Is Paranoia the Key to Pandemic Preparedness?

In January 2020, government and business leaders from around the world gathered in Davos, Switzerland, for the annual World Economic Forum. Among the attendees, there was widespread agreement that climate change was the principal threat to humanity. George Soros said it. Greta Thunberg said it. The forum’s Global Risks Report, published shortly before the Davos gathering, listed as its “top five global risks in terms of likelihood” extreme weather, climate action failure, natural disasters, biodiversity loss, and human-made environmental disasters. Three climate-related risks also made it into the forum’s top five “in terms of impact”—a distinction that pandemics had not achieved since 2008. Yet even as the great and the good mingled in Davos, a deadly and highly contagious novel coronavirus was rapidly spreading around the world.

The dangers arising from climbing global temperatures are, of course, real and potentially catastrophic. But to focus exclusively on climate change is to risk underestimating other potential catastrophes: wars, revolutions, and genocides, not to mention volcanic eruptions, earthquakes, droughts, floods, tempests—and plagues such as the COVID-19 pandemic, which continues to wreak havoc on lives and livelihoods around the globe.

The problem with all forms of disaster is that they are characterized by random or power-law distributions. They belong in the domain of uncertainty, not risk, meaning that we cannot attach meaningful probabilities to them, much less predict them. There is no cyclical theory of history that can foretell the timing, the scale, or the nature of the next big disaster. This helps explain why societies tend to lurch from one crisis to the next, often preparing to fight the last war right up until the moment the next and quite different one breaks out. It also explains why bureaucratic preparedness for any given type of potential disaster is worth only so much. Many Western governments were well prepared for a pandemic on paper. Yet they failed to contain the deadly virus while other countries—in particular, Taiwan, South Korea, and Israel—fared much better. 

What these three countries have in common is a general sense of paranoia: a fear that they could be swept away by any number of threats stemming, directly or indirectly, from hostile powers in their regions. Instead of trying to predict one or two future emergencies and prepare for them with cumbersome contingency plans, these countries emphasize rapid reaction and the deployment of technology to maximize their ability to turn on a dime.

It is impossible to know in advance what the next crisis will be. For every conceivable calamity, there is at least one plausible Cassandra. But not all prophecies can be acted upon preemptively. The key lesson of 2020, then, is that it is better to be generally paranoid than to be bureaucratically prepared—in the sense of having produced multiple reports and PowerPoint decks, none one of which will be particularly useful when disaster actually strikes.

THE PARANOIAC’S EDGE

On paper, the United States and the United Kingdom were both exceptionally well prepared for a pandemic. They were ranked first and second in the Global Health Security rankings produced in 2019 by the Economist Intelligence Unit. The United States got a similarly good report from the World Health Organization’s Joint External Evaluation. Yet in January 2020, when reports from China indicated that the new coronavirus now known as SARS-CoV-2 was both contagious and lethal, these governments were slow to act. The American epidemiologist Larry Brilliant, a key figure in the campaign to eradicate smallpox, has said for many years that the formula for dealing with infectious disease is “early detection, early response.” In Washington and London, the opposite occurred.

The failure of the United States, the United Kingdom, and other wealthy Western governments to contain COVID-19 stood in stark contrast to the experience of a handful of smaller countries with fewer resources. Taiwan and South Korea, in particular, stood out for the effectiveness of their pandemic responses. Neither required blanket lockdowns to contain the spread of COVID-19. In fact, their pandemic restrictions, as measured by the Oxford Blavatnik School, were among the least stringent in the developed world. The pandemic-related death tolls in both countries speak for themselves: 12 in Taiwan, 1,891 in South Korea. (The outbreak of cases that has necessitated a partial lockdown in Taipei this week is attracting attention not because of its size but because it is the first time case numbers in Taiwan have exceeded double digits.)

Why were these two countries—both much closer to the source of the pandemic than the United States—so much more successful in coping with it? The proximate answer is that they learned the lessons of two previous coronavirus outbreaks, SARS and MERS. But that explanation understates the creativity of their responses. Taiwan used online platforms to gather and share information about symptoms and exposure, ration facemasks when they were scarce, and enforce quarantines. Schools remained open, albeit with strictly enforced precautions.

