Offline: COVID-19 as culture war

When Dr Anthony Fauci challenged Senator Rand Paul last week during US congressional hearings, he exposed how politicians have exploited the COVID-19 pandemic for their own personal advantage. Fauci showed screenshots of Senator Paul’s website, which included the message “Fire Dr Fauci”. He pointed out that Paul was inviting people to send donations to firefauci.org. He explained how Paul’s exaggerations were creating the conditions for violent attacks on himself and his family. In December, 2021, a man was arrested on his way to Washington, DC, with an AR-15 semiautomatic rifle in his car. When asked why he was travelling with this gun, he replied that he was going “to kill Dr Fauci”. Fauci provided compelling evidence that, in his words, “you are making a catastrophic epidemic for your personal gain”. As the pandemic enters its third year, the difficult truth is that the political debate about COVID-19 has evolved into a bitter culture war, where arguments have become struggles between different social groups holding different beliefs about how society should be constructed and governed. As one UK Government adviser said to me recently, his greatest worry was that the mistakes made by scientists over the risks posed by the omicron variant of SARS-CoV-2 might have emboldened the right wing of the Conservative Party to attack and undermine the government’s efforts to manage the country out of a pandemic.

A culture war between libertarian conservatives and scientists is a grievous place to be. But it would be too easy to blame politicians who seem disposed to ignore reasoned public health advice. Scientists should be prepared to evaluate their own attitudes and approaches to the pandemic. For we have made mistakes too, and how we exit the pandemic and learn the lessons of our response depend on a fair accounting of our own successes and failures. Philip Ball, writing in The New Statesman, has described the “strange insouciance in the UK scientific community”, the unwillingness of scientific advisers to hold politicians accountable for poor decisions, a very British reluctance to speak out that quickly shades into fatal complicity. A liberal sprinkling of knighthoods and honours plays its part in dampening criticism. The response to omicron is a case study in error. On Dec 14, 2021, Dr Angelique Coetzee, a South African doctor with first-hand experience of managing patients infected with omicron, pointed out that the UK’s reaction “is out of all proportion to the risks posed by this variant”. Her message was clear: “I can reassure you that the symptoms presenting in those with Omicron are very, very mild compared with those we see with the far more dangerous Delta variant.” Coetzee explained that COVID-19 deaths in South Africa were not rising dramatically and nor was the average length of time people were in hospital. She suggested that “This huge overreaction is scaring people unnecessarily.” Her advice was ignored. Indeed, the UK Health Security Agency actually fuelled public fear by predicting 200 000 omicron infections daily. The result was our own version of the Paul–Fauci culture war. “It’s Boris versus the scientists”, proclaimed the front page of the Daily Mail on Dec 16, 2021. It took a month for the UK Health Security Agency to agree with the testimony of Coetzee that omicron caused a low severity of disease in adults.

An honest appraisal of the past 2 years of pandemic management might include the conclusion that from the very beginning there has been an over-reliance on mathematical modelling and too little emphasis on the experience of health workers on the front lines of care. Scientific advisers continue to advise caution. They highlight uncertainties. They want more data. They warn against complacency. They draw attention to the ongoing pressures on the National Health Service. They argue that it is too early to conclude that the worst of omicron is over. They predict a summer surge. All reasonable points. Yet we should also acknowledge that this pandemic is now in transition. Governments need to maintain rigorous surveillance for new and more lethal SARS-CoV-2 variants. Vulnerable groups must be protected. Global vaccination efforts should be accelerated. But now countries need to encourage a vigorous debate about a future and fairer vision for their societies. And scientists, clinicians, and public health practitioners should find their voice in this most important phase of the pandemic.