Aotearoa New Zealand has been consumed today by discussion of the varied fiascos around the government’s COVID-19 border quarantine and self-isolation policies and practices. Obviously there have been a wide range of failures here, which cannot be reduced to a single source. But I want to draw attention to a specific, very consistent element of the Ministry of Health’s attitude to COVID-19 policy that has, in my view, caused problems for the government’s COVID-19 response from the beginning, and which now risks wrecking the enormous progress the country has made in the goal of eliminating COVID-19.

Put bluntly, the Ministry of Health is absolutely convinced that there is very little point in testing non-symptomatic people. This has been clear in their testing guidelines from the beginning, and the great difficulty people had getting tested. It is now confirmed in testimony from people who have recently arrived in the country, and who were unable to persuade MoH staff to test them even as part of the government-overseen isolation process. Per this 1 News report:

She and her family members also didn’t get tested before leaving yesterday, because she was told it was optional. “She then said to us that it was pointless us having the test done unless we were showing any symptoms.” Another woman who stayed at the same hotel as the two new positive cases says she was told the same thing. She got a test anyway, but now, home, still hasn’t received her result.

Why is the MoH so determined not to test non-symptomatic people? Obviously the following is somewhat conjectural, but in my view some core elements of the NZ government’s view on COVID-19 are as follows:

First, the government is convinced that asymptomatic transmission of the virus is extremely rare. Asymptomatic here means not just “non-symptomatic”, but “will never become symptomatic.”

Second, the government is convinced that symptomatic cases can be identified when symptoms emerge, and contact tracing can then take care of any transmission that took place in the few days before symptoms emerged.

Third, these opinions are supplemented by the recognised statistical fact that interpreting the likelihood of a false positive in a test result is highly dependent on the underlying probability that the individual being tested has the condition.

Fourth, the government is convinced that for these reasons, those calling for widespread testing of non-symptomatic people are being irrational. To the extent that the government are willing to test non-symptomatic people they will do so reluctantly and tardily, in order to (in their eyes) placate a hysterical public and media, or at best out of a hyper-abundance of caution, rather than for good public health policy reasons.

Fifth, and particularly irrationally, these attitudes have been extended even to the testing of individuals in mandatory isolation to attempt to prevent new COVID-19 cases from circulating within the country.

All of these positions are problematic. It is plausible but not established that asymptomatic transmission is very rare; it is easy to miss the symptoms even of symptomatic cases – as in fact happened with the two new cases of COVID-19, one of whose symptoms was apparently (mis)attributed to a pre-existing condition; the risk of statistical artefacts can be greatly reduced by repeated testing; it is in fact extremely rational to adopt a policy of broader testing, as I argued in an earlier post; and none of this makes any sense when you’re talking about a process that has specifically been designed to prevent new COVID-19 cases from entering an as-far-as-we-know currently otherwise virus-free country.

And yet the Ministry of Health and the government more broadly, in my view, remain in the grip of a baseless conviction that calls for testing of non-symptomatic cases are fundamentally silly, a demand to be placated rather than acted upon. Until the MoH abandons this idée fixe, the country will not be able to adopt a fully rational COVID-19 pandemic policy.

I’ve had enough separate conversations in which I’ve had to demonstrate what John Edmunds actually said on the Channel 4 coronavirus special of March 13, that I’ve decided to transcribe the entire segment for ease of future reference. I may well come up behind this and add some comments at the end, but for now I’m just going to publish the transcript.

The segment itself can be watched here, beginning at 9:50 and ending at 23:55.

TRANSCRIPT

Presenter: Well joining me now is John Edmunds, professor of epidemiology at the London School of Hygiene and Tropical Medicine, he works on the mapping of infectious diseases and is currently advising the government on the coronavirus, and from California a silicon valley executive and writer Tomas Pueyo, he’s not a scientist but his detailed modelling of the virus’s spread has set the internet alight with its stark warnings about the rate of infection. Welcome to you both.

Let me start with you Tomas, in California. President Trump we just heard a few minutes ago has declared a state of national emergency. What will actually change now, because of that?

Pueyo: The country has moved from trying to contain the illness from outside to making sure that inside it doesn’t transmit, and that’s the key here, they’re realising “oh my god, it’s [not] that it’s coming from outside, it’s here, it’s spreading, it’s everywhere, and we need to stop this, we need to stop the transmission between different people, so that’s what they’re trying to do – they’re trying to create social distancing, keeping people spread, not everybody together, so that the transmission goes down.

