Tuesday, September 22, 2020

The Use of Games in Pandemic Planning.

Environmental & Science Education, STEM, Medicine, Health, Models, Society, History of Science  

Ed Hessler

You've heard of wargames, "a type of strategy game, "according to the Wiki entry, which realistically simulates warfare. A military wargame, specifically, is a wargame that is used by some military organizations to train officers in tactical and strategic decision-making, to test new tactics and strategies, or to predict trends in future conflicts."

Wargame scenarios on global pandemics have also been played by academics, government officials, and business leaders to identify the risks and gaps in the ability of governments and organizations to respond. 

Amy Masmen and Jeff Tollefson published a Nature feature about these scenarios and simulatons on their success and failures. They write  "The exercises anticipated several failures that have played out in the management of COVID-19, including leaky travel bans, medical-equipment shortages, massive disorganization, misinformation and a scramble for vaccines. But the scenarios didn’t anticipate some of the problems that have plagued the pandemic response, such as a shortfall of diagnostic tests, and world leaders who reject the advice of public-health specialists.

"Most strikingly, biosecurity researchers didn’t predict that the United States would be among the hardest-hit countries. On the contrary, last year, leaders in the field ranked the United States top in the Global Health Security Index, which graded 195 countries in terms of how well prepared they were to fight outbreaks, on the basis of more than 100 factors. President Donald Trump even held up a copy of the report during a White House briefing on 27 February, declaring: “We’re rated number one.” As he spoke, SARS-CoV-2 was already spreading undetected across the country.

"Now, as COVID-19 cases in the United States surpass 4 million, with more than 150,000 deaths, the country has proved itself to be one of the most dysfunctional. Morhard and other biosecurity specialists are asking what went wrong — why did dozens of simulations, evaluations and white papers fail to predict or defend against the colossal missteps taken in the world’s wealthiest nation? By contrast, some countries that hadn’t ranked nearly so high in evaluations, such as Vietnam, executed swift, cohesive responses."

The authors describe the history of their use , including a box with a timeline of games and some results, commenting on the difficulty of translating what was learned by policy-makers into policy--"actionables" as they are called but that are the opposite, what I would call as "inactionables" in practice.

What Maxmen and Tollman note in particular is a response focusing on the endgame--the development of an effective vaccine--rather than the important middle game: "the complex, systemic deficiencies in the public-health system" and how to strengthen it." Taiwan has held annual outbreak exercises for 17 years; in other words they "practice, practice, practice." At the date the essay was written on 6 August, Taiwan had had only seven deaths from Covid-19.

The pandemic has revealed the lack of coordination at the U. S. federal level, silencing agencies (notably the CDC), revising well prepared guidelines and I think worst (all are horrible) actively "undermined authority" of agencies and experts at nearly every turn. However it is much worse. Trump has conducted a disinformation campaign against our democratic institutions from the beginning of his administration. An attack on one agency has ripple effects. 

In his recent The New Yorker essay, Joshua Yaffa (September 14, 2020) probes and expands on such effects. He writes "Democratic institutions depend on the trust of citizens who share a factual universe." This includes the use of evidence, reasoning and a rational view of the world.

Pandemic games and their players make assumptions about government, particularly administrations, e.g., that during a pandemic the response would make use of existing plans and consult with experts as well as to use evidence-based data to make decisions. It is unlikely that a game would include this "what if" and/or that players would consider it likely, "but," as Maxmen and Tollman point out, "none explored the consequences of a White House sidelining its own public health agency. Perhaps they should have...."

There will be more games, simulations, scenarios but the question lingers. Will policy makers act? To give you an idea of how seriously we should consider this is noted in a scenario called Event 201, played in Geneva Switzerland last year. Ryan Morhard, a biosecurity specialist who devised the game, the name recognizes that "we're seeing up to 200 epidemic events per year...eventually one would cause a pandemic.

The report by Maxmen and Tollefson is four pages and in my view worth the time.



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