Intended for healthcare professionals


Covid-19: Experts condemn UK “freedom day” as dangerous and unethical

BMJ 2021; 374 doi: (Published 19 July 2021) Cite this as: BMJ 2021;374:n1829

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  1. Elisabeth Mahase
  1. The BMJ

International health leaders have raised significant concerns over the UK government’s relaxation of all covid-19 restrictions, calling it “foolish” and “unethical” as new cases continue to rise to nearly 50 000 a day.

The UK’s “freedom day” on 19 July come as hospital admissions are rising and experts have warned that around half a million people could develop long covid during this wave of infections. This is on top of the two million people believed to have already developed the condition.1

Writing in the Lancet, experts warned that the UK government’s current covid-19 strategy, which tolerates high levels of infection, is “both unethical and illogical” and called on leaders to reconsider. “We believe the government is embarking on a dangerous and unethical experiment,” they said.

The letter outlined mitigation measures—such as adequate ventilation, reduced class sizes, mask policies, testing, contact tracing, and isolating—that can be taken until everyone, including adolescents, has been offered a vaccination, uptake is high, and reopening can be reconsidered.

If not now, when?

Speaking at an event hosted by non-profit campaigning group The Citizens, authors of the Lancet letter were asked about Prime Minister Boris Johnson’s “if not now, when” approach to ending all covid-19 restrictions.

Former secretary of the Australian health department Stephen Duckett said, “There are two criteria that you should be considering. Firstly, is the pandemic under control? And secondly, is the population protected? If you open up when either of those is not the case, you are doomed to an exponential spread of the virus, exponential increase in hospital admissions, and exponential increase in deaths.

“The UK still has neither of those in place. They’ve got good vaccination rollout but it’s still not high enough, and they still haven’t got the pandemic under control. It’s foolish to open up right now.”

Lessons from Israel

Executive director of the Kohelet Policy Forum, Meir Rubin, who advises the Israeli government on risk management and national policy, said the UK must remember that “even the best vaccines are only a tactic and not a strategy.” He warned that when restrictions are only used to flatten the peak and stop healthcare becoming overwhelmed, vaccine protection will only last until a new variant emerges.

“In one area of Israel we have over 80% of the population fully vaccinated with Pfizer and they still had a serious outbreak where many kids got infected and also infected their parents,” he explained. “Even the minister of health claimed that the efficacy of the Pfizer vaccine against becoming infected and infecting others dropped from above 90% to around 60%, which is very bad.”

In June, Israel’s successful vaccination programme saw infections plummet and the country drop nearly all of its social distancing restrictions,2 but four weeks later the government was forced to reimpose certain restrictions as the delta variant spread across the country.3

“Right now, we see in Israel an outbreak of about 100 cases per million people a day. We are also seeing people dying, even though they are fully vaccinated,” Rubin said. “I really hope that the government in Israel will change course soon from mitigation to elimination, protecting our kids until we can vaccinate all of them hopefully in the first quarter of 2022. And I think we will see a lockdown in Israel in a few weeks unless we act very aggressively now.”

Long covid in children

Taiwan’s former director general of health promotion administration Shu-Ti Chiou said she is concerned for children and young people who cannot yet get vaccinated.

Taiwan has been seen as one of the success stories from the pandemic, as one of the few countries that has followed an elimination strategy—which aims towards zero community transmission.

Chiou highlighted studies from Italy showing that while mortality among young people is low, prevalence of long covid is much higher than expected. One study of 129 children infected with the virus found that only six were admitted to hospital but six months later half of them still reported at least one covid-19 symptom.4

She said, “In our culture, there’s a saying that it’s unethical to take the umbrella away from a person while it’s still raining. Now it’s politically unethical to take the umbrella away when it’s still raining, and it’s actually raining very hard. So I hope the politicians can take this into consideration and keep the umbrella there.”

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