Richard Horton’s crisply written book was finished in May. So much has happened since then, yet most of it is prefigured in the book, and much is still not getting the urgent attention Horton calls for. His case is that too much – on occasion he even says all – of what has befallen us could and should have been avoided, if policy-makers had responded properly to the accumulating evidence produced by medical scientists. And he is worried that – unlike China, South Korea, Taiwan and Singapore, scarred (and in China’s case, internationally embarrassed) by their experience of SARS – we in the UK will not learn from our experience of COVID-19. Horton fears this failure to learn will mean a missed opportunity to radically reorientate our treatment of public health, medical science, and of health policy-making. The recent announcement that the government is to cobble together its outsourced test and trace system with bits and pieces of Public Health England into a new ‘health protection institute’ has nothing whatever to do with the kind of reorientation that is needed, as Horton has made forcefully clear.
A government looking in the wrong direction
Horton’s most pointed criticisms are of the UK government and UK scientists, but a central theme is the global nature of the new virus, and the need for a global response to the others that we can expect to follow it. The World Health Organisation’s (WHO’s) international intelligence system, and its power to declare health emergencies and deploy crucial expertise where it is needed, is our only significant line of early defence against new viruses. So Horton considers Trump’s decision to cut the WHO’s funding in the middle of the pandemic to meet the definition of a crime against humanity. And the question of how funding is to be made up has been barely discussed in the UK. Instead the UK government – which for its part has massaged and at times withheld the most basic data on the progress of the pandemic in the UK – has come close to endorsing the US government’s unfounded charge that the Chinese state covered up the COVID-19 outbreak.
Horton is not starry-eyed about China, and wants to know more about what happened in Wuhan before the identification of the new coronavirus on 30 December 2019. But he notes the radical investments in medical science that the Chinese made after the 2003 SARS outbreak. These made it possible for Chinese clinicians and researchers to provide the rest of the world, just three weeks after the initial identification of the virus, with the crucial initial information needed for preparing a defence: its genome, the fact of human to human transmission, the progress of the infection, the incidence of severe cases, and the fatality rate, especially high for older patients. And he asks, again and again, why neither the UK government nor the medical establishment paid serious attention to this for the next month and a half, by which time the virus was already spreading rapidly in the UK.
