Many people will have had a grim sense of déjà vu on Sunday night when the prime minister once again interrupted proceedings to address the nation with a plan for containing a new Covid variant in the run up to Christmas.
The announcement of a huge acceleration in the booster programme was on top of the Plan B measures (work from home, mask mandates and Covid passports) set out on Wednesday – over which Boris Johnson already faces a huge rebellion from his own benches. Yet some scientists (and reportedly some within government) [i] already think he has not gone far enough, with concerning new modelling from the UK Health Security Agency estimating there are already 200,000 Omicron infections per day.
The country faces a precarious and uncertain few weeks. Here are five questions the government needs to answer to build confidence in its approach and show it has learned from its handling of the pandemic to date.
Ministers are being forced, once again, to make big, difficult judgements under conditions of huge uncertainty. Omicron appears to be more transmissible, but evidence on virulence is so far less conclusive. It may be less deadly, but there are concerns that – even if it is – the extra transmissibility alone would still mean it threatens health capacity. There are doubts over how much to extrapolate from data emerging from South Africa, which has very different demographics and immunity profiles, while the lag in hospitalisations and deaths means understanding the threat the UK faces will be difficult until cases are very widespread.
Last December, the government handled similar uncertainty – that time over the Alpha (Kent) variant – incredibly poorly. Having boxed itself in by pledging to “save Christmas”, it ignored mounting evidence of the threat the UK faced before folding at the last possible moment. This resulted in disruption, confusion and ultimately a huge and deadly wave in January.
The prime minister should take a different approach the time – drawing on his more successful staged plan for exiting lockdown earlier this year. He should set out the assumptions the current approach is based on and under what circumstances restrictions would be eased if Omicron does turn out to be less harmful – or tightened further if the data gets worse – to help people plan for the coming weeks and months. He should reassure backbenchers who worry his approach heralds “seasonal restrictions forever” by promising faster boosters to tackle future variants.
In public health emergencies, communication is often as important as the policy itself. Messages need to be simple, consistent, well-reasoned and repeatedly endlessly.
The revelations about last Christmas’ Downing Street parties threaten to undermine the government’s instructions to the nation, while muddled messages are causing further confusion. Ministers rebuked Jenny Harries, the head of UK Health Security Agency, for suggesting people should avoid unnecessary socialising, and then spent several days offering a range of opinions on whether people should kiss at Christmas.
They will face repeated questions over the coming weeks about social gatherings, isolation policies, testing requirements and much else besides. Clarity and consistency will matter not just for getting through Christmas, but for coping with the surge in January. The government needs to ensure that ministers and health officials have clear lines to take on new restrictions, guidance, or general advice – and the rationale for them.
The extra protection provided by a third jab means accelerating boosters is the single best tool the government has for fighting Omicron. But Johnson’s target of offering all adults the chance to book a booster by the end of the year – and jabbing over a million people a day – still looks incredibly ambitious.
High-profile targets always risk distorting behaviour: Matt Hancock’s 100,000 tests a day target led to a narrow focus on the number of tests, rather than on how they were being used to curb transmission. In this case the target is better aligned with the desired outcome – a booster offers direct protection against infection, hospitalisation and death – though the government will still need to ensure that the process happens (and is seen to happen) safely.
There are also big questions about how quickly boosters can be accelerated – and at what cost. The NHS does not think it will get close to meeting the target: it is being asked, with minimal warning, to more than double its previous daily record and sustain that daily. The jolt to the system may succeed in galvanising efforts, but ministers should avoid any sort of blame game if and when progress falls short.
NHS England has said all non-urgent care should be open to delay to make space for boosters – and appears to be hoping this will flatten the curve enough to avoid operations being cancelled in January. But the government should explain – not least to those facing costly disruptions – the calculation it is making (recent FT analysis has suggested a large number of excess deaths this year may have been caused not by Covid but by delays in other treatments).[ii]
The government is switching from a highly managed process – people waiting to be invited and booking a slot – to a much less planned approach: increasing capacity and asking many people to join a queue. Not surprisingly, the online booking system has already crashed.
The latter approach may be the only way to achieve the sort of acceleration it wants, but it is not without risks. Images of people waiting hours in the cold could put others off, while large waiting rooms could easily act as super-spreader events if they are not well managed. Some people or communities – those less attuned to public announcements or without digital skills – may be slower in coming forward. Opening up vaccinations to everyone could make it harder for more vulnerable people to access them.
None of these are reasons not to accelerate the booster programme – but they are risks the government will need to manage. Its ability to match supply with demand will be critical if the process is to be as smooth and orderly as possible.
The government decided to phase out economic support for businesses at the end of the summer to save on spending and help get the economy working more as normal. It made little sense to keep supporting businesses that otherwise might not survive.
But the Omicron surge – and the government’s response – will cause further problems for businesses. Hospitality and other consumer-facing businesses are going to be badly hit as people decide, or are told, to avoid socializing (this is already starting to happen). Large venues are also being asked to check Covid passports – an additional burden.
The Treasury may, not unreasonably, be reluctant to intervene again – though it has also hinted that it could do so in private briefings to journalists. But nervous businesses will need some certainty in order to plan. The government should clearly set out the circumstances which would prompt it to step in.
Many people will be desperate to avoid a repeat the chaos of Christmas 2020 – the prime minister included. He will need to show he has learned from previous mistakes, though, if the public is to have confidence in his latest plan.