Henderson on Pandemic Planning

I recently started reading The Big Fail: What the Pandemic Revealed About Who American Protects and Who It Leaves Behind, by Joe Nocera and Bethany McLean. They had previously written the book All the Devils are Here: The Hidden History of the Financial Crisis, which I found to be one of the better books on the 2008 financial crisis, so when I saw their new book I was eager to dive in. I expect I’ll have more to say about it going forward, but one thing that jumped out at me in the early chapters was the mindset of government officials in the years leading up to the Covid-19 pandemic, and of one in particular – Donald Ainslie Henderson. (Yes, I will confess that I deliberately made the headline of this post slightly click-baity, at least for the regular EconLog reader!)

In the aftermath of the Covid-19 pandemic, it wasn’t at all uncommon to hear people rail against the government for being unprepared and for its complete lack of planning in the event of a major pandemic. But Nocera and McLean point out that, in fact, plans had been worked on and established for years prior to the arrival of Covid-19 in America.

Plans for handling a national pandemic began to be put together in 2005, as a result of then President George W. Bush reading John M. Barry’s book about the 1918 flu pandemic, The Great Influenza. After finishing the book, President Bush told his officials “Look, this happens every 100 years. We need a national strategy.”

While this is when the government began to formulate a national strategy in earnest, there had been many urging this step be taken before, as Nocera and McLean write:

Indeed, for decades there had been a small group of scientists who tried to warn the government about the potentially disastrous consequences of a pandemic. The leader of the ad hoc group was an epidemiologist named Donald Ainslie Henderson, or D. A. Henderson, as he was known to everyone, including his wife.

And Henderson, shall we say, knew a bit more than most about controlling the spread of disease:

In 1966, as a thirty-seven year old scientist, Henderson was lent to the World Health Organization to lead a program with a seemingly impossible task: eradicating smallpox, one of the world’s great scourges. Henderson turned out to be a remarkable leader, and in the span of a decade he and his team pulled it off.

Henderson was brought in to help with the development of a strategy: “By the time Bush began pushing his administration to come up with a pandemic plan, Henderson was seventy-eight years old. He had spent a decade as the dean of the Johns Hopkins School of Hygiene and Public Health, and had rotated in and out of government several times.” He joined the “Center for Health Security when Bush began agitating for a pandemic plan. But because of his stature, he was brought into some of the administration’s discussions. He was not happy with what he was hearing.”

Why was he unhappy? Henderson was different from most health officials in one particularly interesting way. He was not what Adam Smith would famously call the man of system, described by Smith in the following way:

The man of system, on the contrary, is apt to be very wise in his own conceit; and is often so enamoured with the supposed beauty of his own ideal plan of government, that he cannot suffer the smallest deviation from any part of it. He goes on to establish it completely and in all its parts, without any regard either to the great interests, or to the strong prejudices which may oppose it. He seems to imagine that he can arrange the different members of a great society with as much ease as the hand arranges the different pieces upon a chess–board. He does not consider that the pieces upon the chess–board have no other principle of motion besides that which the hand impresses upon them; but that, in the great chess–board of human society, every single piece has a principle of motion of its own, altogether different from that which the legislature might chuse to impress upon it.

Henderson was keenly aware that people have “a principle of motion” all of their own, and fruitlessly tried to get other officials to understand that. One of Henderson’s colleagues, Tara O’Toole, described his mindset this way:

“D.A. kept saying, ‘Look, you have to be practical about this,'” O’Toole recalls. “‘And you have to be humble about what public health can actually do, especially over sustained periods. Society is complicated, and you don’t get to control it.’ There was also the fact that D.A. and I had been in government. We had a pretty clear sense of what government was, and wasn’t, capable of.”

Henderson particularly stressed the importance of situations being managed through decentralized, hands on, real world experience rather than top-down planning. His ability to understand this was no small part of the reason why his team’s efforts to eradicate smallpox was successful. In planning discussions, he would emphasize the importance of understanding that people aren’t simply chess pieces that can be moved around at will:

Henderson liked to say that there were two kinds of epidemiologists: those who used “shoe leather” – that is, they got out of the office and talked to people to learn about a disease and its spread – and those who used computer models. He was firmly in the shoe-leather camp. In meetings to hash out the plan, he made his position plain: he opposed creating policy based on hypothetical models – which, after all, were themselves based on hypothetical assumptions. “What computer models cannot incorporate is the effects that various mitigation strategies might have on the behavior of the population and the consequent course of the epidemic”, he said. “There is simply too little experience to predict how a 21st century population would respond, for example, to the closure of all schools for periods of many weeks or months, or to the cancellation of all gatherings of more than 1,000 people.”

However, the leadership of the pandemic planning team had a very different mindset:

The two men heading the planning team were Carter Mecher, the gadfly at the Department of Veteran Affairs, and Richard Hatchett, and oncologist who had been serving as Bush’s biodefense adviser since 2002. They were smart and dedicated, but neither had any experience with epidemiology or pandemics.

Mecher and Hatchett didn’t share Henderson’s reservations about centralized, top-down plans based on hypothetical models. And that’s putting it mildly:

They wound up embracing a model built by a high school student, Laura Glass, for a science project.

Eventually, President Bush’s prediction came true – we had a pandemic that seemed comparable to the 1918 flu. And there was a plan in place, ready to go for Alex Azar, the then Secretary of Health and Human Services:

Azar immediately began “marching through the pandemic playbook,” as he’d later put it, that had been written in the Bush administration and updated by the Obama administration. But for all the man-hours that had been spent putting together the pandemic plans, the documents were essentially worthless. Reality was a lot different from a simulation or a war-game exercise.

It turned out that in practice, the “plan” was in the best case worthless, and in many cases actively harmful. While Mecher and Hatchett saw their role as creating a playbook for everyone to follow, Henderson saw the goal as maximizing the opportunities for people to adjust and adapt in their own way. It’s worth pondering how different the world might look today if policymakers had taken Henderson’s advice in the era of Covid-19 – or what it might look like today if the smallpox eradication effort had been run by people like Mecher and Hatchett.