This meaningless phrase allows the government to shift blame to the public for failing to be sufficiently responsible writes Owen Jones in The Guardian
Officially, the new strategy is “personal responsibility” and “good, solid British common sense”, as our prime minister colourfully describes it; unofficially, operation blame the public is well under way. As media outlets query why London’s trains and buses are rammed despite government advice, our transport secretary, Grant Shapps, pleads with silly old commuters not to “flood” back on to public transport.
The small flaw is that the government has ordered millions of workers to return to their jobs, and given the continued failure to invent teleporters, they need a means to bridge the distance between their homes and their work. If you’re a Londoner earning more than £70,000 a year, this is no big deal: about 80% have access to a car, and most can work from home. Unfortunately, nearly half of the capital’s citizens – and over 70% of those earning less than £10,000 – do not have access to a car: if you want to understand those images of packed trains and buses, start here.
It is unsurprising that a government that has presided over Europe’s worst death toll is so invested in shifting the blame. Was it “good, solid British common sense” to pursue herd immunity and impose a lockdown later than other European nations, even despite having advance notice of the horrors of Lombardy? Perhaps, indeed, it was “good, solid British common sense” to send vulnerable patients back to care homes without testing them for coronavirus first, seeding the illness in a sector in which up to 22,000 people may have died? Or, who knows, perhaps “good, solid British common sense” could explain how frontline staff have been left exposed for a lack of personal protective equipment?
But the strategy in the government’s new approach is clear. “Stay alert” is meaningless, of course, except to devolve responsibility for what happens next to individuals. Grownups don’t need a nanny state to hold their hands, scoff the government’s outriders: rather than relying on detailed instructions and central diktat, we should rely on our judgment. The implication, of course, is that if there is another spike in infections and death, that will be the public’s fault for not exercising adequate levels of personal responsibility.
Here is a revival of the ideals of High Thatcherism, except applied to a pandemic. Back in the 1980s, what were once known as social problems requiring collective solutions – such as unemployment and poverty – became redefined as individual failings. “Nowadays there really is no primary poverty left in this country,” declared Margaret Thatcher herself. “In western countries we are left with the problems which aren’t poverty. All right, there may be poverty because people don’t know how to budget, don’t know how to spend their earnings, but now you are left with the really hard fundamental character – personality defect.”
If you were poor, it became an increasingly popularised attitude that it was because you were feckless, workshy, stupid and lazy. Thanks to the former Tory minister Norman Tebbit, “get on your bike” became a national cliche: it was more convenient, of course, for the government to pretend that mass unemployment was caused by a lack of effort, graft and can-do determination, rather than monetarist economics that ravaged entire industries.
What the dogma of “personal responsibility” does is erase the inequalities that scar, disfigure and ultimately define society. It pretends that we are all equally free, that our autonomy over our lives and circumstances are the same; that a middle-class professional working from home with access to a car can make the same choices as a cleaner expected to work halfway across a city.
The estimated 60,000 people who have so far died in this national calamity were not wrested from their families because the public failed to be responsible, and neither will the deaths to come in the weeks ahead. Any uptick in infections won’t be down to someone standing one metre rather than two away from their parent in a park. It won’t be down to people inviting neighbours round for forbidden cups of tea in their kitchens, instead of paying poverty wages to cleaners to wash away their dirt.
The explanation will instead be straightforward: the government relaxed a lockdown to force disproportionately working-class people into potentially unsafe environments at the behest of employers who have prioritised economic interests over human life. Another aggravating factor will be the abandonment of clear instructions in favour of confusion. It may well be this is a deliberate strategy, to claim that the government was perfectly clear, but the public let the team down by not showing enough “good, solid British common sense”. Whatever happens, the attempt to shift blame for the most disastrous government failure since appeasement on to the public must not succeed. This is on them: they did this, and we must not let them forget it.
Friday 15 May 2020
Goodhart’s law comes back to haunt the UK’s Covid strategy
Chris Giles in The Financial Times
Every so often, public policy provides a reason to discover or remember the value of Goodhart’s law. The UK’s response to coronavirus is a powerful and tragic example.
Named after Charles Goodhart, a financial guru, former chief economist of the Bank of England and a sheep farmer, the maxim is about the dangers of setting targets. When a useful measure becomes a target, the law states, it often ceases to be a good measure.
Mr Goodhart developed the law after observing how Margaret Thatcher’s government in the 1980s targeted the supply of money to control inflation but then found the monetary aggregates lost their previously strong relationship with inflation. Inflation ran out of control even when the government held a tight grip on the money supply.
What was true in 1980s UK economic policy is regularly experienced in the private sector. Far too often companies hit their top-down targets without improving underlying performance.
In the current crisis, target-setting is altogether more important. Early in March, Italy’s government strove to protect the nation’s health by locking down the Lombardy region. Initially, this led to a mini exodus that probably increased the spread of the disease to other parts of the country.
But it is in the UK where Goodhart’s law was most obviously overlooked. Throughout the crisis, “protect the NHS” has been the government’s core target. Along with “stay at home” it was the slogan repeated daily to “save lives”.
At first sight, nothing seemed amiss. Ensuring hospitals would not be overwhelmed seems so obviously necessary. Who would have wanted to see them starved of funds in a public health crisis? And their staff needed to be given all necessary equipment to battle the pandemic. With many weeks of experience, however, the slogan and associated numerical targets for making hospital beds available have been nothing short of a disaster. The evidence is overwhelming that instead of saving lives, they have cost them.
