‘Not again’ will be the first thought of many climate-change veterans. They will recognise in the Great Barrington Declaration (GBD) echoes of the dispiriting and distracting climate-science wars. Released on 7 October, the declaration is a brief statement promoted by three eminent epidemiologists. It is highly critical of lockdown approaches to tackling COVID-19 and argues for a complete and immediate reopening of societies across the globe. Think Sweden’s strategy, but more (and also less, a point to which I will return). In responding to it, progressives should make sure not to fall into the same traps as they did over climate change, even though all the triggers are in place for them to do so. Differences over COVID strategies, as over climate change, are not mainly about science. Nor should they be.
The Great Barrington Declaration
The GBD advocates allowing herd immunity to the coronavirus to build up and do its disease-containing work. It calls for ‘life as normal’ to be resumed—travel, face-to-face learning, working from the office, sports and entertainment—with no restrictions in place. It argues that the negative health and other effects of lockdown are too great. Handwashing and staying home while sick should be encouraged ‘to reduce the herd immunity threshold’. Finally, it calls for ‘Focused Protection’ for those most at risk, such as the elderly, through measures such as using staff with acquired immunity in aged care , or the elderly getting their groceries delivered. Masks are not mentioned, nor is ‘test, track and trace’. Nor is it acknowledged that countries such as China and New Zealand have largely reopened, domestically, with infection rates seemingly under control.
The brief declaration was released by three leading academic epidemiologists, Professors Jay Bhattacharya (Stanford), Sunetra Gupta (Oxford) and Martin Kulldorff (Harvard). Scientists, doctors and members of the public have been encouraged to sign up to it online. At the time of writing, more than 200,000 people have done so, although the public listing of additional signatories was placed on hold after it became clear that significant trolling of the process was occurring—Professor Mick E. Mouse, Dr Mad Scientist and so on.
The declaration says that it comes from ‘both the left and right’, but if so, it has certainly been loaded, perhaps deliberately, with triggers to arouse resistance in those of a ‘progressive’ inclination. Trigger 1: the release of the statement was the culmination of a workshop hosted by the American Institute for Economic Research (AIER), a libertarian US think tank, funded by the Koch Foundation, with the self-proclaimed agenda of promoting ‘personal freedom, free markets, private property, limited government, and sound money’, and with a long record of attacking proponents of action on climate change. It’s like the Institute of Public Affairs in Australia, only older, bigger and more powerful. Trigger 2: following the declaration, the three professors were taken to the Trump White House, where they met Health and Human Services Secretary Alex Azar, and Trump’s key COVID-19 adviser, Scott Atlas. Both welcomed the declaration. Indeed, Atlas was a participant in the meeting that drafted the GBD, and he pre-endorsed its publication.
Hard as it may be to do so, it is important to put these triggers to one side and acknowledge the validity of some of the key arguments made in the declaration. The differential age threat of coronavirus: ‘vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young’; the reality that many lockdown-type strategies adopted have indeed produced ‘devastating effects on short and long-term public health’—vaccination programs, cancer screening, mental health and so on; and that ‘the underprivileged [have been] disproportionately harmed’. It is entirely legitimate to ask if, from a societal perspective, ‘the cure is worse than the disease’.
Taking the declaration seriously
But taking the declaration seriously is not the same as endorsing it. Three things struck me when I read the declaration.
1. Sweden and ‘herd immunity’
First, there was neither acknowledgement nor discussion of the importance of social context and government financial support when deciding upon a COVID-19 health strategy. While anti-lockdown proponents have been mesmerised by the Swedish experience, the reality is that Sweden did impose some restrictions. It limited gatherings to fifty people. It shifted university and older schoolchildren to online learning. And it implemented a strict test-and-trace regime with strong quarantine requirements for entire households where anyone tested positive. The state pays for antibody tests and provides financial support for those required to quarantine. These restrictions were aimed at reducing social contact. They were indeed lighter than those of many other countries.
It has been widely noted that Sweden has also experienced a death toll ten times that of neighbouring Finland and Norway (although it may still be early days for making such reckonings). Its immigrant communities have been especially hard hit. There has been a greater contraction of GDP than for its Nordic neighbours that embraced stricter lockdown strategies. Arguably, the Swedish strategy, which had strong public support, rests on a foundation of high levels of trust in government, a sophisticated and competently managed public health system, strong social-security systems, and the world’s highest marginal tax rate. The GBD avoids these contextual issues entirely.
