Members of the Conservative Party have recently received an email from the Secretary of State for Health in which he proclaims himself ‘delighted’ that the Government has hit its target of ‘offering the Covid vaccine to residents in every eligible care home in England.’ His delight has been all but universally shared by the national media, with William Hague’s leading article in The Daily Telegraph claiming that the Government ‘has rediscovered how to succeed’ being representative.
All this, however, takes the level of incomprehension of the Government’s Covid policy by the media, the public and the Government itself to a new height, or depth. The setting and hitting of this target was possible only because the Government effectively suspended the policy of suppressing or even – it is amazing to say that one cannot be clear what the aim has been – eliminating or eradicating Covid-19 throughout the entire UK population. It instead did what it should have done at the outset by focusing its effort on the vulnerable, and I shall focus on the most numerous group, the vulnerable aged. Those in care homes are but the first of four categories of those over 70 to which priority has been given.
Were it to be capable of learning from its ‘achievement,’ the Government should now self-consciously abandon the policy aimed at the entire population, the most important part of which would be to end lockdown, tiers, and all such general restrictions. But this would require the Government to acknowledge that its policy has been a mistake from the outset, and the general lack of capacity the Government has shown includes a lack of capacity to make such an acknowledgement. One has to fear that the mistaken policy has become ‘reflexive,’ in that the magnitude of the government’s failure has itself become the major obstacle to the government being able to acknowledge that failure.
When the UK Government became aware of the Covid-19 virus, it was obliged to make a decision with extremely imperfect knowledge. In part the imperfection was of knowledge of the organism itself. Though knowledge of human coronaviruses has accumulated over more than 50 years, Covid-19 was very likely only recently existent and certainly only recently known to UK and worldwide epidemiology. But much more important was the imperfection of knowledge of what sensibly could be done. A policy aimed at the entire population was from the outset bound to impose burdens on the Government’s capacity to formulate in detail and implement a policy unprecedented in the history of the modern state. All that could be said at the outset was that the costs of such a policy would be immense, certainly greater than those of any other peacetime policy ever adopted.
Such a policy was nevertheless adopted, largely on the basis of the claim that it was extremely desirable as it would avoid huge illness and loss of life. I must make it clear that I believe the predictions of these effects were speculations of a familiar, alarmist type, since given public credence by statistical reporting and other official information that is worse than worthless.
The point I wish to make here, however, is that desirability has no logical connection with possibility, and the Government’s lack of capacity to formulate and implement its policy has been amply demonstrated by the extremely undesirable results of its actions over the last year. The conclusion that because one’s knowledge of risk is extremely imperfect one therefore should undertake an extremely ambitious policy to eliminate that risk is absurd. Wanting to do something does not mean that one knows what to do, and to respond by trying to do everything means undertaking the impossible, and so inevitably encountering repeated failure. The damage having been done, the issue now is how to abandon the policy.
Once the view was taken that sufficient was known about Covid-19 to conclude it posed a significant danger as an epidemic respiratory disease, the Government was obliged to focus on the protection of the vulnerable, and in particular, the vulnerable aged. I by no means defend what has been done, but the questioning led by Jonathan Sumption of the medical policies adopted to prolong life, whilst valid and of great importance, does not, in my opinion, alter this obligation.
Such questioning follows from our longstanding failure to properly debate the legitimate aim of NHS care of the elderly which the Government could not be expected to resolve before taking action. As it has turned out, emerging knowledge of the epidemiological consequences of Covid-19 emphatically confirms the wisdom of adopting a focus on the vulnerable aged, but it was a wise policy in the face of the imperfect information at the time. It was also a policy that it was possible to carry out; one that could have been carried out without incurring the immense costs of a policy aimed at the entire population; and a policy which would have earned time to learn.
However, the Government not only failed to focus on the vulnerable aged but gravely damaged the welfare of those in care homes by taking untested persons from hospitals and putting them in care homes. We will not go over this and the myriad other actions taken that were manifestly deplorable, and not merely in retrospect. The point is that by now at last prioritising those in care homes, the Government has effectively adopted a focus on the vulnerable aged that it should have had in the first place. It has thereby set itself a target it could meet and achieved a highly positive result. Can the Government now draw the natural conclusion that policy aimed at the entire population should be consciously abandoned?
I have said why I fear the government will not do this. But though it is already overwhelming, the argument for abandonment must grow stronger. Abandonment would allow more focus on the vulnerable aged and avoid a number of undesirable consequences of the policy aimed at the entire population. Only a small proportion of those over 65 live in care homes and by virtue of their situation they have been relatively very easy to vaccinate. At the moment they are literally a captive target. Though progress so far is reported to be good, reaching all the remainder of those over 65, and in particular those incapable of independently participating in a vaccination programme, will require greater problems to be solved. The Government has set a target ‘to have offered a first vaccine dose’ to those over 70 by 15 February. We will see, with particular interest in the official meaning which will be given to ‘offered.’
The remainder of the population will be a different matter again. The success of this unprecedented vaccination effort will depend on the take-up of vaccination against a virus of unremarkable significance to those not vulnerable when the vaccine itself must pose risks to human health. Vaccination is racing against the evolution of Covid-19, which it was known from the outset would die out independently of vaccination or become endemic, with mutations into forms for which the current vaccines cannot be designed and against which they may be ineffective.
The use of a number of vaccines which will be administered with varying degrees of efficiency across a huge population magnifies the unknowable risk of undesirable unintended consequences. Unless the UK becomes completely isolated, this risk must be assessed globally, taking into account the epidemiological effects of the ‘pandemic’ spread of Covid-19. The longer the policy aimed at the entire population remains in force, the greater this risk will be, and should it substantially crystallise, it will throw the Government into new states of bewilderment and panic. One already sees a hint of this in the Government’s draconian but incomprehensible response to the ‘South African variant.’ In sum, without an acknowledgement of the failure of the policy aimed at the entire population, there can be no end to that policy. A good start would be for the government to look at the dictionary and consider a shift in its definition of ‘success.’
I must confess that I expected this shift to take place nearly a year ago as the costs of its policy dawned upon the Government and the unremarkable significance of Covid-19 for those not otherwise vulnerable became clearer to it. The success of the effort to maintain a climate of panic has astounded me. One can speculate that currently emerging disagreements within Government and the Parliamentary Conservative Party are evidence that a shift in the meaning of success is now being considered. But in light of the Government’s now successful focus on the vulnerable aged, it would be enormously better if the Government now openly acknowledged its error and abandoned general lockdown and all connected policies, whilst continuing efforts to protect the vulnerable.
This paper has been written on the supposition of agreeing that the Government has hit a meaningful target. In order to make this supposition, one has to adopt some of the Government’s assumptions, but it has rarely been possible to do so and still make sense. As it has never been clear what the aim of the policy addressed to the entire population actually was, one cannot know what purpose vaccination is intended to achieve. But with regard to the vulnerable aged, the most important assumption is that the vaccines are acceptably effective when used to inoculate those over 65. The incredibly accelerated UK approval process and the extreme focus on speed of vaccination have meant that there is no corrigible medical trial evidence of effectiveness to go by. This itself is, however, a reinforcement of my central argument. If vaccine development or the process of its administration has been compromised because they took place in the context of policy addressed to the entire population, then one hopes that that policy could not be denied to be, not merely extremely unwise, but wholly bankrupt.