What the Western world confronts is not the threatening advance of alien civilisations, but its own dark shadows moving through China and Russia.
The retreat of the West began with the fall of communism in 1989. Our triumphal elites lost their sense of reality, and in a succession of attempts to remake the world in their image went on to vacate some of the planet’s most strategically decisive regions. The end result of their attempt to export their system of government is that Western states are weaker and more endangered than they were at any point in the Cold War.
Yet viewing this debacle as a defeat for Western ideas and values is a fundamental error. Western ideologies continue to rule the world. In China Xi Jinping has embraced a variant of integral nationalism not unlike those that emerged in interwar Europe, while Vladimir Putin has skilfully deployed Leninist methods to resurrect an enfeebled Russia as a global power. Ideas and projects originating in the illiberal West continue to shape global politics. At the same time, in an intriguing synchronicity, Western liberalism has itself become illiberal.
The geopolitical descent of the West was visible in the aftermath of the invasion of Iraq in 2003 and is palpable in the withdrawal of American-led forces from Afghanistan. Iran is now the predominant power in Iraq. With the Afghan state and regular army melting away following the US withdrawal, the future will be decided by the Taliban and neighbouring states that are sucked into the ensuing power vacuum. After years of Western intervention and the deaths of hundreds of thousands of people, in Syria Bashar al-Assad is still in power and Russia is the deciding force. Following the Western-engineered overthrow of Muammar al-Gaddafi in 2011, Libya is an ungoverned space and a gateway of people-smuggling into Europe.
In recent months the pace of Western retreat has accelerated. Joe Biden’s meeting with Putin in Geneva in June gave the Russian president what he most wanted. Accepting that the Nord Stream 2 gas pipeline will be completed, Biden has empowered Russia to cut off energy supplies in transit countries. Ukraine has been left twisting in the wind, and Poland and the Baltic states are exposed to increasing Russian power.
The rationale for what is, in effect, a major geopolitical defeat is presumably to allow Germany to secure its energy supplies in return for supporting US efforts to contain China. But the chances of Germany risking its commercial relations with China have always been small. Last year, Germany exported almost €100bn of goods to China – roughly half the value of all EU exports there. China has not only become the biggest German export market, on some measures, but also the fastest-growing.
German foreign policy is dictated mainly by domestic factors, and industrial lobbies will ensure that trade links with China are not compromised. For the influential Greens, Germany’s exit from coal and nuclear energy transcends any geopolitical cost. In conjunction with the French president, Emmanuel Macron, Angela Merkel has made it clear that Berlin wants détente with Russia. In any great-power struggle, Germany – and thereby the EU – will likely aim to stay on the sidelines, neutral or non-aligned, while in practice inhabiting a Russian zone of influence. No longer as constrained by European diplomacy after Brexit, Britain is resisting this tendency. But without support from the major European powers it is not clear how much the UK can do beyond protecting its own national interests.
The decomposition of the West is not only a geopolitical fact; it is also cultural and intellectual. Leading Western countries contain powerful bodies of opinion that regard their own civilisation as a uniquely pernicious force. In this hyper-liberal view, which is heavily represented in higher education, Western values of freedom and toleration mean little more than racial domination. If it still exists as a civilisational bloc, the West must be dismantled.
This hyper-liberalism is not presented as one among a number of standpoints that can be examined and questioned in open debate. It is a catechism policed by peer pressure and professional sanctions. Those who enforce it like to dismiss practices such as “cancellation” as nightmares of the fevered right-wing mind with no basis in fact. At the same time, they believe disagreement is an exercise in repression.
In the hyper-liberal credo, only what are regarded as simple, self-evident, morally impeccable truths can be tolerated. Assessing the costs and possible benefits of Western empires for the peoples they governed is not far from being a prohibited enterprise, as is examining the involvement of non-Western states in slavery. Some on the right have compared such ideological restrictions to those enforced under communism. The difference is that in Western societies these curbs on free inquiry are self-imposed.
The upshot is that the liberal West is more a subject of historical investigation than a contemporary reality. Those who believe humankind is converging on liberal values overlook the fact that Western societies are fast discarding them. The “arc of history” points to a model that no longer exists.
