The Perverse Incentives of Public Health Officials/When the Experts Don’t Listen to the Science
When it comes to the novel coronavirus and its variants, the most likely worst-case scenario is not that we’ll face an unending wave of pandemics for the next five, ten, twenty years… through the end of recorded time.
It’s that we’ll be forced to behave as though we might.
That nightmare isn’t inevitable. As of now, it’s not even particularly plausible. The only group of people with a vested interest in maintaining our current state of hyperarousal—along with the personality traits that make their own hyperarousal genuine—is our present class of high-ranking public health officials.
Public health officials are not front-line healthcare workers, the majority of whose responses to the course of this disease have been nothing short of heroic. Nor are they evil or corrupt human beings. They are, however, human beings: fallible, and, like everyone, prone to filtering the information they receive and transmit according to their preexisting narratives and prejudices.
One such prejudice is the worldview that draws people to the public health bureaucracy to begin with. Successful public health officials are detail-oriented, rule-bound, willing to enforce compliance in the face of resistance, and extremely risk-averse. They’re also highly attentive to easily quantifiable, tangible harms that can be traced directly to the source of an imminent threat.
They’re less expert at gauging or mitigating indirect or “invisible” harms, especially ones that may come from the fallout of their own policy recommendations. Present examples traceable to COVID-19 related restrictions include increased rates of mental illness, abuse, economic damage, cognitive or intellectual decline, and interpersonal suffering. Future ones may include higher long-term death rates caused by school closures as well as delayed diagnoses or treatments for other health conditions.
During a public health crisis, public health officials aren’t supposed to ruminate on the possible iatrogenic consequences of their interventions. Their job is to quell the most immediate health threats. But when an elite class of harm-avoidant, rule-bound people is asked to perform mass triage on the level of the general population for an extended period, the incentives that come with their doing so—praise and compliance for positive developments, and excessive blame for negative ones—can produce the very outcomes they seek to avoid. Especially when those incentives are coupled with the hall-monitor-esque personality traits many of their profession’s most accomplished tend to possess.
Let’s face it: no one typically pays much attention to public health officials. They operate as middle-managers, advising the public based on the mandates given them by policymakers, and advising policymakers based on scientific and public trends. Usually, the public has little desire to do what health officials say; the media have no interest in giving them much air time or print space; and their higher-ups typically have more pressing political interests than the (typically adverse) electoral consequences that might come from enforcing their every recommendation.
Extraordinary health crises invert those conditions. Suddenly, everyone cares what public health officials have to say. Politicians, their voters anxious for a leader who will listen to the experts, benefit from implementing their demands. The public, their reality hijacked by extreme uncertainty, also benefits physically and psychologically from heeding officials’ advice, at least in the short term.
None of that helps people feel less fearful, but it does help them feel more informed, and that, at least, gives them a semblance of stability and consistency in an otherwise increasingly chaotic environment.
This process activates a positive feedback loop: health officials provide information. The public listens. After a bit of a lag and some trial and error, their advice seems to work. Case rates go down. The public keeps listening. Officials’ bosses are even listening!
Stoked by demand, health officials keep landing panels, television slots, and articles in big-name publications. It’s not necessarily fame they’re after, but compliance, motivated by good intentions. The more people see them and listen to their good advice, the thinking goes, the better outcomes will be.
For a while.
Then there’s a twist. Soon, fresh information changes the stakes of the health crisis. Newer risks—but also fewer risks—distort that positive feedback loop. Viral mutations and treatment innovations, in spite of their both being promising, produce further “known unknowns”. New choices bring new uncertainties. The public’s sense of stability and consistency, which initially surged after people began listening to health officials’ advice, begins to wane.
That’s due in no small part to the increased rhetoric of instability and inconsistency coming from health officials themselves, who, in true hall monitor fashion, aren’t content with a six percent risk when maybe, just maybe, they could hew those stakes down to three, then two, then one, than half, than one-quarter, than one-eighth, then…
Accordingly, their recommendations become more inane: wear two masks (this from a CDC study, whose results are being wildly misinterpreted). Wear a mask in your house. Wear a mask forever. Nothing changes after you get vaccinated until we reach 60 percent immunity. 70 percent immunity. 80 percent immunity. Maybe more. During one CNBC interview, Dr. Anthony Fauci shifted his personal herd immunity target from 70 to 85 percent within the span of two sentences.
When the New York Times finally grilled him on his endless equivocation, Fauci explained:
“When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70 to 75 percent. …Then, when newer surveys said 60 percent or more would take it, I thought, 'I can nudge this up a bit,' so I went to 80, 85.”
In other words, the more people are willing to take the vaccine, the more people—in excess of that number—will “need” to take it before the crisis abates. The lockdowns will persist until morale improves.
At this point, we should be asking why the nation’s highest-ranking public health official considers it ethical to bargain back our civil liberties using techniques we wouldn’t want used against us in a business negotiation. This isn’t science; it’s a shell-game.
By the end of 2020, Fauci hinted he’d eventually insist on as high as 90% vaccine compliance. His newest (and highest) demand is 85% compliance—at which point, he notes, we might be able to start talking about “approaching some degree of normality.”
