On Monday, the same author published an essay arguing for “a pandemic amnesty”. We should, she suggests, move on from the conflict, fear, uncertainty, and doubt that roiled the pandemic years, and focus instead on the urgent issues of today. But while I can understand why Oster might wish to put all the Covid-era bitterness back into a box labelled “the common good”, her effort to do so has not been well received. And this is a consequence of the very policies which Oster would now like everyone to forgive and forget.

Reading avidly in the run-up to my daughter’s birth, it was already clear to me that many of the so-called “mummy wars” are proxies for class issues. Against this emotive backdrop, Oster’s book felt like a refreshing counterbalance. It’s astonishing, in fact, how recently it still felt possible to weigh competing claims on the evidence, and settle on something reasonable. But a great deal has changed since then. And it’s easier to understand why when you consider the difference between trying to settle the “mummy wars” via science and trying to agree upon public health policy during a pandemic.

If the “mummy war” is a class war writ small, Covid policy followed the same dynamic. It was, in fact, a class war writ so large it encompassed minute micromanagement of nearly every facet of everyday life, for years on end, and doled out material consequences for dissenters. And it was all justified with reference to the supposedly neutral domain of science.

This tracks a slow convergence of supposedly neutral governance with partisan class differences that was well under way before the virus, a phenomenon exhaustively documented following the two plebeian revolutions of Brexit and Trump. These events gestated concurrently with my daughter; I won’t rehash the debates here, save to note that they represented the first shot across the bows of the End of History belief that technocracy could be genuinely neutral, and based in objective evidence.

In questioning this doctrine, the mutineers dragged an incipient class war into the open, between what N.S. Lyons characterises as the “Virtuals” of the laptop class, and the “Physicals” whose work is more rooted in the material world. Amid this conflict, Oster’s plea for amnesty is unlikely to be heard, since under those appeals to neutral science much of Covid policy served in practice as a Virtual counter-volley to the 2016 uprisings.

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In its most rarefied, de-materialised, Virtual form, the contours of that counter-volley are captured by a short series of declarations of faith. This text, a kind of Nicene Creed for Virtuals, first appeared in response to Trump’s election, and has multiplied across posters, t-shirts, tote bags, and (in America, where they do such things) signs stuck into the front lawns of the faithful.

The Virtuals’ Creed reads as follows:

In this house, we believe:
Black lives matter
Women’s rights are human rights
No human is illegal
Science is real
Love is love
Kindness is everything

Each of these dicta sounds unimpeachable in theory, but is far more contentious in practice. “No human is illegal”, for instance, sounds true; but how do we manage the welfare state, without a means of distinguishing between citizens and non-citizens?

When this lawn sign first appeared, I could have given you a critical run-down of the political pitfalls and ideological sleights-of-hand buried in all those dicta, bar the claim that Science Is Real. Since then, though, I’ve seen this line in the Virtuals’ Creed weaponised without compunction, as a bludgeon to enforce a moral consensus that wasn’t scientific, and wasn’t rational.

This consensus was, instead, far more religious in character. Even famous and high-profile dissenters have faced harassment at its hands, for airing topics that ought, you’d think, to be within the scope of objective discussion. Celebrity podcaster Joe Rogan has faced calls to be cancelled after asking Covid questions. UnHerd’s Freddie Sayers was censored for interviewing lockdown dissenter and former WHO cancer lead Dr Karol Sikora.

Nor is having expertise or evidence on your side much of a defence. Dr Peter McCullough, a top American cardiologist, argued against vaccinating those with natural Covid immunity, and voiced concerns about the effect of the Covid vaccine on cardiac health. For expressing such views, and despite evidence that natural immunity is more robust than the vaccine and that myocarditis is a recognised side-effect of the vaccine, McCullough now faces being struck off by an American medical board.

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Even as scientific debate has been stifled, obvious inferences from widely available evidence were ignored where these conflicted with settled Virtual consensus. There was, for example, no rationale for mandatory vaccination once it became clear that — as acknowledged as far back as December 2021 by even the Virtuals’ house journal the New York Times — vaccines didn’t prevent virus transmission. And yet mandates remained in place across many locations long after that date. Indeed, around the time the NYT article was published, Oster herself was advocating escalating pressure to vaccinate, from public shame to stopping the unvaccinated from travelling, working or attending events.

It may be optimistic of Oster, and others of the Virtual class, to try to restore public faith that Science Is Real. But it’s also understandable. First, for reasons of self-interest: those who drove Covid policy presented themselves not just as people doing their best, but as the sole bearers of rational truth and life-saving moral authority. Doubtless the laptop class would prefer that we judge Covid policy by intention, not results, lest too close an evaluation result in their fingers being prised from the baton of public righteousness.

But the rot goes deeper still, for the very foundation of that moral authority is a shared trust in the integrity of scientific consensus. And Covid has left us in no doubt that there is a great deal of grey area between “science” and “moral groupthink”. Where “science” shades into the latter, British care workers and American soldiers and police officers dismissed for refusing a vaccination that doesn’t stop transmission can attest that science is sometimes “real” more in the sense of “institutionally powerful and self-righteous” than in the sense of “true”.

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This touches on another source of rage that many would doubtless like to forget: the asymmetry in whose shoulders bore the heaviest load. It wasn’t the lawn-sign people who bore the brunt of lockdowns — they could mostly work from home. Rather, lockdown shuttered countless small businesses permanently, or burned them to the ground in lawn-sign-endorsed riots that were justified on public-health grounds even as others were fined for attending Holy Communion in a car park.

Our journey to this point was, at every stage, narrated as the inescapable conclusion of Science, which is Real. But nearly three years out from the start of the pandemic, it looks a great deal more like the massed consensus of “public health” officials and their journalistic cheerleaders has delivered a public that is sicker, unhappier and poorer across a host of measures.

Oster lists among the urgent issues of the day the learning loss experienced by children as a consequence of Covid policy, with the youngest and poorest hardest-hit. She notes the drop-off in routine vaccinations (also a consequence of Covid policy). To this list we might add the rise in non-Covid excess deaths, also a consequence of Covid policy, not to mention the stagnant economy and the rocketing inflation rate.

And these are all downstream of a pandemic-era public discourse that felt like the Brexit/Trump wars on steroids: a battle for class dominance, in which one side used its stranglehold on public institutions to frame censorship as “fact-checking”, and all dissenters as stupid, unscientific, or actively hateful. It’s not that “we” collectively tried to get it right, and “mistakes were made”. It’s that a self-righteous cabal arrogated to themselves a priestly right to determine the proper social order, and to excommunicate those who didn’t conform. Their record in securing the common good speaks for itself.

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Public faith in objectively shared political ground was already dissolving while my daughter gestated. If the Virtuals have a problem now, it’s that their counter-volley to Trump and Brexit consumed the last vestige of trust in that shared political ground: our faith in science. And the notion that such ground exists is the sine qua non of Virtual political legitimacy in its current technocratic form.

In this light, Oster’s call for amnesty can present itself as an effort to rebuild the neutral space of shared political endeavour after a period of conflict. But it reads as a continuation of now-familiar efforts to weaponise the appearance of such neutrality and common purpose, in the interests of one side of that conflict.

We all knew every pandemic policy would come with trade-offs. The lawn-sign priesthood forbade any discussion of those trade-offs. I don’t blame the class that so piously dressed their own material interests as the common good, for wanting to dodge the baleful looks now coming their way. But no “amnesty” will be possible that doesn’t acknowledge the class politics, the corruption of scientific process, the self-dealing, and the self-righteousness that went to enforcing those grim years of lawn-sign tyranny.

Science, it turns out, is not always “real”. And nor, I suspect, will kindness now be everything.

Its latest such gambit is a claim that the Office for National Statistics’ data shows “a significant rise in the death rate for adolescent males over the last eight months”. HART have put together an “open letter to Sajid Javid, Chris Whitty, Patrick Vallance and the relevant public health bodies”, saying that “the concern is that this time period coincides with the rollout of vaccinations to this age group”.

There’s a saying in journalism that you should play the ball, not the man. And I will play the ball, but I want to play the man a bit first. HART has form for suggesting that vaccines kill people: on p35 of its ‘Covid-19 Response’, still prominently linked on their website, they suggest that the second peak in deaths “coincided with the mass roll-out of novel mRNA/DNA vaccines” and that “whilst we cannot infer causation from correlation, the mRNA/DNA vaccines had not been tested on this cohort” and it would be “negligent” not to ask whether “the rise in deaths during this period is linked in some way to the vaccine roll-out”. (The second peak in deaths was, in fact, caused by the second peak in Covid cases which preceded it by a fortnight or so.)

HART is populated by odd people who believe strange things: one of its publicly listed members worried, in a since-leaked private chat, that the vaccines were literally making people magnetic. Other leaked messages show a member suggesting that the group “seed the thought that vaccines cause Covid”, and that the vaccine rollout is “a crime against humanity” and part of a plan for “massive scale depopulation”. It’s worth noting that while these people may seem to be cranks, they also seem to have some influence with senior Tory backbenchers.

But let’s look at the ideas, as well as the people. After all, stopped clocks are right twice a day, and there have been plenty of stopped clocks in the pandemic. So: what’s the evidence that vaccines have been killing young people?

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Here’s HART’s case. They say that according to ONS data, there were 402 deaths among 15 to 19-year-old boys between May and December last year, and that that’s about 65 more than the average for that period over the years 2015 to 2019. I’ve looked into it, and these numbers are about right. In fact, they are a slight understatement of reality: you can see the figures for 2021 here, and the five-year average here. This is, the ONS acknowledges, a “statistically significant” increase.

