Intended for healthcare professionals

Opinion Talking Point

John Launer: Wishing upon a tsar—covid and health literacy

BMJ 2023; 380 doi: (Published 14 February 2023) Cite this as: BMJ 2023;380:p331
  1. John Launer, GP educator and writer
  1. London
  1. johnlauner{at}
    Follow John on Twitter @johnlauner

I was once invited to become a tsar. This wasn’t a tsardom of the Ivan the Terrible variety, which might have appealed. It was a request to take on one of those government posts designed to make a noise about an aspect of health policy.1 The job was meant to promote health literacy, the public’s understanding of health.

The person who approached me said that they could only pay expenses but reassured me that I wouldn’t need to do much except read statements “ghosted” for me by civil servants. I declined. I’ve no idea how firm the invitation was or if anyone else was asked and appointed. I assume that other tsars have been given better terms and were more qualified anyway.

I sometimes wonder what might have happened if I’d agreed. I thought about this while the covid pandemic unfolded and public discussion became swamped with disinformation, government spin, exaggerated controversy, and superstition. I also pondered on how different things might have been if a genuine health literacy expert had been appointed to bring in a consistent framework for messaging the public and had worked with ministers in harmony, driven more by science than by politics.

I suggest that they might have wanted to convey two key ideas from the outset. The first is that scientific evidence is bound to shift constantly, especially when a crisis is evolving and vast amounts of research are being carried out. Guidance might therefore seem contradictory over time, but this would be a sign that scientists were doing their jobs and learning from each other. Reiterating a headline message of this kind, accompanied by explicit updates (“Last month we told you XYZ; this week we’re confirming X but changing Y and Z”), would have made it easier to change tack. This might have enabled a shift from simplistic slogans about handwashing to a greater emphasis on masking, particularly about the right kind of mask. It might also have made it possible to promote air filtration and ventilation, which weren’t on the original agenda and haven’t been emphasised enough since.

Secondly, the pandemic could have offered an opportunity to teach everyone how to assess personal risk and calibrate their behaviour accordingly. It’s astonishing how many people, including those who are vulnerable or unvaccinated, have remained unaware of basic information about covid: for example, that being outdoors massively reduces the risk of catching it; that most transmission is airborne from symptomless carriers (including vaccinated people); that carbon dioxide monitors give a good indication of the virus’s concentration in the air; that prevalence in the UK goes up and down as much as sixfold from month to month; and that variants are now several times more infective than the original ones.2 Stating these largely undisputed facts clearly and regularly on the news could have encouraged individuals to take more responsibility for protecting themselves and others they cared about, independently of government mandates.

In terms of advancing health literacy and saving lives, it’s sad that these opportunities were lost. Perhaps they could still be seized. Tsardom, anyone?


  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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