EIS Council recently resolved to examine differing approaches to combating Covid that have been adopted around the world. The aim was to explore the two main policy theories implemented to tackle the spread, and effect of Covid-19: Mitigation and Suppression Strategy, and Elimination (Zero Covid) Strategy, as well as drawing examples of how these policies have been implemented in some countries and examining the successes that have been linked to each policy, as well as exploring the ongoing challenges that Covid-19 prevalence presents.
Mitigation and Suppression Strategy
Before Covid-19 emerged, most of the world’s pandemic response plans were predicated on flu, because flu has caused most pandemics in history. Flu spreads rapidly through a population, because an infected person can infect others before they develop symptoms, and because the disease has a short serial interval (the time between successive cases) of three days. For these reasons, the consensus is that flu cannot be eliminated; it has to be managed.
In the first few months of the Covid-19 pandemic, many countries across the world followed the containment advice that had been drawn up to manage potential flu outbreaks.
When Covid-19 first moved out of Asia and into the wider world, much of its characteristics still unknown, most of Europe, indeed most of the world implemented a mitigation and suppression strategy. ‘Herd Immunity’ was cited as a key objective of the UK mitigation and suppression strategy in the early stages of the pandemic. When a high percentage of the population is vaccinated, it is difficult for infectious diseases to spread, because there are not many people who can be infected. The initial reliance on herd immunity, without a matching vaccination programme, led to a rapid growth in infection levels which threatened to overrun NHS services and led to a policy reversal which saw the introduction of strict lockdown measures.
Vaccinations are a critical element in tackling the Covid virus. The UK was the first country in the world to administer Covid-19 vaccines to their citizens. Whilst the United Kingdom has faced criticism over its slow initial response to Covid-19, it has excelled in rolling out its vaccination programme. The UK has the 4th highest number of Covid-19 vaccine doses administered per 100,000 of the population.
In a study published in the Lancet on 19th February health officials in Scotland have reported that vaccination with either the Pfizer-BioNTech or AstraZeneca jab was helping to lower hospitalization rates due to COVID-19 in the country.
The Impact of National Lockdown
The mitigation and suppression policy model relies on the continued use of lockdowns in order to suppress the virus, especially when the R-number begins to rise above 1, or hospital admissions put significant pressure on NHS services and critical care.
The first six weeks of the pandemic and lockdown had a major impact on the UK population’s mental health and wellbeing, according to research published by the University of Glasgow. The researchers concluded: “The mental health and well-being of the UK adult population appears to have been affected in the initial phase of the COVID-19 pandemic. The increasing rates of suicidal thoughts across waves, especially among young adults, are concerning.”
The impact of the second set of National Lockdowns has yet to be full assessed but it would seem clear that many of the problems associated with extended lockdowns have deepened further, with those from the most vulnerable backgrounds faring worst, and significant concerns growing around the impact of social isolation on the mental well-being of a range of demographic groups.
Elimination Strategy (Zero-Covid Strategy)
In countries that have achieved a low incidence of COVID-19 infection, such as Australia and New Zealand, disease elimination has been proposed. Yet we do not have a definition of elimination for COVID-19. Both these countries implemented early, widespread, and strict disease mitigation strategies. With low cumulative incidence, most of the population in these countries remain susceptible to Covid-19.
The concepts of disease elimination and eradication mostly relate to immunisation programme outcomes. Disease eradication is the global reduction of infection to zero cases, whereas disease elimination is the absence of sustained endemic community transmission in a country or other geographical region.
Elimination of any infectious disease is an ambitious strategy, requiring substantial resources to achieve.
Elimination Strategy in New Zealand and Australia
New Zealand moved into lockdown on 25th March 2020. Prime Minister Jacinda Ardern had introduced the country to the now well-known alert level system only a few days earlier. Like many citizens across the world, New Zealanders were told to stay home. Thousands of non-essential businesses were told to set employees up to work from home or close their doors.
On the 25th March 2020 when New Zealand announced their national lockdown, they had 102 confirmed cases at the time — 36 new cases had been announced that day and transmission had been identified in the community. The UK entered lockdown on the 23rd March 2020, just a few days beforehand with daily cases at over 2,000 and a death toll of 364.Over the last year, New Zealand, along with Australia have both managed to achieve zero covid cases. Although that position has now been maintained and there have been further outbreaks and localised lockdowns. These two nations who have a longstanding political alliance have just recently opened up a travel corridor, enabling quarantine-free travel between both nations.