Presenter: So can we now expect, as a result of this state of national emergency, the kind of measures in America that we’ve seen in places like Italy?

Pueyo: I think we will. Italy’s different from the US, obviously, individual freedoms are substantially more important here, but it is the only thing that is going to stop this thing.

Presenter: Ok. So you welcome this move, of the President today?

Pueyo: Absolutely, not only do I but the markets are also responding, they were up four percent in the US as Trump was speaking.

Presenter: Ok, I want to get back to you in a minute because I want to talk to you about your particular modelling of this virus, but John Edmunds, should we be declaring a state of national emergency here – something as dramatic as that?

Edmunds: No.

Presenter: No?

Edmunds: For what gain? What gain would we get from that? So we’re going to get people up into a panic and stuff? We need people to come with us in a stepwise way. This epidemic is not going to be over in a week or a month, this epidemic is going to last for most of this year, and so if we’re going to ask people to change their behaviour quite radically, it’s going to be very difficult for them to do, it’s going to have major economic and social impacts, on them, then we’re going to have to limit the amount that we’re going to ask them to do, yeah?

Presenter: Limit the amount that we’re going to ask people to do.

Edmunds: So we stop the epidemic, or we slow the epidemic right down, so that the NHS doesn’t become overwhelmed, hospitals don’t become overwhelmed, that’s the idea. The only way to stop this epidemic is indeed to achieve herd immunity.

Presenter: Ok. Tomas Pueyo, you’re shaking your head and now you’ve got your head buried in your hands, what’s your response to what John Edmunds just said?

Pueyo: This is like deciding, you know what, this forest might burn so let’s cut a third of it. This is crazy. We want to have ten, twenty, thirty percent of the population catch this, the UK has what sixty six million people, that’s how many people, that’s around twenty million people, one percent of these people are going to die, so we’re saying that we want to kill 200,000 people in the UK, so that’s –

Presenter: I don’t think anyone is saying that, I don’t think anyone is saying that, but I think there is a real debate in the scientific community going on about the value of herd immunity, so just briefly, what do you think about the value of herd immunity, and can it be created through the measures that the government is introducing right now?

Pueyo: We need to understand what it means, this herd immunity, they’re saying everybody’s going to catch it, so once they catch it they can’t catch it any more. That’s crazy, we don’t want people to catch it, we want people not to catch it, ‘cause otherwise they’re going to die, and right now the cases are going exponentially, in a week the NHS is starting to be collapsed, in two weeks it’s going to be completely collapsed, if we don’t take measures now then people are going to panic, maybe not today, if we don’t take the measures, but they’re going to definitely panic next week or in two weeks, we have thirteen days of advance compared to Italy, right, they thought the exact same thing two weeks ago, and then one week later they realised “oh my god this is exploding”, they have now what, 17,000 cases? It’s exploding there, they realised too late that they were not containing this, UK now has an opportunity to catch this before the weekend, and we need to catch this before the weekend, because everybody’s going to spread this, with their friends, with their families, that they haven’t been seeing during the week, so it needs to be declared now, that’s why

Presenter: OK, Tomas, let’s bring in John, I mean, has he got a point here, we’ve got to catch this right now?

Edmunds: There’s two things, there’s two strategies, with a new virus, a new epidemic, there’s two strategies: one, you can stamp out every single case in the world, every single case _in the world_, and then the virus, then you’re free. You’ve stopped that epidemic without achieving herd immunity, but you must get every single case in the world. When the mild disease, that’s incredibly difficult. That’s the phase that we were in when we were trying to do containment and everybody else was trying to do containment, yeah? Trying to stamp out every single case in the world. It hasn’t worked, yeah? We haven’t managed to do that. The next phase, when the virus – the genie is out of the bottle, the virus is all around the world and spreading, the next phase, the only other way that the epidemic is going to come to a stop is ‘achieving herd immunity’, this is – and let me explain, there are different ways that you can… The natural way, that this will is happen, is the epidemic will run very fast, and the epidemic will come up and come down very fast, and the herd immunity threshold is reached not at the end of the epidemic, that’s what people sort of think, it’s not at the end of the epidemic, it’s at the peak of the epidemic. At that point there’s not enough susceptibles in the population to spread, and it’s very important to understand this one further point, because at the peak there’s so many infectious individuals that they all infect so many other individuals, and so if you can bring the number of infectious people down at the peak, then the epidemic doesn’t overshoot, you can manage the epidemic and reduce the total number of

Presenter: [Right.]

