Emma Ross
Okay and good morning and thank you for joining us for this week’s COVID-19 briefing with Chatham House Distinguished Fellow, Professor David Heymann. I’m sorry it’s very slow to get in today, we’re having technical difficulties, so I hope too many people didn’t give up, but more people are joining as we speak. This is our last session before the summer break, and, to finish off, we have with us today Dr Richard Horton, Editor-in-Chief of The Lancet, one of the world’s most esteemed medical journals and most authoritative voices in global health. It has also so far published a large proportion of the key science that has informed the pandemic.
Last year, Richard was dubbed one of the world’s most committed, articulate and influential advocates for population health. He doesn’t mince his words, he acknowledges that health is political, and he has had his fair share of controversies. We’ve even got Lancetgate in this pandemic. But, through all that, he has, to the surprise of some, survived at The Lancet’s helm for 25 years. Before we go any further, a reminder of the housekeeping stuff. The briefing’s on the record, and questions can be submitted using the Q&A function on Zoom. Upvoted questions are more likely to be selected, so if you have a question that’s similar to one already there, please just upvote it. So, welcome, Richard, and thank you for joining us today.
Dr Richard Horton
It’s great to be here, Emma, thank you, and lovely to see David, as well.
Professor David Heymann CBE
You too.
Emma Ross
There are so many themes we could explore with you today ‘cause your knowledge is just encyclopaedic, almost rivalling David’s, but – given that I can’t…
Dr Richard Horton
Inferior.
Emma Ross
…imagine an angle on the pandemic that you couldn’t speak to, but the plan is to zero in on the pandemic science and how it’s playing into the response. So, I was hoping you could start us by orienting us to the way this works by explaining the process by which scientific evidence emerges, gets established and taken up. I mean, it can seem confusing, or even confused, when there appear to be 1800 turns in the scientific advice, and that makes it easy for some people to conclude, as we’ve seen in this pandemic, or allege, that the Scientists got it wrong, were dragging their feet in coming round to the evidence that others think has been clear for a while, or that they’re just making it up as they go along. So, could you start us off by talking about the scientific process of how Scientists work out what’s going on and what’s best to do.
Dr Richard Horton
Okay, Emma, that’s a tall order. I mean, the first thing I’d like to just acknowledge is that I think the – although the research community may not have been seen as some of the frontline workers in the response to this pandemic, they actually have been frontline workers. I’ve never seen – you were quite right to say I’ve been at The Lancet 25 years, and I’ve never seen the scientific community respond to a health threat in the way that they’ve responded to this. It has been absolutely remarkable. Scientists, working across different countries in different disciplines, collaborating together in the most free and open manner, it’s been truly, truly remarkable. I mean, even, you know, the response to AIDS was pretty remarkable, but this beats everything.
So, I really think we need to acknowledge the value and importance of the research community. There’s no question that the research that has been produced has saved tens of thousands of lives by getting information about the virus, the disease, the patterns of transmission, modelling scenarios about what public health action should be done, and so on and so forth. By getting that information out, remember we didn’t even know this virus existed six months ago, it is an unprecedented effort, and I hope that, as governments go forward, the value that the research community has given to health is recognised, and, indeed, protected, because we’re now moving into this economic crisis, the worst for 300 years, and it would be very tempting to have measures that will cut the – cut communities, such as science, and yet it’s very important that we protect those communities.
Now, coming back to how we establish knowledge. You know, we first heard of this outbreak early in January. We made immediate contact with the Scientists and Physicians we knew in China to find out what was going on, and I think one of the – and, again, a rather unacknowledged contribution has been the Chinese Scientists on the frontline of this. Remember, you’ve got a group of Scientists in another country, where English is not their first language, and they are struggling with a – basically a SARS outbreak, which they are absolutely fearful of, and have been fearful of for 20 years, it’s come back, we’re in a political context, which is, let’s just say challenging, and they’re trying desperately to understand what on earth is going on.
And in those early weeks of January, these Scientists came together and wrote five or six papers that essentially defined the entire co-ordinates and contours of the past six months by defining the nature of the virus, sequencing its genome, establishing the basic case definition of COVID, what we now call COVID-19, proving human-to-human transmission, and recognising the global pandemic threat. And all of the issues that we’ve talked about, testing PPE, all the public health measures, were all set out in that early work that they did, and these were all Chinese Scientists. And, you know, I’m probably jumping ahead a little here, but, you know, we’re now in this very strange geopolitical context where China is the villain, it’s the enemy, it’s the threat. Well, as a Physician and Scientist myself, I think it’s very important that we acknowledge the massive contribution that Chinese medicine and Chinese science has made to helping us control this pandemic.
