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Inside Covid-19: Iconic Dr William Haseltine’s advice for SA; Logic from Actuarial Prof Roseanne Harris. Ep 38

A medical worker test an electronic body temperature thermometer in a pre-triage center at a hospital in Turin, Italy, on Thursday, Feb. 27, 2020. As the number of people infected by the coronavirus in Italy rises above 500 -- mostly in the rich, industrial north -- restrictions imposed to stem its spread are threatening deeper economic woes. Photographer: Federico Bernini/Bloomberg

In Episode 38 of Inside Covid-19, we meet former Harvard Medical Professor William Haseltine, the HIV/Aids pioneer who has forthright suggestions on the steps SA should take to handle the pandemic; talk coronavirus with the super achieving Wits Prof Roseanne Harris who is about to become president of the International Actuarial Association; and revisit the chequered history of lockdowns which, in the West, only became official policy in 2006. – Alec Hogg

In the Covid-19 headlines today:

Roseanne Harris joins us now. She’s the Professor of Actuarial Science at Wits and Head of Regulatory and Policy Affairs at Discovery Health. Roseanne, that’s not all; you have also been nominated to become the President of the International Actuarial Association, and from what I read – sixty thousand actuaries around the world, 106 bodies. Are there many nominees?

No, I am the only nominee, thanks Alec, and I guess it will be confirmed come November. But at this stage, at the first virtual council meeting of the IAA that took place a week or so ago, I was announced as being the only nominee for that role.

What would it entail? 

So the IAA, as you said, is an association of associations. So what it is is the global body for actuarial societies around the world to meet and essentially compare notes, but also ensure that there’s some global consistency in terms of actuarial professions and the way in which the global profession operates. So, essentially the role would entail heading up that association of associations over a period of three years. You spend one year as President Elect, and then one year as President, and then one year as Past President, so the nice thing is that there’s a fairly diverse team heading the association at any particular time. So three offices, generally coming from various parts of the globe. So, I feel quite excited about the opportunity to bring the South African perspective to that leadership role, but also to be working with other actuaries from other diverse backgrounds, different economies, different social protection mechanisms in place, different perspectives on how we manage risk in the financial services industry across the globe.

It’s interesting also, looking at your background, that apart from graduating at Wits and being the Professor of Actuarial Science there – you’ve also taken a very close interest in healthcare. Where did that all start?

When I graduated from Wits a while ago, the area of healthcare was not a usual place for actuaries to be working and I had the opportunity as an actuarial student at that stage to take up a role in that area of practice and to essentially establish it as an area of practice. At that stage, there weren’t many actuaries working in healthcare and we had the opportunity to bring the actuarial skill set to this area, which was appropriate – to be applying some of these techniques that have been developed over many years in areas like life insurance and general insurance, and to apply them to the area of managing health risk. And so over the period of my career, health is now very much an established area of actuarial practice and established in the actuarial curriculum. We have fellowship subjects that actuaries qualifying as nowadays can take health as a particular discipline and specialisation. So, it was really interesting and exciting having that opportunity to be part of that whole development. And, of course, I got the opportunity to work with some fairly illustrious actuaries, particularly people like Barry Swartzberg at the time in terms of also establishing that area of practice.

Actuarial science has really come to the fore – as has all sciences – through the Covid-19 crisis, because people are looking for facts rather than opinions. But it does confuse the rest of us when even the actuaries are not able to talk on the same page. What do you make of the diverse views that we’re seeing from actuaries?

It’s an interesting question, because it begs the question about what the role of actuarial modelling is. I remember the Institute of Actuaries in the UK – they always had the motto of actuaries making financial sense of the future, and I guess one has to ask oneself the question, ‘What is the role of actuarial modelling?’. And I like to think of it as a way of understanding risk. What we have at the moment is that we are being bombarded daily with new facts and information and it is actually very difficult to discern the facts from the suppositions. And we need a mechanism to try and make sense of what all this information means, and I guess that’s a very important role that actuarial modelling can play – is providing a framework to bring together information and making sure that it’s dynamic enough that as that information unfolds and evolves, we can start making sense of what it means and understanding the forward projections and understanding even what’s in front of us right now. The challenge, of course, is that one has to be quite balanced and rigorous. One has to not be looking to perhaps perpetuate a particular point of view or get too hung up on perhaps a projection that you made in the past. If you think of how things have changed just in the space of the last 30 days; some of the questions that we were looking at in terms of the resilience to the virus, what the factors are that seem to be contributing to the spread – even that information has changed quite dramatically over the space of just a short period of time. And so we need to be quite disciplined in terms of our approach; of how we filter that information and how we take it into account in something like a model. So I think the point about actuarial modelling is that it’s a scenario planning tool. It’s as good as the information that you’re putting in and the scenarios that you are setting. But the value of the tool is understanding the risk, understanding the range of possibilities, understanding the opportunities to intervene and take actions and – provided that we are taking that disciplined and scientific approach in how we interpret information – then we are going to get useful results, but we do need to stick with that sort of professional integrity of how we use the information at hand.

