The number of COVID-19 fatalities in the United States reached the 500,000 mark sometime over the past week — the equivalent of killing off the population of two or three small cities in a little over a year. That is more than twice the upper estimate projected by the White House coronavirus task force in late March of last year. Yet the figure, while horrific, is somehow less shocking than it should be when taken by itself. Context matters, and in this case the context is global.
A country with 4.25 percent of the world’s population and 29.4 percent of its wealth has had a little over one-fifth of the global death toll (more than 2.49 million so far, according to the journal New Scientist). By comparison, India has close to four times the U.S. population and holds one-eighth of its wealth, but it has had under one-third the number of deaths from COVID. From now on, discussions of American exceptionalism should start with this phenomenal distinction. It is the product of a special kind of political leadership: one willing and able to govern from a secure location in fantasyland.
Around the time we passed the milestone of a half million deaths, I started reading Cass R. Sunstein’s Averting Catastrophe: Decision Theory for COVID-19, Climate Change, and Potential Disasters of All Kinds (NYU Press). The author, a professor at Harvard Law School, also serves as chair of the World Health Organization’s recently formed Technical Advisory Group on Behavioural Insights and Sciences for Health. Anyone taking the subtitle as a promise to grapple with the current pandemic may be perplexed and disappointed, however, since most of the book was written (and all of it excogitated) before the virus had been transmitted to humans. If every reference to COVID were removed, it would be effectively the same book, albeit shorter by a fraction of one page.
The announced topic, rather, is a general perspective on public policy decision making applicable to “potential disasters of all kinds,” with a particular emphasis on how preventative regulations can be assessed. Sunstein served as “regulatory czar” in the first Obama administration, which, as I recall, earned him a place at the time on Glenn Beck’s jumbo blackboard of proto-QAnon conspiracy diagrams. No one determined to believe that Sunstein is an old-school liberal of an even faintly social-democratic sort will be dissuaded by a mere lack of evidence, but Averting Catastrophe would not be helpful for the task. Here, risk assessment and decision-making processes are framed not only through cost-benefit analysis but in the most literal way — i.e., quantified in terms of dollars and cents. In an endnote, Sunstein does allow for the possibility that “deliberative considerations or welfarist considerations might trump the cost-benefit analysis” in some cases. But this seems an afterthought. (It is also the closest the book ever gets to mentioning the 45th president of the United States.)
Insofar as it has a target, Averting Catastrophe takes aim at certain corollaries or variants of what Sunstein identifies as the Precautionary Principle, which amounts to a policy of “better safe than sorry” at its most single-minded: “The central idea is that regulators should take aggressive action to avoid certain risks, even if they do not know that those risks will come to fruition.” This approach can be coherently generalized only just so far. Taking precautions against every possible risk is impossible and ultimately self-contradictory, since regulations can impose risks of their own. A more tempered precautionary framework would seem to be “the maximin principle, which calls for choosing the approach that eliminates the worst of the worst-case scenarios.”
One bug affecting the maximin decision making is the Principle of Insufficient Reason, which “holds that when people lack information about probabilities … they should act as if each probability is equally likely.” (Why the author capitalizes the names of only some principles is not clear.) In assessing risk, guessing the odds are 50-50 is seldom either valid or likely to work well. If you go outside, a meteor will either hit you or not hit you, and on that basis, you might decide never to risk it. But the likelihood of it happening is infinitesimal. The precautionary and maximin frameworks can neglect enormous disproportions in severity among various worst-case outcomes, while also disregarding how some outcomes are more likely than others.
Such carelessness would be unfortunate but understandable among the general population, Sunstein implies, but it’s inexcusable from people who have responsible positions in public life. A lot of Averting Catastrophe is devoted to thought experiments about preferences in deciding among variously weighted alternatives. For example: “Which would you prefer? (a) A 99.9 percent chance of gaining $60, and a 0.1 percent chance of losing $200 million; or (b) A 49.9 percent chance of gaining $10, a 50 percent chance of losing $10, and a 0.1 percent chance of losing $100 million.” The fact that you probably don’t have hundreds of millions of dollars at hand is not pertinent here. It’s a matter of being stuck with choices among “low-probability, high magnitude risks [that] might accompany more than one option.”
Any proposal regarding climate change falls under such a heading. Steps intended to avert climate-change catastrophe “might threaten to create some massive economic downturn and geopolitical instability.” Likewise with a pandemic and the trade-off between limiting the spread of infection and the economic and social costs of lockdown. And while at times the book seems to posit a situation in which costs, benefits and probabilities are known — with the potential for entering them all into spreadsheets, from which policy wonkdom’s best and brightest can read off the optimal outcomes — in fact, any potential crisis entails factors that are unknown or unknowable. Averting Catastrophe does not provide anything like an algorithm for averting catastrophe but more a suggestion of what due diligence in the effort might look like.
So it is all the more noticeable how much the disaster of this past year begs for a forensic inquiry. A close, hard look at how costs and benefits were assessed at every level of decision making seems necessary to make sure nothing like it ever happens again. For now, it almost beggars belief that it was even possible the first time.