An open letter from your ideal national leader

MY fellow [insert collective noun for residents of geopolitical region].

Tonight, as your [insert role description (eg, President, Prime Minister, Premier, Chief Minister etc)] and the leader of our wonderful [insert classification (eg, nation, state, territory)] of [insert name of nation, state or territory], I am speaking to you about a very grave threat to the security and stability of our community.

Once again, far sooner than any of us expected and on top of the huge burden of our need to address global climate change, we are facing another global pandemic of a new disease – this time, of the highly infectious and deadly [name of disease]. Like so many diseases, this new virus has emerged from our natural world upon which we have, to our shame, inflicted so much disruption.

We are all at risk of becoming seriously ill, and perhaps dying, from this virus.

Viruses are very simple life forms, so simple in fact that some people prefer to describe them as molecular machines, almost too small to be considered as life. New versions appear frequently because the reproduction of viruses is imperfect and produces many mutations. Most of these cannot reproduce, but occasional successes can thrive at our expense. They exist because they are able to use more complex organisms such as us to reproduce themselves in vast numbers and cause us to respond to them in ways — virus-laden runny noses, coughing and sneezing — that spread them from one person to another.

As we experienced with COVID-19, none of us have any innate or acquired resistance to new pandemics parasites such as [name of disease].

But we know how they operate and we know what we have to do to slow their spread. Eventually, we will discover treatments and vaccines, but in the meantime, there are things that we must do to protect our community, and these actions will come at some cost.

Many of us will get sick and some of us will die. Others will not be infected, or experience minimal or no symptoms.

Older persons, the disadvantaged, the disabled, and those of us with pre-existing serious illnesses are at particular risk, as are those who carry as yet unidentified factors in their genes.

Around the world, there have been numerous deaths and reports of prolonged illness among people of all ages, from the very young to the extremely old, and across all races and socio-economic groups.

This pandemic is already causing disruption to our lives and to the functioning of our community on which we all depend for our daily survival.

Just as with the challenges of reducing carbon dioxide emissions, the necessities of disease control in the interests of the community as a whole mean that it has become impossible for us to continue with business as usual. This pandemic will test our community as never before and we must prepare ourselves for some bad outcomes.

We, your government, have a duty to step in to manage our community in our long term interests. As with the COVID-19 pandemic, inaction is not an option.

Unfortunately, there are no easy solutions.

Every path that we might choose leads to undesired consequences – sickness, deaths, disorder or economic harm:

• If we shut down the economy and education to contain the pandemic, countless individuals, businesses large and small, and educational institutions and their students and staff will suffer long term harm.
• If we try to maintain business as usual, [name of disease] will spread rapidly and, as we saw with COVID-19 in the US and many other nations, large numbers of very sick people will overwhelm our hospital services that were never designed to provide treatment for large numbers of people with a life-threatening pandemic illness. All health care will be disrupted, families will be denied access to patients, health care staff will become sick and some will die, and the economy will suffer regardless.
• If we transfer all residents of aged care facilities to hospital when [name of disease] emerges, hospitals and their staff will soon be overwhelmed. If they remain in place in environments that were never designed and operated with pandemic illnesses in mind, they will not receive intensive treatment to hospital standards that might prevent some of them from dying.
• If our community is locked down too hard and for too long, then we risk increased mental illness, economic harm, civil disobedience and unrest, with the consequence of further spread of disease and the outcomes described a moment ago.

Focusing on one area of the impact of a pandemic will cause even greater harm across the other domains.

The only pathway for us to deal with these conflicting challenges is through compromise and significant sacrifices.

Our goal as your government is to minimise the sum of all harms.

Always remember, we are a robust community with many great strengths:

• Our society is founded on individuality, openness, constructive problem solving, and a willingness to accept compromise and reach a consensus.
• As we have shown by our more recent responses to the clear threats of global climate change, we base our decisions on science, wise decision making, and the interests of our community as a whole.
• We are innovative, active and vibrant.
• We participate willingly in our community, and generally refuse to be controlled by hierarchy, autocracy, suppression or subservience.
• Our health care services aim to deliver the best possible treatment to all patients, and we care about the lives of all our citizens, particularly during a pandemic.

Fortunately, we have learned a lot in the past decade that can guide us through the difficult times ahead:

• The power of modern scientific understanding of disease, the strengths of our economy and the resilience of our community provide support for evidence-driven and thoughtful decision making for dealing with [name of disease].
• Evidence from across the world tells us that those nations with highest mortality from COVID-19 also had the greatest level of economic decline as measured by their GDP.
• COVID-19 showed us that, even when a pandemic appears to be under control, if we are not sufficiently vigilant or open up too quickly, we risk a rapid emergence of disease that can soon overwhelm our community.
• We know that we must care about everyone, and that the actions of every individual member of our community determines the outcome.

Together, these points mean that it is vitally important that we, the people of [insert name of nation, state or territory] maintain control over the spread of [name of disease].

The COVID-19 pandemic taught us that misinformation, poor organisation, ineffective leadership, compassion-free responses and a divided community cause great harm. We can all agree that engagement with science and accurate information, not subservience to ideology, offers us the best hope for the least damaging outcomes from this pandemic. As your leaders, we have agreed to set aside our partisan positions to work together to make the best choices based on the facts.

Unfortunately, there is still so much that is as yet unknowable about this particular pandemic disaster and how it will play out in the future. New diseases bring with them many unknowns and, as many of you will have realised, the outcome from our decisions cannot be guaranteed.

We will be candid, open and honest about the gravity of the challenges that we face, the expected consequences and the uncertainties in the decisions that we are making, and the reasons that we have acted as we have. We will make our decisions based on the best of the knowledge, science, understanding and wisdom that are available in our robustly open society.

Nonetheless, we know that we cannot avoid having to make hard choices in the interests of the whole community. At times, we will have to make choices with inadequate information or between conflicting expert opinions – inevitably, we will sometimes discover in hindsight that we have made wrong choices. We simply ask for your tolerance and understanding.

And during and after this emergency, we will do all within our power to minimise and repair the damage to our society, and particularly for those who have sacrificed the most.

The coincidence of COVID-19 and the awakening by the climate crisis of our awareness of our dependence on the stability of the natural world taught us that we must provide for everyone’s interests with compassion and foresight.

Our community of [insert collective noun for residents of geopolitical region] is simply all of us – our families, our friends, our neighbours, our teachers and our students, our employers and our employees, the people we pass in the street, and ourselves – but it is also far more than the sum of its parts.

We are asking nothing more of you than that you consider how, by your actions, you can promote the interests of all our fellow [insert collective noun for residents of geopolitical region], and indeed the citizens of the world. We hope that you will voluntarily join in those activities that will best help our community to remain strong and recover quickly from [name of disease].

Dr Will Cairns is a palliative care specialist based in Townsville.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.