HART thinks, or at least heavily hints, that the extra deaths are caused by myocarditis, an inflammation of the heart muscle which has been seen in rare cases following vaccination with the Pfizer jab: “​​a connection cannot be excluded,” they say, and it would be “a grave dereliction of duty” not to investigate. They took the ONS to the High Court to get them to release more data, including the age, gender, and vaccination information of everyone who died between the age of 12 and 19 since 1 May last year[1. The ONS is looking into it, but they can’t release the data easily: so few people die at that age that if they gave much more information about them then individuals would be identifiable. The High Court agreed that they shouldn’t release it.].

HART are not the only people to worry about this. In the US, there are regular outbreaks of concern around the mRNA vaccines and myocarditis. But is there anything in it?

For the record, HART is right that the number of recorded deaths in that age category is unusually high. I spoke to the ONS, and they agree — a spokesperson told me that there has been an increase of recorded deaths, compared to the five-year average.

That said, it’s not clear that the rise is real. The ONS only becomes aware of deaths when they are officially registered, which — if the death is referred to a coroner — could be weeks or months after the death itself. Young people’s deaths are much more likely to be referred to the coroner, and in 2020, coroners’ offices were under enormous strain from the pandemic. The spokesman also speculated that there might be a simple backlog from the previous year. There may be all sorts of other reasons, and until the coroners’ reports are in we won’t know.

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Another problem for the myocarditis hypothesis is that, although HART says that the “time period coincides with the rollout of vaccinations to this age group”, it doesn’t really. The first mass vaccinations for under-18s didn’t start until August, and even then only began relatively slowly: only about 40,000 people a day were being given first doses in that period, down from a high of 600,000 in March. HART also says that the real risk is second doses, and under-18s wouldn’t have received those until September. Admittedly, 18 and 19-year-olds would have had their jabs somewhat earlier, but not that much earlier: even 30-year-olds were unable to have theirs until the end of May.

And looking at the data that HART themselves cite, there doesn’t seem to be an obvious spike after younger people get the vaccine: while the number of deaths does seem to go up after about May, there’s no spike in August when large numbers of young people started getting vaccinated.

The ONS spokesperson said that there have been adverse vaccine reactions mentioned on death certificates — but only 13 of them, and the ages ranged from 35 to 94. Perhaps there’s been a rash of unreported myocarditis cases, or other vaccine reactions, among young men, but it would be a bit surprising given the attention on the issue.

But let’s grant HART’s premise. Let’s imagine that some percentage of these excess deaths are not statistical artefacts, and are caused by myocarditis. What would that mean?

The main conclusion wouldn’t change: vaccines save lives. Look at this Our World in Data page on the risk of death for vaccinated vs unvaccinated people, in various countries. An unvaccinated American is around 100 times as likely to die as a triple-vaccinated one; an unvaccinated Swiss is about 165 times as likely to die. Similar if less extreme numbers can be seen in Chile and England, although OWID doesn’t yet have data on the effects of boosters in England.

Of course, that’s across all ages. But when you look at 12 to 17-year-olds in the US (the only country where there’s a reasonable amount of data), about one in every 100,000 unvaccinated died each week. That would be about 250 a week, if everyone were unvaccinated. It’s well over ten times the risk to vaccinated children of that age.

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The US CDC assesses the risk like this: if 100,000 children are vaccinated, they’d expect around five to seven cases of myocarditis, likely mild. But if they weren’t vaccinated, they’d expect about 5,500 of them to be infected with Covid in the following three months, and about 50 of them to be hospitalised. Out of the 25 million or so 12 to 17-year-olds in the US, that would be around 12,000 hospitalisations in three months. Perhaps ironically, a fair number of them would develop myocarditis: the UK government says about 18% of hospitalised Covid patients suffer myocardial injury.

The point is: even if some non-trivial number of young people have died of myocarditis because of the vaccine, the odds are that more would have died without it — and likely very many more would have suffered a really nasty illness and ended up with some quite long-term effects from it. And, of course, they’d have been more likely to pass it on to other, more vulnerable, people, including their own families.

It is easy to say “even one death is too many”. Of course, each death is a tragedy; but two deaths is twice as big a tragedy, all else being equal. I hope that the ONS is able to find some hint of what caused the apparent increase in deaths among adolescent males; I sincerely doubt that it’s the Pfizer vaccine. But even if it is, the likelihood is that it saved many more lives than it cost. 

Luckily, I think the battle over vaccines has largely been won — more than 90% of UK adults are now vaccinated. But groups like HART have influence over serious people on the fringes of real power, despite being deeply strange people who think those who advocate vaccines for children “need shooting”.

The trouble is, HART’s data is superficially convincing, and takes work to rebut. There are still many thousands of children, and others, who have yet to have their vaccine: if some of them die unnecessarily because of this nonsense, that really would be a tragedy.

Sitting respectfully in our ‘pews’, we put our hands together… and clap. This is not a service but a comedy night. And Amsterdam’s newest ‘church’ is really a theatre for debate and cultural centre in disguise. Incensed by the illogical nature of the current Dutch coronavirus restrictions, Yoeri Albrecht, director of De Balie, last week changed the statutes of his organisation and registered it with the chamber of commerce as a faith-based movement: overnight, The Philosophical Society; the Community of Reason was born.

It is unlikely to be the last. His example, a group of Dutch mayors predicted wryly in an open letter to the government, is likely to mark the start of “an unprecedented religious revival in the coming weeks”.

The Netherlands has been in partial or full lockdown since November, primarily due to the pressure of patients with the Delta variant on the hospital system and one of Europe’s least efficient booster campaigns. But just over a week ago, the restrictions were loosened — albeit in a strikingly surreal fashion.

In the Netherlands today, brothels can open but museums can’t. You can sweat, unmasked, in a gym but you can’t sit in a bar nursing a quiet gin. “You can come together in the Veluwe [in the country’s Bible Belt] to talk about a 2,000-year-old book, but you can’t get together in Amsterdam to talk about a book from last month,” as Albrecht put it.

So last Friday night, I was among 50 people who snuck into De Balie under the cover of darkness — for fear of the police turning up — who signed a big, black book to join the community, and prepared to enjoy a night of much-missed comedy. “The Philosophical Society; the Community of Reason is about democracy and the rule of law, the solace and consolation of culture, experiencing something together that culture can give, seeing a bit of light after two years of darkness,” said Albrecht – something of an unusual opening blessing.

Everything about the evening was as absurd as the situation in the Netherlands. The crowd devoutly wore face masks and staff religiously scanned coronavirus ‘QR code passes’. But the comics were not announced in advance, photos and recording were banned, and the whole affair had the illicit frisson of an under-age boozing session.

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Yet De Balie is far from alone in its rebellion. Across the Netherlands, bars and restaurants have been opening regardless of the restrictions – especially in towns near the German and Belgian borders. On Saturday, for instance, 30 hospitality venues threw open their doors in Horst aan de Maas in protest. Last Wednesday, some 70 museums and galleries around the country decided to ‘open’ as temporary hairdressers, beauty salons and gyms – including world-renowned institutions such as the Van Gogh Museum, the Concertgebouw, and Amsterdam’s oldest theatre, De Kleine Komedie.

“We have a problem with the fact that hairdressers and nail bars and commercial activities can be open, and we can’t,” explained Van Gogh Museum director Emilie Gordenker. “We support everything we need to do in order to keep people safe. But this policy just seems contradictory and it seems to favour the commercial sector over the cultural one.”

Even the Dutch government appears to recognise this inconsistency. In a bizarre moment during a recent press conference, Mark Rutte emphasised that the Dutch have a constitutional right to protest, and that temporary openings could be viewed in this regard. “The right to demonstrate also applies to sectors like the hospitality industry, and I can imagine that mayors could look at ‘what’s allowed for a little while’… with the emphasis on ‘a little while’,” he said. “So if they want to open for a few hours to show ‘we are demonstrating’, then it’s up to the mayors how they deal with that.”

If it was an attempt to shunt on responsibility for enforcing his restrictions to local government (even though this is actually their structural role in the Netherlands), it soon backfired. Last week, 31 mayors — including Amsterdam chief Femke Halsema and non-conformist Breda mayor Paul Depla — wrote to the Government, pointing out that short-term policy-making is “reaching its limits” and putting local enforcers in a perilous position against a growing mood of civic disobedience. “It is in fact impossible but also undesirable for the state to use repression to forcibly convince Dutch citizens that the measures are correct,” they pointed out.

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Ahead of the Government’s next coronavirus press conference tomorrow, it also emerged at the weekend that the country’s medical advisory body, the Outbreak Management Team, wants cultural and hospitality venues to reopen alongside everything else until 8pm each day.

No doubt it would be a welcome move; but is it too little too late? In the Netherlands, the damage from these lockdowns has become increasingly evident. In the government’s most recent press conference, new health minister Ernst Kuipers admitted that two-thirds of young people are suffering from loneliness. Even since the November partial lockdown, the SCP, a social and cultural government think tank, has found that psychological wellbeing had dropped, particularly among the young.

And as for the affected industries, it’s unlikely that, even if the restrictions are lifted, business will be able to return to normal any time soon. Thousands of people working in the hospitality and culture sectors have simply given up and looked for work elsewhere. Many will be in coronavirus quarantine, after coming into contact with someone who has been infected. And for those who do want to return, it won’t simply be a matter of turning up to work the day after an announcement is made. An orchestra can’t just suddenly pick up bows and be ready to perform again next week: they need advance notice to plan.

“You see that the Netherlands is mentally exhausted with the pandemic and all of the restrictions — young people but also a lot of others,” said Concertgebouw managing director Simon Reinink on Wednesday, as the orchestra gave a protest rehearsal in front of a crowd of 50 people. “The one thing that can give meaning to life is the cultural sector. There has been a chronic underestimation of the importance of culture for people’s psychological health and wellbeing — and this is a huge problem.”

