UK’s alternative scientific advisers put public health firstBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2056 (Published 27 May 2020) Cite this as: BMJ 2020;369:m2056
All rapid responses
John Middleton, writing on behalf of the UK’s independent SAGE group, states baldly “Efforts to revive the economy are vital, but no one contributes to the economy if they are dead.” (1)
This is 100% true.
This issue should be teased out further, in that one key reason why we have many of the political problems we are now facing arise out of the fact that, worldwide, we have come to rely massively on economic, financial and banking systems that have rapidly descended into absolute chaos within an exceedingly short time after the easy flow of people, capital, people, services and goods across distances and international borders had to be turned off.
Put bluntly, when faced with a pandemic caused by a lethal virus transmitted through the respiratory route, while the population at large has responded extremely well to the need to lock down and socially distance, there has in contrast proven to be comparatively less resilience evident in the prevailing political system.
Accordingly, if we want people to once again embrace the world of work and be keen to return to spending their money - both of which are essential to economies as we currently know them to be able to function - can we simply go back to “business as usual?”
Actually there is a case for saying that we need to very quickly re-think and re-boot much of what we have in the past taken for granted.
For example, we need to look seriously at adopting ongoing ways of living and working which embrace social distancing and other strategies essential to allow us all to avoid transmitting a lethal respiratory-borne virus from one to another. It may be a long time before an effective vaccine comes along, (2) and even then we absolutely must learn for the future from this experience.
For example, to get things going again is it mandatory that we have to pick up from where we were before prior to covid-19? Do we all need to travel to work and back at the same time? What is wrong with more people working from the home? Do we all need to squeeze into the same shops, cafes, pubs, houses of worship and hospitals simultaneously? Do we need to start routinely designing infection prevention and control for respiratory viruses into all public buildings? Do we need to be routinely sending planes and ships carrying vast amounts of goods daily from one side of the planet to the other? Do we have to jet people around the circumference of the world for meetings when we have perfectly adequate internet meeting facilities available? Are “just in time” manufacturing processes absolutely essential, or are they simply financially desirable? Do we really have to depend on economic and financial systems so fragile that they rely day-to-day on people living in debt for them to function? Do we need to keep chopping down huge areas of forest and jungle across the world? The latter is especially important as it may well be important in the genesis of fresh zoonoses, some of which clearly turn out from time to time to be very dangerous indeed, like covid-19 itself. (3)
These questions absolutely have to be asked. We have all, including political leaders, been guilty in the past of not heeding warnings when they came along, (4) and what comes next on the microbiological front after covid-19 may be even worse. (3)
The advent of covid-19 has brought with it many unprecedented challenges, but also opportunities - particularly for political, business, social, and academic leaders everywhere - to heed and analyse what has happened, take a long hard look at where we are, work out what was responsible for this state of affairs arising and fix it, and come up with some inspired ways forward that make us all less dependent as a species and a community on practices which have been revealed – by covid-19 – to be able to put us all in mortal peril and simultaneously potentially impoverish everyone.
A liveable future may not be driven solely by self-interest. Nurturing the civic virtues which have allowed the vast majority of people in the street to cope with lockdown and the social distancing necessary to battle covid-19 effectively may represent a way forward. Fresh economic, social and political thinking underpinning and incorporating ethical considerations (5,6) should shape both private and public decision-making.
On the political front, where can we look to for inspiration? US journalist Eric Levitz has stated “..the pandemic has ‘expanded the spectrum of imaginable futures and political possibilities…. (and) provides a vivid reminder that the state is perfectly capable of sheltering its constituents from the market’s mercilessness,’” indicating that perhaps progressivism (and even democratic socialism) may have a place in any effective future response, even in countries where that might have been hitherto thought extremely unlikely if not impossible. (7) Conversely, one could ask if capitalist principles - and the need to preserve a market with money to spend and hence for buyers/customers to sell goods and services to - could be helpful in the forthcoming battle to ensure entire populations can be vaccinated against covid-19, once (hopefully) effective vaccines become available. (8) Adam Smith and Karl Marx are not the only political economists in town!
1. Middleton J. UK’s alternative scientific advisers put public health first. BMJ 2020; 369 DOI: https://doi.org/10.1136/bmj.m2056 (Published 27 May 2020)
2. Deutsch J. How long will it take to develop a coronavirus vaccine? Politico, 4 April 2020. https://www.politico.eu/article/coronavirus-vaccine-how-long-will-it-tak...
3. Green ST, Cladi L. High time for an efficient and effective internationally-supported zoonosis surveillance system? Journal of Infection 2020, DOI: https://doi.org/10.1016/j.jinf.2020.05.015
4. Green ST, Cladi L. Cassandra’s curse and covid-19: why do governments listen to businesses over doctors? BMJ 2020; 369 DOI: https://doi.org/10.1136/bmj.m1852 (Published 13 May 2020)
5. Fritz Z, Huxtable R, Ives J, Paton A, Slowther AM, Wilkinson D. Ethical road map through the covid-19 pandemic. BMJ 2020; 369 DOI: https://doi.org/10.1136/bmj.m2033 (Published 21 May 2020)
6. Cladi L, Green ST. Ethics and politics in the provision of healthcare: a marriage made in heaven or hell? (rapid response). BMJ 2020, 369 https://www.bmj.com/content/369/bmj.m2033/rr-2
7. Horgan J. Will covid-19 make us more socialist? Scientific American, 20 April 2020. https://blogs.scientificamerican.com/cross-check/will-covid-19-make-us-m...
8. Green ST, Cladi L. Would capitalism benefit from ensuring universal access to affordable effective covid-19 vaccines? (eLetter). Science 2020, 368. https://science.sciencemag.org/content/368/6495/1035/tab-e-letters
Competing interests: No competing interests