Success of Elimination Strategies
Research published by the Institut économique Molinari compares the G10 countries to three OECD countries that have implemented an elimination strategy (Australia and New Zealand) and South Korea who adopted a similar strategy. The data collected in this research shows the benefits of the elimination strategy and contradicts the idea, widespread in the UK, that it was necessary to choose between protecting the economy and protecting public health on the grounds that these two goals were in conflict.
One consideration to be noted is the role of vaccines within the elimination model. As both New Zealand and Australia implemented policies to contain the spread, they have not yet vaccinated the most vulnerable within their society.
Whilst the success of the elimination strategy is clear in the short term, which reduced mortality rates, improved economic performance and fewer damaging lockdowns that have been shorter in duration what is less clear is the longer-term benefits. As there have been significantly fewer infections within New Zealand when compared to countries like the UK, that means that all herd immunity will have to be achieved through vaccination.
Sustainable Suppression Strategy
There are significant common elements to the differing camps around how to tackle the Covid virus, although retrospective analysis sharpens the differences especially around pace and emphasis of specific areas, for example the use border controls.
The Independent Scientific Advisory Group for Emergencies (Independent SAGE), in a report published in February 2021 (“A ‘Sustainable Suppression’ Strategy for Keeping Society Open”) advocated what it referred to as a “sustained suppression strategy”.
The sustainable suppression strategy rests on five key policy pillars:
- Vaccination for the entire population (including children once approved) in the expectation of regular boosters in the future as required.
- Widespread testing (including, where appropriate, testing of asymptomatic cases) as part of a test, trace and isolate system rooted in local communities and organized through local public health bodies.
- A comprehensive resource package which enables people from all sections of the community to self-isolate.
- Accreditation as “COVID secure space” of all public spaces (schools, hospitality, workplaces etc.) through a robust system of guidance, support, regulation and inspection to ensure that they meet COVID safety standards (spatial distancing, ventilation, enhanced hygiene etc.).
- Strict control of borders and limits on international travel.
In outlining their proposal for a Sustainable Suppression Strategy, Independent SAGE said, “There are two main elements to our approach. The first concerns the short-term ‘lockdown’ measures necessary to bring infections down to levels where the strongest restrictions are no longer necessary… The second element concerns the measures necessary to keep infections at a sufficiently low level to allow for local outbreaks to be handled without the need to impose general lockdowns. While vaccination is a key measure – and makes suppression considerably easier – it is certainly insufficient on its own until the entire population is vaccinated.”
Implications for the EIS and Scotland’s teachers
The EIS position is intended to reflect the mood of members on Covid 19. Clearly there is not always a unanimous position on all matters, but there has been strong support from members around the Institute’s advocacy on health and safety matters and the challenges associated with lockdown and remote teaching.
National EIS surveys have underlined member support for maintaining school opening where safely possible to do so and there is a clear recognition and concern around the significant challenges being faced by children and young people.
Whilst the current demands around “vaccination, ventilation and face coverings” remain pertinent, the reopening of schools as a necessary part of the move out of lockdown has been largely accepted by most members, notwithstanding ongoing safety concerns.
From the evidence, it is clear that countries that implemented an elimination Covid approach fared better in the short-term when compared to other countries that implemented a mitigation and suppression policy. Mortality rates were significantly lower, and the impact to the economy has been considerably less damaging.
However, the Zero Covid campaign advocates strongly for a continued Lockdown Strategy as part of its platform, to almost zero cases, which may be a challenge for many members. The mental health impact on teachers and students of sustained periods of lockdown, added to the demonstrated detrimental impact of remote learning on many young people already facing disadvantage, is a matter of significant concern to the Institute.
For that reason, the sustained suppression strategy advocated by Independent Sage, key elements of which coincide with an elimination objective, would seem to offer the policy framework which is most inclusive of EIS objectives.
Following lengthy discussion on the merits of the differing strategies, EIS Executive and Council agreed to endorse a “sustainable suppression” strategy (over ‘zero covid’) as the policy position of the Institute and to campaign broadly, especially within the trade union movement, for the adoption of such an approach by government at both Scotland and UK level.