As it now appears that H1N1 influenza is probably not going to be a highly lethal worldwide pandemic, we are left with an opportunity to evaluate our available response mechanisms in the event of a more serious medical threat.
As Tyler Cowen writes in his recently published issue of Mercatus On Policy, “Detecting a pandemic, instituting protective measures, and applying treatment all require the effective cooperation of many individuals and institutions…. Local health-care institutions must therefore be both free and able to respond to crises.” A decentralized response to minimizing the spread of disease is the best option that we have because local knowledge is crucial to distribute medical supplies and to spread information about treatment and prevention of illness in communities across the country.
Despite the practical need for city and regional governments to take over leadership during health disasters, the swine flu outbreak has demonstrated that around the world, national governments tend to take more activist roles during times of fear. In Mexico, President Felipe Calderon took executive action to shut down non-essential government work in Mexico City and asked to “shut their doors to reduce the spread of infection” across the country.
While this response may seem warranted, it has come at a high economic cost by cutting down productivity in Mexico during a recession. Without President Calderon’s warnings, some municipalities may have determined that business as usual was appropriate if swine flu was not directly impacting their residents. In Egypt, a much more costly political decision is now widely judged to have been an overreaction: the Egyptian government required the slaughter of all of the nation’s pigs, even though there are no known cases of H1N1 flu in Egypt, and the virus is not spread by eating contaminated meat. This incident exemplifies the bluntness of nationwide policy actions where local governments could have made more nuanced decisions in crisis situations.
The World Health Organization advises, “Scientific research based on mathematical modeling indicates that restricting travel will be of limited or no benefit in stopping the spread of disease. Historical records of previous influenza pandemics, as well as experience with SARS, have validated this point.” While the temptation to block out illnesses along national borders is strong, as exhibited by calls to close the U.S.-Mexican border during this outbreak, viruses do not recognize political boundaries, and attempting to take such action at the national level would direct scarce resources away from the local level where they could be used to treat and prevent illness on a case-by-case basis.
Thankfully, Dr. Richard Besser, acting head of the Center for Disease Control and Prevention, has so far dealt with this public health threat by emphasizing the importance of community preparedness and avoiding making any statements that could cause mass panic.
Thankfully, the H1N1 flu virus appears to be much less fatal and less contagious than the catastrophic Spanish flu of 1918 on which much of our knowledge of contagious disease management is based. In the event of a more serious virus, the federal government can be of assistance in funding medical research and vaccine stockpiles, but dissemination of medicine and information at the local level must be permitted by a federal government which avoids attempts at micromanagement.