A Gallup poll last week found that only 54% of American adults drank alcohol in 2025. Drinking among Republicans is in a rapid collapse, with only 46% of Republicans reporting that they drank in 2025, down from 65% two years ago. (Democrats, by contrast, are drinking only slightly less than before, 61% this year, down from 64% in 2023.) The phenomenon seems to be, at least in part, mimetic: President Trump doesn’t drink. RFK Jr. abstains. Charlie Kirk preaches sobriety. Tucker Carlson is sober.

This might seem like a winning issue for the Right — and one that unites the Trump coalition, since the tech libertarians who now finance the party don’t drink, either — but anyone who cares about human conviviality should be skeptical. 

Republican teetotaling is part of a general decline in having fun; partying — drinking, sex, going out — has slumped since the pandemic (during which public authorities told Americans that physical alienation from each other is a responsible social pattern). It turns out that when you lock up members of an already atomized, lonely society, people don’t easily recover the sociality that Aristotle taught is one of the fundamental characteristics of the human animal. Restless un-leisure — doom-scroolling, scrambled attention spans, ordering in — has gradually become more normal than being together. 

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Across the board, alcohol consumption is declining — men, women, white, nonwhite, rich, poor. Biohackers like Bryan Johnson or self-optimizing influencers like Andrew Huberman believe no level of alcohol is safe. Sobriety or “California sober” — no alcohol, but plenty of cannabis — is another emerging trend and is increasingly normal among Gen Z and millennials, who prefer stimulants, nootropics and nicotine. GLP-1 drugs like Ozempic are also reducing consumption in general, drinking included.

Against the backdrop of a broad decline in social trust and socializing, the general decline in alcohol consumption becomes relevant — and the more specific decline in drinking among Republicans is especially ominous. 

To some extent, the embrace of sobriety on the Right is a reversal, since lately it’s been progressives who are anti-pleasure. But in the longer historical perspective, it’s a return to form. Over the last 150 years, temperance has been a consistently Republican virtue. The reputation for drinking and “fun” belonged to Democrats. 

It was the Republicans who were the “drys” during Prohibition, casting themselves as the party of sobriety, order, and Protestant reform, while Democrats were associated with saloons, ethnic political machines, and speakeasies. The old Republican rallying cry “Rum, Romanism, and Rebellion” — caricaturing Democrats as the party of booze, Catholic immigrants, and Confederate nostalgia — was first uttered by a Protestant minister during the 1884 presidential campaign. 

Excess drinking and alcoholism are deadly, to be sure, and some people should never drink. For many others, not drinking is super fucking lame; moderate drinking is fundamental feature of a good life. Certainly, that’s been the position of Western civilization both before and after the advent of Christianity. “Mix stronger wine,” Achilles commands in Homer’s Iliad, “a cup for the hands of each guest — / Here beneath my roof are the men I love the most.” Wine is used for cooking, at meals and during religious rituals in the poem. The guests in the Platonic dialog The Symposium negotiate how much they’ll drink at the beginning of the evening — and then go on to imbibe more than planned, joking about their drunkenness and referring to each other as “o my companions in drink.” 

Christianity, of course, incorporates wine in the central mystery of the Eucharist, though sometimes some of the more dour denominations have substituted grape juice. Medieval paintings by Pieter Bruegel the Elder portray village life as scenes of rowdy and joyous drunken revelry, and the still life tradition in the 1800s showed tables laden with glasses, bottles and carafes. Private drinking parties made life tolerable, for me personally, during the pandemic; good dive bars are part of what justify the price of rent in New York City — or any other big city.

Anything that unites — even accidentally — the neuroticism of tech optimizers, progressive scolds, and rightoid incels is probably bad. Americans need convivial practices like drinking with friends. The decline of drinking is a decline in spending time with other people, learning about them, and knowing them. Temperance promotes isolation and alienation.

Politically, the neo-temperance movement also threatens the plurality and energy of the Trump coalition. Part of Trump’s appeal was his basically liberal attitude toward the good life (he doesn’t drink, but doesn’t proselytize about it, either). The better aspects of Trump-era populism implied solidarity, community, revelry, and a good time, and stood against the dominant qualities of the Left: moral superiority, hyper-rationalism, fear of the body, fear of spontaneous community, fear of mixing it up, fear of confession, fear of the local, the street, the bar, the friend. Drinking promotes a neighborliness and bonding essential to a conservative view of the polis.

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Republican neo-temperance, moreover, not only smacks of a 19th-century purity and social stiffness, but a 20th-century clubbiness and suburban rejection of blue-collar values of the union hall or the bar — and even of the emotions that emerge from working class people in the tempo of drinking. Temperance culture is repressive.

Similarly, a Calvinist-in-spirit shunning of imbibing and inebriation — the spurning of the social and even moral uses of alcohol — is suggestive of a larger rejection of courtship, reproduction, and communal behaviors. There’s something about energy drinks and Zyn that seems suited for staring at a screen, for locking in to a kind of isolated work practice, but not conducive to talking, flirting, boasting, taking pleasure in free-spirited afterwork hours.

The Trump coalition will endure if it stays chill. An abstemious, Puritan attitude threatens the gains of the post-pandemic counterrevolution against progressivism and Bidenism, against the antisocial, judgmental, unpragmatic, and anti-communal behaviors of late progressive culture. Neurotic liberals have already driven less-neurotic liberals out of the Democratic Party; Republicans should remember that those voters can move the other way.

Moreover, temperance is, whenever enacted, unpopular and a losing position. Sermonizing conservative Protestant neuroticism about drinking resembles sermonizing liberal post-Protestant neuroticism about everything else. If conservatives embrace and accelerate accidental temperance, they risk creating a mirror image of the progressive Left: afraid of doing things, afraid of the world, afraid of irrationality.

In the 2020s, a good rule of politics, policy, and culture might be: normal is good. Most of what people were doing 40 or 50 years ago was better than the antisocial mores of today. Social drinking is a traditional good that conservatives ought to be conserve.

The answer, it seems, lies in a shift in the global HIV response, one that the United Nations hopes will finally “end Aids by 2030”. To push HIV out of the “crisis” stage, in which it has been stuck for decades, and shrink the rate of new infections, health practitioners want a massive roll-out of the preventative medications that are no longer protected by drug company patents or exclusivities. And they want to target that specific sub-population that is disproportionately affected by HIV: transwomen who have sex with men.

In parts of the world, trans prostitutes are up to 80 times more likely than anyone else to be HIV-positive. It is estimated, for example, that in Brazil, as many as a third of travestis — male prostitutes with a female identity — are HIV-positive. Elsewhere, hijra, kathoeys and waria — names used in different cultures for males who adopt female names, clothing, hairstyles and pronouns — are a significant concern for health officials, since they are tricky to monitor and tend to have risky sex with men who often have a female partner at home.

To encourage these at-risk individuals to take part in HIV testing and treatment programmes, global health experts want to offer them a form of integrated care, which could include hormones, reassignment surgery referrals, and other “affirming” services alongside PrEP. As a study in The Journal of the International Aids Society made clear as far back as 2016: in scaling up PrEP for trans women, it is essential to engage trans communities, utilise trans-inclusive research and marketing strategies and identify and/or train healthcare providers to provide gender-affirming healthcare to trans women.”

In India, for instance, a recent white paper detailed a scheme to incentivise hijra and “transgender persons” to take part in HIV screening that involves a comprehensive package of services including gender-affirming care. In Thailand, one programme found that kathoeys were more likely to show up to clinics if they were staffed by transwomen — inspiring trials of similar initiatives in the Philippines, Myanmar and Nepal. It is a strategy that has been adopted in the developed West, too, albeit one that lacks transparency. In 2021, the US Department of Health and Human Services ordered HIV clinics to start offering “gender-affirming care” — a move celebrated in March this year, when the White House made clear that the federal government’s strategy “to end the HIV epidemic” included providing “access to gender affirming care and treatment services to transgender and gender diverse individuals with HIV”.

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It is not unusual for health authorities to group services together, or incentivise individuals to make healthy choices. But we have known for at least two decades that transwomen are inordinately at risk of being exposed to HIV. As long ago as 2009, doctors in community clinics in California reported that the availability of hormones and other affirming care would make trans patients more likely to show up to clinics for prevention.

The shift in attention may be down to the fact that, in recent years, with lesbian and gay equality effectively secured in much of the West, LGBT organisations have started to champion transgender causes. But it may also be down to the fact that, in some countries, HIV transmission is beginning to occur at a faster rate among heterosexuals than gay and bisexual men. And this is perhaps in part due to a subsection of heterosexuals, who have transwomen as partners.

Gynandromorphophilia was first coined in 1984 to describe the sexual preferences of ostensibly heterosexual men who are also attracted to males with exaggerated female features, such as big breasts, hips and lips. Gynandromorphophilic males (or Gamps for short) play a role in the transmission of HIV to the general population because their sexual relations with these often high-risk men put their own female partners at risk, which can also result in the virus being passed to unborn babies. We know, too, that heterosexuals tend to be diagnosed late, once their immune system has already been compromised. This also applies to their female partners, who might never suspect that they have been exposed.

In 1995, when Belgian virologist Peter Piot was entrusted with leading the global Aids response at UNAids, it didn’t take him long to realise that stigma relating to sex was the real barrier to ending the epidemic. Shaming “people with diverse sexuality”, Piot said, forces them into the shadows and keeps the virus in circulation.

