Blog: Jumanji – Public Health Challenge becoming reality in COVID times

Blog a collaborative effort by Nohad ElHajj, Anne van Marwijk and Herman van der Meyden Many of you will have seen the movie or read the book ‘Jumanji’, a story […]
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Oct 30, 2020

Blog a collaborative effort by Nohad ElHajj, Anne van Marwijk and Herman van der Meyden

Many of you will have seen the movie or read the book ‘Jumanji’, a story in which a group of teenagers plays a game that then becomes reality, with the teenagers themselves as pawns in the game. At Perspectivity, we recently felt like we have entered into a Jumanji type of situation with our game the Public Health Challenge.

In the Public Health Challenge, six teams play to maximise the years of quality life of the population in their regions. As a player, you step into the role of the public health department of one of those regions. As the game progresses, players have to make strategic decisions to guarantee the health of their population and are faced with health risks, such as disease outbreaks.

As COVID-19 unfolds, we feel like many of the challenges and decisions faced in the game are now facing the world in real life, with ourselves as pawns in the game. What was designed to be a simulation of a reality that might (one day) occur, became reality. It feels like the second or third waves hitting various countries across the world are just one of the eight rounds of the game we have been playing. One where different countries are using different strategies leading to different outcomes. Yet, the players are not going through a gamified learning process, but through a life or death situation that might shape our societies for years to come.

As we’re slowly moving from chaotic crisis control to complex virus outbreak management, we feel it is the right time to reflect and look at which lessons the simplified reality of the Public Health Challenge can teach us.

Devilish dilemmas in health and economy
In the game, a variety of the elements affecting the decision-making processes of our national leaders are built-in. When we first played the Public Health Challenge, we often received the feedback that the dilemma between health and economy that you encounter in the game is an unrealistic one. Although the game presents a simplified version of reality, the COVID-19 crisis is teaching us that when it comes to disease management, national governments are often walking on a tightrope between economy and health. And although the two are not mutually exclusive (after all healthy people mean a healthier economy and vice versa), governments do have to weigh short-term and long-term effects on both sides. For example, weighing the economic repercussions with the health effects and effects on social cohesion and wellbeing in the closing of businesses, such as bars, restaurants, hairdressers and others.

In the game, you have to weight the buying of so-called ‘wealth machines’, which provide you with income in the next rounds, with investments in prevention, through buying prevention cards. More complex versions of this are happening in real life. Maintaining wealth machines by keeping economies open and using preventative measures like investing in facemasks and protective clothing, like in South Korea, is compared to strict lockdowns, like in France, where wealth machines are taken off the table. The jury is still out on which strategy works best. In the game, however, we’ve seen that health regions that take their wealth machines off the board often spiral towards unaffordable health care systems as not enough wealth is being generated.

Another dilemma is investing in cures or in health care services. In the game, building hospitals is a large upfront investment and then generates a cure card in every round. An alternative is to buy the cure cards yourself. Over a number of rounds, it is cheaper to build your own hospitals than to keep buying cure cards. This dilemma is, for example, experienced in the Netherlands around diagnostic testing and protective clothing and facemasks: should we buy on the overheated market or invest in local production? The latter costs more upfront but makes you more autonomous.

The concept of winning
Across the world, countries are using different tactics to combat the same threat. Some countries opted for early lock-down, some allowed freedom of movement for a long time, and others choose a mix of the two. Exactly like the different players choose different strategies to play the game. Most governments believe that the approach they have selected is the right approach and that it will lead to the best results for their population. Or, in other words, the approach that will make them win the game. Just like in the game, we see that many governments select an approach for their own country and are hesitant to collaborate with others. Contexts, of course, vary widely from country to country and not all approaches will work everywhere. Additionally, the crisis nature of the task at hand provides limited time for reflection and elaborate conversations with others to align approaches and governments are hesitant to take this time. We observe the same process when we play the game. Even though explicit moments to discuss the situation on the board with all players are provided (and even though there are no real lives at stake in the gamified situation), players prefer to get on with business and not spend precious time talking to others. However, the game also shows that the outcomes for the whole gameboard are better with more collaboration and alignment.

Even though as one individual player you thought your country was winning the game, you will not reach the highest score as a gameboard, if you were playing alone. In the real world, individual countries can do really well at combating the spread of the virus, however, unless a vaccine is developed, their population will get infected again as soon as borders are reopened.

The Cure: All for one, one for all
As WHO representatives declared, social distancing realities and the fear of future outbreaks will become the norm if a vaccine is not developed. While a few countries, organisations and private companies have already entered into the rat race of developing one, the need and interest for it is global and shared between all the earth’s population. This situation poses a crucial dilemma, how can a ‘universal’ cure be developed by a group of diverse and incohesive parties? If we look closely at the actions and responses of the most influential players, two polarisations emerge: collaboration vs privatisation and ‘a few’ vs ‘the many’.

This is, for example, evident in the approach (and discourse) of the United States versus Germany and France. The US Administration’s advance to have exclusive access to a vaccine developed by a German biotechnology firm prompted a national security response from high-level officials in Germany[1] and a general fear over efforts to privatise and limit the access of a potential vaccine to individual countries. This approach strongly contrasts with the launch of an $8 billion coronavirus vaccine fund by the World Health Organisation, French President and German Chancellor. The fund does not only aim to accelerate the development of a vaccine but, most importantly, it stresses the importance of having a global unity to face this threat as well as working on having the developed vaccine ‘available to everyone’[2]. To put it in the game’s terminology, the USA is playing a move to ‘claim a cure’ while the WHO, France and Germany are playing to ‘put it in the middle’, freely accessible for everyone on the game board.

Now what? 
Similarly to the Public Health Challenge, COVID-19 outbreak challenged us, as citizens and countries, to face our own priorities as well as the effect of our actions on the greater common good both at local and global levels. Some countries are already experiencing the unfavourable outcomes of their short-term, individually- oriented strategies while others are experiencing the great success of their long-term and common good oriented ones.

As game facilitators, we often see an intrinsic concept slipping away while playing the game- together all regions influence the variable Global Health Level. Yet, the winners were always the players who acted upon this concept and worked together towards achieving a common win.

The Jumanji board had to be closed at the end to avoid any future disasters but we believe that the Public Health Challenge gameboard should always stay open. More games need to be played so more players can draw on its insights and learnings. And who knows, maybe the first step to overcoming our 21st-century challenges is by playing a board game.

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