Round Two of Covid-19: the UK’s Strategy Against Further Lockdowns

Three questions to Eva Thorne

Political Scientist at the Tony Blair Institute for Global Change

The Covid-19 crisis management of European countries reveals their structural weaknesses and strengths. It unveils not only the degree of robustness of their health system, but also the effectiveness of their digital system, the resilience of their emergency management system, the level of public trust in the governments... By comparing large scale government responses to a single disaster and the outcomes of these responses, we are able to highlight their core assets and compare their cruising pace in some fundamental public policy strategies.

As the second lockdown in the UK is being extended, Anuchika Stanislaus, International Affairs Officer at Institut Montaigne, interviewed Eva Thorne, Director of University Partnerships of the Tony Blair Institute, in order to understand the UK’s level of performance in mitigating the crisis, especially through the UK’s advanced research on vaccines.

What conclusions can be drawn from the UK’s past management of the pandemic and how do they guide the British government's current choices?

Experts predicted there would be a large pool of infections that would contribute to a second wave or a spike as we entered the flu season. It's utterly depressing to see that everything they said was correct, especially as there was no reason to think that they wouldn't be, because they were using models, statistics, data, and past experience. We are now in the next phase of this pandemic, which is happening during the flu season, and it’s all the more important to get a flu vaccine now.

In the United States, cases are out of control. Last week, the country had more than 1,000 deaths per day for several days straight. Similarly in the UK, the infection rate was also rising for a while. Hopefully this lockdown will help slow the spread of the disease. Hopefully the UK government will use this period to put measures in place, so that we do not have to go into another lockdown. On a positive note, we’ve learned a lot since the spring and health care professionals are better equipped to treat people, which reduces the death rate. Also, we now have dexamethasone to treat people. We also have patients who can participate in the UK's RECOVERY treatment trial, with some access to some of the drugs which are being tested, particularly antibodies which we know are powerful.

That all being said, we know from experience with various governments that it’s more difficult to get the virus under control in the absence of coordinated national and local strategies. Until a vaccine is distributed, we have to focus on what we can do now. In September, the head of the Center for Disease Control in the United States was giving congressional testimony before we had any news about Pfizer. He held up a mask and said "Until we get a vaccine, this mask is our best protection". Yet, we see a reluctance to push masks mandates in many places. Mass testing, contact tracing and isolation, social distancing, being outdoors, and frequent hand-washing are also part of what works and what people need to do to manage until we have mass vaccination. This virus knows no boundary nor borders, and piecemeal approaches just aren’t good enough.

Mass testing, contact tracing and isolation, social distancing, being outdoors, and frequent hand-washing are also part of what works and what people need to do to manage until we have mass vaccination.

The UK government has pledged more than USD 700 million to COVAX, the global facility that is helping to mobilize resources, so that developing countries can have access to Covid-19 vaccines. It’s great to see the government involved like this. It shows strong and compassionate leadership during a time when it is desperately needed. Investment in multilateral institutions is needed more, not less. COVAX has become the central body to organize support for vaccine access in developing countries. More resources are needed. We must remember that we will become safer as more people are vaccinated.

What happens in low- and medium-income countries matters to us all. Ensuring vaccine access is ultimately about enlightened self-interest, in addition to being the right thing to do.

What are the strengths of the British strategy against the spread of the virus ?

The UK has a number of really important strengths:

First of all it has a world-class community of scientists and innovators. Over the past year, there has been an increased collaboration across different disciplines and a lot of innovations and breakthroughs have resulted from it, in terms of antibody and vaccine research.
The second aspect is that the UK benefits a lot from its centralized health system with the NHS. Even though the NHS certainly is under strain because of the pandemic, it provides a good focal point for organizing the logistics and the distributions of whichever vaccines come to market first. Having that central structure is a very powerful tool, especially if you contrast it to the United States’ health system which is completely fragmented and decentralized. It makes decision-making easier.
The UK is approaching trials of therapeutics rather cleverly. What we’ve seen is that clinical trials that have taken place around therapeutics have often been fragmented and uncoordinated. The WHO is trying to address this with it’s large randomized trial, Solidarity. But the UK got organized and launched an ever larger therapeutic trial - RECOVERY. It has produced the most robust and clear evidence as to which drugs work (dexamethasone) and which ones don't (hydroxychloroquine). The leaders came up with a good process to save time so that we can get information in an expedited but safe way. The results are important and impressive.

Vaccines are not a magic bullet. They're part of a larger toolkit that we need in order to address the pandemic. In fact, they also have their limits:

We hope that the early data on some of the vaccines holds up. It certainly looks promising, and vaccines will surely help most people. At the same time, there could be some people who can't take the vaccine because they're elderly and their immune systems aren't as responsive, or because they may have underlying health conditions. That’s why therapeutics like antibodies could be very important, since they could help people who may not be good candidates for vaccines.
The complementarity of therapeutics is also important, and the toolkit available is about vaccines just as much about therapeutics. Therapeutics such as antibodies, which some of the companies are working on, could be effective for up to 6 months and 12 months. For example, the Astrazeneca therapeutic that's being trialed uses a technology that increases the length of its effectiveness, possibly for up to a year. But antibodies are expensive to produce and we don’t have enough doses available for the need. It takes time to manufacture them.

How is the debate on vaccines structured and what is the population's level of support around vaccines in the UK?

The general numbers overall indicate that there are more people than not willing to actually take the vaccine, which is critical. The Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine is doing excellent research on this topic.

On the one hand, we know that there’s a relatively small but very organized, effective, highly vocal, and social media savvy anti-vaccine lobby. On the other hand, anti-vaccine narratives happen not just in developed countries, but also in developing countries. In the context of sub-Saharan Africa, a French doctor caused controversy when he proposed that vaccines for the Covid-19 pandemic be tried on Africans because they lack masks and other personal protective equipment. It became a rallying cry that worsened existing suspicions and fueled skepticism about having clinical trials done in sub-Saharan Africa. It is unfortunate as we need variety in clinical trials and we need diversity with respect to age groups, ethnicity, etc. in order to make vaccines as effective as possible.

Vaccination roll-out has come along with combating anti-vaccine narratives, making sure there is an ongoing public information campaign about vaccines that reaches people and sets their minds at ease.

The challenge of getting people to take vaccines stems from public distrust towards the government. The Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine has done world class research, but if it is actually 90% effective and nobody takes it, it is no longer useful. Vaccination roll-out has come along with combating anti-vaccine narratives, making sure there is an ongoing public information campaign about vaccines that reaches people and sets their minds at ease. This includes showing leaders themselves taking the vaccines, getting community based organizations involved, anything that would reduce suspicion and combat misinformation. The UK does carry out public information campaigns, but more will have to be done with massive, effective public information campaigns, and micro targeting of specific groups that might be resistant to taking vaccines, in particular marginalized communities that already have pre-existing distrust of government. Having representatives from those communities and taking a human-centered approach can help.

Copyright: Tolga AKMEN / AFP