Transcript: Episode 43
One year on: What do we know now?
people, pandemic, vaccines, ucl, uk, behaviour, countries, susan, oksana, virus, government, communities, misinformation, transmission, isolate, home, world, run, issued, showing
Oksana Pyzik, Susan Michie, Vivienne Parry
Vivienne Parry 00:02
Hello and welcome to Coronavirus, the whole story, UCL's award winning podcast all about the pandemic and the vital research happening right here at UCL to fight it. Over the past year, I've spoken to staff and students from what feels like virtually every single department here at UCL. Dear listeners, we've still barely scratched the surface of the treasure chest of talent being applied to the pandemic by this fine institution. In this week's episode, almost a year to the day since the UK is first locked down, are speaking to two researchers from the UCL School of Pharmacy and the UCL Division of Psychology and Language Sciences about that year, how far we've come, and how we're going to use all that research to improve public health policy and ensure that we're better prepared to tackle disease outbreaks and prevent future pandemics. My first guest today is Oksana Pyzik. Oksana is a lecturer in Global Health at the UCL School of Pharmacy research department of practice and policy. She leads the UCL Global Citizenship Programme on outbreaks of infectious disease, and in 2015, founded UCL Fight the Fakes Alliance to advocate for affordable and efficacious medicines for all. Earlier this month, Oksana gave a lecture on the coronavirus pandemic, and how it evolved over the past year. And you can watch a recording of that lecture via the link in the description of this episode. I'm also delighted to be welcoming back Professor Susan Michie. Susan is a professor of health psychology and director of the Centre for Behaviour Change here at UCL and her research, which focuses on behaviour change in relation to health in the environment, has been hugely influential on public health policy. Susan serves as an expert advisor on the UK scientific pandemic influenza group on behavioural sciences, and she's also a consultant advisor to the World Health Organisation on COVID-19 and behaviour to supremely qualified guests this week, and two questions. What happened? What's gonna happen next? Easy peasy. Let's start with that first question. Oksana. In the UK, it feels very much like the pandemic is starting to come to an end. But is this really the case? And what are the global Coronavirus statistics look like now,
Oksana Pyzik 02:23
we're in the UK we have been managed to roll out a very successful vaccination programme. But ultimately, we are still in the acute phase of the pandemic globally. So we aren't at the end yet. So far, there have been about 2.7 million deaths associated COVID. And that's likely an underestimate, and about 300 million vaccines of all sorts administered. But there has also been a huge inequity in that distribution, which means that some countries may see cycles of outbreaks and lockdowns until 2023 and 2024 if we don't start to think about this problem, in a more global sense, and I think that the UK has been desperate for some good news after we reached a very tragic milestone, previously having the highest mortality rate per capita in Europe in the world. And this shocked many, because the UK for a long period of time has been viewed as the home to many leading experts, and advise many countries on Ebola and Zika, and how to really improve infectious disease response. So I think not just the UK citizens but the rest of the world, the handling of this pandemic has been puzzling. And we still have many threats that we should not underestimate, including a recent report, which shows that the AstraZeneca vaccine may not be as effective as we had hoped, for the South African variance. So variance are the next frontier as well as vaccine distribution. And I would say until we emerge out of the acute phase, this is not over yet,
Vivienne Parry 04:14
look trying to use Susan, from a behavioural point of view, how differently are people around the world behaving compared to this time last year,
Susan Michie 04:24
it's very difficult to get an overall global picture. And it's very varied because some parts of the world had obviously had experience of SARS, and MERS and had a whole variety of behaviours that were already very adaptive. And those communities especially those in Southeast Asia, were very used to taking the lead from their government on public health measures. We also have countries where historically and socially, they just tend to follow what governments ask them to do Scandinavia. Sweden, Finland and Norway are examples of that. And those countries, much more quickly than other countries adopted the kinds of restrictions and the kinds of measures that they were being asked to, in order to reduce transmission at the beginning, because it was such a shock to so many people, I was so novel so uncertain, most people in most countries very rapidly change their behaviour in terms of staying at home, and abiding by the guidance. And then what we've seen over time, and it very much varies according to the country. And according to the nature of the leadership and the communication strategies, the very, very high levels of tyranny have gradually come down somewhat. However, what's very striking is that even though many of these restrictions have come with serious challenges for people, for younger people staying at home rather than seeing friends, many people losing jobs, families, not able to say goodbye to loved ones, or to keep in touch with them and care homes. But overwhelmingly majority of population have been adhering and what's been interesting, and you can see it very vividly in the UK, is the relationship between people's behaviour and what's being asked of them and how it's being asked of them. So, in the UK, you can see people's behaviour following the kind of tears, the lockdowns, the restrictions. And so that has overall had quite a powerful effect on behaviour.
