Public Health Still Needs an Economics Transfusion

T his month marks the fourth anniversary of the proclamation on March 13, 2020, that declared a national emergency concerning the pandemic. We’ve learned that lives and livelihoods depend on replacing the health profession’s reliance on government planning with an appreciation for market solutions that empower individual choice.

Doctors Francis Collins and Anthony Fauci at the National Institutes of Health became the public faces of the pro-lockdown policies. Collins recently acknowledged focusing only on the minimization of disease alone while ignoring other aspects of the pandemic was a mistake. Fauci admitted in closed congressional hearings that the guidelines for social distancing (and other disruptive protocols) were arbitrary.

The public-health profession often fails to consider the impact of a disease beyond its mortality and morbidity rates. That explains why public-health officials deliberately misled the population about benefits of disease-focused recommendations and overestimated the ability of governments to manage disease. Citizens rationally responded with doubt in the profession’s ability to devise effective disease-related policies.

The total harm of a disease is the sum of the cost of prevention and the harm of the disease itself. Public health frequently trivializes prevention costs, and therefore misjudges the overall effects of disease policies. One example is the claim that the U.S. failed in its early 2020 response by not adopting Europe’s more restrictive policies. But as we have argued in these pages before, the total loss from both disease and loss in economic growth was lower in the U.S. than in the EU.

Another example was advocating for lockdowns that ultimately obstructed learning, production, and health care for non-Covid illnesses. It’s unclear whether lockdowns even reduced long-run cases of Covid-19 because they undermined private activities fighting the disease. As early as mid March 2020, one of us serving on President Trump’s economic team advised him that the public-health perspective is woefully incomplete, and that the lives of low-risk young adults driving the economy should not be disrupted. It was the high-risk elderly who needed protection. Now, four years later, the staggering costs of disruption are finally acknowledged.

We’ve all heard that “the doctor knows best,” but the doctors in government have proven that they do not. Public health is ultimately a social science, but unlike other social sciences, it does not empirically or quantitatively analyze how fiscal and regulatory policies addressing disease affect private-sector behavior. When disease risk drives private prevention efforts, public-sector success typically lowers private prevention, which is part of the reason, in addition to new variants, why the first year of vaccines elevated the overall Covid-19 death toll in 2021 as preventive behavior fell through with people going back to their normal lives.

Due to a lack of understanding of such private-sector interactions, public-health officials often fail to value deregulation. Despite his participation in earlier pandemic-deregulation projects, Dr. Fauci did not anticipate the ability of Operation Warp Speed (OWS) to speed up development. But OWS enabled a record-speed transition from idea to market by relying on market forces rather than government. In essence, capitalism, by spurring innovation through selling to new markets, mitigated Covid-19 because the rewards for new vaccine and treatment innovations were enormous given the global market size. OWS was a natural result of the Trump administration’s emphasis on deregulation. In contrast, career bureaucrats preferred the federal health bureaucracies to respond, which created the cumbersome Covid-19 testing rollout.

Any patient would be horrified to learn an economist will perform their surgery. Yet federal health bureaucracies operated by doctors and lawyers regulate about a fifth of our economy and a quarter of the federal budget. Their lack of economic expertise leaves the population they serve at the mercy of poorly informed and heavy-handed policies.

Tomas J. Philipson, the Daniel Levin Chair Emeritus at the University of Chicago, served as a member and acting chairman at the White House Council of Economic Advisers, 2017-20. Casey B. Mulligan, a professor of economics at the University of Chicago and senior fellow with the Committee to Unleash Prosperity, served as chief economist at the White House Council of Economic Advisers, 2018-19.