Spike by Jeremy Farrar with Anjana Ahuja — ignoring the science
The darkest moment of the pandemic for Jeremy Farrar came on September 21 last year. Incident cases of Covid-19 had been rising in England through the summer. Boris Johnson, prime minister, had urged the lifting of lockdown in May. Amid general optimism that the worst was over, pubs and restaurants opened their doors in July, then Rishi Sunak, the chancellor, launched his “Eat Out to Help Out” scheme, dubbed by some as “Eat Out to Help the Virus Out”.
There were simply no plans in place to meet the predicted autumn rise in cases. By the time of the Scientific Advisory Group for Emergencies meeting on September 21, infections were doubling about every week, even before the impact of school reopening. Sage was clear: “A package of interventions will be needed to reverse this exponential rise in cases.” The measures included a short lockdown, a circuit breaker. By their actions, the government was also clear: we won’t follow the scientific advice — we’ll say we will, but we won’t.
Farrar, who gives this account, asked himself why he should continue reviewing the evidence, serving on Sage, doing everything he could to reduce the toll of the pandemic, if the prime minister refused to act until far too late.
Farrar is in little doubt that government reluctance to act led to preventable deaths. “As the government remained rooted to the spot, transmission was already getting away from us. It was a catastrophe playing out in slow motion,” he writes.
Spike is a necessary insider’s account — a scientist’s A Journal of the Plague Year — of how the pandemic was, and should have been, handled. The book is written in the first person as the voice of Farrar. It is, though, a collaboration with FT science writer Anjana Ahuja. Whether its fluency and clarity are a testament to one or the other does not much matter. It is a pleasure to read.
My own approach to the pandemic was that it exposed and amplified inequalities in society: the greater the deprivation, the greater the loss of life from coronavirus. That leads to two approaches to reduce suffering: reduce inequalities — my Build Back Fairer reports — and control the pandemic, as laid out in Spike. Both are vital.
Farrar had good grounds for frustration that his advice was ignored. He is a global expert in infectious disease control, he directs the Wellcome Trust, one of the world’s largest medical research foundations, and is on first name terms with all the key players responding to the pandemic. His, and Sage’s, advice is not ignored because he is an outsider.
A first reason for the government’s failure to act at the beginning of the pandemic from January 2020 was lack of understanding of the urgency. With exponential growth of infection, the days, the hours, mattered. As early as January 23, Carter Mecher, an impressive US epidemiologist, said “we are not going to be able to outrun it” and advocated targeted layered containment.
If that meant, at the extreme, lockdown, Farrar along with most others close to decision-making thought that it might be acceptable in China, but it couldn’t be done in Europe. Then Italy did it. By March 10, Sage concluded the UK would have to follow Italy and lock down. Initially, the government refused.
A second reason was the prime minister’s libertarian instincts. On March 11 he said one strategy was “perhaps to take [the virus] on the chin, take it all in one go . . . ”, although he later went on to say that more had to be done. Farrar is scathing about the idea of taking it on the chin, or developing some form of herd immunity. Simple modelling by Imperial College suggested perhaps 510,000 deaths. Natural herd immunity as a strategy is scientifically and morally indefensible.
It is worth noting that on March 10 2020, when Sage was recommending urgent lockdown, there were 113,702 known global cases of Covid-19. On July 19, 2021, the day the prime minister labelled “freedom day” and lifted all remaining restrictions, there were about 45,000 new daily cases in England alone. Yes, of course, a majority of adults have had at least one vaccination, but hospitalisations are rising, as will deaths, and there will be more cases of “long Covid”. It looks like herd immunity is back as a tactic.
A third reason against taking action to lock down was concern for the economy. Everyone shares that concern. But the idea of a trade-off between public health and the economy was simply contradicted by the evidence. The data are clear. Countries that better controlled the pandemic had a smaller economic hit.
There was scientific disagreement, too. Farrar dismisses the Great Barrington Declaration — written by three scientists from prestigious universities, which argued for a form of herd immunity — as “ideology parading as science and the science was still nonsense”.
Spike is a closely observed and deeply analysed case study of the intersection between science and politics. Beware of politicians claiming to be following the science. There are lessons to be learnt as to how to handle the next pandemic when it comes. Farrar lays them out. The world needs to take heed.
Spike: The Virus v The People — The Inside Story by Jeremy Farrar with Anjana Ahuja, Profile £14.99, 272 pages
Michael Marmot is the director of the Institute of Health Equity at University College London
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