The Oxford Covid Debate

On November 19 the Committee for Academic Freedom (CAF) hosted one of the first genuine debates on Covid policies. The nature of the debate, the issues discussed and the responses since, are all revealing as to where the last five years have brought public engagement on difficult topics – and how painful that time has been.

CAF invited to the debate two speakers who had at the time been critical of Covid policies from a left-wing perspective: Sunetra Gupta (Professor of Theoretical Epidemiology at Oxford, and co-signatory of the Great Barrington Declaration) and myself, Toby Green, a Professor of African history; along with two speakers who had been critical of the critics: UCL Clinical Professor of Intensive Care Medicine Hugh Montgomery (who at one time famously claimed people not amending their routines had ‘blood on their hands’) and Guardian journalist and medical historian Mark Honigsbaum. The chair, reproductive biologist and an advocate for public-facing science Güneş Taylor had a tough job on her hands, which she performed with aplomb.

Several things are important to note about the discussion. First is that there were some clear areas of agreement. Britain certainly got the issue of school closures wrong, along with the rest of the world. The fraught nature of the Covid crisis was exacerbated by the failure to prepare adequately for medical emergencies in the West through building spare capacity in health services rather than using a ‘just-in-time’ model based on neoliberal economics. The shutting down of debate was widely agreed to have been a serious problem, and to have exacerbated mistrust in government and the crisis of misinformation (or information saturation); moreover the systematic failure in previous decades to have proper debates about social values related to death, and how society should in fact approach end of life in an ageing population, contributed to the discourse collapse.

What was also encouraging in the debate was that there was some evidence of ability to listen and change opinion. Hugh Montgomery said that he had changed his mind on some topics over the evening. I too was also touched by his discussion and that of a nurse in the audience of the genuine fear and stress felt by medical staff at the outset of the crisis.

All participants agreed on the social cost of the lockdown measures. Almost inevitably, however, this was where the differences were ignited. Did those catastrophic costs make them unjustifiable? Mark Honigsbaum thought they had become inevitable once China began to build its quarantine camps, citing the oft-quoted projection of Imperial College modeller Neil Ferguson that locking down a week earlier would have saved 20,000 lives in the U.K. alone – a quote repeated the very next day on the publication of Baroness Hallett’s Covid Inquiry report in the U.K.. In spite of strong disagreements on this, what was striking was also the breadth of the debate, even on lockdowns: where did lockdowns sit on the scale of values as compared to our debts to the young, the kind of society we wish to live in, and the immense rupture which Covid had brought to people’s digital habits and mental health – already acknowledged as a serious problem for the young prior to lockdowns and digital ‘learning’?

If, as I pointed out, evidence suggested that over the long haul of an eighteen-month pandemic, fatality rates were very similar in lockdown and non-lockdown cases, what was the lockdown for? If it offered to buy a limited window of time to bring in PPE equipment and protect frontline medical staff, this could perhaps for a short time be justified (and here too there was some agreement). Nevertheless, it remains my view that had we invested sufficiently in primary healthcare pre-Covid there would not have been the same sense of panic, and such a dramatic suspension of basic civil liberties would have been unnecessary.

What was encouraging about the debate itself was its breadth. Though at times the participants diverged into their 2020 camps, there were broader discussions about social change, the current systemic and social crisis, and the young – all the kinds of discussion that were systematically shut down in 2020. This itself was positive, and while in his Substack summary of the event Honigsbaum reverted to the lockdown for-and-against discussion, which had been just a part of what was debated that night, this breadth of debate and evidence of listening was something that, as one of the participants said later, restored their faith in humanity.

What was also fascinating about the event was the audience, which was almost entirely anti-lockdown, as Honigsbaum noted in his ‘post-match report’. As indeed he also said, it was also difficult to find anyone to debate the pro-lockdown position. Therefore, he must be thanked for agreeing to participate. It is also hard, it seems, to get those who aggressively supported the measures to attend and engage in a post-mortem. Is this because people hate being proven wrong in such a massive way? Or is it because they still hunker down in an algorithmic silo contending that debating an issue will give succour to the ‘far right’ (by which, unless they are really disturbed, they cannot mean Sunetra Gupta and me)? Whether it is for both reasons is for the reader to decide.

At this stage, sadly, it seems that one person’s far right is another person’s far left on so many issues – and this itself is symptomatic of the systemic social crisis we now face in the West. What is clear is that, as I said in my closing remarks, unless we are prepared to listen better to each other, and discuss the moral and political crisis we are living through openly and without judgement, all of us will pay the price.

In conclusion, I provide the answers I prepared for Güneş Taylor’s questions for the Oxford debate – most of which, in some form or other, I tried to get across.

Opening comments  in response to the title of ‘What did Britain get right and wrong during the Covid-19 pandemic?’