Emma Ross
You’ve said before that what other countries should have done the minute those papers came out, other Scientists, is contact their Chinese colleagues to find out what’s going on and what they should do, and you’ve expressed some scepticism as to whether that ever happened. Do you know whether that happened or not, or are you supposing, from the responses, that it probably didn’t?
Dr Richard Horton
I do not know whether it happened, but I – what I surmise is that, if various medical or scientific leaders or advisers had contacted Chen Wang or George Gao, just to name two people who were definitely on the frontlines of managing this pandemic, and asked them, “What is this that’s going on? What is this virus? What is this disease? Is it something we should be worried about?” And when George Leung published his paper on January the 31st raising the issue of the risk of a global pandemic, if somebody had written to George and said, “George, what’s taking place here? Is there really, genuinely a threat, or is this something that can be locally contained within China?” I think people would have woken up much sooner to what was taking place, and that’s not even mentioning the fact that Dr Tedros declared a public health emergency on January the 30th.
Now I don’t want to relitigate history too much, but the simple point that I would want to emphasise is that, when people say, “We’re following the science,” that plainly is not true because the science was very clear, by the end of January, sufficiently clear that the IHR Emergency Committee was sufficiently convinced about the science that they insisted on a declaration of a public health emergency. What happened afterwards? So, that’s then the – the question to ask, I think, that we should be asking our political leaders, “So, what happened after January the 31st? What were you thinking? What was the process of evaluating that science, and what was the process of evaluating the meaning of what WHO was saying?”
Because WHO has also been criticised, and I think extremely unfairly. WHO has never moved faster than it moved in this pandemic. WHO did an extraordinary thing in managing to, again, gather the evidence, funnel it into its IHR Emergency Committee, and arrive at the decision it arrived at. And, again, we should be expressing gratitude to WHO for the way it assembled the evidence, evaluated that evidence, and sent a signal to the rest of the world. So, the – what I find so perverse is the entire history of this pandemic is being rewritten, actively now, in a way that is completely 1800 contrary to the facts that were emerging in January.
Emma Ross
David, you’re nodding there. I’m dying to hear what you think about this. Unmute. Mute.
Professor David Heymann CBE
Thanks, Emma, and thanks, Richard. I certainly agree with what you’ve said, Richard, that the Chinese Scientists did provide information early on, continue to provide it, and, as you know, I sit in a privileged place. I’m Chairman of the Advisory Group to the Emergencies Programme at WHO, and the Chinese have never refused information when we request it. In fact, just two weeks ago, we had an update from George Gao and his centre, Chinese CDC, on the outbreak in Beijing, and they will be meeting with us again this coming Tuesday to give us an update. There’s never been any hesitancy, on the part of Chinese, or on any other Scientists in the world, to provide information to WHO, and that’s why we learned so rapidly about the virus and about its epidemiology, because they shared information, they published it in The Lancet and other journals, but also, they were willing to debate it within the WHO centre.
The second thing is, as you know, WHO, on the 5th of January, notified all focal points in countries electronically about the outbreak. The countries in Asia, by the 20th of January, were already detecting cases coming in from China and containing those outbreaks. They didn’t sit around and wait for an Emergency Committee. They didn’t sit around, they took the information that was given to them and they responded. So, I think that what you say is, there’s 1800 turnaround because many countries are looking now to scapegoat, to find someone who’s guilty for their lack of good detection and response systems. So, I support you, Richard, 100%. The Chinese Scientists, the WHO, are important in all of this solution, as is every other country in the world.
Emma Ross
Okay, so, I’m going to start with Richard on this. Debora MacKenzie, who’s a New Scientist Journalist, has recently released a book on COVID, as have you, Richard, but I just want to draw you in on something from her book, if I may? She said that, “We were unable, as a planet, to muster our considerable scientific understanding of disease in time to soften the blow, never mind preventing it in the first place.” And the question is, did science fail us or did government fail us in their ability to act on the science together? What’s your feeling on where the responsibility lies for us not getting on top of it?
Dr Richard Horton
Well, I do not – her book is sitting here, and I have to – and it’s on my reading list, and congratulations to her for getting it out so quickly. I do not believe that science has failed us. I actually think science has served communities in an extraordinary fashion. I will underline again that we did not know about this disease until December the 31st, and the extraordinary mobilisation that’s taken place since then, and the continued now, continued understanding that we’re having of the virus, whether we’re talking about asymptomatic transmission, or airborne transmission, or the development of therapeutics and vaccines, I mean, this is a – you know, an escalating process of knowledge production that we’re in. So, I think the scientific community broadly deserves our thanks.
