Johnson’s coronavirus chaos criticised by UK doctors demanding greater transparency

Boris Johnson’s coronavirus strategy appears to be changing by the minute. Against the advice of the WHO (World Health Organisation), his government initially pushed adopting a ‘herd immunity’ experiment to combat the COVID-19 outbreak. Many, including a leading US epidemiologist, slammed this approach.

But health minister Matt Hancock since appears to have changed tack, saying that herd immunity no longer applies. So it’s no surprise that given this confusion doctors across the land are demanding the government provides greater transparency to its strategy.

Johnson damned

UK doctors have written an open letter damning the government’s coronavirus strategy, or lack of. They don’t hold back:

we request that the government urgently and openly shares the scientific evidence, data and models it is using to inform its decisions on the Covid-19 public health interventions in the UK. This transparency is essential to retain the scientific community, healthcare community, and the public’s understanding, cooperation and trust.

And leading US epidemiologist William Hanage also points out that:

We talk about vaccines generating herd immunity, so why is this different? Because this is not a vaccine. This is an actual pandemic that will make a very large number of people sick, and some of them will die. Even though the mortality rate is likely quite low, a small fraction of a very large number is still a large number. And the mortality rate will climb when the NHS is overwhelming.

Indeed, the herd immunity strategy is regarded as an experiment because it is invariably applied to public health scenarios where vaccination is available and required on a mass scale. And that’s not yet the case here.

More criticism

Former World Health Organisation (WHO) director Anthony Costello has also raised crucial questions via a Twitter thread concerning herd immunity:

1. Will it impair efforts to restrict the immediate epidemic, and cause more infections and deaths in the near term? Evidence suggests people shed virus early, and those without symptoms may cause substantial spread…

— Anthony Costello (@globalhlthtwit) March 13, 2020

The Canary has previously reported that Costello believes the UK government’s herd immunity strategy is “wrong and dangerous”.

This quote came from the director-general of the WHO:

4. Doesn’t this herd immunity strategy conflict with WHO Policy? After the announcement of this being a pandemic, Dr Tedros, Director General WHO, said “The idea that countries should shift from containment to mitigation is wrong and dangerous.”

— Anthony Costello (@globalhlthtwit) March 13, 2020

Further, Costello expresses concern that this proposed UK strategy is based not on evidence but modelling. And he also questions the ethics of the UK strategy:

Is it ethical to adopt a policy that threatens immediate casualties on the basis of an uncertain future benefit?

Sobering thoughts.

Herd immunity

So what is herd immunity?

“Herd Immunity”: A Rough Guide explains the common meaning of the term is that: “the risk of infection among susceptible individuals” in any population can be “reduced by the presence and proximity” of people who are immune. It also notes this can be referred to as “indirect protection” or a “herd effect”.

According to ITV’s Robert Peston on 12 March, the proposed herd immunity plan would:

allow the virus to pass through the entire population so that we acquire herd immunity, but at a much delayed speed so that those who suffer the most acute symptoms are able to receive the medical support they need, and such that the health service is not overwhelmed and crushed by the sheer number of cases it has to treat at any one time.

Yet, the Rough Guide also warns that herd immunity is a different form of immunity and can leave people “fully susceptible to infection”.

Who’s behind the government’s COVID-19 strategy?

At such a crucial time it seems vital to question who may be behind such controversial plans.

One key player involved in discussions about government strategies to combat COVID-19 is Johnson’s special adviser Dominic Cummings.

Cummings chaired a meeting on the virus with representatives of big tech companies. Also present were UK chief scientific advisor Patrick Vallance (who backs the herd immunity strategy) and NHS chief executive Simon Stevens.

The tech companies included:

Google, Facebook, Amazon, Apple, Microsoft and Palantir, alongside smaller British companies such as food delivery service Deliveroo and Babylon Health.

Anyone else?

According to the BBC‘s Mark Easton, a group of behavioural scientists, known as the ‘Nudge Unit’ are also advising the government on its coronavirus strategies:

Experts from the government-funded Behavioural Insights Team (nudge unit) @B_I_Tweets have been moved to the coronavirus control centre at the Department of Health to help prevent an 'misinfodemic' (over or under reaction to the disease).

— Mark Easton (@BBCMarkEaston) March 10, 2020

The Behavioural Insights Team (BIT) was set up in 2010 and has worked on a number of projects, including influencing how people can avoid COVID-19 infection. On its website BIT explains that:

We have run more than 750 projects to date, including 400 randomised controlled trials in dozens of countries. …

Our staff have conducted over a thousand workshops and training courses for governments around the world, training 20,000 civil servants and practitioners in behavioural insights.

BIT’s staff includes:

ex-civil servants, policy specialists and academics from disciplines including behavioural economics, social psychology, neuroscience and anthropology.

BIT’s specialist COVID-19 team includes Dr David Halpern, formerly “chief analyst at Tony Blair’s Strategy Unit”. Halpern explained herd immunity in a BBC interview:

This is the Nudge unit “behavioural scientists” talking on the record to @BBCMarkEaston about the plan for most population to get “herd immunity” – which I think means getting Coronavirus, while protecting the vulnerable – ie elderly via “cocooning”

. pic.twitter.com/WzLLDF9oNJ

— Faisal Islam (@faisalislam) March 12, 2020

Cabinet Office role

Set up under the Tory-coalition according to the Independent, BIT initially “declined to divulge all its members and the full extent of its work”. In 2011, Halpern reportedly said:

It matters who tells you. If you are [going] to say something about vaccination, you are much better off having the Chief Medical Officer say it than a Cabinet minister … if you want anybody to follow the advice.

So this may well explain the importance of Vallance and Prof Chris Whitty, the government’s chief medical adviser, appearing with Johnson at a press conference to announce that the UK was moving into the ‘delay’ phase of tackling coronavirus on 12 March. Herd immunity underpinned the government’s approach at that time.

BIT says it is now “independent of the UK government” and is:

jointly owned by the UK Cabinet Office, innovation charity Nesta and our employees.

Our lives at risk

To understand how best to combat the virus we need to have full confidence in the data available, whether that be from UK authorities or from other parts of the world. Equally important, we need to know if there is a political agenda to the strategies being developed.

Given the clear challenge from medical experts about herd immunity, and the government’s seeming U-turn on the policy, it’s getting harder to understand why Nudge Unit theories gained so much influence at a time of national crisis.

So it’s timely that in a letter to Johnson, Labour leader Jeremy Corbyn has demanded greater transparency in how the UK government is formulating its COVID-19 strategy:

this crisis demands political as well as scientific judgements and clearer public communication based on greater transparency of scientific and behavioural evidence and modelling than has been provided to date.

This is vital because untested theories and modelling may risk lives.

Our lives.

Featured image via YouTube