Is lockdown right? Bioethics, global health, and COVID-19

I gave a public lecture at Virginia Commonwealth University, and it’s up on YouTube here. Bear in mind it was midnight my time… surreal but enjoyable experience.

In this talk I argue for these five claims:

  1. Several common arguments for lockdowns fail
  2. Many actual lockdowns have been unjustified and wrong: other measures would have been better
  3. Globally, lockdowns shift the burden of disease from the powerful and wealthy to the less powerful and poor
  4. The global preference for lockdowns is due to their favoring the interests of the rich and powerful
  5. Optional extra: the favoring of lockdowns by the “left” and rejection by the “right” has nothing to do with their intrinsic character: they are as much right as left and vice versa

Lancet letter: ‘Lockdown is not egalitarian: the costs fall on the global poor.’ #epitwitter

We wrote this letter a couple of months ago in response to an editorial in the Lancet suggesting that opposing lockdowns was neoliberal. I continue to be surprised by how the world hasn’t noticed that, in fact, extreme measures to combat COVID-19 shift the burden from the wealthy to the poor, who suffer more from the measures than from the disease. It’s a disease that primarily affects the old, and thus primarily the wealthy. This is true even if people who are of the same age fare worse if they are lower down the socioeconomic scale. That is unsurprising, extremely so; what is surprising, and what outweighs that effect massively, is that this disease is so much more dangerous for demographics that are dominated by the wealthy of the world. I still feel that has not been grasped in the global north. So, I’m very pleased to have this letter out. Maybe it will change the perspective just a little towards a more global one.

UJ Panel on the Post-COVID World, Wed 13 May 5.30pm SA time, with Johan Giesecke, Joyce Banda and Sehaam Khan. I’ll be facilitating. Can’t wait! Register for the webinar here: #epitwitter

This is the first in a series of webinars on Shaping the Post-COVID World, organised by the Institute for the Future of Knowledge on the initiative of the Vice Chancellor’s Office at the University of Johannesburg.

You need to register to watch this live, and it will be posted as a recording afterwards. Register here:

Historians distinguish two ends to a pandemic: the biological end, consisting in the eradication or control of the disease, and the social end, when people stop fearing the disease and society resumes its normal shape. The “Post-COVID World” may never come from a biological perspective, and some are also saying that it may never come from a social perspective either – that the world will never be the same again. Whatever the case, it is clear that the pandemic that took us by surprise was in fact highly predictable, and indeed predicted by the World Health Organisation, the former President of the United States, and many others. It is, moreover, anything but unprecedented. Sometimes, we cannot predict; but other times, we can, but don’t. Whatever the Post-COVID World is like, our first lesson must be to think more carefully and openly about the future – starting with the Post-COVID World itself.

Our first panelist, Her Excellency Dr Joyce Banda, founded and leads the People’s Party in Malawi. She was President of Malawi 2012-2014. She is an advocate for the rights of women and children, two groups who have been disproportionately affected by the consequences of the COVID-19 pandemic despite being less at risk from the disease itself. Malawi is one of the world’s poorest countries, with over half the population living in poverty and a quarter in extreme poverty (food insecurity and malnutrition), with significant dependence on foreign aid, rendering it vulnerable to global economic downturn. The human consequences of economic downturn will linger in Malawi and elsewhere long after the lockdowns in Europe and America have eased. When the world looks to the future, it must bear these consequences in mind.

Professor Johan Giesecke is an infectious disease epidemiologist, and the scientist masterminding the Swedish response. He has advocated focusing on what comes next – most strikingly, when he asked Australia whether it intended to keep its borders shut for 30 years, in the unlikely event it succeeded in eradicating the virus within them. Contrasting with the “lockdowns” implemented in many countries, the Swedish approach has been to focus on evidence-based (rather than precautionary) interventions to slow the spread of disease, and on protecting vulnerable groups. This is sometimes referred to as a “herd immunity” strategy, which is inaccurate; protecting the vulnerable is the goal, while herd immunity is a by-product of any strategy short of eradication. The Swedish approach stands in contrast to lockdowns pursued in many European countries, and is motivated in part by an eye on the medium and long term future.

Professor Sehaam Khan is a microbiologist and Dean of Health Sciences at the University of Johannesburg. Under lockdown, South African universities have moved to online delivery of teaching. Opinions differ as to how successful this is proving, and how sustainable it may be. Not all students are able to access online resources, and not all subjects are amenable to online teaching. Disciplines requiring hands-on training, including some medical disciplines and laboratory sciences, are heavily impacted by lockdown. Much more than schools, universities mix generations, and while evidence suggests that schools can be reopened without much risk, there is little evidence about universities. The sector will need to think ahead, bringing together health expertise with a deep understanding nature of the university and its and societal role, in order to emerge strong from the chaos.

COVID on the Breadline documentary – 7 min and 30 min versions in one place

Documentary showing the reality of lockdown for the world’s poor

7 min version (low res, suitable for whatsapp etc)

COVID on the Breadline. Short version from PICTURING HEALTH on Vimeo.

30 min version

COVID on the Breadline from PICTURING HEALTH on Vimeo.

If you’ve never been to an African hospital, please watch just a few seconds of this (not graphic/gruesome, just informative) #epitwitter

Thanzi la Onse (Health of All) from PICTURING HEALTH on Vimeo.

This is a film someone sent me about allocating resources in Malawi’s main hospital, and by extension, in all low resource settings. It’s interesting in itself but I think just the images are worth seeing if you’re from the West/North and have a Western/Northern image of a hospital. It’s not gruesome or graphic: it’s just striking how small and informal everything looks. Watch a bit more and you’ll get a flavor of both the shortages, and the way that allocation works – competition, persuasion, patching budgets together. It gives you a flavour of the sub-Saharan context of operation. The lack of basic equipment such as ventilators is of course shocking. (If you aren’t aware, the ICU unit is fundamentally built around the mechanical ventilator.) It’s eye-opening. You’ll see what I mean…