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Whose Lives? What Values? Herd Immunity, Lockdowns, and Social/Physical Distancing
As in the case of face masking, disagreements about mass public health measures such as lockdowns and physical distancing have dominated the discussion around COVID-19. Policy-oriented discourses such as recommendations and media briefings have argued for more or less severe measures, ranging from national curfews to mandated social distancing, or mitigation strategies built on the premise of quickly reaching herd immunity. All these different measures have been extensively debated in the media and other public forums and continuously monitored by international organizations such as the WHO, CDC and ECDC. Policy arguments have also been revised or refocused in tandem with a growing body of research and natural experiments as countries began to introduce either mandatory or voluntary policies. This chapter examines various arguments deployed in this debate and the complex dialogue between political, scientific and popular values and discourses.
It is fair to say at the outset that, once again, at least some of the resistance to such measures can be explained by the structural and material incoherence of public policy in many areas of the world. As Devi Sridhar, Chair of Global Public Health at the University of Edinburgh, explains (Sridhar 2020), in the case of the UK the late imposition of a full lockdown followed by cycles of short lockdowns that were not accompanied by an effective test and trace strategy, with people actively encouraged to go abroad on holidays in between these short lockdowns, left many exhausted and confused, and hence, she concludes:
It’s no surprise that those offering easy, compelling solutions – “You can have your life back by Christmas”; “It’s either the economy or health”; “This virus is practically harmless to those under 55”; have found a willing audience in a frustrated and fatigued society.
Hickman (2020), Professor of Public Law at University College London, has similarly argued that public policies have obscured the distinction between advice and information about legal prohibitions, which has led to a form of material incoherence that he calls “normative ambiguity”:
This phenomenon meant that the scope of individual liberty was unclear and at times misrepresented. Whilst the coronavirus guidance was drafted to fulfil well-intentioned public health objectives, by implying, even unintentionally, that criminal law restrictions were different or more extensive than they in fact were and by failing accurately to delineate the boundary between law and advice, the coronavirus guidance failed to respect individual autonomy in a fundamental way.
Furthermore, the arguments supporting the need for and the measures adopted in the implementation of restrictions have been interpreted and applied very differently in various areas of the world, giving some the impression that the measures imposed on different populations are arbitrary and indeed not to be trusted. Early in the pandemic, China introduced a full-blown lockdown in several provinces and imposed very strong measures of control, including barricading of villages, hiring of community guardians, financial rewards for reporting those who broke lockdown regulations, and phone apps to track the movement of citizens (Feng and Chen 2020). Several European countries, including Spain and France, also introduced formal curfews forbidding citizens to leave their homes. In Spain, even children under 14 were not allowed to leave their home for a period of six weeks (Hedgecoe 2020), placing immense pressure on them as well as their parents. The level of stress caused by extended confinement varied considerably, depending on the nature of the space in which families experienced the lockdown. Those higher up the social and economic scale, who had more room to work and live, naturally experienced lockdowns and curfews differently from those whose living space was more restricted. As one contributor to a twitter exchange about the wisdom of lockdowns put it, “Lockdown is a luxury of the middle classes. … Middle classes work from their gardens”.
At the other extreme, the Norwegian government’s attempt to introduce an emergency bill allowing the imposition of a limited curfew for a few hours a day, and only in extreme cases, was defeated even before reaching Parliament due to massive public resistance. Similarly, Sweden built its strategy on responsibility and trust rather than enforced restrictions and introduced few behavioural restrictions compared to most other countries (Orange 2020). The UK’s approach to lockdown perhaps constitutes the starkest example of structural incoherence and led to widespread confusion and loss of trust. It started in March 2020 with the three-point slogan ‘Stay home, protect the NHS, save lives’, a clear message that was well received, in part because the NHS is a widely trusted and much loved institution with which a majority of British people readily identify. In May 2020, however, this slogan was replaced with ‘Stay alert, control the virus, save lives’, leading to much confusion. Not only was the reference to the much loved NHS lost, but the ‘stay alert’ message – which replaced an action with a subjective cognitive state – was too vague. Even government ministers were unable to articulate what ‘stay alert’ meant in practice. Finally, the government went back to the initial slogan of ‘Stay home, protect the NHS, save lives’ with the third national lockdown in England in January 2021. By then, the argument supporting the need for lockdowns had lost much ground (Evans 2021).
