Covid-19: has science failed?
Why are the number of Covid-19 deaths highest in some of the most scientifically advanced countries with efficient hospital systems such as the United States, France and the United Kingdom? Does it mean that science has failed? Or is it that scientific experts failed to influence governments sufficiently early and decisively?
Analysing the relationships between science and society in Europe as I have for more than twenty years, I decided in February 2020 to write day after day about the evolution of the pandemic. With the help of numerous testimonies and interviews with scientists, doctors, government representatives, journalists and citizens from China, France, the United Kingdom and the United States, I retrace in my latest book, “The Science and Politics of Covid-19” (Springer, 2021), the history and the management of the pandemic.
Actually, everything we have seen about the Covid-19 outbreak corroborates with Rudolf Virchow, the 19th century father of pathological anatomy who said, “an epidemic is a social phenomenon with some medical aspects.” Labelled by some as the biggest threat since World War II, the coronavirus pandemic tells us a lot about the relationships between science and society, and highlights mistakes in government strategies and scientific research.
A Strategy Based on Science
My objective was to try and understand how Anthony Fauci and Donald Trump in the United States, Chris Whitty and Boris Johnson in the United Kingdom, Jean-François Delfraissy and Emmanuel Macron in France, Nanshan Zhong and Xi Jinping in China cooperated during the pandemic. How did these impossible couples manage and survive the crisis? How did scientists and decision-makers live under the same roofs, even though everything else separates them? Between the long-term of science and the too-short term of politics, between scientific rigour and political judgment, between the questions of researchers and the responses of decision-makers, is there an opportunity for genuine cooperation and even for mutual understanding? The question is not new and gets asked with each major crisis. Researchers struggle to get the facts and their part of the truth heard, while politicians do not always succeed in sharing their reasoning. Of course, this unique pandemic is now a textbook case, both in terms of the number of countries involved and by the scale of the measures taken: more than half of humanity was in total lockdown in March 2020. So, what did we learn?
First, governments clearly underestimated the pandemic, notably In France, the United Kingdom and the United States. By almost systematically ignoring warning signals, or waiting too long to react, these countries have paid a high price. I argue in my book that these governments consciously, continuously and deliberately delayed taking the actions that they knew could have saved many lives. If there is one lesson to be drawn from the COVID-19 pandemic it is this: speed is everything. By underestimating the risks of the epidemic, the leaders of these countries have placed a huge burden on their respective populations.
There is no doubt our leaders expected to find an easy way out of the crisis; no doubt they were afraid of giving in to panic; no doubt they tried to save the economy while protecting the people. But officials were weak, and policy-makers have failed. The then future President of the United States, Joe Biden, did not say anything else on March 12, 2020: “A tragedy is added to the crisis, it is all the suffering that could have been avoided thanks to a quick decision and to decisive action. It is a challenge that requires leadership. It requires transparency and urgency.” He also added that, “the nation must be guided by science.” Furthermore, several of those countries that have accused China of withholding information - a classic political tactic aimed to shift the focus - have shown an incredible lack of transparency at home. It is a global political scandal. This is also the conclusion of Richard Horton, editor-in-chief of The Lancet: “Why did President Macron, President Conte, Prime Minister Johnson, President Trump do nothing? Did they not understand what was going on in China? Did they not believe the Chinese? Didn't they ask their diplomatic representations in Beijing to investigate? I do not understand.
The evidence was very clear by the end of January1." In interviews aired by CNN on March 28, 2021, Debora Birx, who coordinated the coronavirus task force in the U.S., said, “there were about a hundred thousand deaths that came from the original surge. All of the rest of them, in my mind, could have been mitigated or decreased substantially2."
Second, experts themselves acknowledged that they did not rise to the challenge. For example, Jean-François Delfraissy, president of France’s Covid-19 scientific council, had been very explicit: “Perhaps we did not sufficiently appreciate the gravity of the epidemic.” Jean-Paul Moatti, a former director at IRD, the French National Research Institute for Sustainable Development, confirmed: “The scientific community has not been able to provide information and gain a better understanding of the situation. At the end of February/beginning of March, we could already see that South Korea's policy of combining in particular large-scale testing and contact tracing was giving positive results in containing the spread of the epidemic. With a better analysis of epidemiological curves and international comparisons, we should have been better prepared to carry out mass testing3." In the United Kingdom, experts had given the alert very early, at the very beginning of March. However, in retrospect, these experts acknowledged that they were probably not firm enough, probably so as not to create panic and also because, according to some of them, the population would never have accepted containment measures like those applied in China4.