Approaching some degree of normality. Forget asymptomatic carriers—we’ll all be asymptotic carriers, infinitely approaching but never quite reaching the liberties we were once allowed to care about. The thought lends an entirely new meaning to the term “risk calculus.”
Then—wait! There are new strains! We don’t know how the vaccine responds to new strains! We also don’t know how long immunity lasts to begin with!
Actually, we have a pretty good idea about how long immunity from the novel coronavirus lasts, along with how well the current vaccine will inoculate us to new variants. For now, the data suggest that if you’ve already had COVID-19 or been vaccinated, chances are you’re looking at immunity from this strain and others closely related to it for anywhere between 8 months to 17 years—perhaps even decades.
Moreover, viral mutations are usually a promising development. Mutations become prominent when they increase a species’ chances of survival. Viral mutations make it easier for viruses to live in two ways: by making them more contagious; and by making them less deadly. If a host dies, the virus dies. Even if we encounter a variant that’s resistant to today’s vaccines, then, chances are it will be far less deadly than the first strains of COVID-19. New, more contagious variants are not necessarily bad news. Not only that, the vaccines’ innovative mRNA-based design makes them much easier and faster to re-engineer in response to viral mutations.
Why are public health officials wary of being this straightforward? Simple: because of the phrase “chances are”. “Chances are” means there’s a chance things could not go according to what science, statistics, and history have given us to expect. And when death is on the line, health officials are less concerned with telling you what your chances of living are than they are with keeping your chances of dying as low as possible.
It’s not in health officials’ interest (or, from their perspective, yours) to tell you what they think about the best-case scenario. It’s better for them to tell you what they know about the worst-case scenario. Their personality type and occupation make them eager to insist that you eliminate as much risk as possible, for as long as possible. After all, as public health officials, if the information they give you leads you to take risks that result in your death, it won’t be a good look for them. (Speaking bluntly, death also probably won’t be a very good look for you.)
For evidence, look no further than Dr. Anthony Fauci’s recent remarks that “whenever there is transmission and viral outbreaks throughout the world, the United States will always be in danger, no matter what we do,” (emphases added) and that “we can start thinking about having the masks come off” only “when the virus is so low that it’s not a threat at all.”
This condition is absurd on its face. When is a virus “not a threat at all”? The flu is a threat. Chickenpox is a threat. A stomach bug that you don’t even know you have could leave someone else hospitalized. HIV is a threat—should the government try to ban sex until we completely eradicate HIV/AIDS?
It’s also worth noting that, if you replace “viral outbreaks” in the quote above with “Islamic terrorism,” you’ll get the same sort of rhetoric that led us to undertake the most expensive war in U.S. history—one that has yet to be concluded twenty years later, and one for which we still lack a solid exit strategy. There’s a lesson here: from the war on terror to the war on COVID, the same problem appears any time bureaucrats operate according to risk thresholds that are impossible both to quantify and to overcome.
The solution, on the other hand, is simple: stop waiting for bureaucratic permission to trust ourselves again. It’s time to follow the science, even if it leads in a direction that public health officials dare not tread.
To do that, we need a more reasonable risk barometer than positive tests or transmission rates. One fairly straightforward suggestion for gauging reopening readiness is to use a vaccination/hospitalization threshold instead of going by crude infection rates.
That’s partly because vaccines might not prevent individuals from contracting COVID-19, but rather keep them from becoming symptomatic. If that’s true, it wouldn’t be surprising or rare. It’s normal for us to carry up to 15 viruses at any given time without knowing it. We don’t shut down our lives, our schools, and our economies any time we test positive for one of them. What made COVID-19 different (from an epidemiological standpoint) was its novelty and severity. As fewer people are hospitalized for COVID-19—especially relative to the proportion vaccinated—we can start treating this virus like any of the others we might be carrying right now.
Some people will still prefer to take extra precautions, including wearing masks in public, particularly in winter months or in crowded spaces. Like COVID-19 itself, that practice may be with us for a long time; and those who feel safer wearing masks should be free to do so without judgment. But as vaccination rates go up, masking requirements and fractional occupancy caps should become a thing of the past. As things stand, it seems reasonable to lift any outdoor mask requirements immediately; lift indoor mask requirements by this summer if immunity continues to rise; and resume most if not all indoor activities, including school and university classes, this fall—without mandatory masks.
A final example of what the public health bureaucracy should not do in the aftermath of the COVID-19 outbreak can be found by studying the aftermath of the 2008–09 economic crisis. Whatever you think about whether the Federal Reserve’s immediate response—large-scale asset purchases, coupled with interest on excess reserves, and a number of other “unconventional monetary policy tools”—was warranted or well-executed, the repeated retracted footballs of money market retrenchment that have persisted to this day have only painted us further into a corner (or closer to the edge of a cliff, depending).
On many points, the public health policy response to the COVID-19 crisis has looked like a rerun of the Fed policy response to the 2008 economic crisis. The time to rewrite that script is now—before it morphs into an even worse spinoff series.