In South Korea, the government and the private sector collaborated to rapidly ramp up testing; at the same time, the government deployed a mobile-phone-based system of contact tracing. Under legislation passed at the time of MERS, the government had the authority to collect mobile-phone, credit-card, and other information from anyone who tested positive and use it to reconstruct his or her recent whereabouts. Those data, stripped of personal identifiers, were then shared on social media apps, allowing others to determine whether or not they had crossed paths with an infected person. Like Taiwan, South Korea strictly enforced quarantines.

The key lesson of 2020 is that it is better to be generally paranoid than to be bureaucratically prepared.

Alongside Taiwan and South Korea, Israel gets an honorable mention. True, its record of containing the coronavirus was more mixed. After a strong early response to the pandemic a year ago, Israel weathered two major waves of deaths that peaked in October 2020 and January 2021. Israel’s vaccination procurement and rollout, however, were the best in the world.

Taiwan, South Korea, and Israel are, of course, all leading innovators in the realm of technology, which no doubt assisted in their pandemic responses. But even more important is the fact that all three have very good reasons—in the form of hostile neighbors and near neighbors—to be paranoid. Taiwan faces the ever-present threat of China, whose fighters and bombers regularly encroach on Taiwan’s airspace and whose hackers and propagandists seek to undermine its democracy. Similarly, South Korea lives with the knowledge that its northern neighbor’s ballistic missiles could reach it within minutes, and Israel faces daily threats from Iran, as yet unreconciled Arab states, and terrorist organizations too numerous to list.

I happened to visit Taiwan in early January 2020, before the full scale of the biological threat emanating from Wuhan had become clear. The officials I spoke to were more focused on the threat of Chinese interference in their election. But I was deeply impressed by what I learned about the work of Audrey Tang, who was appointed digital minister after creating a media and digital competence program for Taiwanese schools in 2017. Tang’s approach—to use software and smartphones to empower citizens and make the state more accountable—has its roots in the 2014 student protests known as the Sunflower Movement, which she supported. She has inspired a new way of thinking that regards democracy as facing multiple threats, including from within, and technology as enabling a new form of crowdsourced defense.

The contrast between her approach and that of most Western countries could hardly be more stark. In the U.S. government, multiple official documents gave the illusion of preparedness, but, as a new report from the Independent Panel for Pandemic Preparedness & Response points out, in the absence of drills and simulations, there is no guarantee that these preparations will work “in actual conditions of pandemic stress.” Robert Kadlec, who served as assistant secretary for preparedness and response at the U.S. Department of Health and Human Services until January 2021, evidently suspected as much. In a lecture in October 2018, he gave a startlingly frank assessment of the state of the United States’ biodefense policy and the need for an effective insurance policy against a pandemic. “If we don’t build this,” he said, “we’re gonna be ‘SOL’ [shit out of luck] should we ever be confronted with it.”

CRISIS ROULETTE

What disaster will befall the world next? Surely not another pandemic—that would be too obvious to be plausible history. It is nevertheless possible. A new strain of swine flu is never far away, nor is some other new respiratory disease. Antibiotic-resistant microbes such as Staphylococcus aureus already exist; one awaits with trepidation an antibiotic-resistant strain of bubonic plague. 

Already, as one disaster so often begets another, COVID-19—with the help of swarms of locusts—is causing a crisis of nutrition in parts of Africa and South Asia. The World Food Program estimates that 34 million people are on the brink of famine, notably in countries such as Afghanistan, Burkina Faso, Haiti, and Zimbabwe. Matters have been made worse by the disruption of established vaccination programs. Outbreaks of diphtheria currently rage in Sudan and the Dominican Republic, cholera in Mozambique, and measles in the Philippines.

Last year’s extensive wildfires in California seemed to validate the warnings of climate change alarmists, although the fires revealed as much about the state’s mismanagement of its forests as about global warming. In any case, a huge earthquake on the San Andreas Fault could make wildfires seem a small problem, and the eruption of the Yellowstone Supervolcano would render discussion of man-made climate change superfluous. Nor should we forget the extraterrestrial threats posed by fluctuations in solar or stellar activity.

In addition to these exogenous threats, there are the various technologies humans have devised or are devising that have the potential to destroy us. A nuclear war between two major powers or a significant act of nuclear terrorism could kill more people in a matter of hours than COVID-19 has killed in a year. The nuclear winter that would follow a nuclear war would render large parts of the planet uninhabitable. Biological weapons could have comparably catastrophic consequences, were they to be deployed or accidentally released on a large scale. Genetic engineering is a more recent innovation that, like nuclear energy, could be used for malign as well as benign purposes.

