Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.
As the bells rang in the New Year, I reflected on the one just left behind and what lies ahead. I am sure I was not alone. For those of us in the Western Hemisphere, 2020 must have been the most disruptive year we have experienced since 1940; a vicious pandemic, social divisions, migration, political incompetence, and the increasingly obvious effects of climate change, ending the year in Britain with floods.
As 2020 ran on, our eyes were opened to the interconnectedness of these apparently separate disasters. The conditions that give rise to them are the structures of our society; they relate to civilisation itself. Civilisation is the term that we give to mankind's method of creating our own habitat; our attempt to overcome our obvious disadvantage in terms of genetic evolution by adapting our environment to suit ourselves and our lifestyle. But within the great flowering of civilisation, the product of mankind's ingenuity, lie the seeds of its destruction, and they are beginning to germinate.
Two adjectives have become irritatingly noticeable in the discourse of politicians: incredible and fantastic. As I write them, I can hear the tone of voice in which they are expressed, and I expect you can too. I am afraid that we need to take them more literally than those who use them intend. The promises made in support of ideological commitments were certainly hard to believe, often obviously untrue, and were indeed based on fantasy, as our fishermen and the poor in the north of England are beginning to realise. The impetus for Brexit came from the wealthy and powerful, from those who had presided over the progressive impoverishment of a large section of society in Britain and the USA, to the benefit of the few.
Now we have to live with the all too credible reality of economic and societal damage from the combination of COVID-19, climate change and Brexit. But there are some signs that make me cautiously hopeful. They are the product not of small-minded, ideological and nationalistic politics but of international collaboration in science; they are vaccines.
Where are we now? The arrival of vaccines
On 18 November
, I discussed the likely arrival of several vaccines and urged caution in expecting a rapid resolution of the pandemic. My two pinches of salt were that we should expect distribution problems and that it would be unlikely that life would ever quite get back to normal. I also drew attention to the propensity of the virus to mutate.
In the past few weeks, two new mutants have evolved – one in England and one in South Africa. Both involve genetic changes to the spike protein that it uses to latch onto cells in our airways. These changes are associated with the virus becoming even more transmissible though probably not more virulent. Nevertheless, the more who are infected, the more end up in hospital and on respirators, and there is now a frightening amount of pressure on the NHS. We can expect more variants to evolve and therefore I believe that COVID-19 is well on the way to becoming an endemic disease, requiring continuing annual vaccination.
So far, three vaccines have been introduced in UK for emergency use and the early indications are that the Pfizer/BioNTech nanoparticle mRNA vaccine is being administered with distribution difficulties owing to its requirement to be kept at -70C, leading to tales of hospitals giving it to anyone who is available as refrigerator time runs out while frontline staff go without. The Moderna vaccine is very similar but requires to be kept at a temperature of -20C. The Oxford/AstraZeneca vaccine can be kept at normal freezer temperatures and is available in larger amounts.
Essential workers most at risk in hospitals and all those in care homes should get vaccinated first since they are most exposed and most likely to pass it on to others. Moreover, I hope that teachers will be vaccinated before the children arrive back at school. Next come the vulnerable elderly in the community.
Until then, we must be prepared to endure isolation and serious restrictions for another few weeks or months. Both require two doses a few weeks apart for full immunity, although three weeks after one dose there is good protection for an unknown period. Because at present the NHS is seriously threatened and supplies are limited there is a strong case for giving one dose to as many people as possible and prolonging the two-week period up to 12 weeks until sufficient supplies are available, as this will undoubtedly save more lives. The duration of protection is so far unknown but is likely to be long enough to have a substantial influence on the pandemic wherever there is widespread uptake.
All three vaccines can be expected to give good protection from serious COVID-19 and to be safe in adults. They are radically new; the Pfizer/BioNTech and Moderna ones contain engineered spike protein mRNA encapsulated in a lipid nanoparticle, whereas the Oxford one contains a harmless attenuated adenovirus to which the mRNA of the SARS-CoV-2 virus spike has been fused.
It usually takes up to 10 years for a new vaccine to be introduced, but these three and several others in USA, China and Russia have been introduced within 12 months. While all have gone through the initial two phases of development, in all cases the more prolonged experience of their efficacy and safety in usual phase 3 trials, while still continuing, has been interrupted for emergency introduction. The three introduced in UK so far both work and are reasonably free of side effects other than very mild symptoms such as we get after influenza vaccines, but it is not possible yet to comment on their relative efficacies in general use.
At present, experiment evidence shows that all three vaccines are likely to be effective also against the new variant SARS-CoV-2 virus, since the mutation of the spike protein is relatively small. Moreover, an advantage of these mRNA vaccines is that they can be modified and manufactured much more easily than traditional vaccines. It is therefore reasonable to suppose that if enough of us are vaccinated soon enough, we should see a slow return to a less restrictive life over the next six months. This is now dependent on efficient distribution and on our cooperation. The more of us who are vaccinated, the safer we all shall be.
Where are we heading?
One of the most shocking aspects of our response in Britain to this pandemic has been the attitude of a subsection of the population, not excluding people in authority who should have known better, who seem wilfully to ignore advice intended to reduce spread of the virus. Initially, this subsection included the Prime Minister himself, his chief advisor, and our own then chief medical officer, who thereby must have had a huge influence for harm. This reflects a common attitude of their generation, the shift from the post-war more centrist consensual politics to the neo-liberal competitive attitude, to the primacy of self over society that has resulted in our divided and troubled nation.
This fundamental shift in economic thinking in the 1970s, setting aside its underpinning in morality from the time of Adam Smith, has been behind all these problems we now confront – the appalling management of the pandemic, isolationism, the growth of an underclass and a parasitic super-rich class, and failure to manage the Earth's resources. It is easy to be pessimistic, but it is also easy to grasp at unrealistic solutions put forward on ideological grounds. As it is clear to many that Brexit is of no benefit either to the EU or to the UK, is it sensible to suppose that Scottish independence from its major market would benefit either party? The loss of one partner, Mr Johnson, may be regarded as a misfortune; to lose both looks like carelessness.
A better world: we are all in it together
It is to be hoped, with some justification, that the announced arrival of the more easily transported Oxford/AstraZeneca vaccine will within a few months make significant inroads into the spread of COVID-19. Whether it does will also depend on continued serious commitment by the population in maintaining the public health measures we have become used to and accepting vaccination as not only personal protection but also civic duty.
But welcome as an end to the pandemic would be, this alone is not enough since there is something rotten in our nation and indeed more widely across the globe that set the scene for the medical emergency and its effects. This is something that all young people must now think about as they look to the life they will live over the next decades. Where do they see the present system of acquisitive capitalism leading us individually and collectively? Where are the advantages to the people of the planet from withdrawing from negotiated alliances and long-term associations?
It might be helpful to reflect on another world than the politico-economic one that has led this decline; the world of science that has discovered the ways to combat this virus through international collaboration, much of it by work in government-funded universities by individuals driven by curiosity and altruism more than by financial incentives.
Bells toll not only for death but also to warn us and to bring us together for safety, rather like the air raid sirens that were a feature of my early life. The dawn of 2021 is our 1940 moment as we approach the second peak of the UK epidemic, but there are signs of new thinking, from David Attenborough and Greta Thunberg on the climate to the economist Paul Collier in his book, The Future of Capitalism
. Plagues have a history of changing the world; the bell is tolling for all of us to do what we can to change it for the better.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own