Life in the Pandemic XVI: The light at the end of the tunnel

The great sulk continues in the actual Whitehouse. The great contrast with the Bartlett Whitehouse continues (yes, I know it’s made up, but I’m still enjoying it). The great pandemic continues. Indeed in the land of the Whitehouse it is getting unbelievably worse. Each day in the US literally thousands are now dying, with the numbers still growing. No slick drama could cover this misery. Or the tearful frustration of healthcare workers at the end of their endurance pleading with people and politicians alike to do what can easily be done to ease the situation. We have our moments on this side of the Atlantic, and have endured our own share of political chaos and incompetence during the pandemic, but it does not seem to have reached quite the proportions of the Trumpian dystopia in the US. However, a light has now appeared at the end of the COVID tunnel.

Thanks to a remarkable effort and a ton of public money, there is now good evidence of no less than three effective vaccines, and slightly weaker evidence for at least two more. These have already been used on tens of thousands of people in various clinical trials. In the UK the first vaccine was authorised for use on the 2^nd December, and the needles were stuck in the first arms earlier this week. There are lots of people who deserve lots of credit for these achievements. Those who pioneered some of the underlying science behind the “Pfizer” and “Moderna” vaccines certainly deserve credit because they have come up with a new way of designing and producing vaccines which, at least in this case, appear to be amazingly effective. In the case of the Oxford/AstraZeneca vaccine (not far from approval now), science plus some inspired guesswork appear to have produced the most usable of these initial vaccines. Because of its simpler production, ease of transport and robustness, this is the one that will perhaps have the most global impact. (Some) politicians and the regulators deserve credit too. There appears to have been little haggling over funding to push forward with trials, and real cooperation to expedite both trials and approvals without compromising safety. If there has been a conspiracy, it has been to advance as quickly and safely as possible, and it has achieved something of real and lasting benefit. And for once those on the outside of the rich, industrialised and wealthy world have not been forgotten. Yes, I’m sure grubby politics and grubbier economics will soon reassert themselves, but for now it’s worth smiling about much of this. But, of course, it is just the start.

There is a world of difference between a vaccine and vaccination. The real value of the work that has been done will only be realised when the vaccines end up in peoples’ arms. There are lots of other people we will need to rise to meet a whole different heap of challenges before we approach the end of the pandemic tunnel. Manufacturing enough vaccine for close to the whole human population of the planet is hardly trivial. Production problems have already reduced the rate at which the newly approved Pfizer vaccine can be rolled out in the UK. And after making the stuff, it has to be transported, and then distributed. For the Pfizer and Moderna vaccines this is a challenge because they appear to be rather delicate requiring very cold transportation and storage temperatures, and minimal handling. That's why it’s the Oxford vaccine, which is slightly more robust and happy at roomish temperatures, will probably have the global impact. Once all of these challenges have been overcome, there is the issue of the population’s willingness to bare their arms.

This will all take time. So for at least the next few months most of us will need to do what the media claims we’re all sick of doing. The routine of facemasks, social distancing, handwashing and lots of working from laptops at home where we can, will all have to continue. Restrictions on activities we all used to take for granted will also continue. And if we don’t stick to this, more people will die than would otherwise be the case. Maybe, just maybe, next summer we might be returning to something akin to what we used to think of as normality. The virus won’t have disappeared of course. And we don’t know how quickly our new-found, vaccine stimulated immunity will. So care will still be needed. There remain many unknowns. In reality we have a distance to travel in the tunnel, and the light, while reasonably bright, isn’t stellar yet.

Which brings me to what I’ve been reflecting on. The COVID tunnel is far from humanity’s longest or darkest. COVID vaccines, impressive as they are, are no solution to our biggest problem. Indeed, although they are vital, it would be a great mistake to indulge in any collective hubris about our achievements, before moving on to some other issue. After all, it was almost certainly human activity that led to the pandemic in the first place. And before most of us adopt a smug attitude because we know whose fault it all is (or think we do), there’s plenty of collective blame to go around for all sorts of abuses that have exacerbated the pandemic. Some of the very same things may well lead to the next global disaster. And that’s all before we get to other things like the climate crisis. It turns out that the inevitable progress of humanity has never been inevitable at all. And sometimes progress is not as progressive as is claimed. In economics, poverty abounds and seems only to shift rather than decline (although statistically until the pandemic progress had been made). In health as we’ve seen, old diseases may be conquered (if not eradicated) but new ones emerge. Even although poverty, illness, war and famine are avoidable, we manage not to avoid them. There are lots of good things that we can now do which previous generations didn’t even dream about. But for all that we appear to be largely stuck.

Maybe this is because fundamentally humanity’s big problems aren’t intellectual or technical. Therefore the really big issues do not have intellectual or technical solutions. The nub of our problems are moral, and beyond that, spiritual. The real tunnel we’re naturally stuck in is that we’re just not what or who we are supposed to be. But particularly at this time of year, we remember a light that appeared. And it appeared not at the end of our tunnel, but in the middle of it. It would be hard to put it better than John put it at the beginning of his Gospel:

^9 “The true light that gives light to everyone was coming into the world. ¹⁰ He was in the world, and though the world was made through him, the world did not recognize him. ¹¹ He came to that which was his own, but his own did not receive him. ¹² Yet to all who did receive him, to those who believed in his name, he gave the right to become children of God— ¹³ children born not of natural descent, nor of human decision or a husband’s will, but born of God.” John 1:9-13

Note to self: It’s time I stopped fixating on the pandemic, and considered again the events that culminated in the arrival in this very world of Jesus, who came to illuminate the way out of this very tunnel.

