Government Adviser Devi Sridhar What Europe Can Learn from Scotland in Fighting the Pandemic

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Global health expert and government adviser Devi Sridhar explains Scotland’s ambitious “zero COVID” strategy, which aims to completely eliminate the virus within the country’s borders. She argues that the plan should also be applied to the rest of Europe.

Interview Conducted By Veronika Hackenbroch

Sridhar, 36, is a professor of global public health at the University of Edinburgh and an adviser to the Scottish government in the fight against the COVID-19 pandemic. She is currently working on a new book in which she analyses why countries such as the United States and the United Kingdom failed in the fight against the coronavirus and explains how we can better protect ourselves in the next pandemic. Its working title: “Preventable: The Politics of Pandemics and How to Stop the Next One.”

DER SPIEGEL: Professor Sridhar, when did it hit you that this virus that was spreading in China was dangerous?

Sridhar: I can actually tell you the day. It was January 24th, when I read a clinical paper in The Lancet in which doctors from Wuhan described what an infection with this novel coronavirus actually meant for those who were ill, based on 41 hospitalized patients. Half of the hospitalized patients developed shortness of breath, one third had to be admitted to intensive care, and 15 percent died. For me it was clear at that point that we had to do everything to stop this virus.

DER SPIEGEL: Did you suspect at that time that the world was facing a pandemic?

Sridhar: It was crystal clear that the way this virus was spreading — via droplet infection — is probably one of the worst ways it could, and that it would be very hard to stop. I was lying awake in bed and had that deeply unsettling feeling that the world was going to change profoundly, and that there was probably no good way through this. I was sure at that point that the novel coronavirus was a long-term problem that was not going to go away in a matter of weeks or months.

DER SPIEGEL: You are not a virologist or epidemiologist, but rather a coronavirus expert whose field of expertise is “global health governance.” What is it that you do?

Sridhar: Virologists, immunologists, epidemiologists, clinicians, pharmacologists, they all figure out what to do in this pandemic. My task is then to find out how best to implement these measures. It’s about leadership, strategy, logistics, financing and the structures of delivering public health. How do you convince people to wear face coverings and practice social distancing? How do you get governments to work together in fighting this virus? How do you get the right partners at the table? What is good leadership? Often it is quite clear what should be done. But to actually do it is horribly difficult. I am doing my best to help with this.

DER SPIEGEL: You are one of the coronavirus advisers to Nicola Sturgeon’s government in Scotland. Your strategy is “zero COVID.” What does this mean?

Sridhar: We want to ensure that there are no more COVID-19 cases in Scotland. We want to stop the transmission of the virus entirely. And the strategy to do that is not very difficult: You leave the lockdown measures in place until the number of cases is extremely low, in the single digits, then you carefully release the lockdown, step by step, while testing a lot, tracking down and isolating contacts, and making face masks compulsory in shops and on public transport. Scotland has also decided not to reopen schools until after the summer holidays. Now we are almost there. There are now only about 10 new cases a day – while in neighboring England there are still more than 500.

DER SPIEGEL: So, Scotland is following in the footsteps of New Zealand?

Sridhar: That’s what we are trying to do. I think this is the fastest way to get normal life back for people, with open schools, concerts, weddings and football matches. It’s the best way to get the domestic economy going again and to stabilize the health services. But you really need to keep cases close to zero for this.

DER SPIEGEL: Isn’t it enough to reduce the number of new infections to a few hundred cases a day, as is the case in Germany?

Sridhar: That’s what we thought at first. But the more we learn about the spread of the virus, the clearer it gets that it is not. I like to compare this with the difficult task of letting milk simmer on the stove. Most of the time it goes wrong, because the milk can boil over at any time and cause a huge mess. It is just as dangerous to let the virus infections simmer at a low level. Take countries like Israel or Australia, where containment went really well at first, but now the cases are rising steeply, the situation is threatening to get out of control. Sars-CoV-2 is not a harmless virus. Lots of young and healthy people become seriously ill and later have chronic health problems. We must try to prevent as many infections as possible.

DER SPIEGEL: Scotland is part of the United Kingdom. How can your zero-COVID strategy work if England doesn’t follow suit?

Sridhar: You are right. Scotland is not an island like New Zealand, nor can it really control its borders.  And England has limited itself to keeping case numbers only low enough so that the health system does not collapse. That is a problem.

DER SPIEGEL: Isn’t your strategy then doomed to failure?

Sridhar: Not at all. We can carry out massive testing and consistently isolate infected people and their contacts so that infections are limited to imported cases. And we are trying to convince the rest of the U.K. to adopt Scotland’s strategy. Northern Ireland is already doing quite well and I think that England and Wales could use the summer months, when people spend a lot of time outdoors, to reduce the number of cases effectively. We need to aggressively hunt the virus down to get rid of it!

DER SPIEGEL: What can Germany learn from Scotland?

Sridhar: Germany has done very well so far, and we have learned a lot from Germany. But now my impression is that you, too, are just trying to keep the number of cases low instead of getting them down to zero. You let the milk simmer. Why don’t you go one step further and try to eliminate the virus from Germany?

DER SPIEGEL: But that’s unrealistic. Even if we could, the virus would come back into the country from outside.

Sridhar: You must not see this as a purely German approach, but as a pan-European project. The heads of state and government from the Schengen area would have to get together and decide: “Let’s get rid of this virus together!” As soon as the cases have dropped to zero, people could again move freely and safely within Europe’s borders – provided that we then test and temporarily quarantine all those people who enter from other regions of the world.