While the government focused on hospitals, care homes were given much less priority. Over the past five years between mid-March and the end of April, an average of 17,700 people have died in England and Wales’s care homes. This year, the total is just above 37,600. There is a debate over whether coronavirus was recklessly seeded into care homes when patients were moved there from hospitals. But there can be no doubt that relegating care homes to second division status contributed to the 19,900 excess deaths in the care sector.
Far more people than normal have also been dying at home and most of the excess deaths have not been classified as related to Covid-19 on death certificates. We do not yet know precisely why, but at the height of the crisis local doctors were asking their elderly patients to think hard about whether they really wanted to go to hospital or use the emergency services. A fit and sharp relative of mine received two of these calls.
The exact causal links will take time to establish. But 29,874 people have died at home since mid-March in England and Wales, 10,800 more than normal.
No one should think the government’s ambitions deliberately cost lives. But it was a deadly example of Goodhart’s law. The moment “protect the NHS” became the mantra, people dying elsewhere or without being tested didn’t count.
By comparison, the much criticised target of performing 100,000 coronavirus tests a day by the end of April was better conceived. Although the health department fiddled definitions to hit the goal for one day, earning a rebuke from the statistical regulator, the effort has left the UK better positioned for its ultimate objective of testing, tracking and isolating those with the virus.
Goodhart’s law always pops up in unexpected places. The failure in this crisis to think through the incentives created by the “protect the NHS” slogan will haunt Britain for many years.
Every so often, public policy provides a reason to discover or remember the value of Goodhart’s law. The UK’s response to coronavirus is a powerful and tragic example.
Named after Charles Goodhart, a financial guru, former chief economist of the Bank of England and a sheep farmer, the maxim is about the dangers of setting targets. When a useful measure becomes a target, the law states, it often ceases to be a good measure.
Mr Goodhart developed the law after observing how Margaret Thatcher’s government in the 1980s targeted the supply of money to control inflation but then found the monetary aggregates lost their previously strong relationship with inflation. Inflation ran out of control even when the government held a tight grip on the money supply.
What was true in 1980s UK economic policy is regularly experienced in the private sector. Far too often companies hit their top-down targets without improving underlying performance.
In the current crisis, target-setting is altogether more important. Early in March, Italy’s government strove to protect the nation’s health by locking down the Lombardy region. Initially, this led to a mini exodus that probably increased the spread of the disease to other parts of the country.
But it is in the UK where Goodhart’s law was most obviously overlooked. Throughout the crisis, “protect the NHS” has been the government’s core target. Along with “stay at home” it was the slogan repeated daily to “save lives”.
At first sight, nothing seemed amiss. Ensuring hospitals would not be overwhelmed seems so obviously necessary. Who would have wanted to see them starved of funds in a public health crisis? And their staff needed to be given all necessary equipment to battle the pandemic. With many weeks of experience, however, the slogan and associated numerical targets for making hospital beds available have been nothing short of a disaster. The evidence is overwhelming that instead of saving lives, they have cost them.
While the government focused on hospitals, care homes were given much less priority. Over the past five years between mid-March and the end of April, an average of 17,700 people have died in England and Wales’s care homes. This year, the total is just above 37,600. There is a debate over whether coronavirus was recklessly seeded into care homes when patients were moved there from hospitals. But there can be no doubt that relegating care homes to second division status contributed to the 19,900 excess deaths in the care sector.
Far more people than normal have also been dying at home and most of the excess deaths have not been classified as related to Covid-19 on death certificates. We do not yet know precisely why, but at the height of the crisis local doctors were asking their elderly patients to think hard about whether they really wanted to go to hospital or use the emergency services. A fit and sharp relative of mine received two of these calls.
The exact causal links will take time to establish. But 29,874 people have died at home since mid-March in England and Wales, 10,800 more than normal.
No one should think the government’s ambitions deliberately cost lives. But it was a deadly example of Goodhart’s law. The moment “protect the NHS” became the mantra, people dying elsewhere or without being tested didn’t count.
By comparison, the much criticised target of performing 100,000 coronavirus tests a day by the end of April was better conceived. Although the health department fiddled definitions to hit the goal for one day, earning a rebuke from the statistical regulator, the effort has left the UK better positioned for its ultimate objective of testing, tracking and isolating those with the virus.
Goodhart’s law always pops up in unexpected places. The failure in this crisis to think through the incentives created by the “protect the NHS” slogan will haunt Britain for many years.
Thursday 14 May 2020
The coronavirus slayer! How Kerala's rock star health minister helped save it from Covid-19
KK Shailaja has been hailed as the reason a state of 35 million people has only lost four to the virus. Here’s how the former teacher did it writes Laura Spinney in The Guardian
How has this been achieved? Three days after reading about the new virus in China, and before Kerala had its first case of Covid-19, Shailaja held the first meeting of her rapid response team. The next day, 24 January, the team set up a control room and instructed the medical officers in Kerala’s 14 districts to do the same at their level. By the time the first case arrived, on 27 January, via a plane from Wuhan, the state had already adopted the World Health Organization’s protocol of test, trace, isolate and support.
