14 saturday review Saturday April 9 2022 | the times
South Korea has a lot
to teach us about how
to combat the next
pandemic. Review
by Tom Whipple
S
hould we have done a New Zea-
land and shut out the world? Or
done a Sweden and let freedom
reign? It is the great Covid dicho-
tomy: lockdown or let it rip? It is a
dichotomy that makes idiots of us all.
Here are some different questions, ques-
tions that, oddly, have not had the same
attention. Should we have copied Senegal?
What, if anything, should we have learnt
from the experiences of Kerala? Or Viet-
nam? Or even — a country whose Covid
policy might, if you are geeky enough, just
Preventable
How a Pandemic
Changed the World
& How to Stop the
Next One
by Devi SridharViking, 432pp; £20about have reached your consciousness —
South Korea?
For all the ferocity of social media, the
entrenched debates and the politicisation
of public health, few in Britain have con-
sidered these questions. Which is a shame,
Devi Sridhar argues, because the answers
could well be important next time.
Sridhar is a professor of global public
health at Edinburgh University. We have
just had a global pandemic. In her book
Preventable she reminds us about the
“global” bit, because there are pandemic
responses worth looking at even in coun-
tries containing people who don’t look like
us. There is, in fact, a whole world between
the freedom-loving Europeans of Stock-
holm and the (actually, for much of the
pandemic, quite a bit freer) ethnic Europe-
ans of Auckland. And, just maybe, one of
the problems throughout the pandemic
has been a tendency to ignore this world.
At around the time someone in China
was meeting a sick bat, or perhaps leaving
a lab’s freezer door open, Britain was
ranked, alongside the US, in the top two
countries for pandemic preparedness.
This ranking might have explained, Srid-
har argues, what happened next. “UK
experts were so used to telling poorer
countries how to do global health that they
completely forgot humility and to listen to
what experts in those poorer countries
were saying or doing,” she writes.
When Vietnam was closing borders,
British experts were holding meetings.
When South Korea was empowering con-
tact tracers to access CCTV, phone GPS
and credit cards, Britain in March 2020
had announced the cessation of testing,
something it reversed a few weeks later. In
Britain, we “tried to ‘outsmart’ the problem
of the virus through complex models and
maths, instead of doing the hard work of
building the logistics of a response and
using common sense to stop an infectious
disease spreading”, she writes.
At the heart of this book — the justifica-
tion for the title Preventable — is a “what
if ?”. Not “what if we locked down two
weeks earlier?”. Instead, what if we had
paid attention in January 2020? What if
the world had learnt from each other’s
experiences? What if countries had co-
ordinated their efforts? What would have
happened if more rich countries had, like
South Korea, exploited the full range of
electronic surveillance — while accepting
the civil liberties trade-off — to stamp
down on outbreaks?
What if more poor countries had made
the decision, like Senegal and Vietnam, to
go all out to stop the virus? There, they did
not have debates about the trade-off
between the economy and health. “The
reality [is] that Vietnam does not have
enough budget to sacrifice the economy
and support businesses and individuals
who had to cease operation,” an adviser to
the government explained — so they went
for rapid elimination within their borders.
Was the pandemic really preventable,
though? For some, the author alone will
be enough to put them off this book. Srid-
har, a scattergun-tweeting, otter-loving,
fitness-fanatic adviser to the Scottish
government (and, the book surprisingly
explains, personal fitness trainer to Nicola
Sturgeon), has been one of the more
unexpectedly divisive characters of the
pandemic. Partly, I fear, this is because she
has committed the crime of being young,
female and funny.
Partly, though, it is because, perhapsmore than any other Covid-famous scien-
tist, she became associated with the idea of
“zero Covid” — that with enough suppres-
sion we could have eliminated the virus
entirely, at least within our own borders.
In the summer of 2020 she argued that
this was achievable in Scotland, were it not
for the border the country shared with the
perfidious and laissez-faire Sassenachs to
the south. The conventional view is that
after April 2020 this really wasn’t possible
in the UK. Although it is also the case that
conventional views have had a poor time
of it in the pandemic.Rarely have conventional views tum-
bled so fast as they did in the first month of
the UK pandemic. Her account of what we
did in those much-disputed weeks, in
particular in explaining the thinking
around that unexpectedly famous epide-
miological term “herd immunity”, is
among the most coherent I have heard.
The book is most valuable, though, and
at times fascinating, as a round-up of what
others did. The oddly parochial British
debate has reached a stage where some
now argue that having any mandatory
interventions at all was ultimately futile —
that we all ended up with the same toll. The
book is a reminder that some countries did
far better over the past two years — on
whatever metric you choose.
What can we learn from them? At this
stage, everyone has their biases — and
everyone’s cherished arguments can top-
ple in the face of new realities. Hundreds of
papers are yet to be written comparing
international Covid strategies — appor-
tioning success to policy, population struc-
ture and, frankly, sheer dumb luck.
These days, South Korea still looks like
a model to follow: it has been freer, safer
and richer throughout. Thinking back
to our own stalled and blundering early
efforts, Sridhar’s description of their effi-ciency is boggling. “Within about ten min-
utes of receiving confirmation that a
patient was positive, Korean public health
teams could trace exactly where that per-
son had been over the previous week and,
based on those locations, identify who else
could have been exposed,” she writes.
Other measures required far less tech-
nological prowess. There were simple
policies like isolation wards to prevent
transmission in households. And while the
stick for breaking rules was severe — a
£6,275 fine for violating quarantine —
there were also sensibly thought-out car-
rots. “Those Koreans who tested positive
and preferred to stay home were checked
on twice a day to report any symptoms;
they also received food and toiletry deliv-
eries as well as psychological counselling.”
Vietnam, which has recently experi-
enced a surge in deaths that started roughly
when Sridhar finished writing her book, is
less of a paradigm. But that doesn’t mean it
can’t offer lessons. “Lockdown” is a word
that obscures rather than enlightens. It
covers everything from welding doors shut
to mandating masks, and in doing so kills
the nuance of just how effective, in the
broadest sense, each of the policies avail-
able to us is.
The debate, too, has ended up obscuring
the science. Sridhar is unusual in that
her position seems to have evolved from
zero-Covid-leaning to living-with-Covid-
leaning. Many have not.
Many books are being written about the
pandemic. There will be no definitive as-
sessment of the “correct” course, and what
truths there are will not emerge in a single
irrefutable revelation. Instead, thanks to
insider accounts and outsider analyses —
of which this engaging account is both —
we are piecing together a jigsaw. In trying
to cover such a vast topic, Sridhar’s book
can feel a little overstretched. Equally,
though, its scope is its virtue — extending
that jigsaw not just to countries geographi-
cally distant to us, but to those culturally
distant too. Because while our thinking
may stop at linguistic and geographical
borders, it turns out the virus doesn’t.
Even, we now know in this post-Omicron
world, if that border is New Zealand’s.South Korea
exploited electronic
surveillance to stamp
down on outbreaks
zero covid Devi Sridhar, an adviser to Nicola Sturgeon, became a divisive figurebooks
Which countries passed the Covid test?
ROBERTO RICCIUTI/GETTY IMAGES