The COVID-19 Catastrophe E-Book

Richard Horton

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 301

Veröffentlichungsjahr: 2021

Beschreibung

This expanded, updated, and completely revised edition of The COVID-19 Catastrophe is the authoritative guide to a global health crisis that has consumed the world. Richard Horton, editor of the medical journal The Lancet, scrutinises the actions taken by governments as they sought to contain the novel coronavirus. He shows that indecision and disregard for scientific evidence has led many political leaders to preside over hundreds of thousands of needless deaths and the worst global economic crisis for three centuries. This new edition provides a systematic discussion of the pandemic's course, national responses, more transmissible mutant variants of the virus, and the launch of the world's largest ever vaccination programme. Only now are we beginning to understand the full scale of the COVID-19 crisis. We need to learn the lessons of this pandemic, and we need to learn them fast, because the next pandemic may arrive sooner than we think.

Leseprobe

CONTENTS

Cover

Dedication

Title Page

Copyright

Preface to the Second Edition

Preface

Acknowledgements

Introduction

Notes

1 From Wuhan to the World

Notes

2 Why Were We Not Prepared?

Notes

3 Science: The Paradox of Success and Failure

Notes

4 First Lines of Defence

Notes

5 The Politics of COVID-19

Notes

6 The Risk Society Revisited

Notes

7 Towards the Next Pandemic

Notes

Epilogue

Notes

End User License Agreement

Guide

Cover

Table of Contents

Dedication

Title Page

Copyright

Preface to the Second Edition

Preface

Acknowledgements

Introduction

Begin Reading

Epilogue

End User License Agreement

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Dedication

For those whose lives were lost to COVID-19

The COVID-19 Catastrophe

What’s Gone Wrong and How to Stop it Happening Again

Second Edition

Richard Horton

polity

Copyright © Richard Horton 2020, 2021The right of Richard Horton to be identified as Author of this Work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.First edition published in 2020 by Polity PressSecond edition published in 2021 by Polity Press

Polity Press65 Bridge StreetCambridge CB2 1UR, UK

Polity Press101 Station LandingSuite 300Medford, MA 02155, USA

All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.

ISBN-13: 978-1-5095-4911-5

A catalogue record for this book is available from the British Library.

The publisher has used its best endeavours to ensure that the URLs for external websites referred to in this book are correct and active at the time of going to press. However, the publisher has no responsibility for the websites and can make no guarantee that a site will remain live or that the content is or will remain appropriate.

Every effort has been made to trace all copyright holders, but if any have been overlooked the publisher will be pleased to include any necessary credits in any subsequent reprint or edition.

For further information on Polity, visit our website: politybooks.com

Fear can be considered the basis for all human civilization.

Lars Svendsen, The Philosophy of Fear (2008)

Preface to the Second Edition

Hindsight or history? Presidents and prime ministers worldwide have argued consistently that no one could possibly have foreseen the brutal human consequences of the COVID-19 pandemic. ‘Unprecedented’ was, and remains, one of the most commonly used words describing this extraordinary outbreak of contagion. Those who criticise the slow early responses of many Western governments, or the complacency over preparations for a second or third wave of coronavirus, or the lack of adequate support for those hit by the ensuing economic crisis, are not surprisingly censured for their apparently self-righteous, retrospective wisdom. President Trump led the way with what one might call ‘the exceptionalist defence’. In March 2020, he said, ‘there’s never been anything like this in history. There’s never been … nobody’s ever seen anything like this.’

It’s tempting to sympathise with this point of view. The tragedy that began in December 2019, and continues still despite the allure of a vaccine, was surely unprecedented in many ways. But comforting though such a conclusion might be, it is, unfortunately, not true. And the reason is history.

Governments, scientists, doctors and citizens had a pandemic handbook readily available to guide their understanding, even their planning and decision-making. For the events that gripped our lives in 2020 can be read with uncanny and disturbing resonance in Daniel Defoe’s A Journal of the Plague Year, published in 1722. Neither fiction nor pure documentary fact, his Journal described what Defoe imagined it was like to live through the Great Plague of London in 1665. His envisioning of the events of ‘this calamitous year’ – as they unfolded week by week, month by month – plots with devastating accuracy our own epidemic crisis today.

