Early in 2020 Western governments, alarmed by reports from China, asked the international public health community whether they should close borders to limit the spread of coronavirus into their country. The UK government consulted its pandemic flu plans which, in line with the expert consensus, told them:
"It will not be possible to halt the spread of a new pandemic influenza virus, and it would be a waste of public health resources and capacity to attempt to do so."
"International travel restrictions are highly unlikely to interrupt the spread of an epidemic significantly"
The media reported the expert consensus of the time:
“The evidence on travel bans for diseases like coronavirus is clear: They don’t work. They’re political theater, not good public health policy.” - Vox
"Travel and trade restrictions might seem like a common-sense public health response — so why does the WHO frequently recommend against them? Here’s why border measures do not work" - Washington Post
"Health experts overwhelmingly decry travel and trade restrictions as bad policy and irresponsible violations of international law. Yet governments continue to implement them, even though scientific evidence—and economic self-interest—advises otherwise" - Foreign Policy
"World Health Organization chief Tedros Adhanom Ghebreyesus said Tuesday that widespread travel bans and restrictions weren’t needed to stop the outbreak and could "have the effect of increasing fear and stigma, with little public health benefit." - Politico
"Border controls are more an expression of xenophobic policy than an enduring solution to an infectious threat. Today, there’s far more to gain through international cooperation than by keeping borders locked down" - Politico again
"Countries are taking measures to ban travel. These changes rarely prevent the spread of disease, but they are likely to spur devastating economic and health consequences. They may also violate international health law." - Think Global Health
"The US has a sophisticated public health system and the CDC is the best in the world... the risk to Americans is relatively low and there is no justification for extraordinary, draconian action, like a travel ban" - Health Affairs
Little wonder that governments outside China and then Asia were so hesitant to take action. When New Zealand and Australia shut their borders in their attempt to suppress and ideally eliminate covid, they were going well against the grain of professional opinion. So why were these anti- border measure views so strongly presented to governments and the media in the early days of 2020?
A year later and we get some insight from Lawrence O Gostin, global health law professor at Georgetown University, a man who contributed to the international law governing disease outbreaks which penalises countries for attempting to limit travel due to epidemics and is quoted in many of the articles above. Prof Gostin now says:
“I have now realized that our belief about travel restrictions was just that — a belief. It was evidence-free.”
I think Gostin might be overstating it- there are reasonable arguments that closing borders can hurt without helping if it’s done too late, or if say you were generalising from land border closures during Ebola, you might think that closing off road crossings would still see some disease spread via porous, untracked land routes- again getting a loss of trade with little disease benefit.
But overall these arguments for closing border faster and more effectively, not abandoning the idea altogether.
The straightforward lesson to take from this is that international public health experts belong to a social and political class which thinks closing borders is bad for mostly domestic political reasons, and in the absence of external reality checks like a pandemic, people wanting to make a career public health can really only advance by mimicking the beliefs of the senior people who are the gatekeepers for advancement. If they hate border closures, and you want them to give you a job, well you’d better hate border closures too.
If you had attended the conference (alongside Lawrence O Gostin) at which the international pandemic preparedness index was created, a conference which judged a country less prepared for a pandemic if it favoured closing borders in response to a disease outbreak, and said you thought that idea was silly and anyone thinking about it for five minutes would reach the obvious conclusion that a disease which spreads from person to person will not spread if a person doesn’t cross the border and encounter another person, you’d have been right of course, but what does that count for? Is there any mechanism at all for alternative views to surface? After all, you can’t short their belief. Maybe you can get them to bet you money that’ll pay out in the event of a pandemic, but you’d actually have to convince them to take the bet. Maybe you could buy property in New Zealand like Peter Thiel did in what looks now like a pretty prescient move? None of this sounds realistic for anyone likely to be in those rooms. I think if you were an early career researcher in public health and sceptical about the prevailing beliefs, there basically isn’t much of a way for you to speak your mind at all and even if you did, if global pandemics happen every 100 years, you could have lived your whole life before being proved correct. The experts can stay wrong longer than you can stay alive
The scary lesson in all this is that for unusual risks like pandemics, where the real-life test of expert theories occurs very rarely, we should expect many expert consensus views to be completely back-to-front wrong, because the in-group incentives will drown out any real-world test of their theories and beliefs. This is obviously an argument against planning, or at least an argument for making those plans as flexible as possible, because early planning will just entrench the weird and wrong political views of the relevant expert class (see the UK pandemic flu plan above).
If we know that they were this wrong about something as important as a global pandemic, what other horrors are hiding in the expert consensus on every other rare event?
Coming next week: facemasks and expert reasoning