The Premonition by Michael Lewis

First, I’m an outbreak geek. The Hot Zone is a perennial favorite and public health and epidemiology fascinate me, so I pounced on Michael Lewis’s The Premonition, which dissects pandemic preparedness and the Covid response in the US. As always, Lewis’s book reads like a thriller, save for the real-life absurdities a writer could never get away with in fiction. NOTE: find a Imagineering Protopia commentary and interview with Michael Lewis after the review!)

The Premonition has been criticized as attacking the Trump administration’s response to Covid. Though Lewis has no love of Trump, he makes clear that the problems the US had responding to Covid were systemic and enduring. If Clinton had won, the lack of preparation and dysfunction in the decades and administrations before 2016 would have been the same, and what played out from there would still have been, out of US political dysfunction, too little and too late. 

Through the pandemic-fighting efforts of a “redneck” epidemiologist, a free-thinking MacArthur Fellow, a big-picture public health officer, and a 13-year-old girl, Lewis demonstrates that while the US government had some on-again-off-again policies for a pandemic—kicked off by George W. Bush after he read about the 1918 flu pandemic—they didn’t have an organized pandemic response system. Yet, the US was the most pandemic-prepared and thus looked to for guidance by the rest of the world. In fact, CDC-trained people with the courage to implement CDC protocols in their home countries had many fewer deaths and illness than in the US.

The Premonition is a fascinating—and sobering—look at the backroom deals, bubble gum and bailing twine serendipities, CYA gamesmanship, inter-agency hijinks, bureaucratic tarpits, and politicization of public health as the stage on which the Covid response unfolded. 

The three takeaways that Lewis leaves us with are: 1) The US doesn’t have a health care or a pandemic response system because everything is disconnected and thus responding to a common threat devolves into a turf war; 2) Governments must lead on a united front and fight a pandemic proactively and vigorously on both the medical and economic fronts or it risks losing both; 3) The politicization of the US government has degraded the function of government by giving great responsibility to short-term politically appointees who are always in a CYA/looking-for-the-next-job mentality while sidelining public servants with the expertise needed to solve problems and build resilient systems that function no matter which team is at bat.    

Along with the edge-of-the-seat account of what went right and wrong, Lewis suggests how the pandemic response system could be fixed before the next pandemic, which will likely look much different than this last one.

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Imagineering Protopia

 A theme in recent reads from Michael Lewis (The Premonition, Liar’s Poker, The Big Short) as well as with Rachel Maddow’s Prequel and numerous podcasts and news interviews is that when it comes to governments and the economic systems we live under, no one’s driving the bus of government, society, or the economy. 

 Much of that is by design. When government is overly centralized government, it’s easy for a charismatic populist leader to turn a country into a political dictatorship or autocracy. While we parrot the line that in a market economy the magical market should make the decisions, but we expect government to intervene here and there to jiggle things for the public good, like the requirement for seatbelts in cars that cause a ruckus but has brought the deaths from car accidents down to a fraction of what they were beforehand. 

At the same time, the lack of a centralized system during a crisis means that any response turns into a losing game of whack-a-mole that, with pandemics, means that you just keep playing until a virus or pathogen burns its way through the population and then declare victory when it exhausts its natural life-cycle. That worked for COVID-19, which, while still spreading and killing like the flu, has become less virulent and thus more of an inconvenience than a life-altering experience for most people. But what if the next pandemic has a double-digit mortality rate? 

In any case, I’ve been pondering the centralization/decentralization continuum in a protopian system and asking myself: What if centralization is in the wrong place in our current systems? In top-down governments, centralization is slow and often politicized. If we vest the private corporate sector to manage a centralized response system, we’d create a monopoly consumed with maximum profit and minimal innovation. 

A more effective pandemic-response model could be something like a robust and empowered Red Cross/Red Crescent that worked in tandem with other institutions transparently, was resourced as needed without drama, and had global communication and organization while trusting local teams to adapt to local needs, constraints and norms. 

I’ve been playing with systems in a YA series I’m working on. And looking at how globally collaborative but locally implemented food production, energy production, health care, education, engineering, transportation, innovation, and production might work. 

If you could create a world from scratch, how would it look?

While you ponder, check out this entertaining and interesting conversation about The Premonition with author Michael Lewis below…