Viral Myths: my response to the British Medical Journal

The British Medical Journal (BMJ) has published a “rebuttal” of my IEA paper “Viral Myths: Why we risk learning the wrong lessons from the pandemic”, entitled “The IEA has used covid-19 as another opportunity to brief against the NHS”. The author, David Oliver, makes it clear right from the start in what spirit his piece is written:

“One problem with all of this is that the IEA has repeatedly denigrated the NHS model […] It also relies on funding from tobacco, and in the past it has taken funding from gambling, sugar, soft drinks, and alcohol industries—which are hardly friends of public health policy. The BMJ has previously covered both issues, casting serious doubts on the IEA’s impartiality.”

This is one of those familiar knee-jerk responses to everything we say, but none of it has anything to do with my paper. Oliver is clearly trying to imply that there is some major conflict of interest here, but I am not quite sure what that conflict is supposed to be. My paper does not advocate any specific policies, which could align with the commercial interests of any particular company or industry. It is a “big picture” publication: it is about the way in which the pandemic is changing the overall climate of opinion in Britain. My starting point is the (fairly unoriginal and uncontroversial) observation that some countries have done a much better job at handling the pandemic than others. Which soft drinks manufacturer, or which casino operator, benefits financially from me making this claim?

But be that as it may – the question about my own trustworthiness, or lack thereof, is beside the point anyway, because I am not asking readers to accept anything I say on the basis of trust. Every factual claim in the paper is fully referenced. It comes from sources such as the OECD, the International Monetary Fund, the ONS and its equivalent on other countries, the Human Mortality Database, the Worldometers database, Our World in Data, the New Scientist, and various countries’ health ministries and finance ministries. Have they also all been bribed by soft drinks manufacturers and casino operators?

Oliver is, of course, merely virtue-signalling to his readers. This is this all just a roundabout way of saying “I am one of the good people, with fashionable opinions. Niemietz is one of the bad people, with unfashionable opinions.”

But let’s ignore the generic “Boo, IEA! Bad!”. What, specifically, is Oliver’s problem with the paper?

The role of state intervention

Oliver claims that

“many countries with low covid mortality achieved this through considerable state intervention. They focused on non-pharmacological interventions including […] support for people in isolation—alongside well organised testing, contact tracing, quarantine, travel restrictions, and identification of spreading events.”

This is correct. It is also something that could almost have been copied and pasted from my paper. For example, on p. 24, I point out that countries with low Covid mortality

“adopted measures […] [such as] mass testing, digitally aided contact tracing and tracking, rigorously enforced quarantining and isolating of positive cases (combined with financial incentives), and selective travel restrictions.”

And on p. 54, I explain:

“The best performers […] got large-scale testing off the ground quickly, they came up with effective systems of contact-tracing and tracking, they rigorously enforced quarantining and self-isolation requirements (coupled with financial support to make this feasible), and they imposed selective travel restrictions.”

I hope I am not embarrassing Oliver too much in front of his peers by pointing out that we actually agree on these points. But one wonders what made him think that paraphrasing something I said in the paper is somehow a brilliant takedown of the paper?

My guess is that he has not read either of those passages, and simply assumed that since I am a free-market liberal, I must be opposed to all forms of state intervention. This, in turn, led him to believe that merely pointing out that state intervention played a role in all successful pandemic responses was some kind of killer argument.

This is not so. A pandemic is, of course, a textbook example of a collective action problem. Even free-market purists usually have no trouble conceding that collective action problems require some form of collective coordination, which, in practice, usually means government action. Of course, free-marketers will never embrace government action enthusiastically. Unlike Big Government cheerleaders, we are all too aware of the dangers of government failure – of which we have indeed seen plenty since the start of the pandemic. But whether we embrace government action enthusiastically, or whether we just grudgingly accept it as a necessary evil, is, in this case, irrelevant. The point is that governments which acted swiftly and decisively, like the governments of Taiwan or Hong Kong, ultimately had to do a lot less than the laggards, such as the UK. This is, ultimately, also preferable from a liberal perspective.

The size of the public sector

My paper also points out that some of the countries that have done the best job at coping with the pandemic – especially Taiwan, Singapore, and Hong Kong – have very low levels of public spending. Oliver takes issue with that:

“Japan’s public spending as a percentage of GDP is low by western European standards. But Australia, Canada, and New Zealand approach UK levels. High performing European countries such as Denmark, Finland, and Norway are also high state spenders. They all spend on healthcare in a similar range of GDP percentage or dollars per capita to the countries Niemietz criticised.”

