“Consideration of Trade-offs Regarding COVID-19 Containment Measures in the United States: Implications for Canada,” by Mayvis Rebeira and Eric Nauenberg

Rebeira and Nauenberg’s paper presents an exploratory analysis of a challenging question which I paraphrase as: “Were the extraordinarily costly social responses to the COVID-19 pandemic economically justified?” They wade bravely into the always controversial topic of assessing whether what governments spend to achieve health gain – or in this case prevent its loss – are worth it, in economic terms.

They apply well-known methods of modelling incremental cost-effectiveness analysis for value of life years gained, balancing that with comparisons to value of statistical life years measures used in different sectors. They encounter and detail many uncertainties in assembling the evidence on the effects and costs of social restrictions to prevent COVID-19 infection and spread, and the economic support programs used to buffer the negative effects of the pandemic. Their conclusion, perhaps not surprisingly, is for the United States – maybe – and for Canada, with more apparent success in epidemic control, perhaps a bit better.

Perhaps the greater value of their paper is not its conclusions, but rather its posing of the questions. Here are some things it led me to ponder:

• Firstly, a society- and economy-wide crisis like the COVID-19 pandemic and its duration starkly illustrate our limitations in cause-effect analysis. Such extensive and extended events present the challenges of complex adaptive responses in large systems. How did different groups in society behaviourally respond to unprecedented restrictions and unprecedented government efforts to reduce the costs of such restrictions? Often the best we can do is estimate the average effects, but COVID-19 clearly affected different groups in very different ways. Full confidence in results is a tall order in such complexity.
• Secondly, this kind of ex-post analysis underplays one striking aspect of the pandemic: policy-makers were very uncertain about the future at many points in time, especially early in the evolution of the pandemic. If they “over-reacted” in economic terms based on ex-post analysis, was that necessarily an error at the time, given such unknowns?
• And thirdly, are the questions they pose ethically legitimate? Should one be valuing life in this way? Such questions have entailed many debates about applying economic analysis to health issues. We don’t have to like the enterprise to feel we can learn something from it.

So, readers, if you read through this paper, try to calm any skepticism, frustration, or even outrage that you may feel, and pause to reflect on the challenges of economically sensible policy responses to unprecedented events – this may not be the last of those. And “close” may not count in horseshoes, but perhaps isn’t bad in crisis response.

Prof. Peter Berman is a health economist with five decades of experience in research, policy analysis and development, and training and education in global health. Prof. Berman is Professor Emeritus of Population and Public Health and formerly Director, School of Population and Public Health, University of British Columbia in Vancouver Canada, and also currently Adjunct Professor in Global Health at Harvard T. H. Chan School of Public Health, Harvard University.

Health Reform Observer - Observatoire des Réformes de Santé, Volume 11 | Issue 1 | Article 7. https://doi.org/10.13162/hro-ors.v11i1.5622.