Tag Archive for: Coronavirus

Making our own luck in the face of a pandemic

In their prophetic 2018 book, The end of epidemics, authors Jonathan Quick and Bronwyn Fryer warned that ‘a severe worldwide pandemic could cost the global economy up to [US]$2.5 trillion.’ They also warned of the need to constantly maintain a high level of readiness for pandemics.

Australia, like many countries, failed to heed such warnings. Critical pandemic readiness policies were overexposed to short-sighted budget cuts underpinned by the dogged pursuit of efficiency. The long-term development of critical infrastructure was left to the whims of market forces. Nation-building efforts were underpinned by a user-pays model.

Covid-19 has already shown that market forces don’t promote adequate national resilience in myriad areas, from broadband bandwidth to the capacity to produce basic medical supplies, and that far too much of our preparation for pandemics, along with national resilience, was predicated on good luck.

Experience suggests that Australians will begin their search for the crisis’s heroes and villains well before we beat the Covid-19 virus. Inevitably, there’ll be several years of reviews and commissions of inquiry, involving all manner of finger-pointing and blaming. In that maelstrom, many valuable strategic lessons, especially about national resilience, will be obfuscated by the drama of the day: it’s easier to attribute fault than to learn. Therefore, it’s critical to encourage immediate public discourse on the issue.

One powerful lesson from the first few weeks of the pandemic is that our national resilience can’t be left to chance. Yet, Australia’s Covid-19 success during the first two weeks of February 2020 was underpinned by dumb luck.

By late January, it was clear to the Australian government that the outbreak in the Chinese megacity of Wuhan was a serious problem. At the time, some 600 Australians were in or near Wuhan, and many of them wanted assistance with their evacuation back to Australia.

By the first week of February, the government was seeking to repatriate Australians from Wuhan and quarantine them to prevent a further outbreak of Covid-19 in Australia.

The government needed a remote location where the evacuees could be socially isolated from each other and safely quarantined from the broader Australian community for 14 days. This was where Australia had its first stroke of good luck.

In February, in response to concern over the possibility of a sudden wave of asylum seekers because of changes to refugee medical transfer laws, the Morrison government re-established the Christmas Island detention centre. The centre, with only four detainees, has cost Australian taxpayers around $27 million to maintain. It was there, it was all but empty, and it was isolated from the local community and the Australian mainland. The availability of the centre had more to do with Australian politics than deliberate preparedness planning.

Further evacuations from Wuhan a week later required the use of a second quarantine site. And Australia’s run of good fortune held.

In 2012, Japanese oil and gas company Inpex began work on its Ichthys LNG project in Darwin. The project is a joint venture between Inpex group companies (the operator), major partner TOTAL and the Australian subsidiaries of Tokyo Gas, Osaka Gas, Chubu Electric Power and Toho Gas.

In 2014, after spending almost $600 million, Inpex opened its accommodation village at Howard Springs near Darwin for its construction workforce. The 67-hectare village, capable of accommodating 3,500 workers, included a 50-seat cinema, a swimming pool, an outdoor beach volleyball court, a cardio and spin room, a gym, a music room, basketball and tennis courts, and cricket nets. It also had a 24/7 medical centre.

When the construction phase of the Ichthys project was completed, the village was no longer needed. Inpex faced a $30 million remediation bill for the site. But, in another stroke of luck for the Australian government, Inpex sold the village to the Northern Territory government for $1. Over the last 12 months, the NT government spent $8 million maintaining the site.

Since the Bali bombings in 2002, Darwin has served as a triage centre for Australians evacuated from Southeast Asia. The Australian Medical Assistance Teams, which are responsible for enhancing Australia’s capacity to provide clinical and academic leadership in disaster and trauma care, operate from Darwin. Despite these facts, there was little federal government interest in using or assisting in maintaining the site, which would eventually become critical to Australia’s Wuhan evacuations.

Until now, Australian long-term funding of national resilience and responsiveness often seemed economically inefficient. Little surprise, then, that policymakers regularly looked to the market to provide such resilience, especially in critical infrastructure investments. However, the creation of spare capacity is often not a commercially viable prospect. Arguably, the NT government’s decision to maintain the Howard Springs site, without a clear customer, was a high-risk one.

The Covid-19 pandemic has made it increasingly clear that Australia’s current model for nation-building infrastructure investment is far too narrowly focused. The notion that such investments should be funded mainly by those who directly benefit from them is inhibiting the country’s resilience. This is even more obvious in Australia’s north, where Defence so often wears the cost of developing infrastructure that ought to be funded as part of a wider national security program.

While much will need to be done to address this policy challenge, it seems that national security, in a holistic sense, needs far greater policy consideration if we’re to stop relying on dumb luck. As a starting point, Prime Minister Scott Morrison’s government needs to consider appointing a senior secretary-level national security adviser. That adviser would need to help ensure that Australia’s Covid-19 recovery efforts have a strong strategy focus on achieving greater national resilience and security across the breadth of the country’s nation-building efforts.

Geopolitics in the time of corona

In a world filled with think tanks, shrewd minds and an internet, interesting assessments of the geopolitical ramifications of Covid-19 appear almost daily. From Michel Duclos’s observation that the pandemic is ‘a crisis revealing a new world’, to Sven Biscop’s judgement that less will change, and less radically, than pundits now anticipate, to Allan Gyngell’s insistence that ‘the world before coronavirus is not returning’, analysts are clearly not of one mind.

That’s no surprise. On the traditional strategic agenda, pandemics and other health emergencies are generally listed in the same category as climate change and bushfires—that is, they pose security threats rather than change strategic orders.

The classic case usually involves a comparison of World War I with the Spanish flu (1918–1919). The latter likely killed more people—statistics vary widely—but it’s the former that history and international relations students study at school and university. Why? Because strategy and war are about politically motivated violence, not sickness and death. It was the war, and its subsequent settlement at Versailles—not the flu—that set in place the geopolitical order of the 1920s and 1930s.