According to Richard Horton, the global response to SARS-CoV-2 is the biggest science policy failure in a generation5. He did not hesitate to blame researchers and experts. While China, traumatised by the SARS experience, correctly estimated the dangerousness of the new coronavirus and quickly quarantined entire cities, British scientists were still thinking that Covid-19 was a kind of 'flu. “Our scientists," Horton writes, "suffered from a ‘cognitive bias’ towards the milder threat of influenza.” At the same time, in February-March 2020, the government was reluctant to consider anything as draconian as a lockdown. “We were poorly prepared,” wrote Ian Boyd, former Chief Scientific Adviser6.
So, those who advised governments failed to have a decisive influence on the timing and the direction of political decisions. Could this be down to a lack of firmness or confidence on their part? Is it because scientists are known to be reserved and place great importance on fact-checking? Or is it because, having seen that politics is what it is, they seemingly resigned themselves to having little impact? Were they afraid of making a mistake? Afraid to tell the truth?
In any case, in three of the four countries analysed in detail, scientific advisers failed to appreciate the risks and the urgency. Apart from China, all these governments wasted time before going into lockdown in early 2020 although this was at that time the only possible option to slow down the pandemic. In addition, many hiccoughs happened in the scientific community: downplaying of the outbreak, wrong vaccine predictions, peer-reviewed publications retracted after a few days, short-circuiting of clinical trials, research supported for political reasons, scientific vagaries, spectacular announcements in the media etc. We have seen the best as well as the worst in recent months and the public discovered “science by press release.”
The situation was different in China. It turned out that the reports of Nanshan Zhong and of a small WHO delegation, which came to Wuhan on January 19 and 20, 2020, had been decisive. Nanshan Zhong heads the Public Health Commission in Beijing which coordinates the fight against infectious diseases at national level. On June 1, 2020, Nanshan Zhong confirmed to me that this visit and the report he and his colleagues gave to the Commission influenced the government's decision to put Wuhan into lockdown on January 23, 2020. Nanshan Zhong's scientific credibility and proximity to political circles enabled him to obtain the best information in Wuhan (which does not always reach Beijing). He also acknowledges that the government had been listening to the experts and in particular the executive committee of the Commission, and followed their advice for monitoring the evolution of COVID-19 in China. This was confirmed to me, also on June 1, by another scientist well known in China (and appreciated for his freedom of speech), Wenhong Zhang, professor at the Fudan University in Shanghai.
Of course, the very fast development of vaccines is a major success. The mRNA vaccines developed by Moderna and Pfizer/BioNTech have been hailed as a fundamental and global scientific breakthrough - probably the only one of the whole pandemic. This is partly true. This achievement owes as much to science as to the industry. Moderna designed its mRNA vaccine on 16 January 2020, only five days after the full genome sequence of SARS-CoV-2 has been made public.
So, What Did We Learn?
Here are 10 messages and recommendations developed in the book:
- Politicians and scientists have a shared responsibility for the mismanagement of the crisis. Many experts acknowledge that they did not rise to the challenge and underestimated the contagiousness of the virus and the dangerousness of the disease
- A major political mistake was that countries pulled down their blinds, locked their doors, and promoted national approaches rather than international cooperation
- We are not certain that SARS-CoV-2 originated in China as the coronavirus was already circulating in Europe in early December 2019 (at least in France and Italy)
- We did not learn the lessons from previous epidemics. Countries that have performed the best are those that implemented non-pharmaceutical interventions (NPIs) as soon as possible. Speed is everything
- Mismanagement, miscommunication and incomprehensible delays led to genuine “time bombs.” Prevention of an epidemic does not start when the epidemic starts
- Expert committees should not be created “ex nihilo” but attached to the competent administration departments in order to secure decision processes and communication
- The crisis accelerated the development of “science politics” at an unprecedented scale, unveiling the links between the production of science and the private sector, the intermingling of science with politics and the political objectives of some experts
- The overall mismanagement also reflects the importance of overspecialisation and miscommunication, which has become a way of life in our society
- Despite rapid advances on vaccines, the pandemic will not end before several months or years have passed. Herd immunity may never be reached
The resistance to masks and vaccines show that scientific knowledge disseminates slowly. It is now time for political distancing to put the basics first: develop science, fight ignorance.