However, however, there is then, the question of how you connect knowledge to decision-making, and I do think there are questions to ask about that because, certainly if I take the country I’m sitting in now, the United Kingdom, there was a failure of the system of science policymaking. I do not think there were individual personal failures. Every – the people I know, who sit on the various committees, who are in leadership positions, are the most dedicated professionals that you could possibly have in those roles. Absolutely 100%. However, something did go wrong, from the point of production of knowledge to decision-making, and we need to be open and honest in a non-blaming way about how that happened, and I think there are some pointers to what happened.
I do think that there was a cognitive bias towards influenza as the number one risk for a pandemic threatening western countries. I think there was a lack of, let me say, curiosity about interrogating the information coming out of China. I think there may have been a view that perhaps the Chinese health system couldn’t cope with an epidemic such as this, perhaps it wasn’t as serious as was being reported, maybe the information coming out of China could not be relied upon 100%. These are issues that we need to understand better, but certainly, there was a delay from the knowledge that we had to March the 5th, which is when Neil Ferguson’s group first put in front of the Scientific Advisory Group for Emergencies the fact that we needed to have a lockdown because community transmission was so severe. And that – the period of time, from the end of January through to early March, was time that we could have done more to accelerate the application of knowledge into policymaking.
Emma Ross
Okay. I’m going to credit Debora MacKenzie again ‘cause I liked this quote, and her book also said, “Every disaster movie starts with somebody ignoring a Scientist.” So, speaking of following the science, I’ll start with David on this, is Tony Fauci, the face of the pandemic science – scientific advice to President Trump’s administration, the Scientist most under siege when it comes to blame and undermining, or are there others around the world, having similarly a hard time? And the second part of that question is, is this sort of thing going on at a particularly unusual scale or particularly unusual degree in this pandemic, or is this really nothing new, this kind of dynamic?
Professor David Heymann CBE
Thanks, Emma. Well, you know, I think one of the major failures that’s occurred is that the political leaders and the public health leaders can’t, for some reason, communicate in the correct way during this pandemic, and many times, it’s the political leaders who have decided what to do, many times against what the public health leaders are recommending. That’s happened in the country that I come from, in the US, it’s happened here, in the UK, it happens in many countries because political leaders see this as such as an important outbreak. And so, they’re making decisions that, many times, are against what the public health agencies are saying, and, in fact, public health agencies, in many countries, have been marginalised and pushed aside and are not even visible in many times during this outbreak.
In the US, for example, the face of pandemics in the past has not been a Clinical Researcher, who’s Tony Fauci, it’s been the Center for Disease Control, CDC, in Atlanta, which has always been the face of the response to outbreaks. Fortunately, Toni Fauci has been able to step up and do that because the CDC in the US has been marginalised, and this is an agency that I know well because I spent 25 years with them.
At the same time, there’s also been a failure in the past, and that’s, again, in political leaders not willing to provide the research funding that’s necessary to understand public health events, and I go back to the SARS outbreak in 2003. During the end of that outbreak, the Chinese began to study in the markets in Guangdong province the levels of coronavirus in market live animal handlers, as opposed to the general community, and they found about 13% coronavirus antibody positivity in market workers, whereas, in the general community, it was about 2 or 3% and they thought this was clearly SARS outbr – antibody that they were finding. However, when the outbreak stopped, so did the funding stop, and the Chinese Government didn’t continue to support that research, and the research that could have led to better understanding, would have given us possibly the understanding that we need now to better deal with preventing outbreaks such as this, and hopefully, that will occur in the future. It’s not a criticism of the Chinese Government, other governments have done the same. As soon as an outbreak’s over, the funding dries up, vaccines are no longer being developed, diagnostic tests are not being developed, and it’s a failure of our political system to look in the short-term and not in the long-term.
Emma Ross
And before I go over to you, Richard, I just want to tell the audience members, some people were diverted to the livestream, but you can still ask questions, if you want to, if you’re watching on livestream, and you can do that by going to Slido, s-l-i-d-o.com, and inserting the hashtag #CHMembers. So, please do submit your questions that way and they will get to me. Richard, do you have anything to add on that?
