COVID: The Pandemic Without Honor?

It’s become a truism of the current pandemic: everyone is now an expert and wise before, during, and possibly after the event. A crisis has always demanded judgment, so judge we do, incessantly. No one these days is slow to express an opinion about the risks of different viral strains, the dangers of aerosol spread, the effectiveness of various masks, the benefits of ventilation, what sort of test to rely on, which vaccine to procure, when to get boosted, how long to self-isolate, whether to open borders, and so on, and on. Some claim special insight into how and where SARS-CoV-2 emerged, or how and when the pandemic will end. Indeed, after a couple of years, the character and quirks of the now not-so-novel coronavirus may be more familiar to us than the traits of many family members. The virus has turned into the most intimate of adversaries.

Most of us have particularly strong opinions about the arguments and actions of politicians, public health bureaucrats, epidemiologists, and medical scientists who seek to manage the SARS-CoV-2 pandemic. We are convinced that we know exactly what the government should do, or should have done, to mitigate or control, if not eliminate, this affliction. But until recently, we’ve learned little about the deliberation and agitation that occurs among government advisors and functionaries behind the scenes. What do the “real” experts—at least those credentialed and legit—really think? How do they feel about their fellow experts and their political chiefs? What might we see behind scientific cloaks and bureaucratic masks?

The dirty politics behind pandemic science advice is revealed in The COVID-19 Catastrophe by Richard Horton, the incensed editor of the Lancet. Meanwhile, the inside story of how not to improvise disease control is told in Spike by Sir Jeremy Farrar, director of the Wellcome Trust and former member of the British Scientific Advisory Group for Emergencies (Sage). Having read these books—which expose the gaffs and pratfalls of authorized experts—we may even decide the common “expertise” of the ordinary COVID-19 aficionado doesn’t sound quite so wacky and misjudged at all.

Both Horton and Farrar are leading members of what they call the British “medical establishment.” Horton’s Lancet is perhaps the most provocative and influential of medical journals; Farrar’s Wellcome Trust (now simply “Wellcome”) is the largest private funder of medical research in Britain. It’s as though the editor of the New England Journal of Medicine and the director of the National Institutes of Health—or maybe just Deborah Birx—resolved to write books in the middle of the pandemic giving us the lowdown on scientific advising and medical decision making in the United States, including the trials and travails of courting an erratic, irresponsible, and delusional Donald Trump.

It would be like Anthony Fauci finally showing his hand, upending the table, and shouting: “To hell with you all!” (Yes, I agree, it’s unlikely to happen.) The nearest American equivalent that comes to mind is Andrew Cuomo’s immensely self-satisfied and narcissistic American Crisis: Leadership Lessons from the COVID-19 Pandemic (2021), which is best read—if read at all—accompanied by Frank Sinatra singing “My Way” on a loop. Cuomo’s book is about everything he did right—but Horton’s and Farrar’s books, as their titles suggest, are about everything their colleagues and political masters did wrong.

“Slow, complacent and flat-footed. The country was glaringly unprepared”: thus, Horton appraises the British state response. Writing in the middle of 2020, when the pandemic was smashing Britain, Horton describes in vivid detail how the “science and politics of COVID-19 became exercises in radical dehumanization.”

Despite various dress rehearsals, including SARS, the world was woefully unprepared for any novel viral onslaught. For years, some global health experts had been urging sharpened vigilance and enhanced surveillance of emerging viruses. Still, national and international efforts remained perfunctory, even negligent. Trump and other heads of government, Horton points out, showed “no global leadership, no willingness to cooperate, and no ability to view what was taking place as a lethal global challenge demanding a coordinated global response.”

Curiously, the COVID-19 pandemic from the outset was perversely nationalized: imagined nationally, modeled nationally, and subject to contrasting national reactions and interventions (including, later, national hoarding of tests and vaccines).

At the beginning, UK scientists and politicians colluded in fighting an old-style war against an imagined influenza-like virus, complacently and naively hoping for rapid “herd immunity” with little detriment to public health while shunning direct engagement with the actual coronavirus threat.¹ The government was tardy in closing borders and locking down communities to limit transmission. Before long, failures in provision of personal protective equipment and diagnostic testing compounded the multiple failures of calculation and communication. Horton forcefully condemns the British medical establishment, who thus “let down those they were supposed to protect.”

Of course, Britain was not alone in botching the response to the novel coronavirus. But it was in the vanguard. And it did manage to screw up with exceptional swagger.

In both Britain and elsewhere, Horton argues, similarly cracked attempts to understand and to parry the pandemic represent “the greatest political failure of Western democracies since the Second World War.” Again and again, there were political debacles, inadequate preparedness, bureaucratic indecisiveness, deficiencies in technical advice, glitches in scaling up services, and scanty or defective communication. Governments could have anticipated and stalled the pandemic; instead, they flailed around and blamed China and the WHO.

