The comfort of simplicity

How two loud extremes convinced themselves that pandemics are easy to solve

It’s funny how groups with widely differing views can eventually coalesce. Take vaccines. At one extreme, we have people who claim COVID was harmless and hence vaccines had no effect whatsoever¹. Some of these people are apparently so determined to have ‘independent thinker’ in their social media bio that they’ll find whatever scrap of biased, inconsistent data they can to try and convince people that widely accepted conclusions are wrong.

And the other end, we have people who claim COVID is still as bad as it was in 2020². Despite having the opposite view on risk, they have a similar view on vaccine effectiveness. If COVID is still the same problem, it must mean vaccines haven’t done anything to protect people. These people often cite estimates of low recent vaccine effectiveness against symptoms, perhaps not appreciating these estimates aren’t comparing current vaccine recipients with an unvaccinated person teleported from early 2020. These studies are instead comparing a recently boosted group with a ‘control’ group that will also have had multiple exposures by now, both to vaccines and similar infections.

These are two groups that on the face of it couldn’t be more different, but have become united in a flawed view about the effectiveness of vaccination.

We see something similar with attitudes about how to deal with a pandemic before vaccines become available. At one end, we have people who suggest that respiratory infections can be suppressed (i.e. pushing the reproduction number below 1, tipping the epidemic into decline) simply by adopting lighter touch measures, like more mask wearing or getting more infected people to isolate. These measures will have some effect, but not enough to suppress transmission on their own. Despite the COVID experiences of places like Hong Kong and Singapore, with additional local measures – and strict border restrictions – introduced to supplement widespread mask wearing, the notion seems to be that we can fully control epidemics without having to take much action, or make particularly difficult decisions.

At the other extreme, we have people who argue that it’s simply not possible to suppress infections like COVID, often citing muddled analysis of the effectiveness of control measures. In this narrative, the COVID pandemic declined because of strong (yet conveniently impossible to detect) immunity, or other explanations that are long on speculation and short on evidence. Yet the conclusion is the same: we don’t have to do anything difficult when faced with a novel pandemic.

Recently, the US recorded its second ever case of H5N1 avian influenza (aka ‘bird flu’), in someone who’d been in contact with cattle. Although this particular incident is unlikely to lead to further spread in humans, it’s part of a wider picture of H5N1 spreading in a range of species in a range of locations around the world. For the first time, with unprecedented genomic surveillance globally, we may well be watching a new pandemic virus emerging in slow motion. Or, perhaps, H5N1 won’t make the required evolutionary leap to spread efficiently in humans, and the next pandemic pathogen will be something else entirely. Maybe it won’t even be a respiratory infection; we’ve previously had vector-borne (Zika) and sexually transmitted (HIV) health emergencies.

If countries want to avoid a repeat of COVID, they must address some difficult questions about what is feasible and acceptable. The volume around easy solutions will only grow as the memory of the worst of the COVID pandemic fades. But if we retreat into the comfort of narratives that pandemics do not require much action or preparedness, the memories could end up even worse next time.

Additional note: A couple of comments have queried the line above that ‘we have people who claim COVID is still as bad as it was in 2020’ – although it’s an extreme position, there are still lots of posts on platforms like Twitter claiming ‘COVID is as dangerous as ever’ or similar.

1. COVID isn’t harmless, and vaccines do work.

2. It isn’t as harmful now as it was in 2020.