One of the things the COVID-19 lock up got me thinking about was Noah\u2019s Ark. Remember the original: God vowed to destroy mankind with a great flood because of its wickedness, but told Noah and his family to self-isolate themselves in an ark \u2013 a substantial building with three stories – with enough food for a long stay; to bring in two specimens of every living and creeping thing; and to stay put till the flood had subsided. Noah and his clan isolated themselves seven days before the flood started. The flood peaked in 40 days. As the waters receded the lock-up instructions were gradually relaxed and in a further two months it was safe for Noah and his family to go out again and resume their normal lives. Everyone and everything on land that had the \u2018breath of life\u2019 had died.<\/p>\n\n\n\n
Leave aside the striking parallels which will convince all Jehovah\u2019s Witnesses, religious fundamentalists and omnes gentes <\/em>that it\u2019s \u2018all in the Bible\u2019. Leave aside also one big difference, which is that so far at any rate the corona virus is much more forgiving that the biblical deity. Most of us will survive this particular flood of germs.<\/p>\n\n\n\n Nevertheless, the Noah\u2019s Ark problem arises whenever rising demand presses on a fixed supply. In the biblical story the shortage was in the supply of salvation, which was strictly limited to the righteous Noah and his family. <\/p>\n\n\n\n In today\u2019s secular version, there is a fixed (in the short run) supply of medical goods, notably protective clothing, tests, ventilators, hospital beds, and so on. So these items have to be rationed. <\/p>\n\n\n\n On what\nprinciple? The free market solution is to ration by price. The price of goods\nin short supply goes up, leaving only the rich able to afford them. If we had a\nfree market in health care, they would be able to buy up the lion\u2019s share of scarce medical goods. Eventually the quantity\nof medical goods would rise to meet the increased demand, but in the meantime\nthe poor would have to do without. <\/p>\n\n\n\n The\nsocialist solution is ration books or queueing. In the first case everyone is\nallocated an equal share of the scarce resource; the second works on a \u2018first\ncome first served basis\u2019: the people at\nthe heard of the queue get what\u2019s in the shop, and the rest get nothing. Long\nqueues with nothing in the shops to buy was a well-known feature of late\ncommunism.<\/p>\n\n\n\n But as\nsoon as we think of the problem in terms of life-threatening viruses and\nmedicines, we see that neither the free market nor socialist solution can be\nmade to work. <\/p>\n\n\n\n Any attempt to apply the free market solution would lead straight to revolution. Socialism has severe problems too. Some medical supplies, like masks, can be successfully rationed, with everyone getting a fixed number. But hospital treatment can\u2019t be rationed like, say, meat and eggs were in the war, because it can\u2019t be divided up into individual portions. For example, it would make no sense to allocate a tenth of ventilator to everyone. The bottom line here is that though testing can be done on a random basis, treatment cannot be random. <\/p>\n\n\n\n Evidently some different principle of selection is needed. This takes us back to the biblical story. God saved the virtuous; we have decided to prioritise the economically useful. The old, the sick, the infirm, those with \u2018underlying health issues\u2019, will be left to live or die as they may under conditions of lock-up; the giant share of scarce medical supplies will go to those with a viable future. Utility replaces virtue as the highest value.<\/p>\n\n\n\n Given\nthat we have got ourselves into this particular shortage trap, it is hard to\nsee what other principle of selection is available. Allocating scarce medical\nsupplies to the medically and economically\nuseful is clearly the only sensible\nthing to do. <\/p>\n\n\n\n But it\nsits very uncomfortably with another principle to which the liberal world is\ncommitted: that each life is of equal value. \nIt is in the name of equal rights to \u2018life, liberty, and happiness\u2019 that we ban all kinds of discrimination\nagainst particular individuals and groups. But in the situation we face today, someone is\ngoing to have to decide that some lives are more valuable than others. Some\npeople will be selected for the Ark, and others will be left to face the future\nas best they can till we develop a vaccine or the virus has done its work. <\/p>\n\n\n\n The\nconclusion seems clear enough. Given that we have no ethically accepted\nprinciple of choosing between who is to live and who to die, we should take\nexceptional pains to ensure that