Part 2 of the Perspectivist series about the Covid-pandemic

The coronavirus has been a modern and complex phenomenon that exacerbates existing trends and shortcomings within health systems and society. The “war against the virus” approach is emblematic for how we deal with contemporary issues. Our approach to health has become technology-focused, militarized, and superficial. The response to the pandemic has emphasized the shortcomings of authoritarian and exclusionary measures. With the notion of the “covid tunnel vision”, this article puts into perspective the way public authorities and society at large has responded in order to draw lessons for a more holistic approach to public health.

When we look back, the first one to declare a “war”, a “"people's war" to be precise, was Chinese President Xi Jinping in February 2021. Originally covering up the breakout of the new virus, Xi’s start of the use of the war narrative against covid now leaves a bitter side taste. In the West, it was French President Emmanuel Macron boldly declaring, “nous sommes en guerre,” “we are at war” on 16 March 2020. He called for a “general mobilization” against an „invisible enemy”. His call has been followed by Johnson, Trump, Giuseppe Conte and many others in politics, media, up to science communications. The message was clear: exceptional measures need to be taken, forces are to be mobilized, the enemy must be exterminated.

General mobilization: from lockdowns to vaccines

With the announcement of war, a series of shortcomings have started to be justified through that narrative. The army’s first line, that were the healthcare workers and doctors. They often had to work in extremely stressful conditions for long periods and with too often poor pay. The second line, that were the citizens who were called to observe their duty and follow the rules. The arms were first the general lockdowns, later joined by the new generation of mRNA or vector-based vaccines for Covid, developed and marketed by pharmaceutical companies or joint ventures. Different regional blocks developed their own vaccines that were not always recognized in other parts of the world. And no patent waivers are foreseen for developing countries.

The war metaphor

Militaristic metaphors such as the “war against” the coronavirus are inherently violent, paternalistic and power-based. They contribute to remove agency from patients and citizens and add to fear and division in society. The war narrative promises a victory that might be illusory and promotes the idea that all means are legitimate for the sake of the war. Even great collateral damage is made acceptable. This narrative has been used to legitimize lockdowns and is now increasingly being used to justify mandatory vaccination for all. While exceptional measures were indeed needed, it is questionable whether this is compatible with public health interests and democratic principles.

A shifting enemy

When it comes to the social effects, fighting a war generally unites one group against the other, necessitating the search for an enemy. The enemy, that has been portrayed in great variety: China, the virus itself, or those who think differently. Furthermore, such war narrative also threatens the web of relationships within a health system, including the doctor-patient, doctor-doctor, or hospital-ministry relationships. Not the relationship counts anymore, but the goal of destroying the virus. The talk about the “tyranny of the vaccinated” may have pointed at a new enemy: the unvaccinated.

The war narrative is emblematic for a militaristic and mechanistic way of dealing with public health issues. It reduces the space of action significantly by focusing on a handful of military-inspired measures. Measures for the “fight” are justified mostly based on a cost-benefit calculation, although often opportunistic measures are given priority. In any case, profoundly ethical questions, including mandatory vaccination and the human right to dispose of the own body, have little to no space within this utilitarian analysis.

Moralization and individualization of responsibility

As everyone is expected to contribute to “fighting” the pandemic, citizens are expected to behave accordingly. In countries like Germany or France, this understanding has increasingly extended to everyone getting vaccinated, regardless of risk factor. The debate has seen a very high degree of moralization, up to the consideration of what “good” and “bad” citizens are. People who decided not to get vaccinated were and are under great moral scrutiny and may also be subject to stigmatization.

Getting vaccinated has also been called a question of “solidarity”, especially regarding the risk to end up in hospital and thus impacting the health system. Such a logic of risk reduction could however also lead to questioning unhealthy food choices, smoking and other risks. Furthermore, an unvaccinated person that gets tested and avoids risks may be less “dangerous” than a vaccinated person that does not test and meets many people. A double standard seems to have been established without looking onto other areas where this logic would not be acceptable, including diseases or behaviours that lead to millions of deaths every year. Also considerations on the real effects on unvaccinated have not been studied, for instance if the exclusion would result into more private gatherings, leading to higher case numbers.

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Human rights and the majority

For proponents of mandatory vaccination, obliging the individual to get vaccinated is justified in the name of the collective to be protected. The end justifies the means. Yet, individual human rights, articulated also against the majority, have been a direct lesson from the experience with totalitarian regimes. A totalitarian state is one that says it protects its citizens all the time everywhere. It is a state that is present in the lives of citizens permanently. Today, no state should be expected to protect all citizens all the time. There is a level of risk that citizens must live with, also when it comes to other diseases.