Admittedly, some countries performed better than others—at least, they did from Horton’s standpoint in mid-2020. He praises China (after its initial secrecy) and Taiwan for their efforts to eliminate SARS-CoV-2, whether through intensive lockdown or rigorous testing, contact tracing, and isolation. New Zealand was “an even more astonishing story of success,” rapidly closing its borders and locking down hard and early. He commends Prime Minister Jacinda Ardern for “her clear, consistent and confident messaging to the public … a model of political choreography in a crisis.”

In contrast, the “US response has been as pitiful as it has been surprising,” partly because Trump was so “lamentable” as a leader. Thus, “a superpower—or its reputation at least—had been slain by a virus.” The coronavirus acted like a stress test, leaving scores of shattered polities in its wake.

Britain was not alone in botching the COVID-19 response, but it did manage to screw up with exceptional swagger.

“I don’t believe there was any conspiracy inside government to kill people off,” Jeremy Farrar assures us. “From what I saw there was no plan.” In Spike, Farrar takes us further into the belly of the beast, deeper into the bowels of British pandemic decision making. Having worked on outbreaks of dengue and influenza in Vietnam, he knows better than most how an emerging disease, a new epidemic, makes its debut.

Farrar—with the assistance of his coauthor, science journalist Anjana Ahuja—begins his story dramatically, in an airport lounge in Africa on the eve of 2020. It was here he first got word of mystery pneumonia cases in Wuhan, China. Straight away, he called his old friend George Gao, director of the Chinese Center for Disease Control and Prevention in Beijing—“a brilliant impressionist and a karaoke enthusiast,” we learn—who told him not to worry, it wasn’t SARS.

During the following months, as the Chinese continued to suppress epidemic intelligence while others tried to produce bootleg sequences of the virus, Farrer “became exhausted and scared. … I would do things I had never done before: acquire a burner phone, hold clandestine meetings, keep difficult secrets.” The book’s combination of name dropping, immodest disclosure, medical melodrama, and histrionic confession is disconcerting, yet compelling. It’s reassuring to find out that the authorities and the experts are just as vain and needy as the rest of us.

Farrar delights in showing us how well connected he is. His phone was “buzzing constantly with new updates from Wuhan”; he chats regularly with Sir Patrick Vallance and Chris (later Sir Christopher) Whitty, the British chief scientific and medical advisors; his emails to Horton demand attention; he’s in daily contact with scientists around the world. Fauci is on speed dial. Farrar likes to mix with knights and dames at home and with “important-looking” people at exclusive conferences abroad, sorting things out over a quiet tipple. Tedros Adhanom Ghebreyesus, the director-general of the WHO, sends texts, pleading with Farrar to fill in for him at the World Economic Forum in Davos, Switzerland. As director of Wellcome, Farrar relishes his closeness to major pharmaceutical companies and the intelligence services. He’s aware the world “operates through private phone calls and messaging apps,” not through formal channels and democratic processes. Who better, then, to spill the beans?

At early Sage meetings in February and March 2020, Vallance and Whitty seemed unduly complacent, while Prime Minister Boris Johnson didn’t even bother to attend. About 30 or more scientific and medical experts, along with government representatives, gathered regularly in a basement room in Westminster, most of them apparently unaware of the gravity of the situation. Initially, they rejected any behavioral and social regulation, accepting the Orientalist argument that only Asians would ever countenance such discipline. Britons, meanwhile, as rugged individuals, would soon display behavioral fatigue and flout restrictions—or so the thinking went. Some of the Sage experts drifted toward discussion of letting the virus rip through the population, delivering eventual herd immunity.

It was “unbelievable”—Farrar thought as he listened to these fallible experts—that Britain was “so woefully poised to respond and scale up fast to a public health emergency.” Even as the virus multiplied across the country, there was no commitment to testing, contact tracing, and isolation. Masks and other protective equipment were scarce; the National Health Service lacked sufficient ventilators. Soon overwhelmed with the sick and dying, the whole healthcare system teetered, about to collapse. “Many of us wish we had been blunter and clearer with our comments” in those initial gatherings, Farrar writes.

Ultimately, the Sage advisory group came to realize the magnitude of the viral menace later in March 2020, belatedly admitting that unleashing the virus would cause social and institutional collapse. But, by then, few politicians cared to heed its warnings. Confident in British exceptionalism, government leaders often denied any epidemic debacle was possible. After succumbing to COVID-19, Johnson continued to resist moves to lock down the nation. As Farrar recalls, “the epidemic was on a runaway trajectory” and all the dithering and deferral “undoubtedly cost lives.”