One thing we got wrong: this is pretty hard to choose, to be honest, as I think so many things were got wrong. I would emphasise especially here the jettisoning of previous pandemic plans which led to many of the subsequent crises – and corruption in contracts, as responses were being made up on the back of an envelope. Many figures who worked extremely hard on those previous plans, such as Lucy Easthope and Robert Dingwall, have emphasised the extent to which they were ignored. I would also mention the inhumane cruelty of isolating care home residents in the last months of their lives and depriving them of contact with their families – where the life expectancy of someone entering a care home is about one year. This is as cruel as you can be.

My focus will be on something broader here, as I will zoom in on more details later: the lack of debate. The shutting down of debate by public service broadcasters and social media platforms was nothing short of a catastrophe. It has contributed to many of the subsequent catastrophes. In particular, the lack of trust in government and media today – which links to the increasing appeal of Populism. So, I want to thank my fellow panellists this evening for being here and enabling this event to happen. We may have strong disagreements, but we are willing to air them in public, to try to understand each other’s perspectives, and thereby to understand what happened so much better. It’s quite shocking that this appears to be the first such event that has taken place in the U.K., and that it has taken five years to have it.

It was also pretty hard to think of one thing that we got right in the U.K., but eventually I did remember one. It was the decision not to lock down in the December of 2021 during the Omicron wave. There was a huge amount of pressure, and The Guardian reported that we might have two million cases a day by New Year. In the end, the peak was at a little over 200,000, so this was an exaggeration of 1000% – not the first time this happened during the pandemic; with the misrepresentation of PCR testing as a diagnostic tool rather than a laboratory test giving the impression things were much worse than they were. And afterwards, many media “experts” such as Jeremy Vine intoned that they “had not realised” that “people adapted their behaviour automatically” at times of health crises – even though this was precisely what Sweden had said, under Anders Tegnell, in the spring of 2020, when deciding not to lock down.

As it was things were already bad. On a call with a practising G.P. that winter, he told me that he was the only emergency G.P. in a city the size of Oxford, because everyone else had been called in for the booster rollout.

A student put it to me like this: “If we lock down again, it’s going to mean more weeks doing my classes on the stairs.” The enormously regressive impacts – as a 2022 Sutton Trust study showed – of education lockdowns meant that advances in educational outcomes among the poorer sectors of the population had been reversed by ten years. We also cannot easily estimate the health costs of taking these measures, including pathological loneliness, and missed diagnoses.

What measures were taken e.g. masks, vaccine passports etc? Did they ‘work’? How were Covid deaths measured? Could more lives have been saved through earlier and longer lockdowns? 

There is no evidence that more lives would have been saved by earlier and longer lockdowns. A new book by Frances Lee and Stephen Macedo, In Covid’s Wake, shows no discernible difference in Covid mortality pre-vaccine between U.S. States which locked down and those which did not. Meanwhile, excess deaths in Sweden were among the lowest in the OECD between 2020 and 2022, comparable with its much-lauded neighbours. [Editor’s Note: according to this 2023 OECD report: Notably, Sweden, which was under the spotlight at the beginning of the pandemic, saw excess mortality among 65+ age group below the OECD average in 2020 and negative in 2021 and 2022, as well as overall.]

And this is the key statistic, overall societal deaths, for the precise reason that measurement of who died ’from’ or ‘with’ Covid is so unreliable. In April 2020, the WHO changed the definition of death from Covid to someone who had a positive PCR within 28 days or just the suspicion of Covid. Peru changed its means of measuring Covid deaths after 18 months, for instance, which suddenly gave it far and away the world’s worst per capita mortality figure; in Italy it was the reverse, and in November 2021 the Italian ministry of health revised figures to show the numbers who had died without any comorbidities as dying “of Covid”, which was very small (under 4000). Indeed, at one point Priti Patel went on TV to try to argue that Covid mortality was lower than stated because of the comorbidities – and this was probably true, since Neil Ferguson himself had said quite early in the pandemic that a third of those who died of Covid would probably have died within the next year anyway.

In effect, politicians became prisoners of statistics. This also led to the focus on vaccines and vaccine passports, even after the Associate Editor of the BMJ Peter Doshi  reported in the BMJ in October 2020 that the vaccines were not being studied to determine whether they would interrupt transmission, so could not guarantee a sterilising vaccine. Given the history of vaccination and its connection to colonial power in Africa and racialised experimentations in the U.S. and elsewhere in the West, vaccine passports were nothing short of racist and discriminatory – and scientifically illegitimate, given the fact this was not a sterilising vaccine, and never could have been.

This global perspective points to another issue, which is the absurdity of focussing on lockdowns when so many other variables are at stake: health spending per capita, socioeconomic wealth, obesity, age pyramids of populations, other health priorities, and so on. Given the huge range of health variables, and global socioeconomic conditions, it really is extraordinary that a medieval policy – developed when the humoural theory of medicine was still in vogue – was rolled out again, and assumed to be fit for the entire world for eighteen months to two years. Cui bono? The billionaire class!

