2007 - 2022

Preventable: How a Pandemic Changed the World

Preventable: How a Pandemic Changed the World and How to Stop the Next One, by Devi Sridhar, Viking Press £20.

Belief in science and expertise has had a bit of a resurgence as a result of the Covid 19 pandemic. Admittedly, this is not universal as there has also been a countervailing and worrying trend towards science scepticism.  Some academics have risen in prominence and Professor Devi Sridhar is one of these with a significant profile in both mainstream and social media. As Professor and Chair of Global Health at Edinburgh she was well placed to advise and comment on the pandemic having been involved in monitoring and researching other infectious diseases of global concern such as Ebola. She has drawn on this experience and expertise in her new book, Preventable: How a Pandemic Changed the World and How to Stop the Next One.

At one level, Preventable is a sobering account of both the global and our national response to the pandemic which Richard Horton, editor of The Lancet has described as the greatest policy failure of a generation. It provides a comprehensive historical record of the period from the first signs of SARS-CoV-2 in Wuhan to mid 2021 with a short afterword written in January 2022. 

Through evidence accrued by Chinese doctors and often shared with the world at considerable personal risk, and the unfortunate experiment that was the Diamond Princess cruise ship, a remarkable volume of information about incubation and transmission of the disease via both symptomatic and asymptomatic individuals and the likely case fatality rate was known very early on. The response by countries with previous experience of serious infectious disease showed that timely and comprehensive introduction of the recognised public health measures of communication, testing, tracing, isolating with appropriate financial support and restricting travel had a profound effect on the incidence of Covid19. Drawing on her international knowledge, Sridhar highlights the case of Senegal which, despite being one of the poorest countries in Africa, was ranked second after New Zealand for its strategic response in 2020 because of its systematic use of public health measures.

As we know to our cost, these early efforts were met with a shocking level of complacency amongst certain Western countries, Sridhar rightly pointing out each of the opportunities missed to make a different set of decisions. Where certain prescient countries such as the Czech Republic and Greece acted fast and pre-emptively drawing on precautionary principles, decision making in the UK initially relied on a toxic combination of wait and see, false premises such as herd immunity, belated lockdowns and an over emphasis on modelling.

In a devastating chapter, “Britain, herd immunity and follow the science,” Sridhar details the lack of both scientific and political leadership by the UK Government. By contrast, she lauds Scotland’s attempt at elimination which, despite the significant error in relation to care homes, was more successful until the disease was re-seeded as the result of travel relaxation and then exacerbated by new variants. Notably, local public health teams were deployed for contact tracing rather than the expensive and ineffective private company arrangements that were on offer in England.

Now, despite the success of vaccines and the knowledge accrued from the range of national experiments undertaken as the result of different political decisions, countries with populist leaders invariably doing worse – these are well chronicled in the book – Covid 19 appears to have stabilised but has not gone away. Independently minded scientists are still highlighting the risks and activist groups such as Zero Covid Scotland campaigning for improved school and workplace conditions.

We have a legacy of millions of excess deaths, Long Covid, decimated health services, infants missing out on socialisation, massive educational disruption, poorer mental health, disrupted economies. So, on the face of it, it does appear that the pandemic changed the world, or at least part of it. Threaded throughout the book however is commentary on who suffered most, in short those already experiencing the effects of social and economic inequality. To that extent Covid 19 has merely amplified pre-existing structural conditions, people in poverty more likely to be exposed to the disease and more likely to die because of underlying poor health, poor countries unable to access sufficient vaccine because of the greed of both richer countries and the pharmaceutical industry.

In this respect, Sridhar is not hard hitting enough, describing but not analysing, neglecting to highlight who actually benefited from the pandemic and in whose interests the world was designed to stay exactly the same if not better. Tax Justice UK for example has highlighted that by September 2021, six companies in the UK, including Serco who were given the disastrous test and trace contract, had made £16 billion in excess profits.