As the passengers filed off the Chinese flight, they had their temperatures checked. Three who were found to be running a fever were isolated in a nearby hospital. The remaining passengers were placed in home quarantine – sent there with information pamphlets about Covid-19 that had already been printed in the local language, Malayalam. The hospitalised patients tested positive for Covid-19, but the disease had been contained. “The first part was a victory,” says Shailaja. “But the virus continued to spread beyond China and soon it was everywhere.”
In late February, encountering one of Shailaja’s surveillance teams at the airport, a Malayali family returning from Venice was evasive about its travel history and went home without submitting to the now-standard controls. By the time medical personnel detected a case of Covid-19 and traced it back to them, their contacts were in the hundreds. Contact tracers tracked them all down, with the help of advertisements and social media, and they were placed in quarantine. Six developed Covid-19.
Another cluster had been contained, but by now large numbers of overseas workers were heading home to Kerala from infected Gulf states, some of them carrying the virus. On 23 March, all flights into the state’s four international airports were stopped. Two days later, India entered a nationwide lockdown.
FacebookTwitterPinterest Indian citizens arriving from the Gulf states are bussed to a quarantine centre. Photograph: Arunchandra Bose/AFP via Getty Images
At the height of the virus in Kerala, 170,000 people were quarantined and placed under strict surveillance by visiting health workers, with those who lacked an inside bathroom housed in improvised isolation units at the state government’s expense. That number has shrunk to 21,000. “We have also been accommodating and feeding 150,000 migrant workers from neighbouring states who were trapped here by the lockdown,” she says. “We fed them properly – three meals a day for six weeks.” Those workers are now being sent home on charter trains.
Shailaja was already a celebrity of sorts in India before Covid-19. Last year, a movie called Virus was released, inspired by her handling of an outbreak of an even deadlier viral disease, Nipah, in 2018. (She found the character who played her a little too worried-looking; in reality, she has said, she couldn’t afford to show fear.) She was praised not only for her proactive response, but also for visiting the village at the centre of the outbreak.
The villagers were terrified and ready to flee, because they did not understand how the disease was spreading. “I rushed there with my doctors, we organised a meeting in the panchayat [village council] office and I explained that there was no need to leave, because the virus could only spread through direct contact,” she says. “If you kept at least a metre from a coughing person, it couldn’t travel. When we explained that, they became calm – and stayed.”
Nipah prepared Shailaja for Covid-19, she says, because it taught her that a highly contagious disease for which there is no treatment or vaccine should be taken seriously. In a way, though, she had been preparing for both outbreaks all her life.
The Communist Party of India (Marxist), of which she is a member, has been prominent in Kerala’s governments since 1957, the year after her birth. (It was part of the Communist Party of India until 1964, when it broke away.) Born into a family of activists and freedom fighters – her grandmother campaigned against untouchability – she watched the so-called “Kerala model” be assembled from the ground up; when we speak, this is what she wants to talk about.
The foundations of the model are land reform – enacted via legislation that capped how much land a family could own and increased land ownership among tenant farmers – a decentralised public health system and investment in public education. Every village has a primary health centre and there are hospitals at each level of its administration, as well as 10 medical colleges.
This is true of other states, too, says MP Cariappa, a public health expert based in Pune, Maharashtra state, but nowhere else are people so invested in their primary health system. Kerala enjoys the highest life expectancy and the lowest infant mortality of any state in India; it is also the most literate state. “With widespread access to education, there is a definite understanding of health being important to the wellbeing of people,” says Cariappa.
Shailaja says: “I heard about those struggles – the agricultural movement and the freedom fight – from my grandma. She was a very good storyteller.” Although emergency measures such as the lockdown are the preserve of the national government, each Indian state sets its own health policy. If the Kerala model had not been in place, she insists, her government’s response to Covid-19 would not have been possible.
FacebookTwitterPinterest A walk-in test centre in Ernakulam, Kerala. Photograph: Reuters
That said, the state’s primary health centres had started to show signs of age. When Shailaja’s party came to power in 2016, it undertook a modernisation programme. One pre-pandemic innovation was to create clinics and a registry for respiratory disease – a big problem in India. “That meant we could spot conversion to Covid-19 and look out for community transmission,” Shailaja says. “It helped us very much.”
When the outbreak started, each district was asked to dedicate two hospitals to Covid-19, while each medical college set aside 500 beds. Separate entrances and exits were designated. Diagnostic tests were in short supply, especially after the disease reached wealthier western countries, so they were reserved for patients with symptoms and their close contacts, as well as for random sampling of asymptomatic people and those in the most exposed groups: health workers, police and volunteers.
Shailaja says a test in Kerala produces a result within 48 hours. “In the Gulf, as in the US and UK – all technologically fit countries – they are having to wait seven days,” she says. “What is happening there?” She doesn’t want to judge, she says, but she has been mystified by the large death tolls in those countries: “I think testing is very important – also quarantining and hospital surveillance – and people in those countries are not getting that.” She knows, because Malayalis living in those countries have phoned her to say so.
Places of worship were closed under the rules of lockdown, resulting in protests in some Indian states, but resistance has been noticeably absent in Kerala – in part, perhaps, because its chief minister, Pinarayi Vijayan, consulted with local faith leaders about the closures. Shailaja says Kerala’s high literacy level is another factor: “People understand why they must stay at home. You can explain it to them.”
