Following the Science or a National Scandal

We can see in the United States right now the dangers of having a populist [1] president running the country during a serious pandemic. Incredibly 90% of Republicans trust the president to give them accurate information about the outbreak. A president who first called the pandemic a Democrat hoax, and then said it was under control and now wants to end social distancing to celebrate Easter. Some of those people will be paying with their lives for this misplaced trust, but by the nature of pandemics plenty of those who are not Republicans will also share this fate.

The UK also has a populist government. Johnson and his cabinet are where they are now because they championed a cause that pitted the elite and experts, who thought being part of the EU brought benefits to the UK, against the ‘people’ who thought otherwise. But superficially it appears that with this pandemic these populists are taking note of experts. They are following the science, we are repeatedly told.[2]

But what science have they been following? The World Health Organisation (WHO) provided detailed information in February about what was happening in China, and their advice was test and socially isolate. Western countries were all far too slow to follow that advice, but the UK stands out because it tried to follow a different policy. The government no longer likes the name, but herd immunity was the government’s initial response to COVID-19. That is why it seemed content to allow large gatherings, even those involving fans from a Spanish city that was already in partial lock down, to go ahead. So why did the UK go for herd immunity when the experts in the WHO and who advise other countries gave very different advice?

What detailed discussions were going on in the group advising ministers (SAGE) we will not know until an inquiry is held, but it seems highly unlikely that they were unanimous in presenting “the science”. The UK’s chief scientific adviser, Patrick Vallance, has said “If you think SAGE is a cosy consensus of agreeing, you're very wrong indeed”. According to one report:

“Several of the scientists frantically argued that the UK must immediately introduce social distancing to halt the spread of the virus. Some pleaded with the government to change tack or face dire consequences. But others continued to believe that introducing social distancing now would be unsustainable for a long period and would lead to a more disastrous second wave of infection.”

In other words there was no unified science, but disagreements among experts advising the government. There also seems to have been a concern within the government about the economic costs. So the question to ask is why did the government follow some of the experts (a small minority internationally) and not others?

Here we have to introduce the preferences of the Prime Minister. We need to go back to January, when the seriousness of the news out of China became clear. According to this report, the Chief Medical Officer Chris Whitty warned the cabinet in January that other countries might experience this pandemic, but Boris Johnson’s instincts were to resist a life changing crackdown, and Dominic Cummings agreed.

It seems that so convinced were both politicians that nothing needed to be done that they failed to do what any good politician should do, and plan for contingencies. The time that was lost in those days before the “herd immunity” strategy was changed is the key to why so many things have gone so horribly wrong since. These range from minor, like Johnson continuing to shake hands, to critical failings like not ramping up testing capacity (the UK was among the first to develop a test, but is testing far fewer than other countries), not ordering more ventilators until dangerously late, a failure to deliver protective equipment to all doctors and nurses well before they were needed and the complete failure to quickly unroll a public information campaign.

No doubt attempts will be made to blame the advice Johnson received rather than the Prime Minister himself. [3] But Johnson’s and Cummings’ instincts led them to follow some advice and not others. Any Prime Minister, seeing that their strategy was virtually an outlier among other European countries, should have realised that the advice he was choosing to follow was not being followed elsewhere, and questioned how much they were being selective in what advice they followed. At the very least they should have prepared for the possibility that they were wrong.

Both Cummings and Johnson should have realised that herd immunity was playing with fire. As deaths mounted were they really going to sit on their hands. As Chris Giles points out, herd immunity is not time consistent, which means a plan made today will almost inevitably be changed tomorrow. Given that, doing nothing at first and then going for suppression makes the job of suppression much more difficult. Herd consistency, like wait and see, has costs attached that can be measured in lives lost.

There is also the issue of risk. Let us suppose one of the epidemiologists advising the government had once suggested that under a herd immunity strategy hospitals could just about manage at the peak of the pandemic. In those circumstances any serious politician should have asked how much uncertainty was attached to that prediction. Could what happened in China happen here, they should have asked? Anything other than a resounding no to that question should have led any politician worth their salt to plan for a worse case outcome. Instead Johnson appears to have done nothing.

Even after 16th March the Prime Minister followed the suppression strategy in a half hearted manner. What he should have done, as soon as was possible, was to impose something close to the maximum degree of suppression immediately. Instead it came in a piecemeal fashion: The Prime Minister kept saying “when the time was right” at his press conferences. Instead of trying to get the pandemic under control as soon as possible, it seemed he was trying to squash the curve by just enough to ensure hospitals were not overrun.

As Chris Giles also points out, that is not a strategy any economist would ever advise. It is the equivalent of walking on the very edge of a cliff path. Given the uncertainties involved, there was a high probability that you would fall off the cliff, which in this case would mean overwhelmed hospitals and many more deaths. I doubt it is the path that any epidemiologist would advise either. Instead it reflects the Prime Minister’s distaste for restricting people’s freedom, as well perhaps as his own charmed life.

The damage Johnson’s inaction has caused and will continue to cause is measured in lives needlessly lost. Please listen to the voices of doctors and nurses being asked to put their own lives at risk because of the impact of austerity (WHO standard protective equipment was not ordered in 2017 because it cost too much), and because the government bet everything on the success of herd immunity until 16th March. Tragically on 29th March the first NHS doctors died of COVID-19. As many have said, medical staff don’t need handclaps, they need proper protective equipment.

Ian Dunt writes “You get what you pay for. We elected an after dinner speaker for prime minister. And that was what we got.” We can be more specific. Voters elected a leader who told us that we shouldn’t worry about the economic and political costs of leaving the EU, because everything will be fine. The Blitz spirit, taking it on the chin and so on. That is bad enough when the economic costs are real and have already started to be felt, but that same approach before a pandemic will bring disaster in very short order. A blusterer who has a problem remembering specifics is not the kind of leader you need in times of crisis. (Nor do you want a Prime Minister to delegate strategic thinking to someone who despises the apparatus of government and wants to listen to weirdos and misfits.)

Did the government follow the science? In a way that question is irrelevant. As Ben Chu suggests, dealing with a pandemic does not involve dealing with a science where the answers are well established and known with near certainty. No scientist would want to stop a government, on seeing the first cases of COVID-19 in the UK in mid-February, distributing PPE equipment to medics, ordering new ventilators and ramping up testing capacity. That this didn’t happen in the UK until mid-March is, as the Lancet suggests, a national scandal.

[1] I’m using the term populist in the sense of Jan-Werner Müller: see here.

[2] There is one case where the government’s Brexit position may have directly put lives at risk. The idea that the UK government missed out on EU procurement of PPE and ventilators because an email went missing is as plausible as the dog ate my homework (see here). It seems much more likely that someone didn’t like the optics of the EU helping the UK out in a crisis.

[3] Nafeez Ahmed describes why the advice they might have been getting could have been wrong. As I noted in the Update to this post, I was concerned based on my own limited knowledge of pandemic modelling that there was too much groupthink based around modelling a milder flu pandemic.