There are two books that many people have returned to read or discovered during the pandemic which–taken together–have been pretty good source material for decision-making around the pandemic.
The Coming Plague: Newly Emerging Diseases in a World Out of Balance
“Any of the events chronicled in Garrett’s book would have been transformed by the…government-subsidized scientific research and development (over a thirty-plus-year period) which created the momentum for the “miracle’ that is the mRNA vaccine “warp speed” development and deployment.”
The first is Laurie Garrett’s The Coming Plague a 750-page tome organized around plagues, pandemics, epidemics, and disease outbreaks over the course of history and all over the world. This book then leads you to Stephen Soderbergh’s film Contagion (for which Garrett was a scientific advisor). Contagion, as a piece of media, is a foresight strategy document with the resources of a Hollywood film. A master class in storytelling fused with scenario planning to tell the story of a potential future. Garrett had a major role in the accuracy and authenticity of the film. Garrett is a Pulitzer-winning science journalist.
The takeaways from Garrett’s experiences around the globe covering these public health crises and disasters for decades are:
- A Marathon Not a Sprint: The book and the film established Garrett’s credibility when she appeared as a talking head in various news outlets. At the onset of the pandemic (in early 2020 as a guest on various podcast and television outlets) Garrett went on the record with advice based on vast experience (not a prediction, as some interpreted her statement): According to Garrett at the time, “Covid-19 is a pandemic that from head to tail will last 36 months [3 years] and is going to test the mettle of the American people.”
- Humility: You read each harrowing case study in each chapter of the book and it is all very similar: complex, messy, heartbreaking, and frustrating. People are dying and it is all a race against time. It makes you realize the human race has been here before – many times. Catastrophizing doesn’t help (or making everything about the terminal uniqueness of the current situation) and instead parse really well-curated, science-based information about this current challenge – run a tight OODA Loop – and get on with it. Have informed humility, but Decide and Act at the same time.
- Pandemics are Deeply Connected to Human Frailty and Empathy: The book uses the experience of characters at the center of each narrative to illustrate how communicating with communities struck by public health crises and disasters – and the human behavior and social psychology that experience unleashes real-time- is really difficult. The public health community knows this from training and experience and has been remarkably patient and tenacious throughout this current experience. It has been more difficult for the medical community at the tip of the spear, experiencing mass casualty events multiple times in the last two years. For them, it is managing the ravages of the disease and a death ritual reduced to FaceTime with families and heartbreaking isolation that has broken them and the healthcare system over a two-year period.
- Experts Do Matter. The public health community is operating on a vast amount of experiential learning, training, and institutional knowledge – as are some of the really serious journalists (like Garrett) who have traveled around the world documenting public health crises for years, large and small. Trust but verify- but this community knows its stuff. And they know when they are losing battles while keeping their eye on the war. And short of the death threats that have come at them as a result of the misinformation climate in which we are all operating, they have been impressive in their ability to lean on their training and knowledge, keep it professional and not take it personally. A lesson for us all when in high stakes/high impact, stressful situations.
- An Inflection Point in Human History: Only a handful of the case studies in Garrett’s book matches the human scale of our experience in the last two years – making this pandemic a major historical event.
- Give Credit Where Credit is Due: The Trump Administration, the Pharmaceutical Companies, and the alphabet soup of government agencies that pulled off Operation Warp Speed and the Biden Administration’s vaccination distribution efforts should be lauded across the board in a bipartisan fashion. Any of the events chronicled in Garrett’s book would have been transformed by the basic and advanced, government-subsidized scientific research and development (over a thirty-plus-year period in the run-up to this pandemic) which created the momentum for the “miracle’ that is the mRNA vaccine “warp speed” development and deployment. Crisis management and disaster preparedness may have been lacking at the Federal level, but this scientific, strategic solution was in place and positioned for success in record time.
If you are interested, a runner-up to Garrett’s book as a source for exhaustive, well-researched case studies of public health crises taken from history, see
The Premonition: A Pandemic Story
“A few chapters of the book are absolutely mindblowing…”
Author of Moneyball, The Blind Side, and The Big Short (all of which have been made into compelling movies), Michael Lewis is a celebrity author, no doubt. That celebrity is based on the substance and rigor of his research and storytelling – and the way he finds characters who have talents and traits that shine new light on a system or institution that is heading into a crisis or otherwise failing around them – or failing them personally. They may not be given the chance to fix or intervene on the systemic failure but they see it with clarity and conviction. Michael Lewis structures his stories around these compelling characters and in the course of Lewis’ telling of their stories offers really sophisticated insights into the system or organization he is studying through them. True to form, In the The Premonition Lewis tackles the story of the pandemic through very compelling characters.
A few insights came out of The Premonition:
- Apolitical Organizational Structure Matters: Lewis makes clear one structural element of the federal response which was really impactful over time. Many departments and agencies have moved away from lifelong or long-term positions at the helm of the CDC towards politically appointed positions. When the crisis came, this political structure to decision-making and job security made for an inability or lack of incentive structure ‘up the food chain to make any real decisions in the onset of the pandemic.
- The CDC Observed and Oriented, but did not Decide and Act: The CDC had become an academic institution, structured around rigorous research after a public health crisis started or was mid-stream, making for a culture of analysis paralysis and an inability to make any clear decisions.
