The organisation ignores uncomfortable truths about our pandemic response
A report last week from the world’s oldest scientific academy, the UK’s Royal Society, “unequivocally” found that lockdowns, masks, contact tracing apps, travel restrictions, and other non-pharmaceutical interventions (NPIs) reduced Covid transmission.
But its shortcomings, as with the Lancet Commission report released last year and other high-profile work, reveal an unfortunate detachment from reality in our prestigious scientific institutions: better to exclude or minimise the uncomfortable outliers and data that question orthodoxy and sidestep the hard policy questions.
The result is more entrenchment of simple narratives and comfortable popular projections. Outlets as varied as the Guardian and the Daily Mail lapped up the findings because of the Society’s renown. Masks worked; lockdown slowed the spread; it was all worth it. No further questions.
Based on the findings, Chris Dye, a professor of epidemiology at Oxford who participated in the evidence synthesis, called for a 100-day global preparedness vision to support using NPIs, such as lockdown, early on during the next pandemic. Such policies would be imposed in anticipation of successful vaccines and therapeutics, already part of an existing global 100-day mission roadmap. This is our new lockdown doctrine.
The linguistic acrobatics are certainly noteworthy. Here is the most significant soundbite from the Royal Society report:
How can we really assess NPI “effectiveness” without considering how decisions had harmful consequences? Something can work and be powerful but still be “unequivocally” misguided. This report, as do many others, does not advance a comprehensive analysis, since it does not look at the consequences of NPIs on society. This is not necessarily wrong: all studies have limitations. Yet narrowly defining search terms limits one’s vision of reality. When the next pandemic hits, the usefulness of this type of analysis, for the hard balancing act of real-world decisions, will be limited.
This is not what society really needs from its thinking class. Hundreds of millions of people around the world were pushed into food insecurity, lost education and poverty. The report even says that such adverse effects from NPIs provide “a key question for inquiries being conducted around the world”, and calls for “another report, complementary to this one”. Yet no such report has appeared.
Moreover, just how confident is the Royal Society that this new lockdown doctrine is “unequivocally” correct? In this case, the analysis only looked at transmission reduction, not illness and deaths. It found a lack of effect when evaluating individual NPIs in isolation. It selected case studies from South Korea, New Zealand and Hong Kong but not Sweden, India, Haiti or Nicaragua: a veritable pick & mix of Covid evidence. The report relied heavily on observational studies, and the evidence review on masks contradicted a recent Cochrane systematic review.
The lockdown and social distancing review mixed and matched time periods, had to juggle different effect sizes, and did not distinguish between voluntary or mandated behaviour change. Most research studies are from high-income countries, limiting how far findings can be generalised.
Importantly, the report also concluded, based on this selective evidence, that NPI “effectiveness” reduced over time and was most “powerful” when transmission intensity and cases were low. This is hardly surprising, although other studies do call this into question. But it also ignores the political determinant of the new lockdown doctrine: the domino effect. We have seen in the years since 2020 that once you impose a slew of government mandates, repealing them is just as difficult.
For the 17% of the world that could stay home (about 500 million people) during the height of global lockdown, reports are now written that render the other 83% invisible.
Sceptical academic voices remain the oddballs. Yet I remain naively dedicated to the idea that better analysis can be carried out, if only when divorced from the many powerful interests, spin and egos at stake.