5th April, 2020
Health and economic emergency must be managed together
This document presents the structure of an Action Plan and practical immediate measures to manage the current crisis, drawn from the contributions of experts in many different fields. Given the nature and complexity of the issues, this remains an open agenda that requires continued input and expertise from around the world. The document is promoted by Corrado Passera and the active participation of other contributors is therefore warmly welcomed.
The two objectives are closely linked: it is imperative to avoid choosing between our physical and economic wellbeing.
Governments and leaders around the world today are facing enormous pressure and have the same overriding two objectives:
The two objectives are closely linked: it is imperative to avoid choosing between our physical and economic wellbeing.
Many actions have been taken in Italy and Europe during these first few weeks of the crisis but it is clear that we need more: we need further action and we need to make the actions we have already taken more effective. Getting the country back on track in just a few months is achievable but we need to be determined and we need more resources. We must be clear to distinguish between temporary measures to mitigate the crisis and structural measures that will create the conditions for fast and sustainable economic growth.
We must act urgently. If we do not, the situation will get out of hand:
We must accept however that there are no shortcuts and it would be a mistake to pursue them. We must do everything we can to reopen society, but doing so in just a few weeks, even if done in waves by age group, would have an enormous cost on human life without actually achieving anything on the economic front. Indeed:
Countries such as the United Kingdom, which considered taking these shortcuts, have had quickly to change their approach. Others have very different demographics to Italy and different forms of social organisation (Israel’s average age is about half ours). Other countries, such as Germany or Sweden, have healthcare facilities that are better equipped.
We need a comprehensive action plan – both for the short and medium term – to supplement and reinforce the measures taken so far. We need a plan that gives us time to manage the health emergency while still allowing us to tackle the economic emergency and build the conditions needed to kick-start growth. The initiatives below are just some of those that will be necessary; others will have to be proposed by experts in various sectors. Some of those listed need further elaboration; some have already been planned; and some have been suggested elsewhere – it is important that all useful contributions are tied together into a single cohesive plan of action.
The different parts of the action plan need to be co-ordinated and carried out simultaneously:
To contain the infection, lockdown and social distancing measures must be maintained and made stricter if necessary. Work will need to be done to make this lockdown as short as possible, but it should be maintained as long as necessary to sufficiently strengthen healthcare facilities (see point 2). Lifting the lockdown without ensuring we can withstand the impact could have catastrophic consequences and make subsequent lockdowns harder to manage. The experience acquired so far should enable us to introduce more effective procedures and protocols to manage new outbreaks.
Confining people in their homes must be made sustainable, especially for those such as the elderly who are not completely self-sufficient. Some private entities such as the large retailers, voluntary and community groups and also the military and Civil Protection organisations must be mobilised and co-ordinated to ensure supplies of food and pharmaceutical products as well as guarantee a minimum level of essential services to those unable to secure them for themselves. We need to work on how to improve home delivery of basic necessities.
Knowledge of the scale, change and spread of the infection is imperative. The data and statistics that we are currently using appear to be totally inadequate, if not to mention misleading. It is essential to test, sometimes repeatedly, people most at risk and to carry out large-scale testing, by focusing on priority segments, on the entire population. Wherever possible, testing should be done at home to avoid further infection. Data collected at home and from the health services has to be sent to a single monitoring and analysis point of contact. This does not mean that the Regions will be stripped of their rights but creating a central authority for data is essential – see below.
The availability, quality and rapid centralisation of relevant data can make a difference to the length of the crisis and to the possibility of anticipating further waves of infection. Various monitoring and tracking apps are being developed and experimented with across the world which could greatly contribute to the containment of the virus and the reduction of the more extreme isolation measures, as well as the detection of new outbreaks. (Regarding the use of personal data, see some observations below.) Co-ordinated work across borders is important. There are many proposals and it is important to identify which ones can be most effectively implemented across Italy in a unified way.
It is essential that entire industrial and logistical supply chains are maintained. Saying for example that pharmaceutical companies should remain open is not enough if the companies that produce the packaging for the medication are closed and the logistical equipment needed to deliver the medication to the final user is not operational. Companies from different sectors could be authorised to open if they are considered to be of particular strategic importance and if they can guarantee compliance with the best safety measures. Obviously, some supply chains are highly integrated at European level and proper co-ordination is required. Further in-depth study is needed of essential supply chains, their operations and the leading companies involved to ensure they function better.
Many of our healthcare facilities are on the brink of becoming unsustainable with some already past this point. They are running only thanks to the generosity and sacrifice of their staff. But they are unable to deal with an increase in patients and soon may not even be able to maintain their current level of service. We must take drastic action and use extraordinary measures if we want to reduce the level of lockdown within a reasonable timescale.
Such a system of co-ordinated intervention can profoundly change the outlook for the management of the virus and the prospects for recovery of those infected. Italy has in many cases shown great efficiency at critical times. Although the healthcare situation is very different in the various regions, if we act with the necessary determination, we could complete this part of the programme in 1-3 months.
At some point it will be necessary to have the political courage to accept a reasonable compromise between a functioning society and safety. We may have to learn to live with the virus, rather than definitively to defeat it. This will require adapting our behaviour, work organisation and lifestyles until a vaccine and/or therapies are available on a large enough scale.