The Indian government plans to lift the lockdown on 17 May (the date has been extended twice). After that, she predicts, there will be a huge influx of Malayalis to Kerala from the heavily infected Gulf region. “It will be a great challenge, but we are preparing for it,” she says. There are plans A, B and C, with plan C – the worst-case scenario – involving the requisitioning of hotels, hostels and conference centres to provide 165,000 beds. If they need more than 5,000 ventilators, they will struggle – although more are on order – but the real limiting factor will be manpower, especially when it comes to contact tracing. “We are training up schoolteachers,” Shailaja says.
Once the second wave has passed – if, indeed, there is a second wave – these teachers will return to schools. She hopes to do the same, eventually, because her ministerial term will finish with the state elections a year from now. Since she does not think the threat of Covid-19 will subside any time soon, what secret would she like to pass on to her successor? She laughs her infectious laugh, because the secret is no secret: “Proper planning.”
‘Our clinics for respiratory disease meant we could look out for community transmission’: KK Shailaja, health minister.
On 20 January, KK Shailaja phoned one of her medically trained deputies. She had read online about a dangerous new virus spreading in China. “Will it come to us?” she asked. “Definitely, Madam,” he replied. And so the health minister of the Indian state of Kerala began her preparations.
Four months later, Kerala has reported only 524 cases of Covid-19, four deaths and – according to Shailaja – no community transmission. The state has a population of about 35 million and a GDP per capita of only £2,200. By contrast, the UK (double the population, GDP per capita of £40,400) has reported more than 40,000 deaths, while the US (10 times the population, GDP per capita of £51,000) has reported more than 82,000 deaths; both countries have rampant community transmission.
As such, Shailaja Teacher, as the 63-year-old minister is affectionately known, has attracted some new nicknames in recent weeks – Coronavirus Slayer and Rockstar Health Minister among them. The names sit oddly with the merry, bespectacled former secondary school science teacher, but they reflect the widespread admiration she has drawn for demonstrating that effective disease containment is possible not only in a democracy, but in a poor one.
On 20 January, KK Shailaja phoned one of her medically trained deputies. She had read online about a dangerous new virus spreading in China. “Will it come to us?” she asked. “Definitely, Madam,” he replied. And so the health minister of the Indian state of Kerala began her preparations.
Four months later, Kerala has reported only 524 cases of Covid-19, four deaths and – according to Shailaja – no community transmission. The state has a population of about 35 million and a GDP per capita of only £2,200. By contrast, the UK (double the population, GDP per capita of £40,400) has reported more than 40,000 deaths, while the US (10 times the population, GDP per capita of £51,000) has reported more than 82,000 deaths; both countries have rampant community transmission.
As such, Shailaja Teacher, as the 63-year-old minister is affectionately known, has attracted some new nicknames in recent weeks – Coronavirus Slayer and Rockstar Health Minister among them. The names sit oddly with the merry, bespectacled former secondary school science teacher, but they reflect the widespread admiration she has drawn for demonstrating that effective disease containment is possible not only in a democracy, but in a poor one.
How has this been achieved? Three days after reading about the new virus in China, and before Kerala had its first case of Covid-19, Shailaja held the first meeting of her rapid response team. The next day, 24 January, the team set up a control room and instructed the medical officers in Kerala’s 14 districts to do the same at their level. By the time the first case arrived, on 27 January, via a plane from Wuhan, the state had already adopted the World Health Organization’s protocol of test, trace, isolate and support.
As the passengers filed off the Chinese flight, they had their temperatures checked. Three who were found to be running a fever were isolated in a nearby hospital. The remaining passengers were placed in home quarantine – sent there with information pamphlets about Covid-19 that had already been printed in the local language, Malayalam. The hospitalised patients tested positive for Covid-19, but the disease had been contained. “The first part was a victory,” says Shailaja. “But the virus continued to spread beyond China and soon it was everywhere.”
In late February, encountering one of Shailaja’s surveillance teams at the airport, a Malayali family returning from Venice was evasive about its travel history and went home without submitting to the now-standard controls. By the time medical personnel detected a case of Covid-19 and traced it back to them, their contacts were in the hundreds. Contact tracers tracked them all down, with the help of advertisements and social media, and they were placed in quarantine. Six developed Covid-19.
Another cluster had been contained, but by now large numbers of overseas workers were heading home to Kerala from infected Gulf states, some of them carrying the virus. On 23 March, all flights into the state’s four international airports were stopped. Two days later, India entered a nationwide lockdown.
FacebookTwitterPinterest Indian citizens arriving from the Gulf states are bussed to a quarantine centre. Photograph: Arunchandra Bose/AFP via Getty Images
At the height of the virus in Kerala, 170,000 people were quarantined and placed under strict surveillance by visiting health workers, with those who lacked an inside bathroom housed in improvised isolation units at the state government’s expense. That number has shrunk to 21,000. “We have also been accommodating and feeding 150,000 migrant workers from neighbouring states who were trapped here by the lockdown,” she says. “We fed them properly – three meals a day for six weeks.” Those workers are now being sent home on charter trains.
Shailaja was already a celebrity of sorts in India before Covid-19. Last year, a movie called Virus was released, inspired by her handling of an outbreak of an even deadlier viral disease, Nipah, in 2018. (She found the character who played her a little too worried-looking; in reality, she has said, she couldn’t afford to show fear.) She was praised not only for her proactive response, but also for visiting the village at the centre of the outbreak.