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In an effort to address the estimated 4,500 undiagnosed HIV cases in the UK and halt the virus, the NHS now recommends that certain at-risk groups “may benefit” from taking the now widely and freely available PrEP medication. These at-risk groups include “trans or non-binary person [who] are regularly having condomless sex”. And with this group, “gender-affirming” incentives will increasingly be a part of that medicalising strategy.

While there is an urgent and noble objective here — the eradication of HIV — my worry is that it is taking place without any serious public debate about the consequences. With so much still unknown about the effects of transitioning, gender-affirming therapy is being made more accessible. And at what cost? Only when the HIV epidemic finally ends, will it become clear how subtly it has reshaped the world it’s left behind.

The Gambia announced its first Covid lockdown, in March 2020, at a fragile moment. Following years of President Yahya Jammeh’s dictatorship, the democratic government installed under President Adama Barrow in 2017 had ushered in hope. There was, for instance, a noticeable drop in Gambian youth’s attempts to cross the Sahara and the Mediterranean to reach Europe. Yet the country’s pandemic response has erased those gains, and also dealt a severe blow to Gambians’ confidence in its young democracy.

The timing of The Gambia’s lockdown could not have been worse. In March 2020, as many African countries shut down in accordance with WHO advice, The Gambia’s main market at Serekunda closed for six weeks. Late March is when Gambians buy seeds to prepare for planting, in readiness for the rains. The unilateral closure of markets meant that seeds were widely unavailable. A transport shutdown meant that even where they did have seeds, people could not take them to their villages for planting. Even when public transport restarted, several weeks later, social distancing requirements meant that buses were only allowed to operate at half capacity. As this was uneconomic, many buses did not run at all.

Anyone who did manage to sow crops then had difficulties in harvesting, since social distancing protocols meant that no more than two people could work a plot at one time. When food was finally taken to market, the forced impoverishment of the population meant that few could afford to buy it and much went to waste: the UN estimated on-farm losses of 50% in Africa in 2020.

The aggregated effect of The Gambia’s Covid response was a massive reduction in farming revenue and in available food. In effect, these were policies guaranteed to cause hunger and malnutrition — and to stoke food price inflation through the destruction of stores and harvests. Food inflation quickly grew in 2021 and remains in double digits, much higher than pre-pandemic levels.

At the same time, and as in the rest of the world, the Gambian government threw money at Covid-19. Donor advice on hygiene saw all public institutions forced to buy large plastic vats and gallons of hand wash and disinfectant. This, and the costs of implementing Western biomedical surveillance regimes, was paid for by taking on new debts: the Gambian government implemented a 500 million dalasi (US$10 million) emergency response fund — a vast sum for a country with a per-capita GDP of US$772. This was financed by a World Bank loan of the same value, and by an IMF loan of US$21.3 million.

Meanwhile, Gambian tax revenues fell by half in 2020, owing to the economic cataclysm, meaning that debt repayments stacked up even higher. This is money that The Gambia does not have. It was frequently said that “we could have fed the country for 10 years for the amount of money that we spent on Covid-19”. The Gambia is beset by poverty and malnutrition. Structurally indebted to Western creditors, with a median age below 18, and where a teacher’s monthly salary is under £50, the spending of these sums to implement Western protocols for a disease quickly known to affect mostly the elderly and obese is scandalous.

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Gambians themselves protested vociferously. Some tried to break into Serekunda market to continue working, and others — when a mask was demanded — asked who would pay for it. But the question remains: why did Gambian politicians implement these policies? In fact, creditor pressure from the EU and other Western embassies, from the World Bank and the WHO, made it almost impossible to do anything else.

Still today, billboards line the country with EU funding logos, indicating the “correct” way to wear masks. This offers a flashback to the bombardment which Gambian officials received from Western agencies on handling Covid-19. Weekly flurries of information arrived with instructions on “appropriate” behaviour. Weekly “situation reports” were demanded from the Gambian Ministry of Health by these partners: these reports had to indicate the effectiveness of the Covid protocols, and case numbers. This information was a prerequisite for further access to the finance so essential in the economic meltdown.

The Covid vaccine rollout made this dynamic even clearer. When by late 2021, vaccination numbers remained low, the UK High Commission warned Gambian counterparts that tourists would not return until all those in the tourist industry were vaccinated. Indeed, the UK only removed The Gambia from the red-list of countries once the vaccine rollout had “decreased risk to British nationals”. In the end, public officials were virtually forced into vaccination. Most of these vaccines were not gifted to the country, but paid for through World Bank loans which increased structural indebtedness.

The consequences have been vast. The impact on Gambian young women has been especially severe. The closure of schools in the pandemic made schoolgirls vulnerable to being sent away for marriage by parents desperate to earn some dowry money to assuage the pain of the pandemic restrictions. One expert in the field described how early marriage had become common in The Gambia during the pandemic.

Secondly, there has been a huge increase in Gambian youths seeking to migrate to Europe illegally. The restrictions shattered the Gambian economy. Hotels, which employ more than 50,000 Gambians, were closed. The youths lost their jobs and many of them were forced into the dangerous ‘backway’ journey to Europe. Indeed, the fledgling democratic government’s noticeable achievements in youth job creation were all but wiped out by the pandemic, and the 2022-23 season tourism was still only at 30% of pre-pandemic levels.

Another harm came in the primary health sector. The pandemic and the endless Western agency briefings as to the requirements on vaccination, social distancing and masking meant that frail health facilities were completely rewired to focus on Covid-19 patients. This meant that as malaria, fevers and digestive diseases took their usual toll on the population, no one did much. The medical personnel, drugs, ambulances and facilities were all dedicated to fighting the pandemic in accordance with the demands of Western embassies and NGOs. This made maternity, child health and outpatient services suffer disruptions which were, in many cases, fatal. There was also a severe disruption in the Meningitis A, Tetanus, and Hepatitis children immunisation schedules, which still have not completely recovered.

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Given the devastating impacts of the pandemic response on the general population, Covid vaccine hesitancy is strong. A recent survey suggested that close to 70% of Gambian adults surveyed trusted “prayers” more than the vaccines. Many accuse healthcare officials of diagnosing simple cases of malaria as Covid-19. Popular distrust extended to the Government’s efforts to alleviate the food scarcity caused by the restrictions. A series of corruption scandals have broken pointing to the embezzlement of Covid-19 relief funds, while key suppliers contracted by the World Food Programme over two years failed to deliver the required 8,550 tons of rice intended as relief for needy families.

All of this could take decades to fix. Austerity has been forced on the country by external creditors and their incessant demands for information and compliance to protocols that, to most Gambians, were useless — and where Covid-19 was far from the greatest health threat they faced. As elsewhere around the world, vast levels of corruption were involved with the effective printing of money that went with the Covid response. Meanwhile, international solidarity collapsed, as Western activists appeared far more concerned by the political landscape in their own countries than by the effect of these policies on African lives — about which many remain reticent to this day.

What policymakers do not appear to have grasped are the consequences that all this will have. For all multi-billionaire philanthropist Bill Gates’s plans, and the current US government’s ideas about future pandemic preparedness and mass vaccine manufacturing in Africa, it is clear that no citizen of that continent will be prepared to trust future lockdowns, social distancing measures or mandatory vaccinations. While policymakers opine and “official narratives” are constructed, the experience in The Gambia, and across Africa as a whole, will ensure its response to the next pandemic will be nothing of the kind.

* Co-contributor Hassoum Ceesay is writing in a personal capacity

Though the intention of campaigns is often to inform, persuade or convey particular values of those behind them, their most powerful function can in fact be to shape the expectations we have of each other. Since spotting the staring poster, I’ve come across a raft of messages on the transport network warning against upskirting, revealing intimate body parts, touching, cyber flashing and catcalling. This messaging ignores a wealth of evidence suggesting it risks not only failing but having a counterproductive effect. There are benefits to surfacing underreported crimes (which sexual harassment tends to be), such as reducing a feeling of isolation in victims. But there are risks too. Simply making a noise about something is not the same thing as understanding it, let alone fixing it.

Take the case of Drinkaware, which in 2012 launched a multi-year, multimillion-pound responsible drinking campaign (Why Let Good Times Go Bad?) designed to reduce binge drinking by warning of its consequences and giving tips on how to drink responsibly. Despite initially seeming to resonate with its target audience, when robustly evaluated the campaign was found to have likely increased alcohol consumption. To their credit, Drinkaware terminated the campaign a year early.

Why did this happen? Most of the time, we do not actively think about the multitude of messages that dominate our daily environments. But they do leave an impression on us. And this impression is often different to the one we get when actively engaging with their messages: when not executed carefully, campaigns highlighting a problem can make that problem seem more common than we previously thought it to be: they have a normalising effect. This affects behaviour, but in precisely the wrong way. For example, those inclined to sexually harass another passenger may give themselves more licence to do so if they get the impression that plenty of other people do it too, especially where the chance of being caught is perceived to be slim. Research from Princeton identified a similar risk in publicity campaigns to prevent sexual violence.

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Preventing bad behaviour is generally harder than promoting good behaviour and there are plenty of examples where well-intentioned policies have backfired. Warning campaigns can increase fear and anxiety about being victimised. Mandatory sexual harassment training can make those inclined to sexually harass more accepting of such behaviour. The Scared Straight programme, for instance, an intervention that took young offenders into a prison to deter them from future offending by showing them the potential consequences of their actions, turned out to increase offending. The reason for this, though subject to a degree of speculation, is that the experience encouraged the participants to think of themselves as career offenders: it increased their sense of criminal identity.

