So was today really “Freedom Day” for the UK? The government has gone ahead with its plans to remove nearly all pandemic restrictions—but to judge from the press briefing a week ago, Boris Johnson may now be regretting the framing that he has developed around this fourth and final Step of the road map out of lockdown. “I cannot say this powerfully or emphatically enough,” he said back then, “this pandemic is not over… We cannot simply revert instantly from Monday 19th July to life as it was before Covid.” The problem is that, without restrictions, we certainly can. Johnson is simply gambling that we won’t.
He is surely right, for many people are well aware of the risks, and will consider the welfare of others as well as of themselves. In any event, some organisations, such as Transport for London, are continuing to require masks to be worn in their public spaces. But Johnson’s distancing from the earlier rhetoric of freedom – and his backtracking already on nightclubs, requiring evidence of vaccination as a condition of entry from early September – betrays unease and contrasts with his previous determination to hand over all responsibility for limiting the spread of the virus to the public. That new discomfort could hardly have a more concrete justification, as Johnson announces the change while in self-isolation himself after the Health Secretary Sajid Javid tested positive.
Many scientists have raised a chorus of alarm about the decision to open up further. A letter to the Lancet, to which more than 1,000 international scientific and public-health experts added their names, accused the UK government of “embarking on a dangerous and unethical experiment.” And a letter to the Financial Times from representatives of the UK Clinical Virology Network called the near-complete relaxing of restrictions before vaccine-induced immunity “a recipe for disaster, with the risk of negating the long-term benefits of the UK roll-out of vaccines.”
With the virus already spreading at a “world-beating” rate of more than 50,000 new infections a day, much of the country is headed for a summer not of liberation but of self-isolation, fear, illness, uncertainty and, for some, hospitalisation and death. Were it not for the vaccines, these numbers would undoubtedly necessitate another lockdown. As it is, despite Johnson’s incorrect claim that the vaccines have “severed” the link between infection and hospitalisation, the facts that only just over 50 per cent of the population has been doubly vaccinated and that a double dose of the vaccine typically confers just 60 per cent protection against infection by the ubiquitous Delta variant mean that many will discover—perhaps after having a false sense of safety—that the vaccines have not done this at all.
I have spoken to several experts from various fields, including epidemiologists, virologists, Covid modellers, data experts and specialists in public health. None has endorsed the government’s plans, and some are deeply alarmed by them. “There is absolutely no justification for relaxing restrictions now,” said Peter English, former chair of the British Medical Association’s Public Health Medicine Committee. “If anything they should be tightened, at least until the increase in case rates has reversed.”
Don’t believe it, then, if politicians or the media say the experts are divided. Even the generally cautious Observer’s Yes/No framing of the question “Is it wise to open up fully?”, with the arguments pro and con presented respectively by Dominic Wilkinson, professor of medical ethics, and Trish Greenhalgh, professor of primary-care health sciences, both at Oxford University, did justice neither to the true state of play nor the positions of the protagonists.
On close inspection, there is rather little disagreement between the two positions. Wilkinson has previously said that “lockdowns have been effective, but they have also had huge impacts on healthcare, education, and the economy.” That’s entirely uncontroversial, as is his comment that “restrictions will only continue to be proportionate if their public health benefits are still sufficient to outweigh these costs.” He is right, moreover, to say that “science cannot tell us when to unlock—that depends on what we choose to prioritise.”
As Wilkinson says, the key issue is proportionality: there is no justification for restrictions that seriously impede freedoms or risk further socioeconomic or health problems if their effect on reducing the spread of the virus is marginal or unproven. Experts are likely to agree on that too.
But the UK is no longer in lockdown anyway, vaccines having reduced hospitalisation and death among infected people about tenfold since the dreadful second wave in the winter. The question is now which remaining mitigation strategies, if any, are still justified. That is the only sensible basis for discussion; talk of “reclaiming our freedoms” traduces it. As Harvard epidemiologist Bill Hanage told me, “I wish the UK had moved beyond the simplistic emphasis on the promised land of no interventions.”
The most fraught issue here is mask-wearing. This is obviously no panacea, and indeed there has been considerable scientific debate over whether masks make much difference at all. But the weight of evidence now suggests that they do—some estimates say they can reduce transmission by around 25 per cent. One might hope that if masks were to become as normalised in the west as they are in Asian countries, future transmission of colds and flu would also be reduced.
At any rate, mandatory mask-wearing is such a negligible imposition on liberty, and so easy and low-cost a measure, that its abandonment makes no scientific sense at all. Even Wilkinson agrees: “Some measures (for example, mask-wearing on public transport) represent a minimal incursion on personal liberty, and should continue.”