Again, this is correct. And, again, this could almost have been copied and pasted from my paper:

“The claim of this paper is not that the best performers did well because they have small states […] Because as easy as it would be to find examples which fit that story, it is just as easy to find examples which do not. […] The Nordic social democracies of Norway, Denmark and Finland, characterised by very high levels of public spending […], have been among the best performers in the developed world” (pp. 16-17).

So again, as embarrassing as Oliver may find this, we are actually in agreement here: we can find high-spenders and low-spenders among the best performers, which suggests that the size of the state cannot be the decisive factor ether way. But, as above, one wonders what makes Oliver think paraphrasing something I am saying in the paper is somehow a brilliant refutation of the paper?

As above, my guess is that he has not read that passage either. He simply thought “Niemietz is a small-state liberal, so surely, he must believe that countries with a large public sector cannot handle pandemics.” But that is not what I am saying. I am saying that for successful pandemic management, a large public sector is neither necessary, nor sufficient.

The type of healthcare system

My paper is not specifically about healthcare, but it contains a section which addresses the misconception that the NHS has emerged as some kind of superstar performer during the pandemic. That section has riled quite a few people, and Oliver takes issue with it as well:

“It’s true that several of the better performing nations have health economies with […] private or employer insurance, and a mixture of public and private provision; [but] others such as Canada, New Zealand, and the Nordic countries have models far more like the NHS, with most healthcare still funded or provided by the state.”

To return to a now familiar theme: this is correct – and it could also almost have been copied and pasted from my paper. As I point out on p. 51:

“All in all, we cannot say that any one type of healthcare system emerges as the clear star of the pandemic, or that any one type of system has been discredited. There is simply too much variation within each family of systems. The state-run health services of the UK, Spain and Italy have been struggling throughout 2020. The state-run health services of Denmark, Norway and Finland have not.”

For the third time in a short space, then, Oliver and I are actually broadly in agreement, awkward though this may be for him: the type of healthcare system has not been the decisive factor in the pandemic. To return to the now familiar question: what makes Oliver think that repeating what I say in the paper is a skilful rebuttal of the paper?

Which returns us to the now familiar answer: Oliver has either not read the relevant passages, or he is pandering to an audience which he knows would never touch an IEA publication with a bargepole. So he attacks an argument which I am not making, but which he and/or his audience think I would make: that state-run health services have failed everywhere during the pandemic, while market-based systems have been a roaring success.

Unsurprisingly, Oliver’s BMJ piece has been celebrated on Twitter as an “Excellent take-down of the questionable IEA”, so if cheap applause on Twitter was his aim, then he has achieved it. Content-wise, though, his piece is a lot less impressive. I suggest that next time Oliver responds to one of our publications, he should spend a bit less time playing to the gallery by signalling his general dislike of the IEA, and a bit more time familiarising himself with the actual argument on hand.


Head of Political Economy

Dr Kristian Niemietz is the IEA's Head of Political Economy. Kristian studied Economics at the Humboldt Universität zu Berlin and the Universidad de Salamanca, graduating in 2007 as Diplom-Volkswirt (≈MSc in Economics). During his studies, he interned at the Central Bank of Bolivia (2004), the National Statistics Office of Paraguay (2005), and at the IEA (2006). He also studied Political Economy at King's College London, graduating in 2013 with a PhD. Kristian previously worked as a Research Fellow at the Berlin-based Institute for Free Enterprise (IUF), and taught Economics at King's College London. He is the author of the books "Socialism: The Failed Idea That Never Dies" (2019), "Universal Healthcare Without The NHS" (2016), "Redefining The Poverty Debate" (2012) and "A New Understanding of Poverty" (2011).

2 thoughts on “Viral Myths: my response to the British Medical Journal”

  1. Posted 01/04/2021 at 12:44 | Permalink

    I wonder if you actually need to be able to read, to be able to write for the British Medical Journal. Perhaps he should think about retaking an English Literature GCSE.

  2. Posted 26/04/2021 at 10:38 | Permalink

    Hi Kristian
    Don’t worry, it is just another attempt at knocking down a straw man that Philip refers to. Furthermore, as many NHS workers are socialist inclined, as they believe that the NHS is the best health care system in the world, the BMA doesn’t like to admit that there is some free market health care in the UK and it continues to do well.
    Best regards
    Roger Fox. [email protected]

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