Learning from Europe? As if…

As new restrictions, of some form or another, loom over the United Kingdom, the Prime Minister frequently cites European countries like France and Spain whose situations he is desperate to avoid. Recently, the Health Secretary Matt Hancock mentioned Belgium as a country which had ‘effectively suppressed’ a second wave (recent data seems to refute this). The widespread introduction of curfews seems to be inspired by the Belgian model of introducing an 11pm curfew in Antwerp where many cases were linked to nightlife.

Early on in the crisis, the government was criticised for not adopting the same measures as European nations and reportedly they never asked doctors in European hospitals for advice. However, if the government actually wishes to learn from Europe, or indeed the world, then they should stop treating other countries as a grab bag for new restrictions. Instead, they should analyse what has been effective so far.

Obviously, the pandemic is not over. However, it has been raging for over 6 months, so an assessment of which countries are in a better position to go forwards into the next phase is now possible. There is evidence on what seems to have so far worked.

It is not the case that there is one single effective strategy. However, it is always more effective to have a strategy, and holding out for technologies and vaccines that don’t exist yet isn’t one. Whatever their methods, more successful countries have benefitted from always making clear what they are doing and why they are doing it, in the longer term.

New Zealand has effectively eliminated coronavirus twice. The country of 5 million has seen only 25 deaths. Sweden, instead of artificially crushing the curve only to see it pop up again when restrictions are loosened, adopted what chief epidemiologist Anders Tegnell described as a ‘sustainable’ strategy. Sweden’s 7-day average for daily deaths is one and cases have been declining for months. They are planning to further relax their already less stringent restrictions, as many European countries tighten theirs.

The relative success of other strategies can be seen in South Korea, where an effective test-and-trace system meant lockdown was never necessary, and in Germany, where a lockdown was applied then successfully lifted, a strategy most of Western Europe has pursued with varying degrees of effectiveness (although Germany’s success is at least in part due to their more effective contact tracing system, which emulates that of South Korea). 

If a UK resident were to depart this country and move to one of the four mentioned above (although you technically can’t move to New Zealand), they would find themselves somewhere which has suffered fewer coronavirus-related deaths per 100,000, where they had more personal freedoms, and a lower chance of catching coronavirus. Sounds tempting. 

So, four countries and four different strategies. What unites them?

First, giving real power to scientists, and making evidence-based decisions rather than knee-jerk ones. Sweden and New Zealand have allowed their chief scientists to determine policy and the politicians have taken a step back. The United Kingdom claims to follow the science, and the situation here is far from that of the US, where the president has suggested people inject themselves with disinfectant. However, Johnson generally only wheels out his chief scientists to give bad news he himself is uncomfortable with.

Next, the decisions taken by those in charge need to be clearly communicated and explained to the public. In explaining the significance of the R number to her suppression strategy, Angela Merkel clearly set out what would happen in a variety of scenarios and what the rationale behind her decisions was. Possibly, Merkel’s science background gives her the advantage of understanding the statistics she is explaining; an understanding that the UK government seemingly lacks.

A reason for high levels of compliance with the original lockdown is that people felt it was justified. There is now much less faith in the UK government, and therefore people are less willing to abide by new restrictions. The lack of explanation for these restrictions means that even if they do have a reasonable basis, no one knows what it is.

Thirdly, all the countries mentioned treat their public like adults, rather than naughty children. Several newspapers compared the UK government’s new idea of snitching on your neighbours, to the Stasi. In contrast, NZ’s Ardern regularly refers to her ‘team of 5 million’, a suggestion of collaborative effort likely more useful than the UK government’s policy of blaming the public for their failures.

The Swedish focus on personal responsibility has led, as Matt Hancock acknowledged when asked whether Britain could learn from Sweden, to a higher degree of compliance than was required by law. When in South Korea a variety of clusters led to an outbreak in the late summer, stricter measures were required – the public understood why, and obeyed them. The measures worked.

Finally, the spending cuts that are a normal result of economic downturns, especially one as large as New Zealand has seen, can be just as damaging as disease – everyone agrees that austerity kills. The truth is that in a pandemic no one is going to keep everyone happy and no choice comes without a price. The idea that countries must choose between protecting the economy or the people is overly simplistic, because the two are intertwined. Sweden’s economic downturn is similar to that of their nearest neighbours. However, crucially, they are in a position to loosen restrictions without jeopardising public health, arguably an ideal situation.  In contrast Denmark and Norway are both facing increasing cases leading Denmark to reimpose some restrictions. 

Thus, all these governments have acknowledged that their chosen strategies will cause some harm. Much has been made of Sweden’s high death toll, although fewer people have died per 100,000 than in Italy, Spain, Belgium and the UK, all of which employed lockdowns. New Zealand’s economic downturn is staggering, but unsurprising considering they are almost entirely shut to the world. However, Anders Tegnell is a national hero, and Jacinda Ardern is widely expected to win the election which she delayed.  

The UK government is rightly advised by a large group of scientists. They will naturally hold different opinions. When a decision is made, some people will oppose it – strongly. American progressives and a minority of Swedish scientists have been criticizing the Swedish strategy for months. However, Sweden has chosen to stick to their strategy, because being as reactionary and sensitive to criticism as the British government would have the infinitely worse impact of undermining public trust in disease control measures.

On Friday’s BBC News, a member of the public said that the government has no understanding of how normal people live. Public trust in the government’s handling of the pandemic is at an all time low. It would be a lot higher if people felt the government had a plan which they could actually start delivering now.Scientists, from the head of Oxford’s Centre for Evidence-Based Medicine to the expert whose modelling gave rise to the initial lockdown, have called for a more sustainable approach. Different strategies are applicable to different countries, but it is clear that the government needs to start making evidence-based decisions and commit to a clearly explained strategy. That is the real lesson Europe should teach them.