This does not mean hyper-liberalism has won. Democracy, insofar as it still functions, imposes limits on ideological orthodoxy. The marketplace, for all its excesses, produces alternatives. Venues encouraging intellectual pluralism continue to survive; some, like this magazine, thrive.
Hyper-liberalism is the ideology of an aspirant ruling class that aims to hoard wealth and position while flaunting its immaculate progressive credentials. Intractable culture wars and an epistemic crisis in which key factual and scientific questions have been politicised are a part of a bid for power by these counter-elites. But except in New Zealand and English-speaking Canada, there is no sign of them achieving hegemony.
Even so, schools are pressured to teach a single version of history, private corporations sack employees for deviant opinions and cultural institutions act as guardians of orthodoxy. The prototype for these practices is the US, which regards its singular history and divisions as defining every modern society. In much of the world the woke movement is regarded with indifference, or – as in the case of France, where Macron has denounced it as “racialising” society – hostility. But wherever this American agenda prevails, society is no longer liberal in any historically recognisable sense.
The evanescence of Western liberalism does not mean we inhabit a post-Western world. Arguments for Western decline are usually rehashed versions of the Harvard political theorist Samuel Huntington’s speculations about clashing civilisations, joined with prognostications of inescapable Chinese supremacy. Such claims have force insofar as they reflect the sharp contraction of Western power. But they miss the most remarkable feature of the contemporary scene: the continuing dominance of modern Western ideas. Not those of liberalism as traditionally understood, but mixtures of fascism, communism and integral nationalism.
Both China and Russia – avowed rivals of the West – are ruled by ideas that derive from Western sources. (The same is true of Narendra Modi’s nationalism in India and some Islamist movements.) What the West confronts is not the threatening advance of alien civilisations but its own dark shadows.
The formative influence of Western ideas on China’s leadership is illustrated by the references to the ancient Greek historian Thucydides that used to be common among official spokespeople. China, they would assure Western visitors, had no intention of falling into “Thucydides’ trap” – the tendency of rising states to seek to dislodge established powers from their dominant position, leading to war. Since Beijing’s switch to “wolf-warrior diplomacy”, a more assertive and aggressive form of statecraft, some have questioned the significance of the Thucydides trap in Chinese thinking. But Xi Jinping referenced it explicitly in a talk I heard him give in Beijing several years ago. He appears to have become more confident since then.
The study of Western classics is actively promoted in Chinese universities. The texts are often taught in their original Latin or Greek (a practice no longer required at Princeton, where some consider it racist). China’s meritocratic intelligentsia is also notable for having a grasp of Western political thought that exceeds that of many in Western universities. The works of Alexis de Tocqueville, Edmund Burke and Thomas Hobbes, as well as 20th-century thinkers such as Michel Foucault, have been closely studied. The German jurist Carl Schmitt (1888-1985) has been accepted as having the most to teach regarding China’s political development.
Schmitt gained recognition in the German academy by examining the influence of theological ideas on Western jurisprudence. During the 1920s he fashioned a set of ideas in which the Enabling Act of March 1933, which formally established the Nazi regime, could be formulated and justified. Law was created by sovereign political decisions, and whoever decided when a “state of exception” or regime crisis existed was the sovereign. In 1932 he published The Concept of the Political, arguing that politics was not a dialogue among members of a shared community with divergent interests and values, but a struggle between enemies – in other words, a mode of warfare.
Joining the Nazi Party weeks after it came to power, Schmitt distinguished himself by endorsing the burning of books by Jewish authors . But he seems not to have been sufficiently anti-Semitic for his Nazi patrons, and in 1936 was accused of opportunism and had to resign from the party. At the end of the war he was arrested by Allied forces and spent a year in internment. He never recanted from his theories, elaborating on them in the decades that followed.
Uniform vision: Carl Schmitt believed the sovereign should promote the homogeneity of a people. Credit: getty images
Schmitt’s theory of law is not wholly original, or necessarily anti-liberal. A similar view can be found in the work of Hobbes. The difference is in their view of politics and the state. Whereas Hobbes believed the purpose of the state is the protection of individuals from violence and insecurity – a fundamentally liberal position – Schmitt charged the sovereign with promoting the homogeneity of the people.