But perhaps pandemics are geopolitical chameleons, and their effects are masked by the environments in which they arise. That would mean the geopolitical consequences of the Spanish flu were comparatively minimal precisely because the outbreak occurred at a time when a major shaping event—World War I—was drawing to a close, leaving largely status quo powers victorious. Similarly, perhaps the geopolitical consequences of more recent pandemics were diluted by unipolarity, or by the rigid bipolarity of the Cold War.

If that’s true, we could reasonably expect Covid-19 to accelerate changes that were already unfolding in 2019. And that was a time when the world was becoming more strategically competitive, when US global leadership was weakening and the US itself was in relative strategic decline, and when multilateral institutions were—metaphorically speaking—struggling for breath.

Even before Covid-19 came along, Western alliances were roiled by insularity and transactionalism. Even before it came along, China and Russia were both flexing their muscles in their grey-zone activities in the South China Sea and Ukraine.

Those changes were already undoing Australia’s vision of the ideal future, because they pulled against our long-term aspirations: for a world where great-power frictions are managed and contained, where US leadership and strategic clout remain purposeful and strong, and where multilateral institutions effectively dilute the importance of hierarchy in international relations.

If Covid-19 is accelerating those changes—magnifying their intensity and compressing the time taken for them to work through the system—we will emerge from this pandemic to a sharper, more competitive world, where our main ally is less influential and where multilateral institutions are increasingly under the sway of other great powers that believe in hierarchy, and not in equality.

Thus far, revisionist powers haven’t attempted a more serious rebalancing of the international order by exploiting the pandemic’s greater disruption of European and US economies and societies than of their own. Of course, we’re still in the early days of what might prove an 18-month battering of the international order. It’s possible that future opportunities—to create a sudden fait accompli in the Baltic states or Taiwan, for example—may look more tempting.

True, the degree of temptation depends on something we don’t currently know: are China and Russia really more capable of managing this virus than we are? If they aren’t, the opportunities will seem less enticing. But if they are, or perhaps more ominously if they believe they are, we have a problem.

The simple solution, of course, would be to keep Western militaries relatively free of both infection and virus-related commitments, but that’s probably not an option. If we can’t do that, we need to accept that, for the next 18 months or so, Western conventional military forces are not going to be at their peak in their ability to deter international adventurism.

That might mean the West needs to increase its reliance on nuclear deterrence during that window as a deliberate policy choice. Nuclear deterrence adds a strong dose of ‘ugly stability’ to the upper rungs of the existing order. It doesn’t stop change further down the international ladder, unfortunately, because the threats to use nuclear weapons are only really credible in relation to vital interests.

And, by itself, nuclear deterrence can’t prop up an anaemic international order.

Further still down the ladder, countries that depend on the presence of UN peacekeeping forces will be looking at how willing UN member states are to maintain and rotate such forces during a global pandemic. The UN may find it harder than usual to persuade countries to sustain their peacekeeping commitments abroad when their militaries are suddenly burdened with new challenges at home. That’s an issue that Australia confronts given the ADF deployments in South Sudan and the Middle East.

The issue is not just one for contributor nations. It’s possible some nations hosting those missions will push back more vigorously against them, or use Covid-19 as a justification for deciding which countries’ militaries to accept on their territory.

If that’s so, we’ll run into a set of problems centred on issues of state fragility, and there will likely be opportunities for revisionist powers to meddle down on those lower rungs of the ladder too.

Where does that leave us? Putting it briefly, in the short to medium term, we’re likely to be living in a world of greater strategic opportunism. That’s a worry—but a worry essentially about peripheral strategic interests. Over the longer term, Australia faces a larger concern: a strategically more challenging world. A world in which we probably need to power up, to lower our expectations that the US will be there to save us, to find partners where we can, and to reduce our reliance on ‘rules’. That’s not entirely the fault of Covid-19. It was coming anyway—go back and look at 2019.

A gender lens for Covid-19

When pandemics strike, world leaders and health responders must adapt quickly to the looming threat. Often the last factor they consider—if it makes their to-do lists at all—is gender.

As advocates for the health and rights of girls and women, we’ve heard the excuses time and time again: ‘Gender isn’t a priority right now’, leaders say. ‘Maybe when things calm down’, they claim. ‘It’s not the right time’, they insist. If we are to pursue the most effective responses to Covid-19—or any health emergency—this must change.

Girls and women experience outbreaks differently than boys and men. A gender lens highlights the specific risks and vulnerabilities girls and women face because of deep-rooted inequalities and traditional gender roles. And the facts such a perspective uncovers can save lives and ensure that nobody is left behind in our emergency responses.

To reframe our pandemic response with gender at the center, we need, first, to protect and support the global health workforce, 70% of whom are women. It is crucial that these health workers are trained, resourced and equipped, which means filling global shortages in protective gear like medical masks and gloves, so that they and their patients are adequately protected.

It also means tackling the 28% gender pay gap in the global health workforce and providing decent and safe working environments. This will prevent interruptions in service delivery by ensuring health workers themselves don’t fall ill and by promoting retention as they work around the clock to fight Covid-19. In addition, we must dismantle the discriminatory system that excludes women health workers from the decision-making bodies that initiate life-saving emergency protocols in healthcare settings.

Likewise, it will be impossible to provide reliable evidence about Covid-19 to health workers, policymakers and the media without investing in the timely collection of gender- and age-disaggregated data in all surveillance and monitoring efforts. Past health emergencies such as the 2014–16 Ebola epidemic and the 2012 cholera outbreak in Sierra Leone show that the absence of gender-disaggregated data seriously impedes smart decisions, strong responses and swift recoveries. While these health emergencies may have challenged us in different ways than Covid-19, the need for evidence-based solutions, backed by quality data, remains the same.

We must also ask how traditional gender roles shape how people of all gender identities and backgrounds experience Covid-19. This means going beyond preliminary data from China that suggests Covid-19 infections are slightly higher among men than women. It also means that we need to assess what makes girls, women, boys, men and non-binary people vulnerable in the first place.

For example, past health emergencies demonstrate that women’s traditional role as caregivers for sick family members often increases their exposure to infectious diseases through person-to-person contact. This occurred during the Ebola outbreak, the 2002–03 SARS epidemic and India’s 2018 fight against Nipah virus in Kerala. In all these cases, large numbers of caregiving girls and women were infected. Knowing this enables carers to understand the importance of reinforcing preventive measures in their households, as outlined in the World Health Organization’s Covid-19 prevention guide, and of reporting cases when symptoms first appear.

