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Failing to plan, planning to fail

Disaster studies catastrophically marginalised

20 05 21.alexander.ata

This is the story of the birth, growth and marginalisation of a key discipline in the fight against the Covid-19 pandemic.

On 6th December 1917 a munitions ship exploded in Halifax sound, Nova Scotia. The blast devastated the surrounding area, killed 1,950 people and injured 9,000. This was the 'big bang' of disaster studies. A talented Anglican curate, Samuel Henry Prince, set about recording the social effects of the catastrophe and the progress of the relief effort. It was not quite his first disaster, as five years previously he had conducted funerals for some of the victims of the Titanic. At Columbia University, Prince wrote his PhD thesis on the Halifax disaster and in 1920 he published it as a book. This was the first modern, systematic, analytical account of the social effects of catastrophe. Other authors quickly followed Prince's lead. Thus we have 100 years of study in the field of disasters.

In 2003, concerted international action stopped the spread of an epidemic form of a sudden acute respiratory syndrome (SARS) virus which had badly affected East Asia and parts of Canada. This could have been a much more serious outbreak and it stimulated researchers to look into the possible consequences of bigger pandemic. At the same time, interest was growing in the task of reconstructing the history of the 1918-1920 influenza pandemic. Over the period 2003-2009 a number of authors contributed to the scenario. In 2005, urged to action by the SARS outbreak, the World Health Organisation produced a plan for coordinating national efforts to manage a pandemic. It was assumed that the culprit would be influenza of a kind that is more virulent and lethal than the seasonal strains which appear every winter. SARS viruses, including SARS-CoV-2, are not forms of influenza, but they have some similar effects, including potential mass release of cytokines, proteins that modulate the immune system's response to a virus. The so-called 'cytokine storm' can be lethal.

Generally, diseases are not part of the core material that disaster specialists study, but an exception is made for pandemics as so many of the effects are social, psychological and economic.

The scenario extended well beyond the medical side of the story to the social and economic effects. Generally, diseases are not part of the core material that disaster specialists study, but an exception is made for pandemics as so many of the effects are social, psychological and economic. Indeed, managing a pandemic involves balancing efforts to contain, deal with and recover from all of these things simultaneously. As the scenario was developed, individual countries followed the lead of WHO and produced their own national coordination plans and strategies. For example, the US pandemic influenza strategy was published in November 2005. A prototype UK plan was made in 2005, rewritten in 2011 and revised again in 2014.

I first learned the scenario from a presentation given in 2008 by Professor Ziad Abdeen of Al Quds University, Jerusalem, who started his talk with these prophetic words: "My task is to tell you things you don't want to know, and ask you to spend money you haven't got on something you don't think will happen." I have been teaching the scenario ever since. It also fed into the intense work that emergency planners carried out over the period 2008-2013 in preparing for the next pandemic. But by the middle of the last decade, their efforts in this field had been shouldered aside by a renewed emphasis on counter-terrorism.

In Britain, after 2016 the emergency planners devoted almost all of their attention to devising ways to deal with the supply-chain disaster of a hard Brexit. Since its inception in 2010 the UK National Risk Register, a pioneer concept, has consistently named pandemics as the greatest threat, in terms of both likelihood and consequences, out of 94 risks that the United Kingdom generally faces. Nevertheless, there was something of a false sense of security. Countries that had stockpiled antivirals for an anticipated influenza outbreak found that they had to destroy them when they remained unused. The high cost of this measure discouraged further preparation. Most zoonoses, or cases of the passage of a disease from an animal to a human host, led to infections that, it was felt, could be controlled by ad hoc measures. Despite this, concern about pandemics did not evaporate entirely. In October 2016, the UK held Exercise Cygnus, a three-day national command-post exercise designed to simulate the response to an overwhelming outbreak of influenza. It resulted in a report (which, tellingly, was not released to the public), that made 22 recommendations to improve what the exercisers regarded as Britain's inadequate level of preparedness.

In late 2019 and early 2020, when Covid-19 began to proliferate, mistakes in strategy were easily made. Given the level of economic and social disruption, many countries were reluctant to apply measures widely in the early stages. Leaders had a tendency to underestimate the seriousness of the situation, showing instead a form of psychological 'normalcy bias'. At this point, one has to ask what had become of the emergency plans.

Leaders had a tendency to underestimate the seriousness of the situation, showing instead a form of psychological 'normalcy bias'.

In some respects, emergency planning is a form of 'codified common sense'. Yet it is both an art and a science, as it needs to be both inventive and highly systematic. It also needs to be extremely professional, which requires sizeable inputs of education and training. In a major emergency, there are three commodities: plans, procedures and improvisation. At all levels of government and organisation, the responders enact the procedures, which are orchestrated by the plans. Indeed, a symphony orchestra is a good analogy. The conductor has the score (the plan) and the instrumentalists have their music (the procedures) and they must all play in harmony. In emergency response, this means that urgent needs must be anticipated and responsibilities for fulfilling them must be allocated. The ways in which this will be accomplished must be worked out in advance. As every emergency involves some degree of uniqueness, improvisation cannot be ruled out but it must be minimised. Unwarranted improvisation is inefficient and it can be tantamount to negligence, which in its worst form may allow lives to be lost unnecessarily.

