“Personal responsibility” is a complete abdication of government responsibility – a government that has completely failed the public.
First published in July 2021.
Some thoughts on the prime minister’s briefing on the ending of COVID restrictions on 19 July.
- False ‘now or never’ narrative alert;
- No mention of long COVID or the clinically vulnerable (CV);
- Implicit that mass infection of young people doesn’t matter;
- Abdication of the government’s responsibility;
- Internal inconsistency and confused messaging.
First, the ‘now or never’ narrative. The government says we are in a position to open up because vaccines are working well and keeping hospitalisations down. The prime minister says that, “if we don’t open up now, when?” He and Professor Chris Whitty claim that opening up in winter may make matters worse. Is this true?
This is an interesting claim – the suggestion is that we should let it rip now rather than delaying because then the surge will coincide with winter, leading to a bigger wave. This claim doesn’t even pass basic scrutiny. Here is why:
Internal inconsistency alert!
If the government claims that we are in a position to open up now when 50% of our population is fully vaccinated, then surely vaccinating more people over the summer (the PM said all adults will be offered vaccines by September) will help hugely and do the opposite.
If the claim is that vaccines are good enough to protect us now, why wouldn’t they be good enough to prevent hospitalisations and deaths in winter, when many more will be vaccinated – lowering transmission and weakening the link between cases and deaths further?
So, then, the wave in the autumn should be much smaller, despite possibly more indoor contact, shouldn’t it? Or is something else going on?
As far as I can see, the claim is actually derived from this statement in the Imperial College London model released on 9 June.
This suggests that the problem may actually be waning immunity in the population and a lack of vaccination of children over the winter. So, a large wave over the winter (compounded by a lack of childhood vaccination and schools open) may impact even those who have been fully vaccinated.
But it suggests this could be offset with booster doses and childhood vaccination, which wasn’t examined in the model at all – and doesn’t seem to have factored in the government’s decision making. Why? The government is essentially providing us with a false choice between two bad options.
Tolerate mass infection now when only 50% of the population is fully protected. Or tolerate mass infection over the winter when it could be worse due to waning immunity and a lack of vaccination among children.
We shouldn’t need to do either if the government got its act together.
Remember that if we are in a situation where immunity is far more short-lived in the elderly now, it is largely because we imported a variant that has moderate escape against vaccines – which reduces the duration of protective immunity among the elderly.
Suggesting that mass infection now is better than vaccination, when many more people will be vaccinated in the coming weeks, makes no sense. If we are concerned about waning immunity, we need to deal with this by vaccinating everyone, including children, and a clear plan for boosters.
Mass infection to boost infection acquired immunity for a better winter really shouldn’t be the strategy. Also, vaccinating adolescents could have a fairly large impact on transmission – this could have an important impact on the size of the wave, including an autumn/winter wave.
It would also mean that we are protecting young people and adolescents rather than exposing them to the very real risks of long COVID – that 7-8% of children who get infected will develop for 12 weeks or more. For many, this will last for over a year, and be debilitating.
Why are we happy to follow a strategy of protection of the vulnerable through vaccination and mass infection and herd immunity in children – when we could vaccinate many of these groups in the coming months?
Imagine having children develop infection and long COVID, knowing they could have been vaccinated. But we are planning to rather expose millions of children to infection in the coming months – and there is no plan for vaccination for them.
And, of course, no mention that this is exactly the strategy that has been shown to provide the best grounds for virus adaptation towards escape – high transmission in the unvaccinated and vaccination of the more vulnerable alone.
Transmission has consequences.
We have already seen them with the emergence of the Alpha variant in the UK. If we manage to evolve an escape variant that reduces the effectiveness of vaccines further – this is problematic at global level, given how efficient we are at exporting new variants.
If the government is following a mass infection strategy, because they, 1. don’t have a clear booster strategy to deal with the waning immunity, 2. have no plan to vaccinate children despite most other countries doing this – they should be honest about this. And stop presenting two false options. They should be honest that there were other options like childhood immunisation that could have massively reduced some of these risks, but they have decided not to do that and rather decided to expose our children to mass infection.
They should also be honest that they are hanging the clinically vulnerable out to dry. There is nothing CV children or adults can do to protect themselves in environments where others don’t wear masks, where there is no attention to ventilation. Many (particularly children) will not be eligible for vaccination and some will not respond fully to it. What should they do in terms of “personal responsibility” to protect themselves? What do they do when they go into classrooms and workplaces with no mitigations?
What do they do when their employers tell them they have to come in because the government has removed ‘work from home’ guidance? Do they accept losing their jobs, or risk their lives going into workplaces where masks aren’t mandated, where there are no ventilation requirements?
“Personal responsibility” is a complete abdication of government responsibility – a government that has completely failed the public. The impacts of this will, of course, be amplified for the disadvantaged, the vulnerable, ethnic minorities, and for children.
Please tell me what “personal responsibility” my child can exercise in a classroom of 32 children where no one is required to wear masks, and there are no basic ventilation requirements and infection rates are sky high. What “personal responsibility” can I exercise as her parent?
The government should make clear that ‘herd immunity’ by infection is an active choice being made here. One that will lead thousands of our young disabled, with future impacts we don’t even fully understand.
A choice our government made when safe and effective vaccines were available.
— AUTHOR —
▫ Dr Deepti Gurdasani, Senior Lecturer in Epidemiology, Statistical Genetics, Machine Learning, Queen Mary University of London.
GET THEM INVOLVED:
- Evaluating the Roadmap out of Lockdown: modelling step 4 of the roadmap in the context of B.1.617.2 | Imperial College London
- Neutralising antibody activity against SARS-CoV-2 VOCs B.1.617.2 and B.1.351 by BNT162b2 vaccination | The Lancet
- Vaccine escape in a heterogeneous population: insights for SARS-CoV-2 from a simple model | medRxiv
[This piece was first published as a Twitter thread and turned into the above article on 7 July 2021 with the purpose of reaching a larger audience. It has been minorly edited and corrected, and published with the author’s consent. | The author of the tweets writes in a personal capacity.]
(Cover: Flickr/Number 10. - PM Boris Johnson. | 7 July 2021. / Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)