In allowing mass infection, Boris Johnson’s government is pursuing a strategy that will lead to avoidable deaths and long term illness, say this group of authors
The statement from the prime minister, Boris Johnson, on 12 July leaves little doubt that the government’s latest pandemic plan involves recklessly exposing millions of people to the acute and long term effects of mass infection. We believe this is a terrible mistake. This strategy is already putting intense pressure on struggling healthcare services and will lead to many avoidable deaths and long term illness.
The narrative of “caution, vigilance, and personal responsibility” is an abdication of the government’s fundamental duty to protect public health. “Personal responsibility” does not work in the face of an airborne, highly contagious infectious disease. Infectious diseases are a matter of collective, rather than individual, responsibility. The government’s strategy will place around 48% of the population (children included) who are not yet fully vaccinated, including the clinically vulnerable and immunosuppressed, at unacceptable risk.
More than 1000 scientists have signed a letter to the Lancet setting out why allowing mass infection this summer is a “dangerous and unethical experiment.” The government is following an apparent strategy of achieving herd immunity through mass infection, rather than the much safer (and more predictable) path of vaccination. Mike Ryan, executive director of the WHO Health Emergencies Programme, called a strategy of letting infection spread through a population “moral emptiness and epidemiological stupidity.” The British Medical Association, Association of Directors of Public Health, SAGE, the Academy of Medical Royal Colleges, the Royal College of Nursing, and NHS leaders have all highlighted the dangers inherent in allowing mass infection. If the government is following “data not dates,” it has not made an evidence based case for this, and the scientific consensus is firmly against its approach.
The argument made by the prime minister that it is better to accept mass infection now than to postpone until winter, when “the virus has an advantage,” is deeply flawed and misleading. A strategy that chooses mass infection in the young now over vaccination, in order to achieve greater population immunity to protect the vulnerable in winter, is unethical and unscientific. This strategy, and the modelling it relies on, also completely ignores public health measures, such as mitigation in schools, workplaces, vaccination of adolescents, and booster doses for the vulnerable that could protect our young now and offset increased risks over winter. Getting and keeping transmission low now will give us time to vaccinate more people, rather than exposing them to mass infection. We could offer two doses of vaccine to everyone over 12 by the autumn, providing the best possible protection.
This strategy of mass infection will lead to a significant burden on a health service that is already under immense strain, with some hospitals again cancelling elective surgeries and delaying cancer treatment. The health secretary has warned that this could lead to a backlog of 13 million people waiting for routine care. Ministers have been told to expect 1 to 2 million cases in the coming weeks, with cases reaching 100 000 per day. A significant proportion of these people will go on to develop long covid. Both the CEO of NHS Providers, Chris Hopson, and chief medical officer Chris Whitty have expressed grave concerns over the prospect of hundreds of thousands more cases of long covid among the young during the coming months. Allowing unmitigated transmission in a partially vaccinated population also provides a fertile environment for selection of escape variants, which could have huge consequences for the UK and countries globally.
Opening the UK up further is billed as “freedom day,” but for many people it is anything but. Those living with health conditions that make them more vulnerable to covid (and vaccines less effective against it) fear a return to shielding indoors as they are no longer protected by low case numbers and measures such as others wearing masks, physical distancing, and isolation of contacts. Since vaccinated people can and do transmit the virus, many of their loved ones will need to restrict their activities to protect them. For too many people, removing mandated mitigations restrict, rather than enable, freedom. This is unlikely to bolster public confidence and engagement in economic activity. And if the government strategy leads us into yet another lockdown, this could have an even more devastating impact on the economy.
The public overwhelmingly supports sensible public health measures such as masking indoors. This begs the question why dangerous public health decisions that are neither in the public interest, or in line with public sentiment, have been made in the midst of a raging pandemic. Credible sources suggest that the government is pursuing policies that will appease a political minority of its own backbenchers and lobbyists.
The government messaging is confused. On the one hand we hear some cabinet ministers say masks are restrictive and they can’t wait to cast them off, and on the other hand we are told that it is a public responsibility to continue to wear masks on transport and other indoor places. How does the government expect the public to engage with such confused messaging?
We believe that infections both matter and are avoidable. Instead of allowing infections to rise, we urge the government to take urgent actions to inform and protect the public and prepare for autumn:
- The government must articulate a long term strategy for pandemic control.
- We need clear, evidence based information on how to protect ourselves and others.
- Keep basic preventive measures, such as masks, physical distancing, and outdoor hospitality, until cases return to the levels seen in May. These measures are minor disruptions that increase our freedoms rather than restrict them.
- Data not dates: We fully agree with the government’s own slogan here, and they need to hold to what they promised, not set arbitrary dates tied to public expectations or political lobbying. We must wait until cases are low, school and workplace mitigations are in place, and most people aged 12 and above are vaccinated before opening up further.
- Make workplaces, schools, and public transport safer: Support resourcing of ventilation or air filtration. Re-introduce masking in secondary schools, and move learning outdoors as much as possible. Allow employees to work from home whenever possible, and ensure that workers can travel to work without being placed at risk.
- Test, trace, and isolate. Provide local authorities with the means for extensive testing and support people to isolate if potentially contagious.
- Prepare for school re-opening: Invest in making schools safer ahead of autumn.
Signatories and co-authors:
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.
John Drury, director of research and knowledge exchange, School of Psychology, University of Sussex. Participant in the UK’s Scientific Advisory Group for Emergencies and/or its subgroups, and a member of Independent SAGE.
Trish Greenhalgh, professor of primary care health sciences, University of Oxford, UK.
Stephen Griffin, associate professor, University of Leeds.
Deepti Gurdasani, senior lecturer in machine learning, Queen Mary University of London.
Zubaida Haque, member of Independent Sage.
Aris Katzourakis, professor, University of Oxford.
Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. Member of Independent SAGE.
Susan Michie, Centre for Behaviour Change, University College London. Participant in the UK’s Scientific Advisory Group for Emergencies and its subgroups, and a member of Independent SAGE.
Gabriel Scally, visiting professor of public health, University of Bristol. Member of Independent SAGE.
Robert West, professor of health psychology, University College London. Participant in the Scientific Pandemic Influenza Group on Behavioural Science (SPI-B): 2019 Novel Coronavirus (Covid-19).
Kit Yates, senior lecturer, Department for Mathematical Sciences, University of Bath. Member of Independent SAGE.
Hisham Ziauddeen, consultant psychiatrist, Cambridge and Peterborough NHS Foundation Trust, UK.
Competing interests: nothing further declared.