In view of this drive by capitalism, and its supportive politicians, to ensure that profiteering remains unimpeded despite a global threat such as Covid 19, how likely are we to avoid another pandemic and to what extent does this book help us? From the start Sridhar appears to have undue faith in certain centrist politicians (Merkel, Obama, Biden), so-called philanthropists (Gates) and the altruism of the World Bank, naively ignoring that they have contributed to the problems which allowed the pandemic to flourish in the first place. 

The next pandemic is potentially around the corner, either as the result of a novel flu virus to which we have no immunity or a new virus resulting from animal to human spillover. The likelihood of the this is greatly exacerbated by the inroads we are making to natural animal habitats through deforestation, poor agricultural practices and pollution. Climate change is also a significant factor in creating the conditions for spillover and transmission. If we are serious about prevention then the threats of our unfolding ecological disasters and the mass movement of people associated with this have to be addressed at a level for which there is no current sign.

Sridhar makes no reference to this, an important omission. She rightly argues for improved global surveillance and sequencing of new viruses to make vaccine development easier to achieve but fails to fully explain what it would take to make this likely and where and how the global institutions such as the World Health Organisation and other arms of the United Nations should operate differently. Further, what mechanism would need to be put in place to guarantee that the vaccine inequality that she describes does not occur in the future?

Making the right decisions once a virus with pandemic potential occurs is undeniably complex and some mistakes will be inevitable even by the most committed governments. To minimise the risks, the public need to know what to expect and what resources are required to ensure that the fundamental public health measures are fully in place. There is pandemic planning in the UK but we now know from the most recent exercise into a possible mass flu outbreak, Cygnus, that there were significant gaps in readiness, all of which added to the confusion and to the burden of disease when Covid arrived. Most significantly there has been an erosion of the public health function at local level as the result of underfunding and NHS reforms. This is likely to continue and to further undermine the ability to quickly mount a robust testing and tracing regime if required. 

This book was presumably written as an aid to public education but would have been greatly enhanced in this function had the conclusions been far more comprehensive, setting out the all the requirements for pandemic containment at global, national and local level – a manifesto if you like – and where in the author’s estimation the most significant shortfalls still remain. Not only would the general reader have been able to make a better judgement about the ongoing risks but it would have had the further benefit of acting as a set of demands around which campaigning could be organised. 

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Comments (22)

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  1. Squigglypen says:

    And you think Johnson would read it…..and even act on it?….too busy drawing lines under stuff.

    He who knows not and knows not he knows not..he is a fool shun him…Independence from fools.

  2. Alasdair Macdonald says:

    Why does Ms Laughlin not write the book which she is accusing Professor Shridhar of not writing?

    Having read the book, I welcomed what Ms Laughlin describes as “commentary on who suffered most, in short those already experiencing the effects of social and economic inequality.” I think that there is a lot to be written about that and, I think that such books will come along and after the public enquiries have taken place (which the BBC and unionist/financialist media will pick over for parts which criticise public agencies and exonerate the UK government).

    However, I do not think that was the principal aim of writing the book at the time she did. I think she was intending to provide an overview of how the pandemic evolved and how it was dealt with in different parts of the world and, that, of itself, is valuable for lay readers such as I.

  3. SleepingDog says:

    Sure, you cannot treat public health as a merely a one-nation problem, and pandemic preparation has to be undertaken within a complex framework of other considerations (like food security, child development, regenerative economies, environmental stabilisation and repair, international redistributive life-support resource justice, medical intellectual property commons, and peace building). These are biocratic not democratic decisions. They will require new political systems to be effective.

    1. 220613 says:

      It’s quite legitimate to criticise each nation’s response to global emergencies like a pandemic, though; some government’s responded more effectively than others.

      Also, global problems don’t necessarily call for a totalitarian response.

        1. 220614 says:

          Indeed, and that’s why we need to be democratising the state (and its subsidiaries like WHO) as much as possible, so that it can remain a social contract rather than a technocratic ‘camp’.

          Thanks for the link: a nice application of the Foucauldian concept of biopower. I’ve a lot of time for the people at ASH.

          According to Foucault, biopower emerged historically with the transformation of power formations in Western societies under capitalism. The sovereign’s right to take life or let live, symbolised by the sword, was sublimated into society’s power to manage life, both by caring for life and by limiting it, even to the point of termination. This new power over life – biopower, evolved in two forms: the anatomo-politics of individual bodies and the biopolitics of populations.