But all is not lost. There is sufficient evidence from high quality research to make better programmes and effective campaigns, but there needs to be the right incentives for decision-makers to understand what constitutes accurate evidence, and to pay attention to it. This means focussing on the effects that campaigns have on their audience, rather than what they might say about the organisations behind them.

In the corporate world, there is a growing convention for companies to demonstrate their principles by highlighting their opposition to social ills. When companies are perceived to be sincerely committed to doing good, they can benefit from improved employee engagement and reputation. For companies selling directly to consumers, it may be an effective way of encouraging us to part with our money: there is evidence to suggest that we are more accepting of materialistic values after we believe we have made a virtuous choice.

And these companies are often well-placed to address social challenges, by minimising the negative externalities associated with producing and selling their goods, adapting the design of what they sell, or by using the influence they have with consumers to affect behaviour. The latter is more likely to seem legitimate when the behaviour is directly relevant to the interaction they already have with the consumer. For example, though large supermarkets must accept much responsibility for food waste, Tesco’s campaign to encourage families to habitualise picking  a weekly “Use Up Day” is well thought through and likely to have a positive impact.

What is worrying, however, is the tendency of organisations merely to spotlight a broadly defined social ill in order to demonstrate their opposition to it. If to define who we are, we must generate outrage about who we’re not, we will end up creating bigger problems than we had to begin with. Some may find it ironic that many organisations have calculated that portraying their social credentials brings them competitive advantage. But if in doing so they also make the problem worse, irony may turn to ridicule.

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Fretting about collective threats and amplifying moral panics is not new by any means, though it has traditionally been the domain of divisive politicians. Why has it gained broader appeal? The answer is partly to do with a lack of accountability, which in turn is to do with outdated ways to assess the impact of communication in the real world. But it’s also to do with incentives. In the modern attention economy, campaigns that generate engagement — clicks and articles — are highly valued (even when the link between engagement and tangible or commercial outcomes is unclear).

There is evidence in psychology that negative stories and experiences are more powerful at capturing our attention than positive ones, which is an attractive proposition for those trying to keep our eyes on screens or conjuring ‘likes’ from people searching for ways to attach themselves to a cause. This is most obviously seen in the content of news media, where it can cause its greatest damage.

Returning to the theme of crime, in recent years almost every news outlet in the UK has been talking about the “violence epidemic” sweeping across the country, particularly focussing on knife crime. It is always shocking when a life is lost to violence, but both the level and tone of this reporting seems overstated and ignores important context. Overall patterns of violence have been on a sustained downward trajectory for over 20 years. Police recorded crime shows small increases since the middle of the last decade from an all-time low. But this is partly explained by changes to police practices for recording crime and changes in the definition of violent crime (such as the inclusion of death by dangerous driving). Oxford University’s Dr David Humphreys and colleagues analysed hospital data for injuries relating to violence, a reliable and consistent data source, and clearly show the incongruity of the problem to the way it has been presented:

In addition to the overall prevalence of knife violence being overblown by media reporting, the risk of victimisation is highly localised, with just 1% of London neighbourhoods accounting for 69% of all knife homicides. So public perception is being skewed — the media is making us all frightened, and this has its own consequences. Being scared of knife crime (and any risk of violence) is likely to undermine “collective efficacy” — when high levels of trust and cooperation among residents in a neighbourhood lead to achieving collective benefits, such as lower rates of crime and antisocial behaviour, particularly in poorer communities. It is also likely to encourage imitation crimes and have an effect on people carrying weapons — an important predictor of knife violence. This is made worse by the police’s insistence on sharing images of knives seized, which for many years has been suspected to be counterproductive. Meanwhile, measures that might prevent violence — such as restorative justice, one of the most well-evidenced and cost-effective tools for addressing serious violence — are underutilised.

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The commercial incentives driving news broadcasters to keep our attention with sensationalised content are harming our communities for commercial gain. But in addition to commercial incentives, I wonder if there isn’t a deeper issue at play too: uninspiring politics. When leaders can’t see and articulate a compelling and uniting future, they fixate on who’s to blame for what’s wrong with the present. This is true across the political spectrum, and it has a trickledown effect on the rest of society.

Shouting about problems, priming mistrust and offering people the ecstasy of sanctimony is not leadership. Leadership is providing a vision, working hard to understand what it takes to get there, and being accountable for your role on that journey. I hope those politicians, public bodies and companies who can do that will be heard through the noise.

Last week, Politico reported that the US Food and Drug Administration might wait until this summer to consider authorising a vaccine for children under five years old. Only a few days earlier, a judge had struck down the nationwide mask mandate on airplanes, prompting angry reactions from some who claimed that the ruling would result in dead children. Some parents have loudly proclaimed that they will continue to shield their kids from social interactions until a vaccine is available. And in New York City, children aged between two and four are still required to mask in schools because they are too young to be vaccinated.

As Covid restrictions and mandates have been dropped across the America and the Western world, unvaccinated kids have become a rallying cause for Americans unable or unwilling to leave the pandemic behind. But the truth is that children under five don’t need to wear masks and don’t need to have their lives put on hold pending vaccination. Hysteria about the risk to them is not just unhelpful but harmful. It deprives them of a normal childhood without any countervailing justification.

A decision on vaccines for young children is probably a few months away, given that U.S. public health authorities want to consider the Pfizer and Moderna vaccine data together. While some parents are understandably angry and frustrated with delay, the FDA is right to be cautious here. Young children are at low risk from the virus and the benefits of vaccinating them are uncertain. Even if the vaccines are approved, it is not clear that they will make a big enough difference to justify placing restrictions on children in the interim.

First, consider that the FDA has not tasked the vaccine makers with proving that their vaccine lowers rates of hospitalisation in kids. Nor do they have to show that the vaccines reduce MIS-C (an inflammatory condition that may arise after infection) or even rates of Covid infection. Rather, the FDA has asked Pfizer and Moderna to prove that their vaccines, at the dose given to kids, generate levels of antibodies that are comparable (or “non-inferior”) to levels of antibodies generated among older, fully vaccinated people. This is a low benchmark, and means that, in practice, the trials being run to clear it are very small. Indeed, they may be too small to detect reliable signals for the most important benefit — reduction in severe Covid — and for harms.

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Yet so far, Pfizer has failed to clear even this very low bar. Two doses of three micrograms of the Pfizer vaccine (1/10th the adult dose) fell short in December of 2020, to the disappointment of many. The FDA allowed the company to take another shot at it, literally, by adding a third dose. In late January of this year, there was buzz that the FDA would take the unprecedented step of authorising the vaccine despite the failed trial because it looked like it might reduce infections, but just a week later, Pfizer announced they would wait for the results of the 3rd dose before seeking approval. The flip-flop generated national news and outrage from some parents and doctors.

Then, on March 23, 2022, Moderna announced that its children’s vaccine — two doses of 25 micrograms, or 1/4 the adult dose — did generate sufficient antibody levels, again raising hopes that FDA approval would be forthcoming. But only limited results have been released so far. We don’t know the full spectrum of adverse effects, nor the impact on the outcomes we really care about: cases, severe disease, hospitalisations, MISC-C, and deaths. These outcomes are especially important for conducting a cost-benefit analysis for Moderna, which has clearly been linked to higher rates of myocarditis in young men than has the Pfizer vaccine.

As the clinical trials have dragged on, moreover, the landscape of kids and Covid has changed. Children have always been at relatively low risk, but newer variants appear to be even less risky for them. A recent preprint from the UK suggests that children infected with Omicron were less likely to be hospitalised with severe disease than children infected with the alpha or delta variants. We have also learned that MIS-C is less common often with the newer variants. Delta was less likely to trigger the condition than alpha, and CDC data suggests that omicron was less likely to trigger it than delta.

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More generally, it makes no sense to be overly cautious about low-risk children at a time when the United States is dropping most restrictions for adults. The risk to an unvaccinated healthy child under five is often lower than the risk to their vaccinated or even boosted parent. Natural immunity is also powerful and prevalent. It protects strongly against reinfection and even hospitalisation after reinfection. Not that the data here is from adults — naturally immune children are so rarely hospitalised that it is difficult to conduct studies on them.

Most kids have already had Covid, even if they and their parents don’t know it. Prior to the omicron wave, up to half of American children had been infected, and the virologist Trevor Bedford estimates that omicron might have since infected 40% of Americans. Although there is surely some overlap between the two numbers, most kids have probably already had Covid at least once, and it would be difficult for a vaccine to offer them any significant further protection. Finally, we have learned that vaccination has rapidly waning protection against symptomatic infection. Some studies report that vaccine effectiveness in those aged 5-11 for symptomatic Covid is less than 20%.

If you put all this together, the story becomes clear. The vaccine trials have been inconclusive. Most children have had Covid already, and the ability for a vaccine to further improve their health is limited. Finally, they are at extremely low risk to begin with. Parents may encourage their offspring to get vaccinated if and when vaccines become available, but they should not be consumed with fear pending FDA approval. Nor should they prevent their children from living a normal life.

For those who preferred the first perspective, there was plenty of data to lean on. Meticulous records of the death toll were being kept in most countries, especially the wealthy ones, and presented in stylish graphs on various sites: the Johns Hopkins University website, Worldometer, Our World in Data.

It was a lot harder to measure the consequences of the lockdowns. They appeared here and there as scattered anecdotes and figures. Perhaps the most striking data point came from the US: by the end of the academic year, a total of 55.1 million students had been affected by school closures.

