The UK government’s response to the B.1.617.2 variant is, once again, characterised by complacency, dither, and delay

The rapid rise of the B.1.617.2 variant of SARS-CoV-2 in the UK, since late March 2021, has been associated with exponential rises in cases in many areas of the country, raising concerns about a third pandemic wave. The potential seriousness of B.1.617.2 was evident in early April when it became apparent that it was contributing to the rapid growth of the pandemic in South Asia, outcompeting B.1.1.7 in many Indian states, just as it is doing now in the UK. Given that B.1.1.7 was already about 60% more transmissible than the variants it replaced, the rapidity of the growth of B.1.617.2 in conditions in the UK that are able to reduce cases of B.1.1.7 is all the more concerning. [1] 

Given the UK’s inadequate border policies, the import of new variants—and in particular this variant—into the UK was inevitable. Indeed, SAGE and Independent SAGE had both warned that a failure to implement effective border controls would inevitably result in new variants being imported. [2-4]

Worryingly, England’s response to this public health crisis has been characterised by a lack of transparency—or, even worse, a deliberate suppression of material that is at odds with the Government’s narrative—as reflected by delays in the release of critical data necessary to scrutinise public policy. There is growing concern that this is, at least in part, for political rather than scientific reasons. On 5 May 2021, the planned weekly release of data on variants of concern was delayed by Public Health England (PHE). This was attributed to processing issues, but a leaked document suggests that it was linked to local government elections. This was despite despite PHE’s risk assessment that ongoing risk to public health from B.1.617.2 was “high.” [5] 

In a briefing held on 14 May 2021, Boris Johnson, the UK prime minister, announced that his government would proceed with stage 3 of easing lockdown, even though this was contrary to its own scientific advice.  A situation update released by SAGE earlier that day, estimating that B.1.617.2 was very likely more transmissible than B.1.1.7, suggested that a 40-50% increase in transmissibility would lead to hospitalisations at a level similar to or higher than the January peak in the presence of stage 3 easing. Advancing to stage 4 could exceed this. [6] A model from SPI-M-O suggested that this peak could be even larger if B.1.617.2 showed a degree of vaccine escape. [7] While we do not yet know the exact extent of B.1.617.2’s greater transmissibility, a significant risk clearly exists. Thus, one of the key tests for further easing of lockdown, “the assessment of the risks is not fundamentally changed by new variants of concern,” was not met. 

Removing the requirement for students in secondary schools to wear face coverings as part of a wider package of easing restrictions on 17 May was against advice from SAGE, experts, and education unions across the UK. [8,9] Even at the time of the briefing, several outbreaks of B.1.617.2 had been reported in schools. [10] In Bolton, where the variant was known to be dominant, there has been a rapid growth of cases among school age children, with infection rates among 10-14 year olds 3 times those in 25-29 year olds, leading to policy U-turns in many areas days after it was announced. [11]

Unions, scientists, and MPs pressed PHE to release data on cases of B.1.617.2 linked to schools ahead of the decision on mask policy in schools. [12-14] Despite repeated requests, these data were not released and, on 22 May, the Observer reported that documents seen by the Observer suggested that these data had been withheld from the 13 May PHE technical report at the behest of 10 Downing Street, a claim not yet denied by PHE. [15,16] These data have still not been released and there is no information about when they might be. 

On the same day, the Financial Times covered an important leaked report by Public Health England, which suggested vaccines were highly effective against B.1.617.2 following two doses. [17] This was widely presented as a “good news” story across the media, prior to the full report being published. When it was, the full report along with additional documents (including a delayed report on variants) released late on a Saturday, presented a stark contrast to the message in the media. [18-21] Apart from showing substantial reduction in efficacy against symptomatic infection after the first dose (33% efficacy for both Pfizer and AstraZeneca), and modest reductions after the second dose (89% efficacy for Pfizer, 60% for AstraZeneca), it showed that vaccinated individuals were 1.5 times more likely to carry B.1.617.2 compared with B.1.1.7 (over a period when B.1.1.7 was the dominant variant), confirming greater vaccine escape than B.1.1.7. [19] This is concerning given that only 30% of the UK population has been fully vaccinated. Furthermore, the reports described a rapid growth of B.1.617.2, which by 15 May comprised 50% of all sequenced positive tests and was likely the dominant variant in many parts of England. [21] In non-travellers, the secondary attack rate of B.1.617.2 was 50% higher than that of B.1.1.7, consistent with higher transmissibility. [21] As a result of these findings, the PHE risk assessment increased the alert level associated with vaccines from amber to red. [20] Far from being the “good news” story reported in the media, the data suggested a real risk to public health from B.1.617.2 spread. We are seeing rapid spread of a new more transmissible variant with the ability to partially escape vaccines, with predictions from government advisors suggesting that if transmissibility is at the higher end of the plausible range, we are heading towards another wave that could be as large as the last one. Although there is uncertainty around the impact of spread of B.1.617.2 on hospitalisations and deaths given current levels of vaccination and accelerated vaccine rollout, it is clear that hospitalisations are already increasing in some areas (e.g. Bolton). [22] Until and unless we have definitive evidence that B.1.617.2 is not as threatening as it currently seems, we must act with caution.

The implications of these findings have not been communicated by government since these reports were published on 22 May. Apart from continuing surge testing and vaccination, the only response to this emergency seems to be an update on the government webpage to say that local restrictions had been put in place in at least eight regions in the UK on the 21 May, a policy that does not seem to have been communicated to local authorities and their directors of public health. This rapidly led to a U-turn when it was clarified that no additional restrictions would apply to these areas. [23] Instead ministers have been in the media saying that the roadmap for complete opening in June is on track. [24] 

These events build a picture of a government in disarray. On the one hand the government is unwilling to acknowledge the seriousness of the data or use them to deviate from it’s “roadmap,” but on the other hand it is aware that the data provide serious cause for concern. This contradictory position leads to contradictory messaging which combines a facade of optimism with dire warnings of what may happen if people take advantage of those things they have just been told that they can do. We have seen this around issues such as holidays, social contact, and now domestic travel. 

What is more, when it comes to preventing and dealing with infections, the Government has increasingly made it a matter of personal choice and responsibility, but without providing either the information or the means to act in ways that make the individual and their community safe. This combination of messaging that undermines the will to act along with the lack of support for people to act—even if they want to—is potentially fatal.

It now seems not only that the progress made through enormous sacrifices by the public is being reversed, but the UK government’s response, once again, is characterised by complacency, dither, and delay.

Deepti Gurdasani, senior lecturer in machine learning, Queen Mary University of London.

Christina Pagel, professor of operational research (branch of applied mathematics), director of the Clinical Operational Research Unit & co-director of the UCL CHIMERA hub, University College London. Member of Independent SAGE. 

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. Member of Independent SAGE. 

Stephen Reicher, professor, School of Psychology and Neuroscience, University of St. Andrews. Member of Independent SAGE and the advisory group to the Scottish chief medical officer. 

Hisham Ziauddeen, consultant psychiatrist, Cambridge and Peterborough NHS Foundation Trust, UK.

Competing interests: none further declared.

References:

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