          The first form of biopower – the anatomo-politics of the body – focused on the body as a machine and sought ways to discipline it, to make it both useful and docile so that it could be integrated in the larger ‘machine’ of industrialised society. This is what ‘discipline’ means in Foucault’s Discipline and Punish. At first, the main institutional field of the anatomo-politics – or discipline – of the human body were the school and the army, but this aspect of biopower soon came to operate in fields such as prisons, hospitals, factories, sport, youth organisations, and marketplaces.

          The second form of biopower – the biopolitics of population – is concerned not with disciplining individual bodies but with managing the larger ‘machine’ of society; that is, with managing our reproduction, births and deaths, collective behaviour, and health. Biopolitics of the population consists in all sorts of techniques to intervene in and control populations. It pertains and is manifest in area such as sexuality and gender, race, disability, reproduction, body image and enhancement, public health, medical practice and the ethics thereof, biomedical science and and its application, etc, etc. The management of bodies and populations and the sciences involved in that management (collectively known in postmodernist circles as ‘the micro-relations of power and knowledge’) has become ubiquitous and largely superceded the ‘grand narratives’ of Left and Right and Left vs. Right in practical politics.

          If we care about how we are managed and how we can resist the effects that that management has on us, then Foucault’s analysis can be extremely useful . We cannot escape power relations altogether (we are inescapably enmeshed in an ‘establishment’ – whole matrix of official and social relations within which power is exercised), but we can work to improve our standing within those power relations, defend ourselves against their effects, and open up though subversion and dissent new possibilities for action and being.

      1. Paddy Farrington says:

        No need for totalitarianism. But what we do need, though, as Sue says in her review, is to strengthen institutions like the WHO, and to develop global systems to level up the inequality in vaccine provision. This will mean challenging the ownership of patents by pharmaceutical companies, extending not-for-profit vaccine distribution, and creating vaccine research and production facilities in developing countries.

        Sue also tells us that Shridar details the failures of the UK’s scientific and political leadership at the start of the pandemic. I suspect some of these may be put down to arrogance. Cuba succeeded in developing several low-cost, high efficacy vaccines, vaccinated virtually its entire population, and has donated stocks to other countries. Might we conceivably have something to learn from them?

        Thanks for the review, I look forward to reading the book!

        1. 220614 says:

          Yep, the nexus of power and knowledge around the abuse of patents needs to be looked at. Patents and copyright were originally designed to remove a disincentive to research and development, the idea being that researchers and developers should be able to retain exclusive rights over the marketing of a product for a short period of time so that they could recoup the initial outlay involved in bringing that product to market. However, those time periods have been gradually extended over the centuries to create virtual monopolies.

  4. florian albert says:

    ‘Where certain prescient countries such as the Czech Republic and Greece acted fast and pre-emptively drawing on drawing precautionary principles, decision-making in the UK relied on a toxic combination of wait and see, false premises such as herd immunity, belated lockdowns and an over-emphasis on modelling.’

    According to the figures in today’s Guardian, deaths per million from Covid from the three countries mentioned are;

    Czech Republic; 3,763

    Greece; 2,880

    UK; 2,640

    In the first wave of Covid, from March 2020, most of East and South East Europe emerged comparatively unscathed.
    Subsequently, this area was hit very severely.
    Ten of the eleven countries in the world with the highest recorded death rates are in that area. Peru is the eleventh and – statistically – the most afflicted country.

    1. AudreyMacT says:

      For a very clear picture of the patterns Sars cov-2 followed in Europe see here https://www.eugyppius.com/p/sars-2-surges-only-in-the-winter?s=r
      The behaviour of the virus has nothing to do with lockdowns or masking or any of the other non-pharmaceutical interventions and everything to do with geography and climate.

      1. AudreyMacT says:

        And the seasons.

  5. Jenny Tizard says:

    Devi Sridhar has been an inspiring figure these last 3 years. Great review of the book and her position. Thank you.

  6. Leslie Cunningham says:

    An excellent review of what seems to be a well-intentioned but flawed analysis.