Dr Richard Horton
No, no, no, I fully endorse what David says about CDC. CDC is the pre-eminent national public health agency, not just in the United States, but worldwide. The – again, the global contribution of CDC Scientists is second to none actually, and it has been astonishing to me to watch the way CDC has been sidelined over the last four years by the current US Government. I mean, CDC is a jewel in the crown of America’s public health and medical system, but also the world’s, and to see that position eroded is a – should be a concern not just for United States citizens, but for all of us concerned about public health.
Emma Ross
There was something disturbing I read actually on that, that, last week, CDC updated its advice on opening schools, and it was aligned with President Trump’s pressure to reopen schools two weeks after he criticised earlier CDC recommendations on schools as very tough and expensive, and media reports last week said the documents, which apparently gloss over the risks and extol the benefits of in-person learning, were, “edited by the White House.”
Dr Richard Horton
Well…
Emma Ross
And that seems…
Dr Richard Horton
…can I make a comment on that, Emma, because I think this is an issue about the role of independent science, and independent scientific advice to government and I – and it is a difficulty that we have, and it’s one to explore. Of course, at the moment of a national pan – a national crisis, such as a pandemic, everybody wants to work together, and everybody wants to support the response, and so it’s absolutely right that Scientists see themselves as working closely with governments, so that knowledge can be applied to decision-making. But those Scientists, their greatest contribution is the fact that they are independent of government, that they’re not politically aligned, and that they can be, in a sense, dispassionate or give unvarnished, critical advice to political decision-makers, and also, speak to the public because the public needs to have confidence in the independent scientific advice that’s given to government.
And I think that’s where there – something also went wrong. I think that the – certainly in the UK, the Scientists and Doctors who have – health professionals advising government, they got very, very, very close, and that relationship became so close that it felt to me at times, when we were watching the press briefings, where you had Scientists standing next to Politicians, that sometimes the Scientists were repeating the messages of the Politicians, and saying things that those of us watching knew were not true. We knew that it wasn’t true that the United Kingdom was an international exemplar on preparedness, and yet we saw a Medical Advisor say that on camera. We knew the importance of test, trace and isolate systems, and yet we were told, again by Medical Advisors, that that wasn’t necessary. We knew that there was not PPE on the frontlines of our health system, and yet we saw Scientists and medi – and the Medical Advisors saying that it was. We knew that wasn’t true. I think that our system of scientific advice lost some of its independence, and I know that at CDC, it’s very hard for CDC Scientists to speak outside the degrees of freedom given to them by the government. So, I do think that’s an issue that we need to look at. You know, the greatest value the science community can give to the public is its independence, and I think it lost some of that independence during this pandemic.
Emma Ross
Related to that, David, I was hoping you could give me your top three interventions or response behaviours that you think have not been scientifically grounded or following the scientific advice, globally.
Professor David Heymann CBE
Well, number one, I think countries prefer to use travel bans rather than strengthening their own systems to detect and respond when diseases come in. We know that, in the long-term, these diseases will spread. We need to have the monitoring systems, the detection systems, in place to detect these diseases early and deal with them when they enter the country. So, travel has been banned, in many parts of the world. We’ll see in the end what that has brought. We know from modelling early on that, when China did stop travel, it did decrease the speed with which the virus exported to other countries, but we just don’t know what the full outcome of travel bans have been. But they should never be used, and they are being used now, to prevent a – or to substitute for setting up good detection and response systems in countries. That’s number one.
I guess the second thing – Emma, what are we talking about again? What have you asked?
Emma Ross
Response – interventions or response behaviours that have not been…
Professor David Heymann CBE
Yeah.
Emma Ross
…scientifically grounded or not following the scientific advice.
Professor David Heymann CBE
Yeah, well, I think the second was, and Richard alluded to this earlier, was that countries were prepared for influenza, and they just used – the modellers used influenza as a means of determining what would happen with this infection. Now, that wasn’t wrong, because we didn’t know a lot early on, but we do know now that this virus does occur in outbreaks, whereas influenza doesn’t, and outbreaks can be contained, contacts isolated, and prevent new change in transmission into the community. So, many countries that started with contact tracing, the good response that’s necessary, abandoned that in order to flatten the curve and, by so doing, they increased the chains of transmission from outbreaks that were going into communities. Countries like Germany, countries in Asia, that continued contact tracing, appear to have had an easier job of keeping the reproductive number low than did others. So, the second thing is what Richard said earlier, influenza was a model that was used early on, and it was maybe not the right model. The right model would have been a disease that causes outbreaks and can be contained. So, that’s the second I would think is important, and where evidence was not followed.
