Predictions, pandemics and public health

Those who did not consider an anticipated pandemic as a reason to have a good public health care system were insouciant

Updated - July 17, 2020 12:58 am IST

Published - July 17, 2020 12:15 am IST

COIMBATORE, TAMIL NADU 03/07/2020. (Standalone) Women walk past a graffiti on a wall to create awareness about wearing masks to avoid the risk of the COVID-19 in Coimbatore on Friday July 03, 2020. Photo: M. Periasamy/ The Hindu.

COIMBATORE, TAMIL NADU 03/07/2020. (Standalone) Women walk past a graffiti on a wall to create awareness about wearing masks to avoid the risk of the COVID-19 in Coimbatore on Friday July 03, 2020. Photo: M. Periasamy/ The Hindu.

Human beings have two remarkable traits, the second of which we had little reason to suspect that we possessed until the rise of new technologies such as the Internet.

The first is the capacity to anticipate events and tendencies, map their future in the short, mid, and long term, and act accordingly. We can, of course, go wrong, and so there is always an element of risk in making decisions on the basis of the exercise of such anticipatory gifts that we possess. Nevertheless, to a considerable extent, such exercises are a great potential asset.

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The second is a trait which, as I said, I did not know we possessed until a few decades ago. I’m not sure what the best word for it is. Perhaps it should be ‘cognitive generosity’. I stress cognitive deliberately to contrast with ‘material’. Someone who has never given a penny to Oxfam, say, or indeed even to a panhandler, will put down every little thing he knows on the Web, for the world to read and share in the knowledge. She has found an effective way to remove ink stains from clothes. She will post it on some website. He has made a delicious biryani. He will post the recipe. The humblest of knowledges and we seem to want to share it with the world. If this really is a trait, it must be the product of evolution, but it took the technology of the last few years to trigger it in us.

Combining the two traits

Now, if we combine these two traits — the remarkable capacity for decisions and actions on the basis of anticipatory knowledges and the disposition to be generous and share the knowledges we have — we should have been able to pre-empt or, at the very least, to fairly quickly contain the pandemic with which we are now faced. The striking genomic similarity of the novel coronavirus with SARS is now well known and many who had studied SARS had anticipated the inevitability of more contagious pandemics than SARS in the offing and had sounded the alarm for the whole world to know and act upon the knowledge.

Yet no one did. Why? The answer is quite obvious. There is no quick profit in public health issues of this preventive kind. If one tenth of the anticipatory gifts we have that seem to be exploited for immediate private gain on the part of corporations and investment bankers were put to use in the preventive domain of public health, not only would the crisis that we have been landed in be swiftly contained, it might even have been pre-empted by suitable medical safeguards.

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It would be glib to conclude from this that the two remarkable dispositions we possess which I mentioned at the outset are no match for the human disposition to greed. The eventual resting point of analysis cannot just be to record the contest between conflicting human dispositions, but to explore the extent to which the conflicting dispositions can be enhanced or undermined by institutions. Thus, for instance, no less a site than the White House institutionalised our dispositions to act on our anticipatory knowledges by setting up an office called ‘Predict’ intended as an early warning system for pandemics, with a view partly to aiding foreign countries that are pre-conditioned to be most vulnerable. President Donald Trump shut it down just a few months before COVID-19 hit the news — yet another symptom of how much we have allowed our political economy of some four decades to institutionalise and channel almost all of our dispositions, including the capacity to act intelligently on anticipatory knowledge, for private rather than public gain.

So, human dispositions can be directed in all sorts of ways by the economic and political institutions we construct and entrench. But, equally, if it is we who construct and entrench these institutions, it is we who can dismantle (or re-mantle) them. Perhaps the one clear lesson of the current pandemic and our utter failure to act on the anticipatory knowledges that had been posted far and wide by knowledgeable people is that no re-mantling short of the public ownership of health care and pharmaceuticals will suffice.

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Someone may agree with this last remark but deny the stronger thing I am claiming. Scientists and public health officials didn’t really predict the pandemic, it might be said. It was more like saying that there is bound to be an earthquake in a certain region in the coming years. That is not a prediction. A prediction surely must identify a more specific time, as, say, of a solar eclipse. And so, even though there are very good reasons for having a public health care system, the fact that it will help to control the spread of (and even perhaps prevent) a pandemic could not have been expected to be one of the reasons considered for proposing a good public health system, where it is missing (in the United States, or India, say).

An arcane distinction

The facts simply belie this scepticism. First of all, we do use the word ‘predict’ in far more informal ways than is being suggested here. I may, for instance, quite properly say, without doing any violence to the linguistic norms around the word ‘predict’, about someone I know very well, ‘I predict that he will return from Oxford to the job we have kept open for him in our department at Columbia University’, without giving any precise specification of when he will return. And second, I don’t deny that there is a distinction between 1) Effectively controlling the spread of a pandemic is one of the many reasons we would and should consider for proposing a good public health care system, and 2) Were there a good public health care system, it would effectively control the spread of a pandemic. You can believe in 2) without believing in 1). But given the highly detailed warnings that were given by scientists after SARS of its anticipated offshoots that would be both highly contagious and lethal (a combination of properties that was not standardly true of the influenzas and other viruses of the last many years) and the urgent need to prepare for it — again with highly detailed suggestions about the development of cluster vaccines, production and distribution of medications, hospital equipment such as respirators, accessories such as masks, etc. — the distinction between 1) and 2) is academic and arcane.

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Those who did not consider the need to control the spread of an anticipated pandemic as one among the other good reasons to have a good public health care system where it is missing were simply insouciant.

Akeel Bilgrami is Sidney Morgenbesser Professor of Philosophy at Columbia University

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