The villagers were terrified and ready to flee, because they did not understand how the disease was spreading. “I rushed there with my doctors, we organised a meeting in the panchayat [village council] office and I explained that there was no need to leave, because the virus could only spread through direct contact,” she says. “If you kept at least a metre from a coughing person, it couldn’t travel. When we explained that, they became calm – and stayed.”
Nipah prepared Shailaja for Covid-19, she says, because it taught her that a highly contagious disease for which there is no treatment or vaccine should be taken seriously. In a way, though, she had been preparing for both outbreaks all her life.
The Communist Party of India (Marxist), of which she is a member, has been prominent in Kerala’s governments since 1957, the year after her birth. (It was part of the Communist Party of India until 1964, when it broke away.) Born into a family of activists and freedom fighters – her grandmother campaigned against untouchability – she watched the so-called “Kerala model” be assembled from the ground up; when we speak, this is what she wants to talk about.
The foundations of the model are land reform – enacted via legislation that capped how much land a family could own and increased land ownership among tenant farmers – a decentralised public health system and investment in public education. Every village has a primary health centre and there are hospitals at each level of its administration, as well as 10 medical colleges.
This is true of other states, too, says MP Cariappa, a public health expert based in Pune, Maharashtra state, but nowhere else are people so invested in their primary health system. Kerala enjoys the highest life expectancy and the lowest infant mortality of any state in India; it is also the most literate state. “With widespread access to education, there is a definite understanding of health being important to the wellbeing of people,” says Cariappa.
Shailaja says: “I heard about those struggles – the agricultural movement and the freedom fight – from my grandma. She was a very good storyteller.” Although emergency measures such as the lockdown are the preserve of the national government, each Indian state sets its own health policy. If the Kerala model had not been in place, she insists, her government’s response to Covid-19 would not have been possible.
FacebookTwitterPinterest A walk-in test centre in Ernakulam, Kerala. Photograph: Reuters
That said, the state’s primary health centres had started to show signs of age. When Shailaja’s party came to power in 2016, it undertook a modernisation programme. One pre-pandemic innovation was to create clinics and a registry for respiratory disease – a big problem in India. “That meant we could spot conversion to Covid-19 and look out for community transmission,” Shailaja says. “It helped us very much.”
When the outbreak started, each district was asked to dedicate two hospitals to Covid-19, while each medical college set aside 500 beds. Separate entrances and exits were designated. Diagnostic tests were in short supply, especially after the disease reached wealthier western countries, so they were reserved for patients with symptoms and their close contacts, as well as for random sampling of asymptomatic people and those in the most exposed groups: health workers, police and volunteers.
Shailaja says a test in Kerala produces a result within 48 hours. “In the Gulf, as in the US and UK – all technologically fit countries – they are having to wait seven days,” she says. “What is happening there?” She doesn’t want to judge, she says, but she has been mystified by the large death tolls in those countries: “I think testing is very important – also quarantining and hospital surveillance – and people in those countries are not getting that.” She knows, because Malayalis living in those countries have phoned her to say so.
Places of worship were closed under the rules of lockdown, resulting in protests in some Indian states, but resistance has been noticeably absent in Kerala – in part, perhaps, because its chief minister, Pinarayi Vijayan, consulted with local faith leaders about the closures. Shailaja says Kerala’s high literacy level is another factor: “People understand why they must stay at home. You can explain it to them.”
The Indian government plans to lift the lockdown on 17 May (the date has been extended twice). After that, she predicts, there will be a huge influx of Malayalis to Kerala from the heavily infected Gulf region. “It will be a great challenge, but we are preparing for it,” she says. There are plans A, B and C, with plan C – the worst-case scenario – involving the requisitioning of hotels, hostels and conference centres to provide 165,000 beds. If they need more than 5,000 ventilators, they will struggle – although more are on order – but the real limiting factor will be manpower, especially when it comes to contact tracing. “We are training up schoolteachers,” Shailaja says.
Once the second wave has passed – if, indeed, there is a second wave – these teachers will return to schools. She hopes to do the same, eventually, because her ministerial term will finish with the state elections a year from now. Since she does not think the threat of Covid-19 will subside any time soon, what secret would she like to pass on to her successor? She laughs her infectious laugh, because the secret is no secret: “Proper planning.”
Any Covid-19 vaccine must be treated as a global public good
David Pilling in The Financial Times
Imagine if, in a year’s time, 300m doses of a safe and effective Covid-19 vaccine have been manufactured in Donald Trump’s America, Xi Jinping’s China or Boris Johnson’s Britain. Who is going to get them? What are the chances that a nurse in India, or a doctor in Brazil, let alone a bus driver in Nigeria or a diabetic in Tanzania, will be given priority? The answer must be virtually nil.
The ugly battle between nations over limited supplies of tests and personal protective equipment will be a sideshow compared to the scramble over a vaccine. Yet if a vaccine is to be anything like the silver bullet that some imagine, it will have to be available to the world’s poor as well as to its rich.
Any vaccine should be deployed to create the maximum possible benefit to public health. That will mean prioritising doctors, nurses and other frontline workers, as well as those most vulnerable to the disease, no matter where they live or how much they can afford.
