How much should it cost to contain a pandemic?

Over the past week, protesters across the US have held demonstrations to demand “liberation” from lockdown measures brought in by states to contain the spread of the Covid-19 virus.

Fuelled by a belief that the economy must reopen to protect the health of people’s businesses, these public gatherings (often attended by anti-vaxxers and far-right activists) make for colourful television pictures — and divisive social media messages that President Donald Trump has been only too happy to promote. But as these protests swell, sparking counter-protests from America’s medical establishment, the issue raises an intriguing question: is there a limit to how much containing a pandemic should cost?

Many of you — including doctors — might howl “No!” to such a notion. Certainly, the value of a human life cannot be measured only with economics. And Covid-19 is so new that it is hard to model its trajectory. In New Zealand, however, one of the country’s leading think-tanks has ventured into this moral minefield.

In “Quantifying the Wellbeing Costs of Covid-19”, a research note written for the pro-free-market New Zealand Initiative and published earlier this month, Bryce Wilkinson sets out to examine some of the fiscal trade-offs around coronavirus when it comes to health, wellbeing and cost. Whether you agree with his approach or not, the results are worth reading.

First, Wilkinson’s work suggests that there is indeed a sensible limit to action — albeit a high one. Using existing research (undertaken in 2017) into what might happen if a 1918-style -pandemic were to hit New Zealand, he has updated this framework for Covid-19 alongside gross domestic product figures.

Wilkinson’s conclusion? That the New Zealand government could justify spending up to 6.1 per cent of GDP on pandemic-fighting, if it were to save 33,600 lives (the number of deaths projected by the country’s Ministry of Health if the pandemic was uncontrolled).

It could also justify spending 3.7 per cent of GDP to save 12,600 people (the projected outcome if the pandemic was brought under control more quickly). However, Wilkinson concludes: “To spend more [than these sums] begs the question of whether more lives could be saved over time if the money went instead to make safer roads and buildings, or perhaps spent on other health services.” And while he stresses the results are “highly conditional” and his report “a contribution to public debate, nothing more”, Wilkinson believes “evaluating this trade-off is essential for good policy advice and decision-making, such as lockdown decisions and border closures”.

Now, as it happens the New Zealand government itself has managed to avoid the darkest implications of such trade-offs. When the coronavirus erupted, it announced a stimulus package worth 4 per cent of GDP (although Wilkinson predicts this will rise). But the government put the country into such an effective lockdown that the death toll currently stands at just 13. The country’s prime minister Jacinda Ardern now says that New Zealand has “done what few other countries have been able to do” in stopping the spread of the virus and is preparing to ease controls.

Another interesting point is raised by Wilkinson’s paper: why are so few other economists trying to calculate these trade-offs in such an explicit way? The obvious answer is that it would seem to breach all kinds of political and cultural taboos. After all, taboos are powerful because they reveal ambiguities we prefer to ignore. And in many cultures, it is commonly supposed that life is sacred and cannot be valued with mere money — even though this is what governments implicitly do every day. Discussing morbidity trade-offs makes voters wince in horror.

There’s another factor too: knowledge silos. As author and consultant Christian Madsbjerg points out, expertise in western culture tends to be very tribal: although economists are supposed to talk about the economy and epidemiologists discuss pandemics, almost nobody dares to blend the two. If Deborah Birx, the chief medical adviser to the White House, were to offer fiscal advice, there would be an outcry; so too if Steve Mnuchin, the Treasury secretary, were to lecture us on “flattening the curve” of death. This is unsurprising: it takes years of training to become an expert. But here is the rub: almost all of the important decisions in modern democracies require this “silo-busting” analysis. Without this it’s impossible to discuss the trade-offs around pandemics, or anything else.

So I salute Wilkinson for publishing his speculative models — however contentious — and I wish others would do the same, including national treasuries, which must make their own private calculations of such trade-offs. Taboo or not, these numbers could at least spark proper democratic debate. In these troubled times, that’s something we badly need.

Follow Gillian on Twitter @gilliantett and email her at [email protected]

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