- Regional Public Health was not Connected: Traditionally underfunded – some still using fax machines for public health incident management and communication – regional and state public health officials had zero mandate for or resources to respond to the pandemic. More appropriate would have been a high-tech spoke and wheel, hub, or mesh network architecture connecting all these front-line professionals and sources of information back to the CDC and other federal organizations. None of the wargames or scenario planning done by the government in the run-up to the pandemic resulted in the creation of a ‘national pandemic network’ in time for the arrival of Covid-19. Again, the CDC was structured to learn of this deficiency in response only in a ‘lessons learned’/post-mortem’ fashion.
- Experts with the “The Premonition” were also out of the Loop: There were deep institutional structures that kept the cast of characters Lewis found for his book out of the loop and out of the “room where it happens.” Worse, they suffered professional and reputational consequences for some of their efforts. A few chapters of the book are absolutely mindblowing in their telling of how this group of people (with “The Premonition’ of the pandemic) found each other and were able to form an informal network that became the “ghost agency” of sorts for actionable information on the true threat. They were then getting information (in the form of computer models) to the federal government, state and local officials through official channels. This intervention informed California Governor Gavin Newsom’s decision to be the first state to go into full lockdown.
What’s Next? Managing the Exponential Risk of Infectious Disease
“One clear roadblock preventing society from forecasting catastrophic risk is the inability of the human brain to accurately assess the risk of exponential growth. It will be critical to establish a systematic process that has the flexibility to respond to many types of biosecurity risks….”
Dr. Charity Dean had the premonition and is a central character in the Lewis book. By the time we are in the management phase of the crisis, Dr. Dean found herself at the center of the pandemic response for the State of California (first as the Acting State Public Officer then as the Assistant Director of the California Department of Public Health). The timing of her resignation from her position with the State of California is very telling: July 2020. Her frustration and reasons for her resignation are discussed in The Premonition.
The analysis of lessons learned in this post is an effort to shift gears in our analysis of the future of this pandemic and the threat of future pandemics. We are still experiencing a mainstream saturation in coverage of the pandemic, which contributes to all of our burnout and frustration. We want to pivot and provide an analysis of positive, future-forward, solutions-driven issues surrounding the pandemic. Based on Garrett’s and Christakis’ advised timelines for this pandemic, it is time to start looking forward in a positive fashion.
Our initial analysis:
- A Huge Dataset and Vast Experiential Learning: At the risk of sounding a bit maudlin, the major silver lining of this pandemic is that it has generated a huge digital dataset and real-world case studies that can be used to prepare for what experts predict will be more pandemics and outbreaks. It is not a question of if but when. We did it the hard way, but we now have a baseline of a variety of fascinating datasets and tools on which to build a future strategic response.
- Encouraging New Strategic Efforts Have Begun: We initiated the pivot in our coverage of the pandemic with an analysis of this promising, vital project: Inspired by COVID-19 High-Performance Computing Consortium, Cabinet-level National Science and Technology Council’s Blueprint for a National Strategic Computing Reserve.
- Dr. Charity Dean and The Public Health Company: Based on her experience, Dr. Dean was approached by venture capitalists and has shifted gears to a private sector response to public health. Her start date as CEO of The Public Health Company was August 2020. Dr. Dean and her team have already generated solutions-based white papers for public consumption. One of their first white papers, How is your Business Managing the Exponential Risk of Infectious Disease?, is a great place to start when assessing your organization’s current position vis a vis the ongoing pandemic and future resources and responses. Dr. Dean and her team provide an overview of what they term “biosecurity threats”, with the following factors and recommendations:
- Disease behavior and characteristics: As traumatic as the COVID experience was for most, it was simply a dress rehearsal for the real thing – the “next big one” may in fact be much bigger. Although we can’t predict exactly what the next crisis will look like, we do know the underlying drivers of biosecurity risk are increasing rapidly, and it’s unlikely the next crisis will look exactly like the current pandemic. This means the specific actions taken to contain COVID-19 may be ineffective for other pathogens, and businesses will need broad resilience and rapid response capabilities to persevere. It will be critical to establish a systematic process that has the flexibility to respond to many types of biosecurity risks.
- Underappreciating Exponential Risk: One clear roadblock preventing society from forecasting catastrophic risk is the inability of the human brain to accurately assess the risk of exponential growth. For example, in a well-known survey, when given the option of choosing between taking either (1) $1 million today or (2) a penny today that doubled each day for a month, 90% of respondents chose to take a million dollars. Yet, mathematically, a penny doubling every day would be worth $10 million after a month, highlighting the bias people have in underestimating exponential growth. Another example of society’s inconsistency to evaluate exponential risk is the way businesses use insurance. Insurance is a popular tool for perceived risks even where both the probability and value of loss is low (e.g., airline flights), but what insurance or resilience measures does a company have to protect against another biosecurity event that has previously threatened the entire viability of their business?
- Medical options to fight disease: The scientific response to COVID has been nothing short of a medical miracle. The speed of vaccine development shattered any reasonable expectation, and the deployment of those vaccines is what will allow us to overcome the pandemic. Decades of scientific research in public and private sectors, and partnerships that brought vaccines to production and distribution rapidly, gave us the medical countermeasures we needed.
- Public health infrastructure: The majority of the focus (and funding) centers on science, whereas public health infrastructure and capabilities are the overlooked “blocking and tackling” function. It is incumbent on private sector leaders to ask themselves whether they should take some ownership for the public health sector – particularly since they are liable for its failures.
Related Reading:
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About the Author
Daniel Pereira
Daniel Pereira is research director at OODA. He is a foresight strategist, creative technologist, and an information communication technology (ICT) and digital media researcher with 20+ years of experience directing public/private partnerships and strategic innovation initiatives.
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