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Book Review: The Premonition by Michael Lewis

Book Review: The Premonition by Michael Lewis

Reading Time: 5 minutes


This is the first book review I’ve written since being in secondary school, which…well, was a while ago, so go easy on me. I was inspired by a tweet a few weeks ago…

There has been some chatter both online and offline recently about the ‘visibility of emergency management’. Professor David Alexander’s article last summer asked “where are the emergency planners?“. The Emergency Management Growth Initiative has been seeking to bring greater awareness. And there have been recent challenges to the narrative that ‘plans didn’t exist’ for the UK response to the COVID pandemic. 

Generally, there’s a view from within, that that emergency management needs to be more mainstream, especially in the minds of political leaders. 

Over the last 9 years I’ve also tried to use this blog as a way to bring greater visibility to emergency management issues; most directly in an early post about breaking out of the bunker, which is simultaneously the natural habitat of the Emergency Manager but can also be what holds us back as a profession.

It was with great excitement that I ordered Michael Lewis’ book The Premonition, about a group of like-minded (and like-frustrated!) individuals who know that something serious needs to be done about pandemic planning. The book tells how a small group initiated and then performed repeated course corrections to US pandemic planning in the face of indifferent, layered, and fragmented bureaucracies. Speaking about the Swine Flu pandemic of 2009 one of the cast notes “there was no one driving the bus” and that despite pockets of good work across the country, the formal bodies people looked to for leadership (the Centre for Disease Control gets an especially scathing review) were deeply dysfunctional.

The book repeatedly asks the question “What happens when the people in charge of managing the risks have no interest in them?”. Pretty much every time it circles back to passionate people fighting to be heard and finally breaking through (often to be un- or under-appreciated).

Like Love Actually, there are several intertwined stories at play. Initially, each of the main characters (they’re actually real people) are doing their own wonderful things in splendid isolation, solving local problems using local means. But characters are brought together through chance meetings, introductions or happenstance, and realise their collective power.

One observation is that for a Public Health Officer in the States, there is no defined career path. I’ve heard similar representations about Emergency Management. This is thought to represent a problem because it means such a diversity of approaches and backgrounds and therefore a lack of a common approach. However, I would argue that this allows multiple perspectives to be more easily readily and more organically, but agree that some standardisation could be beneficial.

Like in an emergency, rapid response is vital to control and reduce the impact of disease outbreaks. The response to outbreaks and emergencies often needs to be instinctive, Kahneman’s ‘System 1’ rather than the more considered ‘System 2’. As one of the protagonists remarks about a Hepatitis C outbreak “if we had waited for enough evidence to be published in journals then we would have already lost,” and similarly, later in the book talking about wildfire response, someone remarks “you cannot wait for the smoke to clear – once you can see things clearly it’s already too late.”

Active vs passive choice seems to be another recurring theme throughout The Premonition, reminiscent of the Trolley Problem:

In particular, there is a chapter that considers a response to potential health issues following a Californian mudslide and one of the stars of the book is described as “She processes information quickly and spits out a decision fast, that makes people nervous. You don’t find people like that in government.”

Considering the profession, or at least the decision-makers background, there is an observation that the Homeland Security Council was “staffed by military types who spent their days considering attacks from hostile foreigners, not the flu” and that this had the effect of cognitive narrowing, choosing to not see the things which were unfamiliar. 

One of the characters talks about how they wanted to try to get the President, then George W Bush, to pay attention to the widespread impact that a serious pandemic could have across all society, not just healthcare. I was particularly amused that rather than formal submissions and briefings, actually what got the President interested was providing him with an annotated history book.

An intensivist doctor talking about touch clinical decisions remarks that “I felt like my best when shit hits the fan. I focus like a laser when everything is going to shit” and someone else mentions “You are going to make mistakes. The sin is making the same mistake twice and best is to learn from other people’s mistakes.”

The Premonition isn’t a popular science review of pandemic interventions and response strategies. Although, if there is a Hollywood adaptation (like Lewis’ Moneyball) then there would be parts for Selena Gomez to reprise her role in explaining dense public health theories and concepts. There’s an extended section which compares 1918 influenza pandemic interventions in Philadelphia and St Louis and supporting evidence which indicates “cities that intervened immediately experienced less disease and death” and further that cities which “caved to pressure from businesses to relax social distancing then experienced a more severe second wave.” 

