Senior Fellow and former Fulbright Research Chair in Science and Society, ISSP, uOttawa
President Emeritus of theCenter for Policy on Emerging Technologies, Washington, DC
A pandemic seems a simple enough problem. Long before vaccines, before germ theory, we had quarantines, social distancing, even masks. Stay apart and the virus will stop hopping around onto new victims.
Yet the complexity of our modern societies has made handling such a situation as unsimple as it gets. Early in the pandemic I asked the question Why are governments finding the new plague so hard? – and noted the trade-offs involved in managing competing policy goals, together with the clunky character of government decision-making culture. This latter has been sadly borne out, not least in the contrast between nimble Asian states and Europe and North America. Early on, Canada distinguished itself: despite the relatively low Covid death rate, as many as 81 percent were in care homes, the top of the OECD’s table.
There are many drivers of plague complexity. For one thing, the clutch of disciplines: epidemiology and virology, plainly, but also behavioural psychology, a key to public health management. And of course economics. And communications. And everything through the prism of politics itself; and subject to law. (Case in point: the Belgian government’s endless shifting regulations have been ruled illegal.)
Then, context. The authoritarian Chinese may or may not be covering up the true cause of the outbreak, and also its actual extent within China. For the first critical 10 months of the pandemic the United States was led by a clownish conspiracy theorist; and the CDC, supposed global centre of excellence, made early technical blunders that were then compounded by political interference. Vaccines are finally being rolled out, but in a world of unprecedented vaccine skepticism – and plain loony-tune conspiracy theories.
The policy in almost all “western” nations has been what we might call “maximal manageable infection” – an effort to steer a course between Covid suppression (the “zero Covid” policies of Australia, New Zealand, and various Asian nations) and the ghastly risk of Covid-19 overwhelming healthcare resources (as happened in some southern European countries and New York City). Why not suppression? Either it is impossible, we are told, or its economic and social cost is too high. This “western” approach has all along risked the evolution of deadly variants more transmissible than the original (which has already happened), and potentially resistant to the first wave of vaccines (already so in part). Every virologist’s nightmare is a highly transmissible variant with the killing power of SARS 1 (case fatality rate of 14-15%) or MERS (perhaps 35%).
Critics of the mainstream western approach fall into two categories. First, people with an assortment of ideas that may look strange from the outside but are held with passionate conviction by some. For example, concerns about Bill Gates. According to one poll, in May of 2020 44% of U.S. Republicans believed that Gates was "plotting to use a mass COVID-19 vaccination campaign as a pretext to implant microchips in billions of people and monitor their movements." And more! Conspiracy theories come in many forms. Here’s another: If you get the vaccine it will affect your friends’ menstruation.
Side by side with these headline-grabbing claims are distinguished professionals who have launched serious critiques of mainstream thinking. On one side, for example, is Independent Sage, a group of British scientists convened by the UK’s former Chief Scientific Officer which has challenged UK government policy at every point and argued instead for “zero Covid” – suppression. On the other side, and more fundamentally, we have those arguing against the basic western approach with its combination of lockdowns and other measures.
The outlier in Europe has been Sweden, poster child for the “Skeptics” and their Minority Report. The contrarian approach of Anders Tegnell, architect of Sweden’s policy, has been widely critiqued (including by Sweden’s King!) though it’s had its defenders. (Tegnell’s assistant courteously declined an invitation to be interviewed for this piece.) In Europe, the website Lockdown Skeptics is a key rallying point.
On the global scale, three skeptic academics (from Oxford, Harvard, and Stanford) have combined to write the U.S.-based Great Barrington Declaration, named for the small Massachusetts town where it was launched last autumn. The Declaration has come under sustained attack from advocates of mainstream thinking.
The leading skeptics raise several basic questions. First, they argue that lockdowns are inherently unnecessary, since individuals’ responses to rising infections have led to reductions in social contact and thereby contained infections without the need for government restrictions. Secondly, and relatedly, they argue that a smarter approach would allow the virus to circulate freely among younger and healthy people, whose likelihood of severe disease is very small, to give them immunity and build toward “herd immunity” for the community. At the same time, they say, we should ramp up protections for those whose immune systems are compromised or who are older; a policy of “focused protection.” Third, they claim, advocates of the standard approach have failed to address the harms they are causing – from isolation of the elderly to children’s absence from school to the medical implications of giving priority to Covid over everything else from routine health screenings to cancer patients.
I spoke with one of the three authors of the Great Barrington Declaration, Professor Sunetra Gupta of Oxford University, a distinguished epidemiologist who is also well-known as a novelist, both in her native Indian language as well as in English. There were two rather different matters in my mind – both the pros and cons of different approaches, but also and more fundamentally what we are to make of the phenomenon of deep disagreement among experts in the context of policy advice to governments. What follows is a sample of our engaging discussion on Zoom.
NC: Why have these disagreements not been resolved?
SG: The minority view is being disparaged. You have very influential people describing other viewpoints, such as mine, as “fringe” and “dangerous”… Instead of debate being encouraged, the minority view has been dismissed. In the absence of debate you get a very unproductive conflict. Belligerent attitudes taken toward minority views, and perhaps also vice versa…
NC: What about the policymakers? How do you see the science policy advice process?
