The present pandemic is too much with us to be a subject for the stage at the moment, but I have no doubt that in future years it will offer a range of possibilities for plays arising from the personal sacrifices and tragedies which make up the material of news from the radio and TV. But apart from the many specific human problems, there is a more general central problem which could be explored and make a political play.
The strategy of the Government is to follow what they consider to be the medical advice. This was first a matter of avoiding personal contact and hand-washing, but has now been extended to as near a complete lockdown as the public is willing to tolerate. This strategy is summed up in slogans such as: 'Save lives and protect the NHS'. There were, however, voices from the start which pointed out that this policy will lead to economic catastrophe.
'Economic catastrophe' can seem an abstract worry as compared with the immediate need to protect lives, but in reality economic catastrophe is far from abstract. It means ruined small businesses, poverty for young families and the grim reality of unemployment. Yes, we want to see shots of the nation applauding the workers in the NHS and the care sector but we should also remember the grim shots of dole queues during the depression in the 1920s and the use of troops against strikers. Perhaps the slogan 'Save the NHS' should be balanced with 'Save young families'. Poverty can stunt lives and kill as well as a virus.
What is interesting is that this tension between a legitimate medical aim and a wider social aim has already been worked out in a drama by Henrik Ibsen. An Enemy of the People
was first performed in 1883. The play succeeds in making us vividly aware of a central ethical problem of public health medicine.
The main character in the play is Dr Stockman, who is the doctor in charge of baths. The doctor had the idea that the creation of baths would bring tourists and some prosperity to the small town in which the baths are to be situated. This has proved true and when the play opens the doctor is popular in the community both for the creation of the baths and for his medical work among the townspeople. Unfortunately, for reasons of cost, the baths have been located below a tannery against the doctor's advice and the water flowing into the baths has been contaminated by effluent from the tannery.
In the first act, the doctor receives conclusive scientific proof of the contamination of the water and the resultant danger to public health. He proposes to publish his report, which has been enthusiastically received by the local newspaper editor. The mayor of the town is the chairman of the baths committee. He has vested interests in the baths and tourism; argues that the doctor's scientific report is exaggerated (fake news); that the town will lose its tourist appeal; and that he as the chairman forbids the publication of the report. He sacks the doctor. The newspaper changes sides and will not publish the report, and at a public meeting the mayor, the editor and their supporters turn the people against the doctor who is declared an enemy of the people.
Perhaps the central point for the present time is made by the editor of the newspaper in Act II. Dr Stockman is portrayed as in many ways a simple character, dedicated to scientific truth. The editor does not dispute the scientific truth of the doctor's report but says: 'You're a doctor and a man of science, and to you this business of the water is something to be considered in isolation. I think you don't perhaps realise how far it's tied up with a lot of other things'.
I suggest these 'other things' create three problems for public health medicine. The first is the one which is highlighted in Ibsen's play. The medical point of view has to be implemented in a complex social and economic situation. There can be conflict between the value of saving lives and other values, such as employment and individual freedom. This conflict is acute. Despite the tragic deaths of some young people and some NHS workers, the vast majority of the deaths are of the elderly with underlying conditions. We must set against these deaths the ruin of small businesses and young people facing indefinitely impoverished lives for themselves and their children.
The second problem is that, whereas there are well-known uncertainties around economic predictions, there are also uncertainties around the predictions of public health medicine; epidemiologists can differ in their predictions, preferred models and methods, and different countries have employed different approaches to the situation. For example, while we were told that schools must be shut, some public health doctors are now querying the need for this, and certainly it didn't happen in other countries such as Finland. Or, we are told that the total lockdown must continue, whereas some epidemiologists suggest that not all sectors need to be locked down. The Government may be following some medical/scientific advice, but the evidence of epidemiology can be controversial because, as we learn in Ibsen's play, 'it is tied up with a lot of other things'.
The third problem is that the views of both economists and public health scientists must be conveyed to the general public. But the public does not respond well to uncertainty and is always on the look-out for someone to blame and put the boot in (as our former Chief Medical Officer has discovered). At the moment, the standard way of presenting policy is to have a centrally-placed politician flanked on either side by the Chief Medical Officer and the Chief Scientist. I wonder if it might be more appropriate to have one or other of the two wingers replaced by someone from the Institute of Fiscal Studies. Now that would make a drama, and not one with a happy ending.