When the first cases of plague were reported early in 1665, London’s authorities endeavoured to conceal the outbreak, echoing evidence that police officials in Wuhan, China, sought to suppress what they disingenuously called ‘rumours’ of a new SARS-like disease. When plague was finally accepted as a reality in London, the government was unprepared. And the public was understandably terrified as the infection took hold with forceful menace. Mental health, for example, suffered badly – a kind of ‘melancholy madness’ descended on England’s capital.

But not everyone was affected equally. The richer elites in seventeenth-century London society were able to flee the city for the safety of their country retreats. In doing so, they left the poor behind on the frontlines of the epidemic, a frontline they faced ‘with a sort of brutal courage’. The same was true for essential and mostly poorly paid workers during successive waves of COVID-19. They too bore the brunt of infection and death. Three centuries ago, London was abandoned and left desolate, just as cities across the world today have been emptied of people, confined as they have been to working from home under curfew. Music houses, theatres and shops closed in 1665. The public felt ‘a kind of sadness and horror at these things’. Defoe’s description is one most of us will recognise.

There was fake news in the era of plague too. ‘Deceivers’ proposed plague to be the judgement of an angry God. Or, insisted others, it was caused by a blazing star or comet. ‘One mischief always introduces another,’ wrote Defoe. The plague enabled fortune-tellers, wizards and astrologers to flourish. Quackery prospered – an array of pills, preservatives, cordials and antidotes were peddled. We should not, perhaps, have been surprised by the furore over President Trump’s unevidenced advocacy of disinfectant, irradiating light and hydroxychloroquine as remedies for COVID-19.

The response by public authorities to coronavirus also mirrored that of plague – isolation and quarantine for those thought to be infected. At least we can be thankful that those living in Paris, Madrid or New York were not padlocked behind their front doors, on which was painted a bright red cross. But London’s officials struggled then, just as governments around the world have done with COVID-19, to produce clear and consistent guidance for the public to follow. Physical distancing, mask wearing and ventilation were all advised then as now. Mass gatherings were prohibited. People became more conscious of their personal hygiene. Plague in the seventeenth century led to a morbid fascination with the Bills of Mortality, a statistical account of the epidemic’s progress. Tormented, we too have watched the rising numbers of deaths in countries that had hitherto been able (apparently justifiably) to boast of their power, resilience and advanced healthcare – all undermined and overturned by a virus. And, just as now, in 1665 there was vigorous disagreement about the efficacy of many of these measures.

We should not be surprised that the behaviour of the public was similar across the centuries. During the first wave of lockdown in 2020, people willingly, even enthusiastically, followed the instruction to stay home. They learned to enjoy the opportunity to take up new activities. The same was true in 1665. Defoe mentions baking bread and brewing beer. Public compliance during the first wave of the 2020 pandemic successfully suppressed the outbreak. But, once it was controlled, people desperately wished to return to some level of normal life. Governments wanted to reignite their economies. Perhaps everyone was exhausted and fatigued by the ‘anthropause’ – this temporary cessation of humanity. The result? Many countries let their guard down and the virus bounced back – a second wave. In 1665, a similar complacency took hold. By the end of September the plague’s fury was beginning to relent. People came out of their homes, shops opened, businesses resumed. The outcome of this ‘imprudent rash conduct’ was a second wave of plague that ‘cost a great many’ lives.

The economic calamity that has ensued from COVID-19 was entirely predictable. Defoe explains how manufacturing and trade were brought to ‘a full stop’. He describes the ‘immediate distress’ that followed, rising levels of unemployment, deepening inequality, hunger and the overall ‘misery of the city’. Relief provided to the poor was then through charitable assistance rather than from government furloughs and job support schemes. But the effects were similar. Here is Defoe: ‘This caused the multitude of single people in London to be unprovided for; as also of families, whose living depended upon the labour of the heads of those families; I say, this reduced them to extreme misery.’

