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COVID-19: The Highs and Lows of Health Regulation

By Neil Quarmby, CEO of Intelligence Rising

One of the usual reviews conducted at the end of any democracy’s national security crisis is a public review of their intelligence system. “Did we see the threat coming?” “Was there appropriate forewarning?” And quite rightly so. For the billions of tax-payer dollars that Western countries each spend on intelligence systems to warn them of hidden threats that may kill a few of their folk down the track, the public need to see value for money in a system designed to reduce their fear of the unknown.

The current COVID crisis ‘lessons learned’ process will be interesting to watch. Unlike the national security system, the question of forewarning will be asked of the medical system who are heavily involved as decision-makers, designers, and regulators of the business they operate. Medical and health regulators in Western countries are not seen in contemporary professional intelligence circles. Rather they seem content to invest in data systems monitored by data analysts and health professionals.

So while there has been ample and often shrill warnings from health risk assessment experts, there appears little integration within an accountable decision-system like we know and fund in national security. Where health regulators exist, they are full of wonderful people caught in a failure of design as the regulators are not constructed to reduce harm to the public but rather are:

  1. Not independent of policy arms and hence are hopelessly constrained by the central messages on health and are not able to provide estimates to government and the public on real risks

  2. Only allocated narrow jurisdictions – meaning there is a patchwork of regulators/enforcers with no connected intelligence and very narrow behavioural interests. For example:

  • Some have a focus only on medical and pharmaceutical frauds – that is, they monitor the ‘appropriateness’ of billing and funding streams

  • Others have a focus on medical devices and pharmaceutical medicines – making them licencing authorities who may not see their role being associated with better health outcomes

  • Others receive and respond to complaints from patients; being often more case and mediation focused

  • Others (mainly membership bodies) have a focus on quality of services and medical standards – how do you treat patients?

  • Others monitor specific health-related concerns such as water quality

  • Others focus on the bio-hazards in the movement of animals and plants

  • And yes, there are some that licence facilities – like hospital registration authorities – but these are audit led and not intelligence led.

Health legislation normally has objectives to protect and promote public health, control the risk to public health, promote the control of infectious diseases, and prevent the spread of infectious diseases. However, the functions of supporting regulators will be confined to registering and testing facilities and practices against compliance or conformance check-lists and issuing notices and fines for gaps in the check-list. This is important work, but does not help the regulators to problem-solve.

This means there is no intelligence picture for operational level and strategic level decisions in health as there is in Defence and national security. For the public in the Western world, you can quickly find an assessment of which country you shouldn’t travel to, but there is no advice on which hospital to avoid. Even the term health intelligence means something different in national security warning systems than in Health systems where it refers to disease and diagnosis data (produced for medical practitioners).

A clear sign of the absence of intelligence capability is the failure to learn from history. Having quarantine systems that kick in for maritime travelers in high risk transmission environments has been a feature of countries with water borders since the plague and carried through a range of deadly bugs on into influenza times; yet appears to have been lost in current health environments dealing with cruise ships. Compare this to the movement of animals and plants through quarantine that is carefully managed in the bio-hazard regulatory world as national regulators generally have invested in robust intelligence systems to support operations. The lack of learnings and situational awareness in the human environment is evident in the inevitable squabbles over who is responsible, capable and responsive to such threats. Also inevitably, the absence of public service accountability for the reduction of harm so intrinsic to modern regulators leads to deflection of blame. In the current circumstance, the deflection is towards the cruise ship operators, not the absence of robust and accountable health regulatory systems preventing poor behaviours in ports.

Another clear sign is who stands up in the public domain as accountable. When major harm occurs in society the main regulator or enforcer is put through the mill of public, judicial and government review. They are castigated, cleaned out and re-legislated. In this case, there are no heads of health regulation stepping forward; only ‘health advisors’. Before we look for the intelligence system, try to find the regulatory authority. It is notable that in the absence of such harm prevention systems, the media makes a vague reference to the ‘failure in the health departments’.

To preempt another learning issue, in modern times the absence of professional intelligence in regulation usually ends up in recommendations for better data. More tax-payer dollars spent on data solutions that will clarify for you what the problem was in the past. The unknown threats will thus not be a threat until they have killed you (…that is if the data is cleansed first…).

So …do we currently have a failure of intelligence or failure of regulatory design and leadership? The answer to such questions in intelligence reviews after cataclysmic failure in national security is usually a modicum of both. However, in this crisis, with strategic thinking and accountabilities most absent, it will be interesting to see if this fundamental question is even asked.

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