And as more rules are broken, mainstream civic disobedience risks becoming a habit; this is a country where ‘rules’ (like soft drug laws) are already treated flexibly and even the prime minister admits society tends to be “slightly anarchistic”. “Rules only work if they rest upon social and political agreement,” pointed out the group of mayors in their letter last week. “For example, almost everyone in the Netherlands understands and respects the importance of stopping for a red light. Enforcement powers are there to bring the few offenders into line and issue fines.”

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Despite last week’s mini-revolts, that remains a sentiment shared by most of the country. While “wappie” Dutch vaccine sceptics and pugilistic rioters sometimes make a lot of noise, 89.2% of the population is double jabbed, and almost 55% are boosted. Most of us have done our bit, we’ve followed the rules, despite their inconsistency and blunt capriciousness.

But all the signs suggest that we have reached a turning point: the latest reports suggest that while mostly-Omicron coronavirus infections are ramping up, the number of people needing hospital treatment is relatively stable.

Covid-19 doesn’t discriminate, or at least does so on the basis of age and health conditions rather than politics. Why, then, have views on how we should manage it — and particularly how we should treat vaccination — become so heartless, judgemental and politically tribal?

We have a milder case of it in Britain than some countries. But there’s a correlation between (broadly Remain-affiliated) liberal urbanites and the new hygiene-authoritarianism. This has been emerging for a while: back in 2020 the research group UK In A Changing Europe noted that while “it’s not the case that all Leavers are lockdown sceptics” nonetheless “it’s pretty much the case that all lockdown sceptics are Leavers”. More recently, 99 Tories voted against Covid passes before Christmas, compared to 22 in Labour.

In the US, analogous (and angrier) patterns emerge. Free-wheeling, mask-optional Republican Florida is pitted against Democrat California, which mandates indoor mask-wearing, including for all children over the age of two, and announced in October that vaccination would become mandatory for in-person school attendance. Vaccination is already mandatory for employment in the police force and healthcare on public-health grounds.

More interesting than arguing for either one side or the other, though, is what the arguments reveal about our ongoing political realignment. In particular, it sounds the death-knell for a relatively mild-mannered twentieth-century version of progressivism characterised by a desire to ensure the world is fair, and to avoid harming others.

What’s emerging to replace it is more bellicose, more ruthless — and increasingly religious. So-called “secular liberalism” has, in other words, stopped pretending to be secular. It’s been received opinion since the end of World War II that authoritarian religiosity was exclusive to the Right. Theodor Adorno’s 1950 The Authoritarian Personality cited batteries of research to argue that fascism, and the Holocaust, could be explained by the prevalence of an ‘Authoritarian Personality Type’. This ‘personality type’, he argued, was characterised by blind allegiance to conventional beliefs about right and wrong, respect for submission to acknowledged authority, and a tendency to project one’s own feelings of inadequacy, rage and fear onto a scapegoated group.

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In turn, Adorno’s conviction that these behaviours are characteristic of the Right crops up again in a far more recent, but also influential book: Jonathan Haidt’s 2012 The Righteous Mind. Here, Haidt argued that the reason ‘liberals’ and ‘conservatives’ routinely misunderstand one another is that there exist five ‘moral foundations’ on which we all base our political views: care/harm, fairness/cheating, loyalty/betrayal, authority/subversion and sanctity/degradation. Haidt argues that liberals are only interested in care/harm and fairness/cheating, while the Right is attuned to all five foundations.

Does this apply in the Covid debate? Certainly at the surface, calls for coercive measures tend to start off with arguments about protecting people. For example, Scottish public health adviser Jason Leitch told BBC Good Morning Scotland that the aim of Covid passes was “to allow people to attend events and environments safely”.

At the core of this argument is the not unreasonable point that when it comes to physical wellbeing, we can’t be wholly individualistic. The moment you get ill or injure yourself as a consequence of having taken some risk (for example after breaking your leg skiing), you need care and are thus, by definition, no longer taking sole responsibility for your wellbeing.

Does this mean vaxx authoritarians have a point? Hiltzik points out that mandates have long existed on other health grounds where risk-taking imposes costs on wider society, such as seatbelt-wearing, smoking, or drink-driving. Insisting on the individual right to choose whether or not to be vaccinated therefore “places a perverse conception of individual “freedom” in opposition to the communal interest”.

We might simply shrug, and say this is just another data point for that 2021 study which showed that contra Adorno, there is abundant evidence for authoritarianism among left-liberals. Certainly, calls from self-identified progressives to “crush the resistance” to vaccines by making the lives of the unvaccinated a “total misery” might challenge the idea that the ‘authoritarian personality’ can only flourish on the Right.

But it’s the character and chosen terrain of the emerging progressive authoritarianism that’s distinctive. For it’s not merely a matter of progressives waking up to the possibility that they, too, may use coercive measures to pursue their chosen ends. It’s also the nature of those ends. Consider, for example, the fact that in 2020 fentanyl killed more Californians than Covid. But unlike Covid, the drug epidemic inspired few coercive measures — only safe injection sites, billboards encouraging users to take drugs with friends or programmes that pay them not to use.

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If avoiding harm justified coercive interventions, surely we’d have seen more of them in Californian drug policy. But their absence in the case of drug abuse, and fervent application in the case of virus control, suggests there’s a different motive at work than the prevention of harm.

In an Evening Standard piece last week, former editor Emily Sheffield argued that our capital city’s unvaccinated residents should “pay with their freedoms, not ours”. And on social media, we saw the same punitive ferocity recently when one American mother reported that when her son tested positive she didn’t just quarantine him but also “took the X-Box”, a measure more consistent with chastisement than infection control. The only reason she didn’t also confiscate the phone, she says, “is so he can text for food and water”.

Recently, we’ve had news that Omicron appears to be more infectious but milder, and research that indicates vaccination does very little to prevent transmission of the virus. So rationally, none of these vengeful attitudes make much sense. What’s going on?

The recent furore over the entry into Australia of (unvaccinated) tennis superstar Novak Djokovic offers a clue. One Melbourne journalist tweeted about how, since he was allowed into the country, fans “won’t want to come” to the tennis matches. Objectively, one single unvaccinated tennis player would make a negligible difference to someone’s risk of catching Covid; the only possible reason someone might skip the Australian Open because of Djokovic’s presence is if the fear was of a subtler, more metaphysical contagion.

In the Bay of Kells, in Ireland’s County Kerry, there’s a small secret graveyard that until recently was overgrown with brambles and largely forgotten. It was a place where grieving parents buried babies who died before they could be baptised — for the unbaptised were spiritually unclean, and therefore not permitted burial on a churchyard’s consecrated ground.

In Eugenics and Other Evils (1922), GK Chesterton observed that “it seems quite natural to our politicians to enforce vaccination; and it would seem to them madness to enforce baptism”. Today the prescience of Chesterton’s remark is clear, as is the convergence in terms of social meaning between vaccination and baptism.

The growing tendency for ‘the vaccinated’ to treat ‘the unvaccinated’ as other or impure recalls the willingness of an earlier age to deny others simple forms of inclusion on the basis of baptism. Never mind what studies say about the efficacy of Covid vaccination in protecting us from severe illness (which evidence strongly suggests it does) or mitigating further infection (perhaps more debatable). Increasingly, vaccination carries a social meaning as well as a medical one. It’s a ritual infusion — albeit via injection, not anointment — of sacred liquid, whose application confers freedom from spiritual taint.

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Perhaps it’s just that the correlation between left-liberalism and secularism in both Britain and America has left progressives especially hungry for something to fill the God-shaped hole, and the yearning for measures that speak to the fundamental moral instinct Haidt calls ‘sanctity/degradation’. This might help account for the ongoing, fruitless, rationally debunked but nonetheless persistent obsession Tom Chivers recently noted, with disinfecting surfaces ‘because of Covid’ despite mounting evidence that the virus is airborne.

An increasingly post-Christian West, then, finds itself grabbing gratefully onto Covid hygiene theatre, in pursuit of a purity more metaphysical than bacterial. And as we’ve now spent two years clapping for carers, sharing dancing nurse videos, and creating window iconography and even altar-cloths to venerate medical professionals, it’s probably a bit late to rein this blossoming spiritualisation of hygiene.

For to imagine we can do so would be to say we still live in a world of reasoned debate. And when ‘experts’ offer ‘evidence’ to counter rumours of Covid propagandising, only to be met with derisive accusations of using fact-checking to propagandise, we might as well abandon ‘reasoned debate’ altogether and, in the words of Edmund Blackadder, stick two pencils up our noses and wear underpants on our heads.

Or, alternatively, start praying. Progressives spent half of the twentieth century telling us that this was pointless: the search for metaphysical purity was low-status, ‘authoritarian’ or simply obsolete, and reason replaced all that. Their children, though, have discovered that purification rituals don’t have to be confined to the individualistic realm of ‘juice cleanses’ or ‘clean eating’, but can be imposed on entire societies.

We can expect them to go on chasing that high. And meanwhile, it seems enough of the rest of us like having something to worship, and a suitable group of sinners to despise. If you don’t already pray, you might as well start; we all once again live in a religious world.

This is certainly a new departure. As we have previously noted on UnHerd, the Left has strongly supported restrictive measures in the fight against the pandemic.

It argued that these restrictions, which clearly infringe on individual freedoms and rights, were nonetheless justified in the name of “the collective good” and “the collective right to life”. This allowed them to pre-empt any criticism of the new Covid consensus: if you’re against any of these measures, you’re against the collective interest. And so thinkers like us, who have always criticised neoliberal individualism and argued in favour of progressive state intervention, suddenly found ourselves accused of being libertarians or outright “Right-wingers”, just for taking a critical stance of governments’ response to the pandemic.