It is this aspect of Schmitt’s thought that appears to be most attractive to the Chinese leadership. If the state and the people are one and the same, minorities can be suppressed, or obliterated, in the name of public safety. The forced assimilation of Tibetans, Kazakhs, Uighurs and other minorities into a uniform Han Chinese culture is not oppression, but a necessary means of protecting the state from forces that would destroy it.
The German jurist’s ideas are well suited to legitimating Xi’s increasing repression. In 2020 the Beijing law professor Chen Duanhong drew on Schmitt’s thought in a speech in Hong Kong to support the recent “national security” law, maintaining that the exercise of China’s sovereign authority to extinguish liberal freedoms in the former British colony is no more than the state securing its future.
Schmitt supplies a template for Xi’s integral nationalism. The construction of homogeneous nation-states did not begin with National Socialism. It had a European point of origin in revolutionary France. In the early 1790s, the Jacobins used an idea of the nation to crush a popular rising in the Vendée region of western France, in a campaign of repression that may have cost in excess of 100,000 lives. The construction of the French nation-state continued in the 19th century through the institutions of military conscription and national schooling, eradicating the diversity of languages and cultures that existed under the ancien régime.
Ethnic cleansing became central to nation-building in the wake of the First World War. The collapse of the Austro-Hungarian, Ottoman and Romanov empires enabled the emergence of nation-states asserting a right to self-determination – a development reinforced by the US president Woodrow Wilson in the Versailles settlement of 1919. His goal was to reconstruct Europe as a community of civic nation-states. But there were internal minorities in many of these states, and in the years that followed large population transfers occurred. Huge numbers fled or were expelled – as many as 1.5 million Greeks from Turkey and around 400,000 Turks from Greece, for example.
The process continued during the Second World War, with the Nazis killing millions in the territories they occupied in eastern Europe and the Soviet Union, and attempting the complete extermination of the Jewish people. Stalin deported peoples whose loyalty to the Soviet state he mistrusted (such as the Chechens and Crimean Tatars) from their homelands to Central Asia, many of them perishing during the journey or soon after their arrival.
The nation-state is a Western invention. Nationalism emerged in China towards the end of the Qing dynasty (1644-1912) as a response to the humiliating subjugation of the country by Western powers. Seeking to confer “Chinese characteristics” on his project, Xi Jinping has cited Han Feizi, a third-century BC aristocrat in the Han kingdom and a proponent of the Legalist school of philosophy, in which law is used to fashion a strong centralised state.
As in interwar Germany, Schmitt’s thought facilitates a shift to totalitarianism. The distinction between authoritarian and totalitarian states is nowadays dismissed as a relic of the Cold War. Yet it captures a crucial difference between illiberal regimes. Authoritarian states are dictatorial in their methods but limited in their goals, whereas totalitarian states attempt to transform society and intrude into every area of human life. Bismarck’s Prussia and late tsarist Russia fall into the former group, and National Socialist Germany and the Soviet state throughout most of its history into the latter. Xi’s China has moved into the totalitarian category. Through the 95 million-strong Chinese Communist Party, which celebrated its centenary on 1 July this year, the state aims to be omnipresent throughout society.
China represents itself as a “civilisation-state” based on Confucian ideas of social harmony. Yet Xi pays tribute to Mao Zedong, who between 1949 and the mid-1970s laid waste to Chinese civilisation in the pursuit of an ugly occidental utopia. The move to a more limited authoritarian regime that seemed to be under way in the time of Deng Xiaoping, who led the People’s Republic between 1978 and 1989, has been reversed, and totalitarianism renewed. China is the site of an experiment in coercive nation-building whose closest historical parallels are in interwar Europe.
Putin’s Russia and Xi’s China are often understood as similar types of regime. There is some basis for this as both are vehicles for Western projects. Lenin always maintained that the Bolshevik takeover continued the Jacobin tradition in the European Enlightenment. A type of pedagogical terror was a feature of the Soviet state from the time of its foundation in 1917. Even after the Sino-Soviet split in the 1960s, Mao continued to emulate the Westernising Soviet model.