It will also mean deploying initially limited quantities of vaccine in order to snuff out clusters of infection by encircling them with a “curtain” of immunised people — as was done successfully against Ebola last year in the Democratic Republic of Congo.
With Covid-19, this looks like a pipe dream. Far from bringing the world together, the pandemic has exposed a crisis of international disunity. The World Health Organization is only as good as its member states allow. That it finds itself squeezed between China and the US when humanity is facing its worst pandemic in 100 years, is a sign of the broken international order.
How, under such circumstances, can we possibly conceive of a vaccine policy that is global, ethical and effective?
There are precedents. The principle of access to medicines was established with the HIV-Aids pandemic, in which life-saving medicines were originally priced far above the ability of patients in Africa and other parts of the developing world to pay.
But in 2001, in the so-called Doha declaration on Trade-Related Aspects of Intellectual Property Rights, the World Trade Organization made it clear that governments could override patents in public health emergencies. Largely as a result, a tiered pricing system has developed in which drug companies make profits in richer countries while allowing medicines to be sold more cheaply in poorer ones.
There are also tried-and-tested methods of funding immunisation campaigns that have saved literally millions of lives in Africa, Asia and Latin America. Gavi, the Vaccine Alliance, was founded in 2000 to address market failures. It guarantees the purchase of a set number of vaccine doses so that companies can manufacture existing, or develop new, vaccines knowing there will be a market for their product.
Along similar lines, 40 governments this month pledged $8bn to speed up the development, production and equitable deployment of Covid-19 vaccines, as well as diagnostics and therapeutics. There are already more than 80 candidates for a Covid-19 vaccine, with some of these now in human trials.
Then there is manufacturing. Lack of diagnostics and PPE has exposed the flaws of a just-in-time system that builds in no redundancy. Vaccine capacity must be built up now, even if that means some of it will go to waste. Nor can existing capacity simply be given over to a putative Covid-19 vaccine. That could unwittingly unleash outbreaks of previously controlled diseases, such as mumps or rubella.
Manufacturing will also have to be dispersed geographically to ensure a vaccine can be deployed globally.
Most vaccines are international collaborations. One against Ebola was discovered in Canada, developed in the US and manufactured in Germany. It is unlikely — and certainly undesirable — that any one country will be able to claim a Covid-19 vaccine all to itself.
Even if a successful candidate is developed, not everyone will want to take it.
Heidi Larson, director of the Vaccine Confidence Project, says surveys show that up to 9 per cent of British people, 18 per cent of Austrians and 20 per cent of Swiss would not agree to be immunised. Trust in vaccines is generally higher in the developing world, where the impact of infectious disease is more obvious. But here too there could be resistance, particularly if people suspect they are being used as guinea pigs.
The vaccine against a fictional pandemic in the 2011 film Contagion is distributed through a lottery based on birth date. When a vaccine against a real-life Covid-19 is found, it must be deployed as a global public good.
Health experts estimate it will cost some $20bn to vaccinate everyone on earth, equivalent to roughly two hours of global output. This is the best bargain in the world. Let us hope the world can recognise it.
Imagine if, in a year’s time, 300m doses of a safe and effective Covid-19 vaccine have been manufactured in Donald Trump’s America, Xi Jinping’s China or Boris Johnson’s Britain. Who is going to get them? What are the chances that a nurse in India, or a doctor in Brazil, let alone a bus driver in Nigeria or a diabetic in Tanzania, will be given priority? The answer must be virtually nil.
The ugly battle between nations over limited supplies of tests and personal protective equipment will be a sideshow compared to the scramble over a vaccine. Yet if a vaccine is to be anything like the silver bullet that some imagine, it will have to be available to the world’s poor as well as to its rich.
Any vaccine should be deployed to create the maximum possible benefit to public health. That will mean prioritising doctors, nurses and other frontline workers, as well as those most vulnerable to the disease, no matter where they live or how much they can afford.
It will also mean deploying initially limited quantities of vaccine in order to snuff out clusters of infection by encircling them with a “curtain” of immunised people — as was done successfully against Ebola last year in the Democratic Republic of Congo.
With Covid-19, this looks like a pipe dream. Far from bringing the world together, the pandemic has exposed a crisis of international disunity. The World Health Organization is only as good as its member states allow. That it finds itself squeezed between China and the US when humanity is facing its worst pandemic in 100 years, is a sign of the broken international order.
How, under such circumstances, can we possibly conceive of a vaccine policy that is global, ethical and effective?
There are precedents. The principle of access to medicines was established with the HIV-Aids pandemic, in which life-saving medicines were originally priced far above the ability of patients in Africa and other parts of the developing world to pay.
But in 2001, in the so-called Doha declaration on Trade-Related Aspects of Intellectual Property Rights, the World Trade Organization made it clear that governments could override patents in public health emergencies. Largely as a result, a tiered pricing system has developed in which drug companies make profits in richer countries while allowing medicines to be sold more cheaply in poorer ones.
There are also tried-and-tested methods of funding immunisation campaigns that have saved literally millions of lives in Africa, Asia and Latin America. Gavi, the Vaccine Alliance, was founded in 2000 to address market failures. It guarantees the purchase of a set number of vaccine doses so that companies can manufacture existing, or develop new, vaccines knowing there will be a market for their product.