DER SPIEGEL: You want to build a kind of Fortress Europe. Not a very realistic scenario.

Sridhar: It may sound like that. But actually it would be a very rational strategy. China and New Zealand have shown that the elimination of the virus is technically possible and not even particularly difficult, even though there will always be minor setbacks. Before we have a good vaccine, “Zero COVID” is by far the best strategy to get the economy going again and allow a normal life.

DER SPIEGEL: Do you share the observation that countries with female leaders such as New Zealand, Germany or Scotland are coming through the crisis better?

Sridhar: What is striking, at any rate, is that female heads of government are more cautious and more risk averse than their male counterparts. It is not the right time to gamble, because we are gambling with people’s lives, health and livelihoods. If you look at three countries where things are particularly bad – the United States, Brazil and England – you can see a certain pattern in the personalities of their leaders. They all have an appetite for risk.

DER SPIEGEL: You grew up in Florida, your family lives in Miami. The pandemic seems to be out of control there. What’s going wrong there?

Sridhar: It’s horrible to see Florida repeating the same mistake that so many other countries and so many other U.S. states made before: reopening everything too quickly after a lockdown. So many deaths could have been prevented! I have the feeling that my worst nightmare is coming true. You know: If you run someone over with your car because you didn’t pay attention, you will go to court. But if tens of thousands of people die because you develop a bad policy, nothing happens to you. Where is the justice in that?

DER SPIEGEL: Why does the World Health Organization (WHO) appear so helpless in this pandemic?

Sridhar: Many people do not understand what WHO can do and what it can’t do. This organization, whose roots go back to the 1850s, is simultaneously dealing with strokes and high blood pressure, traffic accidents, anemia, obesity, snakebites, mental illness and epidemics. WHO has to deal with all these health issues simultaneously, but it has no real power.

DER SPIEGEL: Why is that?

Sridhar: Well, the legal powers of WHO are very limited. The World Health Organization requires member states to report a new pathogen, which is what China did in the case of coronavirus on December 31st. If a dangerous pathogen starts to spread in the world, WHO can declare a “public health emergency of international concern,” which happened on January 30th. But that’s all there is to it.

DER SPIEGEL: After that the countries themselves are responsible for fighting the pandemic.

Sridhar: Exactly. The individual states decide how they react to the threat, what measures they take or do not take. The role of WHO is above all to provide information. They are not an enforcer. They are not a watchdog. For this, the 194 member states would have to agree on giving WHO that power.

DER SPIEGEL: U.S. President Donald Trump accuses WHO of being too friendly towards China. Is there any truth to this accusation?

Sridhar: I did think the praise of WHO head Tedros Adhanom Ghebreyesus for China was a bit exaggerated. There are undoubtedly gaps in the report of the first WHO mission to China, and I also expect gaps in the report of the current mission that is meant to investigate the origin of the virus. But that is the price WHO has to pay for access to China. Unfortunately, its staff do not have the same rights as nuclear weapons inspectors. China is very concerned about its reputation, so if WHO wants data from China, it must praise China. That is called diplomacy.

DER SPIEGEL: What will happen to WHO if the U.S., the largest contributor, withdraws next year, as decided by the Trump administration?

Sridhar: If the Democrat Joe Biden wins the presidential election, he will hopefully reverse Trump’s decision. The U.S. contributes about 15 percent of WHO’s two-year budget of $5.6 billion (4.8 billion euros). It would be very difficult to fill this huge financial gap. Moreover, the U.S. is also the largest compulsory contributor among the member states – and the World Health Organization only has real control over this part of the budget. In contrast, more than 80 percent of the WHO budget is voluntary contributions from member states or private donors such as the Gates Foundation. Most of these contributions are earmarked for specific purposes, such as the fight against HIV, malaria, tuberculosis or polio.

DER SPIEGEL: So, a large part of the WHO budget is determined by rich donors and rich countries, some of which pursue their own agenda?

Sridhar: That is the bitter reality. And if the U.S. actually leaves the World Health Organization, the influence of these donors will increase even more.

DER SPIEGEL: But does it really matter who finances the fight against disease?

Sridhar: Very much so. Since voluntary contributions to WHO are mainly intended for the prestigious fight against infectious diseases, two equally important areas have been systematically neglected in recent decades: the development of good, sustainable health systems in poor countries and measures against non-communicable diseases such as high blood pressure, diabetes and coronary heart disease.

DER SPIEGEL: You are being heavily attacked on social media for your fight against the coronavirus, as it has involved tough measures and restrictions for many people. How do you deal with having become a figure that is hated by some people?

Sridhar: It is very difficult for me to be in the public eye, especially because as a scientist I am actually used to being hidden in the university. In the meantime, I try to see it simply as part of my work. I think that experts and scientists have been thrust into direct advisory roles like never before and suddenly have a share of responsibility for government action. The pandemic is making people angry and aggressive, and we scientists are becoming the targets of that anger.

DER SPIEGEL: How has the pandemic changed you personally?

Sridhar: I think I have become much tougher. I no longer bother with formalities and appearances. I’m saddened by the many deaths, but at the same time I’m quite hopeful based on what I’ve seen about communities, how people are helping each other. The solidarity that we are experiencing at the moment is remarkable.

DER SPIEGEL: Will we ever get our old life back?

Sridhar: I don’t think the world will look the same after COVID. I think we will all have changed in many ways.

DER SPIEGEL: Professor Sridhar, we thank you for this interview.

Der Spiegel

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