Niall Ferguson (the historian, not to be confused with Neil Ferguson the epidemiologist) has written an interesting but peculiar book. It professes to be a ‘general history of catastrophe’. Wars, famines, floods, earthquakes, epidemics, exploding nuclear reactors, rail and air crashes and disasters at sea are all here. But in fact, it is mainly about epidemic disease, in particular Covid-19. Even the parts that are not about Covid-19 have clearly been written with an eye to current events. Doom is essentially a work of instant history. But, as in most of his books, Ferguson is not content to be just a historian. He makes larger claims and looks for overarching theories and political lessons.
The trouble with ‘catastrophe’ as a category is that it is too large and miscellaneous to permit much in the way of general theories. If there is a ‘correct’ response to an earthquake, it is unlikely to have much in common with the ‘correct’ response to an epidemic. If there are general lessons to be learned from both, they have to be pitched at such a high level of generality as to be practically useless. And so it is with Doom.
Ferguson’s argument can be summarised as follows. Some catastrophes are man-made, and man can avoid them with suitable care. Some are natural catastrophes, the impact of which man can mitigate with suitable care. Unfortunately, although we appreciate the possibility of almost every kind of catastrophe, we do not know when or where they will strike. So we organise ourselves on the assumption that they will not affect us. In the case of pandemics the problem is contagion. The answer in an age of global movement of people, animals and pathogens is to limit human interaction by ‘hierarchical mandates’ (he means laws). Ferguson says that to achieve this what we need is not great leaders, who are unlikely to make much difference either way, but public bodies with real institutional and managerial depth. They must be imaginative, understand the risks in advance and know how to learn from history but without fighting the last war.
If all this sounds rather obvious, that is because it is. But its essential banality is concealed beneath some grandiose chapter headings, impressive-looking graphs and tables, a great jumble of facts and a certain amount of jargon. Ferguson would have written a better book if he had been less ambitious and cut out the stuff about the Bengal famine, the Titanic, Chernobyl and the like, which clutter up what would otherwise have been a decent history of human responses to epidemic disease.
The core of the book is to be found in the three chapters that deal with Covid-19 and the three 20th-century pandemics that most closely resembled it: the ‘Spanish flu’ pandemic of 1918–19, the ‘Asian flu’ pandemic of 1957–8 and the related ‘Hong Kong flu’ pandemic of 1968–70.
Spanish flu was less infectious but more mortal than the coronavirus strain involved in the present pandemic. It killed an estimated 200,000 people in the United Kingdom, at a time when the population was two thirds the size it is now. It mainly attacked young and fit people in their twenties and thirties. The army on the Western Front in the final months of the First World War suffered heavy losses to Spanish flu. Across the world, governments did nothing. This was partly because they did not appreciate the seriousness of a gradually developing situation and partly because they did not regard social control as a function of the state. The major exception was in the United States. Some US states imposed quarantines. Some closed schools and banned mass gatherings. Some required masks. These measures had some effect, but it was limited. Ferguson argues that the states which took no action, like New York, were culpably incompetent. This is probably true, but it is far from clear that they would have acted differently had they been competent.
That much is suggested by the story of the Asian and Hong Kong flu pandemics. The mortality and virus reproduction rates were broadly comparable to those seen in the present pandemic, yet governments did nothing, even in the United States. In Europe attitudes had changed little since 1918–19. In the United States the inaction was deliberate. The collateral effects of restrictions in a society that was much more mobile than it had been four decades earlier were thought to be too great. The fact that, like Spanish flu, Asian and Hong Kong flu attacked the young and fit who were economically and socially the most active elements of society added to the distaste for compulsory distancing. The federal government’s interventions were limited to supporting vaccine research. The death rate was high, but the economic damage was minimal. No one complained at the time, and Ferguson himself appears to approve of the US government’s approach. He observes, rightly, that the main difference between these outbreaks and the current pandemic is a dramatic rise in risk-aversion among Western populations in the intervening decades.
When he gets to Covid-19, Ferguson considers that lockdowns were a mistake, a position with which the present reviewer agrees. This, Ferguson argues, is because other forms of social distancing, such as school closures, bans on mass gatherings and selective isolation of vulnerable groups would have achieved a comparable reduction in transmission, and because the collateral damage resulting from more aggressive measures has proved devastating. This view is borne out, as he demonstrates, by the experiences of countries that avoided lockdowns, such as Sweden, Singapore, Taiwan and South Korea. It is also supported by a considerable body of academic work, which Ferguson reviews, showing that there is no correlation between the severity of national lockdowns and mortality, whereas there is a close correlation between the severity of national lockdowns and economic damage.
Ferguson criticises governments for prematurely lifting the lockdowns that he thinks they should never have imposed. That seems rather odd. He is also an enthusiast for testing and tracing, though it rarely works once a disease has become endemic, as the experience of the highly efficient German system has shown. It is also extremely expensive and economically wasteful (because most contacts required to isolate will not develop the disease).
Interestingly, the case of Covid-19 is inconsistent with Ferguson’s general theory that failures to manage pandemics stem from a lack of institutional depth and foresight. Britain and the United States have done badly, except on the vaccination front. Yet both countries, together with Germany, had comprehensive plans, the fruits of over a decade of planning, for just such a pandemic. Ferguson does not deal with these plans, but they are interesting because they envisaged a response very similar to the one that he recommends. They were based on selective shielding of the vulnerable and on limited and voluntary measures of social distancing. These plans were informed by the experience of earlier pandemics and by a review of the collateral consequences of different policy choices. This is exactly the kind of institutional preparation that Ferguson thinks we should have made. The fact is that we did.
The mistakes were made by the leaders, notably Donald Trump and Boris Johnson. Ferguson is keen to defend them, not on the ground that they did well but on the ground that the failures were institutional, not personal. The evidence does not seem to bear this out. Johnson threw out a decade of British planning in a weekend and replaced it with an indiscriminate lockdown for which there had been no preparation, research or cost–benefit analysis. This was his decision, and that of his sidekick Dominic Cummings. It is true that without good institutional preparation, leaders, however talented, are unlikely to do much good. But they still matter. At their worst, they can do infinite harm through ill-conceived measures. And at their best, they can stand up against public demands for such measures, if they have the necessary moral and political stature. In this country, we have strong institutions, as the contingency planning and the vaccine campaign demonstrate. What we lacked was the capacity at the top to use them intelligently.