Why we need worst-case thinking to prevent pandemics

Decreased risk

  • We have a healthier population.
  • Improved sanitation and hygiene.
  • Preventative and curative medicine.
  • Scientific understanding of diseases.
  • We have public health bodies to facilitate global communication and coordination.


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Why we need worst-case thinking to prevent pandemics

Why we need worst-case thinking to prevent pandemics


Key Ideas

We remain vulnerable

For all our advances in medicine, we remain more vulnerable to pandemics than we would like to believe.

To understand our vulnerability and to establish what steps we need to take to end it, we should ask what the very worst-case scenario is.

The Black Death

In 1347, the Black Death came to Europe, first brought by the Mongol army, then spreading through Europe.

In six years, tens of millions fell gravely ill. Nearly half of all Europeans succumb to the Black Death, one-third of Egyptians and Syrians were killed, and it also laid waste to parts of central Asia, India, and China.

Disasters that scarred humanity

  • In AD 541, the plague of Justinian struck the Byzantine empire, killing roughly 3% of the world's population.
  • When Europeans reached the Americas in 1492, the two populations exposed each other to completely novel diseases such as measles, influenza, and smallpox.
  • Centuries later, the interconnected world made a global pandemic possible. The Spanish flu of 1918 spread to six continents where between 3% and 6% were killed.

However, even the Spanish flu pandemic had a minimal apparent effect on the world's development. It was less significant than the first world war, which had a smaller death toll but a more substantial impact on the course of history.

Increased risk

  • With a greater population, there are vastly more opportunities for new human diseases to originate.
  • Our farming practices have created a large number of animals living in unhealthy conditions within close proximity to humans.
  • Many major diseases originated in animals before crossing over to humans, such as HIV (chimpanzees), Ebola (bats), and influenza (usually pigs or birds).
  • Modern civilization may make it easier for a pandemic to spread as there is a higher density of people living together in cities.
  • Long-distance transport increases the distance disease can spread.

    Decreased risk

    • We have a healthier population.
    • Improved sanitation and hygiene.
    • Preventative and curative medicine.
    • Scientific understanding of diseases.
    • We have public health bodies to facilitate global communication and coordination.

    Understanding pathogens

    Our understanding and control of pathogens are very recent. Previously a leading theory in the west claimed that a kind of gas produced diseases.

    The past ten years have seen major progress in biotechnology and are likely to continue developing. But we should not assume that this terrain holds only familiar dangers.

    Risks from well-intentioned research

    Scientific and medical research poses a small risk of harm, but it can threaten global harm. 

    • In 2012, a Dutch virologist published details of an experiment on the H5N1 strain that was extremely deadly, killing an estimated 60% of humans it infected. Its inability to pass from human to human prevented a pandemic, but by the end of experimentation, his strain had become directly transmissible between mammals.
    • In 2001, Britain was struck by an outbreak of foot-and-mouth disease where six million animals were killed in an attempt to halt its spread. In 2007, another outbreak was traced to a lab working on the disease.

    Democratization of biotechnology

    The democratization promises to fuel a boom of entrepreneurial biotechnology. But since biotechnology can be misused to lethal effect, making it accessible to everyone also means increasing the chance someone with malign intent may wreak destruction.

    The main candidate for existential biological risk stems from the misuse of technology. The scientific community has tried to regulate its dangerous research, but with limited success.

    A positive outlook

    There has been a robust trend towards increases in the power of humanity, reaching a point where we pose a serious risk to our own existence.

    The problem is not an excess of technology but a lack of wisdom. We cannot wait until a threat strikes before acting. We must be proactive and rise to the challenges. The fact that these risks stem from human action shows us that human action can address them with rigorous thinking, guided by a positive vision of the future.



    A lesson from history

    Near the end of World War One, the Spanish flu infected over a quarter of the world's population and claimed between 50 and 100 million lives.

    During this pandemic, cities around the US ...

    The spread of the new virus
    • If you are infected and continue to socialize as normal, you may pass the virus on to between two and three friends or family members, who could then infect a further 2 - 3 people. In one month, this can lead to 244 other cases, and in two months, it can rise to 59,604
    • A silent transmission - people who have been infected, but don't show any symptoms - can occur in up to 10% of cases. These people may not realize that they need to self-isolate.
    • There is evidence that staying at home and maintaining a safe distance from others can slow the spread.
    The aim of social distancing

    One of the goals of social distancing is to delay the spread of the virus, so it reaches people more slowly

    The idea is to lengthen the time period over which the virus travels through a population and push the peak number of cases back so it appears later. With a lower rate of spreading, less infected people will need urgent care and resources at any given time.

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    A History Of Pandemics
    • A Pandemic is defined as the proliferation of a disease over the whole country or the entire world.
    • Diseases and illnesses have troubled humanity since the earliest days, but ...
    • The original use of the word Quarantine was the act of anchoring a ship arrived in Venice, Italy, for 40 days before landing.
    • Infectiousness of any disease is measured by the reproduction number (R0, or R naught). For example, Smallpox has an R0 of 6 whereas Measles has an R0 of 16. 
    • Vaccination, if available, and herd immunity can curb the spread of disease.
    • Big cities, with exploding population and traffic, can lead to the rapid spread of any infectious disease.
    A new playbook

    Growth evangelists are right when they state that severe lockdowns produce a parallel human misery of unemployment, looming bankruptcies, and extreme financial anguish. Yet, opening the economy too...

    The false choice

    “Save the economy or save lives” is a false choice.
    A group of economists published a paper on the 1918 flu outbreak. Their findings revealed:

    • Early and aggressive interventions saved lives and triggered a faster rebound, such as job growth and banking assets.
    • Without a healthy population, there can be no healthy economy.

    The hope is for a deep, short recession, to show that people have shut the economy down to limit the spread of disease.

    A living wage

    Asking millions of able-bodied workers to stop working creates a crisis of unemployment.

    During this time, the U.S. is expanding unemployment benefits and are also delaying tax filing. In northern-European countries, the government is directly paying businesses to maintain their payrolls to avoid mass layoffs and furloughs.

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