How sunk-cost bias can obscure our vision of a post-COVID world

Part three—the final part—of a series of columns on the biases that shape our view of health.

In science, it is customary for researchers to disclose any potential bias, as part of the process of publishing work. While this is often considered in the realm of financial biases, I have previously suggested that our other biases—our mental architectures that shape how we think, why we do what we do—matter as much, or perhaps more than, easily quantifiable other biases. With this in mind, I will here disclose my own bias, one which has relevance for how I see, and write about, the COVID moment. My bias is this: if presented with a choice between, on one hand, absolute safety at the cost of the interactions and experiences that make life worth living, and having these experiences with the understanding that doing so entailed some amount of risk, I would choose the latter.

Let us call this the sunk cost bias. This bias is our tendency to continue with a given approach to health not necessarily because the data support it, but because we have already invested much in pursuing this approach. The sunk cost bias echoes the sunk cost fallacy, where we continue with a behavior or investment because it is something we have long done. The sunk cost bias is the last in a series of three biases I have discussed in recent columns, as part of the lead-up to the November 1 launch of my new book, The Contagion Next Time, which aims to help us see the true causes of health during a pandemic, which our biases can obscure.          

In some ways, I think my bias is a product of being an immigrant, one who has—like many immigrants—worked to construct a life in a new country, often in the face of uncertainty and risk. While my journey from Malta to Canada to the US has been far less difficult than the journey of other immigrants, I nevertheless know what it is like to experience the challenges that are ever-present in the life of the immigrant. I also know what it is to choose to undertake such challenges in search of a better life, to willingly accept uncertainty and risk because moving forward seems to demand it. This perhaps helps counter the sunk cost bias—I may have a particular perspective on the status quo we have traded in exchange for a feeling of greater security during COVID-19, understanding that it was never as certain as it perhaps seemed. This sense of permanent uncertainty, and the ability to live with it, can help us avoid persisting with approaches that seem to lock down a sense of security which is, in fact, more illusory than we may care to admit. Once we recognize this uncertainty, we are that much closer to realizing that life always entails some measure of risk, and the challenge is to learn to coexist with, rather than eliminate, it.    

As a result of my bias, I have been unable to dismiss concerns over COVID measures over the last year, even as I fully accept the necessity of these measures, in the face of an historic crisis. To be clear: the restrictions we have embraced—from lockdowns, to masking, to distancing—have been, on balance, the correct—if, at times, imperfectly applied—approach to this problem. It is possible to acknowledge this, while also acknowledging the cost they entail. We accepted this cost because the alternative was clearly worse. We are now in a stage of the pandemic where this is no longer so clear. It is a liminal space, between where we have been for the past 20 months and the full reopening of society. Within this space, we have seen calls to maintain strict vigilance, even as vaccinations increase. Among demographics where vaccination has been more or less complete—among, for example, older adults living in nursing homes—there remains a hesitancy to reopen society, even as the science supports the safety and efficacy of vaccines. The difference between the beginning of the pandemic and now is that we have much more information and, therefore, our risk calculus has changed. We know now with greater precision how the virus spreads and who is at greatest risk. We also know about the broader costs mitigation efforts have had on society, ranging from mental illness to unequal economic loss to increases in substance misuse to reduction in non-COVID related research.

This speaks to a broader challenge when it comes to balancing risk. We are quick to identify risk, but we are slow to see how far we have come in mitigating it. We hesitate to trust our own success—whether our success in vaccine development or, more broadly, the progress we have made over the last century in creating a healthier world.

And we have indeed made progress. In many respects, we live in a world which is better, healthier than ever before. Global poverty has plummeted, maternal mortality is declining, and living standards have improved. The world is also less violent overall. This is not to say we do not still have problems—indeed, The Healthiest Goldfish is, in part, a deep dive into these challenges and what it will take to address them. Yet we are sometimes liable to overemphasize the risks we face, or to emphasize the wrong risks, based on a lack of perspective about where we are, relative to where we were. During COVID, this tendency has arguably manifested as the impulse to continue embracing lockdowns and restrictions, even as the data and the reality of vaccines support a return to a more open status quo. Having already invested much in adapting to the new normal of COVID, our sunk cost bias has made it difficult to embrace the next normal of a post-COVID world.

What, then, does it mean to reopen, in a world where risk is ever-present? First, it means weighing liberties vs restrictions differently, not as a zero-sum proposition, but as an effort to strike a balance between living and taking prudent steps to safeguard health. I have written previously on how our conversation about public health restrictions during COVID devolved into a crude partisan binary, with little room for compromise or common ground. The fact is, choices about health are complex and require tradeoffs. We give a little liberty to get a little safety, and to give a little is not to give all (despite what many opponents of public health measures seem to think), nor is it nothing to ask populations to sacrifice some freedom in the name of health (despite what many advocates of indefinite lockdowns seem to think). We need to find a balance, and part of that balance is accepting the risk that comes with living a life.

Second, it is important to prioritize what is good for the next generation. This was particularly relevant during COVID, when children faced disruptions to their education as a consequence of COVID restrictions. The question of whether or not to open schools during the pandemic was, at core, a matter of sacrificing the long-term capacity of students to live healthy lives in the interest of mitigating disease in the short-term. Education shapes our ability to live healthy, fulfilling lives, and this is particularly true of the education we receive in our earliest years. The lack of nuance in our conversation about lockdowns, I would argue, consistently failed students, particularly younger students, as our willingness to pursue a sense of safety at all costs pushed to the side the broader considerations that inform living a healthy life. This reflects a failure to prioritize the next generation in our thinking about health.

While these suggestions may reflect my personal bias, they also, I hope, inform a useful approach to addressing the challenges of the moment. Bias can constructively inform decision-making, provided we are upfront about our biases, dealing openly and honestly in the marketplace of ideas. I am aware that my own biases certainly shaped decisions I made during the pandemic. Given that, as Dean of a school of public health, my choices affected many people, I have worked to balance my biases with the perspective of others, making decisions in consultation with colleagues. Part of managing biases—whether individualistic, positional, or sunk cost—is working to avoid acting on them reflexively, by engaging with different points of view. A key privilege of writing this newsletter has been the chance it provides to engage with these different perspectives, through the comments shared by readers. This engagement can hopefully help us all to recognize our own biases and how they influence what we do and think in this moment.

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Also.

In this week’s The Turning Point, Michael Stein and I ask: can contact tracing work here?

It is also hard to believe we are just a little over a week out from the November 1 launch of my new book, The Contagion Next Time. Pre-order the book here. Or consider joining us for an upcoming virtual book tour event.