While we bolster our medical and epidemiological response to Covid-19, we also must ensure that essential maternal, sexual and reproductive health services aren’t disrupted. The West African Ebola outbreak showed that containment efforts can divert staff and supplies from other services women need. This can have disastrous consequences: maternal mortality in the region increased by 75% during the epidemic, and the number of women giving birth in hospitals and health clinics dropped by 30%.

The need for access to skilled birth attendants, protection from gender-based violence, contraception and safe abortion often becomes more acute during outbreaks. Covid-19 is no different in this respect. Domestic violence reportedly rose in Wuhan during the city’s two-month lockdown. And people still have sex, experience puberty, menstruate, become pregnant and give birth during public health emergencies, so meeting these needs must remain a high priority.

That requires promoting women to leadership roles. Women are skilled service providers, epidemiologists, carers, community leaders and more. Above all, they are the best experts on their own lives and must be meaningfully engaged in all preparedness and response efforts. That means ensuring the participation of girls and women in all local, national, regional and global taskforces on Covid-19. Women must serve on local community councils and in legislative bodies where important decisions are made. At the international level, gender imbalances in global health leadership, where men hold 72% of the top positions, must urgently be addressed.

With sufficient resources, we can avoid past mistakes and devise responses that apply a gender lens at the outset. While the emergency aid pledged by the United Nations (US$15 million) and the World Bank (US$14 billion) is a great start, we need additional investment to implement the policies that an effective Covid-19 strategy requires.

For too long, excuses for not using a gender lens during health emergencies have impeded the responses we most need. To protect us all, this time it must be different.

Regulatory flexibility needed to allow Covid-19 innovations to succeed    

The Covid-19 crisis has sparked a truly inspiring wave of citizen-led, open-source innovation, from 3D-printed medical devices and open-source designs for personal protective equipment, to virus tests which could allow for more rapid, large-scale testing. It may well be that the answers to some of the biggest challenges countries around the world are facing are found not in large corporate labs or government research facilities, but in open-source technologist communities, creative collaboration spaces and citizen science labs.

In order to fully take advantage of this wave of creativity and dynamism, however, governments and regulators need to be equally dynamic, both in lifting red tape where needed and in being ready to apply the brakes when necessary.

In just a matter of weeks, grassroots open-source projects and international coordination efforts have sprung up around the world to find ways to alleviate the huge shortages of vital equipment exposed by the coronavirus pandemic. In Spain, they’re 3D-printing ventilators; Filipino fashion designers are working with infectious disease specialists to create and share designs for personal protective equipment; maker spaces and artisans are collaborating to rapidly prototype everything from face shields to reusable hospital gowns. In Australia, a community of biohackers in Sydney have adapted an open-source design which could enable more rapid and large-scale testing.

Here’s the problem, though: with only a handful of exceptions, these innovations do not have regulatory approval.

As with so much about this crisis, we’re seeing the dynamics of this push–pull between the critical need for these devices and technology and the equally critical need to ensure that they are safe playing out first in Italy. For example, one Italian start-up has developed a design for a 3D-printed respiratory valve which can be used to adapt snorkel masks into ventilators. Because the device has not been approved, however, patients treated with it are required to sign a declaration acknowledging that they will be treated with an uncertified medical device.

And it’s not just regulators that pose an obstacle. In mid-March, reports surfaced that a company which manufactures and sells ventilator valves for US$11,000 had threatened to sue any volunteers in Italy who had found a way to reproduce the valves for just US$1. The facts of the matter are disputed, but either way it highlights the potential for technology patents to stand in the way of producing vital medical equipment cheaply at scale.

Regulations for medical technology exist for very, very good reasons. As technologist Naomi Wu put it, ‘DIY fucking around with respiration—diving helmets, rebreathers, all that, is right up there with DIY manned flight for huge body count.’ Many innovations spawned during this crisis come from well-intentioned makers with no previous experience building medical devices, and range from ineffective to downright dangerous. Medical professionals and others involved in these efforts are increasingly seeking to hammer home the point that, in this context, the ‘anything is better than nothing’ approach is fundamentally wrong and could result in deaths.

No one wants doctors and patients to have to choose between using boot-strapped, insufficiently tested and potentially dangerous equipment on the one hand, or no equipment at all on the other. Nor do we want to see cases of Covid-19 missed either because we didn’t have enough approved tests or because we used unapproved testing methods which later turn out to be inaccurate. Everything about this crisis involves hard choices, with lost time counted in lost lives.

What that could mean for regulators is a need to operate differently. Responding to the urgent needs of frontline medical staff should involve developing a fast-track regulatory process (as suggested by ASPI’s Michael Shoebridge), but it could also involve engaging much earlier and much more actively with the open-source technologist community.

Producing simple, accessible resources that explain the regulatory requirements for devices like ventilators or equipment like respiratory masks or that set out the process for getting regulatory approval could be one step. Another option for regulators could be working with health authorities to actively scan for and identify the most promising ideas among these grassroots and open-source efforts, and then proactively helping them through the process. Governments could also make it clear that they will come down like a ton of bricks on companies attempting to stand in the way of life-saving innovation in order to bolster their own profits.

Amid the darkness of the Covid-19 pandemic, the energy, enthusiasm and commitment of the individuals and communities around the world who are working together to find solutions is a bright spark. The role of governments and regulators is to catch that spark and magnify it, and use it to help light a way out of this crisis.

The power of narratives and the risk of surveillance creep in the response to Covid-19

Remember December 2019? That innocent age before our kids knew how to spell ‘Covid’, when all we were worried about was the terrible bushfires and the ongoing climate crisis? In only three months, the novel coronavirus has spread everywhere and all of us are engaged in a continual, rolling recalculation of its mind-boggling implications.

The virus may have emerged in China, an authoritarian state, but it doesn’t distinguish between political systems: democracy and dictatorship alike have staggered under Covid-19’s frightening spread.