Indeed, it would appear that for many on the Left today, anything can be justified in the name of the “collective good”. It’s easy to see why Right-wing critics view this uncritical invoking of collective benefits as proof of the Left’s inclination towards authoritarian or “Stalinist” control. While such caricatural definitions are easy to laugh off, as leftists we can’t deny that there is something disturbing about the lack of critical commentary from the Left on how to reconcile the need for collective action with the importance of individual rights and freedoms in the response to Covid.

After all, the Left has historically championed civil rights and freedoms in society which are associated with individual liberties: the right to protest, the right to work, the right to sexual independence and freedom. Expanding the freedoms of men and women — while emphasising that this can only be achieved through collective action — has always been a central tenet of leftist, even socialist-democratic, ideology. So clearly something more complex than “default authoritarianism” is at work in the juxtaposition of the current Covid crisis and the Left’s broad response towards civil and individual liberties.

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Part of it has to do, we believe, with the Left’s criticism of the rise of desocialised individualism. The growing emphasis in economic and political thought on personal autonomy and the individual’s responsibility for their own fate, which has accompanied the rolling back of welfarism, has radicalised the ideological construction of the individual. We can see this in the renewed popularity of a figure such as Ayn Rand, with her message of enlightened egoism as the basis of civilised life. However, criticising modern individualism is one thing; laughing off the very idea that individual rights and freedoms matter is another, as is arguing that anything goes in the pursuit of “saving lives” and the “collective good”.

All of which has meant that, until the Observer’s interview with Mark Woolhouse, there has been painfully little critical analysis from the mainstream Left as to whether the raft of restrictive Covid measures we have seen over the past two years have indeed served the collective good — or saved lives for that matter. By definition, for something to be considered in the collective interest of a society, it has to be in the interest of at least a significant majority of its members. However, it’s hard to see how lockdowns (and other subsequent measures) meet this criterion.

Their psychological, social and economic impact might have been justified from a collective-interest and life-saving standpoint if Covid represented an equal threat to all citizens. Yet soon into the pandemic, it became clear that Covid-19 was almost exclusively a threat to the elderly (60+): in the last quarter of 2020, the mean age of those dying both with and of Covid-19 in the UK was 82.4, while by early 2020 the Infection Fatality Rate (IFR) — the risk of actually dying if you catch Covid — in people under 60 was already known to be exceptionally low: 0.5 per cent or less. A paper written late in 2020 for the WHO by professor John Ioannidis of Stanford University, one of the world’s foremost epidemiologists, then estimated that the IFR for those under 70 was even lower: 0.05%. As Woolhouse points out in his interview “people over 75 are an astonishing 10,000 times more at risk than those who are under 15”.

Moreover, given the impacts on other aspects of medical care, the preservation (or prolonging) of life of the elderly was certainly being achieved at the expense of the life expectancies of younger sectors of the population — to say nothing of the catastrophic impacts in the Global South. This has indeed been confirmed by evidence which shows that excess deaths in younger age groups rose sharply in 2021, with very little of this attributable to Covid mortality.

If anything, Covid restrictions should have been framed in terms of solidarity: as measures which implied the overwhelming majority of the collective, which risked little or nothing from Covid, paying a price, and a heavy one at that, in order to protect, in theory at least, a minority (in Western countries people aged 60 or older represent on average around 25% of the population). Acknowledging this from the start would have avoided much loss of trust in public institutions down the road, and would have allowed for a rational discussion around important questions of intergenerational equity, proportionality and the balancing of rights and interests.

A possible counter-argument is that avoiding healthcare systems being overrun with Covid patients, regardless of their age, was in the interests of everyone. This might be true from a purely theoretical standpoint. However, both arguments hinge on the assumption that lockdowns were actually useful in reducing hospitalisations and deaths. But there’s hardly any evidence that this has been the case.

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In early 2021, John Ioannidis published a paper claiming that there was no practical difference in epidemiological terms between countries that had locked down and those that hadn’t. Several other studies have appeared since then that confirm Ioannidis’s initial findings: see, for example, here, here and here. Indeed, some of the countries that locked down the hardest are also those with the highest mortality figures and excess death rate. Peru is an obvious example, while Sweden’s excess mortality is below the European average for 2020.

Meanwhile in the US, the end of 2021 confirmed the reality that lockdown strategies had little or no impact on Covid mortality. The two neighbouring states of Michigan and Wisconsin followed very different Covid policies, with Michigan favouring severe restrictions while Wisconsin lifted them much earlier; yet at the start of this month, Michigan’s Covid mortality rate was far higher than Wisconsin’s, at 2,906 deaths per million compared to 1,919 per million in Wisconsin. Another stark example comes from comparing two other neighbouring states: North and South Dakota. South Dakota infamously imposed no Covid restrictions, while there were mask mandates in North Dakota during the second wave in Winter 2020/2021: yet as of January 1st 2022, the two states’ death rates are very similar, at 2,810 per million (South Dakota) and 2,640 (North Dakota).

Another case that is less talked about is that of Italy. Over the course of the past two years, Italy has implemented some of the strictest and longest lockdowns in the world (indeed, it is the country that “invented” the concept of national lockdown), topping every other Western country in terms of average stringency of anti-Covid measures. Yet Italy is also one of the countries with the highest mortality rate per capita — well above the United Kingdom, Spain, France, Germany, Sweden and several other countries that adopted much less restrictive measures. And there’s evidence that this isn’t despite the lockdowns but, most likely, because of them.

As Piero Stanig and Gianmarco Daniele, two professors at Bocconi University, explain in their book Fallimento lockdown (“Lockdown Failure”), the worst possible thing you can do when dealing with a highly infectious disease that spreads almost exclusively indoors and targets the elderly is to lock old people up inside their homes with other family members, and ban citizens from spending time in arguably the safest place of all: outdoors. In other words, even from the narrow perspective of saving lives, not only were lockdowns not in the collective interest of society, they weren’t even in the interest of those whose lives were actually at risk.

Such an outcome was easily predictable. Indeed, the WHO’s 2019 report on pandemic preparedness states that the quarantine of exposed individuals — let alone of the entire population — “is not recommended because there is no obvious rationale for this measure”.

The grotesquery of the global responses becomes even more apparent when we take into account the fact that while governments went out of their way to keep healthy people locked in, chasing runners down solitary beaches or checking shopping trolleys to make sure people were only buying essentials, they all but abandoned those most vulnerable: nursing home residents. According to a recent Collateral Global study, Covid deaths in nursing homes amount on average to a staggering 40% of all Covid deaths in Western countries, despite representing less than 1% of the population. In some countries (Belgium, France, the Netherlands, Slovenia, Spain, Sweden, the UK and the US), more than 5% of all care home residents were killed.

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In view of this, it seems obvious that the focused protection approach championed by the Great Barrington Declaration (GBD) — based on “allow[ing] those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk” — was the right course of action. It would have avoided inflicting needless pain on workers, women and children through repeated lockdowns, while arguably saving countless lives, by focusing first and foremost on the elderly and especially on nursing homes.

Naturally, the way in which this worked would have been very different in different settings. While in richer countries the resources and infrastructure were certainly available to direct policy in this way, in poorer countries with high Covid mortality and weak healthcare systems — such as Latin America, India and South Africa — the capacity of governments to offer focused protection was limited. Nevertheless, funds could have been used for this purpose, rather than to fund schemes such as contact tracing, which the WHO had specifically disbarred in all circumstances as a pandemic response in its aforementioned 2019 report.

Instead, countries such as Argentina, Colombia, Peru and South Africa have faced the catastrophe of both severe Covid restrictions and high Covid mortality. What has followed is the destruction of the livelihoods and access to food of tens of millions of citizens; a recent report showed that after almost two years, Covid restrictions have completely shattered the world’s informal economies, with 40% of domestic workers, street vendors and waste pickers still earning less than 75% of their pre-Covid earnings.

And yet as we enter 2022, our openness to reassessing the paths not taken remains constrained. Not only has there been no acknowledgment of the missed opportunity of focused protection at the institutional level — and no apology to the authors of the statement, victims of a vicious smearing campaign — but even now the GBD is dismissed by academics and epidemiologists such as Woolhouse, even though the focused protection policy he advocates is drawn from it.

Meanwhile, throughout the past year, governments have actually upped the ante, coming up with even more invasive, oppressive and discriminatory measures — all in the name of public health and the collective interest. Yet surely the past two years have revealed the dangers of assuming that a “collective response” to the pandemic requires lockdown measures. Many other “collective responses” — such as focused protection and the GBD’s suggestions of free deliveries of groceries to the elderly and vulnerable, and frequent rapid testing of care home staff and visitors — would likely have been more effective.

It is time for the Left to look reality in the face and take stock of the fact that the prevailing Covid response of most Western governments has been an abysmal failure on all fronts —not least that of “saving lives”. An alternative approach is desperately needed. Fortunately, and tragically, it’s been hiding in plain sight all this time.

This rhetoric seemed unlikely to spook any of the vaccine-hesitant into getting jabbed. After all, they have already been exposed to plenty of dire warnings about the virus, and are unlikely to be receptive to the admonitions of an administration they have already ignored. Rather, the real addressees of Zients’s sermon were the vaccinated, who could assure themselves that they are on the side of the good.

Early in the Covid era, many believed the virus had made clear that “we’re all in this together”. The pandemic, we were told, would instil a sense of collective responsibility premised on our biological interconnectedness. Yet the reality, starkly revealed by Zients’s proclamation, is that we have entered a new age of biopolitical balkanisation, evident not only in the drastic policy divergence between red and blue states but also in the latter’s attempts to exclude the unvaccinated from public life.

Zients’s boss, Joe Biden, campaigned on the idea that technocratic competence and faith in expertise would end the pandemic. He also promised to scale back the culture wars of the Trump era. “We can,” he said in his inaugural address, “join forces, stop the shouting, and lower the temperature.” This may have been standard political pablum, but it reflected a genuine hope that a less divisive — even pleasantly boring — four years might follow the tumultuous Trump era.