we do not face acute shortages of life-preserving\nequipment. It is a scandal that the\ndeveloped world was caught so short of tools to deal with the latest pandemic,\nsome countries more than others. For this there are a number of reasons. <\/p>\n\n\n\n The first is the policy of austerity, which now shines forth in its full wickedness. The evidence is strong that \u2018pandemic planning became a casualty of the austerity years\u2019. (Sunday Times, Coronavirus\/Insight 19\/04\/39). As a result our government faced a very poor trade-off between medical intervention and \u2018herd immunity\u2019. It may even be worse than we think as recent research has questioned the degree of immunity, so there may be more deaths than expected. Broadly speaking, the shorter we are of medical resources, the more drastic lock-up will need to be. <\/p>\n\n\n\n But\nausterity is by no means the only culprit. A second, and more fundamental,\nexplanation for our lack of preparedness, is the business philosophy of \u2018just\nin time\u2019. As health expert Alanna Shaikh, put it: \u2018Just in time ordering systems are great when\nthings are going well. But in a time of crisis it means we don\u2019t have any\nreserves. If a hospital or a country runs out of face masks or PPE equipment,\nthere\u2019s no big warehouse full of boxes\nthat we can go to, to get more. We have to order more from a supplier, we have\nto wait for them to produce it, and have to wait for them to ship it, mainly\nfrom China\u2019. <\/p>\n\n\n\n This\ncriticism applies to much more than medical procurement. It challenges the\njust-in-time orthodoxy generally prevalent in business. Reserves, the argument goes, cost money.\nEfficient markets don\u2019t require firms to have inventories, just to have enough \u2018stock\u2019 to satisfy the consumer at the point of\ndemand. To hold financial reserves\nagainst a rainy day is also wasteful. In efficient markets there are no rainy\ndays. So firms should be leveraged up to the hilt! <\/p>\n\n\n\n This\nis fine, provided there are no unexpected events. Come a \u2018shock\u2019 like the\nbanking crash of 2008, and the whole efficient market model collapses, and with\nit the economy. Something like this has been happening to our medical services\ntoday. Bed occupancy is as high\nas 98% in our marketised NHS, meaning there is no longer a reserve, and we are\nnot self-sufficient in doctors and nurses and expect other countries to train\nthem for our use.<\/p>\n\n\n\n We\nneed to restore what used to be called \u2018the precautionary principle\u2019. In all\nthose situations in which we can rationally anticipate a severe life-threatening event, \u2018just in time\u2019\nthinking needs to be replaced by \u2018just in case\u2019 thinking. <\/p>\n\n\n\n But this is not all. A major fault lies in the attitude of neo-classical economists and their political followers to \u2018innovation\u2019. The general idea is that nothing will be invented unless companies are given extended monopoly rights (patents) over the invention to enable them to recoup their investment. This is not only historically wrong (most innovation has been done or financed by government), but can have the effect of keeping life-saving inventions off the market. Dr. Shamel Azmeh points out that it would have been perfectly possible to develop ventilators \u2018simple enough to be stockpiled and quickly deployed\u2019, but a prototype of such a ventilator commissioned by the US government was aborted in 2012, after the private company concerned was acquired by a large producer of \u2018expensive, immobile, highly technical, difficult to use\u2019 ventilators suitable for a rich-country market. This kind of suppression of useful medical tools is little short of criminal. (Project Syndicate, The Perverse Economics of Ventilators, 16 April)<\/p>\n\n\n\n A\nfinal cause of unnecessary shortage is our dogmatic reliance on global supply\nchains. It is obviously more \u2018efficient\u2019 to get something produced in a cheap\nlabour location than by our more expensive labour. But what happens when\nsupplies from China are interrupted, because of a sudden increased demand for\nthem in China, as apparently happened with surgical masks?<\/p>\n\n\n\n The\nNoah\u2019s Ark problem can never be entirely avoided because extreme unexpected\nevents will continue to happen. But we can at least be better prepared for the\nnext pandemic. The fact that COVI-19 was\nunexpected, should not stop us taking precautions against this class of\ndisaster.<\/p>\n\n\n\n Key\nmeasures would be:<\/p>\n\n\n\n A final thought: we don\u2019t know how to increase the supply of virtue, but we do know how to increase the supply of ventilators. (1637) <\/p>\n\n\n\n