Yet even as the crisis rages across the world, and the number of infections continues to increase, there’s a ferocious battle of narratives over which political system has mobilised the best response. As China declares no new local infections and goes on the offensive in the disinformation battle, US President Donald Trump pushes the ‘Chinese virus’ line in place of an effective, coordinated response.

Dozens of nations are in lockdown, infections keep climbing and a global recession looms. China was first into the pandemic, so it may be one of the earliest out.

A geostrategic risk out of all of this is that the perceived ‘lesson’ of the pandemic will be that authoritarianism works and democracy is chaos.

Anywhere you look, government is back, in a big way. Most national governments, both democratic and autocratic, have concluded they need to fight the virus by throttling the freedoms underpinning market economies.

But a preliminary picture is emerging: while extraordinary measures curtailing civic freedoms are evidently necessary for curtailing the outbreak in the absence of a vaccine, autocracy has no monopoly on an effective response. The lack of transparency and accountability, the restrictions on freedom of speech and the lack of a free media in authoritarian countries may in fact make things worse on the ground, as it seems to have done in China in the early days of the outbreak, with consequences we are all now living with.

More important in predicting the efficiency of a nation’s response might be whether it has a population and a public health system with a fresh memory of an epidemic, as in Taiwan and Singapore, which were hit by SARS in 2002 and 2003, and South Korea, which was hit by MERS in 2015.

In the past month, South Korea has managed to flatten the curve without resorting to China’s heavy-handed tactics. The death rate and rate of transmission have been dramatically reduced and the country’s approach has been hailed as an example to the world.

Analysis suggests South Korea’s mass testing (almost 360,000 of 51 million citizens tested) has been crucial in restraining the outbreak. Laws enabling aggressive contact-tracing enacted after MERS mean epidemiologists can act ‘like police detectives’ and quickly track down and quarantine infected people. Mass text messaging, effective public mobilisation and a nationalised healthcare system have also been important factors.

After the SARS outbreak, Taiwan empowered a central command centre for epidemics, implementing lessons from that crisis. Taiwan moved fast on Covid-19, establishing health checks for passengers from Wuhan in early January. It is employing a mobile phone location tracking system to keep people who’ve been exposed to the virus quarantined in their homes. As of 29 March, Taiwan—which has a population the size of Australia’s and much closer ties to China—had reported just 298 confirmed cases and two deaths.

Singaporean Prime Minister Lee Hsien Loong told his people in a national address on 8 February that the experience of SARS had prepared them for the next epidemic. Singapore has a National Centre for Infectious Diseases, a stockpile of masks and other medical equipment, a cadre of trained medical personnel and strong research capabilities.

As of 29 March, the global transport hub had reported 844 cases and three deaths. It has cast aside privacy considerations, launching a public health app which creates a record of virus spread risks by analysing the Bluetooth connections of users’ phones. It’s been reported that those not using the app could be prosecuted.

China’s response earned praise from the World Health Organization (although the WHO itself seems to have been less effective as an advance warning system than we would all like), but elements of the Chinese response were troubling. After initially suppressing health workers’ reports of a terrible new lung disease, China locked down whole megacities. Early images showed people who had apparently refused quarantine being violently dragged from their apartments and Chinese drones rebuking unmasked pedestrians. Government censors, meanwhile, came down hard on any discussion of the virus or criticism of the authorities’ response.

An app linked to the popular payment system Alipay assigned tens of millions of Chinese users a green, yellow or red code based on opaque data the users were not aware of, the New York Times reported. Those without green codes, whether sick or not, found themselves arbitrarily forbidden from travelling anywhere, even, in some cases, from entering their own apartment buildings. The Times found the app shared user information and location data with the police each time it was used.

China claimed its first day with no new local infections on 18 March. This milestone presaged an all-out propaganda assault aimed at flipping the story of cover-up and rampant censorship and came amid rumblings of data-fiddling in time for President Xi Jinping’s first visit to Wuhan on 10 March. There are considerable question marks around China’s figures, and China doesn’t include asymptomatic confirmed cases in its final tally.

It’s still early days. The risk of a second wave of infections in Asia, including China, is real. The energy and focus should be on stopping transmission. But the narrative battle matters, because the pandemic risks shaping a more illiberal world.

The deaths and suffering from the virus itself, combined with extraordinary public health measures like isolating people in their homes, are likely to tip most of the world into an economic downturn, bankrupt innumerable small businesses, decimate industries and deepen inequality. All of these factors risk exacerbating existing impulses towards a dismal, nativist politics as fear heightens and nations turn inwards. Distrust in internationalism is likely to increase just as it’s most needed.

Leadership can make a difference to this bleak prognosis, as can tangible international cooperation at this time of crisis. But that kind of leadership has been in short supply so far.

The pandemic is also likely to hardwire our dependence on technology, making our reliance on digital connectivity so absolute that we become more willing to tolerate the downsides of life in a post-privacy age. Democratic governments may be tempted—or driven—to emulate the techniques of autocratic ones. Surveillance creep seems inevitable. The risk is that notions of ‘deviance’ will shift with political priorities: this year the government may want your data for a public health emergency; next time it might be because they don’t like your opinions.

The story of which system wins the battle against Covid-19 will have vernacular power around the world, and it seems likely that—even with strong, fact-based counter-messaging and clarity and transparency around democratic responses—great-power competition will accelerate and a more fractured, more dangerous world will result.

The race between economics and Covid-19

With the novel coronavirus devastating one economy after another, the economics profession—and thus the analytical underpinnings for sound policymaking and crisis management—is having to play catch-up. Of particular concern now are the economics of viral contagion, of fear and of ‘circuit breakers’. The more that economic thinking advances to meet changing realities, the better will be the analysis that informs the policy response.

That response is set to be both innovative and inevitably costly. Governments and central banks are pursuing unprecedented measures to mitigate the global downturn, lest a now-certain global recession give way to a depression (already an uncomfortably high risk). As they do, we will likely see a further erosion of the distinction between mainstream economics in advanced economies and in developing economies.

