Robert Madelin / Mar 2020
History, suggested Mark Twain, does not repeat itself - but it rhymes.
COVID19, on that basis, is not the Black Death, SARS or Bird Flu. But looking back helps to sense the direction of the story. Somewhat.
Having been through the public health scares of 2004-10 as the European Commission’s Director General for Health, it is second nature to find a frame for assessing the present by studying past rhymes.
The story still unfolds but, so far, I would say that the themes of the inevitable peace-time post mortems will focus on some familiar issues: denial, delay, coordination.
The big prize still goes to whoever can work out how best to recover from what looks like being a deep and prolonged economic after-shock. Here I look only at the first three issues, and does so modestly to begin a conversation, rather than to claim wisdom.
There is much allegation these days that the world’s COVID experience is worsened by initial dissembling in Beijing. My expert chums at the Royal College of Physicians find the opposite:
“Despite dramatic headlines in the international press, the outbreak has been characterised by an extraordinarily rapid and effective scientific response, with identification of the pathogen, publication of its genome, and development of highly specific diagnostics within weeks of [Mid-December and] the initial case detection.”
At the same time, and however proud China can be of its mighty fight-back these last two months, it is undeniable that the initial scientific calls were not followed in Beijing by immediate high-level acceptance and promulgation of a crisis plan. If Beijing’s reaction time was improvable, it is also clear that the World Health Organisation could have acted faster. Setting aside the controversy as to whether a pandemic should have been declared earlier, WHO could usefully have pressed for ‘as if’ preparations for a possible coming pandemic.
Overall, the RCP judgment shows that since SARS and Bird Flu, when China and Thailand and others were slow to speak up, lessons have been partly learned. But this also invites a more thorny question – why on this more promising scientific basis, was Europe not better armed?
EU risk science has this time clearly done its job. The EU’s Health Security Committee of national health crisis managers heard from the European CDC (our risk assessor) in mid-February that the COVID19 threat was real and imminent. But that signal, delivered at working level after Health Ministers had concluded that watch and wait was for that period the right strategy, was not the trigger for immediate action.
It is natural that serious risk experts, always in all fields, avoid simplistic calls for action. By overstating the evidence they can forfeit credibility. When other expert calls turned out to have exaggerated the danger (Weapons of Mass destruction in Iraq, likely mortality from BSE…) the experts are blamed, sometimes unfairly, for errors that can be matters of political judgment, not of science.
So what? It may be too early to say. But what the post mortem will conclude is that we need, at the early stage when a red alert cannot yet be identified, to spend more time on “no-regrets actions”. Asking whether we have enough beds, masks, gowns? Whether there is a consensus on public health containment best practice or, failing that, some options for deeper study at continental level? How will essential supplies be defined and how they will in practice be kept running in a closed-down continent?
Such ex post wisdom is easy, especially for armchair ex-planners. The real heroes of EU response do not need such challenges right now. But Europe has gradually built from scratch our current tools, crisis by crisis: SARS found us without any stable coordination, without an ECDC, without a Health Security network: now we have all that. So in response to COVID19 we shall build better tools. These need not require any transfer of competence, simply the creation of a will, and a habit, for cooperation.
Rhymes can help the listener to anticipate the poetry yet unspoken.
In what will be a long fight against COVID19, there are signs both that Europe has better handled this crisis thanks to the lessons since SARS, and that there remains space to do even better.
The quality of crisis communication from the European Commission President is unprecedented. Present, clear, confident, active. Some national leaders, but not all, are at the same level.
The proactive creation of conversations at European Council (EUCO) level has also been a success in setting common goals, notable in the week of 16 March in respect of free flows of essential supplies across the internal market.
Beyond that, there is need for more and better networking. To follow EUCO with siloed conversations for health, transport, interior and agriculture is clearly not creating decisive and coherent action. We need instead a ‘COVID EUCO SHERPA’ network. As in the days after the collapse of the Soviet Union, this can be the Commission Secretary General, or their Deputy, coupled with ad hoc nominees (Coreper ambassadors or not) from each Member State. But something clearer will help European governments to save citizens’ lives in the coming months.
We are, as always in real life, making sense of unprecedented experiences in real time. Europe has done so far a good deal better than ever before, thanks to past experience. We can – as always for humanity – go on learning to do better.
The key magic word will be modesty. Whenever we (nation states, regions, corporations) feel ‘we can beat this’, we will fail spectacularly. To the extent that we stay curious, modest, humble and connected, we can indeed beat the virus, at least to a standstill. Then, there will be another challenge, from a new baseline. So it goes.
 Clinical Medicine, Vol 20, No 2, March 2020.