There may well be a public health case for fewer restrictions and more opening up. There is also a libertarian argument for doing so. But there is not a credible case for linking such calls to a small-government, low-tax ideology as espoused by the statement’s hosts, the AIER. Indeed, the lack of financial support for those needing to isolate, and decades of deregulation and encouraging casualised, insecure and portfolio work (especially in the care sector), have only exacerbated the spread of COVID-19. The GBD seems to want Sweden-plus (an immediate reopening and no restrictions) but also Sweden-minus (none of its social-democratic, economically interventionist state features).
2. First World/Third World
A second observation: the GBD views the world through a First World lens. The GBD is purportedly a global call to arms, but its implicit understanding of the world seems to rest on a particular elite view from the Global North. To take one example only: it seems to assume that most of the elderly are either in care homes, or retired and living alone or with their spouses. It accepts the need for special measures for multigenerational households, although it does not specify what these measures might be. Trust us, it suggests: a comprehensive and detailed list of measures is ‘well within the scope and capability of public health professionals’. Perhaps they are. But for most of the world, multigenerational households are the norm, not the exception.
There is indeed a particularly strong case to be made against adopting harsh lockdown strategies in the Global South. In circumstances where housing is inadequate and overcrowded, where employment is overwhelmingly informal and insecure, where no substantial social transfer payments exist, where savings are few and food insecurity is a day-to-day concern, lockdowns have had devastating effects. They have exacerbated existing inequalities even more sharply than they have in most of the Global North. Countries in the Global South that have been most effective in combating COVID-19, such as Vietnam, have adopted innovative strategies suitable to their own circumstances. This has occasionally included short lockdowns. Importantly, the WHO does not advocate lockdowns as the primary means to control coronavirus. ‘The only time we believe a lockdown is justified’, argues WHO special envoy on COVID-19 David Nabarro, ‘is to buy you time to reorganise, regroup, rebalance your resources; protect your health workers who are exhausted’. Instead it strongly advocates test-and-trace strategies.
Indeed, it can be argued that countries in the Global South that enforced strong and poorly managed lockdowns did so because their elites overly identified with the interests of the rich. Their strategies have helped protect the health of the existing elite and middle classes at the expense of the 90 per cent, especially in urban areas. In India there is a case to be made that the cure has been worse than the disease, with the lockdown having serious negative effects, especially on the poor and on migrant workers, and very few health-protection upsides, if reported current infection and death rates are reliable. In South Africa, the lockdown strategy adopted at the outset, in March, and recommended by experts, imitated a First World European approach. It failed to take into consideration the reality of life for the majority: overcrowded homes with no space for anyone infected to isolate, internet insufficient to allow home schooling, insecure employment and a reliance on crowded public taxis to find daily piecework, and hungry citizens forced to gather in large crowds, without physical distancing, for what food parcels charitable bodies could provide. There is a case against lockdown strategies in much of the Global South, although they have had some success over short periods in China and other parts of Asia. The GBD case lacks this nuance and awareness of context.
3. Epidemiology
My third observation is: why epidemiology? The GBD relies on its audience (us and governments) accepting the expert authority of the three epidemiologists most publicly associated with the declaration. Of course, there are many other, equally expert, epidemiologists who do not share their views, and yet others who share some of their views but not all. I will return to the question of scientific authority in general. For now, we need to ask whether epidemiology is the core scientific discipline needed for guidance in tackling this pandemic. The experience of the past nine months suggests that it should not be. Of course epidemiology has much to say about pandemics and their likely progression, and many epidemiologists have front-line experience with other recent pandemics, such as Ebola and SARS. But other health disciplines also have much to contribute, from front-line health workers and physicians treating those infected, to virologists trying to understand the virus as it spreads and mutates, to experts in track and trace. We are also learning that treating COVID-19 as primarily a public health issue does not sit easily with our experience that it has become a whole-of-society problem. Indeed, one of the positive aspects of the GBD is the recognition of this reality, even though the declaration asks us to accept that epidemiologists are the ones we should turn to for advice. The three epidemiologists who wrote the declaration represent a legitimate view, but it is only one view from one discipline. They should not be treated as ‘scientific dissenters’, as some in the press and the AIER would like us to do, as it strives to recreate the climate and tobacco playbooks.