I have trouble thinking of the third one now. I think people early on were wearing masks to protect themselves, thinking that they could protect themselves, and governments were not getting the message through that masks were only useful in the general public to protect others, because the eyes are also an entry point for the virus. So, I think communication maybe is a third difficulty that countries had in doing – in getting populations to understand what they can do to prevent onward transmission if they’re infected and to protect themselves. And those messages are now clear with most of the population, and it’s good they are because the population is the future of this outbreak, understanding how to do individual risk assessments by people themselves, and how to take measures to prevent themselves from getting infected and prevent others from being infected.
Emma Ross
And before I go to audience questions, Richard, do you want to add any [inaudible – 28:45]…
Dr Richard Horton
Well, I’d like to – could I just…?
Emma Ross
…[inaudible – 28:47]?
Dr Richard Horton
Well, could I, Emma, be a bit cheeky and invert your question? Because there’s…
Emma Ross
Yeah.
Dr Richard Horton
…something that’s very mysterious, looking back, where I think there was evidence, but the evidence was denied.
Emma Ross
Okay.
Dr Richard Horton
If you go back to February and early March, it was repeatedly said that avoiding mass gatherings – there was very little scientific evidence to support the avoidance of mass gatherings, and so we had – there were a whole sequence across the world, whether it was marches in Madrid or going to football matches in the United Kingdom, there were people congregating in large groups, and we had Scientists and Medical Advisors saying, “Don’t worry, the evidence for transmission in mass gatherings is very weak, it’s perfectly okay to continue to do that.” And yet we know, and we’ve published over the last ten years, series of papers on this new discipline, which is, mass gatherings medicine and public health, and we know from the study of very – of mass gatherings, whether they’ve been sports events, or religious festivals, or comings together, such as the Hajj pilgrimage, we know that mass gatherings have been major drivers of transmission of infectious disease. And yet, time and again, I would see a medical – Chief Medical Officer or Chief Scientific Advisor say, “No, don’t worry, the evidence on mass gatherings just isn’t there, you don’t trans – very low transmission,” and I’m thinking, “That is not what the evidence says. The evidence says exactly the opposite.” So, I couldn’t compute that.
Professor David Heymann CBE
Emma, let me jump in here and say that it’s because of Richard that there is this understanding of mass gathering medicine, because Richard was very in – concerned in making sure that there was a meeting, which was held at the London School of Hygiene and Tropical Medicine, where people like Ryan McCluskey from the UK, and Ziad Memish from the Middle East…
Dr Richard Horton
Exactly.
Professor David Heymann CBE
…from Saudi Arabia, got together and made sure that the people understood that mass gatherings are a major source of infection from any disease, whether it’s diarrheal disease or respiratory disease. So, I’d just like to give Richard some kudos…
Dr Richard Horton
Well…
Professor David Heymann CBE
…for that, in his vision to make sure that that happened.
Dr Richard Horton
Yeah, thank you.
Emma Ross
Yeah, well…
Dr Richard Horton
Yeah.
Emma Ross
…thank you, Richard, for inverting the question, ‘cause that was an interesting line. I’m going to go to the first question that is one of the most upvoted from Louise Hart. “There’s been a huge issue with the spread of misinformation during this pandemic. What can be done to tackle this issue and encourage more focus on evidence-based information, both among Politicians and the general public?” Who wants to start?
Dr Richard Horton
Oh, boy. Well, of course, WHO has done a great job in coining this phrase, which I hadn’t heard of actually before, the notion of an infodemic, and – as being as dangerous as the pandemic itself. You know, there aren’t any simple solutions to this, and we’re now in a phase where we may well – we may, I don’t want to say we will, but we may have a vaccine, in the next 12 months, that’s going to come through. We need to prepare the public for that, and already we are seeing the rise of an anti-vaccination movement mobilising, again, and the risk of not just misinformation, but disinformation being deliberately leveraged. That is a real threat to public trust for any therapy or vaccine that might be developed. So, we need to take this seriously. This is not just some pranky conspiracy theories that one can laugh off and dismiss. This is a serious threat to any attempt to control and prevent this disease.
So, I think we need to take it a lot more seriously than we have done. I’m not giving you simple solutions here, but it does mean that we need to have constant, very clear messaging, but also, we need to – you know, there’s a – you will have people – you’ll have a small number of people, who will do what they need to do, whatever the advice is, because they absolutely 100% believe the science. You’ll have a very small group of people who are the convinced anti-people, whether it’s anti-vaccination or spreading disinformation, and then there’s a very large group in the middle, who are watching these debates and are not sure. And we need to listen to that large group in the middle, not dismiss their concerns, not call them stupid, not call them the peddlers of conspiracy theories, we need to listen to their anxieties, and we, in the public health community, need to do the best we can to answer their anxieties and build public trust in the evidence. But that’s now becoming a really, seriously big challenge, over the next few months.