Governments should embrace full-spectrum vigilance and hone their capacity for rapid reaction.

In the realm of computer technology, new dangers have also arisen or could shortly arise. The Internet of Things has created multiple vulnerabilities for governments, whose critical power, command, control, and communications infrastructure can now be wholly or partly disabled by cyberattacks. (The recent ransomware attack on Colonial Pipeline was a trailer for a much bigger disaster movie.) Artificial intelligence systems can already teach themselves how to beat human champions at games such as chess and Go and might one day turn against their human creators, according to Eliezer Yudkowsky of the Machine Intelligence Research Institute in Berkeley, California. Yudkowsky warns of a modified Moore’s law: every 18 months, the minimum IQ necessary to destroy the world drops by one point. A final nightmare scenario is that nanotechnology—molecular manufacturing—leads to some self-perpetuating and unstoppable process that drowns humanity in gloop. 

A number of authors have proposed ways to protect humanity from destruction and self-destruction. In their book Warnings: Finding Cassandras to Stop Catastrophes, Richard A. Clarke and R. P. Eddy suggest employing official Cassandras within governments, international bodies, universities, and corporations. In the United States, they propose creating a National Warnings Office tasked with identifying worst-case scenarios, measuring risks, and devising hedging, prevention, and mitigation strategies. But why would these Cassandras be heeded any more than the original Trojan prophet of doom in Aeschylus’s Agamemnon? After all, there were dozens of eminent people who warned of the risk of a deadly pandemic prior to the COVID-19 crisis. Cassandras will not save us if all they inspire are preparedness plans that aren’t worth the PDF files they are saved on when the next disaster strikes.

Nick Bostrom, a philosopher at the University of Oxford, has argued that governments must together “slow the rate of advancement towards risk-increasing technologies relative to the rate of advancement in protective technologies,” ensuring that people developing new technologies agree to use them for good rather than evil purposes while also developing “the intra-state governance capacity needed to prevent, with extremely high reliability, any individual or small group . . . from carrying out any action that is highly illegal.”

Yet Bostrom’s proposal turns out to be an existential threat in its own right. To protect humanity from itself, he envisages a “high-tech Panopticon” with “ubiquitous-surveillance-powered preventive policing.” The goal would be “effective global governance” with “some kind of surveillance and enforcement mechanism that would make it possible to interdict attempts to carry out a destructive act.” This is a road to totalitarianism—especially at a time when the technologies that would make possible such a global surveillance state already exist. The totalitarian regimes of the twentieth century caused some of the greatest disasters in history, with death tolls in the tens of millions. Building Bostrom’s panopticon to prevent the creation of a doomsday machine would be equivalent to committing suicide for fear of being murdered.

THE PEOPLE’S TECH

Better than being prepared for a specific type of disaster, whether it is climate change or a pandemic, is being generally paranoid—especially if your preparations are likely to prove ineffectual in practice. Governments should embrace full-spectrum vigilance and hone their capacity for rapid reaction, making creative use of new technology as Tang has done in Taiwan.

In addition to the simple fact that it seems to work, Tang’s approach is appealing because it empowers ordinary people rather than the state or the political elite. In an interview last year, she explained that Taiwan now uses open-source software tools to tap the “collective intelligence” of civil society through “participatory mechanism design.” Polling tools such as Join and vTaiwan are built on top of Pol.is—a software program described by one of its co-founders, Colin Megill, as a “tool for turning crowds into coherence”—and provide the government with a “rough consensus” on multiple issues. The American knee-jerk reaction to such innovations—exemplified by the refusal to make serious use of contract-tracing apps last year—is that they are a threat to civil liberties. This is a bit rich from a nation that has had to submit to varying degrees of lockdown during the pandemic. As Tang argues, the Taiwanese approach is the exact opposite of the artificial intelligence–enabled panopticon currently under construction in mainland China. Tang is using technology to protect individual freedoms, not to erode them.

Crowds, of course, are capable of madness as well as wisdom. Still, it seems unlikely that the Taiwanese approach to disaster management—rapid, tech-enabled response rather than bureaucratic pseudo-preparedness—would generate a list of risks as dangerously myopic as the one Davos published on the eve of the pandemic.