At the start of the pandemic, a Covid-19 vaccine was anything but certain. Medical science is as hard as it is unpredictable. Now, in the first weeks of 2021, we have not just one vaccine, but three.
That’s remarkable news – but as I’ve argued in Tribune before, the descent from a peak is always dangerous. More people die coming down Mount Everest than going up, exhausted from the ascent. The same is true of pandemics.
The Prime Minister attests to this fact. On Monday, he said:
This is a very perilous moment because everybody can sense that the vaccine is coming in, and they can see the UK is vaccinating large numbers of those that need it most.
But it’s not the people who need this warning. It’s the government.
We remain in the heat of the crisis. And yet, support is limited, particularly compared to last year. That means we are not doing everything we can to save lives and protect the NHS. Instead, the government’s plan seems to be to grit its teeth, provide minimum support, and gamble everything on the vaccine.
Such a risk is needless. The more sensible plan would be a mass rollout of the vaccine, combined with a mass rollout of social security. Social security would both save lives and protect the NHS—an inoculation against the social injustices on which Covid thrives—while the vaccine secures our exit from the crisis.
Responsibilities Must be Combined with Resources
We need only look at the state of the NHS to see that waiting for the vaccine—even if logistics go smoothly—would be foolhardy. We face a monumental peak of the virus over the coming weeks and months. The severity means some hospitals are at the point where they may have to refuse critical care to the sickest – something avoided during even the April 2020 peak.
Put simply, we are on the cusp of not having a universal health service for the first time since its formation in 1948.
It would be unfair to say that the government is not acting at all. The problem is that their action is increasingly defined by ceding responsibility to individuals. Lockdown has become stricter. The police have expanded their regime of fines. And the Secretary of State for Health and Social Care has indicated that new restrictions could take away things like the right to daily outdoor exercise.
What they’ve forgotten is that responsibilities are meaningless without rights. Why is the government refusing to touch the key policy levers that could help people do difficult things like staying inside, social distancing, educating children from home, caring for relatives, and generally sticking to lockdown?
A major speech by the Chancellor on Monday constitutes a particular missed opportunity. Despite telling MPs that ‘we should expect the economy to get worse before it gets better’, he failed to provide any extra support to people who are struggling.
Nor did he set out a plan to stop businesses forcing people into offices, or indicate a long-term economic plan. What we needed was a plan to keep children fed, to support carers and childcare, to provide enhanced sick pay, to enhance housing security, and to tackle the looming mental health crisis.
These are the policies that would enable people to follow the restrictions closely, self-isolate when needed, and keep the spread of the virus to a minimum.
Reducing Workplace Transmission
Harrowing data released by the TUC this week shows that seven in ten rejected requests for furlough have come from working mums. Nine in ten feel this has led to stress, anxiety, and worse mental health. One in four fear they will lose their job.
This makes it harder for them stay safe, to keep their family safe, and to meet the host of responsibilities being heaped on them. Giving this group stronger workplace rights would be one way to achieve lower NHS demand and good public health programmes while the vaccine programme works.
The government should focus less on personal responsibility and look at how businesses can do more to cut Covid-19 transmission – specifically, halting firms unnecessarily bringing people into workplaces and offices.
The approach to business should not just be punitive either. Businesses have been hit hard by the pandemic. Many will be close to bankruptcy and liquidation, making bosses and employees alike fearful for the future of their jobs, and therefore more likely to take risks around going into physical workplaces.
The government should be doing more to guarantee the future of firms to give employers more confidence to furlough staff or encourage home working wherever possible.
Rather than loading firms with even more debt through loan schemes, they should use public equity injections to support businesses. State financial support, in exchange for public stakes in businesses and corporations, would be one way to leverage public ownership to support public health and economic recovery.
Politicised Targets are No Substitute for Policy
In place of support for businesses and people, we have big targets intended to accelerate vaccination speed.
Ministers have not limited themselves to just one vaccine target, either. There is a full range: every adult by Autumn, two million jabs a week from this week, 14 million inoculated by mid-February.
Such politicised targets aren’t new to the NHS. Since Margaret Thatcher’s government, the NHS has been run according to New Public Management – which preaches a mantra of ‘targets and markets’.
The problem is these kinds of targets don’t actually help. As Charles Goodhart famously put it – when a measure becomes a target, it ceases to be a good measure. Political targets don’t inspire strong delivery so much as gamification, data manipulation, and other unhelpful behaviours.
We can see his point in practice. Last year, testing targets led to Matt Hancock pushing out very suspect testing figures, undercutting the public’s trust in the programme and resulting in a slap on the wrist from the regulator. That’s the risk now being run around vaccines – an area where public trust is absolutely critical.
Inoculate Against Social Injustice
The descent is always perilous. In this case, the danger comes from the government gambling too explicitly on the vaccine, and not doing enough to reduce Covid rates in the meantime.
In the end, the difficulties we face in 2021 will come down to social injustice. If we can’t give people what they need to cope with the responsibilities being hurled at them, then excess deaths will be high, and the NHS will struggle. That will happen regardless of how the vaccine programme does.
What we need is a programme of inoculation against social injustices based on giving more resources to people at home, more rights to people at work, more support to struggling businesses – and a stronger social security safety net to everyone. This would be a sensible gamble.
What we don’t need is our government recklessly betting the house on the vaccine alone.