If the infection rate is contained, if we improve our understanding of the way the virus spreads and if healthcare facilities are brought up to scratch, it is likely that a gradual and at least partial reopening of society will be possible, even without definitive treatments and vaccines. It is also possible that this reopening could happen at different times in different regions.
But it is also crucial to ensure the financial survival of all families and businesses experiencing hardship, at least for the rest of 2020.
Huge numbers of families are undoubtedly already in, or about to enter, serious financial difficulty, and a minimum level of peace of mind and security must be guaranteed for the months to come to lessen the risk of panic.
When it comes to businesses, the work undertaken must clearly distinguish between actions aimed at survival and more structural measures. Some of the structural measures can be achieved independently at a national level and others will require EU involvement.
An enormous number of businesses are in, or are about to enter, financial difficulty. We must ensure that as few of these as possible close permanently by providing the financial resources needed to keep going for the next few months. And these measures must be done immediately.
Benefits and loan payments are often not made quickly enough to keep up with the needs of hard-pressed families and businesses. While the resources needed exist, the centralised distribution mechanisms are proving to be slow and inefficient. We should therefore use the decentralised mechanisms that already specialise in managing financial resources, such as Poste Italiane. Widespread use of self-certification for families and bank guarantees for businesses could be introduced temporarily to speed up processes. These forms of assistance must act as, and be perceived as, a temporary steppingstone towards recovery, rather than becoming disincentives for work.
This is not the place to list all the well-discussed elements that should be included in a medium-term plan to foster sustainable development in Italy from infrastructure development and education to law and the tackling of bureaucracy. However, this dramatic moment in our lives must inspire us to introduce some very strong and extremely simple incentives to unleash the potential of business and power a sustainable recovery.
Getting the economy moving in the years to come will clearly also require an enormous injection of public investment and public contributions to private investment. It is unlikely however that countries such as Italy, devastated by the events of 2020, will be able to find enough resources in their state budgets. The European Union, which already has an important role to play in holding the entire plan together, will therefore have an essential and invaluable role when it comes to public and private investment.
With or without Covid-19, this is the time for the European Union to speak up and act decisively. It needs to avoid becoming trapped between the USA, China and Russia, and it must not be overwhelmed by a tide of populism that springs from recession and brings with its dramatic social consequences.
This “call to arms” represents an opportunity for a visionary reframing of the European project, understanding that no European country can save itself on its own. Such a massive new commitment would not be used up in the service of existing debt, rather all countries would together be funding new investments with the goal of underpinning states’ future wellbeing and sovereignty.
Every component of the action plan must be carried out simultaneously if we want to emerge from this emergency in the best possible condition and if we want to restore hope to our communities.
An action plan on this scale and in this timeframe can succeed only under a unified management and chain of command; this is essential for ensuring speed and the quality of actions taken. It is obviously up to the government to decide how this is co-ordinated and where the “war room” is located. Special laws or suspensions of constitutional rights are not necessary, but it is essential to guarantee:
Creating a truly unified management and chain of command – which lasts right through to the return to normality – is the most difficult organisational challenge, but the social and financial costs of not succeeding are enormous. No crisis can be managed without strong and competent co-ordination and there are many ways this can be achieved.
Everyone in our community should contribute to the success and work together on a programme of this kind:
Managing such a dramatic situation with such an uncertain set of outcomes requires an unprecedented communications strategy. To build trust and ensure the maximum involvement of the whole community a daily bulletin reporting deaths and infections is not sufficient:
A different approach to communication is needed, completely distinct from typical political discourse and a marked change from the first phase of this crisis. To maximise inclusivity, we need communications which are transparent, informative and accountable. Such an approach will allow trust to be maintained as we proceed through clearly defined milestones on a shared path together.
A final point on the necessity of emergency legislative measures. This emergency cannot be managed by following our standard procedures. Special commissioners are needed for example to make urgent procurements and investments. Countless small and big decisions need to be made quickly regardless of the possibility of some wastage.
But there are some aspects of our life which could be irrevocably damaged by adopting emergency measures such as the unconstrained use of personal health data and individual behaviour tracking. Obviously, there is no objection to using data in sophisticated ways to identify emerging health trends, to monitor their development and to allow for the development of alert mechanisms. But no emergency can justify the kinds of pervasive control over individuals which we have seen in other countries with questionable levels of democracy.
Systems being created to track individual movement in some parts of China, for example, seem particularly worrying and present obvious long-term risks of abuse. It is possible however to create a more widespread and sophisticated use of relevant data without transgressing inviolable privacy barriers – some particularly interesting examples are beginning to emerge, among them the “Immuni” system recently created by key players in different industries.
The crisis we are currently living through can be managed. Even without effective treatments and vaccines in the short term, we can aim for a gradual resumption of our society in the coming months. However, we have to avoid shortcuts which would make this crisis even more serious and uncontrollable. A well-managed, comprehensive and co-ordinated plan is within our reach and many lessons are emerging which will serve us well in the future, once Covid-19 is defeated.
Corrado Passera