SG: You have a high level of uncertainty, and I see my role as involving highlighting those uncertainties… We have a range of possibilities; and we assign probabilities to particular outcomes.
In a March 2020 paper we (including those who signed the Great Barrington Declaration) recommended a strategy of focused protection to protect the vulnerable, as we don’t really know what effect lockdowns have had, we don’t really know how seasonality interacts with the population level of immunity, and back then we didn’t know when vaccines would be available. So, given all of this, what should we do? The other point is that mitigation strategies have costs. We’ve just in the last hour (May 4) launched a website called Collateral Global whose purpose is to document the effects, harms and benefits – mostly harms – of the various non-pharmaceutical interventions; obviously our concern is that they have been very harmful. My concern is that there are harms to many strategies that one might use to try and minimize infection, and lots of uncertainties concerning what is actually driving the epidemic. And so the sensible strategy is to try and protect those who are most vulnerable.
NC: The one thing that is universal in Europe and the U.S. is a failure to protect the vulnerable in care homes. There was, if you like, a general adoption of your strategy of focused protection, but in practice it was a lamentable failure. How does that feed into your notion of what the alternative should have been?
SG: I don’t think there was enough focus on the need for protection; what was done here in the UK was the opposite, with patients being discharged into care homes without testing. And the other place was hospitals, where there were many infections. We just didn’t do a good job… Japan for example did. And Singapore… Nobody’s saying it’s easy to protect care homes, and to keep hospitals infection-free. But here for example we should have set up separate fever hospitals, to keep the main hospitals Covid-free.
NC: What are chief scientific advisers to governments to do when there are different assessments being made by scientists? How should this be handled at the interface of government and the academic community?
SG: Once again, by encouraging more debate.
NC: My sense is that the media has not been interested in hosting these conversations.
SG: Interesting you should say that . . . I’m getting abuse on Twitter and elsewhere . . . Much better to have debates.
NC: To put a slightly different point … all kinds of wild things are out there, and they are getting lumped together with your minority view…. Efforts to suppress your view have encouraged this bundling. How do you feel to see fellow-travelers who are not at all interested in the science?
SG: But that’s inevitable, isn’t it?
People saying there really isn’t a disease or pushing hard against the vaccines or saying the mRNA is programmable and can control your brain – there’s all sorts of rubbish going on.
I don’t think the lockdowns did protect the vulnerable, because they allowed essential workers to go out and get infected, but they did a very good job of protecting the Zoom class!
NC: How do you see things going, looking ahead?
SG: I’m hoping that the harms of current NPIs will become more apparent, and we’ll also have more data to see to what extent they have worked to prevent people from dying. What I hope is that the connection between infection and the disease will be broken. In a vaccinated nation we’ll be able to form a more coherent picture of how we can live with the virus.
There is certainly evidence (not least from Sweden) that individual decision-making in response to news of growing infection can make a difference. Yet the core Great Barrington idea of permitting (some have proposed encouraging) transmission while protecting the most susceptible has been heavily criticized, in part because whatever immunity is conferred by infection may not last long; in part because – as we are becoming increasingly aware – infection can have long-term consequences (“long Covid”); and in part as the idea of segregating the compromised and seniors is impractical to the point of impossibility. It would certainly be interesting to see a white paper spelling out their scenario in the kind of detail that policymakers would need. The abject failure of every western nation to protect care home residents and even hospital patients from infection would seem to rule out their theoretical approach. The UK's recent decision to end most restrictions represents a shift to a version of this approach that relies on widespread vaccination of the elderly to limit cases of severe disease as infections burgeon.
Secondly, they suggest that the opportunity costs of lockdowns are ill-examined and potentially huge – and outweigh whatever benefits may accrue from the lockdown strategy. This is a fundamentally important argument that has been essentially side-stepped by proponents of the standard “containment” lockdown justification.
There are broadly three elements here. First, the impact of a year and more of dislocated schooling on a generation of children, especially those from more disadvantaged families. Second, the broad national and global impact of economic contraction. On the assumption that sans lockdowns there would be less or no such contraction this becomes extraordinarily important. Third, the net impact on health when priority has been given to Covid, and lockdown tactics have discouraged normal attendance at appointments. This is potentially enormous, and underlines the significance of Professor Gupta’s proposal for infection hospitals.
Where are the alternative threat/opportunity cost assessments from western governments? Should we not have had them in spring of 2020?
All in all, the skeptics have been pressing questions of key strategic significance. The press have avoided pressing for answers, and the authorities have felt little need to respond.
It’s important that we should not be put off by shrill voices claiming Covid is no worse than flu or masks are useless or vaccines inherently dangerous to recognize that key questions raised by serious skeptics are invaluable – and need to be answered. This is how science properly proceeds, and it’s how it urgently needs to proceed when science and political decisions are so closely intertwined.
The Covid pandemic is far from over, and depending on what happens in poorer parts of the world, and whether further and more dangerous variants emerge, it may not be over for some time. As we begin to assess how we have handled things so far, and work urgently to upgrade global pandemic resilience, it will be important to engage responsible dissident voices.