Implementing all such measures would evidently have saved tens of thousands of British lives and avoided the need for damaging, sustained lockdowns. So, to ask the Prime Minister whether he wishes he’d made different choices to implement them is to answer the question. Obviously, tightening borders in January, green-lighting testing in February, avoiding the grand reopening of late summer, maintaining lockdown before the variant took off in December, or providing better guidance on airborne transmission, all now look no-brainers.
“Lessons,” though, are surely more valuable if they have structural implications, rather than just retrospectively highlighting when decisions turned out to be misguided.
One unspoken lesson we might learn is the value of “human challenge trials” for vaccines, where volunteers are paid to be exposed to viruses in controlled conditions. Moderna’s vaccine took just two days to produce in January 2020.
Months after that were spent navigating trial protocols in various countries, despite the organization 1 Day Sooner having signed up thousands of would-be volunteers for challenge trials woraldwide, with little advertising.
Challenge trials could have accelerated vaccine efficacy assessments, speeding up approval, production, and the end of the pandemic. By giving us data more swiftly, this would have saved thousands of lives and around £3.6bn per week in revived UK economic activity once the pandemic was over.
As Jessica Flannigan writes in a cover essay for the Cato Institute, “every day of bureaucratic delay is a day that public officials contribute to the invisible graveyard of people whose deaths could have been prevented by faster access to vaccines.”
Recently, UK officials have partnered with researchers to begin challenge trials for other Covid-19 vaccines and aim to use them to answer other questions about doses or combinations. But in the high-stakes months last year, supposedly ethical concerns won out. It was seen as inherently wrong to use health resources to deliberately infect someone, because you might make them sick and die without a corrective treatment. Of course, the “cost” of such paternalistic precaution was accepting thousands of additional deaths as the virus spread in a largely unprotected community.
Why was it regarded as ethical to allow elderly supermarket workers to bear Covid-19 infection risks in return for wages, but not for younger colleagues to be deliberately infected for the public good? Some ethicists say people judge the uncertainties of the risks badly. But, as economist Sam Dumitriu has explained, society bats not an eyelid in allowing young adults to join the military during wars, at far greater risk and faced with far greater uncertainty.
Yes, politicians may have been unwilling to sanction challenge trials of more vulnerable groups, or else unable to find volunteers. But challenge trials for young people would still have been valuable, even if traditional trials were needed to ensure efficacy for the vulnerable. By showing effective vaccines were coming, policymakers could adjust other restrictions to improve policy. As Dumitriu says, the earlier “proof of concept” would have led to an earlier ramp up of vaccine production too. At worst, those produced could have been administered to young people earlier, contributing to herd immunity.
In fairness, UK regulators have shown a willingness to “think the unthinkable” elsewhere during this crisis. Approving the vaccines before others and the adoption of “first doses first” showed they recognised the costs of delay and ongoing risks to an exposed public. Widespread antibody survey testing could, in theory, have led to further targeting of vaccines within age groups to ensure herd immunity faster, although that would have been a logistical challenge.
As a result, when the next pandemic threat arises, we’ll probably see swift border closures, liberalised testing, and, if it gets to that stage, commitments by governments for large advanced vaccine orders. But this year’s biggest tragedy is surely that the medical innovation to end the pandemic existed the whole time. If the lives, economic wellbeing, and liberties we’ve lost while waiting for it to become available do not cause us to reassess our ethical and regulatory frameworks, have we really learnt anything?
Ryan Bourne is the author of Economics In One Virus and an economist at the Cato Institute