Along similar lines, 40 governments this month pledged $8bn to speed up the development, production and equitable deployment of Covid-19 vaccines, as well as diagnostics and therapeutics. There are already more than 80 candidates for a Covid-19 vaccine, with some of these now in human trials.
Then there is manufacturing. Lack of diagnostics and PPE has exposed the flaws of a just-in-time system that builds in no redundancy. Vaccine capacity must be built up now, even if that means some of it will go to waste. Nor can existing capacity simply be given over to a putative Covid-19 vaccine. That could unwittingly unleash outbreaks of previously controlled diseases, such as mumps or rubella.
Manufacturing will also have to be dispersed geographically to ensure a vaccine can be deployed globally.
Most vaccines are international collaborations. One against Ebola was discovered in Canada, developed in the US and manufactured in Germany. It is unlikely — and certainly undesirable — that any one country will be able to claim a Covid-19 vaccine all to itself.
Even if a successful candidate is developed, not everyone will want to take it.
Heidi Larson, director of the Vaccine Confidence Project, says surveys show that up to 9 per cent of British people, 18 per cent of Austrians and 20 per cent of Swiss would not agree to be immunised. Trust in vaccines is generally higher in the developing world, where the impact of infectious disease is more obvious. But here too there could be resistance, particularly if people suspect they are being used as guinea pigs.
The vaccine against a fictional pandemic in the 2011 film Contagion is distributed through a lottery based on birth date. When a vaccine against a real-life Covid-19 is found, it must be deployed as a global public good.
Health experts estimate it will cost some $20bn to vaccinate everyone on earth, equivalent to roughly two hours of global output. This is the best bargain in the world. Let us hope the world can recognise it.
Wednesday 13 May 2020
German court decides to take back control with ECB ruling
Martin Wolf in The Financial Times
The 75th anniversary of the defeat of Nazi Germany was May 8. The 70th anniversary of the Schuman declaration, which launched postwar European integration, was May 9. Just days before both, the German constitutional court launched a legal missile into the heart of the EU. Its judgment is extraordinary. It is an attack on basic economics, the central bank’s integrity, its independence and the legal order of the EU.
The court ruled against the ECB’s public sector purchase programme, launched in 2015. It did not argue that the ECB had improperly engaged in monetary financing, but rather that it had failed to apply a “proportionality” analysis, when assessing the impact of its policies, on a litany of conservative concerns: “public debt, personal savings, pension and retirement schemes, real estate prices and the keeping afloat of economically unviable companies”.
Monetary policies are necessarily economic policies. But the ECB’s policies, including asset purchases, are justified by the fact that it was — and is — failing to achieve its treaty-mandated “primary objective”, which is “price stability” defined as inflation “below, but close to, 2 per cent over the medium-term”. The EU treaty says other considerations are secondary.
The court also decreed that “German constitutional organs and administrative bodies”, including the Bundesbank, may not participate in ultra vires acts (those outside one’s legal authority). Thus, the Bundesbank may not continue to participate in the ECB’s asset purchase programmes, until the ECB has conducted a “proportionality assessment” satisfactory to the court.
Yet the EU treaty states that “neither the ECB, nor a national central bank . . . shall seek or take instructions . . . from any government of a member state or from any other body [my emphases].” The court’s instruction puts the Bundesbank into a conflict of laws.
The court is also assailing the right of the ECB to make its policy decisions independently. Germany fought hard to install central bank independence within the monetary union. Now, its constitutional court has decreed that unless the ECB satisfies the justices that it has taken full account of a highly political list of side-effects of monetary policies, asset purchases are impermissible. Courts in other member countries may see fit to decree that their national central banks cannot participate in policies they dislike. Pretty soon, the ECB will have been sliced and diced into a nullity.
Above all, the German court decreed that it can ignore an earlier ruling of the European Court of Justice in favour of the ECB, because the former “exceeds its judicial mandate . . . where an interpretation of the Treaties is not comprehensible and must thus be considered arbitrary from an objective perspective.” This is an act of judicial secession.
The EU is an integrated legal system, or it is nothing. It rests on the acceptance by all member states of its authority in areas of its competence. In a press release after the constitutional court’s judgment, the ECJ rightly responded that “the Court of Justice alone . . . has jurisdiction to rule that an act of an EU institution is contrary to EU law. Divergences between courts of the member states as to the validity of such acts would indeed be liable to place in jeopardy the unity of the EU legal order and to detract from legal certainty.” Imagine if the courts of every member state were able to decide that ECJ rulings were “arbitrary from an objective perspective”.
What are the implications?
If the German court is ultimately satisfied that the ECB adequately assessed the economic impact of its purchases, the PSPP might continue. But the courthas reduced the ECB’s future flexibility by limiting its holdings of any member country’s debt to 33 per cent of the outstanding total and insisting that asset purchases be allocated according to member states’ shares in the ECB.
In the absence of other eurozone support programmes, the chance of defaults has jumped. Indeed, spreads on Italian government bonds have duly risen a little since the court’s announcement. A crisis might ultimately ensue, with devastating effects; perhaps even a break-up of the eurozone.
Others might follow Germany in rejecting the jurisdiction of the ECJ and EU. Hungary and Poland are obvious candidates. Future historians may mark this as the decisive turning point in Europe’s history, towards disintegration.
