I was trained as a scientist and as such always want as much data and evidence as possible when weighing the risks and benefits of a challenging question or problem. So when U.K. Prime Minister Boris Johnson set out the details of Britain’s planned grand reopening, set for July 19, alarm bells started ringing. My initial thought was that there are still many things we don’t know about the trajectory of this virus or pandemic. There didn’t seem to be enough hard data — or not for me at least — to feel comfortable that it would be safe to roll back restrictions now.
Two things changed my mind. First, Johnson made clear that the government could reimpose some Covid measures as needed if the virus staged a resurgence that put pressure on the health service or caused problems for the vaccinated. That’s an important safety valve, because there are still so many unknowns. But I have increasingly come to the realization that we have to bite the bullet at some point, even knowing that there will be risks. Now is a good time. The government already delayed the “return to normal” by four weeks to allow for more vaccinations amid the spreading delta variant, and now a lot more people have been inoculated. Authorities could have waited until the vaccination rate was even higher. But what is the magic number and when would we have hit it? If the government didn’t make the move when schools are closed and most people are able to socialize outdoors (assuming that the British weather allows it), when would it have done it?
Waiting until September for more than 90% of adults to have had the opportunity to have one dose of the vaccine could have made sense, if we were sure that they would actually all step forward to get their doses. On the other hand, making life easier for fully vaccinated people in terms of traveling, self-isolating, etc., may actually incentivize those last few stragglers to go ahead and get their vaccines.
Make no mistake: The U.K. is undertaking a big experiment, but it’s already taken a few chances during the pandemic. It was the first, for instance, to use a large gap of as much as 12 weeks between the first and second dose of vaccine, which worked to its advantage in terms of speeding inoculations and bringing deaths and hospitalizations down — at least until the delta variant arrived. It also continued to vaccinate people over 40 with the AstraZeneca vaccine, instead of increasing the age threshold, despite knowing the risk of the rare clotting side effects. So far, that also has generally worked out without major complications.
As for this latest move, I am in favor of moving forward with reopening, especially knowing that the door is open to reverse if Covid becomes a bigger problem again. But that doesn’t mean I am comfortable with every detail. Here are a few points Johnson’s government should consider and key variables it needs to watch to give the reopening the greatest chance of success.
Why remove the mask mandate? I get that it’s a symbol of the pandemic — but there is still a pandemic. The virus continues to circulate, and such a simple measure as wearing a mask could help reduce the spread. Why have masks become such a political and emotive issue? We know they work in preventing an infected person from passing along the virus and we are now likely to have double-vaccinated people inadvertently spreading infection. Leaving the decision to wear a mask to the individual is like removing all speeding limits on all roads or saying that wearing a seat belt in a car is optional. With delta firmly established, keeping masks up in crowded areas is an easy way to give it fewer chances.
Viral evolution. Recent data show that viral evolution is much more varied in unvaccinated people than those who are fully inoculated. This means vaccine-driven protection “focuses” its evolution on fewer and more consistent mutations. That makes it easier to guess how the virus will act going forward and may prevent the need for specially tailored boosters. In unvaccinated people, on the other hand, the virus undergoes more random mutations. That's more likely to lead to unpredictable results and more concerning variants. What’s unclear is how the virus acts in the significant number of people who have had just a single dose. If it mutates in the same random way as in the unvaccinated, it could create more chances for more problematic variants. We just don’t know, and future developments bear watching in case delta isn’t the worst the virus has to offer.
Long Covid. Even the vaccinated can catch a Covid infection, although it tends to be less severe. But what’s the risk of developing long Covid (an infection with long-lasting symptoms)? We know that vaccination has anecdotally helped some people who are suffering from long Covid, but not all. Does this means that we will have a large number of people suffer to some degree for a very long time? Data recently published by Imperial College London showed that more than a third of people with symptomatic Covid-19 go on to have persistent symptoms for 12 weeks or more. That suggests that limiting infections should still be a public health goal, even if it’s pursued without the most onerous restrictions.
Kids at risk? Schoolchildren are currently not eligible for vaccination in the U.K. What happens to them when school starts up again and the risk of infections rises, as is expected to happen by September? Covid infections in children may not lead to hospitalization or death very often, but they do still cause some morbidity. There’s also a risk that a new variant comes along that can affect children more. It’s another variable that Johnson must account for that could shift the calculus of reopening.
What about the immunocompromised? People with weakened immune systems, including those undergoing cancer therapy, are at greater risk of bad outcomes from Covid and may not get as much protection from vaccines. Some are unable to safely take a vaccine at all. Reducing restrictions is likely to further limit what these groups can do if they want to stay safe. Why are they being marginalized in a society that is free to enjoy its normal freedoms without having to wear masks? Are they supposed to stay in lockdown? A reopening plan that doesn’t include this population, either by offering boosters, finding better treatments for acute Covid, or perhaps through creating Covid-safe spaces, has a big hole.
There are good reasons for the U.K. to take the leap of reopening, but there will be some stops and starts — and lessons learned along the way. The rest of the world, which is grappling with the same questions of when and at what pace to remove restrictions from its citizens, may thank the U.K. for doing the experiment for them.
Sam Fazeli is senior pharmaceuticals analyst for Bloomberg Intelligence and director of research for EMEA.