Without goals, it doesn’t really matter what you do, because whatever you do, it won’t be enough. It can’t be. Success has not been defined, so success cannot be achieved. With no sense of direction, you'll drift aimlessly, tossed about by the waves.
If you want to be successful, you first need to define your goals. That might sound like a tautology or a truism but there are a lot of people out there who clearly don't understand the logic.
The W.H.O. for instance doesn't seem to know what the end goal of all its pandemic preparation should be. That means it can't organise itself or lead the world; it can only issue confused advice about how we might reach a destination it is yet to define.
With no stated goals for the world and no specific outcomes to target or plan for, both the W.H.O. and the nations of the world are drifting aimlessly from one crisis to the next.
The W.H.O. has written three major papers on global pandemic influenza preparedness. The most recent paper was published in 2009, building on the earlier ones from 2005 and 1999.
There is plenty of good advice in these papers (much of which was ignored by policy-makers during the Covid-19 pandemic) but what stood out to me above all was that there was no statement of an end goal. Nowhere in any of these papers does the W.H.O. state the final outcome that all of this planning and preparation is supposed to achieve.
This is not a trivial concern.
As discussed above, plans exist to achieve goals. The goal is the literal raison d'être of the plan, so it's impossible to build a plan without first knowing the purpose it serves and the outcome it is supposed to achieve. All planning must therefore begin with goal-setting, and pandemic preparation is no different.
Before these papers were written, the W.H.O. should have established a goal that the world's nations should aim for, be it rapid suppression, herd immunity, total elimination, or anything else. There should have been a clear, ambitious, worthwhile goal that the nations world could aim for, and around which they could build and co-ordinate their national plans.
With the goal in place, it would have been a lot easier for the W.H.O. to write its papers and issue its advice. It would have been a lot easier for the nations to co-ordinate their responses too, but the W.H.O. doesn't seem to understand that logic.
Instead, we get vague recommendations, pointless exhortations, and banal consultant-speak.
For example, in the 2009 paper (p11), the W.H.O. says:
“Effectively meeting the challenges of the next influenza pandemic will require robust and extraordinary advance planning on the part of W.H.O. and countries worldwide.”
That sounds smart, doesn't it? But it doesn't really help us. What does the W.H.O. mean by "effectively meeting the challenges"? What is the "extraordinary advance planning" that will be required? Why not just tell us directly what the problem is and how we can solve it, instead of filling out space with the phraseology of a business consultant?
Elsewhere (p41) their advice is equally unhelpful:
“The goal of recommended actions during these phases is to reduce the impact of the pandemic on society.”
On first inspection, that sounds like it makes sense. But what does it mean to "reduce the impact"? Reduce it from what and to what? How much reduction is required? If we were to prevent a single infection then we would have reduced the impact on society. Would that be enough? I doubt it. But then, what would be?
It’s a bit like saying, ‘the goal is to win’ or ‘we are aiming to solve the problem’. Yes, but how? What does it mean to win and how do we do it?
Throughout the paper there is talk of strengthening systems (how strong?) or minimising risks (how small?), and more international co-ordination is always recommended, but nowhere does the W.H.O. state the specific outcomes that all of this activity is supposed to achieve.
Why has the W.H.O. failed to establish a global goal for our pandemic prevention efforts? Partly for political reasons, but mostly because the W.H.O. is staffed by medics.
Let me explain…
Hurricanes form and play out independently of our actions. We can't stop them or divert their path. All we can hope to do is to survive them as best we can. We understand that the hurricane is going to do whatever it is going to do, so our goal is to minimise its impact on us: stockpile emergency resources, board up the windows, head down to the storm shelter if we have one or get out of town if not.
Fires are different to hurricanes in that they are interdependent. That is, our fire-fighting actions will impact the path of the fire. If we act quickly and forcefully, the fire can be snuffed out before it gets going. If we stand around looking at each other, then it will spread and grow and become a much bigger problem. A pan fire or a few sparks from a faulty electrical heater can be suppressed with a fire blanket, or it take out a whole building. It all depends on our response.
The problem is that medics treat pandemic influenza like a hurricane, when they should be treating it like a fire. They take for granted that the pandemic will happen and that there’s nothing they can (or should) do to stop it. But in doing so they risk a self-fulfilling prophecy I discussed previously. Nor can they see any specific epidemiological outcome to be achieved, other than a vague sense of doing better i.e. fewer cases, less stress on the health service, minimise its impact, etc.
The medics at the W.H.O. have taken their passive, medical approach from managing seasonal influenza into their fight against pandemic influenza. But pandemic influenza is a completely different beast. It is far more dangerous and taking the passive approach against it can be suicidal. It's like hoping that the pan fire will burn itself out, when it's far more likely to engulf the kitchen, the apartment, and then the whole building. Which is kinda what happened with Covid.