What was the cost of the measures taken? What have been the global ramifications of the pandemic and pandemic response? Its effect on healthcare, economy, civil liberties?

The cost was a catastrophe, which no one wants to talk about. I remember an email which Sunetra Gupta and I received in April 2021 during the Delta Wave in India from a Human Rights lawyer working for a trade union in India – saying that literally millions of informal sector workers were starving by the roadside in the state of Uttar Pradesh alone. In the Philippines, children were not allowed to leave their homes for eighteen months – enormous increases in child abuse were reported.

We often hear that all this was “caused by Covid”. But it wasn’t: it was caused by Covid measures. In November 2023, the U.N. Development Programme (UNDP) stated that ‘50 million more people in Africa fell into extreme poverty as a result of Covid’. This is nonsense: the African continent registered less than 260,000 Covid deaths, and over 100,000 were in South Africa alone. Mortality was very low compared to other endemic diseases – as some predicted right from the start on a continent where the median age is around nineteen.

But now, Africa is entering Structural Adjustment 2.0 according to the New Internationalist. This has been caused by inflation, and collapse of the informal and service sectors during 2020-1. Well documented mass food price increases had already been reported by the World Food Programme and Reuters by October 2020, long before the war in Ukraine – although that certainly hasn’t helped. The result is, OXFAM reports, that over half of Low Income Countries are reducing health and education spending in the next five years. That isn’t going to offer any help in “preventing the next pandemic”.

We saw two years of school closures in countries like Honduras, India, and Uganda. There were 4.5 million schoolchildren alone removed from schooling in Uganda, leading to catastrophic increases in teenage marriage and forced labour. We also have a whole lost generations in India, as documented in Collateral Global’s film The Children of Nowhere.

We saw a massive spike in gender-based violence, a ‘shadow pandemic’ as the UN Women’s Commissioner described it – with twenty years of progress in sexual health wiped out by the closure of clinics; the abused incarcerated with abusers; huge increases in prostitution; and the shuttering of informal markets which are the main source of income for many women in the Global South.

We also saw a version of this in the West. Enormously elevated time was spent by adolescents online, which has led to increased consumption of violent pornography with devastating consequences.

So, closer to home we can see the haemorrhaging of trust in public institutions and government In the UK. There have been huge protests around, for instance, Keir Starmer’s policy of cutting winter fuel payments to many pensioners, saving around £1.5 billion. Yet we have had no debate around the £310-£410 billion spent on Covid policies, with bewildering figures such as £37 billion (the entire UK transport budget) allocated to track and trace – which the U.K. government’s own National Audit office estimates reduced cases by just 2-5%.

Covid spending achieved very little, but it has meant that there is “No money left”. The worst of all – at least for those of us fortunate enough to be in this room – is the generalised collapse in hope and optimism for the future, as we can see all about us. It is this which is degenerating into polarisation, and social fragmentation.

How should this experience shape our future responses to pandemics? E.g. Could the Great Barrington Declaration’s ‘focused protection’ strategy be applied to future pandemic preparedness? What lessons can history teach us about balancing public health, personal freedom and societal impact?

In terms of how the experience should shape future policy, we held a conference funded by Collateral Global at King’s in 2023, which came up with some important recommendations signed by 25 scholars from across the Global South. I am going to share them here:

:- The centrality of public investment in healthcare – especially primary healthcare and infrastructure – and in social welfare, to expand at times of need. The “just in time” model does not work for healthcare or social welfare, and is not “efficient” – this requires rethinking the privatisation of so many features of the state, as countries like Nicaragua and Sweden showed. In the end it was private pharmaceutical companies that profited. Astra Zeneca (branded as “the Oxford vaccine”) wasn’t supposed to be for profit but they altered that policy later on.

:- Proportionality and the disaggregation of risk: people at Low risk of diseases in one country will not be the same in another – we need community-based healthcare, as the WHO’s 1978 Alma Ata declaration demanded, not top-down centralisation derived from a corporate management structure.

:- The importance of an open and accurate flow of information: censorship quickly becomes misinformation and actively works against the public good.

:- Attendance to socio-economic factors and the social determinants of disease: what works for residents of North Oxford does not work for residents of Peckham or Oldham – let alone for Lagos or Kinshasa.

:- Awareness of the complexity of supply chains and the impacts that disruption can have in access to healthcare – transport restrictions can be catastrophic when they are required to get people to hospitals for regular medication, or to bring in medical equipment manufactured elsewhere.

:- Awareness of how policies that aggravate inequality will exacerbate ill-health – as all previous research indicated, and as the Covid policies showed – with the biggest transfer of wealth in history from the poor to the rich, and subsequent prolonged increases in excess deaths in many countries long past the end of the pandemic.

And this highlights the absurdity that those who opposed these measures such as Sunetra Gupta and myself were painted as “right-wing”, when the left has always favoured the opposite policy – the redistribution of wealth from the rich to the poor.