31.08.2021
Sir Peter Gluckman
The Covid-19 pandemic continues to progress in a relatively predictable manner with the evolution of more transmissible variants and countries fighting back with a mix of vaccines and behavioral strategies. The long-term implications of the pandemic will impact on virtually every aspect of our social, economic and political lives [1]. But across the world the policy responses have not been consistent or necessarily coherent despite the global nature of the challenge. Governments have pursued various actions partially informed by science and partially reflecting local politics and their own considerations – they are facing the consequences of choices they made in early 2020 when the virus first appeared. It is therefore worth now reflecting, as the pandemic continues, on the choices and challenges ahead.
The global hero of the story has been the enormous collective effort made by the global scientific community, in both the public and private sectors, to develop vaccines and share information on such a scale and in ways not done before. This effort, in turn, was heavily dependent on years of investment both in basic and applied science. Vaccine development continues – there are many new vaccines in the pipeline, some based on quite novel approaches – in the expectation that recurrent vaccination with vaccines fine-tuned to the newer variants will be needed. Similarly, there has been a variety of exciting innovations in testing, contract tracing, and therapeutics, which have been variably embraced by different countries. Again, these advances show the amazing ability of the science and technological communities to move quickly.
However, the political/policy responses have been much less uniform. Science advice has been both used and misused across the world. The multilateral system has largely failed to agree on, let alone execute, an effective response. Even the provision of vaccines to the developing world through the global mechanism COVAX has had a relatively small and woefully inadequate impact. Efforts to fully understand the origin of the pandemic have been drowned in geopolitics. The need for WHO reform now seems to be in the too-hard basket because of the unstable state of great power relationships.
Response and blame games
In this context, we see further and growing disparities between countries of the Global North and the Global South. In the Global North, life is being pushed or pulled back towards pre-Covid-19 conditions (perhaps unrealistically as the post-Covid era will not be the same as it was before) by a mix of vaccination and virus induced immunity (albeit it in some at enormous cost to human life). Meanwhile, many of the Global South countries, having already faced great tragedy and some, yet to face the worst of the pandemic, have little access to vaccines.
A few countries, such as New Zealand and Australia chose a very distinct path. Such countries kept the virus out from the outset but were slow to vaccinate and now confront the Delta strain being introduced into a disproportionately low vaccinated population. The distinct responses between New South Wales and New Zealand highlight the challenges – both had similar access to data, but the political and societal responses have been very different, and these differences have had consequences.
The blame game, from local to global, is already starting. In virtually every country, some form of open and honest reflection and examination will in due course be needed or demanded. It must be undertaken at the appropriate time and its primary role must be to create learnings for next time rather than seeking scapegoats for we are dealing with a problem child that has many parents. Such reflections will need to be mindful of political overlay because the pandemic has shown that evolving science, policy decisions, political considerations and societal viewpoints cannot be fully separated from each other. Virtually every decision, no matter what has been said by any decision-maker, has inevitably involved all these elements. In some countries, the political component has been very overt. For example, in the USA, there has been a bizarre conflation of views on science with partisan labelling. Other countries have appeared to have been in a hurry to reduce public health measures in response to pressures from society and business for governments with an acceptance that the price may well be greater disease – ensuring summer holidays rather than disease control appeared to be paramount to many in Europe.
Perceptions of risk and trust vary enormously. They are influenced by a range of cognitive biases, and by our worldviews, identities and personal values. Different societies have different risk tolerances and different levels of trust in governments and experts [2]. Some countries, such as New Zealand, inherently exhibit high levels of trust within their citizenry and in their decision-makers, while other countries, for various reasons, do not. Trust is essential to using science well and is critical to ensuring vaccination and compliance with public health measures. And in other places, autocracy has replaced trust in maintaining societal cohesion.
As the pandemic moves from the subacute to a chronic phase, how the disease evolves and its social, economic and broader consequences play out could yet lead to erosions of trust in science or government. If this occurs it could undermine social cohesion in virtually any country. It is critical that transparency and integrity are not subsumed for short-term political gain.
