Politicians around the world have been promoting responses to the Covid-19 pandemic with statements such as: “we must open up”, “we have to learn to live with the virus”, and “freedom day”.
But to us epidemiologists these are almost meaningless political slogans that cover a vast array of possible scenarios, some of which are potentially very harmful, especially for the most vulnerable.
The approach of Boris Johnson’s government in the UK provides a particularly egregious example of how political rhetoric is damaging our ability to discuss pandemic responses in an open and transparent way. Framing our global response to Covid-19 with slogans starts to narrow the range of options in ways that may stifle thoughtful discussion of alternatives.
Having a common language helps us discuss and compare different strategies for managing the pandemic. Like most scientists, epidemiologists spend a lot of time classifying things, whether it is diseases, hazards, or interventions. This process is essential for answering questions about whether the incidence of disease is changing or whether we are just better at testing for it, and whether we have a localised outbreak, or a global pandemic. It is also an essential part of deciding whether a medicine or public health and social measure (such as physical distancing or mask use) makes a difference.
This is one of the reasons why we published a typology for classifying pandemic response strategies. Having a typology allows us to see if particularly strategies are associated with different outcomes. Not surprisingly they are. Countries pursuing an elimination strategy have performed spectacularly better than those using suppression or mitigation based on lower Covid-19 death rates, better economic performances, and less time under lockdown.
Elimination strategies are currently protecting more than 20% of the world’s population, including in China, Hong Kong, Taiwan, Singapore, Australia and New Zealand. Despite the success of elimination, some governments refuse to acknowledge that they are using this strategy, even when they obviously are. In Australia, the Scott Morrison government confusingly talks about “suppression” as the strategy they are using as part of their “road map” out of the pandemic when they are currently intensifying their commitment to elimination. This kind of political spin obfuscates rather than enlightens.
Shared language and framing is essential for having an informed discussion to help guide our emergence from the global pandemic and search for an optimal long-term relationship with SARS-CoV-2. We should not make the automatic assumption that we must “learn to live with this virus” in the same way as we live with the flu (seasonal influenza).
Having highly effective vaccines and public health measures means that we have a choice not to live with Covid-19 in this way. We have chosen not to live with serious viral infections like polio and measles and have country level and regional strategies to eliminate these infections. Even global eradication becomes a possible option to consider. Indeed, the success of countries with sustaining Covid-19 elimination suggests that the global community should seriously consider the pros and cons of a strategy of “progressive elimination” with a potential endpoint of global eradication.
It is disturbing to see “seasonal flu” as a benchmark to aspire to. In a country like New Zealand, it accounts for almost 2% of annual deaths, making it the country’s biggest single infectious disease killer. It also fills up our hospitals every winter with thousands of seriously ill people causing about 1% of all hospital admissions. These respiratory infections all increase inequities with indigenous Māori and Pasifika far more likely to be hospitalised and die from influenza compared with European New Zealanders. If we had highly effective vaccines we would almost certainly choose not to live with the flu.
Covid-19 is much worse than seasonal influenza. It is a multi-organ infection with long-term consequences (long-Covid) for many, including children. Some descriptions of a potential future world where Covid-19 is a recurrent seasonal infection are grim. Limiting spread of Covid-19 as fast as possible is likely to be the best defence we have against ongoing emergence of more infectious and vaccine-evading variants.
There is an important role for the World Health Organization in facilitating the development of a common language for describing Covid-19 response strategies and framing the debate about the full range of future scenarios, and which are the most feasible and desirable.
As scientists, we need to keep pressing our political leaders and colleagues to talk about the Covid-19 pandemic in ways that use evidence and language that supports an informed debate about our collective futures.
As members of the public, we need to demand that our leaders (and scientists) talk in ways that are understandable, meaningful, and consistent. This conversation needs to include the voices of those who are most vulnerable to the impact of the pandemic.
Ultimately, we need to insist on scientifically meaningful framing and not misleading slogans.