Anthony Costello is a pediatrician and international child health expert who was an outspoken critic of the British government’s response to Covid-19. He is a member of Independent Sage, a group of experts set up to provide “solid and independent advice” on coronavirus policies in the United Kingdom, and a former director of the Institute for Global Health at University College London. He has worked in several low-income nations, developing effective strategies for reducing neonatal and maternal mortality rates. He also worked as director of maternal, child and adolescent health at the World Health Organization (WHO) in Geneva.
What do you think of the decision to open pubs yesterday?
Well, it’s very strange in Britain that we are opening pubs before school. It says something about our priorities. Staying outdoors the risks are quite low – 19 times less risk according to a Japanese study. I would have said pubs open as long as you serve outside. The concern is that people will crowd together for a drink and that while they drink, they will lose their inhibitions. And in an interior space there is a lot of potential to be a super-spreader. So I’m a little bit opposed to opening the pubs, but I understand why they did it.
Do you agree with Sir David King, president of Independent Sage, that the government has lost all moral authority?
Has the government ever had much moral authority? The entire English response, almost from the start, has been an ongoing history of individualism and new conservatism, which has damaged public health. Now you have this bizarre situation where suddenly you have this mysterious body called the joint biosecurity center, which will be responsible for the data and nobody knows who they are or where they get them from. You marginalized Public Health England (PHE) and, I would say, abolished, and the Sage (Scientific Advisory Group for Emergencies), which is now wary of politicians, not listened to. So it’s a very strange situation.
PHE has been accused of limiting the coronavirus test process to its labs. Was it a fair criticism?
Yes, I think yes. If they have any defense it is that the entire public health system was overthrown about seven years ago with Lansley’s reforms. We had a structure in place that allowed regional public health people to take control of something like an epidemic and that was dismantled. They have degraded the public health system. You could also argue that the problem was Sage. In early February they should have known that this was a pandemic that was coming and the first thing you wanted to do was a test – and they had a test. Why didn’t they go to the 44 molecular biology labs across the country that were all equipped to do so? There were no public health people on Sage. Nobody who was independent could have said, “Come on guys, this is what you have to do.”
Should Black Lives Matter protests have been allowed to continue?
Given that the protests are outdoors and if they are well managed and the people who organize the protests make a serious attempt to control them, it could be argued that democracy prevails over risk right now because we are at the bottom of the curve. The problem is that if the protests get very big, there is a risk there. But pubs are far more risky than a protest or even Bournemouth beach, which has been slightly unfairly criticized.
What do you think of the criticism that Independent Sage confuses the message and undermines Sage authority?
David King always says that Indie Sage must be relevant to the pandemic and constructive in suggesting areas where improvement can be made. Of course, there are people with axes to grind, including myself, on aspects of what the government or Sage have done. The problem with Sage is that he’s unbalanced. They have very good modelers and good behavioral scientists, but many of them came to us because they were very frustrated that they were not being listened to. Science should be open and discursive.
It is widely believed that the blockade should have started earlier. Why do you think it didn’t and what difference would it make in terms of deaths?
The first reason it didn’t happen is because they decided early on that the tests weren’t going to be done. It was bizarre. This led them to really plan a response to the wrong virus – flu. Flu is a very different virus. Don’t try it because it spreads so quickly. The flu mentality then led them to this idea of flock immunity: that it is a pandemic and you cannot stop it. They had 230 contact detectors for 67 million people. In Wuhan, they brought 9,000 for about 10 million people and had a complete blockade … I fell out of my chair when I saw Johnson’s March 12 announcement. Almost everything they said was wrong. Can you name a virus where you let it pass through the population to get herd immunity? Herd immunity is that obtained from a vaccine. We are currently at around 65,000 excess deaths, according to Financial Times. I honestly think we could have prevented around 50,000 of them if we had gone as early as South Korea. I think Sage was wrong, PHE was wrong and Boris Johnson was wrong.
What is your evaluation of the development of a vaccine and when, realistically, will the first one arrive?
The good news is that you have more labs in the world looking for a vaccine for this virus than any other. They have better techniques for designing vaccines and there is a lot of money to invest. Having said that, they never had a coronavirus vaccine. Vaccines usually take several years to develop because you need to test their safety. And the most worrying thing seems that the immune response to the virus is not very good and fades away. This suggests that any vaccine that occurs may have short-term immunity. For all these reasons, I am cautious. The people I respect say that two years would be a possible time. My guess is that we may have a partially effective one a little faster.
It is possible that, like Sunetra Gupta of the University of Oxford suggests that many people have come into contact with the virus but have not developed antibodies?
Yes, it is possible. When I first looked at Sunetra’s things and spoke to epidemiologists whom I respect, they said he couldn’t be right. He overestimated the spread of the disease and underestimated its strength. Having said that, there is some element of truth in what you think.
What do you think of Matt Hancock’s performance as a health secretary?
I recently tweeted that he should have resigned. At first I thought he was probably the most authoritative of ministers in briefings. So he became obsessed with testing without understanding why you do it, from research, to testing, to isolation and support – you need everything to make it work. But ultimately, I think decisions are made with private companies like Serco and Deloitte, and with this total disaster in Leicester where they can’t get the data because the private sector doesn’t share it – I think it’s almost negligent. And the decision to bypass PHE rather than strengthen it and strengthen links with primary care has been regrettable.
How do you see the virus reproducing from here?
I invited a modeler to Indie Sage, one of the best neuroscientists in the world, a UCL professor named Karl Friston. Makes brain wave models. A total genius. He has come up with a totally different approach to modeling by Neil Ferguson and Adam Kucharski, who are excellent epidemiologists. Do you think the herd immunity level to stop this epidemic is probably much lower than 60%. Do you think it is around 25-30%. What he says is that about half of the population is seized or protected, so it is not exposed. Up to half the others are not as sensitive as children because they have good mucosal immunity. And others may have symptoms but don’t transmit them very easily. We have just sent a letter to Hand about this. If our assumptions are right, this could mean that this crisis ends sooner than we expect. But coronavirus will not be eradicated without a vaccine.
There has been much speculation about the change in society after Covid-19. Do you think it will happen and how would you like it to manifest?
I hope. Although I am a pediatrician and most of my work is concerned with community health in low-income countries, I have been pretty involved in climate change for the past 10 years. I am co-chair of Lancet’s countdown on climate change and health. I was flying too much and I always felt when I was at WHO that there was no need to do it. I know that Zoom can guide you around the curve but we did everything in Indie Sage on Zoom. And it has been incredibly productive. My fear is that within a couple of years, if everything settles down or we have a vaccine, things will go back to where they were. But the climate crisis is much more serious and we have so little time to do it well.