There are telling similarities between the political approaches to COVID-19 and plague too. Defoe wrote his Journal with a very specific purpose in mind. Plague was moving through continental Europe and was now at England’s door. In 1720 in Marseilles and the surrounding region, 100,000 people died from plague – half the population. The government in England moved quickly and fearfully to protect itself. Parliament passed a Quarantine Act in 1721. The law imposed severe restrictions on individual liberty and proposed isolating whole cities or towns if they became sites of contagion. These restrictions were to be enforced ‘by any kind of violence’. Violation of the law would lead to punishment by death. The Bill caused political uproar. It threatened not only to curb precious freedoms but also to interfere with commerce. A group of Tories, led by Earl Cowper, a former lord chancellor, objected and sought to have the law struck down. Defoe’s Journal was intended to remind the public of the terrifying dangers they faced. In his view, the drastic actions that the Quarantine Act proposed were urgent and necessary – ‘a public good that justified the private mischief’. In the era of COVID-19, there has been a similar resistance from libertarians to more strenuous measures to control virus transmission. Tiered controls on indoor socialising, the mixing of households, hospitality, non-essential retail, travel, and the numbers of people who could attend weddings, funerals and church services provoked fury from politicians who argued that the state’s curbs on personal liberties were an affront not only to individual freedom but also to individual responsibility.

There are, of course, differences between plague and COVID-19. There were no effective therapies to treat plague. Doctors in the seventeenth century were impotent in the face of a disease for which they didn’t even understand the cause. And the plague did eventually die out in December 1665, with the onset of a harsh winter. There is no expectation that our present-day coronavirus will recede into the background of our lives quite so gracefully. Mutated variants are giving the virus new life.

After twelve months, we have learned a great deal about the virus and the disease it causes. We have treatments that save lives. Over two hundred vaccine candidates are under investigation. Several have now been proven to be safe and effective. In 2021, we will see the world’s largest, fastest and most coordinated effort to control a disease since the intensified smallpox eradication programme began in 1967. Indeed, smallpox provides a sobering lesson. Despite the presence of a highly effective vaccine, the last case of naturally acquired smallpox was in 1975. Today, we are not trying to eradicate a coronavirus. But it will take years, not months, before we have this pandemic under complete control. We continue to underestimate the impact of COVID-19 on our societies. One hears otherwise intelligent and sensible people talking about a return to normality by the spring or summer of 2021. But there is no simple or straightforward return to the old life that we enjoyed before COVID-19. There is only a new normal to confront.

Meanwhile, the virus continues to shock. A new variant of coronavirus – called the B.1.1.7 lineage – emerged in the UK towards the end of 2020. It is rapidly replacing other forms of the virus and is spreading well beyond Britain. Although the new variant of concern seems to be no more harmful – rates of hospitalisation and death have not, so far, increased – it is more transmissible. Scientists have estimated that the variant has a 50 to 75 per cent transmission advantage over the original ‘wild type’. The R0 of the Wuhan coronavirus was 2.5. The R0 of B.1.1.7 lies somewhere between 2.9 and 3.2, a substantial leap in transmissibility. Although the new variant may not directly increase the number of deaths, the higher incidence of infection because of its enhanced transmissibility will indirectly increase mortality. Of special concern is the pattern of mutations in the new variant. Multiple potentially important alterations in the virus genome affect that part of the spike (S) protein binding to receptors on human cells. If sufficient numbers of mutations change the S protein in meaningful ways, the virus may be able to escape vaccine protection and evade treatments using specific antibody cocktails of the kind given to President Trump. The emergence of B.1.1.7 will not be the last surprise of this pandemic.

I wrote The COVID-19 Catastrophe in London during the first period of lockdown. At that time, the worldwide mortality from the pandemic stood at 337,687 deaths. That figure has since more than quadrupled, to over 1.8 million deaths – and it continues to rise by over 10,000 deaths per day. Meanwhile, the way governments have managed the infection has had profound political consequences. To take just one example: President Trump failed to win a second term in office, despite presiding over a strong economy before the pandemic, largely because he led the worst national response to COVID-19 of any developed country in the world. The American response was characterised by chaos, division and an abundance of misinformation. A spectacular level of ineptitude enabled the country to accrue the highest number of deaths from COVID-19 of any nation – by a very long way. The political price for that failure was high and will continue to be paid for years to come.