Professor David Heymann CBE
Emma, I might just jump in and say, you know, early in my career, I learned that what’s the most important part of an outbreak is to have a face, and that face is someone who provides the information, who everyone can trust, and who is there when there are questions asked. And we’re seeing that in this outbreak, as well, we’re seeing Lothar Wieler in Germany, Gabriel Leung in Hong Kong, we’re seeing Tony Fauci in the US, we’re seeing Chris Whitty here in the UK. People who are trusted and who need to be able to speak. Whether or not they can speak is a decision of the political leaders, but if people follow what they say, and find the information coming from them, they will probably end up understanding where they can go for the right information, and won’t be so confused about what’s coming out on the social media. So, I reiterate, every good outbreak needs a good face behind it.
Emma Ross
Okay. Another upvoted question from Anna Ebers, “While both speakers” – oops, it’s slipped. “While both speakers are clearly partial towards positive view on the response of WHO, it is clear that some reflection is needed as to why member states did not follow the WHO advice and took matters into their own hands, when it came to responding to the outbreak. Countries were well ahead of WHO advice when it came to taking scientific evidence onboard. Could either of the speakers shed some light on the decision-making process at WHO and why did they seem so reluctant to bring forward difficult, clearly evidence-based outbreak control measures, such as border movement control, or simple ones like the use of masks?” That seems to be harking back to the question I said brought…
Dr Richard Horton
Well…
Emma Ross
…confusion.
Dr Richard Horton
Yeah, I mean, David knows WHO better than I do, but there is one mystery that I still have not been able to solve for myself, and that is this, that WHO declared its Public Health Emergency of International Concern, which was excellent, and then nothing seemed to happen. You had the daily updates, which was good, but at no stage has either WHO, or the United Nations, or any other multilateral body, convened countries together to pool knowledge, to share information, and to try and build a global response to this pandemic.
Now, the mechanism that I’ve proposed is the Emergency Special Session of the United Nations General Assembly. You can – there’s only been a dozen or so meetings, in the history of the United Nations. You can only call it when there’s a threat to international peace and security. I would submit that COVID-19 is a threat to international peace and security. It can – there’s no veto rights for members of the Security Council, it’s – you’d have to have a certain number of members of the Security Council, I think it’s seven, to agree on an Emergency Special Session, or you can have a particular number of member states agree to a special session. There’s been no global gathering of countries to work on a global response. The World Health Assembly that took place in May didn’t do that, and so I don’t – it’s a very good question, and I do think that a multilateral body does have a responsibility to bring countries together, to think about what the response should be. That hasn’t happened, and I do think that’s a crucial gap. It may not be WHO’s responsibility alone, but certainly, it has part responsibility for that. But David may be able to throw more light on those systems.
Professor David Heymann CBE
Well, you know, Richard and Emma, I’ve given a lot of thought as to why countries are really acting on their own in this outbreak, as opposed to some events in the past, and one of the reasons that I believe might be important is the fact that there is so much information available now. All the medical journals, all the major medical journals, again initiated by The Lancet, are publishing data in front of their paywalls, and not only that, but they’re reviewing these articles in a rapid manner, so that they can get the information out rapidly. At the same time, WHO is making all kinds of information available on its websites, as are other agencies, and therefore, countries can do their own risk assessments and feel that they are therefore empowered, not only to do their risk assessment, but to tailor-make their response based on their national risk assessment.
And that would be fine, if they understood also that risk assessments must be conducted by a country, but then joined with risk assessments of other countries in a world that’s so globalised, and that’s what’s not happened. The political leaders, for some reason or another, have not been willing to work together, as Richard suggested, in order to jointly make a unified response and, as a result, we’re seeing that they don’t know what to do now. Some countries are locking down and there’s an increase in transmission in part of their own country, or in another country they’re prohibiting travel, a whole series of disjointed events, which could be occurring in unison, making a world which has equal risk and then equalisation of travel and equalisation of other activities. But that’s not occurring, and I think Richard’s idea of getting the political leaders together to really discuss this is very important.
Emma Ross
The most upvoted questions, I’m going to speed up a bit ‘cause we’re coming to time, from Benjamin Stokes. “Grateful for Richard’s comments on the institutional setup in the UK, e.g. how SAGE is constituted? What’s a better way to into – institutionalise the political scientific interface?” Better than SAGE, and also, I would add – can I just add to that, a bit strange, I mean, should we have had to have ended up with a, kind of, rival SAGE setting itself up? I mean, what was…?
