Times of crisis reveal the best and the worst of us. Our new socially distanced world is one of stark contrasts. While social media feeds show compassion and love, only a few clicks away charlatans flog fake COVID-19 cures to unwitting victims. Pollution is at a low at the same time phishing scams in the name of the World Health Organisation are at an all-time high. It’s hard, at times, to acknowledge the good without mentioning the dark underbelly of the internet that inevitably comes along with it.
In times of difficulty the cracks in society begin to show. Just as the coronavirus exposes the vulnerabilities of our immune systems, the ensuing pandemic has exposed the vulnerabilities of British culture and our institutions. Long-held convictions about our institutions, about personal liberty and funding of the NHS have come to the forefront of public debate, and while there is a great deal of unity across the country in honouring the heroic front-line workers tackling the pandemic, there is a vicious debate stewing underneath the surface.
Debates that previously surfaced only in university Politics, Philosophy and Economics course essays are now vitally important to the recovery of our country. I may joke that having a degree in PPE does not make a person qualified to talk about medical PPE (personal protective equipment), but the theoretical arguments our politicians trained in decades ago are now more relevant to our welfare than ever. Is it right to sacrifice personal liberty to safeguard the population against disease? Is it right to shut our borders? Should the government rein in NHS privatisation?
On no topic is this division more toxic than the “herd immunity” debate. When the government set out its COVID-19 mitigation strategy in February, the notion that our government planned to infect a large proportion of the population, seemingly deliberately, understandably caused disquiet. It isn’t entirely surprising that a debate as to whether our government was prepared to view countless lives as collateral damage, in order to achieve broader immunity across the population without a vaccine, has become a vicious one.
The herd immunity debate has become something like a culture war, particularly on social media. The two sides are each completely sure of their position and dismiss the other as malevolent, or driven by some unfair desire to criticise or uphold the Conservative government (delete as appropriate). Moderation should win. But it hasn’t so far. Commentators and activists have by-and-large found themselves sitting firmly in one of two camps: the first insists that herd immunity was a strategy that, even if it was abandoned in March, is still responsible for the mounting UK death toll; and a second, which denies that herd immunity was ever a strategy and points to unfair criticism levelled at a government that is doing its best in difficult circumstances.
As with anything, there is an element of truth to both groupings’ opinions. It’s understandable that some in the second group have bemoaned the government’s critics as some criticism levelled against the government is not valid: it is ludicrous, for instance, to suggest that our government’s expert advisors should have known there would be an epidemic of this scale in mid-January. Hindsight is a beautiful thing, but any cursory glance at medical journals shows how little medical experts knew about the virus at that time. Human-to-human transmission of COVID-19 was first recognised in the prestigious New England Journal of Medicine on 29th January, and apparent under-reporting of fatalities by the Chinese government led to unpreparedness on the part of governments throughout the West. The UK is not an outlier in that respect.
Also, the UK’s pandemic plans were based on influenza, which is not necessarily misguided, but which led to a slow governmental response to COVID-19, which has different characteristics to influenza. Countries that faced outbreaks of SARS and MERS, such as South Korea, had far better contact tracing and PPE provisions as a result of the protocols they developed following those outbreaks. Influenza has a lower reproduction rate than COVID-19, and most influenza viruses have some baseline level of immunity in the general population. COVID-19 does not.
The first grouping believes that the government did pursue a herd immunity policy. It’s naturally controversial to suggest that our government was prepared to pursue a strategy that may have led to countless unnecessary deaths. According to Sir Patrick Vallance, the UK’s Chief Scientific Advisor, around 60% of the UK population would have to be infected to achieve herd immunity. If the COVID-19 death rate is 0.25% (at the lower limit calculated by the US’s Centers for Disease Control and Prevention) then this would mean the UK would suffer around 100,000 deaths to achieve this goal. That doesn’t make for pleasant reading.
Herd immunity is an assumption built into all models of disease epidemics – as an epidemic takes hold, the number of those who have had the disease and recovered from it naturally increases, and with recovery there is usually protection against reinfection. However, to assume that this process would take place with COVID-19 should rightly be questioned, as those who are studying the virus that causes COVID-19 have not so far established whether it gives lasting immunity to those who have recovered. Whether or not herd immunity will develop to COVID-19, those who deny that the development of herd immunity was a government strategy make their argument by saying that it is not referenced in the government scientific advisory papers. But it is.
However, it is not mentioned in the way you might expect. The UK government’s paper on combined behavioural and social interventions mentions building immunity across the broader population:
Within it, divergent opinions are expressed on the likely impact of recommending isolation of at-risk groups whilst not applying widescale social isolation, which was one proposal being considered. It states:
“…One view given is that, by explaining that members of the community would be building some immunity this approach would become acceptable to the general public. Another view cited is that recommending isolation to only one section of society risks causing discontent”
The government papers make ‘herd immunity’ sound less of a mitigation strategy and more of a public relations tactic that bombed, ultimately leading to polarised views. It undermined confidence in the government at a time when unity and compliance with government guidelines was and continues to be vital. Either way, the narrative that the government was actively aiming to infect the population has taken hold across the country.
I cannot help but wonder whether herd immunity as discussed by the government, or understood to be a serious policy, is the result of the UK’s inclination towards unique solutions. Innovation has historically been our strength, and may be our way out of this pandemic quagmire: the proposed vaccine developed at Oxford University is due to begin clinical trials today. But there is a flip-side to promoting oddballs and shadowy ‘geniuses’ at a time of national crisis. While the debates in PPE essays may be central to our country’s future, our politicians do run the risk of treating the UK like a paper intended to impress a tutor with its novelty. In public health, correct is more important than interesting. I personally do not care whether our politicians have flair or panache: all I desire is that they do the job well. Comparisons between herd immunity policies and Dominic Cummings’ personal ideology are unwarranted, but you can see why they exist. Both have that winning feature of being driven by the uniquely British kind of quirky, out-of-the-box thinking.
Of course, the best way to settle the entire herd immunity debate would be to look over the minutes of the scientific advisory group (SAGE) that advised the government on policy. If herd immunity had ever been discussed, it should have been minuted. But that isn’t possible – because the UK government has stated they will not release the SAGE minutes until after the pandemic. The problems arising from this are two-fold: it prevents scrutiny of government strategy; but it also prevents scrutiny of the individuals who sit on the committee. There is no publicly available list of those who form this important advisory group, and no list of their financial interests.
Anyone with any knowledge of the history of science (or any other field, for that matter) will tell you that money can corrupt, and most reputable scientific journals will require research funding sources to be declared when scientific papers are submitted for publication. Despite that, the only list of interests available with regard to the government’s COVID-19 response concerns one subcommittee named The New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), and this entry has not been updated since 2018. So the government currently presiding over our pandemic response may be receiving advice from corrupt cranks, and we will not know it until it is too late.
Even if herd immunity was never a strategy, it does appear that the government is hiding from scrutiny and accountability. And this is where I find myself diverging from those who demand criticism of the government should be withheld until after the pandemic. Right now, interrogation of the government could not be more important. Because this goes beyond party politics. When lives are at stake, scrutiny and accountability could not be more vital. Our lives may depend on it.