Instead, a year into the Biden administration, we have seen a ratcheting up of the propagandistic weaponisation of “science” and a series of self-inflicted blows to the credibility of experts. Much has been said about the CDC’s inconsistent messaging, and during the current Omicron surge, as during previous surges, the administration has been criticised both for being overly aggressive and overly timid. But underlying these inconsistencies is a new mode of liberal technocratic governance, driven by moralising fervour and partisan animus rather than calm neutrality and rational calculation.

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This new strategy of rule places Biden’s administration in contrast with Barack Obama’s, in which he served as Vice President. Although the soaring rhetoric of his 2008 campaign sometimes suggested otherwise, Obama was motivated by a conviction that competent management, not visionary speeches, could unite the nation. The former law professor’s wonkish impulses and academic connections led him to the burgeoning field of behavioural economics, in particular the work of his erstwhile University of Chicago colleague Cass Sunstein, who served as his regulatory tsar between 2009 and 2012.

Sunstein pioneered the approach known as the “nudge”, which gave the title to the 2008 book he co-authored with Richard Thaler. Instead of mandating or proscribing behaviours, Sunstein suggested, governments might alter “choice architecture” to tacitly incentivise desired behaviours and discourage undesired ones. An oft-cited instance is making opt-in the default on certain decisions, like signing up for retirement contributions or the organ donor registry. These apparently small changes, “nudgers” believed, could re-engineer mass behaviour in a prosocial direction. Sunstein and Thaler, David V. Johnson notes, claimed to have “found the Golden Mean between Reagan free-market conservatism and FDR state-guided liberalism”. Their ideas had a natural appeal to a president who had promised to overcome the divisions between red and blue America.

During his second term, Obama signed an executive order committing the government to “using behavioural science insights” and launched a Social and ‘Behavioral Science Team’ that put “nudge theory” into practice. The results of these initiatives were modest. For example, the administration attempted to use text message reminders to increase college matriculation among low-income high school graduates. Such efforts, a reminder of the pre-2016 period when tinkering around the edges of the possible was still seen as a noble and vital mode of governance, seem quaint today.

In his writings, Sunstein directly contrasts nudge-type efforts with mandates, and argues the former are preferable because they are “choice-preserving”. For example, making green energy preferences on utilities the default option predisposes consumers towards environmentally favourable choices, but still gives them an escape. To those chafing against Covid mandates, this “libertarian paternalism” might seem preferable to the current style of Democratic governance.

But behavioural economics also received its share of criticisms at the peak of its influence. Critics argued that nudge-type policies are often attempts to bypass collective deliberation on issues of common concern. Yet this was one of the sources of their appeal: after the 2010 midterms, the White House faced a hostile Congress that thwarted Obama’s ambitions. For an executive boxed in in this way, as Johnson remarked in the final months of the administration, “a nudge can secure policy success without requiring Congressional approval”.

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In the Covid era, the Biden administration and its state-level allies have made a hard pivot away from the nudge approach towards an embrace of mandates. The presumed justification for this shift is that the severity of the Covid crisis required more drastic measures. But something else differentiates Covid technocracy from its predecessors: a remarkable incuriosity about whether the strictures it imposes actually work. This incuriosity has become all the more glaring in recent weeks, as Omicron has brought cases to unprecedented levels in cities like New York, where both vaccine passports and mask mandates are in effect.

The nudge approach, on the other hand, is at least ostensibly outcome-oriented: it assesses interventions on the basis of their measurable impact. So one of the problems with mandates, from the nudgers’ perspective, is that they risk conflating intention and outcome. Mandates are often difficult to enforce and generate backlashes, and thus may prove counterproductive. But they may remain in force, despite failing to achieve their objectives, because they demonstrate a moral commitment to a desired aim.

And as Zients’s holiday announcement demonstrated, when mandates fail to achieve the desired results, it is the fault of those who don’t follow the rules, not those who imposed them. A more empirical approach would treat the reality of noncompliance as part of what needs to be measured in order to assess the efficacy of a proposed policy. But such a strategy would imply that the technocrats themselves, rather than the anti-vaxxers or anti-maskers, should be held accountable for policy failures. Small wonder it has fallen out of favour.

Before last year it might have seemed obvious that the guiding ethos of technocracy was cold utilitarian calculus, but in the past two years it has become something like the opposite: moral fervour. Various factors brought about this shift, but the reaction of the technocrats and their constituency to Trump, with his “war on the administrative state” and love of the “poorly educated”, was arguably the crucial one. Tinkering behind the scenes, as was favoured in the Obama era, was no longer a viable approach for a class that felt its interests threatened.

Early on in the pandemic, the writer Alex Hochuli described the pandemic as “technocracy’s end-of-life rally”. At least temporarily, it had put the experts maligned over the previous half-decade back in the drivers’ seat. But the populist fervour that had driven the Trump movement re-energised itself in reaction to lockdowns and mask and vaccine mandates. Initially, this seemed to place the technocrats in an unassailable position, since they could impugn their allies as aiders and abettors of disease and death.

However, this high ground is illusory: the track record of their mandates has proven middling at best. For instance, Los Angeles county, with vaccine and mask mandates, fared no better after implementing them — slightly worse, in fact — than neighbouring Orange County, which had neither. Furthermore, vaccine mandates for health care workers, many of whom already have immunity from prior Covid infection, have led to staffing shortages nationwide as reluctant workers have resigned or been fired, leaving hospitals worse-prepared to confront the Omicron case surge. The refusal to acknowledge such failures and tradeoffs is even more self-discrediting.

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But there is also a more profound issue at play: while technocrats’ rule by moral fiat has allowed some critics to be bludgeoned into submission, it also exacerbates the deeper problem of governance by unelected bureaucrats in a system nominally premised on the consent of the governed. Sunstein and his Obama-era acolytes were aware of this risk even if their project was informed by anti-democratic assumptions. This was why they were so concerned to preserve at least nominal freedom of choice on the part of citizens.

Biden, however, seems to have forgotten this. His administration’s devotion to mandates, regardless of the evidence piling up against them, looks more and more like a punitive backlash against political enemies. Far from a means of transcending hyperpartisan antagonism, as both Obama and Biden once promised, technocratic management has become another means of pursuing it. Public health messaging has become another opportunity for partisan pep rallies — and America will suffer for it.

That’s not necessarily because they’re wrong. It’s because they are imprecise: the pundits won’t fully commit to anything. “The year ahead will be difficult for Boris Johnson,” that sort of thing. Whatever happens, it’ll be hard to say whether that prediction came true or not.

What’s much more worthwhile is making clear, well-defined, falsifiable forecasts, with fixed timetables: forecasts that commit you to say “OK, I got that wrong.”

I had a go here, here and here during the pandemic (an embarrassing number of which have been wrong). But since it’s the new year, I thought I might stake my own reputation on a few forecasts for 2022.

To do so, I’m going to use the Phil Tetlock “superforecasting” model, of giving lots of forecasts with levels of confidence. So I might say it’s 60% likely that Boris Johnson will have another child in 2022, or that there’s only a 10% chance that Keir Starmer will be prime minister by the end of the year. At the end of the year, I’ll look at all my forecasts. Ideally, about 60% of my 60%-confident forecasts should have come true, and about 10% of my 10%-confident forecasts, and so on[1.  Ideally ideally, I’d have made hundreds of forecasts and you could get a really good sample to see how well-calibrated I am. But unfortunately that’s not going to happen, because calculating these takes ages.].

I’ve used the prediction site Metaculus for my questions. When the site had a good question on it already, I’ve used that; when I needed to make up my own, I’ve done that. I’ve linked to the questions so you can make your own predictions and see what the wider Metaculus community thinks.

Coronavirus

I think that this year will see things return pretty much to normal in Britain. Every so often there’ll be a bit of a flare-up, and some people will call for an immediate return to mandatory masks and closed pubs and all that. But 90% of the population aged over 12 has now had at least one jab and 60% have had three, and most people have probably had the actual disease as well (13 million confirmed cases, which is likely an undercount by at least 60%). So the actual risk to British people is low.

That said, about 100 people are still dying every day with Covid. That sounds bad, and it is, but it’s only about one in every 16 deaths in the UK. Still, if it carries on at that rate for the whole year, we’d expect another 35,000 to 40,000 deaths this year. It may not carry on at that rate all year, but I can’t imagine it’ll drop so much that we see fewer than 20,000. So I’d say it’s 75% likely that we see 20,000 or more deaths within 28 days of a positive Covid test in Britain in 2022.

Also, I think we’ll get a few scares from new variants. The WHO has announced five “variants of concern” since the pandemic began, the most recent being Omicron. Given a base rate of about 2.5 a year so far, it’s pretty likely that we’ll see more this year. Whether any of them will be as devastating as Delta or Alpha is a bigger question, but I’d say it’s 90% likely that the WHO will announce at least one new variant of concern in 2022.

Relatedly, if new VoCs do arise, will one of them overtake Omicron as the most commonly detected strain of Covid in the world? Again, I think this is pretty likely – I’d say there’s only a 30% chance that Omicron will be dominant by next January. Six weeks ago we’d never heard of Omicron and Delta was dominant; the original Covid was overtaken by Alpha only eight months or so after it was declared a pandemic. So far no variant has remained dominant for more than a few months and Omicron appears to be petering out in South Africa.

Predictions:

More than 20,000 people will die within 28 days of a positive Covid test in the UK in 2022 (75%)

The WHO will add another variant to their Variants of Concern in 2022 (90%)

Omicron will be the globally dominant strain of Covid at the end of 2022 (30%)

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Vaccinations

The UK’s booster campaign has rolled out with impressive speed since it was announced in September. But there have been suggestions that we will need to do annual Covid jabs, as we do for flu. So I predict it is likely (65%) that we will offer fourth jabs to healthy British adults before the end of 2022.