But still, the death toll was more interesting. In early summer, The New York Times had published a front page completely devoid of pictures. Instead, it contained a long list of people who had died: a thousand names, followed by their age, location, and a very brief description. “Alan Lund, 81, Washington, conductor with ‘the most amazing ear'”; “Harvey Bayard, 88, New York, grew up directly across the street from the old Yankee Stadium”. And so on.

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It was The New York Times’s national editor who had noticed that the US death toll was about to pass 100,000, and so wanted to create something memorable — something you could look back on in 100 years to understand what society was going through. The front page was reminiscent of what a newspaper might look like during a bloody war. It brought to mind the way American TV stations had reported the names of fallen soldiers at the end of every day during the Vietnam War.

The idea spread quickly across the world. A few weeks later, in Sweden, the front page of Dagens Nyheter was covered with 49 colour photographs below the words: “One Day, 118 Lives.” Those 118 people had passed away on 15 April. It was the highest daily death toll recorded throughout the Spring. Since then, it had steadily been falling.

When the epidemiologist Johan Giesecke read the paper, it left him a little puzzled. On any normal day, 275 people die in Sweden, he thought. He’d spent a large part of his life studying just that: where, when, and how people die. The way the world currently thought about death was, to him, completely alien. When he’d taken part in an online conference in Johannesburg, one participant had pointed out that, in that year alone, more than 2 million people had died of hunger in the world. During the same period, Covid-19 had claimed between 200,000 and 300,000 lives.

Giesecke felt as though the world was going through a self-inflicted global disaster. If things had simply been left to run their course, it would have been over by now. Instead, millions of children were being deprived of their education. In some countries, they weren’t even allowed to go to playgrounds. From Spain came stories of parents sneaking down into parking garages with their children to let them run around.

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Were masks a waste of time?

By Geoff Shullenberger

Tens of thousands of surgeries had been postponed by healthcare services. Screenings for everything from cervical to prostate cancer were put on ice. This wasn’t just happening in other countries. Sweden had seen its fair share of peculiar decisions, too. The Swedish police hadn’t tested drivers for insobriety for months, out of fear of the virus. This year, it didn’t seem quite as serious if someone were to get killed by a drunk driver.

It was becoming obvious that the media, the politicians, and the public had a hard time assessing the risks of the new virus. To most people, the figures didn’t mean anything. But they saw the healthcare services getting overwhelmed in several countries. They heard the testimonies from nurses and doctors.

Here and there in the world — in Germany, the UK, Ecuador — people had been taking to the streets to protest the rules, laws, and decrees curtailing their lives. From other countries came reports that people were starting to flout the restrictions. But the force of the resistance remained weaker than Giesecke had expected. There had been no French revolution, no global backlash.

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The Covid regime has fooled us all

By Jacob Siegel

One explanation for the citizens’ passivity might have been the coverage of the deadliness of the virus in the media; it seemed they had been fed a non-contextualised picture of how serious the Covid-19 pandemic really was. During the Spring and Summer, the global consultancy firm Kekst CNC had asked people in five big democracies — the UK, Germany, France, the US, and Japan — about all kinds of things relating to the virus and society. The sixth country in the survey was Sweden. Sweden was a lot smaller than the other countries, but was included due to the unique path it was taking through the pandemic.

The questions were about everything, ranging from people’s opinions on actions taken by the authorities, to the state of the job market, and on whether they thought their governments were providing sufficient support to trade and industry. The twelfth and final topic in the survey contained two questions: “How many people in your country have had the coronavirus? How many people in your country have died?” At the same time as increasingly reliable figures were trickling in with regard to the actual deadliness of Covid-19, there was now a study of the number that people believed had died.

In the US, the average guess in mid-July was that 9% of the population had died. If that had been true, it would have corresponded to almost 30 million Americans deaths. The death toll was thus overestimated by 22,500% — or 225 times over. In the UK as well as in France and Sweden, the death toll was exaggerated a hundredfold. The Swedish guess of 6% would have corresponded to 600,000 deaths in the country. By then, the official death toll was more than 5,000 and inching closer to 6,000.

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Why Hong Kong can't escape Covid

By Philip Cowley

Reporting the average guess was perhaps a little misrepresentative, as some people replied with very high numbers. In the UK, the most common answer was that around 1% of the population had died — in other words, a lot less than the 7% average. But it was still a figure that overestimated the number of deaths more than tenfold. At this point, 44,000 Brits had been registered dead — or around 0.07% of the population.

The breakdown of the numbers further showed that more than a third of the Brits responded with a figure of over 5% of the population. This would have been like the whole population of Wales dropping dead. It would have meant many times more Brits dying of Covid-19 than during the entire Second World War — civilian and military casualties included.

The war rhetoric brandished by the leaders of the world had had an impact. Their citizens really did believe they were living through a war. Then, two years into the pandemic, the war ended. There were no longer any foreign journalists at the Swedish Public Health Agency’s press conferences. No Americans, Brits, Germans, or Danes asked why schools were staying open, or why the country hadn’t gone into lockdown.

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Should we let children catch Omicron?

By Allison Krug

In large part, this was because the rest of the world had quietly begun to live with the new virus. Most of the world’s politicians had given up hope on both lockdowns and school closures. And yet, considering all those articles and TV segments that had been produced about Sweden’s foolishly libertarian attitude to the pandemic, considering the way some data sources had been referenced daily by the world’s media, this sudden lack of interest was strange.

For anyone still interested, the results were impossible to deny. By the end of 2021, 56 countries had registered more deaths per capita from Covid-19 than Sweden. With regard to the restrictions that the rest of the world had put so much faith in — school closures, lockdowns, face masks, mass testing — Sweden had more or less gone in the opposite direction. Yet its results were not noticeably different from those of other countries. It was beginning to become increasingly clear that the political measures that had been deployed against the virus were of limited value. But no one spoke about this.

From a human perspective, it was easy to understand why so many were reluctant to face the numbers from Sweden. For the inevitable conclusion must be that millions of people had been denied their freedom, and millions of children had had their education disrupted, all for nothing.

Who would want to be complicit in that?

The Herd is published by Scribe.

This policy divergence created an opportunity to examine the impact of mask mandates. Those areas that rescinded their mandates could function as control groups for evaluating the effect of the policy on cases and mortality. But neither public health experts nor any of the major media outlets took up this opportunity. The reason, most of them would likely have said if pressed on the subject, was there was nothing to learn: “the science” was settled.

For their part, critics of masking and other Non-Pharmaceutical Interventions (NPIs) typically relied on principled assertions of freedom. This gave them little reason to examine the evidentiary basis of these policies, since they would have rejected them on moral grounds even if they worked. Only a few sceptical observers drilled into the data that could be found on sites such as the New York Times — even if the paper’s own reporters made little of it. The most prolific of these was Ian Miller, who over the past two years has published copious data-driven commentary on the track record of various Covid public health interventions.

Miller arrives time and again at the same conclusion: that the ad hoc pandemic mitigation policies rolled out since 2020 have systematically failed to achieve goals. Miller has now compiled one subset of his graphs and commentaries into a book titled Unmasked: The Global Failure of Covid Mask Mandates which focuses solely on the most ubiquitous pandemic containment strategy deployed by governments worldwide: masks.

The endorsement of masking by medical bodies and public health authorities worldwide, Miller shows, entailed the abandonment of a longstanding view that masks were a useless and even harmful intervention. Over the previous decades, numerous randomised controlled trials had assessed the efficacy of masks in controlling the spread of respiratory viruses like influenza, and pandemic simulations had evaluated their potential.

A document published by the World Health Organisation in 2019 framed the results of these studies in no uncertain terms: “there was no evidence that face masks are effective in reducing transmission of laboratory-confirmed influenza”. It’s unsurprising, then, that when the CDC briefed reporters on the pandemic in February of 2020, masking was not even mentioned among the NPIs that might be deployed. The UK government, too, stated early in 2020 that there was no evidence to support masking.

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How vaccine mandates became a political weapon

By Geoff Shullenberger

After the CDC and other agencies revised their guidance in April 2020, Dr. Anthony Fauci, by then a staunch advocate of masks, claimed that he and other officials had discouraged the public from obtaining masks to ensure there were adequate supplies for health care workers. Ever since, promoters of masking have cited Fauci’s “noble lie” to account for the abrupt reversal of prior guidance. But as Miller notes, it was not just during the early months of the pandemic that officials said masks were ineffective. They had said so for years, and Fauci had advised against masks not just in public statements but in private emails in early 2020.

In light of the earlier consensus, Miller’s findings in Unmasked should not be surprising. As we might have predicted based on a plethora of trials and meta-analyses published prior to the pandemic, mask mandates have had little to no demonstrable impact on curbing the spread of the virus. Miller reaches this conclusion by comparing areas with mask mandates of longer and shorter duration with each other and with areas that never imposed mandates at all. The results, he shows, simply do not support the standard adage that “masks save lives”.

For example, Los Angeles County, the most populous county in the US, imposed one of the earliest mask mandates in the United States, just after the CDC released its new guidance in early April 2020. By May, the county was requiring masks outdoors as well as indoors and enjoying 96-97% compliance. (It also imposed an array of other strict mitigation measures.) But it had case and mortality rates well above the national average throughout 2020 and 2021. LA currently ranks 3rd among California counties in its Covid death rate, faring worse than numerous counties with mask mandates of shorter duration and lower levels of compliance.

It’s possible to quibble with Miller’s methodology. As he readily acknowledges, we don’t know precisely how LA and other heavily masked areas would have fared against Covid in the absence of mandates, and the fact that mask mandates have tended to be deployed alongside social distancing and other NPIs muddies the water. Miller’s comparisons of LA’s outcomes with those of neighbouring Orange County, which has had no mask mandate since last year but has had lower case and death rates, seem rather conclusive, but a sceptic might note confounding variables such as demographic differences, population density, and so on.