Are we doing that in this country – as far as the official policy is concerned, as far as the direction that the government is taking – is it based on actuarial probabilities?

I don’t have insight in terms of the way in which the decision-making is taking place at the Command Council as much as what’s in the public domain, but it certainly seems to me that there is a lot of rigour being applied and a lot of reference to scientific input. The range of possibilities here is quite wide and I guess that’s what causes the uncertainty and the alarm when we see the range of outcomes. But I certainly do get the impression that we are taking a fairly scientific and rigorous approach to how that information is being interpreted, and where it conflicts – that obviously then there are tough decisions that have to be made. That’s a challenge with any kind of modelling or decision-making tool. It doesn’t necessarily make the decision for you, but it should be providing the adequate support to make informed decisions. And I think the important thing is to always have an open mind to the information as it evolves, so that as new information comes to light you interpret it and make the required decisions without being too wedded to perhaps a previous point of view, which might have been well informed at the time. But as the information evolves, we need to evolve our way of thinking as well.

That sounds difficult, particularly when you’re dealing with politicians who are not known for their humility and it sounds like you need to be humble to change your mind as the facts emerge?

Absolutely. I often think that humility and integrity are quite closely linked. There’s a danger if you don’t exercise humility – then you start to threaten acting with integrity. And I must say, when I watched our President speaking last night; I felt that there was a huge respect expressed for the scientific community and the input they can provide. But ultimately, someone has to make those tough decisions and, obviously, hindsight – as always is 2020 vision, and decisions should be evaluated based on the information that was available at the time and the discipline that was put in place in terms of how that decision was taken.

Do you think that science is going to get a higher role in society after this pandemic – this crisis that we’ve been through? It’s almost like we are now looking more to understanding the world around us through facts rather than the stories we are being told.

I think it’s been a very interesting time in terms of looking at what people have relied on when they’re faced with all of this uncertainty and really alarming information that they’re being bombarded with. Where do they turn for that assurance; that someone knows what’s going on and someone is going to steer us through this. And I think it is interesting that certainly the prominence that has been given to the Advisory Committee and to various scientists is in a way quite reassuring. I guess the difficulty is that that obviously comes head to head with the social media, and when stories are spread like wildfire – people’s ability to do that fact checking and make sure that they’re not being led astray by information that has perhaps been manipulated (is difficult). So it does raise all sorts of issues around how we validate information. I mean it’s just so interesting – if I put my academic hat on; when you think about how long it normally takes to publish research, to publish a paper and the references that we see (being included in the information that’s being released by the NASD and so forth) are things that have been put together literally in the space of the last couple of weeks. I mean, it’s almost unheard of to see literature evolving like that. And, of course, it’s good that this information is being widely available, but it’s also dangerous from the point of view that the necessary rigour of making sure that appropriate methodologies have been followed, that checks and balances are in place, that the evidence is substantial enough to draw the conclusions that have been drawn – that obviously some of those things may well have been compromised in the rush to share the information. So I think that reliance on scientific rigour, as you say, is something that is evolving, but we’re going to have to find a way to strike the balance between getting information out there so that others can work with it and build on it, but also making sure that it’s being appropriately reviewed and validated.

Perhaps you can just give us some advice; for those who want to be rational, who don’t want to get caught up in the drama, and would like to find ways of perhaps balancing their perspectives. What would you suggest?

I think it’s important when you’re looking at these various studies as they’ve evolved, to obviously interrogate that evidence quite carefully, to see where it’s come from, whether it has been on the basis of a proper study. I mean, at the moment; we’re looking at studies where the numbers are quite small and drawing conclusions and extrapolating those can be quite dangerous. So, look at the sources, look at who’s involved, and perhaps rely on some of the more mainstream – particularly where there’s an academic link of resources – to ensure that at least some validation has taken place. I think we’re quite fortunate. There’s a plethora of information out there and our own official SA coronavirus website is actually very useful in terms of having a lot of valuable information (that at least has been vetted to some extent). Regarding getting local information; perhaps relying on those kinds of websites rather than WhatsApp groups is probably a good rule of thumb. I think it’s also quite exciting that there’s a huge amount of collaboration that’s taking place globally as well and that the links between universities, between resources, the people who are involved in managing public health in various countries, officials – all collaborating and sharing information. It’s a very positive thing, but I think we do obviously need to keep an eye on the discipline that’s involved in doing that.

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