Director of Civil Defence Emergency Management Sarah Stuart-Black at the Beehive. (Photo by Hagen Hopkins - Pool/Getty Images)

How do you prepare for a pandemic?

It is critical to ensure our houses are in order with skilled staff and strong procedures, but the valuable ‘lessons learned’ from true-life emergency events are never that cut and dried, writes former public health worker Richard Simpson.

There are different breeds of emergency manager. At one extreme there are the Abraham Lincoln types who, given six hours to chop down a tree, would “spend the first four sharpening the axe”. Then there are the Mike Tyson types, who counter that “everyone has a plan until they are punched in the mouth”.

I recall one of the large emergency management conferences in Wellington which focused on “lessons learned” from the 2010 Darfield earthquake. The room was filled with decision-makers and movers-and-shakers from the government and emergency services. The high profile presenters were well prepared, professional and expert. They had great information about the unusual, sudden earthquake affecting Christchurch and the fortunate fact there were minimal casualties and no deaths.

Then we broke for lunch and, one by one, people’s cellphones began to chirp. The highest profile attendees started to huddle before disappearing out the door. The room began to get strangely subdued. Eventually, the breaking news reached those of us at the lower echelons and at some stage, a bright spark put a live stream on the conference projector. Because this particular conference happened to take place on February 22, 2011.

And this is where items like the Coordinated Incident Management System (CIMS) really shine. Before our eyes, we saw the “responsive, flexible and unified” Lego bricks of CIMS fit into place as we transitioned from conference schmoozing to the pressing needs of activating a national emergency. This is the value of the “all-emergency” element of emergency management, where a strong foundation builds resilience in many areas

A Search and Rescue worker walks through the central business district during a search of earthquake damaged buildings in Christchurch on March 2, 2011. (Photo: MARK BAKER/AFP/Getty Images)

Many conspiracy theorists make hay over the fact these kinds of conferences and exercises “conveniently happen” to take place near major disasters. Of course, we can’t predict earthquakes, but many 9/11 truthers will cry foul over how emergency services were already on-hand in readiness for a bioterrorism drill that was scheduled for September 12, 2001. The loony fringe is already foaming at their keyboards over Covid-19, pointing at recent pandemic warnings by Bill Gates and Anthony Fauci as “proof that they knew” a novel coronavirus would emerge in Wuhan in 2019.

Anyone in the industry will tell you this only demonstrates how frequently these drills and exercises are happening because they’re so valuable. After all, the US is in the middle of a heated debate about whether – and how much – the Trump administration ignored the Obama-era “pandemic playbook”, a document that says at the beginning that exercises are critical “to improve interoperability and real-time decision making”.

So how do you establish an exercise regime that covers off more than the how-to of standard operating procedures and equipment drills, but where the policy and political environment is unpredictable? And how do you do it for something as complex as a pandemic? For some countries, their “worst-case pandemic scenario” doesn’t just involve the human health impacts, but also the survival of political structures and possible civil unrest, not to mention the world economy which is already in ICU.

Preparedness isn’t just about people knowing how to treat a patient or how to use the backup servers. Even before you get into pressure testing or “red teaming” ways to make an exercise more challenging, people need to get comfortable with the scope of their roles. This involves having ownership of their main tasks, and knowing how their responsibilities interact with those in their own organisation and other agencies across the full span of command and control. This is the value of emergency management exercises and conferences. To discuss and test plans on a moving carpet, and always with an understanding that things will change once you eventually get punched in the mouth.

Emergency scenarios are critical for this because exercises are a safe space where people can learn and make mistakes at the outer fringes of their capabilities, not just demonstrate what they already know. The last thing you want is someone to be defensive about participating and arguing that “it wouldn’t really happen this way in real life”.

One option is to use a historical scenario as an initial template. At the very least, it means the overall timeline – as well as the technical and scientific details – can’t be disputed, even if the decisions and the social and political context may differ. But while a historical scenario can be useful, it can be a hard sell for practical-minded participants who may already be uncomfortable with the “play-acting” element of exercises.

