Anthony Costello is a paediatrician and international expert on child health who has been 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 “robust, independent advice” in regard to the UK’s coronavirus policies, and former director of the Institute for Global Health at University College London. He has worked in a number of low-income nations, developing effective strategies for cutting newborn and maternal mortality rates. He also served as director of maternal, child and adolescent health at the World Health Organization (WHO) in Geneva.
What do you think about the decision to open pubs yesterday?
Well it’s very odd in Britain that we’re opening pubs before schools. It says something about our priorities. Being outdoors the risks are pretty low – 19 times lower risk according to a Japanese study. I would have said open pubs as long as you serve outside. The worry is that people will be crowding together to get drinks, and that as they’ll be drinking, they’ll lose their inhibitions. And in an indoor space there’s lots of potential to be a super-spreader. So I’m a bit opposed to pubs opening, but I understand the reasons why they’ve done it.
Do you agree with Sir David King, chair of Independent Sage, that the government has lost all moral authority?
Did the government ever have much moral authority? The whole English response, almost from the beginning, has been an unfolding tale of individualism and new Conservatism, which has damaged public health. Now you have this bizarre situation where you’ve suddenly got this mysterious body called the joint biosecurity centre, which is going to be in charge of data and nobody knows who they are or where they’re getting it from. You’ve got Public Health England (PHE) being marginalised and, I would think, abolished, and the Sage (Scientific Advisory Group for Emergencies), which is now wary of the politicians, not really being listened to. So it’s a very odd situation.
PHE was blamed for restricting the coronavirus testing process to its own labs. Was that a fair criticism?
Yes, I think it is. If they’ve got any defence it’s that the whole public health system was turned on its head about seven years ago with the Lansley 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’ve degraded the public health system. You could also argue the problem was Sage. In early February, they should have known that this was a pandemic that was coming and the first thing you would want to do was test – and they had a test. Why didn’t they go to the 44 molecular biology laboratories around the country that were all geared up to do this? There was no public health person on Sage. No one who was independent who could say: “Come on guys, this is what you’ve got to do.”
Should the Black Lives Matter protests have been allowed to go ahead?
Given that protests are outdoors, and if they’re well managed and the people organising the protests make a serious attempt to control them, you could argue that democracy overrides the risk at the moment because we’re on the downward part of the curve. The problem is if protests get very big, there is a risk there. But pubs are much more risky than a protest or even Bournemouth beach, which got slightly unfairly criticised.
What do you say to the criticism that Independent Sage muddies the message and undermines Sage’s authority?
David King always says Indie Sage has got to be relevant to the pandemic and constructive in suggesting areas that can be improved on. Obviously, there are people with axes to grind, me included, about aspects of what the government or Sage have done. The problem with Sage is that it is unbalanced. They’ve got some very good modellers and some good behavioural scientists, but a lot of them have now come over to us because they were very frustrated that they weren’t being listened to. Science should be open and discursive.
It’s widely thought the lockdown should have started earlier. Why do you think it didn’t and what difference would it have made in terms of deaths?
The first reason it didn’t happen is because they decided early on that testing wasn’t going to be done. That was bizarre. That led on to them really planning a response to the wrong virus – flu. Flu is a very different virus. You don’t test for it because it spreads so quickly. The influenza mindset then led them on to this herd immunity idea – that it’s a pandemic and you can’t stop it. They had 230 contact tracers for 67 million people. In Wuhan, they brought in 9,000 for around 10 million people and they had a full lockdown… I fell off my chair when I watched that 12 March announcement from Johnson. Almost everything they said was wrong. Can you name a virus where you let it run through the population to get herd immunity? Herd immunity is what you get from a vaccine. At the moment we’re at about 65,000 excess deaths, according the Financial Times. I honestly think we could have prevented about 50,000 of them, if we’d gone early like South Korea. I think Sage got it wrong, PHE got it wrong, and Boris Johnson got it wrong.
The decision to test with private companies and the mess in Leicester… it’s almost criminally negligent
What is your assessment of a vaccine development and when, realistically, is the earliest one will arrive?
The good news is that you’ve got more labs in the world looking for a vaccine for this virus than any other. They’ve got better techniques for designing vaccines and there’s a lot of money going into it. Having said that, they’ve never had a vaccine to a coronavirus. Vaccines usually take several years to develop because you’ve got to test the safety of it. And most worrying, it seems the immune response to the virus is not very good, and fades. That suggests any vaccine you come up with may have only short lasting immunity. For all those reasons I’m cautious. The people I respect say two years would be a possible time. My guess is that we may get a partially effective one a bit quicker.
Is it possible that, as Sunetra Gupta of Oxford University suggests, many people have come into contact with the virus but not developed antibodies?
Yes, it is possible. When I first looked at Sunetra’s stuff and I spoke to epidemiologists I respect, they said she can’t possibly be right. She overestimated the spread of the disease and underestimated its strength. Having said that, there’s some element of truth in what she thinks.
What do you think of Matt Hancock’s performance as health secretary?
I tweeted recently that he should resign. At first I thought he was probably the most authoritative of the ministers in the briefings. Then he became obsessed by testing without understanding why you do it, from the finding, testing, isolation and support – you need all of that for it to work. But latterly, I think the decisions to go with private companies such as Serco and Deloitte, and with this total mess in Leicester where they can’t get the data because the private sector doesn’t share it – I think that’s almost criminally negligent. And the decision to bypass PHE rather than strengthen it, and strengthen links with primary care, has been lamentable.
How do you see the virus playing out from here?
I invited a modeller on to Indie Sage who is one of the top neuroscientists in the world, a UCL professor called Karl Friston. He does modelling of brain waves. A total genius. He has come up with a totally different approach to modelling to Neil Ferguson and Adam Kucharski, who are very good epidemiologists. He thinks the herd immunity level to stop this epidemic is probably a lot lower than 60%. He thinks it’s around 25-30%. What he says is that around half your population is either sequestered or shielded, so are not exposed. Up to a half of the rest are not susceptible, like kids, because they’ve got good mucosal immunity. And others may get symptoms but not transmit it very easily. We’ve just sent a letter off to the Lancet about this. If our assumptions are right it may mean that this crisis ends earlier than we expect. But coronavirus won’t be eradicated without a vaccine.
There has been much speculation about societal change following Covid-19. Do you think that will happen and how would you like it to manifest?
I hope so. Although I’m a paediatrician and most of my work is doing community health in low-income countries, in the past 10 years I’ve been quite involved in climate change. I’m co-chair of the Lancet countdown on climate change and health. I used to do too much flying and I always felt when I was at the WHO that you didn’t need to do so much of it. I know Zoom can drive you round the bend but we’ve done everything at Indie Sage on Zoom. And it’s been incredibly productive. My fear is that within a couple of years, if this all settles down or we get a vaccine, things will go back to where they were. But the climate crisis is so much more serious and we have so little time to get this right.