Such a change is sorely needed. With overwhelming evidence of massive declines in consumption and production across countries, analysts in advanced economies must reckon, first and foremost, with a phenomenon that was hitherto familiar only to fragile and failed states and to communities devastated by natural disasters: an economic sudden stop, together with the cascade of devastation that can follow from it. They will then face other challenges that are more familiar to developing countries.

Consider the nature of the pandemic economy. Regardless of their desire to spend, consumers are unable to do so, because they have been urged or ordered to stay home. And regardless of their willingness to sell, stores can’t reach their customers, and many are cut off from their suppliers.

The immediate priority, of course, is the public health response, which calls for social distancing, self-isolation and other measures that are fundamentally inconsistent with how modern economies are wired. As a result, there has been a rapid contraction of economic activity (and therefore economic wellbeing).

As for the severity and duration of the coming recession, all will depend on the success of the health policy response, particularly on efforts to identify and contain the spread of the virus, treat the ill and enhance immunity. While we’re waiting for progress on these three fronts, fear and uncertainty will deepen, with adverse implications for financial stability and prospects for economic recovery.

When thrust out of our comfort zones in such a sudden and violent way, most of us will succumb to some degree of paralysis, overreaction or both. Our tendency to panic lends itself to still deeper economic disruptions. As liquidity constraints kick in, market participants rush to cash out, selling not just what is desirable to sell, but whatever can feasibly be sold.

When this happens, the predictable result is a high risk of wholesale financial liquidation, which, in the absence of smart emergency policy interventions, will threaten the functioning of markets. In the case of the current crisis, the risk that the financial system will reverse-infect the real economy and cause a depression is too big to ignore.

That brings us to the third analytical priority: the economics of circuit breakers. Here, the question is not just what emergency policy interventions can achieve, but also what lies beyond their reach, and when.

To be sure, given that simultaneous economic and financial de-leveraging would have disastrous implications for societal wellbeing, the current moment clearly demands a whatever-it-takes, all-in and whole-of-government policy approach. The immediate priority is to establish circuit breakers that can limit the scope of dangerous economic and financial feedback loops. This effort is being led by central banks, but also involves fiscal authorities and others.

But there will be tricky trade-offs to navigate. For example, there’s significant momentum behind proposals for cash transfers and interest-free lending to protect vulnerable segments of the population, keep companies afloat and safeguard strategic economic sectors. Rightly so. The idea is to minimise the risk that liquidity problems will become solvency problems. And yet, a cash- and loan-infusion program will face immediate implementation challenges. Aside from the unintended consequences and collateral damage that come with all blanket measures, in today’s crisis, flooding the entire system would require new distribution channels. The question of how to get cash to the intended recipients isn’t as straightforward as it seems.

There are even more difficulties when it comes to implementing direct bailout programs, which have become increasingly likely. Far from being outliers, airlines, cruise lines and other severely affected sectors are leading indicators of what is yet to come. From multinational industrial companies to family restaurants and other small businesses, the line for government bailouts will be very long.

Without clearly stated principles as to why, how, when and under what terms government assistance will be offered, there’s a high chance that the bailouts will be politicised, ill-designed and co-opted by special interests. That would undermine the exit strategies for putting firms back on their own feet, and risk repeating the post-2008 experience, when the crisis was brought to heel but without laying the groundwork for strong, sustainable and inclusive growth thereafter.

Given how extensive government interventions are likely to be this time around, it’s critical that policymakers also recognise the limits of their interventions. No tax rebate, low-interest loan or cheap mortgage refinancing will convince people to resume normal economic activity if they still fear for their own health. Besides, as long as the public health emphasis is on social distancing as a means of quashing community transmission, governments won’t want people venturing out anyway.

All of these issues are ripe for more economic research. In pursuing these avenues of inquiry, many researchers in advanced economies will find themselves inevitably rubbing up against development economics—from crisis management and market failures to overcoming adjustment fatigue and putting in place better foundations for structurally sound, sustainable and inclusive growth. Insofar as they adopt insights from both domains, economics will be better for it. Until recently, the profession has been far too resistant to eliminating artificial distinctions, let alone embracing a more multidisciplinary approach.

These self-imposed limits have persisted despite abundant evidence that, particularly since the early 2000s, advanced economies are saddled with structural and institutional impediments that have stifled growth in a manner quite familiar to developing economies. In the years since the global financial crisis in 2008, these problems have deepened political and societal divisions, undermined financial stability, and made it more difficult to confront the unprecedented crisis that is now knocking down our door.

Healthcare sector must be protected from cyberattacks as it deals with Covid-19

Over the past week, Covid-19 has upended our traditional assumptions about how we work and what services are critical, and has shone a spotlight on the importance of communication networks. Nationally, our concept of what is critical is continuously changing. Traditionally, Australian government efforts have focused on protecting the information contained on government and military networks, but largely left civilian networks to fend for themselves. We need to change our national cybersecurity priorities to match our new reality.

Cybersecurity in the healthcare sector is traditionally very poor and medical staff are rightly focused on saving lives rather than upgrading IT systems. The healthcare sector is an attractive target for ransomware attackers because it has an increasingly large attack surface. The sector has to deal with a multitude of different systems from different vendors and the proliferating use of internet-connected healthcare devices. All of that makes hospitals a difficult IT environment to manage.

Healthcare services are also made vulnerable by their need to use specialist medical equipment that is too expensive to replace regularly, but whose software isn’t updated for security, as well as the lack of adequate IT resources to keep abreast of threat trends. Due to the critical and time-sensitive nature of their work, hospitals make particularly appealing targets for ransomware operators, because they are likely to pay ransoms.

Worryingly, last year in the United States ransomware attacks made up more than 70% of cybersecurity incidents in the healthcare sector. Ransomware attacks lock up IT systems until a ransom is paid, and are extremely disruptive to hospitals at the best of times.

In the current environment, when hospitals worldwide are struggling to cope with critically ill Covid-19 patients, any disruption can be a matter of life and death. The virus has drastically altered the consequences from risks we were previously prepared to accept. The security of hospitals has always been seen as crucial, but just mere weeks ago we were content to (literally) live with the consequences of poor hospital cybersecurity.

Just weeks later and the consequences of disruption are unthinkable.

