Two paths to controlling COVID with vaccinations

 

As vaccination is rolled out across advanced economies, the main danger has become mutations of the virus, or variants. We all know about the B.1.1.7 variant that emerged in the UK in September and helped generate the rapid rise in cases in December. We also know about the ‘South African’ variant (B.1.351), which appears to reduce the effectiveness of all vaccines to some degree. But these are just two of the better known variants, which seem to be emerging all the time (see also here).

COVID variants are the reason that so many countries have now severely restricted travel (‘almost closed borders’) into their countries in recent weeks. One of these variants could severely reduce the effectiveness of a country’s vaccination programme. It is likely that scientists would be able to change their vaccines to deal with these variants, but that will still mean at least another year before everyone is re-vaccinated and therefore means another year of lockdowns. We also do not know whether scientists could ever win a race between vaccine development and the ability of the virus to mutate.

Virus variants arise when there is a large amount of the virus about. One of the many failings of Western countries during this pandemic is to believe that you could safely vaccinate in an environment where domestic cases were high. That is exactly the environment that encourages mutations that are better at avoiding vaccines. If Western countries had followed an elimination strategy after the initial outbreaks in Spring last year, it would have been possible to keep borders open between these countries and the chances of producing a variant that can bypass vaccines within these countries would have been eliminated. In addition we would have had a small fraction of the deaths we have seen, with much less disruption to the economy.

Western countries now face a choice of how they handle COVID as vaccines are rolled out. Although no doubt reality will be far more complex than this, I think we can illustrate two types of outcomes available to them by thinking about two possible paths. I will call these two alternative paths ‘elimination’ and ‘living with COVID’. As with any attempt to look into the future, it assumes an existing technology that could change, and it involves some assessments that may prove wide of the mark (or maybe just wrong).

Elimination

This path tries to use a combination of almost closed borders, vaccination and other measures to enforce social distancing (including lockdowns) to get cases down to very low levels. At these very low levels, measures to enforce social distancing can be relaxed and an efficient test, trace and isolate (TTI) programme can keep R<1. During the summer, zero-COVID is achieved. The advantages of elimination are (see also here)

1. Once elimination is achieved, there is no chance that COVID variants that can bypass vaccines will emerge at home. While elimination is being achieved those chances are greatly reduced. This gives scientists a chance to develop new vaccines that can deal with known overseas variants while keeping everyone safe and COVID-free.
   
   

2. Countries that have achieved elimination can very easily open their borders to other countries that have done the same. Obviously this advantage is not that great if no other Western countries eliminate the virus.
   
   

3. Once elimination is achieved, the domestic economy can fully recover, there will be no more deaths from COVID, and there will be no more new cases of long COVID.

There is an important caveat to these three advantages. No ‘almost closed border’ is going to be foolproof, as both Australia and New Zealand have seen. When failure occurs, if TTI cannot eliminate the new cases, a short sharp lockdown is required to ensure the country returns to zero-COVID.

Living with COVID

This alternative arises when governments do not make any attempt at elimination, and two other outcomes prevail

1. Because of widespread vaccination together with TTI, countries can ensure R is very slightly below one in the summer months (If R is a lot less than one, elimination may occur naturally.)
   
   

2. However because COVID cases are still around by the end of summer, as winter approaches R increases to be above one, and cases increase. However because of vaccination cases never increase by enough to threaten health services, and once spring appears (or possibly before that) cases start to decrease again. (If cases rise in winter sufficiently to overwhelm the NHS, a further lockdown will be required.)
   
   

In this situation COVID becomes more like flu (it clearly isn’t like flu without vaccination), causing many deaths in winter but largely disappearing in summer. We learn to live with COVID.

Opening up borders now becomes a more messy affair. Countries would have to take informed guesses about whether other countries COVID cases were ‘safe’ (meaning they contained no dangerous variants) or not. However if most countries do not eliminate COVID, it will be easier to open borders to many countries than under elimination, once those countries have a similar number of cases that don’t include dangerous variants

There are two risks under this strategy. The positive risk is that vaccination turns out to be able to keep R<1 for most of the time, so COVID gradually dies out. This may happen because people feel more confident about being vaccinated as time goes on, and vaccines get better. Under this outcome, we don’t have to live with COVID for very long.

The negative risk is that during winter months when cases are high a mutation may develop that could bypass existing vaccines (partially or completely). This would be a very dangerous outcome, because it is likely to be some time before this variant is detected, by which time its numbers have multiplied substantially. (An advantage of the elimination strategy is that all outbreaks are treated as if they were dangerous, and are obviously much easier to see.) It is not clear to me how such a situation could be controlled without at least a year of lockdowns while new vaccines are developed and/or rolled out. The same danger arises from a failure in the ‘almost closed border’ that lets in a case with a COVID variant that can bypass vaccines.

Compared to the elimination strategy, there are two obvious advantages in living with COVID. The first is that lockdown can be relaxed or ended earlier. The second is that the country becomes less vulnerable to failures in its ‘almost closed borders’. The certain disadvantage compared to elimination is more deaths, and there is also the risk of allowing the development of variants that can bypass existing vaccines.

East versus West

At present the elimination strategy is being adopted by a group of countries which is small in number but does include China as well as Australia, New Zealand and Taiwan. There is no indication at the moment that any other countries are likely to join this group. It is also unclear whether these countries will continue with elimination once vaccination is widespread. They may be doing similar analysis to this (although no doubt better) to help them decide.

One prudent policy for the existing elimination countries is to wait and see how ‘living with the virus’ works out. If Western countries do learn to live with that strategy, the negative risks I point out above do not in practice occur, and they succeed in opening borders to each other at least, then there will be a strong incentive for the elimination countries to abandon that strategy. Equally, however, if it looks like Western countries are constantly playing catch-up with new domestically generated virus variants that bypass existing vaccines we may begin to see some Western countries begin to adopt elimination.

The UK government’s strategy for ending lockdown

Of the four criteria the UK government is going to use in deciding how quickly to ease its lockdown, steadily reducing cases is not among them. Instead we have “Infection rates do not risk a surge in hospital admissions” which is a much weaker criteria. It is actually exactly the criteria you would have under the ‘living with COVID’ strategy. It is therefore clear if unsurprising that the UK government has no intention of switching to an elimination strategy.

Much has been made of the government’s new step by step, data driven patient approach. What is less often said is that such an approach is essential to avoiding another resurgence in cases when most people have not yet been vaccinated. (Perhaps Tory MPs wanting to open everything quickly are only there to make the government look good?) Opening schools all at once in March is a risk. While it is good that secondary school children will be required to wear masks at all times, in France children aged six and over are told to do this. There is probably a lot more that could be done for schools in terms of ventilation, bubble sizes and so on. We also need to prepare for the possibility that schools going back may raise R to almost one, which would effectively invalidate the government's approach.

What is also not widely appreciated is that SAGE forecasts, like those released yesterday, are going to play a critical role in deciding how quickly lockdown is relaxed. Only in this context does the need to ensure “Infection rates do not risk a surge in hospital admissions” make sense. What SAGE needs to forecast is what level of cases in the summer, with lockdown at an end, is sufficient to ensure that the increase in cases over autumn and winter does not overwhelm the NHS. It is a very difficult forecast to make because we have no experience of what happens when most people are vaccinated, and if the government is wise it will base its calculations (on when to ease lockdown) on a worse case scenario. Unfortunately if it did that it would be acting out of character.

You also have to ask whether, if you intend to follow data rather than dates, it is wise to then announce a complete set of dates attached to a detailed list of the restrictions that will be lifted all the way to the end of lockdown? This gives a mixed message at the very least. In reality, given that we are far from clear how effective each element of the lockdown is, there may be a danger that the whole timetable is built on sand. But in political terms, this timetable is going to have a strong influence on expectations (where caveats are forgotten or just ignored by print media). The net result may be that disappointing those expectations will be a large political cost that politicians will not want to incur. A timetable this precise may have the effect of taking decisions away from the scientists when the data turns out to be worse than expected.  

Why vaccines alone are not enough, how the UK government could mess things up again and which European country will eliminate COVID first?

 

Why has the UK government decided to apply serious travel restrictions to incomers because of COVID now, almost a year after the pandemic began? What took them so long, and what has changed? The obvious answer to the second question is vaccination and mutation.

We don’t know how much the vaccines so far approved will stop people passing on the infection to others, but what evidence we have suggests there will be at least some dampening effect. Israel is likely to provide the first firm evidence on this. That will reduce R, the number of people one infected person passes the illness on to. What vaccines will certainly do is substantially reduce the chance of people getting ill from COVID.

The danger is that, as vaccines are rolled out, the virus develops the ability to bypass them through mutation, so vaccines either don’t work at all against this new variant or work less well. This doesn’t seem to have happened to a large extent yet, and it isn’t inevitable, but it has happened to a small extent and it would be unwise to assume it will not happen. The chances are that variants are likely to emerge in other countries first, so it makes sense to try and stop that variant entering into the UK for at least as long as possible.

While this provides an excellent justification for creating travel restrictions today, it doesn’t explain why effective general restrictions were not imposed before. (There have been requirements to self-isolate, but these seem largely voluntary.) A cynic might say that the underlying UK strategy is and always has been herd immunity, but I think that only applied at the beginning of the pandemic. After then, with UK cases more often than not higher than elsewhere, the incentive for effective and generalised border controls was not enough to motivate this government.

While the chances are that any variants that can bypass vaccines will emerge abroad, it is possible they will emerge in the UK because we are vaccinated in an environment of widespread infection. The big danger left is that Johnson will once again relax lockdown restrictions too soon, before enough people have been vaccinated. The quicker we reduce case numbers in the UK, the less chance there is that a vaccine-resistant mutation develops in the UK. In addition the more cases there are, the easier it is for an overseas variant to multiply. No restrictions on people entering can be 100% safe, as New Zealand recently found, and a complete ban on people entering is not feasible because of returning nationals. Johnson should know this because his failure to get case numbers really low over the summer allowed the UK variant to develop and multiply.

It makes sense to reduce UK cases as quickly as possible to very low numbers, to reduce the chances of mutation and increase the chances of isolating any variant that comes in from abroad. Whether you call it zero-COVID or elimination or whatever, that strategy has always been the one that minimizes deaths and gets the UK back to normal as quickly as possible. Vaccines don’t change that reality, they just make it easier to implement. One argument put forward against an eradication strategy has been the costs of quarantine in hotels, but now the UK government is doing quarantine that argument falls away.

Just as the UK is now imposing quarantine for incoming travellers, or requiring recent tests, the same is likely to happen in other countries for similar reasons as their vaccine programmes are rolled out. For a period of time we will have many Western countries where there is much reduced inward human travel. This is an outcome that I imagined happening many months ago once the scale of the pandemic became clear, and should have happened if best practice had been followed.

Once such a situation comes about, it creates two sets of very positive incentives for countries imposing quarantine. First, each country has a strong incentive to eliminate the virus, so that they can free travel up with other countries that have done the same. We will get travel bubbles being formed. Those bubbles will be fragile, as they have been for Australia and New Zealand, but they represent the beginnings of international cooperation to eliminate the virus.

The second incentive for those countries that do eliminate COVID is to get other countries to do the same, so free travel between countries becomes possible again. But even with quarantine, risk can only be completely eliminated when all countries have eliminated the virus. So the second incentive is to get the vaccine to poorer parts of the world as quickly as possible, with the help of international cooperation.

That is the strategy that the UK should now follow. However the UK is a country that has more than a 100,000 dead from the virus, with currently one of the highest death rates in the world. This reflects in part the fact that we have a weak Prime Minister, who is very indecisive, puts off decisions, wants to please and is easily swayed by pressure from others. We already have a large number of Tory MPs and business people who are clamouring to end the lockdown whatever dangers that brings.

The problem is that Johnson does not only listen to scientific advice, which is to avoid any relaxation for some time. He also listens to his MPs, some of whom have very strange but strongly held views on lockdowns. He has already said that he hopes to reduce some restrictions at the end of February, despite also saying that closing schools will be the first restriction to end and it probably will not happen until Easter. Of all the restrictions in the current lockdown there is a strong case for getting schools back first, but any relaxation of other elements of lockdown before then makes that less likely or more dangerous. Time and time again Johnson has gone for short term popularity with terrible long term costs, using as an excuse a trade-off between health and the economy that does not exist beyond the very short term.

Another indicator that Johnson may mess things up is how he has oversold vaccines. They have been presented as the solution to the pandemic, rather than as a key tool among many in ending the pandemic. With new infectious variants already circulating, we cannot be sure that the vaccination of everyone who is willing to be vaccinated will be enough to achieve herd immunity (see also here). But the main reason why vaccination is not enough on its own is the generation of variants. As this excellent discussion from Anjana Ahuja suggests, Taiwan, China, Australia and New Zealand are the examples to follow, and vaccination will make it much easier to follow that strategy.

It would be nice to be optimistic that some other Western countries will follow this advice. Unfortunately, while most European governments are not as foolish as ours, very few have shown much wisdom either. Read this from Le Monde on how Macron is also putting off the inevitable as cases climb. To quote, Macron “does not want to let this measure be imposed as long as the figures do not show the urgent need for it. With around 20,000 new cases per day, France can still avoid it, he believes.” You only need to look at the data to see how unlikely he is to be right.

It is an interesting question why no Western government has learnt the lessons from the East. Why do none have a leader who is prepared to go with the science? Instead we have politicians who balance what the experts say with pressure from small businesses and others in various sectors to do the opposite. Everyone wants financial support and Ministers of Finance worry about the cost. Few with any power seem to realise that the strategy that minimises costs, disruption to business and saves the most lives is locking down hard and fast, and trying to minimise cases. The media reflects the myopia of actors rather than leading. (How many discussions on how Australia has handled the pandemic have you seen in the UK broadcast media, and has it been greater than discussions of Sweden?)

The common idea as to why Australia and New Zealand have followed an eradication strategy from the start is that it is easy because they are islands with less international travel than European countries. That is not quite right for Australia. COVID policy is determined at the state level, and the states have imposed land border restrictions between each other when outbreaks have occurred. We can only hope that once European countries start imposing international travel quarantines as their vaccine programmes are rolled out, and now they have a better understanding about how not to handle the virus, some at least will follow Australia and adopt eradication as a goal.

I think it is likely that once a few European countries do this, most will follow as the advantages of an eradication policy become clear. As Norway already has a variety of border controls including hotel quarantine in place, and a low number of cases, my guess is that Norway may be among the first European countries to adopt elimination of COVID as a strategy. Finland, which also has strict entry requirements and a relatively low number of cases, is another possibility. With a head start in terms of vaccine supply it could be the UK, but with a Prime Minister who says he wants to wait before learning from past mistakes I somehow think it won't be. 

Why the UK’s COVID crisis should be personal for so many Tory voters

 

There are around 16 million over 60s living in the UK, nearly a quarter of the UK population. They are the most at risk from COVID: catching the virus could be a matter of life or death. To them the government’s handling, or rather mishandling, of the pandemic should be a matter of acute personal concern. It certainly is for me. Around 60% of over 60s voted Conservative in the last election.

The NHS is currently at breaking point. Tired and demoralised after almost a year of COVID, doctors and nurses find their hospitals are full and we haven’t yet seen the impact of Christmas and New Year. Whereas Johnson acted in March to save the NHS, this winter he decided to save Christmas instead, until he was forced to backtrack at the last minute. You can blame people for not following the rules, but the government should plan for how people actually behave, not how they should behave.

There are so many errors that led us to this dreadful crisis. Let me list the main mistakes, ordered by time..

1. March itself, while Johnson dithered about whether to follow SAGE advice. That is estimated to have cost around twenty thousand lives but it also was a factor in subsequent mistakes. By allowing cases to build up he made things much harder subsequently. The government’s policy seemed far too laid back at the time, but we now know there were crucial delays between the science changing and policy changes (see also here).
   
   

2. Because cases were so high, it took some time to get them back down. The longer it takes, the more impatient populist politicians and small-picture Chancellors become. What should have happened in April was that the government promised to get cases right down to very low levels, so that subsequent flare-ups would be more manageable. An eradication strategy would have been better, but to be fair that only became a consensus policy among experts around late summer. What Johnson and Sunak did was relax the lockdown too soon, so we ended up with a significant caseload that was not falling in the summer. They also weakened compliance as a result of a well known episode.
   
   

3. Another way you can deal with flare-ups in cases is to have a very good test and trace system. The government promised one, but ended up doing the opposite while spending far more than they needed. It reflected their ideological obsessions: a hatred of government and a conviction that the private sector could always do better. They couldn’t, and local government health teams were left to do the tracing the government’s centralised system failed to do, but by then it was all too late. What it should have been able to do is reduce cases over the summer, but it failed. Rather than accept their error, they kept on with their failing system wasting huge amounts of money. As Chris Giles has noted, the UK spent more and achieved less than other countries.
   
   

4. When cases stabilised in the summer, the government should have started thinking about how it would deal with the return of schools and universities. Instead they seemed to act as if the pandemic was over! They told people to stop working from home, and Sunak even devised a scheme to get people back into restaurants which research suggests significantly increased cases.Once again they ignored what was happening in other countries.
   
   

5. This and the return of schools and universities led to a significant increase in cases. It started to become difficult or impossible for people to get tests. SAGE recommended on 21st September a two week circuit break to try and reverse the upward trend. Sunak was against it and Johnson ignored the advice of his experts. Sunak in particular seems to be in denial, insisting that the furlough scheme will be brought to an end, causing many people to lose their job.

Cases continued to increase exponentially, because the government was doing nothing. Johnson said that people had become “complacent” and “a bit blassé” about transmission, perfectly describing himself. In reality if cases were stable in summer (R=1), you would expect cases to be rising as summer ends (people spend less time outdoors) and schools and universities return. There is nothing unpredictable about the second wave the government is allowing to develop, yet even when it becomes clear the government shows no interest in doing anything to stop it besides blaming the public.

6. Finally in mid-October the government moves, but rather than a national lockdown it introduces different levels of local control: the tier system.  Which tier you are in seems largely based on how many cases there are, rather than the speed at which they are increasing. This system formalises what many have feared, that the government is content to see cases rise up to a certain point.

As a result, the tier system becomes a kind of escalator. The lower tiers don’t do enough to stop local cases rising (in part because people move between tiers), so they become just staging posts before the inevitable move to a higher tier. The tier system slows the pace of the national increase in cases, but national R remains above one. To state the obvious, that allows hundreds to continue to die, and makes a national lockdown all but inevitable.

7. At the end of October, the Prime Minister bows to the inevitable and announces a national lockdown, although not as strict as in March. The lockdown begins to work, and cases start falling. Yet foolishly he states an end date for the lockdown, when any sensible lockdown should end when cases have been largely eliminated, and not by some arbitrary date.
   
   

8. At the start of December the lockdown had brought cases down from an average of nearly 25,000 a day to something like 15,000 a day (based on specimen date data). The Prime Minister stuck to the beginning December end date for the lockdown, and the country moved back into much the same tier system that had previously failed, with London in Tier 2. As Johnson was intending to allow a Christmas break, this was an almost criminal decision.
   
   

9. The warning signs were immediate. Cases started rising again the moment the lockdown ended, if not slightly before. We now know that this was partly due to a much more infectious strain of the virus. The more virus there is around, the more likely it is to mutate. The government, by allowing a high caseload to persist, and provided the environment that made mutation more likely.
   
   By 12th December the number of cases had surpassed the pre-November lockdown peak, yet the government did nothing except move London into tier 3. The government continued with its plans for a five day Christmas break, in what was obviously now a second wave to rival the first in size. It was madness, just based on the numbers alone, without any knowledge of new variants. Yet we had to wait until the 19th of December before the Prime Minister changed his Christmas plans. We were seeing a repeat of March, but this time the government’s failure to adjust its actions to the data looks like overwhelming the NHS.
   
   

10. Tiers are pointless when you have a new highly infectious strain gradually spreading across the country. We should be in national lockdown, with the start of school postponed, because of the new virus strain, as SAGE advised on 22nd December. Yet once again the government has done too little, too late, because it ignores the science. You don’t avoid lockdowns by delaying them, you just ensure they go on for longer. All the controversy about when to get the second vaccine is only happening because the government has lost control of the virus and refuses to do what is needed to regain control.

You might say it is all very well making these criticisms in hindsight, but that is not true. I, together with many better qualified experts, made these criticisms at the time. In May in the Mirror I said that the first lockdown should aim at getting “daily number of new infections down to single figures” to save lives and the economy. In June I wrote in the Guardian that there was no health/economy trade-off beyond the very short-term. Under many of the points above you will find links to my own blogs making much the same arguments at the time mistakes were being made.

How can a government that lived through March 2020 not just repeat the same mistakes again, but make worse mistakes? There are obvious people to blame. Tory MPs with their head in the sand, following a Death Cult that says all we should do is protect the vulnerable. Much of the right wing press pushing articles advocating the same, by journalists who keep getting things wrong but carry on regardless, like all the people who said there wouldn’t be a second wave based on obvious nonsense. A broadcast media that indulges such nonsense rather than ignoring it or putting it down. But when a Prime Minister, supported by his ministers, ignores medical advice again and again, the responsibility rests entirely with him.

The evidence for other countries is now clear. As New Zealand and Australia have shown, you first drive cases down to as close to zero as you can, and then act quick and hard whenever there is a flare-up. That allows you long periods where everyone can behave normally, and the economy can return to normal. The cost of that policy is to have a quarantine system for people coming into the country, not of the ineffective kind enacted in the UK but proper quarantine as done in the countries that have successfully dealt with COVID. Devi Shridhar estimates that following this kind of policy could have saved over 80% of lives lost to COVID in the UK.

The people most at risk from this pandemic are those who predominantly voted this government in. Their lives are at risk mainly because of government failure. In contrast the Labour opposition has acted more responsibly, following the science. They should be switching their votes from Tory to Labour in their millions. But the newspapers they read are doing their best to hide the truth from them, the broadcast media with a few honorable exceptions chooses not to enlighten them, and recently it appears the government has resorted to trying to hide what is happening in hospitals. So those over 60 will continue to vote for a government that through its failures is literally killing them.

Politicians and experts: austerity, Brexit and the pandemic

 

I’ll be talking about fiscal policy during and after the pandemic at a Resolution Foundation/MMF event in a week’s time: https://www.mmf.ac.uk/resolution-foundation/

I have written quite a few posts on the relationship between policy and expertise, and between expertise and the media. The better ones are in my book, but they were all written before the COVID pandemic. How does the relationship between experts on the one hand and politicians and the media on the other that we saw with economists over austerity and Brexit play out with medics and the pandemic?

All three cases are different from each other. Although the evidence set out in my book suggests that the majority of academic economists opposed austerity (a majority that got larger as time went on), this plurality had no impact on either the media or the politicians pushing austerity. A few well known academics who supported austerity got a lot of publicity, but this was because they supported a policy pushed by politicians and the media, and not because they were influential in driving the policy. An obvious example in the UK was Ken Rogoff, who supported protecting public investment from any cuts while the government did much economic harm by cutting public investment.

The most notable feature of austerity was the almost total disregard by the media of the views of the majority of academics. As Alan Winters in his analysis of experts and Brexit points out, it was David Henderson who said in his Reith Lectures of 1985 “There is no doubt that the policies of governments … are influenced by economic ideas. But … these have not necessarily been the ideas of economists”. This applies with equal force to the media. The media appeared to apply the logic of the household to governments, so that the necessity of paying back debt as soon as possible became common sense, even though saying this would be a fail for any first year economics undergraduate. For that reason I called it mediamacro.

The power of media narratives should never be underestimated, as the Labour party has experienced many times to its cost. Austerity was just another example. It was a particularly devastating example, because in this case the media’s common sense did terrible harm to the economy, and the media was ignoring what it should have regarded as a key source of knowledge, academic macroeconomics. Needless to say, media organisations have never examined their own mistakes in this regard.

Brexit was different in two respects. First, what was a plurality over austerity was an almost total consensus on Brexit. Making trade more difficult, which almost any form of Brexit did, would cause considerable harm to the economy. The second difference compared to austerity was that the broadcast media had less of any common sense to appeal to, and so they played the ‘two sides’ game. On the one hand was the overwhelming consensus of academics, together with all the major economics institutions, and on the other was a handful of pro-Brexit economists the most noticeable of whom was Patrick Minford. (A few media outlets, and particularly the Financial Times, did follow the academic consensus.)

In defence of the broadcast media, this ‘two sided debate’ format is their default on most issues, and it doesn’t normally matter what the expert consensus is (which is typically not mentioned). However as we saw with austerity, there are exceptions. Whereas the exceptions should be based on the expert consensus, they instead seem to be based on common sense narratives. As with austerity, the media has never examined its own mistakes in relation to Brexit. As the referendum was very tight, the actions of the broadcast media in treating the overwhelming consensus of academic economists as just one opinion could well have influenced the result.

This trivialising of expert opinion is not inevitable. Strong pressure from academic bodies can yield results. The obvious example is climate change. When broadcasters began to increasingly ‘two-side’ the climate change issue, academics and others protested, and the BBC trust acknowledged that on this issue the expert consensus had to be followed. Not all BBC programmes have subsequently respected the Trust’s findings, but nevertheless you will generally see broadcasters treating the need to reduce man made climate change as a fact, and not as a controversial opinion.

The obvious difference between austerity or Brexit and climate change is that the former involves economists and the latter involves scientists. Actually the difference in methodology between climate change scientists and economists is not that great: both attempt to predict in a highly stochastic environment, and neither can easily conduct experiments. There are differences in public perception, of course. Besides the insight of Henderson noted above, there are various myths about economics that are part of the public debate. But the most relevant difference in my view is the absence of institutional pressure on the media from economists that matched the pressure over climate change.

Another academic discipline that has similarities to economics is medicine, and more specifically public health and epidemiology. The story of COVID-19 initially appeared to be more optimistic than austerity and Brexit. In many European countries, including the UK, governments took scientific advice, although in the UK with a short delay that probably cost tens of thousands of lives. But as Alan Winters notes, that optimism has been short lived. In most countries in Europe, including the UK, the second wave has been far worse because politicians ignored the expert advice.

The rationale they have given for ignoring the medical experts has been to balance health with the economy. The irony is that once again most economists I have seen who have studied this issue have agreed with me that there is no meaningful trade-off between the economy and health beyond the very short term. Once again academic economists are ignored, this time where lives are directly at stake.

The media have faithfully echoed the excuses for ignoring the expert advice, seemingly ignorant of the fact that they have little basis. From what I have seen they have given air time to experts and particularly politicians pushing the ‘lockdowns do not work’ nonsense, as if this is just another opinion. I suspect once again this is because it is ‘common sense’ that there is a health/economy trade-off, because most people do not think in dynamic terms. I have not seen government politicians questioned in interviews for not following expert advice in a similar manner to the way Labour politicians were questioned for doubting Osborne’s austerity.

Why did politicians initially say they were following the science of how to deal with the pandemic, while the same politicians ignored economists on Brexit? It is not because medicine is a science and economics is not. As I have argued elsewhere, the two disciplines have many structural similarities. Henderson’s point about prior beliefs is undoubtedly one reason: not many non-medics thought about pandemics before there was one. For politicians another reason is ideology. With austerity and Brexit it was ideologically convenient, and perhaps even necessary, for its proponents to discount expertise. Initially there appeared to be little ideology involved with controlling a pandemic, beyond libertarian instincts.

One reason attitudes to medical experts changed among government politicians between the first and second wave was the emergence of ideology dressed up as science: the Barrington Declaration and all that, and the influence that has had on many Conservative MPs. Once again, it became in the interests of those politicians to ignore expertise, just as they did with Brexit. The correlation with pro-Brexit and anti-lockdown views is no accident. The lesson is simply not to elect politicians who can so easily cast aside expertise.

Unfortunately that is less likely to happen as long as the media fails to tell viewers what the consensus among experts is. I have made this point before, but I think the lesson of climate change is instructive. The media are not going to change what they do, particularly when some feel their existence may depend on keeping certain politicians happy. What changed the media’s approach to climate change, at least in principle, was pressure from science itself. The reason academic economics gets ignored is that academic economists don’t organise to apply pressure.

I have seen so many accounts of why economics was ignored over Brexit that blame themselves: things should have been presented more clearly, economists should have been more open about uncertainties, and so on. All have some truth, but none will make any difference as long as the media treats the consensus among academic economists as just another opinion. For the media to do otherwise requires the strongest pressure from groups who represent academic economists. At the very least, we need institutions representing economists telling the media what the consensus view (if any) is on particular economic issues. [1]

I suspect that some medics will be beginning to ask similar questions about the pandemic: why did politicians ignore consensus advice, why did anti-lockdown politicians get so much airtime and so on. The answers I suspect are similar to those I have just given for economics. Medics have one big advantage over economists: the bodies that represent them are used to applying public pressure. They should apply that pressure on the media if they want to avoid expert views about the safety of COVID-19 vaccines to be treated as just one opinion to set beside the opinion of anti-vaxxers.

[1] When I make this point I often get comments along the lines that I’m trying to impose conformity, and the public should be told about mavericks opinions because (very occasionally) they turn out to be right. I’m doing neither of those things. What is missing from the media is any sense of what the expert consensus is, and for politicians who depart from the consensus being interrogated on why they think they know better than the expert consensus.

COVID, the US election and media balance

 

I want to start with my last post. It contrasted a minority of countries that were good, were not too bad and the majority that were terrible at handling the pandemic. What surprised me was how willing people were to believe that each of the good countries had some special attribute that explained their superior performance, rather than accept the more obvious explanation that they had more practice at handling pandemics, or just had better governance. These countries that have handled the pandemic well knew that you needed a good TTI operation, you needed to keep case numbers low, you needed strong border control and in most cases that if you lose control of case numbers you lock down quickly and hard.

The UK has failed on all these counts. The experts learnt not to underestimate the virus after the first wave. They recommended a short lockdown in the early stages of the second wave. This is just the kind of thing that the good countries in my classification from last week would do. Johnson (or was it Sunak’s with a veto?) rejected their advice, using the spurious grounds that he was balancing health against the economy. You are balancing nothing when you leave R>1. Johnson and Sunak were wrong and we now have to have a month long lockdown, at least.

One of the consequences of this failure to deal with a second wave is that people get restive about lockdowns. Almost no one likes a lockdown, and restrictions on social life together with constant precautions against the virus get to people. They certainly have begun to get to me. Yet despite this, in the UK most people still support the current lockdown, even among 18-24 year olds. But there are also signs of lockdown fatigue: while a YouGov poll gave only 3% who didn’t support lockdown in the Spring, that figure has risen to 23%.

One important factor behind this growing antagonism to lockdowns is the anti-lockdown crusade that I talked about in an earlier post. The vocal political minority that do not want lockdowns at all are implicitly prepared to see hundreds of people die, and their health services overwhelmed. They talk about protecting the vulnerable but these claims fall to dust on examination.

Some members of the anti-lockdown crusade may really believe they have a better way to save lives, but for most the motivation is different. There is a lot of talk of libertarian ideology, or right-libertarianism, and I’m sure some of the Tory MPs who voted against their government last week see their opposition to lockdown that way. But increasingly this looks like liberty for some, and the opposite for others: doctors and nurses who will have to treat COVID cases in overcrowded hospitals, the vulnerable (however defined) whose liberty is indefinitely postponed, and those who die for the short term liberty of others.

Among the population, there is no doubt that among the minority that oppose lockdowns there are some who are simply selfish. Something along the lines of ‘why should we not be able to do the things we enjoy doing for a year or more of our lives when we know it is unlikely that the virus will kill me’. In addition there are risk takers, who somehow think that they will avoid the fate of others.

Both selfishness and risk-taking is emboldened by those who question the wisdom of lockdowns when cases are increasing out of control. Politicians and the press attacking lockdowns give selfishness and risk taking an excuse they need for their behaviour. They also provide an excuse for those who want to ignore lockdown restrictions. This is why the media should be very careful not to suggest that scientific and public health opinion is evenly divided on the wisdom of lockdowns, because it is not. There are clear parallels with climate change. Unfortunately our media is ruled by political balance, which nowadays all too often means balancing the truth with lies.

This is not the only reason why people may oppose lockdowns. An imperfect safety net for individuals who are adversely affected by lockdowns can give a much more compelling reason why people might turn against the whole idea. If you see a lockdown destroying your business, running down your savings, losing your job or even making you or your children go hungry you have a strong motivation for arguing strongly against it. It is difficult to call this being selfish.

The safety net is far from complete in the UK. The Chancellor has stubbornly refused to increase statutory sick pay for those who have been advised to isolate themselves. But in terms of safety nets the UK is far better than the US. I have seen a few remarks along the lines that without COVID Trump would have easily won the US election. I’m not sure that is right for two reasons.

The most obvious is that without COVID Biden would not have made COVID central to his campaign, and would instead have focused on other issues where Trump is weak. However a second reason is that Trump may be getting strong support from those that don’t want their businesses to close, who don’t want to be thrown out of work and don’t want to rely on an uncertain stimulus cheque.

We can see that to some extent in the national election exit polls. When asked about the issue that mattered most to people voting for each side, three issues stood out for Biden voters: racial inequality, the pandemic and health care. For Trump voters it was the economy followed by crime and safety. The contrast between racial equality for Biden voters and crime and safety for Trump voters is pure culture war. Social liberals rejoice over the black lives matter movement, while social conservatives see it as a threat.

The more interesting contrast is between the pandemic and the economy. The economy, normally near the top of most lists of voter concerns, comes fifth out of five for Biden voters. The pandemic has taken its place, and rightly so because the economy is not going to fully recover while the pandemic rages unchecked. In contrast among Trump voters the economy completely dominates the pandemic as a top issue, perhaps because measures to deal with the pandemic are seen as a threat to their livelihoods. [1]

While the broadcast media, at least in the UK, plays “both sides” games with the pandemic, contrasting the expert consensus with the anti-lockdown crusade as if each has an equal claim to truth, the mainstream US broadcast media stopped playing these games with Trump’s claims about voter fraud. It was impressive to watch CNN fill in the gaps between new votes coming in telling viewers why all votes should be counted, and Trump’s claims had no basis. (Yes, I know I had better things to do.)

These big media organisations (excluding Fox) were fortunate that Trump telegraphed what he planned to do well in advance, so they had time to work out their response together. When it came their response was emphatic, to the extent that most stopped broadcasting Trump’s speech when he started making these claims, telling viewers that such claims had no basis in fact. It is quite something to stop broadcasting a sitting President when he starts telling lies, although by then they knew he was not going to be President for much longer.

That is something to build on. Why not be equally emphatic about voter suppression, widely practiced in the US and coming to the UK. What is the essential difference between claims of widespread voter fraud and climate change denial? What is the difference between claims of voter fraud and claims that lockdowns don’t work and are unnecessary when cases are increasing? How can the BBC justify not following this example? Once media organisations start recognising that balance does not apply when one side is lying, why not stop balancing truth with lies more often?

[1] (added 10/11/20) Another example of how lockdowns can be unpopular comes from the Czech Republic, where it is widely believed that a lockdown was postponed until after senate and regional elections had taken place.  

The political economy and psychology of COVID rebounds

You can call it a second wave, or a resurgence of the first wave. But whatever you call it we are seeing in some European countries a steady (and occasionally rapid) increase in new cases after a longer period when new case numbers have been coming down or been stable.

A good reason to not call this a second wave is that the first wave never went away. Changing social behaviour, aided by government support and a lockdown, reduced new case numbers rapidly. However governments relaxed the lockdown before new cases fell to almost zero, and so domestic transmission continued at a low level. But why have the number of new cases started increasing in the last few weeks in many countries, after a period of apparent stability?

The simplest answer to this question is why shouldn’t they. The natural development of the virus is to create an explosive increase in cases. The first wave didn’t come near to creating herd immunity, so if people started to behave as they did before the virus emerged a second explosion is the inevitable result. What governments and those advising them must have hoped is that

1. social behaviour had been sufficiently scarred by the pandemic that people didn’t relapse into pre-virus behaviour, and instead that they continued to social distance, wash their hands etc

2. changing social behavior was sufficient on its own to keep R at or below one, even though the economy returned to normal, and most social restrictions had lapsed.

3. the country’s track, test and isolate (TTI) technology was good enough to deal with any local outbreaks.

Even if (b) and (c) are correct (and there is no certainty they will be), there is the danger that (a) is a function of the length of time since the initial pandemic. This will be true particularly for an age group where the virus is much less of a personal threat. It is therefore quite possible that the economy remains depressed because a large group of people worry about resuming their previous levels of social consumption, and at the same time another group of people are happy to forget about the pandemic altogether.

Another factor that may account for the recent pick up in new cases is the increased social mixing that generally comes from taking holidays. Someone who has an asymptomatic case of COVID-19 could possibly infect not just their usual social circle, but also all the people they meet on holiday. Such cases, because they transcend local areas, may be more difficult for TTI to deal with.

Why were governments so keen to end the lockdown? The political economy here is pretty obvious. Governments are under pressure from business, together with individuals.who fall through or are substantially disadvantaged by the government’s support apparatus. Because social consumption is such a large part of the economy, this pressure from social consumption sectors can be intense. For the holiday industry, almost a whole year’s business may be lost over a few summer months.

In addition governments start worrying about the cost of the support they are giving. Just the hint that the current level of support may be reduced is also enough to get individuals and businesses putting pressure on governments to relax the lockdown as soon as possible. National Treasuries may add to that pressure. Finally there is the ideology of neoliberalism, which can elevate the economy to become an entity that is more important than the people within it. That influence is very clear in the UK. (Whether the UK is on the point of joining other countries suffering a COVID rebound is difficult to tell, but in some parts it probably is.)

At some point the rise in cases in some countries may force them to reimpose elements of lockdown, particularly when schools reopen. There is a danger of a cycle of periodic lockdowns as cases rise and then fall, at least until a vaccine is available. One possible alternative is to make elimination of COVID-19, rather than just its suppression, the goal of each national government. Few governments have made elimination of COVID-19 their goal, with three exceptions being New Zealand, Scotland and Northern Ireland.

Why might elimination be a better strategy? Individual psychology is shaped by social (in this case government) goals. Most governments have focused on changes (the first derivative), then people and so typically the media has done the same. If cases are rising you throw everything you have at the problem, if cases are falling you can steadily relax any lockdown, but if cases are steady (and governments tolerate that) COVID drops down the news lineup. So (a) above is more likely to fail if governments focus on changes rather than elimination.

If instead the focus becomes eliminating any new cases then initial lockdown might be a little longer, but you could achieve some positive results. First, those that are naturally cautious know that it is safe to resume social consumption, and so the economy recovers more completely, although with bigger short term costs. Second, you would save more lives. Third, and this is much more speculative, if new cases start to emerge that becomes headline news and it receives the full attention of government and TTI resources (see very recent developments in New Zealand). However New Zealand’s success with this strategy owes a lot to enforced quarantine for anyone travelling from overseas, which would be more difficult for most other countries.

I do not know whether an elimination strategy would be more successful at avoiding the kinds or rebounds in cases we are seeing in many European countries, but what is very surprising is that there seems to be little public debate on this question outside Australia. There should be a lot more debate in the UK beyond the pages of the Lancet, given the different strategies pursued by the different nations within it. With previous administrations we would expect some kind of strategy document from the UK government on something so important.

Still knee deep in boxes, so next post will be in a few weeks time.

The reality behind fiscal scare stories, or mediamacro is alive and well

If you listen to the broadcast media, you will have almost certainly picked up the message that at some point in the near future the Chancellor is going to have to raise taxes or cut spending to ‘pay for’ all the support to the economy during the pandemic. At least the Financial Times has learnt the lesson of 2010, and notes in this editorial that the Chancellor

“must hold the line and resist attempts to push the UK into a premature fiscal retrenchment. Cutting spending in the middle of the worst recession since the creation of the country would be a historic blunder and make Britain poorer in the long run through unnecessary unemployment and business failure.”

If only they had said the same in 2010.

But they add “Eventually the bill for the crisis-fighting measures will come due.” This is also the message of the latest report from the OBR. We can see what they have in mind from this chart.

The upper dotted line is the OBR's worst case scenario. Next one down is the central scenario, followed by another dotted line which is their best case scenario. The other lines are previous forecasts.

All the scenarios, including previous pre-pandemic forecasts, show the same underlying instability. The difference is that as a result of the pandemic, this instability kicks in around the end of this decade rather than sometime in the next decade. Here we get to the crucial point I want to make. For the next five years, in its central forecast public debt moves either side of its projected level for 2020/1 of 104% of GDP. (For each year thereafter: 104, 105, 106, 102.)

The implication is that there is no immediate need for large scale fiscal tightening when the economy recovers. The deficit will be higher than we are used to, but with a higher level of public debt and very low interest rates the level of the deficit that stabilises this debt is also higher. Thus there is no immediate need for substantial tax increases or spending cuts immediately after the recovery is complete. According to the OBR something will need to be done after the general election, but I doubt any Conservative Chancellor will raise taxes substantially ahead of a general election based on OBR forecasts alone.

So the big news from the OBR’s report is not only that there is no immediate need for fiscal consolidation, but if the economy recovers according to its central scenario and it has got its fiscal numbers right, there is no need for substantial fiscal consolidation once the recovery is over. A permanent hit to UK output, which in other circumstances would lead to an unsustainable deficit, has been offset by the impact of low borrowing costs and a higher level of debt. Of course the OBR may turn out to have been too optimistic, and their pessimistic scenario does show debt rising through debt rising a bit between 2020/1 and 2024/5.

So why all the talk of fiscal gloom? (Not quite all. Ben Chu at the Independent has made the points I make above.) Are they reflecting what the OBR says? The report is called the “Fiscal Sustainability Report”, so you would expect them to flag the long term instability. But the final paragraph in their summary ends with this:

“in almost any conceivable world there would be a need at some point to raise tax revenues and/or reduce spending (as a share of national income) to put the public finances on a sustainable path.”

It seems that too many ignored the crucial three words “at some point”.

All this illustrates how deep seated the “deficit up = taxes will rise or spending will be cut” meme is. Of all the important economic stories that arise from this stage in the pandemic, the consequences for the deficit and future consolidation is not one of them. I guess one reason these stories are popular is that they are potentially relevant to everyone. Another is that they are so easy to write. Let us just hope that this time around politicians on all sides are not taking them seriously.

Posting may not happen for two or three weeks, because we are finally moving house..