Lewis also presents research that concludes that you “couldn’t design a better system for transmitting disease than the school system,” which got me thinking about perceptions, and why there is a persistent view that closing schools is a bad idea? Surely it’s only a bad idea if it is done badly?

The book notes how we are notoriously bad at understanding statistics and complex dynamics. Exponential growth is hard for us to visualise beyond the first few steps. Lewis provides an example of folding a piece of paper 50 times being able to reach a distance of 70 million miles. It just doesn’t seem right.

What comes through most clearly is that more often than not this doesn’t come down to expertise or evidence. Success often is the result of people who work around the system. Individuals with passion projects that compensate for the failings and deficiencies of their organisations.

My own passion project has been to try and better surface and understand interdependencies between different systems. It’s easy to become a specialist in your own field, but to see how that connects and relates to other areas is less common. My Anytown project started off as a way to try and convey the ‘whole society’ impact of various scenarios. The Premonition covers some of this in a short section that identifies the pressures on the production of nasal swabs which are only manufactured in three locations worldwide and are in extreme demand during a pandemic.

However, Lewis also makes the observation that decisions can no longer be made purely on the basis of technical evidence and draws the book to a conclusion noting that “greater attention needs to be paid to how decisions might appear to a cynical public.”

There are some wild claims throughout, such as “The US invented pandemic planning in 2005”, which I’m not sure would stand up to much scrutiny. And I’m sure that trying to tell a history of COVID whilst we are all still living through COVID means there is more to be uncovered. But overall, The Premonition is an easy to read yet insightful book which casts light on, more often than not, the failings of government-level risk management and the commitment and passion of public health and emergency management professionals, noting that some are “so committed it’s more of a mission than a job.” 


Next on my reading list: Catastrophe and Systemic Change by Gill Kernick

Sit in the messiness a while…

Sit in the messiness a while…

Reading Time: 2 minutes

I’ve just listened to this In Our Time podcast from December 2013. I’m not normally a massive fan of Melvyn Bragg, but with Prof. Ian Stewart (who I met 5 years ago) and Prof. Eve Middleton-Kelly (with whom I worked in the run up to the Olympics) on the panel, I thought I’d take a listen.


It sounds counter-intuitive , but most people are well accustomed to handling complex systems. Whilst the terminology is typically academic, I expect we can all relate to the idea of things happening as a result of unforeseen consequences. That is, to me, what complexity science is about; trying to better understand the factors which lead to things happening. My particular interest, of course, is in enhancing our understanding of how disasters happen.

I’ve blogged before about emergence (Pop Up Emergency Planning), as one of the facets which interests me most when looking at most disaster response case studies. Essentially it’s the idea that when a system is stressed, it can cope up to a point but then finds a new way of coping by developing new structures, relationships or rules. We see this when people on twitter reach out to people who are stranded at airports due to volcanic ash clouds, we see it when spontaneous Broom Armies take to the streets to clear up riot debris; and following conversations in December with @CazMilligan #SMEMChat colleagues – emergence also seems to underlie initiatives like Virtual Operations Support Teams.

Almost exactly 12 months ago I initiated Anytown for London Resilience Team. This was an attempt to look at the interaction of different city systems to see if we could model their interdependencies and better understand the likely and emergent consequences to improve future resilience to disruptions to these systems.

If we were designing a city from scratch then I expect many of its systems would look rather different. Out of the construction of individual buildings and infrastructure components emerges something which has structure (and, buy extension, traits such as culture, tradition and ‘personality’), which is partly planned and partly evolved. We need to embrace the messiness, work with it rather than trying to control it.

New Year is a time of resolutions, so I’m resolving now to take Anytown ‘to the next level’ in 2014. I’d be interested to do this in collaboration with others who are interested in similar issues – get in touch!


Image Credit: Doug Neil at TheGraphicRecorder (who has an interesting comment about the obvious spelling mistake!)

Have I Got News For You

Have I Got News For You

Reading Time: < 1 minute

Regular readers will be aware that I’ve been working on a project called Anytown over recent months. It’s a project looking at complexities and interdependencies between systems and how that can impact on resilience. Previous blog posts about it are herehere and here.