But the differences between Russia and China today are profound. Putin’s Russia is an authoritarian regime in which the state, though violent, is weak. Its spine is the former Soviet intelligence services; but sections of them are semi-privatised, some working in opaque collusion with organised crime. Amorphous private armies operate in Russia’s near-abroad and other zones of global conflict. Putin’s authority appears to be unchallenged in the Kremlin, but he exercises it with the tacit consent of oligarchs who in turn depend on his patronage.
There are signs of decay in the regime. An earlier phase of Putinism in which the population was controlled through “post-modern” media techniques and the management of apathy has given way to one that relies more on the threat of force. Nonetheless, the control of the population by the state is less comprehensive than at any time under the Soviet system until it began its slide into anarchy with Gorbachev’s liberalising reforms from the mid-1980s.
In 2017 the Kremlin declined to celebrate the centenary of the Russian Revolution, with Putin reportedly asking, “What is there to celebrate?” The view of some regime-friendly Russians that Putin, an archetypal product of the Soviet system, is an essentially anti-communist leader is not wholly groundless. Yet the core institutions and methods through which he governs are Soviet inheritances. The “little green men”, for example – Russian irregular forces that effected the invasion of Ukraine – were following the Bolshevik practice of maskirovka (deception). His cyber-warfare applies a similar strategy.
The fantasy of world revolution has long since been abandoned, along with the goal of transforming society, but the state through which Putin rules remains Leninist in its structure.
The belief that challenges to the West emanate from outside the West is a source of some comfort to liberals. The role of an earlier generation of liberal and socialist thinkers in downplaying the colossal human toll of communism in Russia and China can be forgotten. The West’s complicity in present-day crimes can be evaded.
The attempt to erase the Uighurs as a people is the most obvious example of ongoing oppression in China. Confining them in concentration camps, demolishing their mosques and cemeteries, deporting them to work in factories (some of them reportedly in the supply chains of Western brands) and subjecting women to rape, involuntary abortion and sterilisation are crimes against humanity. But any campaign against them soon confronts China’s economic power, which has the potential to derail the global market the West has constructed and on which it now depends.
Despite the Uighurs’ plight being raised at international meetings, there is little real support for them. In most Muslim-majority countries, many of them indebted to China, Uighur cries for help have been greeted with silence. A world in which hyper-liberalism coexists amicably with the restoration of slavery may well be the next stage of social evolution. The Uighurs are on the wrong side of history.
The suppression of minorities in China is instructive because it undermines a consoling liberal narrative: the modern world is based on scientific and technological innovation, which requires an open society. Dictatorship is not just wrong but inefficient and unproductive. Only liberal societies have a long-term future.
China has dispelled this legend. During the post-Mao period a dictatorial regime presided over the biggest and fastest process of wealth-creation in history. As a result of the shift from authoritarian to totalitarian government under Xi, innovation may slow. There are already signs this may be happening. But countervailing forces in the West could yet give China the advantage.
In California, proposals are under consideration that would discourage the teaching of calculus in high schools. In Canada, Ontario’s proposed “equitable” maths curriculum “recognises that mathematics can be subjective”. Deconstructing education in this way, during a time of intense geopolitical rivalry in science and technology, does not look like a winning strategy.
Whether Western elites are capable of strategic reasoning at this point is unclear. Many of their key policies are performative in nature. Schemes to achieve net zero carbon emissions are extremely costly, and will not prevent accelerated global warming. The vast sums would be more reasonably spent adapting to the abrupt climate change that is already under way. But that would demand realistic thinking, which Western opinion-leaders reject as defeatist if not immoral.
A world-view that gripped sections of the Western intelligentsia throughout the modern period and dominated the post-Cold War world is disintegrating. Stories showing humankind evolving towards liberal values are parodies of monotheism in which a mythical logic in history replaces a redemptive providence. Knock away this myth, and the liberal way of life can be seen to have been an historical accident. In time the regimes created by Xi and Putin will crumble. But if the long drift of history is any guide, they will be succeeded by anarchy and new despotisms.
While Western liberalism may be largely defunct, illiberal Western ideas are shaping the future. The West is not dying but alive in the tyrannies that now threaten it. Unable to grasp this paradoxical reality, our elites are left looking on blankly as the world they have taken for granted slips into the shadows.