The purpose of this second edition is not only to update figures. I have revised each chapter to try to take account of new discoveries, perspectives and interpretations. I have added an introduction that aims to reframe our understanding of COVID-19 in ways that have important consequences for protecting our communities from future pandemics. I have tried to survey some of the most difficult controversies that have emerged and what those disputes tell us about our societies. And I have added an epilogue that tries to give a provisional judgement on what the pandemic means for our future. For COVID-19 is not only a new disease caused by a new virus. It is an inflection point in our understanding about ourselves and the planet we inhabit.

Preface

COVID-19 is a pandemic of paradoxes.

Most of those who became infected with this new coronavirus suffered only mild disease, perhaps not easily shaken off, yet shaken off nevertheless. But a substantial number – perhaps as many as one in five – developed a much more severe illness, often requiring intensive care and mechanical ventilation. For far too many, COVID-19 meant that death was their destiny.

Being older and poorer and living with chronic disease were important risks for worse outcomes. Yet a significant proportion of those who endured severe illness were also young and previously fit and well.

The scientific community made an astonishing contribution to producing the new knowledge needed to guide a response to COVID-19. But many questions about the virus and the disease it causes remain unanswered, leaving important gaps in our understanding of the pandemic that make its control, even with the availability of several safe and effective vaccines, exceptionally difficult.

The World Health Organization (WHO) acted with unprecedented velocity to declare a Public Health Emergency of International Concern (PHEIC). But the world’s only global health agency also struggled under intolerable political pressures to retain its credibility.

Countries pledged their support to international cooperation to defeat the pandemic. Yet those same countries were embarrassingly slow to match words with deeds, and too often they resorted to rivalry and blame.

This was a pandemic that was described and reported in terms of statistics – numbers of infections, numbers of patients in critical care and numbers of deaths. Lives were transformed into mathematical summaries. Graphs of the epidemic were drawn. And countries were compared for their rates of mortality.

But those who died cannot and should not be summarised. They must not become lines on squared paper. They must not become mere rates used to argue differences between nations. Every death counts. A person who died in Wuhan is as important as one who died in New York. Our way of describing the impact of the pandemic erased the biographies of the dead. The science and politics of COVID-19 became exercises in radical dehumanisation.

At press conference after press conference, government ministers and their medical and scientific advisors described the deaths of their neighbours as ‘unfortunate’. But these were not unfortunate deaths. They were not unlucky, inappropriate or even regrettable. Every death was evidence of systematic government misconduct – reckless acts of omission that constituted breaches in the duties of public office.

I edit a medical journal, The Lancet, which found itself a conduit between medical scientists urgently trying to understand COVID-19 and politicians, policymakers and the public who somehow had to respond to the pandemic. As we read and published the work of these remarkable frontline workers, I was struck by the gap between the accumulating evidence of scientists and the practice of governments. As this space grew larger, I became angry. Missed opportunities and appalling misjudgements were leading to the avoidable deaths of tens of thousands of citizens. Those misjudgements were repeated during successive waves of the pandemic. There has to be a reckoning.

This book is their story.

Acknowledgements

I owe a debt of thanks to many people. To Ingrid, Isobel and Aleem, for a period of grace. To my colleagues at The Lancet who worked assiduously to ensure that research on COVID-19 was peer reviewed and published rapidly to support those responding on the frontlines of this pandemic. To health workers and scientists around the world who took time under immense pressure and difficulty to describe their extraordinary experiences. To John Thompson, for his constant encouragement. To Emma Longstaff, Helen Davies, Lucas Jones, Neil de Cort and Caroline Richmond from Polity, who helped to make the message real. And to three anonymous reviewers, whose comments and suggestions helped to sharpen the substance of this argument.

