(Belated) New Year Thoughts on the Barriers to Ending the Pandemic

A year ago, we in the UK were approaching Christmas and New Year with quiet optimism as the first COVID vaccines rolled out into the NHS. Light was appearing at the end of a long dark tunnel. Sadly, that hope was extinguished by the emergence of COVID variants, first alpha and later delta. Much of the year was spent in a race between these variants and the vaccination program. Today, we can see the benefits in the wall of immunity that has been created by the combination of vaccination and infection. Over 98 percent of the UK population have a measurable degree of antibodies that should resist the new omicron variant, according to the Office of National Statistics.

This should give us renewed hope for the coming year. Scientists may not yet be able to agree on whether omicron is inherently milder or whether it is being defeated by the level of population immunity. It is not, though, causing either hospitalizations or deaths on the scale of last January. Omicron may even be increasing immunity as it infects those who, for one reason or another, have yet to be fully vaccinated. It becomes harder to imagine another variant sweeping through in the same way, unless there is an even more radical mutation than any yet seen.

Optimism is reinforced by the new anti-viral drugs that can offer effective treatments to those whose illness threatens to lead to hospitalization. New generations of vaccines, targeting different parts of the COVID virus, will provide better protection against potential variants.

The light is coming back, in England at least, as many people decide that the future risks of COVID are tolerable. We do not have to accept a ‘new normal’, where scientific, medical or political elites decide how everyone should lead their lives.

The remaining barriers are social more than scientific. There are at least five to tackle this year.

The most important are psychological, driven by the levels of fear and anxiety created in the population. In previous pandemics, these subsided of their own accord. Events like the Black Death, which killed 30-50 percent of the European population, are incredibly rare. As early as April 2020, it was clear that COVID would never lead to deaths on that scale. But fear was too useful a tool. The traditional partnership between public health medicine and the people it served was sacrificed to the quick fix of intimidation. It will be hard to rebuild the goodwill on which public health practice has rested for a hundred years.

Social barriers are created by the people and groups who have grabbed the opportunity to micro-manage other people’s lives. They often claim to serve some higher moral purpose, like fighting climate change. But is that purpose really moral when it rests on laws and punishments rather than information and consent?

Biosecurity has created vested economic interests though the money to be made out of pandemic management. The scams accompanying UK government procurement of PPE for health and social care workers are being exposed but similar stories could be told about the contractors running the national Test and Trace program for contact tracing and about the software behind COVID passports. The strongest advocates of endless booster vaccinations are some of the manufacturers. Profits from lateral flow tests disappear into US companies with invisible owners. Ventilation and air filtration offer similar opportunities to loot the public purse.

Nationalist sentiment in Scotland and Wales has driven a political agenda. The emphasis on doing things differently from the English will no doubt feature strongly in future referendum campaigns, although there is actually little to show for it in terms of outcomes like infections, hospitalizations or deaths.

Finally, there is cultural damage from the influence, particularly in Scotland, of people who think the aim of medicine should be to control every virus or bacteria rather than trying to mitigate the worst ones. Do we really need a pill for every ailment? Is every death a defeat for medicine or a natural part of the human condition? Do aggressive medical interventions at the end of life get in the way of care and compassion? Anyone who has spent time in the US will recognize that the drive to impose medical control on nature comes with huge social and economic costs.

We will also have to grit our teeth and be ready to commit more resources to remedying the threadbare state of the National Health Service. The pandemic has revealed the consequences of a decade of fragmentation and under-investment. We have a more efficient system than most comparable countries but austerity has pushed this too far. There are important issues about organization and co-ordination to ensure that new money is well spent but the need for additional funding seems inescapable.

We can reach the end of the tunnel in 2022 but there are still a lot of rock falls to clear.