Use the New Statesman’s trackers to monitor the state of the global effort to vaccinate the world against Covid-19.
A global effort to vaccinate people against Covid-19 is underway - with much of Europe tightening restrictions as a second wave of the virus has taken hold.
The New Statesman has launched this page to track the progress of different countries as they seek to protect their populations from the pandemic. It will be updated daily as new data is released.
On top of vaccination data, we have gathered statistics on how well testing systems are holding up (the test positivity rate), as well as collecting in one place the number of hospitalisations, cases and deaths for as many countries as we can.
Combined, the progress on vaccines and the level of the disease should give an idea of where different countries are heading; are we in for a long period of restrictions, or progressing towards a level of freedom from the virus?
International vaccine rates
The live map below shows how many doses have been injected for every 100 people in each country. Most vaccination types require two doses to be effective.
Using the toggle in the top left, you can change the view to look at the raw number of doses, as well as to see how much each nation has invested in the development of vaccines.
Which type of Covid-19 vaccine am I going to get?
Different countries have ordered varying quantities of vaccines from a range of medical companies. These include the Pfizer / BioNtech jabs, Astrazeneca / Oxford University (currently approved for emergency use in the UK), the Russian Sputnik V vaccine from the Gamaleya Research Institute, and vaccines from the Chinese companies Sinovac and Sinopharm.
Where are the new variants spreading?
One of the largest concerns currently is how the virus is mutating. Throughout the pandemic, the virus has mutated a number of times, creating new strains. Most of these mutations are harmless, doing nothing to change the seriousness of the virus. However some concerning variants have arisen in the UK, South Africa and Brazil — raising worries of increased transmissibility or reduced vaccine effectiveness.
Which countries are better at testing?
The test positivity rate measures the percentage of tests that return as positive. It can tell us two things: the overall size of the outbreak in each country, and how comprehensively different testing systems are coping with the number of new cases. The higher the number, the larger the outbreak; the lower this number, the more confident we can be that the testing system is catching most of the cases.
A good analogy is fishing: if you are constantly filling your net when you bring it up, you know it is likely there are far more fish out there that you are missing. But if you cast your net wide and only catch a couple of fish, you know there probably aren’t many others out there.
How many people are in hospital with coronavirus?
The European Centre for Disease Control publishes daily hospital occupancy rates for a selection of European countries. We have added in several other countries around the world from a variety of different sources where we can find them.
The number of people hospitalised with the disease is a good way of tracking the epidemic over time, as it doesn’t rely as much on testing and the way of measuring has generally remained constant over the pandemic.
It is also key to easing restrictions, as many countries will only do so once they are sure their health systems will not be overwhelmed.
How many people have died from Covid-19?
The most important metric is the number of people that have died from Coronavirus. Different countries have different ways of measuring deaths - some, like the UK, only include deaths in their daily figures when someone has tested positive from the virus and died within 28 days. Other countries don’t have a time-limitation in their reported deaths, and some, such as Belgium, include deaths where coronavirus was suspected.
One way of comparing different countries’ death tolls from Covid-19 is to look at the number of people who have died above and beyond what we would expect in a usual year. This measure is called ‘excess deaths’ - and while it may include people that have died from causes other than direct Covid-19, it offers a chance to compare different countries using the same metric.
There are also disparities between the number of cases recorded in each country - in large part due to differences in testing. The graph below is therefore best for comparing the direction countries are heading in, rather than the differences between them.
You can view the figures raw, or compared to population, in order to take into account the different sizes of each country.
The New Statesman has launched this page to track case rates and other key Covid-19 data on a local authority level across Britain. It will be updated weekly every Thursday as new data becomes available.
Vaccinations by local area
The NHS in England publish the number of people that have been vaccinated in each neighborhood (called middle-layer super output areas). You can see how many people have been vaccinated where you live, and how it compares to the rest of your town and to England as a whole by entering your postcode below.
Case rate trends by local authority
The government has now instituted three nationwide lockdowns to curb the effects of the pandemic, but the spread of the virus has always shown variation in different parts of the country: areas in northern England experienced higher rates of transmission over the summer, with London’s second wave only gaining momentum in October.
Use the table below to get a longer-term view of the data and analyse recent trends in case rates across every local authority in England, Wales and Scotland.
