In early 2020, coronavirus disease 2019 (COVID-19) was unleashed on the world.
What began as an outbreak in China quickly spread and was declared a pandemic
in March 2020. In response, governments around the world activated their
regulatory machinery, adopting a wide range of activities, including but not limited
to detainment, surveillance, lockdowns, the shuttering of schools and nonessential
businesses, travel restrictions, and the banning of certain events. The consequences
include but are not limited to economic hardship, massive spikes in national debt,
increases in the prevalence of mental-health issues, and spikes in substance abuse,
suicide, and domestic violence.
The ongoing pandemic raises a host of issues for those concerned with the
maintenance of a free society. What are the role and limits of entrepreneurship, civil
society, and governments in preparing for and responding to health crises involving
collective-action problemsfor example, infection externalities? What is the role, if any,
of government regulationfor example, the U.S. Food and Drug Administration
(FDA) and the Centers for Disease Control and Prevention (CDC)in matters of
public health? How might regulations reduce well-being by stifling innovation and
adaptations? How do government responses to health crises empower Leviathan in ways
that threaten individual freedom and liberty both in the immediate term and in the long
term? The papers that follow are inspired by these and related questions.
In the opening paper, Richard Wagner notes that public health is an oft-used
illustration of market failure and justification for governmental action to solve as a
corrective. COVID-19 is just the latest in a continuing series of claims of market failure
that are alleged to require solutions by politically selected experts. Although recognizing
that COVID-19 presents problems of public health, Wagner argues that solutions
are a complex matter of social organization and not a simple matter of selecting
the right expert to determine the right solution. Subduing COVID-19 requires expertise
provided by the scientific disciplines related to public health, but it requires more
than that. To explore how much more, Wagner draws on Michael Polanyis notion of a
Republic of Science to explain that subduing infectious disease is best accomplished
not through a closed and limited system but instead through a system of free and open
competition among ideas and approaches.
Lockdown measures enacted across the United States in response to the COVID-
19 pandemic have severely curtailed personal and economic liberties. The next two
papers explore the origins and consequences of government responses to the pandemic.
Phillip Magness and Peter Earle analyze the nonpharmaceutical interventions (NPIs)
aimed at mitigating the transmission of COVID-19. Examples of NPIs include closing
businesses, canceling events, restricting travel, limiting the size of gatherings, and
imposing shelter-in-place mandates. Magness and Earle identify the various political
economy dynamics at work in the design, implementation, and persistence of NPIs in
the context of COVID. These factors include bias toward government action, political
path dependency, and the emergence of public-health experts as an interest group
incentivized to perpetuate the status quo. Their analysis has implications both for
understanding the response to COVID-19 as well as for learning broader lessons for
government responses to future public-health crises.
Although a growing body of research estimates the benefits and costs of lockdowns,
Raymond March notes that there is less research examining the role of deregulation
in expanding health-care capacity. His paper fills this gap by analyzing the
impact of the FDA and CDCs deregulation on COVID-19 testing. He finds that
laboratories and test developers greatly expanded both the COVID-19 testing availability
and the variety of tests after deregulation occurred. His findings have implications
for the way we think about responding to pandemics beyond COVID.
Next, Nathan Goodman, Abigail Devereaux, and I explore how government
responses to public-health crises can result in the permanent growth of Leviathan. Some
of the consequences of expansions of the scope of government power in response to
public-health crises are immediate and observable. Others, however, are not readily
observable and appear only over time. My coauthors and I explore these long-run
consequences with specific focus on how institutional changes can persist after a publichealth
crisis ends, causing increases in state power. These changes have the potential to
undermine the liberties of future persons and disrupt bottom-up, nonstate processes of social coordination. We illustrate these dynamics with three historical case studies: (1)
the bubonic plague in Cape Town, South Africa, in 1901 and its influence on apartheid;
(2) the emergence of modern zoning and urban planning in the United States in
response to the cholera, typhoid, smallpox, and tuberculosis epidemics; and (3)
compulsory vaccination in response to the smallpox epidemic of 1902. In each case,
initial government responses to infectious disease had long-term consequences on state
power and the fabric of society.
In the final paper, Byron Carson argues that individuals partially internalize epidemic
externalities by limiting infectious behavior and encouraging preventative behavior.
He notes that this is more likely to happen voluntarily when prevalence and
mortality rates rise. Carson develops the logic underpinning this responsiveness with
specific focus on voluntary changes in behavior, innovative means of prevention, and
changes in rules. He draws on a range of examples from the COVID-19 experience in
the United States to illuminate his argument. Responsiveness, viewed as a voluntary
phenomenon, implies that the effectiveness of many governmental public-health
policies is overstated, that herd immunity depends on responsiveness, and that
public-health agencies can improve their fight against infectious diseases by promoting
the entrepreneurial efforts of individuals. Carsons analysis has important implications
for the way we think about the range of feasible options for dealing with the challenges
posed by infectious disease.