Not that I think we should do this. I think the vaccines we’ve already had will probably protect people very effectively against severe disease and death even once the measurable antibodies have declined, and I think each new jab will do lots more good in the arms of unvaccinated people in lower-income countries than they will in the arm of a triple-jabbed pensioner in Reading. But given that governments have a duty to look after their own citizens, and, more pressingly, a need to curry favour with those citizens to avoid being voted out, I think it’s pretty likely that we’ll do it. Metaculus forecasters think it’s likely in the US, as well.

The important thing will be whether we vaccinate the world, and especially the poorest countries. It should be said that despite a widespread and understandable feeling that the West has hoarded all the vaccines, almost 60% of the world’s population has received at least one jab, and even lower-middle income countries (which include places like Bangladesh and Egypt) have vaccinated more than 50%.

But the truly poor countries – places like Afghanistan, Sudan, North Korea and many sub-Saharan nations – are lagging badly behind, at only about 8.5% coverage. It’s been speeding up, and in richer countries vaccinations have followed an S-shaped curve – slowly, then quicker and quicker, then slowing down again. But looking at the curve on the Our World in Data page, it looks like the low-income countries are taking off at about a quarter the speed that the rich ones did.

It took rich nations about six months to get to 50% coverage: the world makes vaccines faster now, but also there are still huge logistical and incentive problems for getting those vaccines to poorer countries. I’d guess that between 30% and 60% of inhabitants of the world’s poorest countries will have had at least one jab by 2022. I think it’s also pretty likely (75%) that at least one country will still have fewer than 10% vaccine coverage, just because there are a lot of poor countries, some of which have basically no working health infrastructure.

Predictions:

The UK will authorise fourth doses of Covid vaccines for healthy adults in 2022 (65%)

What percentage of people in low-income countries will have had at least one dose of a vaccine by 2023? – between 30% and 60%

At least one nation will have less than 10% of its population vaccinated with at least one dose by 2023 (75%)

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Climate

The world will continue to warm, on average, over the next few years. There’s too much carbon in the atmosphere already for that to change.

But there’s a lot of variability from year to year. Most years are somewhat hotter than the one before, but not always: of the 20 years leading up to 2020, 13 have been hotter than the previous year, and seven have been cooler, according to the Met Office. So the base rate is that it’s about 65% likely that 2022 will be warmer than 2021.

That said, 2021 has been a relatively cool year, due to La Niña, an atmospheric and oceanic phenomenon that brings cold water to the surface of the oceans. La Niña finished some months ago, so it shouldn’t affect 2022. I think it’s therefore very likely (85%) that 2022 will be hotter than 2021, when the data eventually comes in.

Prediction:

The global average surface temperature in 2022 will be higher than it was in 2021 (85%)

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Energy

There’s a cruel joke that goes to the effect that “fusion energy is 30 years away and always will be”. That said, in the last few years, there’s been a lot more excitement about it, and several new companies have started up, with nearly two billion dollars of funding backing them.

It’s very unlikely that fusion energy will reach any of its milestones – “ignition” or “breakeven” or profitability or anything – this year, and pretty unlikely that they’ll do it this decade. But I do think that the excitement will carry on building. According to a survey by the Fusion Industry Association, there are “at least 35” fusion companies around the world, most of which have been founded in the last 10 years. I think it’s likely (65%) that number will go up in 2022, as the technical questions continue to be answered, and as investors and entrepreneurs get more excited about the possibility of a viable, profitable industry.

Also, the cost of solar energy has plummeted over the past decades. It will almost certainly continue to do so, but since it is already cheaper than any form of fossil fuel, cost is no longer the sticking point. Now, the bottleneck for renewable energy is making it available when the sun isn’t shining or the wind isn’t blowing – having loads of sunshine in August is no good for heating your house in December.

There are various ways of doing that, such as installing cables between countries, so the UK’s offshore wind can supply Spain when it’s windy, and Spain’s solar can supply the UK when it’s sunny. But the most obvious is storage, and the most obvious form of electricity storage is batteries.

The cost of electricity storage has also dropped enormously – according to Bloomberg, it’s gone from a global average of about $300 per megawatt-hour in 2018 to $138 in 2021, mainly driven by the electric car industry. Despite supply chain issues and increased cost of various raw materials, mainly metals, I think that’s probably going to carry on – I think it’s 80% likely that the next Bloomberg report will find that the global average drops in 2022.

We’ll still rely on fossil fuels for some years to come. But I think in 2022 we’ll see some of the pieces of the zero-carbon future start to come together.

Predictions:

There will be more fusion companies at the end of 2022 than there were at the end of 2021 (65%)
The cost of battery storage will be lower per megawatt-hour at the end of 2022 than it was at the end of 2021(80%)

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Have we seen the end of Covid?

By Tom Chivers

Medicine

The biggest thing in medicine this year has been the Covid vaccines. And they’re pretty astonishing things. Remember that at the start of 2020, there were zero approved mRNA vaccines in the world: now billions of people have been given one, and millions of lives have been saved.

You can use mRNA vaccines for pretty much any disease, and in the next few years we’ll doubtless see them for all sorts of things. One that really interests me is cancer. Cancer “vaccines” aren’t like vaccines for measles or Covid – they’re treatments, given to people who have already been diagnosed with the disease, rather than prophylactics given to people at risk of contracting them. As I understand it, it involves presenting the immune system with the RNA sequence for a protein specific to that patient’s cancer, which will help the body fight that cancer. It’s a sort of personalised advance on existing immunotherapy, which has already turned various previously fatal cancers into largely manageable chronic illnesses. So this could be a really big deal in coming years.

Lots of drug companies have plans to make cancer mRNA vaccines. For instance, BioNTech has four ongoing Phase II trials. I think it’s pretty likely that we’ll hear good news from at least one of them, and that a Phase III trial with thousands of participants will be announced. Let’s say 55%.

Prediction:

A Phase III trial of at least one of BioNTech’s cancer mRNA vaccines will be announced in 2022(55%).

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Football

Until a week or so ago Liverpool were one point off the lead and looking good: then they drew with Spurs, lost bizarrely to Leicester after missing a penalty, and then drawing with Chelsea despite being two-nil up after half an hour. And Man City should have lost to Arsenal but Arsenal decided to be Arsenal and gave away a penalty and had a man sent off within 10 minutes and threw it away.

So now Liverpool are 11 points off the top (albeit with a game in hand) and let’s face it the title race is over in January. I reckon only about a 10% chance of turning it around. Still, there’s always the Champions League.

Prediction: Liverpool will win the league this year (10%)

Conclusion

I wanted to add another couple of questions, but they’re hard to do good data on. For instance, I bet that global extreme poverty will be lower in 2022 than it was in 2021, as it has been almost every year for the last 40. But we won’t get good data for a few years. I also bet that even though the world will get better on most metrics, such as life expectancy, wealth, etc, an increasing share of people will still think that it’s getting worse, because that’s how we work. But that’s hard to get into a straightforward question, and again, even if we could, the data for 2022 won’t be around until 2025 or something anyway. Still, I think those things are probably true.

My final prediction is that these predictions will not be very accurate. I’d love it if you would have a go and see if you can do better.

Only 40% of the South African population has been jabbed against Covid — a slow take-up which is euphemistically described as “vaccine hesitancy”. It is anything but: it is enraged rejection.

There are a number of reasons why it is so hard to get South Africans to take the umjovu, the injection: appalling technical management of the outbreak, a prevailing scepticism towards science, wariness about the Government and a wide-spread apprehension by the poor and marginalised that this is at best another form of repression and at worst witchcraft. It is a dangerous brew in a country already in a state of great political, social and economic instability.

In common with the rest of the world, South African epidemiological estimates of fatalities at the outset of the coronavirus outbreak verged on the fantastical. Initial predictions were for between 87,000 and 350,000 fatalities in the first phase. There were 103. Two years later, with the virus in retreat, fatalities attributed to Covid (but by no means vouchsafed) are only now beginning to touch the lowest initial estimates.

Yet the South African Government imposed one of the longest and most severe lockdowns, supported by a baying national and social media. The decision has proved inappropriate in nature, premature in timing and catastrophic in impact. In a country where many depend on ad hoc daily or weekly subsistence wages, the sudden cessation of economic activity wreaked havoc amongst the poor and self-employed. A failing state was unable to deliver on its promise of subsidies, responsible policing or effective containment.

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It took more than a year for the first subsidies to individuals or small businesses to start coming through. And even then they were erratic, corruption-prone, inadequate, and according to many attested reports, distributed on a racially biased basis. Nearly a quarter of small businesses have gone to the wall and unemployment has rocketed.

An entire section of the population was effectively criminalised: in the first four months of the outbreak, 230,000 citizens, 0.4% of the population, were charged with infringement of the Disaster Regulations for breaking the restrictions, 311 of them policemen. All the charges were later dropped: the criminal justice system simply could not cope.

For every reported infection to the end June last year, seven citizens were arrested for breach of regulations; for every 100 infections, one police officer was arrested; and for every 1,200 infections there was a High Court urgent application. Seven people had been killed in heavy-handed enforcement.

When two doctors working in a Government hospital were forcibly interned in one of the state’s make-shift rural isolation camps, the High Court ordered they be allowed to self-isolate at home: it accepted the doctors’ deposition that they stood more chance of dying from the conditions of incarceration than from the virus.

Small surprise, then, that the general population, particularly the poor, headed for the hills. Take-up of the crucial HIV-Aids retroviral dropped from 95% to 30%; malaria medication showed the same path. Attendances for tuberculosis screenings dropped by two-thirds, while consultations with GPs were down 60% and tens of thousands of urgent surgery procedures were postponed for the coronavirus patients who never arrived.