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By Malcolm Kyeyune

Such criticisms would be more damaging to Miller’s case if the officials and experts who have embraced mask mandates were more modest in their own assertions. Not only did they jettison years of prior research pointing to the minimal efficacy of masking, they also made empirically indefensible claims that masks alone could end the pandemic.

For instance, Miller compiles the astonishing claims made by Dr. Robert Redfield, who directed the CDC until just a year ago. In September 2020, Redfield described masks as “the most powerful public health tool we have”, claimed they offered “more Covid protection than vaccines would”, and stated: “If we [wore masks] for 6, 8, 10, 12 weeks, we’d bring this pandemic under control.” While they may not rule out some small effects of masking, Miller’s charts expose claims such as Redfield’s as delusional propaganda.

Likewise, those sceptical of what Miller’s comparative graphs can teach us should be even more suspicious of the shoddy studies published by the CDC over the past two years. For example, one study claimed to show a decline in Covid cases in certain Arizona counties as a result of mask mandates. But it failed to note that cases declined at a similar rate over the same period in Arizona counties without a mandate. In the months following the completion of the study, moreover, cases rose well above prior levels in counties with mandates still in place. Such studies produced a mirage of success by limiting the period of study, conflating correlation and causation, and avoiding comparisons with non-mandate counties.

The most disastrous failing of the experts has been their lack of curiosity about the actual results of the policies they have staked their reputations on. Mask mandates have been, in Miller’s phrase, “a population-wide experiment”, but few within the US scientific and medical establishment have seemed interested in parsing the resulting data, leaving that task to outsiders like Miller. Astonishingly, there have been just two randomised controlled trials on masking published since the pandemic began. One found no significant effect at all, while the other found a small effect of 11% for surgical masks and no significant effect for cloth ones. The first was largely ignored or dismissed, while the second was optimistically glossed as proving that masks work.

Moreover, even the most bullish case for the technical efficacy of at least some higher-quality masks does not constitute a case for mask mandates, a distinction that most commentary elides. The only way to measure the efficacy of mandates is to look at their actual track record. This is what Miller has done, and the result, he argues, is clear: “mask mandates have demonstrated very little impact, if any, on case curves throughout the United States and in many other international locations.”

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The Left-wing case against vaccine mandates

By Thomas Fazi and Toby Green

Miller is justifiably derisive about the experts who have oversold dubious policies at every turn, but the ironic implication of his book is that much of the expert guidance from prior to 2020 has been vindicated. Before Covid appeared, scientists and officials advised time and again that masks would be ineffective at containing a pandemic respiratory virus, and the evidence Miller has compiled suggests they were correct.

Two years into the pandemic, the experts are now the last to acknowledge the accuracy of their earlier predictions. This raises the question of why they changed course and sacrificed their own credibility in the process. Miller confines himself to the data, and if there’s a limitation to his book, it’s that he does not offer any compelling explanation of why the expert class threw itself a policy it once regarded as worse than useless.

It is not difficult to see why mask mandates proved irresistible to politicians. Masks are the perfect form of hygiene theatre, conveying an intuitive sense of safety regardless of demonstrable efficacy at scale. They also offload responsibility for controlling the pandemic to ordinary people. The overcrowding of ICUs can be blamed on the bad behavior of “anti-maskers”, rather than on the allocation of resources by governments and hospital CEOs. When cases and deaths spike, it is the fault of the citizenry, not the leadership.

The scientific and medical establishment’s uncritical support of masks and other dubious policies is just the latest manifestation of its lack of independence from political imperatives. After several years of finding themselves at the receiving end of rhetorical assaults from rising Right-wing populists, the experts seized on the pandemic as an opportunity to reassert their own status and authority — and that of the liberal-technocratic politicians with whom they are largely aligned.

In the long run, however, the temporary political advantages they gained from this will be outweighed by the discrediting effect of their embrace of censorship, propaganda, and rule by decree. Making us all put masks on was the expert class’s mask-off moment — and what we can see now isn’t pretty.

But in many of America’s deep-blue cities and suburbs, stringent Covid measures are still the norm, especially for schoolchildren. In New York City public schools, for instance, all students must wear masks at all times, including outdoors, except while eating or during designated “mask breaks”. Palo Alto, the hometown of Stanford University, makes kids wear mask outdoors at recess. And LA public schools, responding to new evidence about the uselessness of cloth masks, recently required children to wear surgical masks or N95/KN95s.

These measures are premised on the idea that America’s children must be shielded from exposure to Covid-19. What kids really need, however, is a return to normal. And when it comes to infectious disease, normality means a world where they are routinely exposed to, and overcome, viral illness. For children, getting sick and recovering is part of a natural and healthy life.

More from this author

We need to talk about the vaccines

By Vinay Prasad

It has become common to criticise restrictions for children on the grounds that they harm mental health and social development. These concerns are valid, but it is important to emphasise that a more laissez-faire approach to kids and Covid makes public health sense, too. Dropping masks, quarantines, distancing, and all other mitigations will allow children to develop the kind of broad immunity gained by living a normal life.

Shielding kids from exposure only increases their future risk. This is partly why the UK does not vaccinate against chickenpox. Serious complications from the disease are rare among children, and the circulating virus allows adults to be naturally boosted against reactivation-driven shingles. By rebuilding population immunity among the least at-risk, moreover, we help buffer risk for those most vulnerable.

With Covid, the nadir of risk is between 5–11 years old — an age where children develop more robust and durable immunity from infection than adults, even with asymptomatic silent infections.

Some parents may think this sounds like a call to put their children at risk of serious illness or death. But it is important to remember that exposure to Covid-19 is inevitable. Vaccines protect against severe disease and side-effects such as MIS-C, but they cannot stop breakthrough infections, and the rapidity of Omicron’s spread suggests that no matter what we do, we cannot avoid the virus. In January, Anthony Fauci admitted as much, saying that Omicron will eventually “find just about everybody”.

The epidemiologist and researcher Francois Balloux puts it this way:

https://twitter.com/BallouxFrancois/status/1486449517503389707?s=20

This idea is not as frightening as it may sound. We know that even unvaccinated children generally do well after Covid-19 infection. A study from Germany found that among healthy, unvaccinated children aged 5–11 who became infected with the disease, just 2 in 100,000 ended up in the ICU and none died (16 in 100,000 received ICU care later for MISC-C). Even children for whom vaccination is not yet an option are at lower risk now than they were last summer: the Omicron variant resulted in 66% fewer hospitalisations than Delta in a study of children younger than 5 years.

In some countries, this data informs policy. In Norway, for instance, parents of 5–11 year-olds can get vaccines for their children if they want them, but vaccines are only recommended for children with serious underlying conditions. This is not because vaccines are ineffective but because, according to the Norwegian Institute of Public Health, “the risk of a severe disease course at this age is small, and the need for vaccines for children and adolescents is limited”.

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By Kate Clanchy

For children who are vaccinated, however, exposure at the lowest-risk age — roughly between kindergarten and middle school — could also be the safest way for young people to develop superior “hybrid” immunity. Last week, the CDC released a large study demonstrating that natural immunity is superior to vaccinated immunity and that hybrid immunity is superior to both. Vaccination provided a 19.8-times reduction in hospitalisation risk, but prior infection provided a 55.3-times reduction and a combination of the two conferred a 57.5-times reduction. Other studies suggest that hybrid immunity confers better cross-variant protection than vaccines alone.

And so schoolchildren, already at the lowest possible risk for severe Covid-19, have now exited what should be their last winter of restrictions. Many have already recovered from infection or been vaccinated, meaning that their risk has dropped from low to miniscule.

“Normal” has been an option for adults — it’s time to allow children to resume normal life, not simply because their exclusion is unfair or hurts them socially and psychologically, but because it is immunologically in their best interest. Parents must consider that exposures are how we best protect our children against the variants of the future. In fact, it is reckless to let children age into a more serious encounter with a disease best dealt with while younger.

This view is shared by the authors of a May 2021 paper in The British Journal of Medicine, who wrote: “Once most adults are vaccinated, circulation of SARS-CoV-2 may in fact be desirable, as it is likely to lead to primary infection early in life when disease is mild, followed by booster re-exposures throughout adulthood… This would keep reinfections mild and immunity up to date.” In fact, Norwegian authorities believe that natural infection will better protect children than vaccines that rely on out-of-date variants of the virus.

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Scientific tyranny has captured America

By Jacob Howland

For parents worried that dropping restrictions will put their children at risk, the way forward is to realise that many of the protective measures we’ve been relying on, including masks — and especially the cloth masks that many American schoolchildren have been wearing for over a year — were never as protective as we’d thought, and are no match for omicron.

Some parents understandably fear the consequences of long Covid in kids, but the largest study to date is profoundly reassuring. Children who tested positive for Covid-19 were only 0.8% more likely to report long Covid symptoms, such as fatigue and muscle weakness, than those who had never tested positive. As the authors of the study concluded: “Long Covid in children is rare and mainly of short duration”.

Anxious parents should also put the risks in perspective. Children in many parts of Europe have been subject to less draconian restrictions than their US counterparts — without disastrous results. And while the death of any child is a tragedy, Covid-19 is less deadly to children than many other risks we accept as a matter of course, including drowning, vehicle accidents, and even cardiovascular disease.

