2020 has been the year that vague epidemiological theories that were mostly of interest to us nerds suddenly became mainstream. Herd immunity, which previously was mostly the purview of epidemiologists in mouldering public health departments, suddenly became worthy of mainstream discussion and endless debate. Infection fatality rates, which were previously restricted mostly to infectious diseases conferences, have suddenly become headline news around the world.
And most recently, we have the debate about cost and benefit. Cost-benefit analyses are a pivotal part of the epidemiological landscape, because as public health experts we are all too aware that there are limited resources to play around with when it comes to health interventions, something that has been even truer this year than ever before. It is a sad fact that restrictions to combat COVID-19 come with a cost, and that cost can be measured in human lives.
As Sir Austin Bradford Hill famously said, “Health statistics represent people with the tears wiped off”.
But the problem with cost-benefit analyses is that they are enormously complex. Take lockdowns, which have been derided by regulation opponents for months as the most costly mistake any government could make.
How do we evaluate whether that’s true?
The Tricky Truth
Well, firstly we can think about the costs. Immediately, this becomes a fraught question, because there is no simple answer to how much lockdowns have cost. We can look at how much the economy has dipped in various places around the world, but famously some places that enacted lockdowns have done relatively well economically and some places that have not locked down have suffered greatly. In fact, it is remarkably hard to address the costs associated with a lockdown, not just because every lockdown in every country has been different, but because the likely alternative — more widespread COVID-19 infection — is costly too.