Vivienne Parry 06:41
It's interesting at the moment, I think, because a lot of people seem almost frightened to go out. And it's not actually about the virus, I think it's about having spent so long being isolated people anxious about crowds, even if they've been fully vaccinated. They've recently had the virus, they're unlikely to be unwell, still, they're really anxious. And my sense is that, although adherence is a problem in some pockets, actually in the in the main people are really gripping to it at the moment,
Susan Michie 07:19
when you look at the survey data, it's often a very big, different picture than what appears to be if you look at media, one example of that, I think, on the one hand, is that there's often a lot of coverage of people going to raves and house parties and flagrantly disobeying rules. This is a tiny percentage of the population overall. And I think it's also the case to some extent, with people who are anxious about going out. Now, yes, there are people who are anxious about going out. But in some ways that's very adaptive. Because as Oksana said, we lost sight of this, yes, the rates are coming down. But the rates of transmission in communities are still very high, and especially in some communities. So I think people will need to have the rates coming right down so that the chance of transmission is very low, and have the majority of the population vaccinated. So although Yes, this is a phenomenon, I don't think it's hugely widespread. But like so many things, we need to keep an eye on this going forward, because none of us can predict exactly how people are going to react to different situations. So just as many people including scientists got it wrong, that the British people would lock down when they were asked to because we saw that when people can see there's a big threat and what they do can make a difference, then they will respond to that. So just as we saw people being wrong about that, I think we have to wait and see that as things open up as transmission levels go right down, and it no longer is the threat that it currently is. Is this going to be a problem or not? I wouldn't say at the moment that it's likely to be a very big problem.
Vivienne Parry 09:10
Now, the very beginning of the pandemic, Patrick Vallance famously said that 20,000 deaths would be a good result. And here we are, whatever it is now 130,000. More book he events, do you think that led us to that enormous death rate? And actually, in particular, a very high case fatality ratio in the UK?
Oksana Pyzik 09:36
I think there were several things that went wrong right from the very beginning. And I think that, given that it is a novel virus at that point, there were things that we underestimated the WTO also underestimated around the role of asymptomatic transmission, in particular, the fact that it could linger in the air via aerosols that Also the usefulness of face masks, which countries who have had experience with SARS in the past, were very quick to adopt, I think there was a bit of a gap in terms of waiting for that evidence to emerge. But history has shown us that the risk of doing nothing while waiting for perfect data just outweighs is especially in this type of scenario, the action based on imperfect data. So acting quickly, it certainly, I think from specifically, if we look at the UK strategy, it was initially based largely on a pandemic flu model. And that also meant that there was this idea that it wouldn't be a benefit to use test and trace systems. So if that was abandoned in March, and then much later reintroduced, although still problematic, even a year later, that initial error around thinking that it could be treated like flu, we heard Boris Johnson make some alarming statements about taking it on chin, and that it would not be desirable to prevent people from being exposed to it in a bid to cheap so called herd immunity, all of this really, I think, led to a situation where we just underestimated the virus. And that led to Super spreader events in crowded places. And meanwhile, other countries who followed a model more closely to SARS, including New Zealand, Taiwan, Vietnam, South Korea, Australia, China, were able to control the virus much more effectively. So certainly from from the get go, I think that this idea that there was nothing that can be done, it was just going to be spread. So there wasn't a point in more specific interventions was mistaken. And we now have evidence of what what could have been done differently.