Emergency plans are about systematic foresight. For a known hazard--and this includes epidemic diseases--scenarios can be made which indicate what needs will arise duringĀ  the crisis and which point to a strategy for satisfying them. A scenario is not a prediction of the future, it is a systematic exploration of possible future outcomes. It has leeway and flexibility, but it constantly asks the question, "What if...?" Plans based on the scenarios need to match available resources to emerging needs in the most efficient, effective way possible. They may also highlight the need to acquire more resources, without which the response will be inadequate. In viral pandemics, this may be the case for ventilators and personal protective clothing. The scenario for a pandemic covers medical, epidemiological, social, psychological, perceptual, economic and environmental responses to the crisis. Despite being more than ten years old, it is remarkable how prescient and accurate it turned out to be when Covid-19 arrived on the scene.

As far as possible, plans need to cover all necessary ground. This means that they are required at all levels of government, from supra-national and national to local, as well as for many different types of organisation. They also need to fit together as a nested hierarchy of interactions. This, fortunately, is not "rocket science" but a matter of comparative reading and weeding out the inconsistencies. Moreover, emergency plans need to be living documents. They should not be left on the shelf (or these days on the memory stick) but must be updated constantly. In addition, their potential users need to be familiar with them. Emergency planning does not cease with the creation of a written instrument. In order to adapt the plan to evolving circumstances, contingent and short-term planning need to go on during the crisis period. Finally, a disaster offers a good opportunity to learn lessons and incorporate them into the next revision of the plan.

When Covid-19 struck, the effectiveness or ineffectiveness of emergency planning was immediately revealed in all relevant contexts. In the United Kingdom, there proved to be a substantial gap between the formulation of plans and their implementation. For years, emergency planners had been ignored, marginalised or underfunded. They also lacked a joined-up system in which the interaction between plans could be guaranteed as a form of mutual reinforcement. The result of this was frantic improvisation and serious inefficiencies in anticipating needs, dealing with contingencies, maintaining supply chains, making rational decisions and communicating with the general public. The prevailing approach was to manage the pandemic on the basis of scientific advice and ad hoc decision making. The main consequence of this was that most of the failings were related to issues that needed to be solved by proper emergency planning rather than scientific advice. The Scientific Advisory Group for Emergencies (SAGE), the UK Government's main source of information had about 56 members, of whom most were medical or epidemiological specialists, two were psychologists and none had any expertise in emergency planning.

When Covid-19 struck, the effectiveness or ineffectiveness of emergency planning was immediately revealed in all relevant contexts.

A proliferating new virus is a source of great scientific uncertainty. Issues that are very hard to resolve include its infectiousness; its rate of spread (the 'R' number); the proportion of infected people who die (the case-fatality rate); the disease's differential impact by ethnicity, gender and age-group; the acquisition of immunity; the relationship of the disease to environmental factors (e.g. pollution and human-animal interactions); and the role of personal protective equipment in reducing infection rates among the public. There is even some dissent as to exactly what the term 'pandemic' means.

In emergency planning terms, an outbreak of influenza or one of SARS have little to differentiate them. They both require major boosts to the health and welfare systems, maintenance of livelihoods, protection against eviction from homes, radical reorganisation of the economy and transportation, and closure of activities. This is, of course, in addition to testing, contact tracing, isolation, quarantine and policing of physical distancing measures. Hence, emergency plans need to deal with everything from contraception to cruise ships, psychological support to continuity of education, conspiracy theories to sudden changes in consumer demand.

In Britain and other countries, Covid-19 has revealed that there is a community of emergency planners. It has shown that there is a need to increase their profile and their status. This should include better provision for establishing emergency planning as a proper academic and professional discipline. A look at the history of this field in the United States over the last 40 years shows how the strength of emergency planning has ebbed and flowed with different political administrations. Hurricane Katrina in 2005 was a low point, in which planning failures abounded and had a very high profile: perhaps Covid-19 is another.

Emergency planning is a 'lateral' field that embraces at least 40 more traditional academic disciplines and professions, from engineering, to cartography, and from geology to sociology. One lesson that needs to be learned from the experience of Covid-19 is that good, robust emergency plans could have solved many problems that festered until they became major crises. Time to establish it as a proper discipline.

Lastly, the scenario for a major pandemic is fairly complete in terms of the early and middle phases, but it tends to become thin regarding the aftermath and recovery. The process of recovering from the 1918-1920 influenza pandemic took at least five years and fed into the Great Depression. Conditions were very different a century ago, but it is now time to take copious notes for the recovery plans.

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