As Covid-19 exploits weaknesses in the immune system of its human hosts, malicious cyber actors take advantage of the fear associated with the pandemic to exploit weaknesses in our computer systems and networks.

Hacking groups are already taking advantage of the chaos caused by the global outbreak of the virus. Despite some hacking groups saying they won’t target healthcare, in recent weeks a Covid-19 testing hospital in the Czech Republic, hospitals in Spain and a public health agency in the US have all been hit with suspected ransomware attacks that have disrupted services including delaying surgeries. Although it’s not clear how these networks were penetrated, there have been reports of phishing emails targeting healthcare workers.

Hospitals are obviously critical infrastructure. But with state and federal governments closing borders and non-essential services, we’re one step closer to the lockdowns that are already occurring in the northern hemisphere.

In January this year, Toll Holdings, a provider of transport and logistics support to businesses like Coles, was a victim of a targeted ransomware attack that took its core services offline for six weeks. At the time, the event was of moderate interest to the media. Today, news of a logistics disruption would fuel further panic-buying of groceries and medicines and require a high-level government response. A similar ransomware attack today would be a problem for the nation, not just a problem for a single company like Toll.

Maintaining access to the internet is also a critical issue. With increasingly large numbers of people worldwide under lockdown and working from home, the provision of reliable internet access has become central to the economy and necessary for supplying telecommunications and even entertainment. Network operators are seeing large increases in internet traffic and some governments have responded by asking people to watch less TV. The European Union recently asked large streaming video companies like Netflix, Amazon (via Amazon Prime Video) and YouTube to reduce streaming volumes and ‘preserve the smooth functioning of the internet’.

Hospitals, transportation and governments influencing people’s behaviour to preserve connectivity—these are all examples of how priorities have been altered by the Covid-19 crisis.

Rather than carrying forward with bureaucratic inertia, our cybersecurity policies and investments should be changed to match these altered priorities. Looking at healthcare in particular, state, territory and federal governments should reallocate federal money to hospital IT defence for worthwhile short-, medium- and long-term initiatives.

Short-term efforts could include ongoing and reinforced education about phishing across frontline healthcare providers. Such programs could include phishing simulations and penetration testing. As cyber criminals and fraudsters seek to take advantage of people’s fears about Covid-19, some practical efforts to make staff more resilient would yield immediate benefits and reduce the risk of phishing attacks leading to catastrophic breaches.

In the medium term, governments could also assist by performing cybersecurity audits and providing (or funding) the expertise to develop remediation plans. This should initially focus on ensuring robust and effective data-backup strategies.

They could also assist in developing robust guidelines for how to either digitally quarantine or replace legacy systems that can no longer be updated or patched.

In the longer term, governments could encourage the development of interoperability standards that allow for a secure healthcare IT ecosystem. Part of the problem in healthcare is that solutions from different vendors often don’t integrate well, placing the onus on cash-strapped IT departments to meld diverse systems into efficient workflows. This is difficult to do well with limited resources, and as a result security is often jettisoned in favour of usability.

Can Africa withstand Covid-19?

Less than five months after the first documented case of the Covid-19 coronavirus, infections exceed 500,000 globally, with nearly 24,000 deaths. This pandemic is devastating societies and economies all over the world, but Africa stands to face particularly severe and long-lasting damage.

To be sure, Africa isn’t suffering as much as many expected—at least not so far. Though the number of affected countries on the continent has risen to 39, the virus doesn’t seem to be spreading as rapidly as it has elsewhere.

Some scientists think this could be partly a matter of climate. One study found that the Covid-19 virus may be less stable at higher temperatures, with the optimal temperature for transmission probably hovering at around 8.72°C. Temperatures in most African countries rarely drop below 15°C. This doesn’t mean that the Covid-19 virus can’t be transmitted in hotter climates, only that it may be easier to contain there.

But other serious challenges to containment remain—beginning with the fact that Covid-19 has a longer incubation time than the common cold (another coronavirus), and asymptomatic individuals are contagious. While symptomatic people are more contagious, and this seems to be the primary mechanism for the virus’s spread, asymptomatic people pose a significant danger, because they are less likely to limit their interactions. This makes transmission much harder to track.

Then there’s the issue of severity. While most Covid-19 cases are characterised by only mild to moderate symptoms, the virus’s severity rises sharply for the elderly and those with underlying health conditions, including cardiopulmonary disease and diabetes.

As the world’s youngest continent, with a median age of 18 (less than half the median age of Europe), Africa may have less to worry about in terms of severity. It’s no coincidence that, based on numbers of confirmed cases and deaths, the mortality rate in Italy—with a median age of 47.3—has reached 9.2%, compared with a global average of around 3.4%.

In terms of underlying health conditions, however, Africa is on a much weaker footing. Though non-communicable diseases like diabetes have traditionally been associated with developed countries, there is evidence that they are proliferating in Africa. Moreover, Africa is beset by two other conditions—HIV and tuberculosis—which could pose serious risks to those infected with Covid-19.

Sub-Saharan Africa is home to about 70% of people living with HIV globally, and 25% of the world’s new TB cases—the leading cause of death among HIV-infected people—occur in Africa. Because HIV and TB are not widespread in the regions hardest hit by the coronavirus so far, there’s little data about their implications for those infected with Covid-19. But it does seem fair to assume that people with HIV and/or TB are at a higher risk of developing more severe forms of Covid-19.

There may be some reason for hope: some countries are evaluating the effectiveness of certain anti-retroviral drugs on Covid-19. If they work, it would be a huge relief for Africans. More than 60% of HIV-positive people in southern and eastern Africa—the regions most affected by HIV—are already on anti-retroviral treatment.

But encouraging results are far from guaranteed. And even if they were, nearly 40% of the HIV-positive population in southern and eastern Africa—20.6 million people, in total—would still be highly vulnerable.

A final major risk for Africa during the Covid-19 pandemic lies in the weakness of healthcare systems. If the virus has been able to overwhelm a modern health system in a developed country like Italy, there is no telling what would happen in an African country with a health system that is already weak and under-resourced.