Covid spread by local neighbourhood
In the UK, local lockdown measures have focused on whole local authorities or regions. But there continues to be significant variation in case rates between the neighbourhoods within those regions.
In Leeds last summer, for example, the villages of Boston Spa and Bramham never had case rates above 200 per 100,000 people, even when a local lockdown was in force and rates were exceeding 500 cases per 100,000 people in the city centre.
Our hyperlocal animated map below allows you to get a picture of how the epidemic has progressed in your neighbourhood. You can enter your postcode and click or tap the “play” button to see this animate over time.
A note on the data
The figures featured on this page are drawn from a variety of official sources. Data on case rates comes mainly from Public Health England, but where Scottish and Welsh figures are shown the sources are NHS Scotland and NHS Wales respectively. Positivity rates are taken from NHS Test and Trace’s weekly data report.
Hospitalisation figures are taken from NHS England and have been mapped from hospital trusts to local authorities using a method developed by Colin Angus, a statistician from the University of Sheffield.
This page will be updated every Thursday evening as new data is released and will display the latest available figures at the time of publishing.
The former chair of the all-party parliamentary group on thrombosis says policymakers need to support and sustain innovation in healthcare all year round.
At the start of 2010, I collapsed at Euston Station. I was rushing to make a three-line whip vote, and at the top of the stairs by the taxi rank my body gave way beneath me and the world went black. I tumbled down the stairs and smashed into an advertising hoarding.
When I came around, I was confused and in pain, but not particularly worried. I was a young man and in relatively good health. I had had a very bad chest infection at Christmas, so put it down to that. I still made the vote. I had no idea how close I had come to dying.
The next morning, after chatting with my wife, I decided to go to the hospital, both to have a check over and to see if the reason for the collapse could be identified. I remember my state of utter confusion when I received the diagnosis – “a pulmonary embolism?! But I’m only 36.”
A pulmonary embolism is when a blood vessel in your lungs is blocked by a blood clot. My experience at Euston was a massive wake-up call for me, and since then I have fostered an interest in raising awareness of thrombosis – the formation of blood clots. I was proud to serve as chair of the all-party parliamentary group on thrombosis and continue to be interested in policy interventions related to it.
It is this interest that has led me to champion the pioneering technology of the endovascular thrombectomy. Simply put, a thrombectomy is the removal of a blood clot under image guidance and can be used to treat an arterial embolism. A doctor may recommend this treatment for certain ischaemic strokes or for specific mesenteric ischaemia (where the blood flow in your small intestine is restricted due to inflammation or injury).
Behind this technical language lies an exciting medical development. The Stroke Association has written extensively about thrombectomy and cites it as one of the most cost-effective treatments in specific cases. A thrombectomy can remove clots that are too big to be broken down via other methods and can prevent long-term disability in people with severe strokes.
Around 10,000 patients a year could benefit from thrombectomy in the UK, but it is thought that fewer than 10 per cent of those eligible receive it. So why on earth aren’t we rolling it out more?
The answer is, as with many medical developments relating to stroke and blood clots, a combination of funding, logistics and training. One key problem is that specialist neuroscience centres, where these kinds of procedures happen, are not evenly spread out across the UK. As the Stroke Association puts it: “Even the most basic stroke treatments are not being given to all stroke patients, let alone new cutting-edge procedures like thrombectomy."
The funding and policy support for stroke treatment remains thin on the ground. This seems both counter-productive and extremely dangerous. Of course, the economic implications of funding stroke research are not the only considerations, but an ageing population means (as consultant stroke physician Martin James has written) that “the economic burden of stroke will almost treble within 20 years”. Cost of investment now then, however expensive, promises to make long-term policy sense.
We also don’t have enough trained specialists to carry out these complex operations, a fact that is very concerning and must be addressed by politicians and healthcare leaders. We need to encourage training programmes abroad to bolster our healthcare system, but also focus on retraining people with comparable and complementary specialisms already working within the NHS.
There seems to be a lack of urgency among policymakers to assist in the roll-out of this type of technology. I was particularly frustrated to read a government response to my colleague Rachael Maskell's question relating to thrombectomy, in which a minister cited several reform goals, but no detailed time frame. The minister stated that there were currently 22 centres in England able to perform thrombectomy, and “another two non-neuroscience centres currently under development to provide access to thrombectomy”.
