Tuesday, April 13, 2021

Imagining an Alternative Pandemic Response

I received my first shot of the Moderna vaccine yesterday -- which naturally got me thinking about how this should've been accessible much, much sooner.  I don't think anyone's particularly happy about the way that our pandemic response played out, but there's probably a fair bit of variation in what people think should've been done differently.  What alternative history of COVID-19 do you wistfully yearn after?  Here's mine (imagining that these lessons were taken on board from the start)...

In early Feb 2020, with Covid declared a "global health emergency" by the WHO, American scientists prioritize preparing a low-dose "challenge strain" of the virus in case it is needed for emergency immunity research.

By early March, as the seriousness of the pandemic becomes clear, the emergency research protocols are approved by the president, and hundreds of volunteers enlisted (mostly young and healthy, but also some terminal patients and elderly altruists who want to help produce a better world for their great-grandkids).

A strict (but temporary) lockdown is implemented for the last two weeks of March, to buy time while the nation waits on the results of the emergency immunity research.  "Immunity passports" grant lockdown exceptions to those who have already recovered from the illness.  Those in possession of immunity passports are highly favoured for "essential work" to minimize transmission risk to others.  There are reports of occasional "pox parties" as some groups pursue immunity via uncontrolled infection, but these are widely condemned as premature and irrational with immunity research results expected any day now...

Finally, the early results are revealed, with the tested vaccines proving surprisingly effective.  Deaths in the placebo group spark public outrage that high-risk individuals weren't given access to a life-saving vaccine (while scientists push back against this, writing op-eds to explain to the public the importance of placebo-controlled trials for quickly verifying efficacy).  Under immense public pressure, Congress passes billions of dollars of funding to ramp up vaccine production as quickly as possible -- with the aim of vaccinating everyone over 70 years of age by the end of summer, and every adult in America by the end of 2020.

Challenge trials continue for other candidate vaccines. Meanwhile, evidence that younger people are at minimal risk from low-dose viral exposures, whilst still securing at least short-term immunity after recovering, creates pressure on public health authorities to approve the targeted use of controlled, low-dose inoculation to create "firewalls" of immunity to contain local outbreaks and protect the most vulnerable populations until vaccine production has ramped up sufficiently.  Elder care facilities and other institutions are required to use immunity-certified workers to protect their vulnerable populations, or risk bankruptcy when sued for reckless endangerment.

Over the summer, most college students secure immunity certificates (half via controlled inoculation, half via uncontrolled "pox parties") so as to be able to attend classes in-person come the fall.  A small proportion of these individuals fail to self-isolate as required while infected, sparking minor outbreaks in their local communities, and much public debate about whether deliberate non-consensual viral exposure should be criminalized.  With widespread testing availability and contact tracing protocols in place, most of the local outbreaks are able to be contained, and epidemiological models suggest that community spread was still reduced on net compared to an alternative situation in which most college students remained susceptible to infection -- as a larger proportion could then be expected to accidentally spread the virus through their communities.  So, despite some grumbling from the general public, inoculation continues through the summer.

By Fall, most elderly and youths have secured immunity (via vaccines for the former group, and inoculation for the latter), and so there's a general sense of "returning to normalcy".  Early immunity certificates begin to expire, prompting booster inoculations to ensure continued immunity.  Many cautious middle-aged folks continue to socially distance until they're able to be vaccinated.  But with so many immunity-certified younger adults employed in service roles from childcare and teaching to restaurant and grocery deliveries, even the most Covid-cautious are generally able to feel as secure as they wish to be in their day-to-day lives, without excessive disruption.  Youth unemployment is the lowest that it's ever been.

The biggest political dispute concerns what to do about middle-aged institutional workers (e.g. teachers and elder-care workers) who lack immunity certification while refusing inoculation or (if available) vaccination.  Teacher's Unions argue that their members should receive full pay for offering online classes, even if no students sign up -- as the latter prefer the in-person schooling provided by the swelling ranks of inoculated "Teach for America" grads.  The inoculated argue back that it isn't fair to tax them more to subsidize those who freely choose to contribute less than they do. Eventually a compromise is reached by which teachers can be covered by generous unemployment compensation while taking a temporary "personal leave" from their workplace.

By the end of 2020, most American adults have been vaccinated, and the government is able to sell off tens of millions of excess doses to other countries where troubling "variants" of the virus are starting to cause alarm...


[P.S. Yes, I know that realistically no policy rollout would go this smoothly. But I still think it can be worth imagining better ways things could have gone, to help motivate taking alternative policy suggestions seriously in the first place.  Once it's on the table and recognized as a legitimate option worthy of debate, we of course need to delve into more detail regarding possible implementation failures, risks, etc.  I'm happy for folks to discuss any of that in the comments.  You're also welcome to set out your own alternative vision for how you wish pandemic policy had unfolded...]

1 comment:

  1. You ask, "What alternative history of COVID-19 do you wistfully yearn after?"

    I wish that the pandemic might remind us that really big, really bad things actually can happen, and that this insight would cause to renew an interest in nuclear weapons.

    You know how we are now regretting that we've lived in denial about the reality of pandemics for decades, and thus weren't adequately prepared for the current pandemic? We're making that same mistake today with nuclear weapons.

    ReplyDelete

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