Emergency procurement of personal equipment, meanwhile, opened the door to the corruption lurking in every interstice of the State. The  heir-presumptive to President Ramaphosa has resigned: a state investigatory agency accuses him of directing a R350 million (£16.6 million) Personal Protection Equipment account to friends. The Gauteng Health Department, industrial heartland of the nation, is embroiled in a R560 million (£26.5 million) fraud inquiry. The female whistle-blower was assassinated within days of the inquiry’s launch.

The begging question, whether President Ramaphosa, a decent man, is presiding over a ruling party in the throes of a Robert Kennedy versus The Mob has at least been definitively answered.

At the same time, a public service already perilously compromised by patronage, corruption, incompetence, and the dismissal of key white personnel for affirmative action reasons, went into a long recess. Two years later it has still not properly returned.

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Enforcement of traffic licencing rules have also been in abeyance for 18 months as 500,000 drivers’ licences await clearance. Estates cannot be closed, forensic inquiries completed, crimes prosecuted (including culprits in the so-called State Capture project of former President Jacob Zuma) and property transferred. More than half a million school children have quite simply not returned to school.

As for the burden of this failure of service delivery, it has been carried disproportionately by the poor, mainly black but increasingly also by white citizens, judged by the street corner beggars. There is little doubt that the effect of the containment strategies advocated by South Africa’s warrior scientists facilitated the July Troubles this year, which claimed 357 lives in a scourge of looting, arson and violence and has directly accounted for the drastic decline in ruling party support in last month’s municipal elections.

South Africans have endured, if never condoned, the absurdities and atrocities of this misjudged, exploited and needless panic to date. The ebb and flow of the global debate about the course of the pandemic has been intensely watched here by the literate and online portion of the community.

They have followed, like many others in the world, the way the arrogant scientific certainties that locked up the world are dissolving in the face of measured science and empirical fact. They understand one cannot follow a “science” when the scientists are hopelessly at odds. They are aware of the abuse of both language and statistics, particularly the new phenomena of snatch-stats whereby mortality from other causes is snatched for Covid-19, or the natural path of an expiring virus is used to justify the efficacy of an antidote or Excess Deaths are annexed to justify a lost cause.

They note the irony whereby their government, correctly, tells the world not to be alarmed by the Omicron variant, while it simultaneously contemplates a grievous assault against the rights of its citizens to contain it, egged on by the usual howling suspects who demanded total lockdowns. Citizens have minutely followed recent reports of how Pfizer arm-twisted their desperate government into signing legal indemnities for its product: who ever heard of citizens being forced to be vaccinated when the supplier is absolved of any responsibility for the consequences?

Most South Africans are not conspiracy theorists but their history teaches them one certain thing: uncontained power always gets one screwed. And many feel screwed now by a confluence of forces (not a conspiracy) that — from Big Pharma, to Big Tech to authoritarian governments — seeks rent from this incomparable tragedy.

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But another, far more important constituency of hesitaters and rejectionists exists. Those who take the time to talk to the black poor and marginalised are astonished by the extent to which, scarred by their lockdown experiences, they regard the current scare as yet another means to oppress them. Curfews, liquor and tobacco bans and the outlawing of political meetings under the guise of fighting Covid-19 support their case. And, for many, the umjovo is nothing less than ubuthakathi or witchcraft.

President Ramaphosa enters dangerous territory here. Take-up of vaccines is higher among the minorities for a variety of reasons and it is a section of the white minority who are the most vociferous supporters of vaccinate-at-all-costs. Banning access to public spaces will instantly translate, as it always does, into a political and racial rumpus. Pieces of paper that permit or restrict certain people’s movements have a terrible record in this country’s history: a bitter resonance for every black person.

Proven and restless forces in South Africa are today looking for chances to reignite the insurrection of July. These are people who do not protest by way of orderly marches, posters and pram-pushing. They seek only opportunity; the consequences brought by the human attempts to contain the pandemic is a revolution.

But revolutions always eventually consume their children. Time will certainly consume the reputations of the architects of this epochal tragedy: the scientists, pharmaceutical companies, politicians and media. And if Ramaphosa isn’t careful, it could also consume the fragile nation of South Africa.

In the year and a bit since then, there haven’t been many opportunities to write straightforwardly upbeat things. So it is with great relish that I write that the vaccines are now unambiguously saving British lives.

One (so far not peer-reviewed) study looking at 5.4 million people in Scotland — that is, basically all Scottish people — found that vaccinated people were 85% less likely to end up in hospital than unvaccinated ones. The Oxford/AZ vaccine and the Pfizer vaccine were statistically indistinguishable; despite ridiculous and confected European concerns about the Oxford vaccine, it is stopping people from dying just as well as the Pfizer one. And in Scotland the AZ vaccine has been mainly used in older people, to great effect.

Another smaller, UK-wide study looking at infections in healthcare workers found that the Pfizer vaccine was about 70% effective at reducing infections 21 days after a first dose, and 85% shortly after a second dose. Further analysis suggests that even if you do get infected you’re about half as likely to get seriously ill or die, suggesting that it’s somewhere up in the 80-90% region against severe disease.

We’re not mucking around trying to reverse-engineer pharma industry press releases and proxy immune responses any more; this is the vaccine out in the field, doing what it was made to do, and doing it well. One of the most heartening graphs showed that the number of severe cases in the elderly was dropping at a far faster rate than cases in younger age groups; when we came out of Lockdown 1, they stayed stubbornly high for a long time. There was some slight concern in the Scottish data that the response started to weaken a bit once you got past 28 days from the first dose, but it wasn’t clear and it didn’t seem to appear in the other study, so I’m not very worried about it.

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When you add in that cases are dropping day by day – the seven-day rolling average is down to around 11,000 positive tests a day, the lowest it’s been since the beginning of October – I think we are allowed to be cheered.

All that might make you think that the road ahead is clear — but there are still reasons to be cautious.

The chief scientific adviser, Sir Patrick Vallance, in a briefing to journalists ahead of the release of the roadmap, said that it is important, as we come out of lockdown, to do it in stages: open up a few things, wait for a few weeks, and watch how R changes; the basic scientific thing of changing one variable at a time.

Schools are the big unknown. It’s nearly a year since schools were closed in the first lockdown, and despite them being opened and closed again since, we still don’t really know what impact they have on transmission. I think it’s pretty clear that they do drive R upward somewhat, but it’s not clear how much. I get different answers depending on which scientists I ask.

In the roadmap, we will open schools on 8 March (plus a few other things which are probably fairly inconsequential from a transmission point of view), and then see what impact that has. Vallance suggested we should leave four to five weeks between new measures, in order to see what the impact is: under the roadmap, we’re leaving just three weeks before further measures are introduced on 29 March, which disease models presented to SAGE suggest would be “unlikely [to] allow the effect of step 1 to be clearly discernible before step 2 takes place”.

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The measures introduced on 29 March seem unlikely to be major causes of transmission: the reintroduction of “the rule of six” outdoors, outdoor sport starting up again. And they will coincide with the start of the Easter holidays. More major changes will come at least five weeks after the schools reopen. But still, this isn’t being overly cautious: if anything, it’s sailing somewhat close to the wind. 

You might, reasonably, say that it doesn’t matter that much whether schools raise R that much, because the vaccines will stop people dying. But not everyone will be vaccinated, and the vaccines are not perfect, so a huge outbreak will lead to a gigantic surge in cases. The SAGE models suggest that if we were to reopen fully all at once, we would end up with the NHS overwhelmed far more than it was even at the peak of spring 2020. 

Slower relaxation, obviously enough, leads to slower growth in cases. And given the uncertainty, especially around schools, coming out slowly is obviously wise. I understand the wish to come out of lockdown quickly: by one measure, we currently have the most restrictive measures in the developed world. But I’d suggest that’s probably at least partly a result of coming too quickly out of previous lockdowns, not a reason to come out quickly now.

There’s another concern, which is that the more infections there are, the more chances there are for the virus to mutate. There are already somewhat vaccine-resistant strains out there. “If we see big outbreaks and exponential growth,” says Rupert Beale, leader of the Cell Biology of Infection group at the Crick Institute, “you might get a more complete vaccine-escape mutant. It’s relatively unlikely, but each new infection is like giving the virus a lottery ticket.” It only needs to be lucky once.

So the roadmap seems sensible: finally Boris Johnson has learned how to pass the inverted marshmallow test.

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A couple of points, though. First, it is baffling that it is “irreversible”, as briefed a few weeks ago. If we reopen schools, they drive R way above one, and we find ourselves in an unexpected new surge, then the sensible thing to do will be to close schools again. It will be awful for a lot of people, but better than a huge second outbreak and the need for a much longer lockdown.

Second, there are missed opportunities here. The number of cases is falling, and that’s a good thing. But as Adam Kucharski of the London School of Hygiene and Tropical Medicine points out, it means that we have only a short window to find things out about the virus. When there are very few cases in the community, it becomes impossible to tell what effect your interventions have: if you tested a vaccine on a population with no disease, then you’d get zero cases in your placebo arm and in your treatment arm. The same applies if you are trying to see the effect of, say, lateral-flow testing.

So now, while there are still a reasonable number of cases, would be an excellent time to do some randomisation. Try lateral-flow tests in schools in a randomly selected 50% of boroughs. Or try new ventilation techniques in half of schools but not in others. Then measure the impact. It is very unlikely that this will be the last we see of Covid, in either this form or some variant; knowing more about how it spreads, what we can afford to leave open and what we definitely need to close will help us when numbers come back up again. 