Introduction

‘Dreadful death, fearsome with her sepulchral torch.’ So wrote John Milton in his Elegia tertia to commemorate the death from plague of the Bishop of Winchester in 1626. The ‘sepulchral torch’ of the coronavirus has indeed been fearsome, causing hundreds of thousands of deaths on every continent of the world. The origin of this pandemic lay in the passage of the virus from an animal to humans – a pathological relationship between two species, with savage and deadly consequences. And yet our response to this pandemic has also yielded strangely benevolent shifts in our human–animal associations, shifts that have revealed surprising and possibly important insights into our capacities to change the world around us for the better.

The white-crowned sparrow (Zonotrichia leucophrys) is a common songbird in the San Francisco Bay Area. Researchers have recorded their songs over many years. They have seen that, as noise levels in city settings have risen, so songbirds have sung louder songs in order to be heard by potential territorial intruders. During the lockdown to control the first wave of the pandemic in the spring of 2020, Elizabeth Derryberry led a team of scientists intrigued by the question of whether birdsong would change when noise in the city fell sharply during its shutdown.1

In April and May 2020 they measured urban noise and found it had declined to levels not seen since the 1950s. They went on to record birdsong in the city and found not only that birds sang more softly during lockdown but also that, by doing so, birds could communicate over longer distances (up to twice as far) and improve their vocal performance – increasing mating potential and reducing territorial conflict. Derryberry showed how changes in human behaviour can benefit animals as well as ourselves. Songbirds rapidly recovered their vocal dexterity when noise pollution declined and the acoustic space around them was emptied. The Silent Spring of 2020 revealed that the harms human beings cause to animals can be quickly reversed. Our relationship with other species with whom we share a planet does not have to be mutually unfavourable after all.

*

It would be a mistake to call the coronavirus that causes COVID-19 ‘clever’. A virus is not a living, thinking, intentional creature. It is an assembly of proteins carrying a piece of genetic material – a genome – that holds the information needed to replicate itself. A virus does not breathe. It does not eat. It does not laugh. But, in its own particular way, the coronavirus that has brought our lives to a halt has qualities that are, if not admirable, then certainly deserving of our respect.

A coronavirus looks like a ball covered with spikes. Within that ball (surrounded by a fatty or lipid membrane) is a piece – a large piece by comparison with other viruses – of genetic material called RNA, or ribonucleic acid. When viewed with a powerful electron microscope, the virus resembles a solar corona, hence its name. But don’t be fooled. The spikes on the surface of the virus are not for decoration. They are the entry cards the virus uses to advance its way into human cells.

The coronavirus spikes bind to the surface of a cell (to a receptor on the membrane of the cell called ACE2, which is widely distributed in the human body). From there, the virus particle is drawn into the cell shrouded by cell membrane. The virus then releases its genome and immediately hijacks the cell’s chemistry to begin the process of its own replication.

The first step in what is by now the beginning of the disease process is for the cell to ‘read’ particular genes contained in the viral genome. That ‘translation’ results in a collection of proteins that gather to form a device for reproducing thousands of copies of the viral genome. And here lies what is so exquisitely ‘clever’ about this coronavirus. This non-living entity has evolved a way to protect itself from genetic spelling mistakes, errors that might otherwise lead to viral extinction. The coronavirus proofreads its own work. It is able to correct errors made during the replication of the viral genome, thereby protecting its virulence and its ability to go on to harm further human cells.

Several features of this ‘life cycle’ of the virus make it especially difficult to destroy with a drug. First, the virus replicates itself inside a human cell. It is hard to discover a means to damage the virus while at the same time shielding the human cell. Second, a common way of disabling a virus is to block its replication by using drugs that mimic molecules essential to the replication process. But the proofreading skills the virus has evolved make the interruption of replication much more challenging. Just when you think you have introduced a catastrophic block to replication, the viral proofreader steps in to remove your intervention. And, third, the coronavirus is agile. It can change. Mutations in the genome mean that it could well evade medicines designed to target a particular piece of the genome.2

What we have learned about the biology of the COVID-19 coronavirus tells us that we are facing a particularly tormenting adversary.