Vivienne Parry 12:03
And Susan, was that a bit of British exceptionalism going on? At the beginning, somehow, we thought that we knew at all We were very clever, we had all these plans in place that we'd gone to the who at in March and said, Who are the countries that are best prepared for this, they would have said the UK is right up there. And somehow, it wasn't taken seriously. And we were locking down very, very late in in the day. And
Susan Michie 12:32
if I could just add to what Oksana said, Before I answer that specific question. I think there were two things going on. One was the state of British society is we went into the pandemic, and the other word, the particular government measures or lack of them, and what there were many problems that have made, I think the UK quite fragile and and showing a real lack of resilience in the face of COVID-19. So we've got a situation of very large inequalities with many of our population living in overcrowded multi generational households. We have many people in a precarious and unsafe workplaces, we have a public health infrastructure that's been run dying over many, many years. And there was a real lack of preparedness, despite previous exercises showing what needed to be done. So we were without the protective equipment we needed we without the ventilators that we needed. And that was the background. And as has been said, there was then this catastrophic delay this sort of hope for the best wishful thinking it's not going to happen here. But then also other real strategic errors. So one of them was not to put controls in on the borders, which we've suffered from now, to a great extent, also not to locate the find test trace isolated support system within communities being run by trusted public health organisations that are joined up with primary care in the NHS, who know their communities, and are trusted by their communities. And it said, outsourcing to large commercial companies without the experience or the expertise, and throughout a lack of really any coherent strategy. So the government was very much in responsive mode, therefore, on the backfoot, responding to things as they played out, rather than, as you've intimated, learning from other countries. And the question as to why that is the case. Is it that the cabinet to have this sense of British exceptionalism influenced possibly by Britain's colonial past? Is it that those running the country have had rather entitled lives and maybe Rather divorced from the realities of the situation and what the threats and the dangers and what needed to be protected were. And there were probably many other explanations also. But it continues to be a real weakness of the government strategy, that they are not listening and learning from those countries that are managing this so much better. And there are other narratives that have been really unhelpful, early on and maintaining it for many, many months. The pitting the health versus wealth narrative was deeply damaging. And many, many empirical studies, reports from the International Monetary Fund and others, showing that quite the opposite. Those countries that have managed the pandemic best and have fewer deaths are also those that have done best, economically had least harm.
Vivienne Parry 16:00
And there were a couple of real errors, for instance, discharging elderly people without testing into care homes where of course COVID spread enormously quickly. And a couple of key areas in policy, which you hinted at Susan, things like not paying people sick pay, while they had to isolate someone I was thinking, you know, of all our lateral flow testing in schools, and a lot of parents being very unwilling to have that. Well, why would you agree to have something if you thought that you were going to have to isolate your family, probably yet again, and not being able to earn any money? I mean, of course, people will take a chance and prefer to put bread on the table rather than be isolated at home. And perhaps in their view, not
Susan Michie 16:54
bill. Absolutely. And on top of that, the government when they find out it's actually from from data from a study the time involved with the courses study showing that more than half of people even with symptoms, were not staying at home for the full time they should have they responded by issuing a 10,000 pound fine. Now, the committee as part of sage, the Thai sit on, have consistently advised that the strategy should be one of support and enablement, not one of blame and punishment. Because obviously, if you are frightened about not being able to isolate and therefore possibly being fined up to 10,000 pounds, of course, you don't put yourself into that situation so you don't get tested. And you don't want to put friends and family and colleagues into that situation. So you don't give information to traces which explains how a few contacts have been given to people doing the tracing from the call centres,
Vivienne Parry 17:52
Oxana I know that one of the things that you're really interested in is misinformation. And the info demick, which is a company that pandemic run the virus around vaccines, among all sorts of other things. What have you learned over the past year about misinformation and how you think we can fight fake news in the future?
Oksana Pyzik 18:11
I think that we have seen that developing a vaccine and the research and development into being able to protect our health is in some ways more straightforward than fighting this info demick as the who Director General Dr. Taylor's referred to it and that in these circumstances where there is fear, and a lot of panic, people turn to many different sources to find their information. This I think also we saw at the beginning, where there was even less known information particularly dangerous, as we saw via people accessing social media sites, etc, listening to people who will who said that you take this particular herbal cure remedy, this will protect you from COVID. And there were deaths reported around the world linked linked to that in Iran and elsewhere. And we even had leaders propagating this type of misinformation under the Trump administration as well, there was repeated denial of the level of significance of this virus. There was, again, premature conclusions made about hydroxychloroquine. And that had direct impact because a lot of criminals saw this as an opportunity to cash in on a public crisis and the United Nations Office on Drugs and Crime had actually before warned the population that there is going to be a shift in organised criminal groups from their typical activities towards peddling fake PP for people who are desperate to get it to here in the UK. Again, due to decades of austerity within the NHS. We didn't have an appropriate stockpile. We only had eight public health. labs that would have been