Yes, diseases will continue to circulate, as they always have done. Schools are not sterile, nor should they be. Immunity is built through illness. If we can’t return our children to normalcy now, knowing what we know about the small risks facing children and the serious harms inflicted on them by pandemic-era restrictions, there is a real risk, at least in the more progressive parts of America, that the current arrangement will become the new normal. And that is a risk none of us should be willing to take.

Editor’s note: A previous version of this article misstated the findings of a study from Germany on hospitalisation risk among unvaccinated children age 5-11. The correct figure for ICU admissions is 2 in 100,000, not 8 in 100,000. We have also added the figure for MISC-C risk and linked to the paper, which can be found here. We apologise for the error.

“I don’t want you to come,” she told me on the telephone.

“But I’ve had coronavirus recently Daphne. I can help you.”

“Yes, but I don’t want you to see me like this. I want you to come when I’m back to normal. I’ve not told you what happened after I left 16th Searchlight Company.”

I am an oral historian. I turn old women’s stories into books and in the process sometimes I cross the professional line. It is hard not to during a pandemic working with 17 isolated veterans all of whom served in the female army (Auxiliary Territorial Service – ATS) during World War II. The youngest is 96. Our conversations are often the only meaningful communication they have from one day to the next. After pleasantries and a quick health check, I ask these women to channel their younger selves.

Returning to her restorative tonic — the war — puts the mettle back in Daphne’s voice. She is quick to remind me that she only accepts guests when her hair is fresh set and coloured (soft chestnut). “In the army they encouraged us to take care of ourselves, that was very important.”

But taking care of herself in this new ‘war’ has proved almost impossible: cut off, alone and now suffering with Long Covid, Daphne is miserable. “I’m doing my best to stay alive for you. I want to make it to the book launch, but sometimes I wish I wasn’t here.”

Army Girls is my third project involving the extreme elderly and the first written during a pandemic. My newest friends are society’s exceptional outliers, with all the research suggesting that reaching a great age takes much more than good genes. Longevity requires optimism, ambition, and multi-generational friendships. Try retaining just one of those criteria with no technology (is your great-granny on Zoom?) and no visitors, while facing down what might well be your last year on earth.

Between the first waves of Covid-19 I visited my oldest friend, Ann. She is 107, lives in a care home and is (more or less) ‘compos mentis.’ By her own admission things have slipped a bit recently. Being alone hasn’t helped. Ann was born before the start of World War I; she can still recall Union Jacks spread out in her Buckinghamshire garden on Armistice Day, 1918, flirting with communism in the Thirties and counting bacon in World War II, but she has never experienced anything like this pandemic. “I just have to accept it, what choice do I have?”

During last year’s visit, our conversation was monitored (a carer kept guard in the corner) and timed. Ann struggled to hear what I was saying, (masks are deafening when you’re old). She stared blankly at my obligatory disposable apron and muttered “it’s time they uninvented plastic.” Post-vaccine, the process of visiting remains cumbersome. For some it is a deterrent. I am shooed out of communal areas despite swathes of impersonal PPE and a negative test. Ann shrugs, “I am currently working hard on forgetting the last 18 months.” Dig deep and Ann is still there but Covid has diminished her. She’s become the personification of our reduced humanity. She can’t wait to get to the end.

Marino Plata, Ann’s care worker who is full of love and song, shakes his head. “It was too sudden; the lockdowns were too much with too little explanation.” Marino is one of the thousands of experienced health care workers who have noticed an accelerated decline in their elderly residents during successive lockdowns and restrictions. “Ann at least understood what was happening, others didn’t. They were confused and desperately missed their visitors and activities. They died sad.”

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By Timandra Harkness

Adam Gordon is a Professor of the Care of Older People and President Elect of the British Geriatrics Society. He saw Covid-19 wreak its worst. “At the beginning of the pandemic even for an experienced practitioner like me, I was affected; early on we weren’t sure how to treat patients with the virus. I still have flash backs, I’ll spare you the gruesome details.”

Adam reminds me that when coronavirus first came knocking, Britain was shamefully unprepared. Between 20,000 and 30,000 of our vulnerable elderly died unnecessarily and horribly. This nightmare scenario led to hastily revised practice: better PPE, strict lockdowns, no visitors. Britain could not keep climbing up the Covid-19 league of shame. And sure enough, fewer very old people have subsequently died. But has their last year of life been worth living?

Do not go gentle into that good night. The prophetic words of Dylan Thomas have proved almost impossible to live up in Covid times. Old age should burn and rave at close of day. Not a chance if you’ve been locked up in your care home (or your own home), with no visitors and, crucially, no voice on the public stage.

“There’s the tension” admits Professor Gordon, “the competition between protecting people from the virus and their other needs was underestimated. It is nuanced.” And modern debate doesn’t like nuance. I was blocked and shouted down on Twitter by several influencers for querying their calls to extend the lockdown last summer. Too many only see one side of the ‘tension’ the professor talks about. After a terrible start, the restrictions Britain’s elderly had to endure were dehumanising to the point that many no longer wanted to live. ‘Deconditioning’ is the word he uses to describe their accelerated cognitive and physical degeneration.

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“It’s dreadful to be alone and old,” explained another Anne. She was 96 years old and a former WWII junior commander in the ATS. Like 107-year-old Ann, she too had lived through an era when duty was the nation’s watchword; the press was censored, the people were conscripted, and hundreds of thousands of her generation died. It is that generation who have once more been in the firing line, but this time their duty was to be solitary and still. Pride is harder to wear in private. For the first time Anne watched Remembrance Day in November 2020 on television, rather than celebrating it with friends in her local church. It was a disappointing replacement. She sighed, “I wish someone would rub me out, I wish I could disappear.”

Anne was a Norfolk County Vice President of the Guide Association and mid-pandemic she reckoned that “the reason why Guiding has been so successful is that we were all involved together in our activities. Humans are built to be together.” Anne died in July 2021, most of her last year lived alone.

Professor Gordon admits that data has not been collected to track the unprecedented deconditioning that’s taken place over the last 18 months. Daily we are assailed with graphics charting Covid-19 cases and death rates, but there is no equivalent measure for the impact of loneliness, suicidal thought, feelings of abandonment and physical deterioration that the restrictions have induced in the extreme elderly. As 107-year-old Ann pointed out “I have terrible forgettery, this won’t be remembered.” Perhaps society is banking on that. When judgement day comes it will ask whether our very oldest, most precious citizens were ‘protected’ from Coronavirus. But who will ask if their last year (or two?) was worth being saved for?

Public health concerns over the spread of the virus have seen the human right to safety bulldoze other basic needs. Rectifying this imbalance is crucial as a second Covid-19 winter looms with large sections of the public already demanding increased restrictions. What will they mean for the extreme elderly? The average care home inhabitant is over 85, with a life expectancy of just two-and-a-half years, many won’t live to see the end of the winter. Has anybody asked them what they want? Do we really want to condemn yet more to a lonely death?

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Covid safetyism has gone mad

By Adam King

When I met her in the summer of 2020 Beryl may well have been the last ATS WWII Physical Training instructor alive and aged 99, with swollen legs in a heat wave and a pandemic, life was hard work. She worried about the modern world — “I think there’s more wrong today. It’s harder for you lot.” Things were certainly harder for Beryl who was struck by the contradictory game of national statistics: “In the Second World War in order to win they didn’t talk about death tolls, but in this current battle it is all we focus on.”

She wasn’t killed by Covid-19, but in February this year Beryl died, and her close friend sent me a message: “She rarely complained and she didn’t give up, but sadly, her last year was more like imprisonment since she was unable to see her friends thanks to coronavirus.” Like so many others, Beryl’s last months were collateral damage in Britain’s war against the pandemic.

As an NHS practitioner, Professor Adam Gordon has lived both sides of the problem. Given all he’s been through I’m embarrassed by my visible emotion during our conversation. In less than 12 months five women I work with have died. I managed to say goodbye to one and I’ve been to just one non-virtual funeral. The Professor confirms that Britain is sitting on a pandemic of grief; hundreds of thousands of people could not see those they loved most before they died and then were unable to give them an affirming send off among friends and family.

It is not just old people who have experienced depression; minus our elders, Britain has struggled with feelings of guilt and loss.

Yesterday Daphne, one of the 17 women featured in Army Girls who we met at the beginning of this article, left me a message. “I can’t get an appointment with my GP. I can’t work the new system.” But she has not given up. “When I get through, I am going to ask them to give me a pain shot so I can come to the book launch.” Many of her contemporaries haven’t been able to ‘rage rage against the dying of the light’ and aged 98, a Covid-19 survivor who is fully vaccinated, Daphne is determined to be the exception.

Unless, that is, a fresh wave of winter restrictions pin her and us down. Then we will need to push back and ask: who is really afraid? The very old? Or those seeking to control them?

An Evening with the Army Girls is at 6.30pm, 10^th November, National Army Museum, London. Tickets are £10. 

Army Girls: The secrets and stories of military service from the final few women who fought in World War II by Dr. Tessa Dunlop is available to pre-order here. 

It seemed reassuring. I know this because I messaged something like “It seems like they might know what they’re doing!”  in a science-nerdy chat group that I’m part of. But my optimism was not echoed. “It seems like they’ve just killed all our grannies,” responded someone.

I recall this to make two points. Firstly, I can’t claim any sort of foresight. I didn’t see then, though perhaps I should have done, that the early response of the British government to Covid was disastrous and wrongheaded. Instead, I was falsely reassured by the confidence of the scientific advisers, Whitty and Vallance. 