As the rapid global spread of Covid-19 makes clear, this is not just a problem for Africa. If the virus gains a foothold on the continent, it could spill back to the rest of the world, creating new outbreaks in countries that had brought it under control. The only solution is for external actors to work with African governments to address key weaknesses—before it’s too late.

Covid-19 is a long-term crisis that will need long-term solutions

The coronavirus pandemic is a fast-moving crisis, but there are many opportunities for long-term investments that will pay off over its duration. The Australian government should immediately create a body to identify, lead, fund and drive solutions to critical capacity and capability shortfalls.

Australia’s deputy chief medical officer says that between 20% and 60% of us could wind up infected. With Covid-19’s estimated 1% fatality rate, that would mean 50,000 to 150,000 deaths. The Imperial College London’s coronavirus response team predicts that in a business-as-normal situation Covid-19 would infect roughly 80% of the populations of the UK and the US. That would translate into 510,000 deaths in Britain and 2.2 million in America.

And 1% is probably optimistic. In countries in which Covid-19 has escalated beyond control, fatality rates appear to be many times higher as health systems are overwhelmed, and nurses and doctors are left with making the impossible decisions on who lives and who dies.

Around 160,000 Australians die from a variety of causes each year. We have about 95,000 hospital beds and just over 2,200 intensive care beds. Many people with Covid-19 require critical care to survive. Based on the Imperial College assumptions, combined with Australian Bureau of Statistics data, a 20% infection rate—even if half of infected people are asymptomatic—would mean almost 180,000 Australians would need to be hospitalised, 60,000 of whom would require intensive care.

In the absence of public health measures, the virus would spread rapidly, might peak in months and could be resolved by the end of the year. In this scenario, most people requiring intensive care would not get it and so fatality rates would probably be much higher. And we’d lose all capacity to deal with other health issues.

Current public health measures—including social distancing, isolation, quarantine and travel restrictions—are designed to slow the spread of the virus, or ‘flatten the curve’. These measures reduce both the total number of people affected by Covid-19 and the number requiring hospital treatment at any one time. These severe restrictions give our health system the best chance of coping with the inevitable increase in demand.

Paradoxically, the more successful our mitigation measures are, the longer they need to remain in place. They delay infections, but given the worldwide spread of the virus we can no longer hope to eradicate it. Covid-19 is now circulating globally and will inevitably be reintroduced to Australia. Without widespread immunity in the population, any relaxation of bans and restrictions could result in the resumption of the rapid outbreak that we are working to avoid.

There are only three scenarios where life returns to normal.

The first and worst option is that the virus burns through Australians and we develop a ‘herd immunity’ because so many of us have become infected. Once the virus has run that course, we could return to life as normal. Two underlying assumptions in this scenario are that people develop immunity and that it’s politically and socially acceptable for hundreds of thousands to die unnecessarily without modern medical care. It seems that this course of action was originally considered in the UK but has since been roundly rejected. Now the restrictions imposed in the UK are tighter than Australia’s.

The second scenario is that we maintain our extensive control measures, and perhaps institute even more stringent ones, until a vaccine is developed. Scientists are optimistic and many efforts are underway, but it will take time to ensure a vaccine is safe and effective and to produce millions to billions of doses to deal with a global crisis. Even a very rapid deployment of vaccine will take 12 to 18 months.

The third and most optimistic scenario is that drugs are developed or discovered that treat Covid-19 effectively. Some existing treatments hold promise and might be available faster than a vaccine, but they’ll have to be proven to be safe and effective and able to be produced in the huge numbers of doses required. We’ll be competing with the rest of the world to secure supplies, and that may take months.

In this war of attrition, the government has the opportunity to start on some long-term initiatives that will reap benefits in the months (or even years) to come.

It should focus investment on three key areas: improving detection of the virus, increasing the capacity of our healthcare system, and maximising the productivity of our recovered workforce.

We should expand our testing and contact-tracing capabilities by orders of magnitude.

Although Australia is already performing well internationally on testing for Covid-19 per capita, our capacity is still constrained. Investment to secure a self-sufficient tenfold increase in capacity would allow testing to extend much more broadly into the community to detect small pockets of infection before they become large outbreaks. Such an ambitious target may need extensive funding, in addition to the investment in the ‘smarter and better’ testing initiatives already underway, to develop or bolster local supply chains, convert university and research labs into testing centres, and train new staff.

In addition, we should invest in technology and processes to more effectively trace contacts. In the aftermath of a 2015 outbreak of MERS (Middle East respiratory syndrome, an even more lethal coronavirus), South Korea enacted legislation to allow warrantless access to private data such as credit card histories, surveillance footage and smartphone data from confirmed and potential patients. An opt-in process enabling infected individuals to voluntarily provide permission to use their information for contact tracing could make the identification of close contacts far more effective. This technology could also help jog the memories of patients about exactly what they’d done and where they’d been in previous days or weeks. Banks, telecommunication companies and perhaps a body such as Data61 in CSIRO would need to be involved. Such a scheme would be unlikely to yield any immediate benefits but it could bring considerable firepower in a longer war of attrition.

We should also expand our healthcare capacity.

Critical healthcare is a highly skilled job, but there may well be opportunities to retrain or reskill medical professionals to bolster the ranks of frontline hospital staff. As this will be a long war, fast-track options become feasible and worthwhile. Current cohorts of students should be accelerated through their studies and employed as quickly as possible.

People could also be trained to fulfil basic healthcare jobs and free highly trained staff to focus on life-saving activities. Already, laid-off airline workers in Sweden are being trained to perform straightforward roles in healthcare.

Shortages of medical equipment should be tackled. Ventilators to help us breathe when we are critically ill will be in short supply, and since these shortages will be global, it’s unlikely that we’ll be able to import as many as we’d like. We should harness our manufacturing base, engineering sector and university talent to build our own. As my colleague Michael Shoebridge has noted, standards and regulations may need to be relaxed, but a quick-build ventilator may be better than no ventilator at all.

As the pandemic continues to unfold, we need to make the best use of those who have suffered through Covid-19 and recovered.

These workers are very likely to be immune, but may not currently be employed in the most useful roles. Being able to work without worrying about infection would be an asset in many frontline healthcare roles and other critical industries. The longer this epidemic continues, the greater the benefit this recovered workforce will provide.