One of the key lessons we need to learn is that different pathogens need different goals, and if they need different goals, then they also need different plans. Some pathogens are so dangerous that they must be identified and eliminated immediately. Others are no more dangerous than a seasonal influenza, and should probably be treated the same. Some pathogens can be suppressed with vaccines, others will need NPIs.
The specific combinations of pathogens and goals can be discussed another time. For now, we just need to establish that goals – clear, specific, measurable, realistic, etc – are essential for pandemic prevention.
Co-operation and co-ordination enable us to become more than the sum of our parts. This is as true for ants, herds of animals, and human beings in their communities as it is for whole nations in the global society.
International co-ordination will be essential if we are to gather and disseminate information, implement border controls, and manage global supplies of key medical resources – all of which are central to effective pandemic prevention.
However, we can’t co-ordinate at the international level unless we first have goals and plans in place at the national level. Otherwise, what is there to co-ordinate?
Think about it like this… If I don’t know what you’re planning to do when the time comes, then I can’t co-ordinate with you. I can only watch and react. If I don’t know what I’m going to do when the time comes, then I can’t co-ordinate with you, or with anyone.
We each need to have some idea of what the other would do in those future scenarios before we can make any progress on co-ordinating our future responses.
Exhortations from the W.H.O. for more co-operation and co-ordination are a waste of time. They do not fall on deaf ears; they are seeds falling on barren ground. ‘Co-operate!’, they command us. But co-ordinate with who, on what, and to achieve what outcomes?
Without goals and plans at the national level, there is nothing to co-ordinate at the international level, and it’s not going to be possible to protect ourselves from pandemics until that changes.
The practical reality is that we can achieve very little at all in pandemic risk management without first stating our goals.
Goals are essential because they streamline our decisions: by stating a goal, we automatically define the infrastructure and resources needed to achieve it. At the same time, we eliminate all other potential decisions and paths. Specific goals thereby create a finite ‘to do’ list for our pandemic prevention efforts.
Goals also serve as a metric against which we can assess our performance. In preparation, we can track our progress against our ‘to do’ list. When the outbreak begins, we can determine whether we are on course to achieve our primary goal, or whether we need to change tack. Goals guide our decision-making at all times.
Without clear goals, preparation efforts will be ignored, deferred, or become box-ticking exercises for apathetic civil servants, while plans will be implemented reactively, amid a media storm, and driven by the political expediency of the day. We’ll have no choice but to respond to events as they happen, instead of taking control and setting our own course. Our attention will be dragged from one thing to the next, and ‘managing the narrative’ will take prominence over managing the outbreak.
The Covid-19 pandemic was a case-study in how badly things can go wrong in these scenarios. As things stand, we are on course to repeat it.
A pandemic is a risk management problem. One of the characteristics of a risk management problem is that it starts with a goal, and the risk management process is what keeps the plan on track to wherever that goal may be. By first sketching our goals and ambitions, we will naturally create a shared direction of travel which then forms a basis for greater international co-operation and co-ordination.
We may not agree on the exact details of what we want to achieve at a national level, but we don’t need to either. As long as our national goals have ‘enough’ in common, we can work together in areas of shared interest, and there will be more coherence to the next global response, when the time comes. The W.H.O. has, potentially, an important role to play in helping to shape those goals.
In the W.H.O.’s 2005 pandemic paper (p11), they stated that one of the W.H.O.’s objectives was: “To promote the development of harmonized global, regional and national influenza pandemic preparedness plans.” This was the right idea. We need national plans that align, and that allow for co-operation and co-ordination. However, the next logical step is that we need national goals that align, since the plans are determined by the goals.
The W.H.O. has made attempts to build on this idea, but they still fall short of what is required. A 2018 paper focused on the harmonisation of preparedness and response, but again, it misses the key point: we need to harmonise the goals first, then we can harmonise our preparations. From that point, the plans will fall into place.
In the absence of such goals however, the W.H.O. is once again left issuing nebulous advice like 'identify priorities' and 'strengthen capacities', which is too vague, lacks purpose, and will only be put on the long-finger by politicians and civil servants alike.
The lack of a goal around which to orient our planning and preparation is a major hindrance to global pandemic prevention.
If we are to protect the world from future pandemics, we need to think about clear, ambitious, national and global goals: goals that can align our responses and which all the world’s nations can get behind. As things stand, we don’t appear to have any idea that this is even required, and it is costing us time, resources, and ultimately, lives.
To summarise, we need goals:
