Amid the select committee revelations from Dominic Cummings, and in his recent claims on social media, there has been a lot of focus on suggestions that the government was following a “herd immunity” policy at the start of the pandemic, costing thousands of lives in the process. Of course, none of this is surprising.
It is very clear that this was the flawed policy of the government through early March last year, not least because it was publicly discussed by the prime minister and by many scientific advisers to the government – including Patrick Vallance, who spoke of “enough people becoming immune to this” with mild illness, to help build herd immunity.
The alternative strategy of high suppression or elimination of the virus was rejected by the government very early on, despite strong evidence from other countries around the world showing that this could be successfully applied.
There were several elements that underpinned the devastating herd immunity strategy. It was believed that infection of large swathes of the population was inevitable, and acceptable, and that there was no way to prevent it. This came with the tacit acknowledgment that hundreds of thousands of deaths were acceptable, most of which would occur among vulnerable and elderly people. A sense of national exceptionalism held by some suggested that other countries’ experiences didn’t apply to us – despite that by March we had had months to observe and learn from countries in south Asia, and seeing the devastating impact of late action in Italy.
Real-world evidence was ignored in favour of models and flawed thinking. The government’s strategy repeatedly conflated Covid-19 with flu, ignoring the much higher transmissibility, higher susceptibility, which would lead to many more people getting infected and dying, and unknown long-term impacts from a novel virus. Finally, there was the idea that the health of the economy needed to be balanced with public health. A lot of emphasis was placed on the disruption lockdowns would cause, with attempts to slow down such decisions, without understanding that delays would inevitably lead to even longer lockdowns and more economic damage.
It is widely known that the government made a U-turn when an Imperial College model showed the strategy would lead to 400,000 deaths. The late March lockdown swiftly followed. But this realisation did not require any sophisticated calculation and many experts had been raising the alarm for weeks. We knew even by March last year that locking down earlier would have saved tens of thousands of lives.
What is even more concerning, and has not been discussed as much, is how little the government seems to have learned from those difficult early months of the coronavirus crisis. Even after the consequences of the herd immunity strategy became clear, the idea still casts a shadow over our pandemic response.
These flawed ideas even reappeared last September when the government’s Sage committee advised another lockdown with cases rising rapidly. The government chose to ignore this advice, instead meeting scientists who were proponents of the “naturally acquired herd immunity” strategy. Lockdown was delayed again, and once again it cost tens of thousands of lives. As recently as January this year, we heard Mary Ramsay, the head of immunisation at Public Health England speak about allowing the disease to circulate in younger people “where it’s not causing much harm” while protecting “the people who are really vulnerable”. Even now the government and its advisers still speak about “living with the virus” and “acceptable deaths”, despite strong evidence that this means thousands of more people getting infected and all that entails. Living with the virus also increases the risk of new variants arising, even as rollout of vaccines continues.
Despite what some continue to claim, there has only ever been one real option: when faced with a novel respiratory virus, with a relatively high fatality rate and unknown long-term impacts, you have to eliminate it. Countries who got this right did so early. The differences between those countries that adopted an elimination approach and ones with mitigation strategies have become ever more stark over time, both for public health outcomes and the economy.
And yet the government continues with a policy of halfway measures aimed at keeping infection levels just low enough so that hospitalisations are below NHS capacity. This has spawned and imported new variants of the virus and has led to at least 150,000 deaths, more than one million people living with long Covid, an over-run health service and a devastated economy. We have normalised illness, suffering and death. Now we have put all our eggs in the vaccine basket while taking no action to protect these vaccines by preventing virus adaptation or the import of new variants.
As continued government negligence herds us towards a third wave of the pandemic, the big question isn’t what mistakes the government made in March, many of which are well-documented, but why it never learned from those errors and continues on a path that risks people’s lives and livelihoods.