Edmunds: So you can achieve herd immunity and not have an epidemic overshooting.

Presenter: But the trouble is, you know, this

Edmunds: You do that by aggressive measures.

Presenter: This is a very important debate, and it’s happening right now in the scientific community, as we discover on air, but getting away from the abstracts, in practice what this means is there will be many many people, vulnerable people in this community, who may die as a result of what is essentially an experiment

Edmunds: But there’s no way out of it now.

Presenter: There’s no way out of it?

Edmunds: No. There’s no way out of that.

Presenter: Ok.

Edmunds: So we’ve given up on the containment phase, that hasn’t worked

Presenter: But, but

Edmunds: I mean Tomas can throw his arms up as much as he likes but that hasn’t worked, yeah?

Presenter: Ok, but the point is that we’re the only country as far as I know that is espousing this model, I mean the Italians are telling us that they wish they had done it earlier, they wish they had told their population two weeks ago, you know, a lockdown means you don’t go to the cafe, you don’t go to the pizzeria, you stay home.

Edmunds: And what happens when they release the lockdown?

Presenter: What does happen then?

Edmunds: It comes back.

Presenter: But is that inevitable?

Edmunds: Because you haven’t got rid of – yes it’s inevitable, if there’s virus around in the population, there’s infectious people, so unless you’ve stamped every case out, not just in – _every case_, not just in Italy but around the world, as soon as you release them out of lockdown it comes back.

Presenter: This is a really crucial question, Tomas, what’s to say that once China, you know, people go back to the factories and back to the offices and traffic’s back on the streets, that this thing won’t come back?

Edmunds: It will come back.

Presenter: And possibly worse the second time round?

Pueyo: It will, but the key there is not to have it big, because when you have it big you have hundreds of thousands or millions of people collapsing the NHS, and when you do that all the people cannot share the ventilators that you need, all the people who are having heart attacks right now cannot get to the E.R., and so what we need is not to have this huge peak, collapsing everything, killing everybody, what we need is to what we call ‘flatten the curve’, slowly grow these cases, contain it so they can be spread over time, we can achieve herd immunity not in two weeks going crazy, but in six months, in a year, meanwhile

Presenter: But that’s what the government – sorry to interrupt Tomas, but that’s exactly what the prime minister was saying yesterday in his rather colourful language, they’re saying we’ve got to flatten the sombrero, that’s what they’re trying to do here by delaying the virus.

Pueyo: That’s right, and how do you do it, you need to take measures where people don’t talk to each other, they don’t interact with each other, so they don’t transmit the virus, so you need to take measures _now_ to avoid people interacting. Now.

Presenter: Doesn’t he have a point, John?

Edmunds: Well it’s exactly the point I was making. So the only way to do this is to achieve herd immunity, to stop this epidemic, and you impose social distance measures to slow it down, to bring the peak down, to spread it out over time, but if we’re going to bring the peak down from a very high point and spread it over time then we’re going to spread it over a very long period of time, six months to a year is what we’re going to – we’re going to be living with this epidemic for that kind of length of time, and so if we’re going to ask people to take these really extreme measures then we don’t really want to ask them to do it before they have to, because they’re going to have to do it for a very long time. Now the epidemic is moving fast, and we will be asking them to do these measures very soon.

Presenter: Let me ask cynically whether there is an element of this that the government doesn’t want to shut down the economy, sacrifice the economy completely as we’ve seen in other countries while it is trying to find the right solution.

Edmunds: Look there’s no easy way out of this. All of these are going to be hugely damaging to people, to people’s lives and the economy, and there is of course a balance, so you have to try and get it, you know, get the epidemic, manage the epidemic as best we can, _and_ manage the other aspects of – we have to manage the economy, of course we do, we can’t ignore that completely, so –

Presenter: But our priority is to save lives

Edmunds: Of course it is.

Presenter: Richard Horton, the editor of the Lancet – prestigious medical journal – has said that our policy at the moment, the government policy, is “playing roulette with the public”.

Edmunds: That’s a kind of easy thing to say isn’t it, you know, that’s a very easy thing to say. But I don’t think they are, I think what they’re doing is trying to take it sensibly, stage it – look, you’ll see measures coming in very fast now, the epidemic is moving, you’ll see measures coming in, so we will be asked to do – and all of us will have to take care to do those things

Presenter: When? When will those measures come in do you think?

Edmunds: Very soon now.

Presenter: In the next few days?