Many more long-term initiatives will be worthwhile, but it’s likely that the pace at which this crisis is developing is overwhelming decision-makers’ capacity to focus on long-term solutions. The government should immediately create a Covid-19 funding body with a mandate to identify critical capacity and capability shortfalls and to encourage, lead and drive solutions.

The time to start is now.

Learning from Apollo 13: a ventilator grand challenge

Australian hospitals are running short of medical gear and those shortages will worsen. Masks, gloves, gowns, cleaning equipment and ventilators are just the obvious ones. We need to get creative urgently, and we can.

In this pandemic crisis, we can’t expect global supply chains to ramp up fast and meet our needs, especially when they can’t meet even their home countries’ demands.

The New York Times reports that the global ventilator shortage is acute and ‘some European governments are deploying wartime-mobilization tactics to get factories churning out more ventilators—and to stop domestic companies from exporting them.’

We know there’s enormous international cooperation to develop vaccines for SARS-CoV-2, the official name for the coronavirus that causes Covid-19.

It’s a different story with ventilators. Individual governments have been working with companies inside their countries on ventilator production, but there seems to be little international cooperation.

That needs to change urgently so that we create what we need fast—open-source designs for easily producible ventilators, using parts and supplies that are likely to be available in most nations.

Hospital ventilators are complicated electro-mechanical devices that go through years of testing and certification in each jurisdiction.

But we’re in a public health crisis where the risks of not having more ventilators outweigh the risks of introducing some that may not meet standards established for normal times.

Some US hospitals appear to be using one ventilator to support more than one patient at a time.

Another solution is to have manufacturers repurpose facilities to produce ventilators. The obstacles are big, but not insurmountable. Ventilator production normally entails navigating a complex regulatory process. Some of those processes will have to be streamlined, probably supported by legal changes to ensure companies and individuals are not later prosecuted under laws and rules made for safer times.

The companies that make ventilators sensibly guard their intellectual property and designs carefully to protect commercial advantage. Some will need to share their proprietary knowledge openly with a global design and manufacturing community, including in Australia.

The UK government has published specifications for rapidly produced ventilators. That’s a great start. Australia’s Department of Industry is also working with our companies on the problem.

The various components and materials required for ventilator production will be in short supply in some places, whether in Australia or elsewhere, so no one design is likely to be producible everywhere on the globe.

That’s not enough to stop urgent work to develop and produce ventilators that are fit for purpose,  not perfect for purpose, and have the chief attribute we lack now: availability. This is about helping people who will otherwise die.

We’re used to thinking speeded-up design and production aren’t possible with safety-critical equipment—but there’s at least one example of a safety-critical system that was devised and made quickly, and it worked. It also involved keeping people breathing. Gizmodo called it ‘the greatest hack in history’.

In 1970, NASA scientists and engineers, with the crew of Apollo 13, designed and built an improvised air scrubber to prevent the astronauts dying from carbon dioxide poisoning. And they did it just hours using spare items from the damaged spacecraft.

Ventilator parts are already being produced using 3D printers, so the Apollo 13 precedent might be relatively easy to follow. With the UK’s standards, and ventilator companies willing to open up proprietary knowledge and make their specialist designers and engineers available to assist ‘crowd source’ designers, we could make huge strides in the availability of ventilators.

Big medical device manufacturers like GE Healthcare and Beijing Aeonmed, or one of the innovative new entrants with simple ventilator designs developed for use in poorer nations, like OneBreath, have the proprietary knowledge the world needs—and they could share it, no doubt with government encouragement and funding. Tesla boss Elon Musk has made an offer to help. So have the big US car companies.

GE Health, Ford and 3M are now working together to manufacture GE-designed ventilators. They’re also working on a simpler design that can be produced more quickly and on a larger scale. In a nod to the space program, the three companies are calling their work ‘Project Apollo’. GE and Ford should share their designs and their development work openly with other partners that have urgent national needs and can also contribute to simplifying design and production proposals at speed. Australia as a close ally with strong design and capable precision-manufacturing firms is a good one to start with.

The US and Australian governments must quickly agree that this will be a joint national endeavour. Then our companies, industrial designers and health technology professionals can jointly develop designs using our nations’ supplies and production systems.

Australia has some of the world’s best medical researchers and medical device designers and manufacturers, including ResMed and Cochlear. We also have scientists and engineers in universities and in government agencies like the Therapeutic Goods Administration, CSIRO, and the Defence Science and Technology Group in the Department of Defence.

Add to that the precision engineering and automotive supplies sector, and some of the big defence companies with strong national supplier relationships—like ASC—and you see a base of medical knowledge and design capability coupled with local precision manufacturing. And precision manufacturing in almost every sector, including defence, is about safety-critical systems.

This is a design and manufacturing ecosystem that can be joined with the efforts of the US and other international partners and turned to this urgent national and international purpose.

It’s appropriate in these strange times to think the otherwise unthinkable. Fast-tracking open-source ventilator designs that can be produced from items we have available is possible. It certainly requires our government to move on changing the regulatory environment to cope with the changed risk balance we face.

But, more importantly, it requires an urgent marshalling of national and global expertise. This, like the Apollo missions, is a moon shot, but with more purpose than putting one man on the moon.

So, this should be the substance of an early call between the US president and our prime minister. And when the G-20 or G-7 meet, it should be on the agenda.

If they can’t lead or agree, the US and Australia can begin this international effort. Partners like Japan, the UK, Germany, France, South Korea, Canada, Israel and Taiwan are likely to want to be a part of it. Our government science agencies, whether the TGA, the CSIRO or Defence’s DST Group could lead.

A DARPA-like ‘grand challenge’ to develop the best open-source design for a rapidly producible ventilator and make it available to all who can produce it would be a fine thing to see in the various packages being assembled by the national cabinet. It will be a wonderful example of the relevance of Australia’s close strategic and economic partnership with the US during this crisis.

We already have cooperation between NASA and our new Australian Space Agency. Let’s make the ventilator grand challenge our new, joint Apollo mission. We are in these times.