Dr Richard Horton
And, yeah. Well, you know, this is what needs to be looked at, and, I would submit, overhauled, our regime of science policymaking, and, you know, it – I don’t think I can give a very simple blueprint for that, but I do think that the system that we had – if you just step back and look at the complexity of it, you have a Chief Medical Officer, and, if you go to his office, you know, he’s got a whole entourage of people who work in the CMO’s office, the Chief Scientific Advisor, then you have SAGE, and then you have NERVTAG, and then you have SPI-B, and you have SPI-M. The point is, that we have an overlapping set of committees, all with absolutely superb individuals on them, but it’s very complicated, and the complexity of the committee system that we have, all feeding through into a decision-making process in government, whether it’s COBRA or the Cabinet Office, I – when I look at the SAGE minutes and I look at the NERVTAG minutes, I get the sense that nobody’s quite prepared to take the responsibility to say, “My God, this is serious. We need to be ramping up the risk assessment. We need to be going to the Prime Minister and saying, “This is something serious.”” There’s a lot of – I don’t – this is not the right – this is not a scientific term, but there was a lot of pussyfooting around, and not really grasping the fact that this was an emergency.
And, you know, one of the things you learn as a Doctor is, you know, you’ve got to be able to spot the patients who are seriously ill, and a good Doctor will spot the patients who – you’ve got a list of 25 things to do after the ward round and you need to be able to prioritise the sickest patients first. And I, kind of, got the sense that these committees were all – were talking about a whole array of things, but were missing the key point, which is, we’re on the verge of being hit with this pandemic.
So, I think we need to streamline the policy advice. We need to make sure we have the right people in the room, because we didn’t have the right people in the room. The reason why independent SAGE was set up was because there was a sense that the actual SAGE didn’t have public health advice properly represented in the group. And that public health advice was then properly represented, it didn’t have people who understood about Black, Asian and minority ethnic communities, that evidence was evaluated in independent SAGE. So, the point is that I think there are grounds for rethinking the way policy advice is made. Streamline it, simplify it, and have a much clearer mechanism for injecting that advice into government.
Emma Ross
This next one, I think I’ll start with David, and it’s an upvoted question from Douglas Andrews. “Both speakers have been laudatory about collaboration with Chinese colleagues and government during the early stages of the pandemic, yet it must be acknowledged that both SARS and COVID-19 emerged from Chinese live animal markets. It has also been acknowledged that there will almost certainly be future pandemics, which may emerge from the same source. What is the probability of convincing the Chinese Government to supress these markets in the interest, among other things, of global public health?” David, do you want to start? What do you think are the prospects?
Professor David Heymann CBE
Well, I think, before anyone supresses markets, we need to understand more about what’s going on in markets. And, you know, suppression of a market, without then being able to enforce that suppression, creates a black market, because, if you don’t decrease the demand for the wild animals, you do end up with a trade that’s under the – out of sight, rather, and black markets are created. So, before shutting down any markets or before telling the Chinese what to do, everyone needs to understand what’s happening. There are ways of preventing wild animals in markets from transmitting infections, for example, if they’re raised domestically, in an area where they aren’t infected, where bats or whatever infects them are kept away, they can be safely sold in markets. So, it’s not just a decision, “We will tell the Chinese to shut down the markets,” it’s getting the evidence of what’s going on and figuring out ways of decreasing demand or satisfying that demand in a more safe way, because no matter what you shut down, if the demand is still there, that will be accommodated through illegitimate sources.
Emma Ross
Richard, anything you disagree with or has David left out on that that you want to add?
Dr Richard Horton
No, I fully agree with David. This is not a simple issue of turning off live animal markets. There’s a lot that we still don’t understand about the origin of this virus, and we do actually need to have teams looking at the connection between wildlife outside of the city, the connection between that wildlife, and then the market itself, the connection between human settlements and the market. I mean, it’s a much more complex dynamic than simply saying it’s the – “The live market is responsible, we need to shut down the live market.” We still haven’t traced the origin of this virus, so I would say, you know, one of the things I hope we can do and – with the Chinese Scientists is study that origin process, and then that will help us make the decision about what to do, but don’t think that the magic bullet here is just shutting down live markets because it isn’t.
