The Covid Inquiry is uncovering distressing evidence of how politicians and civil servants behaved during the pandemic. But equally important is the question of what explanations policymakers and health professionals were giving, and what they were telling the public to do. A new paper in the British Medical Journal explores this question. Its conclusions are alarming: that people died because neoliberal ideology and bad science had become embedded in public policy.
The paper, by academics from Oxford, Brunel and Plymouth Universities, and led by Professor Trisha Greenhalgh, describes the history of the policy and scientific response to the pandemic, and attempts an explanation of why the UK’s response was so poor.
How is Covid transmitted?
At the beginning of the pandemic, there were broadly two theories about how Covid19 is transmitted: by droplets or by aerosols.
- Droplets are generated by infected individuals. They cough, sneeze, or touch their mouths and noses and then touch other people or surfaces which other people touch. The best way to control the spread of a droplet disease is to encourage handwashing, and to clean the surfaces which people touch.
- Aerosols, by contrast, are generated when infected people breathe out. Unlike droplets, which fall onto the nearest surface, aerosols hang in the air, sometimes for long periods, and are breathed in by other people. The best way to control aerosol infection is by ventilation, masking, and social distancing.
Late decisions fed conspiracy theories
Throughout the pandemic, the UK’s response was dominated by the droplet theory. As a result, for a long time the official line was that masking was unnecessary, and this became embedded in public understanding. This undermined public confidence when the policy began to change, allowing conspiracy theorists to argue that masks, lockdowns, social distancing were not public health measures, but attempts at social control and the state’s ambition to suppress personal freedom.
Three reasons we got it wrong
Over time, it has become clear that the virus was mainly spread by aerosols, not droplets, but it took far too long to recognise this, and change the strategy. The paper argues that there were three reasons why the government got it wrong.
In the very early stages there was much uncertainty, and the droplet theory seemed plausible. A frightened public was desperate for explanations and guidance. So, in an attempt to reassure, government offered the droplet theory as the explanation. Once established, it was difficult to change the story. To do so would unsettle public confidence and embarrass politicians and scientists.
The second issue concerns the status of the science. The relevant committees and advisers lacked diversity, and the range of scientific expertise was too narrow. In the academic world, biomedicine is a high-status discipline, and it knows a lot about droplet transmission of disease. Environmental science is much lower down the pecking order of the sciences, and has much less evidence to draw on. So, “high quality” science was prioritised over relevant science.
The third issue was practical. There are limited measures which can be taken to prevent aerosol transmission. Changing the ventilation of public buildings is a long term and expensive project (though some young people spent a winter in classrooms with the windows open). It was unclear what kinds of mask would be appropriate, and in what circumstances, and there was a global shortage. So when masks were finally required, much advice (like how to make homemade masks) may well have been useless. People in exposed situations, like medical staff, often lacked (and some still lack) appropriate masks.
The government’s escape clause
So, the official narrative continued to focus on the discredited droplet theory. Politically this had the advantage of focusing the problem on individual behaviour, rather than public policy. It fits comfortably with the neoliberal world view, which has dominated British and US politics since the 1970s. This argues that, in most fields, the role of the state should be minimal, limited to regulating the behaviour of independent individuals and corporations. If you fall ill, and perhaps die, it is your fault. You didn’t die because the state failed to protect you, but because you didn’t wash your hands properly.
As the paper concludes,
Droplet precautions are, at least to some extent, under the control of individuals and hence resonate with neoliberal discourses about individual freedom, personal responsibility, and restraint of the state (although the “choice” to distance physically, for example, presupposes sufficient space in which to do so).
Airborne precautions require a paradigm shift in policy making, with strategic actions from those responsible for public safety; this approach aligns with a more socialist leaning political discourse and requires considerable up-front investment in the built environment whose benefits may take years to accrue.
The WHO’s tweet emphasises how to protect yourself rather than what to expect of your employer, your child’s school, or your government. Relatedly, we hypothesise a role for populism, the modus operandi of which is cherry picking evidence that supports the policy drive and validating anti-science sentiment under the guise of bringing power to people. Populism drew on public desires to return to normalcy and further marginalised aerosol science by depicting its recommended measures as obscure, unaffordable, and an enemy of the public interest.
A stronger and more honest state
Over at least four decades, the neoliberal suspicion of the state and collective institutions has become deeply embedded in our culture. Populist politics has built on this, celebrating freedom from an intrusive state, and denigrating public institutions and politicians.
Covid was always going to have traumatic effects on our society, but most other countries coped much better. Among the 238 countries covered by the World Health Organisation, the UK comes 18th in the number of Covid deaths per 100,000 population, just behind the USA, another bastion of neoliberalism.
This paper, and a previous one, on the role of neoliberalism and the regulatory state in the Covid response, have unveiled the part ideology played in the death and illness of thousands in this pandemic.
The first duty of the state is to keep its citizens safe. Neoliberalism, at least in some forms, is simply not compatible with that.