But secondly, other people did see it. The failings were predicted. And not just by my friend: a large number of smart, numerate generalists outperformed public health experts repeatedly in predicting the course of the pandemic in those early months.

On Monday night, two House of Commons select committees released the findings of their report into England’s Covid response. The headlines yesterday were stark: the “worst public health failure ever”, “big mistakes”, “damning”. 

The individual mistakes — failure to protect care homes; failure to move quickly enough on lockdowns; failure to build testing infrastructure and more — are certainly worthy of criticism. But having read the report, I want to talk about what strikes me as the overarching theme: being too bloody clever by half.

Let’s return to early March 2020, when I was falsely reassured by the Whitty/Vallance/Johnson press conference. The “flatten the curve” strategy that the three men introduced involved slowly introducing public health measures one by one. The idea was to carefully control the R value – the number of people that each infected person would, on average, give the disease to. The idea was to keep it at just above one, so that the disease would slowly spread through the population rather than either burning through it or dwindling down.

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In paragraph 87 of the report, the committee writes: “It is striking, looking back, that it was accepted that the level of Covid-19 infection in the UK could be controlled by turning on particular non-pharmaceutical interventions at particular times.” 

“Striking” is certainly one word for it. This was a novel disease. We knew almost nothing about its behaviour. On March 6 2020, I went to a gig at Alexandra Palace. Looking back now, it should not have been allowed to go ahead — but because the consensus at the time was that the disease was spread by fomites, by touching surfaces, the only advice was to keep washing our hands. In fact, it is spread largely through the air. 

So we had a completely wrong idea how the virus behaved, but we nevertheless had a confident plan to control it very precisely by now banning large gatherings, then closing schools, then encouraging working from home. We were trying to thread a needle blindfolded.

This sort of overconfidence in highly uncertain science crops up over and over again. As well as flattening the curve, the phased introduction of distancing measures had another purpose: it was not believed that the public would accept long-term restrictions on their freedom. “There is a risk,” Whitty told the public in one of the early press conferences, “that if we go too early, people will understandably get fatigued and it will be difficult to sustain this over time.” 

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This was also the official Sage position: “Sage agreed that a balance needs to be struck between interventions that theoretically have significant impacts and interventions which the public can feasibly and safely adopt in sufficient numbers over long periods.”

It’s not clear what this claim was based on. Other behavioural scientists questioned it, with 200 of them signing an open letter to the Government asking for the evidence. But what evidence were they hoping to receive? What comparable situation have we ever faced? A few small-scale experiments about people obeying instructions under laboratory conditions probably can’t tell us anything at all about what people would be willing to do in order to save hundreds of thousands of their fellow citizens, very possibly including their own elderly relatives. Nonetheless, we based highly counterintuitive policy decisions — not imposing strict lockdowns even as the disease was spreading and killing, despite seeing it being successful elsewhere — on this apparently unevidenced belief.

And let’s be clear: the coming hundreds of thousands of deaths were very much known about. The report rightly says that we over-relied on a plan for pandemic flu. That was a huge mistake, and it led us to strange things like moving to “delay” the virus rather than “contain” it, and stopping community testing. 

That meant that we had no idea how widespread the virus was. “The UK was reduced to understanding the spread of Covid-19 by waiting for people to be so sick that they needed to be admitted to hospital,” says the report. “For a country with a world-class expertise in data analysis, to face the biggest health crisis in a hundred years with virtually no data to analyse was an almost unimaginable setback.”

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So, yes, sticking to the flu plan was a disaster. But if you read the flu plan, it wouldn’t have worked any better for flu. The disaster that arrived was completely foreseen, yet it confidently said we couldn’t do anything about it, so we shouldn’t try. It said that planners should “aim to cope with a population mortality rate of up to 210,000–315,000 additional deaths” within 15 weeks of a virus arriving, and should “plan for a situation in which up to 2.5% of those with symptoms die”. 

The lowest number there, 210,000 over 15 weeks, works out at 2,000 deaths a day. At the peak of the second wave, the seven-day rolling average of deaths briefly – for nine days, in fact — broke 1,200 a day. 

That period was horrifying, but the pandemic flu plan was to “cope” with at least 2,000 deaths a day for 15 weeks. That appears to have been based on the idea that we, the British public, were so profoundly wedded to liberty that we would rather let the equivalent of the entire population of Norwich die in three months than have the nightclubs closed. 

More than that, in fact, it was important to keep them open so that people didn’t get depressed: “Large public gatherings or crowded events where people may be in close proximity are an important indicator of ‘normality’ and may help maintain public morale during a pandemic.” The possibility that people might not want to attend large public gatherings if it might kill them or their family, or might value the lives of their elderly relatives highly enough to stay home for a few weeks rather than watch them die in their thousands, was not considered..

Over and over again, the British response was one of unwarranted confidence in highly uncertain outcomes. We were, of course, dealing with a largely unprecedented situation. But that meant that the evidence was necessarily weak. 

So statements such as “There is very limited evidence that restrictions on mass gatherings will have any significant effect on influenza virus transmission” (from the pandemic flu plan) were on the one hand true, but also basically meaningless. There’s very limited evidence either way. 

But the common sense attitude would be that being in a large group of people probably helps the virus to spread. And given that the alternative, which the plan explicitly endorses, is at least 210,000 people dying in 15 weeks, it seems incredible that the approach was “well, there’s no evidence that it works, so we might as well not try”.

There are other areas where this overconfident, clever-clever approach backfired. For instance, Matt Hancock told the committee that in the early months, they were advised that “testing people asymptomatically might lead to false negatives” so you shouldn’t do it. Of course, it would also lead to lots of true positives. But the fear of a hypothetical second-order effect — like Jenny Harries’s claim last March that wearing masks could increase the risk of infection, because it would make people more confident — overshadowed the very obvious and real risk of disease. It’s like the plan was based around not wanting to be obvious, but always being clever and counterintuitive.

And the reliance on the pandemic flu “flatten the curve” plan meant that there was no modelling of the impacts of a lockdown. Dominic Cummings told the committee: “You are going to have to lock down, but there is no lockdown plan. It doesn’t exist. Sage haven’t modelled it.”

Often, simply plotting an exponential curve on a graph might have done better than the more complex forecasts the Government used. Vallance told a press conference that we were “four weeks” behind Italy, when simply looking at the number of deaths showed that we were 14 days behind. And when other countries locked down, with some success, we didn’t learn from their example, because we had a plan, and we were confident in it.

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And, of course, border closures. Naively, you’d think that stopping people coming into the country would reduce the likelihood of the disease coming here. But overconfident modelling told scientific advisers that it wouldn’t, so they trusted that, rather than thinking “OK, but if the model is wrong then we’ve completely messed up.”

This isn’t to place all of the blame on Whitty, Vallance and Sage — or to exonerate the politicians. There was plenty of cowardice and dithering on the part of the Government, not least (as the report shows) when they ignored scientific advice to impose a short “circuit breaker” lockdown in autumn 2020, presumably because they feared being unpopular. 

But the valuable lesson, I think, is not “we should have done X” or “we should have done Y” specifically, but that we should be less confident in our ability to predict highly complex situations. And more than that: we should look at the possible results of being wrong in our attempts to predict those highly complex outcomes. If you’re 60% sure that lockdowns won’t work, then that implies there’s a 40% chance they will, and that implies that you think there’s a 40% chance of saving hundreds of thousands of lives. Instead, it seems like the whole way through, the thinking was “it probably won’t work so let’s not try”.

I didn’t foresee any of this. I should have: it was all there in the pandemic flu plan. Others, smarter and more conscientious than me, did, or at least foresaw that disaster was a realistic probability. But the takeaway should be not “in the next pandemic, we need to protect care homes” — although we should — but “in the next pandemic, we should stop trying to be so damn clever”.

This is not the mainstream view, to say the least, which is that the pandemic was especially disastrous in the United States precisely because the president was an incompetent populist. The same narrative was central to the way much of the British media covered the pandemic, at least until vaccines saved the day and the prime minister. Even so, it was notable that the parts of Dominic Cummings testimony that attracted the most attention were his criticisms of Boris Johnson as “unfit for the job” of prime minister, “smashing from one side of the aisle to the other,” like a rogue shopping trolley. The New York Times summary was that Cummings had “accused the British prime minister of incompetence that caused tens of thousands of extra Covid deaths”.

For liberal journalists and editors who already had an aversion to populist leaders, the temptation to pin the blame on them for last year’s high excess mortality has been irresistible. We can see the same narrative in Brazil, where Jair Bolsonaro is the populist with blood on his hands, and in India, where Narendra Modi gets the same treatment from his political opponents.

An example of where this assumption of populist guilt can lead even the most experienced writer was James Fallows’s article “The 3 Weeks That Changed Everything,” published in The Atlantic last June. According to Fallows, the poor performance of the United States in response to the spread of the novel coronavirus had one, and only one, explanation: the incompetence of the “person at the top of the system”. He quoted an unnamed “veteran of the intelligence world”— one of “some 30 scientists, health experts, and past and current government officials” he spoke to — who summed up his argument neatly: “Our system has a single point of failure: an irrational president.”

Fallows at no point asked himself why so many scientists, experts and government officials might be so eager to pin the blame on Trump. He was too pleased with the analogy between Trump and the pilot of an aircraft. Hundreds of thousands of Americans died prematurely, he concluded, because the pilot was tweeting when he should have been responding to an approaching storm.