Photo: RNZ / Tom Furley

Another option is to get this social and political context straight from the horse’s mouth. One of the benefits of the National Exercise Programme is to practice the strategic and operational levels of a major emergency in alignment, so those at the regional and local level know the context they’ll be working in. To borrow a US analogy, the type of response that regional and frontline staff are directed to mount within a Trump-era or Obama-era context may be wildly different.  It makes the job of the emergency planning team a lot more comfortable if they left this debate to the actual decision-makers, rather than risk an educated guess about what the higher-ups are likely to do.

But people don’t like to make mistakes in public. People don’t like to appear that they don’t know what they’re doing. These issues are multiplied when people know their performance will be scrutinised by those at higher levels, or that their decisions will be filtered down to the lower rungs in a hierarchy, especially when more than one agency is in the room. This is when you risk the exercise going off-track by upper echelon decisions messing with the exercise with “key performance indicators”. How do you achieve your aim of testing policing methods during lockdown if the higher-ups agree they already did a spectacular job of stopping the pandemic in its tracks?

The natural inclination is to reduce the exercise scope. Are you testing a response to a remote train crash from a collapsed bridge? Well, simply create some kind of fictional timeline that results in this being an issue, and practice specific tasks only within this context. But this reductionist approach often means that exercises stay within the scope of the tried-and-tested in a necessarily artificial setting. In other words, it simply becomes a complicated simulation drill of standard operating procedures. Important, yes, but not necessarily enlightening.

The “sharpening the axe” element of Covid-19 continues to reveal the fact that while it’s critical to ensure our houses are in order with skilled staff and strong procedures, the valuable “lessons learned” from true-life emergency events are never that cut and dried. The current debate over privacy, metadata and tracking apps are an example of upper echelons becoming more hands-on for the operational side of an emergency, but more importantly, it shows the kind of true innovation and change that usually comes from the fringes.

The unexpected connections and the “non-status-quo” rise and shine during a real event, whether it’s the Student Army during the Canterbury Earthquakes, Takahanga marae during the Kaikōura earthquakes, or the national IT groups offering their services to support Covid-19 contact tracing. These groups would arguably either have no seat at the table during a reductionist, status-quo simulation exercise, or their true value (and the consequences) of their involvement would likely not have been explored in-depth, even if they had been.

Despite some pushback from traditionalists, game-based exercises are slowly becoming mainstream, like the approach championed by the PAXsims group. And whether it’s a modified board game or a matrix-style discussion exercise, simple and open-format exercises give a good opportunity to practice decision-making on the fly. These are great for agencies or interagency groups without the budget or organisational backing for a functional or Exercise Tangaroa-scale scenario. Game-based discussions surf the middle ground between the practicality of a complicated, military-style “counters-whiteboard-and-stopwatch” simulation drill, and the ordered chaos of a facilitated “tabletop discussion”.

Simple, rapid, game-based discussions allow participants at all levels to fail early and fail often, in order to get over the stigma of making mistakes. A discussion-based approach also lets players suggest unexpected or off-the-wall solutions to tricky problems. In other words, it represents what will really happen, rather than what we expect or want to happen. These games, as opposed to simulations, do not allow participants to delve into the finer points of their specialist roles, but this can be a good thing. This type of detail is, after all, often an unwelcome interruption during exercises when there are a wide range of specialities and agency interests around the table.

In October 2019, the Johns Hopkins Center for Health Security and the Bill and Melinda Gates Foundation hosted a major pandemic exercise in New York, with a discussion-based format that “illustrated areas where public/private partnerships will be necessary during the response to a severe pandemic”. Reuters recently reported how a South Korean pandemic tabletop exercise helped that country prepare and mobilise quickly for the coronavirus response. One of the experts said the exercise “helped us save much time developing testing methodology and identifying cases.”

This is the true value of multi-level interagency planning and exercises. To create and test different methodologies, to suggest unusual partnerships and solutions, and to work through the huge range of possible actions. Actions that depend on the unexpected decisions filtering from those in the upper echelons who at any given moment may appear to be guiding the overall response either with the benefit of a broad, birds-eye perspective, or with their heads stuck in the clouds.

There is no magic, catch-all solution, but if everyone takes part with a curious and open-minded approach, that’s where real improvements are made.



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