This, I’m afraid, will not cut it. Either healthcare is equally accessible, or it isn’t. We need an injection of funding, ingenuity and government willpower to ensure that those who suffer from thrombosis, and are eligible for a thrombectomy, can access the treatment in time for it to make a difference. Victims and their families need to see that their government is taking this seriously. I know how complex the issue is, but we should be getting more of a grip on this.
It just so happens that when I had my own experience with a blood clot, I would not have benefitted from a thrombectomy. But the fact that other people can have similar experiences, and potentially lose their lives or face long-term disability because of logistics and funding, terrifies me. We are the sixth-richest country in the world, and we should be leading the way on this kind of innovative healthcare.
All too often I feel like the government treats the NHS as if it is something to maintain; to fund just enough to keep it barely breathing, and then pump money into it in a blind panic when in crisis. If we are truly to protect and improve upon the NHS for future generations, policymakers must start to adapt to the needs of perpetually changing populations, support innovative care, and become much better at looking after a health service that is all too often taken for granted.
Andrew Gwynne MP is the former chair of the all-party parliamentary group on thrombosis.
The UK’s coronavirus record has been mixed at best. But one area in which the country has unquestionably excelled is in the identification of new coronavirus variants. Even one of the government’s fiercest critics, former N0 10 adviser Dominic Cummings, picked out this kind of virus hunting as an area of science in which the country was “a superpower”, when speaking to the science and technology select committee in March.
In April 2020, the start of the UK’s first lockdown, the Covid-19 Genomics UK Consortium (COG-UK) was established to sequence and analyse SARS-CoV-2 genomes. The group was made up of a dozen academic institutions, the UK’s four public health agencies for England, Scotland, Wales and Northern Ireland, and the Wellcome Sanger Institute, which conducts genome research.
“We were very fortunate to get funding from the government, through Patrick Vallance,” Sharon Peacock, professor of public health and microbiology at Cambridge University and director of COG-UK, tells Spotlight. The initiative has been a huge success. In January of this year, over one million coronavirus genomes had been shared internationally with the Global Initiative on Sharing Avian Influenza Data (GISAID), the primary tool for scientific data-sharing on Covid-19. Almost half of those, 45 per cent, had been identified in the UK.
The “genomic surveillance” COG-UK is engaged in is crucial in the fight against the coronavirus. It allows researchers to ascertain routes of transmission, look at how different variants behave, monitor the outbreak of immune escape variants, and, crucially, develop vaccines. “There will be a time when we are thinking about this in the same way that we do flu,” Peacock explains. “That is, whenever it’s required, we’ll ask what vaccine will give us the greater coverage for that year, for whatever time frame or region.” The key to that is identifying dominant strains and mutations and targeting them with the correctly modified vaccine.
Peacock is also engaged in work with other genomics researchers, trying to unlock the causes behind the massive differential reactions in patients, spanning from symptomless or mild illness to ventilator treatment and death, or to the protracted misery of long Covid. “We’re working together with Health Data Research UK and Genomics England,” says Peacock. “We’re linking the human genome, and the viral genome and detailed health informatics data [for] a much, much deeper analysis.”
An extraordinarily difficult year for the country has not precluded astounding success in some areas. The vaccine roll-out has been the fastest of any large nation, and years of publicly funded research into pioneering technology and the life sciences meant the UK was able to quickly develop its own jab, one that will be sold relatively cheaply across the world. The NHS has been heavily stretched, but unlike in other areas of the continent, neither ICU beds nor ventilators reached their full capacity (although this is largely due to a rapid expansion of available critical care spaces and the cancellation of elective treatments that now leaves the service with record waiting lists). And while the UK suffered one of the worst death rates (13th highest in Europe and 18th in the world), and endured many months of lockdown, the link between cases, hospitalisations and deaths seems to have been severely weakened.
Genomics research has been instrumental to a lot of what the UK got right in its fight against the coronavirus. It has sharpened the world’s understanding of SARS-CoV-2 in ways that will reverberate through generations, and needs to be nurtured and bolstered for many years to come.