Some of the national differences in the way the pandemic was handled might of course reflect differences in the severity of the outbreaks across regions and nations. Importantly, however, they also reflect differences in values and priorities. Lack of attention to differences in the cultural norms and values that underpin the various measures adopted to control the pandemic may be partly responsible for the increased confusion and resistance on the part of sections of the public in various localities. At the level of policy making, the rationale for adopting any measure has to be woven within a broader narrative of the pandemic and its implications for various sections of a given community: child/adult, young/elderly, healthy/vulnerable, wealthy/poor, working/retired, and so on. And given that narratives are ultimately “symbolic interpretations of aspects of the world occurring in time and shaped by history, culture, and character” (Fisher 1987:xiii), degrees of compliance with or rejection of imposed restrictions , especially those that involve major disruption to people’s daily lives, will naturally vary among locales and communities, as some of the examples we discuss in this chapter demonstrate.
4.3. Transcendental Values and Conceptions of Freedom
Much of the resistance to lockdowns and other such restrictive measures during the Covid-19 crisis was informed by a specific understanding of the balance between individual freedom and social responsibility, and hence the boundaries of legitimate intervention by the state. According to Carothers and Press (2020), protests that advocated individual freedom over restrictive public health measures such as lockdowns and quarantines were “generally concentrated in developed countries”, including much of Europe, the US and Canada. They are characterized by a “wariness of science and immersion in misinformation” and “highlight the distrust of authority that is coloring so much of global politics today”.
Bolsover (2020) identifies various understandings of freedom that underpin the debate about pandemic measures, all of which reveal a negative view of liberty as freedom from restrictions, with freedom of movement as a recurrent theme. Many anti-restriction posts considered freedom of movement as the ultimate expression of freedom, as evident in the following tweet, quoted by Bolsover (2020):
#OpenCalifornia #opencalifornianow it’s time people of the great nation of America to open your doors and not let a silly virus stop you!
Here, freedom of movement is conceived from the perspective of right-wing nationalism, which places much value on the protection of what it perceives as core American values (or, in other cases, core British values, core Chinese values, etc.). For some, like the author of the above tweet, these are transcendental values that trump any other value – or, for that matter, scientific evidence – because they are part of the core identity of those who hold them, a fundamental means by which they demonstrate that they belong to the community they have come to identify with. However, concerns have also been raised from a very different ethical perspective about how emergency measures negatively impact freedom of movement for vulnerable groups. In an article in OpenDemocracy, Mezzadra and Stierl (2020) argue that the ‘stay at home’ message is highly problematic for “people who do not have a home and for whom self-quarantine is hardly an option, for people with disability who remain without care, and for people, mostly women, whose home is not a safe haven but the site of insecurity and domestic abuse”. The consequences of blanket restrictions on movement, moreover, are particularly serious for vulnerable groups who need to move in search of safety and whose freedom of movement was already restricted prior to the pandemic (ibid.):
Migrants embody in the harshest way the contradictions and tensions surrounding the freedom of movement and its denial today. It is not surprising that in the current climate, they tend to become one of the first targets of the most restrictive measures.
Not only are migrant populations subject to confinement measures that are legitimized by often spurious references to public health, but they are also deprived of “this freedom to move” that for them represents “safety from war and persecution, safety from poverty and hunger, safety from the virus”.
Like freedom of movement, the right to religious assembly constitutes a transcendental value for many worshippers, of all creeds. Bolsover (2020) quotes one tweet expressing frustration with what is clearly seen as interference in religious life in the US – “I’m tired of pastors getting arrested for having church services” – but similar sentiments have been expressed by other congregations in different parts of the world. Protestors in ultra-Orthodox Jewish neighbourhoods in Jerusalem, for instance, responded violently to police attempts to “clear yeshiva classes and religious gatherings being held in violation of lockdown rules” in January 2021 (Hendrix and Rubin 2021). Many Iranian religious leaders resisted the closure of pilgrimage sites “as an affront to their beliefs”, and the cartetakers of holy shrines refused to close them down (Iran News, February 2020). In the holy city of Qom, one individual expressed his anger at restrictions on religious assembly by deliberately licking the grid of a shrine (ibid.).