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Emotional polarization of worldviews

The political polarization we have seen is not a rational choice between arguments for or against vaccines, for or against policy strictness or other binary options. Rather than rational policy choices, it has been shown that our emotions and affects[1] are strongly influencing how we view and understand the world around us – and opinions formed as a consequence. Political scientists Hetherington and Weiler for instance have proposed different affective-emotional states: an open and fluid one, a fixed and closed one and a mixed type[2]. Those who tend to the fixed one view the world as a dangerous, threatening place, while the fluid ones see the world as a safe and beautiful place to explore. Most will show mixed forms among these poles.

In times like the pandemic, strong emotions have led many to adopt a closed mindset. This has led to a narrow understanding of potential avenues for action and a broad support to stringent measures without proof of effectiveness. Furthermore, with hormonal-emotional body regulations being strongly influenced by the health of our gut, the microbiome (the so-called “second brain”), the fact that malnutrition has become mainstream, evidenced by many civilizational diseases, further influences public opinion. Human decision-making thus not only becomes a medical question, but a deeply political one.

The debate around the coronavirus has further polarized our societies. Besides existing, and expanding, structural sexism, racism and homophobia, people have been divided into “vaccinated” and ”unvaccinated”. This new identity check has become virtual – per QR-code control distributed among thousands of people. In media and on social networks, shitstorms are describing human beings that are not vaccinated categorically as “anti-vaxxers”, “science-deniers”, “threats” or a great number of insults. World Medical Union President Montgomery went as far to say that we live in a “tyranny of the unvaccinated”.  

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Beyond black and white

Humankind has gone through an incredibly traumatic period living through the pandemic, lockdowns and their impacts. Left unresolved and with a fixed mindset, it is no wonder that the discourse and general climate has become increasingly violent. Fear, anger, violence have gained ground. In this context, legitimate positions beyond black or white have a hard time. Yet, it is only in this fluid in-between space that we will be able to move beyond - to a healthy future.

The coronavirus pandemic has been a historic challenge. And an opportunity to change our health systems in a way that promotes our health and resilience to future disease and pandemics. This requires understanding how our worldview shapes the way we are dealing with the pandemic. Remaining in a restrictive and limitative worldview hinders us in zooming out for seeing different possibilities. After having looked at what this “war against the virus” narrative, how successful has the war strategy been?

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How successful has the war strategy been?

If the objective was to eliminate the virus, the “war” approach has not delivered on  its promises. Also the measures taken, vaccination and lockdowns, have had an ambivalent success. For instance, in the history of vaccinations, only once a virus has been exterminated, the smallbox.

Reduction of deaths

When it comes to lockdowns, the war approach led some countries to adopt a very strict course. However, countries with the longest and most stringent lockdowns were likely to have higher rather than lower excess mortality. Having a strong test, trace and isolate system was strongly associated with fewer deaths, as could be observed in several Asian countries[3].

As Thomas Hale, wrote „old ideas about what contributes to pandemic preparedness need to be updated. Some countries with formidable scientific and healthcare capacity stumbled mightily. At the same time, places with less capacity, including Mongolia, Thailand and Senegal have managed to largely keep people healthy and the economy running.“[4] Smart policies seem thus to be more effective that what could be called war-like measures.

When it comes to vaccination, many deaths could be avoided among vulnerable groups, older people and people with a prior medical condition. Yet, if the objective was to protect all vulnerable groups, this seems to have been far away at global level with a highly unequal distribution of vaccines. Furthermore, new variants have rapidly reduced the effectiveness of the new generation of vaccines, requiring regular booster shots.

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A war focusing on mandatory vaccination and lockdown strictness seems thus to be quite ineffective in dealing with the pandemic. But if we stretch the evaluation of the success of the war strategy to include collateral damage, the results can be considered quite alarming. Over a fifth of EU citizens have missed a medical examination or treatment during the pandemic[5]. The resilience of health system has lowered (there are less hospital beds for imstance[6]), we have a mental health pandemic and civilizational diseases, the main reason for developing Covid19, are on the rise. In conclusion, the "war against the virus" has not only not delivered on its promises, it has left our societies ever more divided and produced worrying levels of collateral damage. This is particularly challenging since civilizational diseases are already on the rise, increasing vulnerabilities to shocks like pandemics.

The next article in this series will draw new pathways to build more resilient health systems that promote public health holistically, beyond a “Corona Tunnel Vision”.

Learn more

Read Part 1 of the Perspectivist series on the Coronavirus: Moving beyond the tunnel Diversifying our perspectives on health

[1] https://www.jstor.org/stable/41684577

[2] https://verdict.justia.com/2018/10/22/q-a-with-the-author-prius-or-pickup-how-the-answers-to-four-simple-questions-explain-americas-great-divide

[3] https://theconversation.com/why-excess-deaths-have-varied-so-greatly-around-the-world-during-the-pandemic-172255

[4] https://theconversation.com/what-we-learned-from-tracking-every-covid-policy-in-the-world-157721

[5] https://www.eurofound.europa.eu/sites/default/files/ef_publication/field_ef_document/ef21064en.pdf

[6] https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Healthcare_resource_statistics_-_beds#Hospital_beds