John Ashton: covid-19 and public accountability—lessons from history

In his recent hard hitting editorial, Kamran Abbasi, executive editor at The BMJ, raises a series of important questions about the failure of the covid-19 pandemic response, not least in a number of wealthy countries.

Abbasi asks “when politicians and experts say that they are willing to allow tens of thousands of premature deaths for the sake of population immunity or in the hope of propping up the economy, is that not premeditated and reckless indifference to human life? If policy failures lead to recurrent and mistimed lockdowns, who is responsible for the resulting non-covid excess deaths? When politicians wilfully neglect scientific advice, international and historical experience, and their own alarming statistics and modelling because to act goes against their own political strategy or ideology, is that lawful?”

In raising these questions, he implicitly places on the table the nature of public accountability in a liberal twenty first century democracy. 

The global covid-19 death toll is now over 2.5 million. A significant proportion of this grim tally is attributable to the lack of decisive and timely leadership in the United States and the United Kingdom. The United States has changed its political leadership in the recent presidential election. In the United Kingdom, which was responsible for about 1% of global deaths in the 1918-19 influenza pandemic, but which now accounts for about 5% of global deaths from covid-19, the public must wait for four more years to hold the government to account through the ballot box. [1,3] With a solid government majority and opposition parties failing to make an impact, the inadequacies of the five yearly elected dictatorship of representative democracy are being vividly exposed. We may yet find that in politics, as in physics, nature abhors a vacuum. 

The UK government’s response to the pandemic carries with it the hallmarks of the false dichotomy that exists between those who see the prime purpose of government as oiling the workings of the economy, and those who see it as the protection of its citizens. Both polarised positions fail to appreciate the interdependence of both. They represent a throwback to the time of Bismarck’s Germany, when the notion that the main duty of government was to protect property was turned on its head. Neumann argued that as the only property possessed by most common people was their health, it fell to the government to concern itself with the protection of the public’s health. [4]

In the UK, it is an irony that a prime minster with a classics degree has demonstrated such a lack of awareness of the lessons from history and from previous pandemics. Among these are the significance of crowds and crowd movements that played such a part in the spread of the plague in previous centuries, and of troop movements and mass assembly that led to the amplification of a local outbreak of flu in the United States in 1918, into the devastating pandemic of influenza that killed over 50 million worldwide. 

There has clearly been a failure to recognise the importance of a practical local approach to rooting out and controlling outbreaks of infection. This is something that the United Kingdom pioneered in the Victorian age and led the world with until recently. 

The potentially wide ranging political and social consequences of pandemics are also clear to see if you study the long tail that may follow pandemics. The Peasants Revolt of 1381, the so-called Summer of Blood, was an indirect consequence of the Black Death of 1381 resulting from a chain of events that began with the massive death rate from the pandemic, leading to a strengthening of the serf and peasants’ wage bargaining position. This in turn caused the landowning classes to impose three successive poll taxes on them to fund their overseas military adventures, culminating in a revolt that saw hundreds of the hated middle and ruling classes being beheaded in and around Smithfield and the City of London. [5]

It was Neumann’s thesis that gave form to the disenchanted young German urban masses in the European year of Revolution of 1848. With the French Revolution and the guillotine still within living memory, Bismarck embarked on wide ranging social reforms. In the UK’s December 2019 election, the Conservatives raised expectations of a “levelling up” of the long neglected post-industrial “red wall,”—previously Labour supporting areas of the North of England. The present administration’s track record of raising expectations that can’t be met, may not bode well that they will achieve this either. The prime minister has precariously placed himself between the two pillars of the economy and the public’s health, and must now face the increasing noise of ambitious colleagues in his own party warming up for manoeuvres—not least the unreconstructed members of the Conservative COVID Recovery Group who want a return to business as usual. 

For one who identifies so strongly with Winston Churchill as a wartime leader, the parallel between victory against the Nazis and the Conservative’s subsequent devastating defeat in the 1945 general election, may cause Boris Johnson to reflect on whether he finally got something right in the rollout of the vaccination programme for covid-19. But, even that may yet be insufficient to prevent so many covid pandemic chickens from coming home to roost in the long term. 

In the same way that covid-19 has forensically examined every aspect of our daily lives, it has also revealed the inadequacy of having a second rate government in a pandemic, with social media acting as inquisitor general. It would be a wise pundit who would claim to know how the next act of this drama will play out. The virus may have many more surprises in store for us yet.

John Ashton was formerly regional director of public health for the North West of England and president of the UK Faculty of Public Health. He has written a new book, Blinded By Corona, How The Pandemic Ruined Britain’s Health And Wealth. Gibson Square Press, 2020.

Conflicts of interest: None declared.


  1. Abbasi, K (2021) Covid-19: Social Murder, they wrote- elected, unaccountable, and unrepentant. BMJ 2021;372:n314
  2. COVID-19 alert.JHU CSSE COVID-19 Data 14th January 2021.
  3. Ashton, J. A fatal reckoning: UK reaches 100,000 deaths from Covid-19. Byline Times.    2021 January 26.
  4. Neumann, S. (1847). Die Offenliches Gesundheitsflege und das eigenthum. Berlin. Quoted in Sigerist, H (1941). Medicine and Human Welfare. Oxford University Press.
  5. Ashton, J. (2020). COVID-19 and the Summer of Blood of 1381. Journal of the Royal Society of Medicine vol 113(10)410-411.