The UK government is removing almost all COVID-19 restrictions from England in what the Prime Minister has as “Freedom Day”, but unfettered freedom does not exist. Sometimes trade-offs are simple; few would argue against limiting people’s freedom to murder and assault to give others freedom from violence. In the past eighteen months, however, we had to get used to more complicated trade-offs, and those with the lowest risk of COVID (like most children and young adults) have made large sacrifices to protect the health and, ultimately, the freedom of society’s most vulnerable.
COVID is not going away any time soon. Despite many great medical advancements, humans have only eradicated one infectious disease, smallpox. We now have effective vaccines against COVID, and are continually improving treatments. However, vaccines are not 100% effective. There are also some people who cannot get vaccinated because of underlying health issues prevent vaccination, they are too young, and those who do not want to be inoculated. So, some people will get sick. Variants risk undermining recent success, already twice in the last eight months, new variants have swept across the globe, and two more a continent. With the vaccines being much less effective against the Delta variant (amongst others), evidence from Israel suggests that the Pfizer vaccine’s efficacy against symptomatic illness is only 64%, compared to 95% for the variants most prevalent in 2020. Pfizer still reduces the severity of infection, so that hospitalizations rates are down by 93% for those who have been vaccinated, but a new more evasive variant could come along at any time.
As all adults in the UK have been offered at least one vaccine shot, it is understandable that politicians want to re-assess what freedoms to curtail in order protect public health, and at some point we need a re-assessment (though personally I’d rather this not happen whilst cases skyrocket).
There is no right answer to the question of when to trade liberty against public health. There are, however, at least four areas the government should look at for long-term planning:
As new variants pose the biggest risk to public health, they should be a primary concern. The government should look to help other countries access vaccines. In addition to alleviating huge global suffering, the less people who contract this illness the less likely the virus is to mutate into a new variant, which would come to the UK. There should be a greater investment in trial design so that researchers can quickly test vaccines against new variants as they arise, in case there is a variant that our current arsenal of vaccines does not work against, new ones can be more quickly rolled out.
More should be done to understand people’s preferences. The two previous attempts to open society ended with strict lockdowns being imposed. Would most people rather forgo some rights now if it reduced the risk of a future lockdown? And if so, what freedoms do people want to forgo? And what is the appetite for risk? COVID was not known about when this parliament was elected, so consulting with the public directly would have greater legitimacy then only relying solely on MPs. Public consultations are a standard part of UK policy process, the central government held 379 consultations in 2019, it’s strange that in such an important policy area there has not seen more formal consultation.
Economic evaluations are also a standard part of the UK policy process but have not been conducted on lockdowns to understand the trade-off. Understanding the social, economic and health risks associated with different restrictions would reduce the subjectivity of decisions. This could be used to create clear and transparent rules of what should be open when. The government says that it is willing to reimpose restrictions should the situation worsen, but we do now know the criteria for restrictions, so the public and non-government experts are excluded from these conversations around trade-offs.
We can open the economy, whilst still protecting against risks.
The vast majority of COVID transmission is through the air. This is less likely in well ventilated buildings. The state should encourage, and possibly fund, better ventilation in premises where people congregate. Even if COVID is not going to be around in the long term (and it is), this would reduce the risk from other respiratory illnesses, as well as from indoor pollution which often leads to headaches, allergies, asthma, rashes and sinusitis.
Masks on public transport and confined spaces are not likely to dampen the economic recovery, and whilst annoying, their impact on people’s lives is far less than lockdowns. Where masks are not practical, such as in restaurants, nightclubs and gyms, rapid COVID tests or vaccine certificates could be used to reduce risk. This would likely reduce public fear and increase demand for these services.
The requirement that people check into venues using the NHS test and trace app, should not be scrapped.
To further encourage people to get tested and then isolate if positive, people should be paid to isolate when they contract COVID. This is particularly true for people on low pay who cannot work from home, when the cost of isolation can be huge. In a matter of weeks, the Treasury designed a furlough scheme to protect people from being laid-off, why can they not design a similar scheme for those who are sick?
Like with influenza and the common cold, we will eventually have to learn to live with COVID. In March 2020, the government had to make a series of quick decisions. However, it is now eighteen months since COVID became a WHO illness of concern. It’s time to prioritize transparency, consultation and long-term solutions.
Everyone wants the world to return to normal, but we need to find a new normal that maximizes freedom in a world where COVID will be ever present, rather than trying to return to a pre-pandemic status quo.