Third, there was something that Vallance said which caught me up short. We can’t expect the vaccine to be entirely successful, he said, because even if it’s 80% effective, we’re only vaccinating 80% of the population – adults – and 80% of 80% is only about 65%.

Which is of course true, but it made me think: perhaps … we … ought … to … vaccinate … children?

It’s just a thought, but 100% of 80% is 80%. The vaccines are amazingly safe in adults, and I don’t know of any reason why they’d be less safe in children. I was worried that there’d be some Joseph Heller-style situation where we can’t do safety trials on children because we don’t know that it’s safe to do so, but it turns out that Pfizer have already recruited participants. We’re going to have to live with this disease for a long time. Vaccinating people on their 16th birthday forever is not ideal, especially if it’s still circulating in schools. It might not be the most immediate priority but I’d like to know if it’s safe.

I sincerely doubt that this will be the last time I write “coronavirus” in my life, or even the last time this week. But the vaccine news does make me think that, if we do come out of things cautiously, then perhaps this time next year, I’ll at least be writing it less often.

But why is that? No doubt that’s the question governments across the world are currently attempting to answer, in the hope of replicating some of Israel’s success. But the truth is that the country’s vaccination rollout has been a unique victory — one that has emerged from a confluence of factors which, while individually common in other countries, Israel is alone in having.

Some of those factors are structural. Israel’s universal health system, for example, is built on a regulated service provided by four competing non-profit health service organisations, called “sick funds” — a bit like having four versions of the NHS. Every resident must be a member of a fund, which are financed by a small progressive health tax that ranges from 3-5% of a person’s income. In effect, the system combines the benefits of universal coverage with competition, though it is hardly alone in the world in doing so.

Far less common, though, is the extent of digitisation in the Israeli health system. Each fund maintains a fully digitised records and appointments system, integrated with smartphone apps, websites, and automated phone systems. Crucially, these records are directly connected to the Ministry of Health’s universal vaccination database. This meant that when the time came for organising Covid vaccination appointments, there was no new infrastructure to set up. Appointments were organised automatically for the people who most urgently needed them on platforms that were already familiar.

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But none of that would have mattered without an adequate vaccine supply. And this is where the Israeli government stepped in. Well before any vaccines were approved, senior officials were already signing deals with Moderna, Pfizer, AstraZeneca and others — as well as funding a domestically produced vaccine, which is still in clinical trials. They also began securing a large supply of syringes and needles, an element of the vaccine strategy which was surprisingly overlooked by other countries, most notably Japan.

Of course, many countries put in early bids for vaccines before they were tested or approved. But while EU procurement was focused on leveraging the bloc’s enormous purchasing power to lower the price of vaccines, the Israelis knew there was little hope that a small peripheral country could drive a hard bargain. Working on the assumption that the costs of further lockdowns and hospitalisations would dwarf an inflated vaccine price, Israel prioritised buying as much of it as possible in the swiftest period of time. Exact figures are yet to be made public, but reports in the Israeli press suggests the government paid between double and triple the going rate.

Yet Israel did not just offer more money to get to the front of the queue. It also offered pharmaceutical companies anonymised real-time data on vaccine distribution, side effects, and efficacy — in effect turning its population into Phase IV trial. Data on this scale goes far beyond anything drug companies could obtain in even the largest clinical trials.

Still, while an adequate supply is crucial for a successful vaccination program, it hardly guarantees one. Indeed, it is Israel’s logistical operation, rather than its digitised record system and political decision-making, that ultimately ensured the country’s vaccination program was a success.

As soon as the vaccines arrive at Israel’s Ben Gurion Airport, they are taken straight to a centralised ultra-freeze facility just outside the airport. From there, three times a week, coordinated shipments of vaccine pallets are sent out to the four Israeli health organisations, as well as hospitals, prisons, army bases, purpose-built centres, drive-through facilities, and even mobile units stationed on weekend hiking trails. All are staffed by nurses from local hospitals and clinics which have seen reduced demand during the pandemic, as well as by paramedics and those specially trained to provide extra capacity in the months before the first vaccines arrived.

These centres process, on average, at least eight patients per hour per nurse. Last week, that meant that more than half of Israelis have received their first dose and more than a third have already received both — a figure made even more impressive when you consider that 30% of the population are under 16 and therefore ineligible for any vaccine (pending clinical trials on younger subjects).

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Israel’s approach has also adapted when necessary. Early on, a call centre to report possible side effects was established to prevent the telephone appointment system being clogged up and, even more important, to reduce A&E visits to a bare minimum. Meanwhile, messaging for Israel’s diverse population has become more targeted: faced with low turnout in the first weeks in the Arab and ultra-Orthodox communities, authorities turned to social media and other outlets with tailored messages.

But, given that much of Israel’s vaccine roll-out benefitted from pre-existing infrastructure and policy decisions that are now too late to copy, is there anything that other countries can still do to try and replicate some of its success? The simple answer is: nobody knows for certain. But regardless of how easy they are to copy, there are two aspects of Israel’s vaccine operation that bear noting.

First, the criteria for the initial rollout were very broad and very simple. There was no list of at-risk professions and no list of pre-existing medical conditions that meant certain people were prioritised. Had there been, it’s safe to assume that call centres would have been deluged by those seeking exceptions, exemptions or early appointments. Instead, anyone over the age of 60 — a much lower cut-off than any other country — was invited to get vaccinated in the first three weeks, together with medical staff and anyone in “institutionalised” living (mostly care homes).

Though people in their 60s are not at a significantly high risk of dying from Covid, by vaccinating them early, the Israeli health organisations attended to most of the relevant pre-existing conditions, particularly diabetes and obesity. “The low initial age minimum covered nearly all of the co-morbidities anyway,” Dr Boaz Lev, who heads the Ministry of Health’s Advisory Committee on Pandemics and Vaccines, told me. “And it generated early momentum in a way that stricter criteria could not have.”

Such simple criteria were easy to understand and hard to resent. And the result was that, in the first month that vaccines were available, Israel and Denmark were the only countries where supply actually became an issue. In the rest of Europe and North America, unused vaccines sat in freezers or, worse still, thrown away.

Which brings us to the second crucial aspect of the Israeli operation that observing governments should take to heart: from the very beginning, there was a strict policy of no wastage. Indeed, if there’s one motif to the entire Israeli effort, it’s the idea that one discarded vaccine constitutes a systemic failure. This meant that in small towns where there were leftover vials at the end of the day, residents received text messages inviting them to be vaccinated. Anyone near a vaccination centre where too many vials had been defrosted was also encouraged to get a jab. Even people under 60 could show up at the end of the day and, in the event that there were extra doses, could get vaccinated.

The no wastage policy has had three benefits. It will save money in the long term, as fewer vaccines will need to be purchased than would have been the case if many had been spoiled and discarded. It relieved pressure on the appointments system by discreetly giving vaccines to those people who, for whatever reasons, wanted them earlier than the criteria would allow and who would otherwise have burdened the system with phone calls. And, perhaps most importantly, it quickly introduced more of the vaccine into the community much earlier than would otherwise have been the case — thereby reducing the virus’s transmissibility.

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What’s remarkable about this most Israeli aspect of the whole Israeli operation is how little consideration was given to it. When I approached officials from the sick funds, the Ministry of Health, and nurses on site with questions about the no wastage policy, they all spoke of it as being common sense; something almost automatic. Israelis who hear the story of Hassan Gokal, the Texas doctor fired for ensuring ten thawed doses would be injected rather than discarded, assume that they have stepped through the looking glass.

These aren’t, of course, logistical innovations that stand alone. A low minimum age at rollout can only really work where the initial supply is suitably large, and a policy of no wastage is only conceivable in a system of fully integrated and readily accessible digital records. In Israel, a leftover dose could be given to someone who happened by a vaccination facility because the nurse was able to swipe that person’s magnetic medical card and see that they have no allergies, no contraindications for the vaccine, no positive tests for the virus — and the person would leave with the appointment for the second dose already booked in the system.

It’s also worth noting that, in retrospect, Israel’s decision to push hard in the first three weeks was also a huge gamble. Indeed, it might have been more prudent in the first weeks of the vaccine rollout to ensure that they went only to those most acutely in need — those over 80, overweight, and over in assisted living facilities. No one knew for sure there would be a steady supply after the first batch.

But, as it turned out, it was the momentum of those initial three weeks and the reliable data it provided that convinced Pfizer and others that a steady airlift to Israel was worth their while. Before this was settled, it seemed that Israel might even have to pause first doses after the third week doses until further shipments could be secured.

As it turned out, talk of a vaccine shortage spurred even more people to show up, as citizens began to worry that they might end up waiting until late February or March to be eligible again. “I swear we didn’t plan it that way,” an official from the Ministry of Health who worked on a number of the vaccination PR campaigns told me. “But the truth is, it did more to sustain momentum and interest than any of the influencers we contracted.”

The question for Israel now is whether it can complete the task. Pandemic fatigue has set in, and the most recent lockdown has already been lifted despite the infection rate remaining far higher than it was when either of the previous two lockdowns were ended. And while Israel’s dense population and efficient public health system have proved invaluable, some of its demographic problems will be challenging to surmount. Vaccination rates are still lower in the Arab and ultra-Orthodox communities, precisely the places where infection rates are higher.

An even bigger challenge is Israel’s young population. Even if all Israeli adults were vaccinated, that would only amount to about 70% of the population, far below what experts estimate is necessary for herd immunity. By summer it is believed that a vaccine will be approved for those aged 12 and up, but the incentive structure for vaccinations will be flipped.

It is easy to persuade vulnerable 80-year-olds to sign up for a vaccine for a disease that might kill them. Whether parents of teenagers will be similarly inclined for an injection that, while absolutely necessary for society at large, only protects their child from what is likely a minor illness, remains to be seen. Meanwhile, for the rest of the world, such a dilemma is yet another cause for envy.