Rather excitingly, you can now find out about Anytown in Resilience, the magazine of the Emergency Planning Society. Yes, there is now a remote possibility that I will be quoted on BBC prime-time programming, having been published in a niche trade magazine! (I’m hoping Charlotte Church might make a reprise as host for ‘my’ episode….)

They saved the best until last, so head to pages 38 and 39 (but then take a look at the rest of the mag). Even if you don’t learn more about interdpendencies, you’ll have an edge over the missing words round, and everyone likes winning.

As always, comments appreciated either in the box below or direct to my inbox over here.

With thanks to colleagues at the EPS for publication

Anytown – latest visualisation

Anytown – latest visualisation

Reading Time: < 1 minute

Displaying complex or detailed information in a digestable way is always an interesting challenge. It’s certainly s certainly one of the challenges that I’ve had with Anytown, my project to better understand interdependencies and complexities within and between systems.

Here’s my latest attempt at showing some of this information, which I developed for an NHS England briefing today, using information from the Hurricane Sandy report “A stronger, more resilient New York.


Nodes of different ‘city networks’ are shown in thematic colours (Gas, Electricity, Fuel, Water, Telecommunications and Wastewater). Please note that this is an illustration not a schematic of each network. The connections within networks are shown with black lines, and where there is an interdependency with another network it’s shown in red.

I’m now working on a way of using this alongside the previously developed ripple diagrams to better articulate interdependencies, ideally in an interactive way. If you have any thoughts on how this could best be achieved, drop a comment in the box below, or get in touch directly via Contact Us.

Complexity & Interdependency

Complexity & Interdependency

Reading Time: 2 minutes


I’m currently working on a project investigating Infrastructure Ecology, although that’s not how I describe it at work for fear of alienating the audience! It’s a fascinating area of enquiry, which the diagram above only partially articulates and I’d need more than one blog post to do it justice. So I thought I’d start with why I think it’s fascinating.

When we flick on a light switch, twist a tap or pick up our phone we expect those services to work. We’ve come to rely on them, and largely that doesn’t cause us any issues – the lights come on, water comes of ouf the tap and we hear a dial tone. However, incidents (Gloucestershire flooding 2007 and Hurricane Sandy 2012 to name just two examples) and exercises that I have either participated in or facilitated consistently reveal that these systems are far from 100% reliable.

Too often we treat things in silos, but increasingly we need to consider how the different systems that we have developed and have evolved alongside over many years interact and depend on each other. In a previous role, I facilitated a business continuity exercise for a large teaching hospital. The scenario was pretty basic, but it revealed that all but 4 of the wards in the hospital had planned to use the same fallback space – in the worst case this meant cramming over 200 patients into a 30 bed ward. We find it difficult to think outside of our sphere; I’m not sure of the reasons why, but we need to recognise that it happens and develop a methodology which forces us to think more holistically.

Interdisciplinary approaches are the way forward. Involving a wider range of people and organisations is risky – and makes camels a more likely outcome – but it’s the only solution to get us out of our silos.

Previous attempts to ‘educate’ professionals about these business continuity challenges concentrated on presentations, and as the same lessons are still coming us, I think we can be confident that levels of awareness have remained largely static. My approach has been to redefine the problem (that non-experts don’t understand interdependencies and complexities of systems) and to look for other world solutions (which is where the ‘ecology’ in Infrastructure Ecology comes in).

Experts in biodiversity have known for a considerable length of time that the key to understanding the key to successful interventions is understanding the underpinning relationships between predator-prey-environment. It’s something that I vaguely remembered learning at school, and without much thought it was clear that it was a model which had applications in helping understand the infrastructure problems encountered.

Last week I ran two workshops at City Hall, with representation from a wide variety of sectors organisations and interests to harvest their experience and knowledge. This will be synthesised to produce a model of an urban area which ‘understands’ how the different systems are related and therefore what the consequences of interruption to one will be on other systems.

I’m now in the process of translating the data we collected into something meaningful. I have some grand aspirations for the project, and alternative between getting carried away and reigning myself in to concentrate on the practical! I’ll keep you posted!

Image Source: NARUC