The government knows that expert opinion clearly favours retaining some mitigation measures. It was painfully evident in Johnson’s contortions on 12th July, when previous talk of “personal responsibility” on masks morphed to the hopelessly mixed message that “we expect and recommend that people wear a face covering in crowded and enclosed spaces where you come into contact with those you don’t normally meet, such as on public transport.” He has calculated that the removal of any legal compulsion to do this will satisfy his party’s libertarians—one minister told the Financial Times that Tory MPs would have rebelled against a move to keep mask rules—while hoping that public common sense will mean some people still wear masks, limiting the health damage. If it doesn’t turn out that way, the public can be blamed; in the meantime, sensibly cautious institutions, shops and other establishments that impose mask rules will be left to take the heat from the anti-maskers.
Herein lies the problem with the Wilkinson formulation. While it is right to say that policy decisions have to balance scientific advice with other factors, that remark presupposes a morally serious government for which those other factors would be primarily issues such as economics, education, mental health, deferred operations and so on. (Such leaders would acknowledge, moreover, that the simple equation that pitches health against the economy is dead. Those countries with good pandemic health outcomes have also tended to be those that suffered less economic harm, as in fact some economists predicted at the start of the pandemic. But Javid, the replacement for the disgraced Matt Hancock, shows no sign of appreciating this point.)
However, the government’s determination to remove restrictions is not driven by a careful weighing up of considerations like these. Mask-wearing, for example, has no bearing on the much-cited problems of lockdown such as economic harm or damage to mental health. (Another wave of infection, on the other hand, will affect both). The only argument for removing mandatory mask-wearing in all circumstances is that it tarnishes the ideological purity of the “end” of restrictions. It would not, you might say, deliver a hard enough freedom day.
The truth is that the whole notion of an “end” to the pandemic is illusory. “People want a clear endpoint, and that’s not surprising,” said Hanage, “but there isn’t such an endpoint for a pandemic. Instead it is a process of responding to the threats and mitigating them.” In the dream of being able to say “it’s over,” Hanage said, lies the dangerous allure of “herd immunity,” which seems again to imply that there’s a finishing line.
Mask-wearing isn’t the only measure worth retaining. For example, “the UK could encourage proactive rapid testing as a safeguard for various venues, such as schools, workplaces, churches and events,” said Lauren Ancel Meyers, director of the University of Texas’s Covid-19 Modeling Consortium. Yet the government, intoxicated by the success of the vaccine rollout as a political palliative, seems to have convinced itself that nothing else is now needed—not even waiting until that programme has itself been completed. Other, often low-cost but effective, measures such as improving ventilation in schools and workplaces have been neglected too.
In contrast to an all-or-nothing decision, Meyers’s group has developed a flexible and adaptive community mitigation strategy, driven by data and designed to balance health and socioeconomic goals, that has been successfully used in Austin, Texas. Meyers, like many other experts, favours approaches that instate or relax measures locally, based on an area’s infection rates or hospital admissions, as are now being used in Germany. English, meanwhile, points to the practice in Belgium of coupling decisions about mask-wearing in a venue to measurements of how well it is ventilated, using carbon-dioxide monitors that can detect the extent to which people’s exhalations are accumulating.
Such schemes would depend crucially on the criteria, and the messaging to explain them, being clear and transparent so as to win public trust. The way to do that, said Hanage, is by “being straight with people.” As behavioural scientist Stephen Reicher of St Andrews University has written, we must “ensure that people have the information they need in order to act for their own safety and that of others.” Simply telling individuals they can now do as they please is no way to achieve that—as some have pointed out, it is like giving people the choice of whether or not to obey traffic lights.
What about Johnson’s constant refrain of “if not now, when?” This is the ideal window for opening up, he claims—when people can be outside where transmission is lower, schools will have broken up, and the NHS is not struggling with other seasonal pressures.
The responses to this position that I have received from experts have varied from sceptical to contemptuous. English calls it “absolute nonsense.” Hanage says the case can equally be made that one should delay Step 4, and use the extra time to improve vaccine coverage so that the threat in the autumn is lower. The minutes of the Scientific Advisory Group on Emergencies (Sage) of 7th July acknowledge this view, but say that the gains might be small compared to the risk of pushing the peak of this wave into the colder months. Maybe so—but even those running the models on which the Sage advice is based differ on whether that’s true.One of them, epidemiologist Azra Ghani of Imperial College London, told me that “many of us in the scientific community would have preferred to see a more gradual relaxation, waiting for all adults to have had the opportunity to have both vaccines and retaining the less intrusive measures such as compulsory face masks in indoor environments.”
Given the uncertainties, none of this is much more than informed guesswork. The real issue, though, is that we should not even be talking about an ideal date for “unlocking,” as Johnson still insists on calling it. His Chief Medical Officer Chris Whitty implied as much in the press briefing of the 12th, stating that there is no ideal date, that different dates for relaxation might at this point make little difference to the outcome, and that there is “overwhelming agreement” that it is more important to take things slowly. As Ghani says, however, that is precisely what we are not doing.