Life in the Pandemic XI: Why science can never be enough.

In the interests of transparency, I should make clear from the outset that I think science is, without doubt, the best way of obtaining sound answers to certain types of questions. And just at the moment, some of those questions are pressing. Here in the pandemic we desperately need to know whether convalescent plasma treatment works, and if it does, how well.  We need to know if any of the vaccines currently being investigated confer immunity to the SARS-COV-2 virus, and if so, how long that immunity lasts. Despite claims by the Presidents of both the US and Russia, these questions remain open. The only way they can be answered is properly constructed clinical trials, which are ongoing. The answer/s will come when they come. Spin, propaganda, political will or economic desperation will not bring them any sooner. Such claims as have been made, appear to be based on political considerations and (sometimes wilful) ignorance, and those making these claims are seeking to exploit the ignorance of the population at large. That they have been perpetrated at all is just one line of evidence that science on its own is never enough.

Part of the problem is that science does not take place in any kind of vacuum, be it political, cultural or ethical (the one exception being science done in a vacuum!). It is a human activity carried on by human beings. Its results, and what flows from them, be those novel medical treatments, new technology, or new answers to age-old questions and problems, have to be understood and then used (where they have a use) by human beings. While as an institution and community science is, at least over the medium term, fairly critical and self-correcting, it can and has produce flawed results and wrong answers. The practitioners of science (ie scientists) are, as individuals, as flawed and fickle as the rest of humanity. Most try to practice their science in a competent, professional and serious way. A minority are known to have behaved fraudulently, with the intent to deceive, usually for some sort of gain. There is sense in which science is under attack from within by this minority. And their activities devalue the whole enterprise. It certainly means that the scientific enterprise is much less efficient than it might be. However, it also risks bringing the whole scientific enterprise into public disrepute (much as has occurred with journalism and politics). So, to bolster science’s self-regulation and self-correction functions, various mechanisms have been introduced, like the US Office of Scientific Integrity or academic and scientific integrity processes in individual institutions. But policing science, practicing it properly, upholding commitments to honesty, decency and transparency, is not a scientific matter, it’s a matter of ethics. And ethics isn’t science. These things really matter for the continuing ability of science to get good answers to tough questions. But they are not themselves scientific. Another example of science on its own not being enough.

Science’s foundations, its method/s (there isn’t “a” scientific method), and lots of elements of its practice are also not themselves “scientific”. What I mean is that they do not proceed along those classic lines from hypothesis, to predictions, to tests and measurement leading to results. They are the stuff of starting assumptions and a necessary framework of commitments that make science work. If science had been proved not to work, then I suppose they would have come under more scrutiny. But now they are so baked in they have become invisible. Philosophers and historians of science have largely given up trying to crack “the” mystery of how science works because so much of it is about all this invisible, intellectual “dark matter”. But this is another way in which science on its own isn’t enough. Scientific method, properly conceived, isn’t entirely scientific.

One of the things science is really good at is making measurements in an organised and objective way, so that the results once obtained can command widespread agreement. This isn’t just about the results themselves, but it’s also about the scrutiny that all scientific results have to be placed under. This is the sort of community activity most commonly seen in the processes of publishing scientific results via peer review, exposure at conferences and the like. This is a key part of the process that leads to sound knowledge in any given field which provides the launchpad for the next phase of progress. In a given field, once the basics are established, there’s no need to go back to square one each time, and so effort can focus on extending and refining explanations and knowledge, making them more powerful in the process. But as powerful as scientific explanations and knowledge might be, they only provide information about, and control over, natural processes by way of statements of facts. The conundrum is that usually this is not really what interests people. David Attenborough documentaries about the state of the planet only get you so far. What occupies most people most of the time isn’t the answer to the what and how questions, but the answer to why questions. And establishing what “is”, is far from establishing what “should be”. We may be cooking the planet, we may be imperilling biodiversity on a global scale. But beyond the notion that might not be in our long term health or economic interests, why is this a bad thing? That’s not a question of science, but a question of values. It’s these values questions that are the important and tricky ones, and science can never give us the complete answer to them.

And here’s the real kicker. Science is all about reason. This is a problem. Because individually and collectively all human beings are not merely rational. Reasons other than reason often drive our behaviour and influence our decisions. Indeed, even if it were true that on average the human population did behave rationally, given human variability that simply means that there will be a lot irrationality about. And science on its own can’t help with that (beyond measuring accurately the irrationality). This type of irrationality can be viewed almost nightly on news channels where people deny the pandemic, and state quite openly that no way will they accept vaccination against the “fake flu”. Only a minority need to adopt this irrational stance (it flies in the face of the evidence), to undermine the usefulness of a C19 vaccination for everyone.

So, deep down here in the pandemic we certainly need science. It will provide us with desperately needed tools. But on its own it cannot guarantee that those tools will be used effectively. Never confuse science with salvation.