sufficient to deal with a virus with that type of security clearance as well, just to re emphasise some of Susan's earlier points about context. But in this instance that we see that there were around the world as a result of all that media attention on hydroxychloroquine and chloroquine as possible treatments that have since been refuted to be to be of any effect that these then started, fake versions of these fake medicines started to circulate the who had issued alerts on this and over 300 pharmacies in Uganda, Cameroon, the DRC were identified. A particularly as these are areas where there is weaker regulation, but even in the US in different forms, such as Corona sprays, and other just falsified products, the FDA issued 1000s of letters, warning different companies about these false claims that they were making. So there's one very specific element of the misinformation that's related to fake medical products. And I'm particularly interested in that due to my work on fight the face and as a pharmacist to ensure that people know where to get legitimate and legal medicines, particularly when were locked down. And people may be nervous to go into pharmacies. And when this was at the peak of the first wave, even just general awareness on how to verify an online legal pharmacies very low. So as a result of this, there have been very specific, I think the issues we've again identified fake vaccines, Interpol managed to break up a vaccine ring 3000 fake doses found in Chinese factory, as well as another 2400 doses in South Africa. So in South Africa, in particular, we know that these these were actually connected to the Chinese factories, they were run by foreign organised criminal groups, and they were checking against they had legitimate vaccines as well to try and make the vials look as closely as possible to the real thing. And in a climate where there's already so much mistrust about vaccines, this is just disastrous. So misinformation comes in many different forms. It can be about the full extent of COVID denialism. And that has been fueled again by leaders of Brazil, and Tanzania, where people in positions of responsibility and power, saying that this is nothing more than the flu and discouraging public health interventions. So this is very damaging, and actually much more difficult to fight than the health consequences of the virus itself. In some ways, it was easier to do it to create the vaccine than to fight misinformation.
Vivienne Parry 22:44
I think one of the difficulties here is that, of course, there are criminal gangs, there are people with deliberate intent to spread falsehoods. But also there are a lot of people who are just very confused and may not have access to medical advice. And they listen to their friends and neighbours, because those are the people that have, you know, most influence we trust their advice most. And some of the things that people suggest, you can understand why they suggest them, I mean, chloroquine. For instance, there was a big rumour in Africa that chloroquine was effective, because they didn't have as greater rates of Coronavirus in Africa, as there was in Europe. And many, many people in Africa took chloroquine on a regular basis for malaria. And you can see why people might join up the dots. So I'm always really reluctant to blame people, for misunderstandings, because often it seems very logical and very sensible to them. What do you think of that, Susan? Yeah, I
Susan Michie 23:51
think that's absolutely right. I think it's always important to start from where people are, and to really try and understand why they are adopting the kind of thoughts they have the kind of beliefs they have kind of concerns they have, you know, will their DNA be altered? Will it undermine their fertility, and there are all sorts of genuine concerns because of what people have heard, as well as what is very common and very rational concerns about side effects about long term safety. The key things to do in this situation is to really engage with the communities who are expressing concerns and have beliefs that undermine the chance that they will have the vaccine and it's not uniformly spread. There are more of those kind of beliefs, more kind of hesitancy among certain communities, especially, for example, in the UK, they're black and ethnic minority groups. And it's important that people who are respected by those communities, those who those communities look up to and identify with be the people who are having the discussions. Having two way discussion is not just talking at people. And these may be faith leaders, they may they may be young people in their communities. And there are several really good examples of borrowers, for example, local authorities in London, having really well attended webinars with many, many hundreds of people, with panel discussions with people from the Somali community, the Hindu community, very different types of communities so that everybody feels listened to and engaged with,
Vivienne Parry 25:33
I want to turn now to the kinds of lessons that we've learned. I'm like, I was worried. Because I suspect we can make a list of them immediately after something like this has happened. But then they get forgotten very quickly. Oksana, what's the big lesson for you in terms of preventing future pandemics?
Oksana Pyzik 25:54
I think one of the key lessons here is the importance of international coordination. And I don't think that we saw that in happen this time around, as well as leadership, really, in terms of ensuring that there is the representation that's needed, instead of just a uniform response. And I think that by not including various voices in that we did see a disappointing response from the UK. I think that this idea, the lessons are, as Susan had hinted at earlier, are still perhaps not hitting home, we have not heard any member of government openly and directly admit that any mistakes or errors were made in an open way and every country has has to some extent,
Vivienne Parry 26:51
even though Dominic Cummings famously said that the Department of Health was a smoking room. I thought it was a wonderful phrase. So that suggests that there might have been one or two mistakes made in burning down the house.
Oksana Pyzik 27:08
Yes. And even now, though, the the way that the language that's used in phrasing is almost around an inevitability that that was going to develop into the situation that we are in now, rather than a constructive conversation on things that we still need to be improving on it. And again, as Susan had highlighted, there's still a border control policy that says lead has left many public health experts wanting. So I I think that the biggest lesson is that there is a resistance for for that process of learning and accountability to be had. So I suppose that's an evolving answer.