*

What will happen to our adversary? In 2003, the first version of this coronavirus – SARS-CoV-1 – simply vanished, less than a year after it arrived. So far, it has not returned. But those coronaviruses that are more seasonal do come back, year after year, to cause variants of the common cold. Will SARS-CoV-2 disappear or will it become endemic, widely prevalent in our society, like influenza?

The answer to this question depends on the risk of reinfection. If reinfection is common, the virus will return again and again. We will live in a permanent state of vulnerability. But if reinfection is rare, it is just possible that we could drive this coronavirus out of our communities for good. Unfortunately, there have already been several reported examples of reinfection. In one case, a 25-year-old man living in Nevada tested positive on 18 April 2020, had two negative tests as part of his follow-up, but tested positive again on 5 June. Genetic analysis showed significant differences with each infection. The second infection was more severe than the first. This particular patient was infected on two separate occasions by a genetically distinct virus.3 The alarming conclusion must be that previous exposure to the virus does not guarantee total immunity. Everyone, whether previously diagnosed with COVID-19 or not, should take identical precautions to guard against infection. But it is still too early in the pandemic to be sure how frequent reinfection will be. What we do know is that four factors will influence the risk of reinfection with this coronavirus, and so the risk of its endemicity.

The first is the degree of immunity each of us develops after infection. If immunity is long-lasting, the virus has fewer opportunities to reinfect those it infected once before. If immunity is short, reinfections will be frequent and the virus will continue to circulate in our society. The human immune response does vary in ways that might make reinfection more likely. The older one is, for example, the less effective is one’s immune response. This phenomenon is called immunosenescence. Sometimes, the immune response is simply insufficient to cause immunity. Or, if it is initially sufficient, it can wane over time. The virus might also mutate, enabling it to escape whatever immunity was initially generated. (But coronaviruses mutate rather less frequently than influenza, thanks in part to their unique molecular proofreading mechanism.)

A second influence is seasonality. Is infection more common at certain times of year? For example, during the winter when people are together indoors, at school, or socially mixing in closed and crowded spaces during holidays. Strong seasonality will favour the return of the virus. Third, an interaction between viruses could play an important part in affecting reinfection. Infection with a different virus might prime the immune system, putting it on heightened alert. If a second virus arrives, one’s immune system might be ready to kick into action faster than usual.

Finally, the interventions we use to lower the prevalence of the virus will shape the evolution of the pandemic. The more we adhere to good hand and respiratory hygiene and physical distancing, avoiding mass gatherings, working from home (if you can), limiting travel and wearing masks, the more we will drive the virus out of our communities. An effective drug treatment would also help, but, as I have explained, a powerful antiviral will be hard to design.

But the intervention with most potential to control this pandemic is a vaccine. The progress made towards a vaccine against COVID-19 is unrivalled. Worldwide celebrations, combined with a high dose of relief, followed in November 2020, when the pharmaceutical company Pfizer and biotechnology company BioNTech announced in a press release that their COVID-19 vaccine was more than 90 per cent effective in preventing disease. The finding, the most eagerly awaited in the recent history of public health, came from a clinical trial in over forty thousand participants. The vaccine appeared to be safe, although the trial was only just over half-complete. Dr Albert Bourla, Pfizer’s chairman and chief executive, said, ‘Today is a great day for science and humanity.’ He was right. Until this moment, although early studies had been hopeful that a vaccine would be found, convincing evidence about the prevention of coronavirus-induced disease was not available. This achievement was indeed spectacular.

The story of the Pfizer/BioNTech vaccine was fascinating in other ways too. The founders of BioNTech were a husband and wife team – Turkish-born Chief Executive Professor Uğur Şahin and Chief Medical Officer Dr Özlem Türeci. Both are children of Turkish immigrants to Germany. Şahin was four years old when he moved to Germany and later studied medicine at the University of Cologne. Türeci grew up in a medical family – her father was a surgeon – and as a child could not imagine doing anything else but medicine. The couple met while working at the University Medical Centre in Mainz and married in 2002. Even on their wedding day, they worked in their laboratory. Together, they saw the potential of science to develop new treatments for cancer. They sold their first company, Ganymed Pharmaceuticals, in 2016 for £376 million. They created BioNTech to continue their work on cancer treatments – specifically, vaccines – based on the immune system. Until the coronavirus vaccine, none of their products had reached the bedside.