Emma Ross
Okay. Last audience question before I wrap up, and this is a quick one for you, Richard, from Dina Mufti, and I’m squeezing this in because it’s come up in previous webinars and didn’t get answered. Do ionisers deactivate COVID-19 in the same way they deactivate other viruses? Are bronchodilators and steroid inhalers effective as a therapeutic?”
Dr Richard Horton
Oh, my goodness.
Emma Ross
[Inaudible – 47:24],
Professor David Heymann CBE
I’m glad you got that question, Richard.
Emma Ross
If you’re up to it. If you’re not up to it, just say pass on that one, but I thought…
Dr Richard Horton
I’m not up to – it’s always good to acknowledge when you’re not up to something, so I will…
Emma Ross
David, do you answer or do we – oh, I think I posed that to you last time and we didn’t get it answered.
Professor David Heymann CBE
Yeah, I’m not – I don’t have the clinical expertise to answer that. But we can certainly get that expertise and get an answer to this person, so…
Emma Ross
Gloria Dina.
Professor David Heymann CBE
…Emma, let’s do that instead.
Emma Ross
Are you committing to that, David?
Professor David Heymann CBE
Yes, Dina, we’ll get you an answer from someone.
Emma Ross
Okay, I’m holding you to that. I’m going to chase you down to get that answered. Okay, so, Richard, just to, kind of, come full circle here, in terms of The Lancet’s role in furthering the science, and you seem to like setting up commissions to take on the big topic. And you’ve announced two COVID commissions so far, The Lancet Commission on COVID-19, that’s already started, and a second one, actually in collaboration with us, which is The Lancet Chatham House Commission on Improving Population Health Post COVID-19, which seems to be a planetary health agenda, to kick off in the autumn. What do you see as the role and impact of Lancet commissions and what contribution do you hope these two will make, and why have you chosen these two topics, and what else have you got up your sleeve, in terms of commissions looking at other angles in this pandemic? That’s my final question to you.
Dr Richard Horton
Oh, yeah, yeah, my colleagues get very upset with me because we spring these commissions on them and I haven’t told them about them. Okay, so, Jeff Sachs, who, along with a fantastic group of people, and we’ve had the first commission meeting actually, is looking at the wider lessons of the COVID – of COVID-19. That’s really trying to take a very broad – not just health, actually, but also look at some of the links between health and economics, health and environment, health and geopolitics, to try and communicate, from an independent group of scholars, what the evidence tells us, or might be telling us, about how we respond in the coming months. So, the idea is that, if you get some of the smartest people from the scholarly – from various scholarly communities around the table, then that can be a platform for independent advocacy to political decision-makers.
The idea is that they’re meeting, over the next few weeks, in order to be able to have a statement for the United Nations General Assembly in September. There will then be an interim report early in 2021, and there will continue to be interim reports and statements, as the pandemic evolves. So, we see this as a dynamic process, it’s not meant to be – again, it’s not meant to be about blame, it’s not meant to be super critical, it’s meant to be constructive and helpful.
And, of course, the one with you, Emma and David, at Chatham House, is trying to take a broader look at some of the more specific public health dimensions. You know, we’ve got Prime Minister Boris Johnson talking about obesity now, that’s very important, it’s a great opportunity, but we need to get that right, and some of the things that he’s suggested I think we would fully support, but we might also want there to be other dimensions to be considered, and it’s not just obesity, there are other issues to consider. So, the commission that we’re doing with Chatham House is going to try and have a very broad look at some of the post-COVID-19 lessons for public health, whe – and that’s not just infectious disease, obviously, it’s also going to be going into the non-communicable disease area. So, that’s what we hope for.
Emma Ross
Okay, great. Thanks for explaining those. So, I’m sorry that that’s all we have time for today, and, sadly, this is our last session before the summer break. We hope you’ve all enjoyed tuning in to the variety of discussions we’ve had over the last few months, on the various aspects of the pandemic, and, of course, the opportunity to field your questions to David and the distinguished guests we’ve had join us. Of course, there are lots more aspects to cover, and we’ll be back in the autumn, but, until then, wishing you a great summer, and, Richard, thank you so much…
Dr Richard Horton
Thank you, Emma.
Emma Ross
…for joining us. And, David…
Dr Richard Horton
Thank you, David.
Emma Ross
…thank you for sticking with it, and being a trooper, as I pushed you along for months and months and months, so hopefully, everyone’s enjoyed it, and that’s it for now, and wishing you all a great day. Thanks.
Dr Richard Horton
Thank you. Take care. Stay safe.
Emma Ross
Bye.
Dr Richard Horton
Thank you. Bye, bye.