Vivienne Parry 27:50
Yeah. So I guess some of the things that have been highlighted, that I've seen most wanting is a global response to, for instance, vaccine production, we have to come together as a global community to create spaces, which we may not see used many in many years, but actually need to be there in exactly four cases like this, and they need to be globally funded.
Oksana Pyzik 28:20
And there's precedent for that, too, if I just jump in one of the reasons that it's just been accepted almost publicly that there is only there are only so many vaccines to go around. Therefore, the rich countries will have the first go and it'll trickle down to the low and middle income countries. But if there, there are ways to improve or scale up manufacturing, and we have heard, again, the who plead with the United Nations Security Council for support on specific methods to make more vaccines, including technology transfer, voluntary licencing, and temporary waiver of intellectual property via the TRIPS agreement, and this is true, the world trade organisation. And that temporary waiver, there are already provisions for that in this type of emergency scenario. So if we can call this an emergency, I don't know what we can. And it's not just again, this this moral imperative, there's there's a strong, they're strong health and economic reasons these two are intertwined, again, as Susan had highlighted earlier, and the precedent for that is actually with the development of the polio vaccine, which the scientists there said you cannot put in the sun. And in that instance, it was a vaccine made for the people and there are, you know, many different ways that to other companies that have developed these vaccines could be reimbursed, etc. There There are ways and certainly that they could be incentivized through through various financial agreements with governments but to say that we are shortage, there is no way to produce more vaccines is just not correct. And we have in the US, again, this is there's a significant amount of resistance to this idea, I think because of what it could mean for access to medicines down the line. And it also really reminds me of the similar crisis that we had for the HIV AIDS epidemic that claimed many millions of lives. And in that instance, again, there was that resistance towards sharing the medication with other countries. Indeed,
Vivienne Parry 30:35
Susan, I wanted to ask you, what for you are the really big lessons, just one or two that you think really needed to be learned, in order to prepare us for another pandemic? Of which assuredly there will be one?
Susan Michie 30:51
Sure. Well, I'm on the public health task force of the Lancet Commission on COVID. And it's been very interesting, having presentations from different countries around the world. And one of the things that has come over light and clear is the importance of leadership and communication, both within countries and internationally. But within countries, the key things, and the key lessons, I think that the UK needs to learn, because we haven't done it well here is to engage communities to have lots of outreach, communication strategies, to have communication that is honest, transparent, where communicators can be open about uncertainty, and about the values underpinning decisions. Also communication that is clear, consistent, coherent, and also where people are not just being told what they should do. But the rationale, the explanation for why is being given, so that people are really building up an understanding of the nature of transmission, the nature of human behaviour within that transmission. And finally, within the whole leadership and communication brand of this is the issue of fairness and justice. And again, in this country, I'm afraid that although we started off very well, you know, we are all in this together, you know, that whole sense of collective solidarity, which is so important, not only to build up but to maintain in handling a pandemic, such as this has been continually undermined by policies, which are communicating, you know, one rule for people with mortgages and other people for renting one set of policies for people who are salaried and work at home, another for those who are freelancing in precarious jobs, and also people in positions of authority, not practising what they're preaching. So this is a really important area, and underpinning everything in terms of your overall question about how can we actually prevent pandemics in the future, we can't get away from the fact that what has caused this and other pandemics is environmental degradation, and the bringing disturbing of habitats of ecosystems and bringing animals who perfectly happily been having viruses as their hosts for centuries into contact with human beings. And so whilst the torch is shining on this pandemic, we have to keep our eyes on and attend to the climate emergency, and the incredible problem of environmental degradation, which is going on day in day out around the world. So, you know, of all the messages I've said today. I think that for me, that's the most important one.
Vivienne Parry 33:43
Well, that was terrific. And if I can be so bold, could I also just mention the significant absence of any women in the senior leadership of government echelons directing this pandemic? That's it? I'm not saying anymore. You've been listening to Coronavirus. The Whole Story. This episode was presented by myself Vivienne Parry produced by UCL with support from UCL Health of the Public and UCL Grand Challenges and edited by the wonderful Cerys Bradley. I was joined today by Oksana Pyzik, and Professor Susan Michie. If you'd like to hear more of these podcasts from UCL Minds, of course, you would, subscribe wherever you download your podcasts or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds bringing together UCL knowledge, insights and expertise through events, digital content, and activities open to everyone. Thank you again to my guests and hope to be with you again soon. Bye for now.