Edmunds: Within – certainly within a week or so

Presenter: And these will be lockdowns of cities,

Edmunds: No, I don’t think we’re going to

Presenter: We’re not going to go that far?

Edmunds: Not, not initially, but we may get there, yeah? We are going to be asking people to take extra measures, they’ve already been flagged up, you had them on your VT that you showed just before, the prime minister talking about the next measures that might be along the line.

Presenter: So you don’t think we’re dragging our feet on this? With possibly dangerous consequences?

Edmunds: I think we’re trying to stage it as best we can.

Presenter: Tomas? If we impose restrictions tomorrow or the day after, you know this weekend, as you just said, is that going to be early enough in order to stop us from becoming Italy in thirteen days time?

Pueyo: With the current number of cases that we have in the UK, around 800, and the growth rate day over day that we have, in a week we have 6,000 official cases, and in two weeks we have 45,000. We have today more cases than Wuhan had when it shut down. What they did when they shut it down was completely cut it, you can see the growth in [new] cases going dramatically down overnight, and now China has only a handful, a few dozen cases every day. They decided “we’re going to go aggressive _now_, so that later on we don’t need them to be suffering all these consequences, and that was the right move because this is going exponentially, so what you need to do is, when it’s going exponentially, you catch it early, and you really really go aggressive against it. You don’t let it fester to collapse the NHS. If you do that then you can relax little by little over the weeks, over the months, the measures, so that now we have more capacity on the NHS, and the cases are spread out over time.

Presenter: And just, Tomas, explain to us, you wrote this article, it went viral on the internet, your modelling for why these, you know, for explaining why the numbers of infections will double every two days, how do you explain that? Based on the China model?

Pueyo: It really depends on what’s happening at every moment, right now this thing is going really really fast in the UK, right? We have 800 cases, it’s growing at 33 percent every day, that means in three days you get 1,900, so it’s more than doubling in the next three days, and so what’s happening is early on when this thing is really catching up cases explode and they grow at say 2x, like they double every two days, and this is the situation in which the UK is today, it is the situation in which Italy was a week ago, it is the situation in which Spain is right now

Presenter: OK, all right, OK. Joh why are you shaking your head at those numbers?

Edmunds: It’s true if you just look crudely at the numbers that the number of cases are doubling about every two and a half days, but that’s because they’re doing more contact tracing, the actual underlying rate of doubling is more like about every five days.

Presenter: Ok, we’ve got to leave it there. John Edmunds, Tomas Pueyo, thank you very much indeed.

In his 1954 lecture ‘What does the economist economise?’, Dennis Robertson writes:

There exists in every human breast an inevitable state of tension between the aggressive and acquisitive instincts and the instincts of benevolence and self-sacrifice. It is for the preacher, lay or clerical, to inculcate the ultimate duty of subordinating the former to the latter. It is the humbler, and often the invidious, role of the economist to help, so far as he can, in reducing the preacher’s task to manageable dimensions. It is his function to emit a warning bark if he sees courses of action being advocated or pursued which will increase unnecessarily the inevitable tension between self-interest and public duty; and to wag his tail in approval of courses of action which will tend to keep the tension low and tolerable.

This passage is approvingly quoted in Part One of Buchanan and Tullock’s ‘The calculus of consent’. And this basic idea informs much of public choice theory – a branch of economics and political science that uses tools often associated with microeconomics to analyse political decision-making. Slightly more specifically, public choice theory often focuses on the ways in which political decision-makers’ individual interests and incentive structures influence their policy-making, frequently to the detriment of ‘the public good’. In Buchanan’s words, in his 1986 Nobel lecture:

Economists should cease proffering policy advice as if they were employed by a benevolent despot, and they should look to the structure within which political decisions are made.

As Robertson says, the idea here is not that altruistic acts are in some way incompatible with human nature; it is, rather, that an institutional structure that heavily relies on altruistic acts for its ongoing stability is likely to be more fragile, all else equal, than an institution that accommodates less noble motives as a major component of its day-to-day functioning. Acts of heroism, kindness, self-sacrifice, selflessness – these are, contrary to more pessimistic views of ‘human nature’, extremely widespread. But a political-economic institution that relies upon these facets of human nature for its day-to-day reproduction, and that will quickly fall apart in their absence – such an institution is at constant risk of either collapse, or transformation into an institution that does accommodate less noble elements of human behaviour, perhaps to the detriment of its intended or apparent goals.