You can find versions of the same piece about most if not all of the populist leaders. “Jair Bolsonaro apparently intended to lead the country to herd immunity by natural infection, whatever the consequences,” meaning that he “effectively planned for at least 1.4 million deaths in Brazil,” according to Vanessa Barbara in the New York Times. “In a series of stunningly reckless decisions,” wrote Sumit Ganguly in the Washington Post, Narendra Modi “invited the second wave that is now crushing the country”. This “colossal failure of policymaking” reflected Modi’s “general callousness, crass electoral considerations, and sheer ineptitude.”

The generalisation follows easily: populism kills. “Strikingly,” noted the Christian Science Monitor in April, “the top five slots in [the] mortality rankings all belong to countries run by populists when the pandemic began — the U.S., Brazil, Mexico, India, and Britain.” In the words of Yascha Mounk of the Council on Foreign Relations: “If you look around the world today, it becomes painfully clear that those countries that are ruled by populists have paid an especially heavy toll in economic damage, case load, and mortality.” Not only the Mexican president, Andres Manuel Lopez Obrador (AMLO), fits the narrative; so too do the leaders of Bolivia, Ecuador and the Philippines.

The necessary counterargument is not that these populist leaders did a good job and need defending. They all did terribly, with Bolsonaro only just edging out Trump for the number of unbelievably stupid, wildly irresponsible things he did. (The redeeming feature of Trump’s response was Operation Warp Speed, which unquestionably laid the foundation for this year’s very successful vaccination campaign. Bolsonaro’s government managed to bungle vaccine procurement, too.)

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Yet to conclude from the populists’ countless sins that the countries in question would have fared much better under different leaders is to draw a dangerously erroneous inference. It would lead you to conclude that, by replacing Trump with Joe Biden, American voters have solved the problem that caused so much illness and death last year; and that Brazilian, Indian and Mexican voters can solve their problems in the same manner when their populists come up for reelection.

There are three flaws to this reasoning, leaving aside the point (made by Brett Meyer in a smart paper for the Tony Blair Institute) that not all populist leaders downplayed the threat posed by the pandemic, while a significant number favoured stringency over laxity. The first is that it is not clear that the countries run by populists did fare decidedly worse than other countries, at least in terms of excess mortality — the best measure of how a country has fared in the Plague Year. The second flaw is that, on close inspection, the mistakes that caused the bulk of premature deaths during the pandemic cannot easily be attributed to presidential or prime ministerial decisions. More often than not, the mistakes were made further down the chain of command, by public health officials and scientific advisers who profoundly misjudged the problem they were facing. Thirdly, and finally, the counterfactuals of better outcomes with different leaders do not stand up to close scrutiny.

Let’s begin with excess mortality data. One study of 32 countries in 2020, which calculated excess age-standardised mortality, arrived at the following worst ten (in terms of mortality per 100,000: Bulgaria came first, followed by Poland, Chile, the United States, Slovenia, Belgium, Czechia, Spain, England and Wales, and Scotland. One might argue that the governments of Bulgaria, Czechia, Poland and Slovenia were led by populists, along with the U.S. and England; but Chile, Belgium, Spain and Scotland?

Or consider the latest excess mortality figures from the Financial Times, which go up to 5 May. The UK and the U.S. are in the middle of the table with excess mortality of, respectively, 17% and 18% above the baseline. Bolsonaro’s Brazil is worse (34%) and AMLO’s Mexico worse still (55%). But excess mortality has been even higher in Peru (123%), Ecuador (67%), Bolivia (56%), Armenia (43%) and Azerbaijan (42%). The problem in each of these countries was not a powerful populist leader.

In Peru, to give just one example, it is Congress that wields the power, so much so that it has brought down three of the country’s last four presidents, including Martín Vizcarra, who was impeached twice last year and finally forced to resign despite an approval rating above 60%. In the case of Ecuador, too, Lenín Moreno did not conform to the populist stereotype last year. In Bolivia, the pandemic struck after the populist Evo Morales had been ousted from power.

In any case, the idea that presidents are to pandemics what pilots are to severe turbulence or engine failure is, to the historian’s eye, deeply misleading. The reality is that the man or woman at the top is struggling to manage multiple government agencies with “stakes” in public health, to say nothing of state or provincial governments.

In practice, as any serious student of modern government knows, the critical decisions in a public health crisis are not made at the top: it is the scientific advisers and principals of the relevant agencies who must decide on the seriousness of the threat and the policy response to recommend. A president or prime minister becomes involved only if there is a fundamental disagreement within the relevant group of expert and officials, or between the Cabinet-level principals. If there is a consensus in favour of a “herd immunity” strategy, as appears to have been the case in London in the first two and half months of 2020, then a prime minister is highly unlikely to overrule that consensus, regardless of whether he is being distracted by a book deadline, a disgruntled girlfriend, or an outsized interior décor bill.

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Anyone listening closely to Cummings’s testimony last month, or reading the long Twitter thread which preceded it, will understand that he was not in fact laying the blame for last year’s debacle on Boris Johnson. “Critical as I am of the PM in all sorts of ways,” Cummings wrote, “it’s vital to understand the disaster was not just his fault.” On the contrary, the entire system failed: not just the elected politicians, but the civil servants and the public health experts—all fell “disastrously short of the standards that the public has a right to expect.”

In other words, Boris was a comorbidity. To some extent, the same may also be true of Bolsonaro, Modi and AMLO.

Perhaps the best way to show the weakness of the populist pandemic hypothesis is to contemplate the counterfactuals. If, thanks to some kink in the space-time continuum, Joe Biden had been inaugurated in January 2020, would U.S. excess mortality have been significantly lower? It is easy to claim, as an eminent TV anchor said to me the other day, that it would have been, because Biden and his administration would have “followed the science.”

Yet Ron Klain, Joe Biden’s chief of staff, acknowledged in 2019 that, if the swine flu that struck the U.S. in 2009 had been as deadly as COVID-19, President Barack Obama’s administration would not have done much better: “We did every possible thing wrong. And … 60 million Americans got H1N1 in that period of time. And it’s just purely a fortuity that this isn’t one of the great mass casualty events in American history. Had nothing to do with us doing anything right. Just had to do with luck.”

And how did the Obama administration do when faced with an opioid epidemic? More than 365,000 Americans died of drug overdoses between 2009 and 2016. Each year saw more deaths than the year before. The most affected age groups were those between 25 and 54, for whom the overdose rates in 2016 were between 34 and 35 per 100,000. For that reason, the total of life years lost may well have exceeded those lost to COVID, albeit over a longer period of time. Yet I have never read an article blaming the opioid epidemic on “pilot error.”

To repeat, I am not here to defend Boris, Trump et al. I am merely arguing that is too easy — and also downright misleading — to lay all the blame for the excess mortality of 2020-21 on populist leaders, though their erratic leadership undoubtedly added some percentage to the body count. What happened in most Western countries, regardless of whether they were led by a populist, a liberal or a technocrat, was a systemic failure of the public health bureaucracy. There were pandemic preparedness plans; they simply did not work. Testing capacity was not built swiftly enough; contact tracing was barely attempted; quarantines were not enforced; the vulnerable (especially in elderly care homes) were not protected but exposed.

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These were the costliest mistakes in terms of loss of life, and it is not plausible that presidents or prime ministers were personally to blame for any of them. The most parsimonious interpretation is that the public health systems in Taiwan and South Korean learned from the experience of SARS and MERS, while ours did not.

To conclude that getting rid of the populists at the top will ensure that we do better when the next disaster strikes is not merely a delusion. It guarantees that, on both sides of the Atlantic, we shall fail to identify where the real points of failure have been and to do something about them, as soon as we possibly can, in every domain of our manifestly dysfunctional systems of government.

That, I think, was what Dominic Cummings was trying to tell us. “The official plan was disastrously misconceived,” he wrote, “DHSC/CABOFF did not understand this or why, & a PlanB had to be bodged amid total & utter chaos.”

This was because Plan A — to go for herd immunity rather than suppress the virus — “was supposed to be ‘world class’ but turned out to be part disaster, part non-existent. … If we’d had the right preparations + competent people in charge, we would probably have avoided lockdown1, *definitely* no need for lockdowns 2&3. Given the plan was AWOL/disaster + awful decisions delayed everything, lockdown1 became necessary.”

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According to one poll, 75% of Britons do not trust what Cummings had to say about the government’s handling of the crisis. This is unfortunate, because what we were presented with last month was a rare, unfiltered glimpse into the reality of life in the corridors of power when a full-blown national emergency strikes. If you think it would have gone much better with David Cameron, Theresa May or (imagine it) Jeremy Corbyn in No. 10, then I have a pandemic preparedness plan to sell you.

In any case, the Cummings critique of the British state has never really been about the personality of the prime minister. His question for years has been: “How does the deep institutional wiring of the parties/civil service program destructive behaviour by putting the wrong ppl in wrong jobs with destructive incentives?” Why are “SW1 incentives … ~all about rewarding *process + fake signals*”? These are the right questions to ask, and a similar set of questions could and should be asked about the Washington Beltway.

The irony is that, back in 2016 and 2017, people voted in populist leaders in large measure because they felt frustrated by the dysfunctional inertia of the “deep state,” whether in Whitehall, Washington, Brasilia, or (for that matter) Brussels. The events of the past 16 months have proved that, as was obvious at the outset, the populists were not a real solution to that problem. But the pandemic has also shown us the deadly consequences of leaving the problem unsolved — which is precisely what we shall do if we conclude that the premature deaths were all the populists’ fault.

Niall Ferguson’s new book DOOM: The Politics of Catastrophe has just been published by Penguin Press.