One of the clear learnings from this pandemic is that collaborative response strategies are the most effective. Such strategies involve experts from a wide range of disciplines, both medical and non-medical (in labour-market policy, for example, or social psychology), and they include public participation and multi-party or non-partisan involvement too. There will inevitably be a variety of views on how best to respond and a need to ‘feel’ our way through this event, combining experiential knowledge, science, expert knowledge, public knowledge and contextual realities. Dealing with COVID-19 is too important to be left to epidemiologists.
Responding to the GBD and to the pandemic
When responding to the GBD, there are a few things progressives should have learned from the climate ‘wars’. Don’t respond to the provocative triggers—the Trump White House and Koch brothers connections. Don’t adopt the tactic of lining up ‘our’ scientists against ‘theirs’. Above all, don’t take the ‘scientific consensus’ route: ‘98% of scientists believe…’, or focus on discrediting individual signatories: ‘Professor Gupta is also bad/wrong in these other ways…’. Such approaches are a political dead end. We can see the effects already in the United States, with sterile arguments between those who suggest that COVID-19 is not so bad and those who stress how bad it is. Driving COVID-19 discourse towards binaries may suit the Koch brothers, but it does little to enhance meaningful public or practical engagement with the pandemic. A corollary of this is to avoid labelling the authors of the GBD ‘dissenters’.
It is also important to acknowledge that there is a great deal of validity to the critique of lockdown strategies, as I hope I have shown above. In truth, the declaration does its prime movers a disservice and does not capture the more complex story some of its authors have told elsewhere. For example, Professor Martin Kulldorff has argued, in an interview with Jacobin, that ‘the question is not whether we get to herd immunity or not, [but] how to get there with the minimum number of casualties…the lockdown is the worst assault on the working class in half a century, and especially on the urban working class’. And Professor Gupta has argued in an interview with The Biologist that she was motivated by the ‘terrifying prospect that lockdown might be implemented in places like India, or in Sub Saharan Africa, where asking someone to stay at home for months is not feasible. The cost is just too high’.
In the process we need to abandon illusions about policy being ‘led by the science’, and the myth of science as saviour. While scientific insights have much to contribute, they are not the sum total of the expertise needed. Science does not have all the answers. What science knows about COVID-19 is continually changing, and will often be contested. Some disciplines will have insights where others have gaps. This is the nature of knowledge production. Disagreement is not a problem. One of the strongest lessons to emerge from this pandemic is to drop naive understandings of the role of science in policymaking. This means searching for the best things to do in response to the pandemic given what we know, rather than arguing that a particular action is the only thing we can do because the science says so.
Progressives need to take many of the underlying points made in the GBD seriously, and not abandon them to the libertarian Right. The GBD should be approached with neither the deference its authors seem to expect nor the defiance its sponsors wish to provoke. In particular, we must be alert to policy proposals where the cure is worse than the disease, or which fail to make provision for ordinary working people to maintain a livelihood or be provided with meaningful compensation when they comply with regulations in the wider public interest. We should be wary too of regulations that grant excessive powers to the surveillance state and big corporations, and that infringe on democratic rights, other than for the shortest of periods. The GBD is right when it points out that lockdown strategies have serious negative effects on healthcare generally, for mental health, and for the young. But its argument needs to be taken further. As has been widely reported, these strategies have also exacerbated the full range of existing non-health inequalities in society. The poorest and most marginal have been the hardest hit. The way through and out of this pandemic needs to place this problem at the centre and find suitable solutions. The GBD has little to say about this. Perhaps engaging with it can open the way.
Thanks to Professor Sujatha Raman for her helpful comments on an earlier draft.
Planed Flat – Victoria, Stage 4: Is the new model barmy?
Guy Rundle, 10 Sep 2020
Yet the lockdown may be a product of the very assumptions classical liberals draw on for their one-dimensional idea of ‘freedom’.
Comments
Many thanks Jeremy, your comments on the GBD are much appreciated and thoughtful as always; it strikes me that given there is so much uncertainty and diversity with the COVID pandemic and still no ‘solution’, any expertise or discipline that wants to claim its own self-assessed superiority needs to be regarded with the greatest suspicion: there seems to be much opinion, but little accountability for wrong, misleading or unproductive opinion in these very uncertain times. One thing is for sure: the socio-cultural determinants of the spread of this pandemic and the wealth determinants of its variable impact on those unfortunate enough to be infected really matter!