Ten questions on the next phase of the UK’s COVID-19 response
1. What values have informed the most recent decisions on COVID-19 restrictions?
The response to the COVID-19 pandemic has involved a number of challenging decisions. There is no rigid set of rules which produces the “right” answer in these circumstances. The Government’s early insistence on “following the science” obscured other consideration and analysis necessary in reaching decisions. As we have argued throughout the response to the pandemic, “science” is only one part of the equation: it is a question of values which determines what policy decision is made.
An approach which aimed solely to prevent COVID morbidity and mortality would justify almost any intervention, no matter how restrictive. Such an approach, however, would fail to take account of a vast number of other competing interests. This is where a number of challenging trade-offs need to be made: between the health of individuals (with different risk profiles); the capacity and long-term stability of the NHS; wider concepts of health (the effects of measures imposed on physical and mental health); individual financial health and wider economic health; and the various short and long-term social impacts of isolation.
These are complex decisions, further complicated by the fact that not all of them are straightforward trade-offs in the traditional sense. Most of these considerations are interrelated (for example, the state of the economy has long-term impacts on health and wellbeing), while many have different timescales - the impact of COVID-19 has been made immediately apparent in terms of directly attributable mortality and morbidity, but the impacts of school closures, the sum of the financial consequences, the impact on diagnosis and treatment of non-COVID illnesses, and the effects of denying people visits to family members in care homes or hospitals may not be felt for some time.
In April, we wrote jointly with Involve to the Prime Minister and Chief Medical and Scientific Officers, to call for greater transparency and public involvement in the next phase of the COVID-19 pandemic. Shortly afterwards, the Prime Minister pledged to ensure “maximum transparency” about how decisions to tackle COVID-19 are being made.
Yet there is still a deficit of information about the evidence underlying decisions and how different interests and risks are being weighed - as well as concerns (see also Coronavirus: Ministers ‘ruling by decree’ on virus, warns Sir Graham Brady), about the level of parliamentary scrutiny that has been brought to bear on those decisions. Despite the Prime Minister’s assurance that the most recent restrictions have been “carefully judged to achieve the maximum reduction in the R number with the minimum damage to lives and livelihood”8 there has been little in the way of open deliberation of how different interests and risks are being balanced; of what interests take priority and why; and of who will be asked to bear the greater burdens and for how long. These questions need to be consciously and transparently addressed, in an inclusive and public fashion, to inform any future decisions.