Learning to live with COVID

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Epidemiologists and public health experts have tended to suggest that the way out of this pandemic labyrinth is to find a vaccine. But could that be just the beginning of another dispute?

What happens if people, fired up by conspiracy theories, choose not to take the vaccine? And what happens if, instead of an international coordinated campaign to make the vaccine available to all, we have ‘vaccine nationalism’, with different countries competing with each other, not sharing their findings, spying on each other, and keeping any vaccine they find for themselves? Imagine the international bitterness that would cause.

There’s already indications of this scenario, with French big pharma company Sanofi saying its client — the United States — would get preferential access to any new vaccine before the rest of the world.

I spoke to two people about these questions. The first was a friend who is working on a campaign called The People’s Vaccine. The campaign, which is being supported by several countries, international bodies, and development experts, says:

Governments and international partners must unite around a global guarantee which ensures that, when a safe and effective vaccine is developed, it is produced rapidly at scale and made available for all people, in all countries, free of charge. The same applies for all treatments, diagnostics, and other technologies for COVID-19… The World Health Assembly must forge a global agreement that ensures rapid universal access to quality-assured vaccines and treatments with need prioritized above the ability to pay.

But, I asked my friend (who works in international development, and didn’t want to be quoted directly), what if people refuse to take a vaccine? What policy options do governments have? He replied:

I don’t know how well punishment works. A punitive approach in public policy does not maintain the social consent essential for public health — better usually to work to allay fears, have respected people model getting it etc. A good thing about the ‘people’s vaccine’ campaign is that it frames the vaccine as a wonderful right you should not be denied and warns that some might try to deny you it — this makes it more attractive than ‘we’ll punish you if you don’t’.

The second person I spoke to was David McCoy, who is professor of global public health at Queen Mary, University of London, where I also work.

I asked him the same question: what if people refuse to take the vaccine?

He said:

Government will probably want to avoid making a vaccine mandatory. It should be possible to vaccinate sufficient people voluntarily so as to achieve herd immunity. There could be some conditions, similar to other vaccines — in some US states you can only send your children to state schools if they have been vaccinated.

Professor McCoy didn’t expect some massive information war over vaccines. We’ve seen some of that over the internet, with anti-vaccine documentaries getting millions of views in the last month; and a new study of Facebook likes by the ‘Vaccine Confidence Group’ finding that

Anti-vaccine pages [on Facebook] are more numerous, faster growing, and increasingly more connected to undecided pages. If the current trends continue, antivaccine views will dominate online discussion in 10 years — a time when a future vaccine against COVID-19 may be critical to public health.

Bill Hanage, professor of epidemiology at Harvard, suggested to me that only 60% of people may need to take a vaccine for a population to achieve herd immunity. At the moment, one third of Americans say they wouldn’t take a vaccine. However, as my friend Liam Kavanagh of Art Earth Tech points out, this virus has only just started moving through populations. As more and more people die, public opinion towards vaccines is likely to shift.

What if the lockdown has worse impacts than the virus?

Professor McCoy had a different concern to the one I raised. He said to me:

We can’t escape the virus. It’s here and will be with us for a while. An affordable and effective vaccine would sort out a lot of problems, but it doesn’t look likely anytime soon, and might never come. That means we have to live with the virus, and find the right balance between protective measures like the lockdown, and getting on with our lives. We have to acknowledge this virus will have a negative impact on human society — the question is, how big, and who will suffer the most. Attempts to control the virus are beginning to have a greater negative impact than the virus itself.

The lockdown is having a negative economic, social, cultural and political impact that is worse than the health impact of the virus. But the impacts of the lockdown are slow burning. You don’t see them immediately. There’s the mortality impact from unemployment, for example, or the impact on household food security. There are chronic, long-term impacts from child malnutrition. Add all of those impacts up, and you can construct an argument that it’s worse than the virus itself.

Has the British government made a mistake, then?

Not just the British government, governments around the world. The short-term visible impact of the virus is very dramatic, and it compels action in a way that the more invisible, chronic effects do not. No politician likes images of bodies piling up in hospitals or morgues. And the medical community tends to want to save life at any cost, even when sometimes that cost is more than the life saved.

It’s a very difficult policy conundrum. I have sympathy for the mistakes policy makers have made. Just in the general population, there’s such a huge spectrum of opinion and huge variants in the perception of risk — from people who won’t step out of their door, to people who are pretty much going on as normal.

Did he feel that SAGE and other public health bodies have provided the government with bad scientific advice?

SAGE is a quasi-government body, with politicians, civil servants and scientists on it. There are all kinds of problems with SAGE, in its composition, its lack of transparency, its outputs. As for Public Health England, I’ve been really disappointed by their contribution to SAGE and to the wider public debate. They’ve been very silent, and when they have spoken up, it’s not been good. The reputation of public health in the UK in general has taken a battering. It’s not performing well. There were mistakes in Imperial College’s initial modelling of the pandemic, for example.

We used to have some of the best public health institutions in the world in this country, providing the best training. There is a lot of public health expertise out there, in Public Health England, in the NHS, in local government. But it’s been very poorly utilised. The government’s approach has been very centralized. That’s one of the main weaknesses. With outbreaks like this, you need a decentralized, localized, bottom-up approach. Instead, the government is using one private company for testing, another private company for tracing, and so on. It’s a recipe for disaster, and that’s what it’s been.

There’s an irony that the Conservatives — supposedly ideologically against centralized statist command-and-control and in favour of grassroots solutions — should be trying to steer through this pandemic using a team of four or five people in Number 10 (not even the entire Cabinet, according to reports). All those thousands of blog pages Dominic Cummings wrote on the art of good government, the science of learning quickly from mistakes, and the wisdom of getting out of the Westminster bubble, and what happens at the first crisis? Retreat to the bunker. Command and control. Don’t trust the civil service or the regions to be able to cope. The cost of that distrust is a general national failure. The government should trust the regions to deal with outbreaks at the regional and local level.

Still, that is not the main takeaway I took from my conversation with Professor McCoy. The main takeaway I took is we need to learn to live with COVID19. We froze into a defensive curl for two months, and now we have to uncurl and get on with living, albeit in a new, socially distanced way. Not just the young and healthy, but all of us. We can’t demand that the vulnerable and the over 70s keep locked up, sometimes in solitary isolation, for a year or more until a vaccine is (possibly) developed and disseminated. That is cruel and inhumane.

It’s also cruel to keep 18–30 year-olds shut in. They are the least likely adult group to die from the virus, but are suffering the worst mental health effects, according to the Office of National Statistics. There are five million Brits who live alone — they cannot stay locked in and denied basic human touch for a year or more. Not possible.

As the Stoics said, it’s quality of life that’s important, not the quantity of years. There is also such a thing as quality of death — why make pensioners die in a hospital alone, surrounded by faceless staff in PPE? Why not let them die at home, supported by a loved one, in quarantine?

We have a responsibility to live carefully so as not to spread the virus to others. But we also have a choice, whether to live our life in fear and cower in our homes waiting for a vaccine that may never come. Life is dangerous and we will definitely die one day. In the meantime let us live.

Written by

Fellow @ Centre for the History of the Emotions. Author of Philosophy for Life, Art of Losing Control, and new book Breaking Open www.philosophyforlife.org

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