This indicates the essential requirement to vaccinate quickly and thoroughly, but also that the period over the next few years, approaching a stable, endemic point, will not involve a simple return to pre-COVID ‘normality’ for most the population – as the activists around the Great Barrington Declaration have urged. We can’t do the equivalent of closing our eyes and pretending this will go away by itself. Policy and planning matter.
The political economy of the pandemic
It is not unreasonable to claim that elimination, globally, should be the aim of governments. In principle, we now have both the policy – zero COVID – and, crucially, the technology – vaccination – that at least create this as a possibility. To reach it would require most, if not all, countries to apply zero COVID as their aim, and vaccines to be distributed smoothly and effectively, repeating doses as needed.
It’s certainly possible to imagine a world in which the vaccine has been distributed fairly and countries everywhere have implemented zero COVID. Unfortunately, this isn’t the world we live in. We live in a competitive global economy, with states working alongside their national firms to compete against other states and firms across the globe. Ours is a world in which the worldwide co-operation needed to achieve both generalised zero COVID and effective vaccination do not exist, and most likely achieving even one would be difficult. As the vaccine roll-out continues, and some countries begin to benefit from the immunity they provide, these sorts of tensions that have already appeared around the vaccination programme, like those between the UK and the EU, are likely to worsen and recur every time new vaccinations are required. Given the likelihood of mutations, this is likely to be often. The best expectation for the global vaccine roll-out is that it will be highly uneven.
Similarly, the major incentive for countries – particularly those like the UK that are tightly integrated into the world economy – to avoid the costs of zero COVID are significant, especially where those costs fall on major businesses. The costs today of a serious suppression strategy are both the domestic losses (both economic and social) from restrictions in our activity, and the losses from shutting borders to outside travel. The benefits of zero COVID implemented today start to appear in the future, as the virus is brought towards elimination at least on a national level. This makes the future benefits hard to achieve without a firm steer politically.
But the more the rest of the world moves towards eliminating the virus, the lower the future benefits of zero COVID start to appear: if the rest of the world is bringing the virus under control, why should a country take on the costs of doing so itself? In other words, the more other countries implement a zero-COVID plan, the less incentive there is for any given country to also implement one.
This applies even when the future benefits are clear to everyone. It’s obvious now that those countries that did best in the first phase of the pandemic are now reaping the rewards, with the economies of China, Vietnam, New Zealand and others forecast to grow relatively quickly over this year. Clearly, when the virus has exploded and the costs of failure to control it domestically are high, there is a solid incentive for any given country to do something – although even this isn’t guaranteed, as the case of the US in 2020 shows, or in the brief period of ‘taking it on the chin’ in Britain.
But as vaccines are rolled out and the virus is (unevenly) brought under more control globally, this ‘free rider’ problem – of countries trying to avoid the costs of elimination by relying on others to do the work – is likely to become more apparent. This is because as the virus is brought under control globally, the future benefits of elimination in any given country, relative to the general level of the virus globally, are reduced: the gap between having no virus domestically, and the situation in the rest of the world, will have been shrunk. The vaccine will be reducing cases domestically, and vaccination in the rest of the world will be reducing the likelihood of importing cases. The costs of zero COVID will look less and less appealing relative to a reduced future benefit.
At the very least, the domestic coalition needed to sustain political support for zero COVID – across different business sectors, and into wider society – is likely to fray, given the presence of those extended costs and the fact that businesses face a competitive global economy. If they can palm off costs, they will; it takes exceptional domestic political pressure to overcome this. The most likely outcome globally is that if even a few countries implemented zero COVID in the initial stages of the disease, over time fewer countries will do so. More likely will be messy combinations in various countries, across the globe, of some attempts at suppression followed by periods of reduced restriction.
Put these two factors together – the difficulties in vaccine distribution, and the costs relative to future benefits of zero COVID – and it should be clear that a capitalist world economy is going to undersupply vaccines where they are needed, and undersupply elimination policy across different countries. We may get lucky, but the most likely path in the future is a fairly rocky one towards something like endemic COVID, globally, as in the modelling discussed above. That means any country pursuing zero COVID today, complete with border controls, test and trace, and extensive financial support for those self-isolating, is likely to have to do so for a significant period of time: in effect, holding out against global capitalism and its endemic disease. If the costs are high, and the future benefits are declining, it will become increasingly hard to hold the line. In New Zealand, repeated lockdowns from outbreaks are prompting debate about the long-term future of its own zero-Covid strategy: it is unlikely, given the global picture, that its current course will be maintained indefinitely.
Tight border controls might be bearable as a temporary measure, and command widespread public support in the UK. What we don’t know is how long they can be sustained at the kinds of levels that an elimination strategy would require. Take New Zealand as a much-cited example: since March last year, its border regime has become strikingly draconian. Only residents and their partners are allowed to enter, with visas to others being granted in only an exceptional number of cases. Asylum obligations have been suspended. Family returns are extremely limited. Cases of legal New Zealand residents becoming stranded by the border regime have emerged. The costs, in a crude economic sense, of severely restricting the flow of people in and out of a country are significant – particularly so in an economy like Britain’s. But there is also the slow social damage of attempting to maintain yourself as a weird semi-autarky for an extended period of time, or of attempting to maintain extended periods of enforced social distancing.
Fences and passports
Proposals to try and ease the costs of an extended period of suppression are already starting to emerge. Immunity passports indicating a person’s current vaccination status and therefore their eligibility to travel, have been floated by the former UK prime minister, Tony Blair, whilst the European Commission has just proposed the introduction of a digital vaccine passport for holidaymakers inside the EU this summer. We are seeing the emergence already of ‘travel corridors’ and ‘approved lists’ of countries, and hard travel bans on others. It is not too hard to imagine a world in which the distribution of vaccines is limited in effect to a relatively privileged minority, who are then biologically cocooned from the wider world in a system of travel corridors and vaccine passports. This would leave the world’s majority patchily vaccinated, suffering repeated waves of fresh mutations of the virus and trapped behind new fences along the rich world’s borders. This is not too hard to imagine as a near-future because, of course, this is very similar to the world we already live in.
Importantly, zero COVID could very easily fit in with a world that starts to look like this: countries that agree amongst themselves that they have eliminated the virus could decide their citizens were allowed to travel amongst themselves, whilst maintaining tight restrictions on entry to the rest of the world. Australia and New Zealand have already made exactly this agreement. In the place of what historian Le Roy Ladurie, surveying the devastation of the Americas, called the “unification of the world by disease”, COVID looks set to provoke its further disintegration.
