at the point of
demand.  To hold financial reserves
against a rainy day is also wasteful. In efficient markets there are no rainy
days. So firms should be leveraged up to the hilt!

This
is fine, provided there are no unexpected events. Come a ‘shock’ like the
banking crash of 2008, and the whole efficient market model collapses, and with
it the economy. Something like this has been happening to our medical services
today. Bed occupancy is as high
as 98% in our marketised NHS, meaning there is no longer a reserve, and we are
not self-sufficient in doctors and nurses and expect other countries to train
them for our use.

We
need to restore what used to be called ‘the precautionary principle’. In all
those situations in which we can rationally anticipate a severe  life-threatening event, ‘just in time’
thinking needs to be replaced by ‘just in case’ thinking. 

But this is not all. A major fault lies in the attitude of  neo-classical economists and their political followers to ‘innovation’. The general idea is that nothing will be invented unless companies are given extended monopoly rights (patents) over the invention to enable them to recoup their investment. This is not only historically wrong (most innovation has been done or financed by government), but can have the effect of keeping life-saving inventions off the market.  Dr. Shamel Azmeh points out that it would have been perfectly possible to develop ventilators  ‘simple enough to be stockpiled and quickly deployed’, but  a prototype of such a ventilator commissioned by the US government was aborted in 2012, after the private  company concerned  was acquired by a large producer of ‘expensive, immobile, highly technical, difficult to use’ ventilators suitable  for a rich-country market.  This kind of suppression of useful medical tools   is little short of criminal.  (Project Syndicate, The Perverse Economics of Ventilators, 16 April)

A
final cause of unnecessary shortage is our dogmatic reliance on global supply
chains. It is obviously more ‘efficient’ to get something produced in a cheap
labour location than by our more expensive labour. But what happens when
supplies from China are interrupted, because of a sudden increased demand for
them in China, as apparently happened with surgical masks?

The
Noah’s Ark problem can never be entirely avoided because extreme unexpected
events will continue to happen. But we can at least be better prepared for the
next pandemic.  The fact that COVI-19 was
unexpected, should not stop us taking precautions against this class of
disaster.

  1. Stockpiling. Billions of dollars are spent in stockpiling weapons of mass destruction. The same logic should be applied to stockpiling weapons of mass salvation. For example, a World Authority  could be tasked with maintaining  a Strategic Reserve of medical supplies  needed to support  the life of everyone on earth for three months – in the face of a limited range of drastic events. It should  be financed by taxes levied on national states  in proportion to their national incomes. Such stockpiling can also be done nationally or regionally: the EU would be an ideal place to start. If this was accompanied by agreed disarmament, it might even be possible to reduce taxes.
  2. No patent laws should apply to medical innovation. Public contracts and prizes should be the only incentive.
  3. Countries which can afford to should retain enough spare domestic capacity to scale up medical production rapidly if needed.  This would be in addition to stockpiling. Part of this spare capacity should be automatically available to counter  medical crises in the developing world. The logic of globalisation does not apply to ‘essential’ services.

Key
measures would be:

A final thought: we don’t know how to increase the supply  of virtue, but we do know how to increase the supply of ventilators. (1637)

Photo credit: Flickr/Jim Forest

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