The tough trade-offs between health and the economy

A poster brandished by a protestor at a rally in Tennessee last week with the message “Sacrifice the weak, reopen TN” has repulsed many. The sentiment amongst some that the protection of the vulnerable — largely but not exclusively the elderly — is holding back the rest of society is hardly a mark of civility and compassion. While the taste of the message can be debated, it lays bare the difficult choices the UK government will need to make in the coming weeks as it seeks to evaluate the economic costs to society of maintaining the lockdown.

The need to confront such tough trade-offs is nothing new. Part of it involves placing a monetary value on life which makes people uncomfortable. But pharmaceutical companies make choices when choosing the areas on which they will focus their research, just as health service professionals have to decide which patients to prioritise for treatment. According to the eighteenth century English philosopher, Jeremy Bentham, the sole consideration in matters of morality should be the maximisation of happiness for the greatest number of people.

That mantra will weigh on the Prime Minister who has returned to work this week after a period of convalescence following his own battle with the virus. It was an Imperial College study in March which predicted that, left unchecked, coronavirus could lead to 250,000 deaths. This led to the lockdown being imposed to minimise fatalities and to allow space for the NHS to create additional capacity to deal with patients. Since the restrictions were introduced, the rate of new infections has declined, although the daily death toll remains high, and a number of temporary hospitals have been established across the country.

However, the negative impact on the economy has led a number of prominent Tories including David Davis, Iain Duncan Smith and the former Chancellor, Philip Hammond, to call for the government to outline its exit strategy. The Labour leader, Sir Keir Starmer, has also chimed in, calling on ministers to treat people as adults and share their plans.

The government has outlined five tests that need to be met before any easing of the lockdown can be considered, centred around a decline in both the rate of new infections and in the number of deaths. Given that the total number of those that have lost their lives has now crossed the 20,000 threshold, which Sir Patrick Vallance, the Chief Scientific Officer had said would be a “good outcome”, there are no easy answers.

A paper from the Wellbeing Policy Group at the LSE has concluded that the net benefits of continued lockdown will be negative from the beginning of June onwards. Gus O’Donnell, the former Cabinet Secretary and one of the authors of the paper, argues that in addition to seeking to reduce death rates, the government should also consider the associated costs of the current strategy. This includes the reduction in personal incomes, higher unemployment, and the negative impact on mental health and children’s education. This merits consideration.

Government ministers have continuously asserted that the actions they have taken have been informed by science. But there is no universal playbook that all scientists across the world are following. Different countries have responded to the crisis in different ways. Germany placed an early focus on mass testing whereas Sweden decided to impose no restrictions at all.

We are in the realm of the unknown. It is only once the crisis has passed that we will be able to judge the effectiveness of differing national strategies. Therefore the judgements that need to be made now, while informed by science, are primarily political.

Given that a vaccine may take months to develop, we will have to find a way of co-existing with this virus that minimises deaths while getting things moving again. That should not alarm policymakers unduly. Societies are used to balancing risk and reward.

Government statistics show that over 26,000 people are killed or seriously injured on Britain’s roads every year. However, driving is not banned. Instead, the risk of fatalities is reduced through the use of speed limits, the requirement to pass a test before a licence is granted to drive, and mandatory annual inspections of vehicles to ensure roadworthiness.

Finding a way forward is a once in a generation challenge. The Prime Minister is the only one with the authority to balance the factors involved. For a man driven by his place in history, this could be the decision that defines his premiership and the fate of his government.