Not all worshippers, of course, and not all religious communities have questioned restrictions on religious assembly in the context of Covid-19. The Rector of the All Saints’ Anglican Church in the Walterloo region of Southern Ontario, Canada found it “puzzling that religious communities have been at the forefront of the protests” (Veneza 2021). His own congregation had moved to virtual media to conduct their faith, prioritizing the need to “care for one another” and recognizing that “the simplest way and best way we can care for one another is to protect one another”. Moving to online services, he argued, had further allowed more people to participate who would otherwise not have been able to attend. Imam Abdul Syed of the Waterloo Mosque in the same region confirmed that his congregation, too, was “willing to do its part to deal with the health crisis before returning to in-person worship” (ibid.):
“We want to see [the coronavirus] gone from the world,” said Syed. “We want to see Canada as a safe place for everyone so, we don’t want to put any lives in jeopardy.”
Here we have two religious communities based in the same region which seem to identify with the larger, national community in which they are embedded and are hence willing – indeed, feel obliged – to adhere to any measures that they believe would serve its welfare. Such wildly different responses to restrictions on religious assembly by equally devout communities reflect differences in political cultures, degree of trust in policy makers and the medical establishment, and a sense of belonging to a community that is either restricted to or is larger than their immediate religious group. They also reflect different understandings of freedom – in the latter case of worshippers in the Waterloo region, understood as freedom to rather than freedom from.
Ultra religious groups of all creeds aside, concerns have also been voiced about the consequences of restrictions on religious assembly for vulnerable minority groups. Ekeløve-Slydal and Kvanvig (2020) report that in India lockdown rules were used by Hindu state officials to target the Muslim minority populations, and Hasan (2020) confirms that the targeting of Muslims was sanctioned at the highest levels:
The government itself has blamed around a third of India’s confirmed Covid-19 cases on a gathering held in Delhi by a conservative Muslim missionary group called the Tablighi Jamaat; one BJP minister called it a “Talibani crime”.
In Georgia, religious assembly was allowed for Orthodox Christians during Easter but the authorities “reacted with hostility when Muslims wanted to gather for Ramadan” (Ekeløve-Slydal and Kvanvig 2020). Such instances of structural and material incoherence in the implementation of restrictions serve to undermine trust in policy makers and the medical establishment, at the same time as strengthening the need among minority groups to demonstrate identification with their religious community rather than with the overall society in which they live.
A ‘Factsheet’ on coronavirus issued by the United States Commission on International Religious Freedom at the start of the crisis, in March 2020, predicted the impact of restrictions on movement on various religious communities and called for addressing their concerns to ensure both respect for their human rights and efficacy of implementation of health policies (Weiner et al. 2020):
It is important for governments to account for religious freedom concerns in their responses to COVID-19, for reasons of both legality and policy effectiveness. From a legal perspective, international law requires governments to preserve individual human rights, including religious freedom, when taking measures to protect public health even in times of crisis. From an efficacy perspective, considering religious freedom concerns can help build trust between governments and religious groups, who in past public health crises have played a critical role in delivering health interventions. Such concerns include the cancellation of large gatherings, among them religious activities, where viruses easily can spread.
Freedom of religious assembly is a particularly sensitive issue for many, whatever their creed, and efficacy of implementation in this area – as in many others – requires trust in medical advisers and policy makers. But trust is negatively impacted by perceptions of structural and material incoherence that remain unaddressed. As many have pointed out, pandemic restrictions do not distinguish between religious gatherings and other kinds of public events and do not provide a rationale for failing to do so. Writing on the UK Human Rights Blog, Keene (2020) argues:
Ultimately, the right to practice religion is specifically protected by the ECHR [European Court of Human Rights] in a way that e.g. attending a football match is not. But overall the impression is given that worship and religious services have been considered together with other public gatherings or activities.