But, in January, Şahin read about the emerging pandemic in The Lancet. Immediately, he understood the threat – and the opportunity. He moved six hundred scientists at BioNTech to begin working on a vaccine. Their approach was highly unusual. Many of the most successful vaccines – polio and measles vaccines, for example – are based on a weakened (attenuated) or inactivated form of virus. But BioNTech’s vaccine uses genetic material – a type of RNA called messenger RNA, or mRNA – to stimulate immunity. The genetic sequence of SARS-CoV-2 was made publicly available by Chinese scientists on 12 January 2020. Şahin and Türeci focused on that part of the sequence which produced the spike protein on the surface of the virus. They took that sequence of mRNA, which contains the instructions to make human cells produce the spike protein, and wrapped it in a bubble of fat that enables the vaccine to enter the cell. Once inside, the mRNA uses the cell’s machinery to produce large amounts of spike protein, which then sits on the surface of the cell provoking the immune response that protects that person from developing COVID-19. The vaccine enables the person who has been immunised to produce their own medicine. Many scientists had been sceptical about whether an mRNA vaccine could work. But by 11 March, when WHO officially declared COVID-19 a pandemic, BioNTech had produced twenty candidate mRNA vaccines.

During the next few months, they tested their prototype vaccines on mice, rats and monkeys and focused on four that seemed most promising. When they tested those candidates in humans, one in particular stood out as safe, as well as effective. It not only stimulated the production of antibodies to attack the virus but also triggered a parallel kind of immunity – cellular immunity – that is mediated by T cells. Their vaccine aimed to corral all the forces of the human immune system to protect the body from viral infection and disease. In July, they began the trial whose interim results were reported in November.

The UK was the first country to give regulatory approval for a vaccine – and that first vaccine was from Pfizer/BioNTech. Programmes to vaccinate priority populations began in December 2020, beginning with residents of care homes (the goal was to prioritise those at greatest risk of premature death, but it was also a poignant sign of reparation, since it was these very care home residents who had been so abandoned at the beginning of the pandemic). The US and Canada quickly followed the UK’s authorisation of the Pfizer/BioNTech vaccine. Alarm was raised after only a few days of the vaccine’s roll-out when three recipients developed severe allergic reactions possibly linked to their immunisation. All three had a history of allergic disease. Regulators quickly revised their advice and recommended that ‘any person with a history of anaphylaxis to a vaccine, medicine or food should not receive the Pfizer/ BioNTech vaccine.’

The approval of a vaccine for widespread human use was a significant milestone in the scientific response to COVID-19. Yet even this success was tinged by political controversy. The UK’s minister of health, Matt Hancock, claimed that Britain had been first to approve a vaccine ‘because of Brexit’. The minister of education, Gavin Williamson, went further. He said, ‘I just reckon we’ve got the very best people in this country and we’ve obviously got the best medical regulator – much better than the French have, much better than the Belgians have, much better than the Americans have. That doesn’t surprise me at all, because we’re a much better country than every single one of them.’ Although Prime Minister Boris Johnson refused to back either Hancock or Williamson, and although June Raine, chief executive of the UK’s Medicines and Healthcare products Regulatory Authority, specifically refuted their claims, their nationalistic, indeed jingoistic, interpretation of the development and approval of a vaccine was a sad moment of misunderstanding. For the truth is that the science that led to the development of a vaccine against COVID-19 was the consequence of an extraordinary global collaboration – from the sequencing of the virus by Chinese scientists, to the development of the vaccine by immigrants of Turkish heritage in Germany, to its manufacture in Belgium. To be sure, the UK can be proud of its own scientists. A team led by Sarah Gilbert and Andrew Pollard at the University of Oxford had, in collaboration with AstraZeneca, developed their own vaccine against COVID-19.4