7. What should guide policy makers and global leaders when making decisions about Covid-19?
Juliet: No epidemic is ever just a health issue in isolation, and Covid-19 has emphasised this on the global stage. There are huge economic ripples and societal repercussions being felt across the world because of this virus. We need to be looking at it in terms of an economic issue, a livelihood issue, a social issue and a political issue too. So trying to find the balance between those interrelated but often conflicting areas is very difficult.
For example, at what point do you prioritise education and balance the risk of children going back to school with the fact that they need an ongoing education and the additional support structures that schools provide? At what point do you balance having people gathering for funerals against the risk of transmission when actually it’s hugely important – emotionally, psychologically and socially – that people can collectively mourn and honour a loved one’s life in the way they feel most appropriate?
These kinds of issues which are both personal and local have been magnified onto the global stage. And it’s those kinds of issues that global leaders are having to struggle with – balancing risk and potential risk with needing to put in place mechanisms to make sure that, going forward, people are safe in their day-to-day life and that the day-to-day structures of society can flow again, including education, healthcare, economics, the movement of people, domestically and internationally, the movement of commodities etc.
Devi: It’s an impossible situation because you can't just let the virus go, because health services will collapse. On the flipside, lockdowns have enormous costs and you can't just lock down society for ever either.
You can't have it all with this virus – schools open, free moving over borders, job security, people out in pubs, weddings going ahead. The places that have done better have recognised the trade-off, and the places that are suffering are trying to do everything.
So you have to make strategic choices and the countries that I think have done well realised that early on. We’ve seen New Zealand, Vietnam and Taiwan saying, we're going to prioritise daily life but restrict freedom of movement. And South Korea saying, we'll have some freedom of movement, but we're going to do mass testing and tracing, and that requires giving up privacy.
I think of all the things to lose, the thing that will affect the largest number of people the least would be international movement, because we have to get kids back at school, we have to get people into jobs and you just try to support tourism through either forming bubbles or through supporting domestic tourism. It’s these difficult political decisions that leaders are having to weigh up and balance on a daily basis.
Erik: Policy makers are much better off if they intervene early. There have been many warnings about the consequences of a pandemic. Some countries took them seriously and were better prepared – both physically, having better supplies of critical equipment, drugs, masks and personal protective equipment, and intellectually – thinking through the response. Also, it seems that countries that had recent experience of epidemics or people in the government who really understood how epidemics work, such as Taiwan and Vietnam, have been more successful.
Policy makers are facing the same choices at the global level – how should we use our limited resources over time? There’s a strong argument for front-loading both measures on the medical side, to address the health emergency, but also on the economic side, to make sure that people can stay at home, and their businesses can survive. These things are closely related.
8. What is the best-case scenario?
Devi: A best-case scenario is a highly effective vaccine, which is safe, cheap, has limited side-effects and doesn't need to be kept cold while being stored and transported. If a large enough number of people are vaccinated, then we could reach a point where the virus is circulating at very low levels, where’s it’s unlikely we would have resurgences.
But even with a vaccine, we’re not going to eradicate Covid-19 anytime soon across the whole planet. If we have a vaccine and a treatment together, and a rapid test as well, then we’ll be in a really strong position. It would be tremendous if we could get to that, and that’s the optimism I have.
Erik: There’s a tendency to rely on science – that we should get a vaccine and then it’s all over. Or that we can develop antivirals and ways of treating patients better. All those things are important, but we cannot rely on them alone. We need to think much more widely and broadly about the challenges – we need the social sciences to help design interventions and protect those most vulnerable.
A good scenario is, of course, if we get a vaccine. Having said that, in the past we’ve also seen that, when we get vaccines, the interest of countries that benefit from vaccines in solving the issues that particular illnesses or epidemics are causing elsewhere goes down. So we need to make sure that even if we manage to immunise populations in the rich world, vaccines also come to low- and middle-income countries and conflict zones.
Even if we don’t have vaccines, in a positive scenario we will have collaboration through international organisations. For me, the most important thing now is that organisations like G20, the EU and other regional organisations take a stronger role. That’s the most promising scenario. If we are relying solely on individual countries to work on their own, it’ll be unlikely to get to a solution very fast or get to a good place.
Juliet: The best-case scenario is that we quickly learn from the failures and weaknesses that Covid-19 has highlighted so acutely, and make significant improvements in terms of how prepared we are and how we respond to a global pandemic most effectively. Should a new pathogen emerge that was similar to SARS-CoV-2 but that was more virulent and had a higher case fatality ratio, the world would still be woefully unequipped to deal with it. A higher level of true global cooperation is absolutely essential and urgently needed.
Secondly, in some settings, physical distancing has made communities come together to be more resilient, has made individuals be dependent on others in constructive ways, and has made sections of society open up to certain vulnerabilities. Moving forwards, we don’t have to go back to life as it was. There is going to be a ‘new normal’, but we have a window of opportunity to make that new normal better and more inclusive – not just for ourselves, but for others as well.
That is the most optimistic scenario that I can envisage: whatever the new normal looks like, it is a more equitable new normal.