For Keene, this is particularly problematic because the evidence given to the UK Parliamentary Science and Technology Committee by the Chief Medical Officer and the Chief Scientific Adviser for England confirms that “there has been at best very limited tailored analysis of the specific risk of transmission of Covid-19 in the context of religious services”.
4.4. Public health recommendations and the values and principles of evidence-based policy making
This brings us to the nature of the medical evidence which has informed policy making throughout the pandemic and the values that underpin it. In the scholarly debate about mass public health measures, some have argued that the pandemic has changed the values and ground rules of evidence-based policymaking. Since its emergence in the early 1990s, evidence-based medicine has been founded on the idea of transparent access to the evidence base underpinning healthcare recommendations through systematic reviews of state-of-the-art research (Timmermans and Berg 2003). As such, medical evidence has arguably been detached from the expert and made available through texts that are accessible to everyone. According to Axe et al., authors of The Price of Panic: How the Tyranny of Experts Turned a Pandemic into a Catastrophe (2020), the current pandemic has reversed these principles and replaced democratic access to evidence with “a tyranny of experts” in which a “narrow, professionally biased thinking dictates policy for everyone” (Axe et al. 2020:156), or as the authors put it in an article following the publication of their book, “government bureaucrats with narrow expertise gained the status of infallible oracles” (Richards et al 2020). A similar view is expressed by Norman Lewis on Spiked: “The experts have set the goal, and the politicians have cast themselves in the role of their spokespeople” (Lewis 2020). This approach has allegedly not only “mystified expertise” (Lewis 2020) but also maximized “a certain kind of safety, to the neglect of other goods”. This is not necessarily a result of bad intentions on behalf of the experts, Richards et al (2020) claim, but a result of their limited perspective:
Such officials tend to think in bulk, to focus on the quantity of abstract life protected in the near term, rather than the quality of actual lives lived over the long term […] Looking for problems is a physician’s job. Misdiagnosis could be considered malpractice. This makes them risk-averse and hypervigilant. They tend to respond to the worst-case scenario. But you, as a patient, have different aims. What you deem best for you, weighing costs and benefits, may not be what is best for the doctor who is treating you.
According to Richards et al. (ibid.), the status and obscurantism of this new elite of medical expert bureaucrats made it possible to mask material and structural incoherence in their recommendations for some time in the initial stages of the pandemic:
In downplaying the danger early on, the World Health Organization seemed to be carrying water for the regime in Beijing. … But in March, the UN agency reversed course. WHO Director-General Tedros Adhanom Ghebreyesus pointed to a scary model from the Imperial College London, which predicted as many as 40 million people could die worldwide without draconian efforts to reduce the spread of the virus. It would be more than a month before non-experts learned that the model was little more than high tech, unreliable conjecture.
From a very different angle, the same experts have been accused of putting too much emphasis on the values of evidence-based medicine, especially randomized-controlled trials. “The search for perfect evidence may be the enemy of good policy”, Trish Greenhalgh says in an interview with Science: “As with parachutes for jumping out of airplanes, it is time to act without waiting for randomized controlled trial evidence” (Shell 2020). A paper Greenhalgh co-authored with Henry Rutter and Miranda Wolpert (Rutter et al. 2020) encourages public health experts to embrace uncertainty rather than searching for a unified evidence-base:
Even when an evidence base seems settled, different people will reach different conclusions with the same evidence. When the evidence base is at best inchoate, divergences will be greater. Unacknowledged or suppressed conflicts over knowledge can be destructive. But, if surfaced and debated, competing interpretations can help us productively to accept all options as flawed and requiring negotiation between a range of actors in the complex system.
The debate about various measures enforced to control the pandemic is thus closely linked to a debate about scientific rationality and its underlying values. The various issues and examples discussed in this chapter, moreover, clearly demonstrate that neither pro- nor anti-restriction discourses can make absolute claims to reason or rationality. Ultimately, we reiterate, arguments both in favour of and against lockdowns and other social restrictions are backed by values and normative commitments that are narratively rational even when not backed up by scientific evidence.