What, then, can we expect in the weeks ahead? Researchers at Imperial and the London School of Hygiene and Tropical Medicine (LSHTM) have attempted to answer that question using epidemiological models. Their forecasts include the possibility that daily infections could rise higher than they did in the second wave—even Javid has admitted they could reach 100,000 a day, while some epidemiologists now say it could be double that. Perhaps more worryingly, hospitalisations could also equal or even exceed the winter wave, according to Ghani. “This means that there remains a risk that the NHS could be overwhelmed,” she said. Already some hospitals are having to cancel operations in order to cope with the Covid surge. The LSHTM team estimate that there could be 19,000 further deaths by the end of the year, although in a more optimistic scenario the figure could be closer to 6,000-9,000.
But these model projections are more uncertain than they have ever been before. That’s because, in the absence of formal restrictions, so much depends on how people choose to behave—which is very hard to predict. (Behaviour from the Euros does not inspire confidence.) That Johnson seems only at the last moment to have woken up to this fact, and tried to rein in his earlier libertarian signalling with his “grave” face on, is shocking. If there is one point the behavioural scientists have been trying to drive home throughout the pandemic, it is that the way to influence public behaviour is through establishing trust and giving clear and consistent messaging.
“There’s no known reason why a new variant couldn’t dodge the current vaccines almost entirely”
The models also contain an alarming omission. One of the most fundamental principles of scientific practice is that to understand the consequences of making some change in your experiment, you need to know what would have happened without that change. Yet none of the modelling studies commissioned to inform Sage looked at the likely outcomes if Step 4 were not taken: if, through the summer, we maintained the restrictions we had, or the least burdensome of them. The reason this was not done, one modeller has told me, is that such a baseline scenario was not requested—presumably because, politically, it was not considered an option. Yet that exclusion undermines the ability to fully assess the outcomes. The idea that scientists provide objective advice to policymakers is rendered nonsensical if the constraints imposed by policymakers do not fit with good science.
So then, the removal of restrictions on the 19th is evidently a huge gamble taken for political reasons, in the face of massive uncertainties and with no real justification from science or public health. But I’m afraid that’s not the worst of it.
For it’s blindingly obvious to every scientific expert that there’s a nightmare scenario to all this. With high levels of infection in the population, there is a wider pool of viral mutations within which new variants can appear. They will spread if they are somehow more successful at replicating: if they have a Darwinian advantage over other variants. Those that have arisen so far seem largely to have benefitted from a faster spreading rate and a greater ability to infect human cells. But in a partly vaccinated population, the selective pressure is instead for variants that can evade the vaccines’ ability to block or hinder them. So far, vaccine evasion in variants such as Delta (and possibly Lambda, on its way from Peru and feared to be even worse) is only slight, although that already makes a difference to our ability to control the pandemic. But there’s no known reason why a new variant couldn’t dodge the current vaccines almost entirely. Virologist Richard Tedder of Imperial College told me that, while he is naturally worried about the deaths and long-term health problems from Covid that we will see accumulate in the summer, that’s nothing compared to his concerns about the emergence of vaccine-evading variants.
This terrible situation might never come to pass. But the government has done almost nothing to acknowledge the awful risk. As Tedder says, “Once you’ve generated a lot of vaccine-resistant viruses, where the hell do you go? There’s no way back.”
“Whitty seems increasingly like a man trying to semaphore his distress without his captors noticing”
Scientists advising the government know all this—so what can they do? The minutes of the Sage meeting of 7th July make for painful reading:
“If the aim is to prevent the NHS being under pressure the priority should be to avoid a very rapid return to pre-pandemic behaviour which could lead to a peak in hospitalisations… Maintaining interventions such as more people working from home, the use of masks in crowded indoor spaces, and increasing ventilation, would contribute to transmission reduction and therefore reduce the number of hospitalisations.”
This sounds about as close as they felt they could come to saying that full opening up now is not the option they would recommend. But it could be read too as a plaintive hope that people will take these precautions of their own accord when the government no longer tells them to.
There seems no prospect that we will find out in the foreseeable future what the scientists in the core Sage group really think: their role seems more to be diplomatic, or even silent. One modeller from that group has told me that, given his advisory position, he cannot comment on policy decisions. Whitty seems increasingly like a man trying to semaphore his distress without his captors noticing. His warning in a webinar by the Science Museum that there could be a “quite scary” rate of hospitalisation soon, and that “we could get into trouble again surprisingly fast,” certainly suggest he does not look favourably on the imminent opening up. My belief is that he and the Chief Scientific Adviser Patrick Vallance feel trapped between their duty as civil servants to support the government, and their knowledge that some of the decisions are political calculations rather than judgments made in the best interests of public health. Their positions have, through no fault of their own, been made almost untenable.
This highlights the tension that exists for scientists formally employed by the government. English told me that the British Medical Association has argued that employees of Public Health England should not be subject to the civil service code, as public health professionals’ first duty should be to the population they serve, not to ministers. That being so, “inevitably there will be times when their duty is to speak out against government policies,” said English. This seems to be where we are now.
In other words, “freedom day” (as we will now be belatedly discouraged from calling it) throws into harsh contrast the deep tensions that exist in the UK between scientific understanding and advice about the pandemic, and political decision-making. It’s a problem that goes deeper than the current crisis—but one that is now putting public health at risk.