This ‘pessimistic’ public choice vision of political-economic institutions has often not found favour on the left. Leftist critics of public choice theory – or of the broader liberal tradition of which it is apart – tend to object both to its methodological individualism, and to the kind of ‘human nature’ that is tacitly or overtly ascribed to the individuals it considers. For many leftists, furthermore, the public choice approach to political economy is less an analysis of the pitfalls of collective action, than it is an attempt to undermine or attack successful collective action, in the service of right-wing, anti-statist interests and policies. From this left perspective, public choice theorists attempt to emphasise the ways in which institutions of collective action are liable to fail, because public choice theorists want such institutions to fail: by arguing that the successful collective provision of social goods is difficult or impossible, and that apparently successful collective action is really a mask for individual self-interest, public choice theorists serve the interests of those opposed to emancipatory collective action.

There is much to be said for this left critique of public choice theory. Public choice theory has, indeed, typically emerged from and aligned itself with the right of the political spectrum, and sought to provide intellectual resources and arguments for those who wish to greatly reduce the size of the state and the scope of democratic or collective social decision-making. It is, primarily, a conservative school of thought, and much of the public choice tradition cannot usefully be interpreted unless its analysis is seen as informed and shaped by conservative political commitments.

But should the tools of public choice theory be exclusively the property of the right? Does it benefit the left for this to be the case? In my view, the answer to these questions is ‘no’, and a ‘public choice theory of the left’ is a worthwhile project, no matter our views on ‘actually existing public choice theory’.

Why is this so? First of all, analytically speaking, there is a lot of potential common ground between public choice theory and traditional left critical analysis: the capture of powerful institutions by special interest groups and the use of power to advance the interests of those with power, as against the broader public good… they are not themes that are entirely alien to left analysis. Public choice approaches should be capable of use for left critique.

Secondly, though, the normative public choice critique of would-be emancipatory collective action also carries weight: the left ought to reckon with this category of critique of its own projects and institutions. Public choice theory is suspicious that institutions – paradigmatically state institutions – that are intended to serve the common good have a tendency to serve instead the interests of those who wield power within those institutions. If left politics aspires to create institutions that are not disastrously vulnerable to this phenomenon, it needs to reckon with this risk and this critique. Moreover, it needs (I would argue) to reckon with this critique in a way that does not appeal to unrealistically utopian claims about long-term selfless action on the part of key social actors.

Perhaps the paradigmatic case here is Soviet communism. For many critics of the USSR, the Bolshevik project was intrinsically flawed because the institutions it proposed and implemented in the name of emancipation were always likely to result instead in state power serving the interests of a governing elite rather than the broader citizenry. Of course, there are many on the left who reject this analysis. But there are also many on the left – including me – who agree that Soviet-style communism was in practice a novel form of domination and oppression rather than a fundamentally emancipatory project. And this judgement raises the question of how to evaluate leftist transformative proposals, to ensure that would-be emancipatory institutions are likely to genuinely be emancipatory.

In my post on Erik Olin Wright’s ‘Envisioning Real Utopias’, I discussed one leftist response to this problem: Wright’s centring of ‘social power’ (as against state power) as the ‘true north’ that should guide ‘the socialist compass’. I argued, against Wright, that there is in fact no reason to believe that ‘social power’ is intrinsically more emancipatory than ‘state power’ or indeed ‘market power’ – that we need more fine-grained criteria for evaluating political-economic institutional proposals, to assess whether these proposals are likely to move us in a more or less emancipatory dimension.

The insight from Robertson with which I started this post, I believe, offers one such useful criterion (of course at a very high level of abstraction). As Robertson writes, we can distinguish between on the one hand institutions that, for their emancipatory functioning, require members of the institutions to persistently navigate a high tension between their own personal interests and those of the ‘public good’, and, on the other hand, institutions that reduce the tension between self-interest and public duty to a “low and tolerable” level. Institutions of the latter sort are, all else equal, more likely to be sustainable. The task for leftists is to construct institutions that are emancipatory in their outcomes and processes, while also exhibiting this feature.

In the jargon of game theory, this kind of institution design challenge is known as “incentive-compatible institution design”. That is to say: when we are constructing political-economic institutions, we want to construct those institutions in such a way that the incentives of individuals within the institutions are aligned with the tasks we would want those individuals to fulfill. In the maxim of many introductory economics courses: “incentives matter”.

This is a lesson that should be applicable across a broad range of categories of institutions. It should not be restricted to the political projects of the right, or to the critique of the left. And the left, I think, needs to get better at thinking about institutions in these terms. Paying closer attention to public choice theory is perhaps one route via which that could be accomplished.