Exclusion, not elimination
The reality is that we will all face this virus into the future. In this regard, the use of words like elimination and eradication are not very useful. New Zealand has done well until now to thwart extensive viral spread within its borders. But given the nature, the global spread including into animals, and the enormous mutational capacities of SARS-CoV-2, it can never be permanently excluded. However, countries with low vaccination rates like New Zealand must continue to try to exclude the virus as best they can through border controls until vaccination rates are very high. That said, they still face the challenge of a possible wave of infections when exclusion measures are reduced, or when the barrier is breached (as happened recently in Auckland or more tragically in Fiji). With their populations attuned to a low viral load, countries like New Zealand, Australia and Singapore will have to carefully manage and titrate opening to impacts on the health system using a range of measures, until they can effectively get close to full vaccination (like the Cook Islands has achieved). But even then, questions remain: should children under the age of 12 be vaccinated? What about booster shots especially for those with relative immune compromise including older citizens? The science is still somewhat uncertain but it increasingly points to such necessities. Governments should be planning with a precautionary lens.
At the same time, no country can be immune to the many other effects of Covid-19, including its impacts on mental health, social cohesion, education, and democratic processes. There will be long-term economic impacts, as excess debt always incurs consequences. The pandemic has demonstrated the limits of just-in-time supply lines, and the geostrategic implications are very real. These longer-term considerations all require substantive public and private sector consideration, and in many cases, could or should lead to substantive resets, despite the pressures to return to business as usual.
Coordination and collaboration
But Covid-19 is not our only existential threat. Climate change brings with it the same conflation of science, policy decisions, political considerations, and societal viewpoints. Like Covid-19, it cannot be dealt with solely as a matter for individual nations, but requires coordination and collaboration of a nature not yet achieved in either case. In both areas, the science communities have shown great global determination and cooperation but sadly the geopolitical communities have not. Some countries are trying to accommodate the need to cooperate, but as the parable of ‘the tragedy of the commons’ highlights, if there are unrestrained freeloaders then the commons is destroyed. Sadly, the big emitters continue to be big emitters.
The Independent Panel for Pandemic Preparedness and Response (IPPPR) report [3] and similar analyses we have undertaken in conjunction with the Foreign Ministries Science and Technology Advisor’s Network [4] have both pointed to the need for tighter and more effective regimes of international health regulation and pandemic management. They highlights the need for global public health reform where technical analyses are conducted more independently of political considerations. Indeed the Intergovernmental Panel on Climate Change (IPCC) processes were largely designed to separate technical argument from policy choices. While Plato’s vison of a society where its major decisions were made solely by experts is never appropriate, clear compilation of evidence, its implications, and its presentation to society and policy makers is critical. Sadly, the requisite transparency has not always been apparent in the Covid-19 saga, because in the end, politics very often obfuscates any other consideration. Trust has been in short supply in many places. Even in New Zealand, mistrust in government is one of the arguments used by those opposed to vaccines.
Earlier this year, Dr Anne Bardsley and I authored a report on policy responses to risk assessments [5]. The underlying commonality was that while risk assessments can be well developed and presented to the policy and political community (despite all the inherent vectors of uncertainty), the responses to those risk assessments are largely determined by cognitive biases and political considerations, such as accountability avoidance. Yet the risk of a global pandemic was long heralded in risk assessments before Covid-19 broke out but preparations for a zoonotic pandemic were generally lacking despite rather misleading global indices suggesting otherwise [6]. Similarly, no-one can claim good global progress on addressing climate change. Both these global challenges require systems thinking, transdisciplinary approaches, and robust and pluralistic evidential inputs, combined with accountable and transparent action by governments and appropriate changes in behaviour and cooperation by citizens.
The time for deep and honest reflection on Covid-19 and its consequences may still be premature. But as the pandemic evolves into a chronic endemic phase when viewed at the global level, and as climate change and its implications continue to threaten the global community, it is not too soon to reflect on how our responses to both the pandemic and climate change, also need to evolve. But in the meantime, vaccinate, vaccinate, vaccinate.
[1] Gluckman P (2021) Covid-19’s ticking clock. Paris: International Science Council
[2] Sturgis P, Brunton-Smith I & Jackson J (2021) Trust in science, social consensus and vaccine confidence. Nature Human Behaviour, https://doi.org/10.1038/s41562-021-01115-7
[3] Independent Panel for Pandemic Preparedness & Response (2021) Main report and accompanying work. Geneva: IPPPR
[4] Gluckman P & Gillespie A (2020) WHO reform: a call for an early-warning protocol for infectious diseases. Wellington: The Conversation
[5] Gluckman P & Bardsley A (2021) Uncertain but inevitable: The expert-policy-political nexus and high-impact risks. Auckland: Koi Tū: The Centre for Informed Futures
[6] Kaiser M, Chen AT-Y & Gluckman P (2021) Should policy makers trust composite indices? A commentary on the pitfalls of inappropriate indices for policy formation. Health Research Policy and Systems 19: 40