But indifference abruptly shaded into panic. In a milieu of “systemic mediocrity,” this government panic resulted in “the kind of haphazard, hour-by-hour decision making in a crisis that wastes time, money, resources and emotional energy.” Catastrophe loomed, yet no one was able to step back and strategize, no one seemed capable of taking stock of the situation and communicating what must be done. Farrar mercilessly dissects the flawed characters and incompetent figures that surrounded him, focusing on the alleged feebleness of Baroness Dido Harding and Dame Jennifer Harries, who happen to be rare women in the medical boys’ club.

Fortunately for the country, belated and dysfunctional lockdowns—though repeatedly sabotaged by Johnson and his merry band of Conservatives—managed to stall progress of the coronavirus until vaccines were developed and rolled out. Writing in the middle of 2021, Farrar befittingly expatiates on the British vaccination triumph, for which he takes some credit. In the meantime, tens of thousands had died, many unnecessarily.

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Both Horton and Farrar insist we need a global response to infectious disease emergence in order to forestall new pandemics. As Horton reminds us, it was intense international collaboration that enabled rapid detection and effective control of SARS at the beginning of this century. The Lancet editor calls for bolstered surveillance of other human pathogens as they find fresh niches to occupy in our globalized world. Public health must be situated within a stronger ecological framework, with an enhanced recognition of the impacts of environmental degradation and interspecies entanglement, which are constantly augmenting and expanding microbial opportunities.²

Farrar also gestures toward the need for ecological preparedness against future pandemics. He hopes for more “nimble” surveillance of microbes as they cross from one species to another, greater sensitivity to such “natural spillover event[s].” “We need to be asking,” he writes, “which viruses in wild and domestic animals are crossing back and forth between humans and animals? How can we spot these perilous cross-species breaches and how should we respond?”

But he proposes a technical fix rather than structural reform, favoring intelligence seeking over fundamental preventive measures. Farrar imagines a global pandemic radar, with “twenty-first century technology, such as genome sequencing, the smarter use of data, artificial intelligence, plus non-traditional sources of information like rumors on social media”—alerting places like Britain to the inevitable next pandemic.

Evidently, there’s a disturbing shallowness in Farrar’s ecological sensibility. At Davos, he came to believe that “capitalists can and mostly do make the world a better place,” despite the contributions of reckless development and unsustainable consumption to the destruction of Earth’s life-support systems. Then there’s the peculiar initial enthusiasm, quickly disowned, for conspiracy theories postulating that the novel coronavirus leaked from a Wuhan laboratory—when, as he admits, there was plausible scientific evidence for interspecies transmission, a more naturalistic and ecological explanation.³ Rather than warmly embrace disease ecology, Farrar thus tried to maintain safe social distance. Perhaps he’d been spending too much time with financiers and spooks.

As coronavirus variants and vaccine rollouts and long COVID continue to present challenges to public health expertise, we should be grateful to Horton and Farrar for their insights into how medical establishments and global networks operate or malfunction. When the pandemic set in, journalist Philip Ball accused Vallance and Whitty of “dangerous complicity” in their relations with British politicians like Johnson. Too often, he claimed, leading scientists under pressure “get sucked into a dysfunctional governance.”

Ball remembered Horton telling him in Summer 2020 that the relationship early in the pandemic between scientific advisors and politicians in the UK was “strangely collusive.”⁴ Farrar recalls frequently contemplating resignation from Sage. He finally took this step in November 2021. “There comes a time,” he writes, “when you have to ask yourself, and the people you trust, whether you are indeed complicit with the decisions that are made.”

In their reflective books, both Horton and Farrar take pains to demonstrate that, unlike some others, they were never in collusion with feckless and fraudulent politicians. They, at least, never connived with the powers that be.

If only scientific advisors and medical journal editors elsewhere were equally prone to such conspicuous displays of virtue. That any dissension occurs at all in the British medical establishment—an old boys’ club if ever there was—surely deserves our appreciation. Perhaps in Old Blighty they have a stronger tradition of public-facing scientific expertise, of holding the brains trust to account. Or maybe there’s a more powerful sense, among at least a few scientific advisors, that integrity really matters.

It’s tempting to think of this moral impulse as a kind of “honorable schoolboy” syndrome—a name that makes obvious reference to the title of John Le Carré’s 1977 tragic novel.⁵ In Le Carré’s book, the Honorable Gerald (Jerry) Westerby, a former cricketer and asset for British Intelligence (the “Hon.” being a courtesy title for the child of a lord), is sent to Hong Kong in the guise of a sports journalist. This honorable schoolboy is supposed to secure an agent defecting from China, but instead he defies orders so he can save Lizzie Worthington, the woman he loves. His personal integrity causes him to scrap mere institutional loyalties. Of course, it doesn’t end well for Westerby. But he did the proper thing, and that’s what matters after all, don’t you know.

This article was commissioned by Caitlin Zaloom.