In the midst of the corona crisis, policymakers prevented an implosion of healthcare at the expense of major economic damage. But which policies deliver the best health outcomes at the lowest cost during a pandemic? Tijs Alleman, affiliated with Ghent University and Johns Hopkins University, started his PhD in search of the ideal policy mix. These are the recommendations to tackle the next pandemic not only effectively but also efficiently.
The welfare gains from a well-thought-out pandemic strategy can be significant. Due to the strict government intervention in March 2020, Belgian GDP fell by 5.4 percent, temporary unemployment rose high, and the government had to provide tens of billions of euros in support to companies to prevent even more failures.
Policymakers intervened drastically to flatten the infection curves, armed with models that predicted the number of infections. “However, these models overlooked the socio-economic impact of measures such as a lockdown. The focus was mainly on containing the epidemic,” says Tijs Alleman, one of the model builders during the pandemic and affiliated with the Faculty of Bioscience Engineering at Ghent University and the Johns Hopkins Bloomberg School of Public Health, based in Baltimore, USA.
Of course, policymakers’ response to protect public health made sense. In addition to the deaths due to Covid-19, there was also the less visible damage caused by long-term Covid and the postponement of operations and treatments.
“We measure this damage based on the number of years of qualitative life lost, where one year of qualitative life is equal to one year lived in perfect health. In 2020, we estimate the number of years lost at more than 143,000, up to half of which are due to the postponement of operations, and a quarter each due to Covid deaths and long-term Covid.
“Putting an amount on a qualitative year of life is delicate, but the World Health Organization (WHO) uses a range of 1 to 3 times GDP per capita. The loss of 143,000 quality years of life then corresponds to a health damage of 5.8 to 17.3 billion euros, or equivalent to 1.1 to 3.2 percent of GDP. The health damage is therefore certainly not negligible compared to the economic damage,” says Tijs Alleman.
To find out which measures can limit the damage to public health at the lowest economic cost, Tijs developed a model that can simultaneously calculate the spread of the disease and the economic damage, as well as take into account complex behavioral changes of the population. This model should help policymakers control a pandemic as efficiently as possible. This provides the following advice that policymakers can take into account during the next pandemic.
1. Respond as quickly as possible
“In a pandemic with an exponential contamination curve, it is crucial that the government recognizes the seriousness of the situation in a timely manner and warns the population. However, we tend to underestimate an abstract threat such as a pandemic. Reacting one or two days faster makes a world of difference,” says Tijs Alleman.
“Belgium went into lockdown on March 15, 2020, but the same lockdown on March 12 had resulted in only half of the influx into intensive care. If Belgium had only gone into lockdown on March 18, even with our very strict measures, we would have had Bergamo situations and our health care would have collapsed. The lockdown of March 15 came just in time. The sooner you intervene to slow the exponential growth of the infection curve, the less harsh the measures will have to be to protect healthcare, and therefore the lower the economic damage will be.”
‘An efficient lockdown consists of mandatory teleworking where possible, a short-term closure of schools for two weeks and the closure of a limited number of sectors, such as the catering, recreation and events sector’
Tijs Alleman, Ghent University
2. Keep lockdowns short and mild
The first lockdown in the spring of 2020, when all economic activities were banned where no distance could be guaranteed, was quite drastic. “It amounted to a de facto shutdown of the entire economy, except essential activities, and was a very effective but expensive measure to break the contagion curve. Milder lockdowns also succeed in safeguarding the health system at a much lower economic cost.
“An efficient lockdown consists of mandatory teleworking where possible, a short-term closure of schools for two weeks and the closure of a limited number of sectors, such as the catering, recreation and events sector. The maximum decline in GDP in this scenario of a mild lockdown would have been only 15 percent in the second quarter of 2020, compared to 24 percent in a strict lockdown, while the effect on the infection curve is almost as great,” says Tijs Alleman.
Policymakers must also take into account the complex behavior of the population during a pandemic. “We should not keep lockdowns longer than strictly necessary,” says Tijs Alleman. “A lockdown that is too long, too hard to completely suppress the infection curve will lead to friction with the population. People then want a quick return to normal life and are becoming less and less accepting of the measures still in force. If the measures are eventually relaxed, this behavior will quickly revive the pandemic. This even leads to a new, even higher peak in the number of hospital admissions.”
‘Policymakers must take into account that building herd immunity takes time. In the meantime, our behavior is causing several waves in infections’
Tijs Alleman, Ghent University
Your and my behavior ensures that a pandemic proceeds in waves until sufficient group immunity has been built up with the help of a vaccination campaign. “In the beginning of a wave, people underestimate the severity of the situation, paving the way for the exponential spread of the virus. But after the peak in the number of hospital admissions, people remain anxious for too long. We also continue to voluntarily adjust our behavior after a wave to prevent contamination, which causes the epidemic to lose further momentum. In the trough of the wave we lose our vigilance again and the cycle can repeat itself. This creates the typical wave movement in the number of infections. Policymakers should keep in mind that building herd immunity takes time. In the meantime, our behavior is causing several waves of infections. So long-term planning is the message,” says Tijs Alleman.
3. Doing nothing is not an option
Is a voluntary behavioral change among the population sufficient to control a pandemic? In other words, are lockdowns necessary? Sweden successfully applied a strategy based on voluntary behavioral modification. There were no strict lockdowns, without hospitals being overwhelmed.
“Early and voluntary behavioral adjustments are better than late and government-forced behavioral adjustments with closures of economic activities,” says Tijs Allema. “But the Swedish approach would probably not have worked in Belgium. The population density is simply lower in Sweden and the Swedish government informed citizens more quickly about the seriousness of the situation. The Swedes may also have followed government advice better because they have more confidence in the government, but we cannot prove that.
“In Belgium, a voluntary behavioral adjustment was probably not enough and forced behavioral adjustments, such as closing the catering industry, were therefore also necessary to safeguard the health system. When people see that hospitals can no longer handle the influx of patients, they will of course voluntarily adjust their behavior for fear of becoming infected, which also causes economic damage. After all, the majority of the population will not happily sit on a terrace when a new and dangerous virus is spreading. Doing nothing also has a cost, and this could even be greater than that of a lockdown.”
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2024-02-24 18:20:00
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