What can be done? The ECB cannot be accountable to a national court. But the Bundesbank could provide the court with the proportionality analysis. Maybe that would be enough, albeit also a bad precedent. Or, the decision could be ignored. If a German court can ignore the ECJ, maybe the Bundesbank can ignore that court. Alternatively, the ECB could just abandon efforts to rescue the eurozone and accept whatever outcome emerges.
The EU could initiate an infringement proceeding against Germany. But its direct target would be the German government, which is caught between the EU organs on the one hand and the court on the other. It could not change the ruling.
More radically, the EU could act to create the needed degree of fiscal solidarity. But the obstacles to this are large. A new treaty looks out of the question in today’s environment of intense mutual distrust. Finally, Germany could boldly secede from the eurozone. Yet, before it makes such a decision, one hopes it, too, will be required to do a full analysis of whether that would be “proportionate”.
One point is clear: The constitutional court has decreed that Germany, too, can take back control. As a result it has created a possibly insoluble crisis.
The 75th anniversary of the defeat of Nazi Germany was May 8. The 70th anniversary of the Schuman declaration, which launched postwar European integration, was May 9. Just days before both, the German constitutional court launched a legal missile into the heart of the EU. Its judgment is extraordinary. It is an attack on basic economics, the central bank’s integrity, its independence and the legal order of the EU.
The court ruled against the ECB’s public sector purchase programme, launched in 2015. It did not argue that the ECB had improperly engaged in monetary financing, but rather that it had failed to apply a “proportionality” analysis, when assessing the impact of its policies, on a litany of conservative concerns: “public debt, personal savings, pension and retirement schemes, real estate prices and the keeping afloat of economically unviable companies”.
Monetary policies are necessarily economic policies. But the ECB’s policies, including asset purchases, are justified by the fact that it was — and is — failing to achieve its treaty-mandated “primary objective”, which is “price stability” defined as inflation “below, but close to, 2 per cent over the medium-term”. The EU treaty says other considerations are secondary.
The court also decreed that “German constitutional organs and administrative bodies”, including the Bundesbank, may not participate in ultra vires acts (those outside one’s legal authority). Thus, the Bundesbank may not continue to participate in the ECB’s asset purchase programmes, until the ECB has conducted a “proportionality assessment” satisfactory to the court.
Yet the EU treaty states that “neither the ECB, nor a national central bank . . . shall seek or take instructions . . . from any government of a member state or from any other body [my emphases].” The court’s instruction puts the Bundesbank into a conflict of laws.
The court is also assailing the right of the ECB to make its policy decisions independently. Germany fought hard to install central bank independence within the monetary union. Now, its constitutional court has decreed that unless the ECB satisfies the justices that it has taken full account of a highly political list of side-effects of monetary policies, asset purchases are impermissible. Courts in other member countries may see fit to decree that their national central banks cannot participate in policies they dislike. Pretty soon, the ECB will have been sliced and diced into a nullity.
Above all, the German court decreed that it can ignore an earlier ruling of the European Court of Justice in favour of the ECB, because the former “exceeds its judicial mandate . . . where an interpretation of the Treaties is not comprehensible and must thus be considered arbitrary from an objective perspective.” This is an act of judicial secession.
The EU is an integrated legal system, or it is nothing. It rests on the acceptance by all member states of its authority in areas of its competence. In a press release after the constitutional court’s judgment, the ECJ rightly responded that “the Court of Justice alone . . . has jurisdiction to rule that an act of an EU institution is contrary to EU law. Divergences between courts of the member states as to the validity of such acts would indeed be liable to place in jeopardy the unity of the EU legal order and to detract from legal certainty.” Imagine if the courts of every member state were able to decide that ECJ rulings were “arbitrary from an objective perspective”.
What are the implications?
If the German court is ultimately satisfied that the ECB adequately assessed the economic impact of its purchases, the PSPP might continue. But the courthas reduced the ECB’s future flexibility by limiting its holdings of any member country’s debt to 33 per cent of the outstanding total and insisting that asset purchases be allocated according to member states’ shares in the ECB.
In the absence of other eurozone support programmes, the chance of defaults has jumped. Indeed, spreads on Italian government bonds have duly risen a little since the court’s announcement. A crisis might ultimately ensue, with devastating effects; perhaps even a break-up of the eurozone.
Others might follow Germany in rejecting the jurisdiction of the ECJ and EU. Hungary and Poland are obvious candidates. Future historians may mark this as the decisive turning point in Europe’s history, towards disintegration.
What can be done? The ECB cannot be accountable to a national court. But the Bundesbank could provide the court with the proportionality analysis. Maybe that would be enough, albeit also a bad precedent. Or, the decision could be ignored. If a German court can ignore the ECJ, maybe the Bundesbank can ignore that court. Alternatively, the ECB could just abandon efforts to rescue the eurozone and accept whatever outcome emerges.
The EU could initiate an infringement proceeding against Germany. But its direct target would be the German government, which is caught between the EU organs on the one hand and the court on the other. It could not change the ruling.
More radically, the EU could act to create the needed degree of fiscal solidarity. But the obstacles to this are large. A new treaty looks out of the question in today’s environment of intense mutual distrust. Finally, Germany could boldly secede from the eurozone. Yet, before it makes such a decision, one hopes it, too, will be required to do a full analysis of whether that would be “proportionate”.
One point is clear: The constitutional court has decreed that Germany, too, can take back control. As a result it has created a possibly insoluble crisis.
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