  7. AudreyMacT says:

    I haven’t read the book by Devi Sridhar but I have read some of her many articles in the Guardian and some of her tweets. I have concluded that, in a very strong field, she comes out as The Worlds Wrongest Woman on Covid. Her strong links to the WEF make her extra suspect in my opinion.
    The reviewer spells her name incorrectly throughout the article which isn’t a great start. She may not be a devotee of Sridhar’s but she is clearly a devotee of The Official Narrative and therefore we get the usual lazy stuff about the source of the virus being a jump from animal to human (it is most likely lab engineered), the massive death toll (clearly inflated by defining a ‘Covid death’ as ‘a death by any cause within 28 days of a positive test’), and Long Covid (simply a mish-mash of vague symptoms bundled together to make the disease seem more serious than it is). We also get the usual garbage about ‘vaccines’, and the usual garbage about NPIs (ie the non-pharmaceutical interventions made by Governments the world over). In fact the NPIs made little or no difference. A report leaked ahead of it’s publication by the Bundestag found no evidence that Lockdowns achieved anything https://www.eugyppius.com/p/bundestag-expert-committee-draft?s=r
    So we got a whole raft of collateral damage from lockdowns and other containment measures but absolutely no gains. Zero. And yet Sridhar and Sue Laughlin want to do it all again judging by their comments.
    One last point. Sue Laughlin accuses Capitalists of ‘profiteering’ – she is quite correct- they made out like bandits. But didn’t Mike Small, the editor of Bellacaledonia, also try to capitalise on the pandemic. He has acknowledged himself in an article he wrote a while back that he attempted to grow the Bellacaledonia audience during the pandemic. He took on new writers to provide additional content, and then he layed them off when his goal (of a bigger readership) failed. Perhaps this is the real explanation for his constant catastrophising and fear porn spreading. Just a thought.

    1. Jenny T says:

      Wow. Where to begin with responding to this stuff?

      Maybe by commending Bella Caledonia for providing a platform for radical critiques and analysis on a wide range of issues. And Mike Small’s unstinting hard work and originality.

      1. AudreyMacT says:

        We’ll note that you’re not responding to this stuff.

    2. Paddy Farrington says:

      Perhaps read the book before trashing it, AudreyMacT? And personal attacks are never a good look.

      1. AudreyMacT says:

        I need to watch my pennies very carefully Paddy so I won’t be buying the book. Thanks to the lockdowns the Scot Gov now £3.5 billion in debt and imposing Tory-style austerity cuts. In addition to this we have inflation caused by UK Gov quantitative easing to the tune of £895 billion. They magiked up this money to pay for their insane COVID response. Now they have to put up interest rates to bring down inflation, and ease off the QE. This will cause a recession. If we’re really unlucky we’ll get inflation plus recession, known as stagflation. I hope you have some savings to get you through.

        1. 220614 says:

          Never mind, Audrey; once the Scottish government is independent, it will be able to borrow even more to make up the deficit.

    3. 220614 says:

      When you do read the book, you’ll find that Devi is open-minded about the COVID-19 lab-leak theory; she currently leans on the present evidence towards the lab-leak theory. Indeed, she remains open-minded about most things and is continually revising her hypotheses as the evidence evolves, as benefits a scientist.

      She has also, as a result of her ongoing learning, shifted from prescribing a ‘zero COVID’ response to prescribing a containment and mitigation response – i.e. learning to live with coronaviruses and managing infection by inhibiting transmission.

      In fact, her open-mindedness is her most admirable quality and makes her more trustworthy than other commentators who are more prejudiced towards in particular pet theories.

      1. AudreyMacT says:

        So how does she propose to inhibit transmission given that the ‘vaccines’ can’t do it and the lockdowns can’t do it?

        1. 220614 says:

          Well, she can’t, but we can: by vaccinating ourselves and practising good hygiene in our interactions with one another; barrier methods.

          She also recommends improving our overall health: high rates of poverty in our society make the population less healthy and, therefore, less resilient to infection. She currently writing a book on health inequalities and the impact these had (and are still having) on the crisis and our recovery from it.

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