How can we prevent a repeat of covid totalitarianism?

When covid lockdowns and (later) vaccine mandates were implemented, I initially thought that the experts were making a blunder. But within a couple of years, it became clear that the experts were actually right. If public health textbooks are correct, then the experts were doing the right thing – they were faithfully implementing textbook recommendations. 

At that stage the question became a different one: Are public health textbooks correct? And so began my first-principles review of public health, which includes verifying everything in the textbooks.

Unsavoury facts about public health 

My review has yielded unexpected insights, many unpleasant surprises about public health. I have been sharing my main findings on this blog; fuller details are available in the fifteen books (available freely, online) that I’m working on. The main unsavoury facts I’ve found about public health include:

1. While isolation of the sick can prevent the spread of some diseases, isolating the healthy (quarantine) is a recipe for disaster. There are endless proofs throughout history that quarantine has rarely worked but has caused great harm. Jointly with eminent co-authors including Dr Jay Bhattacharya, the new head of the National Institutes of Health in the USA, I have published a working paper that summarises “The Failed History of Quarantines”. But public health textbooks and literature strongly promote quarantine and, by implication, lockdowns. Public health uses three ways to turn empirical facts on their head. First, it cherry-picks a few instances in which quarantine might have worked but doesn’t assess the harms caused. Second, it uses mathematical models which can prove anything. Third, it uses ethics to argue in favour of quarantine. 
2. School closures were attempted in the UK in the late 19th century but were given up soon thereafter as they did not stop the spread of disease. The public health literature today, however, demonstrates no awareness of this failure and advocates school closures based on mathematical models.
3. There is no empirical basis for the widespread advocacy of vaccine mandates in textbooks of public health and health economics. Instead, Dr Donald Henderson – the man who eradiated smallpox – insisted on voluntary vaccination and showed how targeted isolation and ring vaccination eradicated smallpox. Mass vaccination was impossible to implement, and quite unnecessary. 
4. Public health journals are hotbeds of propaganda. I recently found that a claim published by The Lancet in 2024, that vaccines saved 154 million lives since 1974, was off by many orders of magnitude. The Lancet has not yet withdrawn the paper.
5. There is no trace of the scientific method in public health, such as the use of natural experiments or a cost-benefit analysis. Instead, they use subjective “tools” like ethics and mathematical models. The founders of public health – Charles Maclean and Edwin Chadwick – used empirical methods and cost-benefit analysis but their empiricism has been forgotten. As a result, public health textbooks today are largely works of fiction in which the truth is often precisely the opposite of what is claimed.

Given this, how are we to prevent a repeat of covid totalitarianism? Perhaps the steps outlined below might help.

1.Review and fix public health 

While we need legislative measures, we must begin by making the case for change. The first thing is to commission a first-principles review of public health and implement methods by which public health will start doing real science instead of models and ethics. This project can take time, but avoiding it is not an option. 

A corollary of this project is to re-write all public health textbooks. If textbooks continue to promote quarantine and vaccine mandates, then that’s what will happen during a “pandemic emergency”. When people panic, they will demand draconian measures; more so, if “experts” advocate such measures. 

There is no textbook on quarantine which analyses failed historical episodes. Charles Maclean was the first to bring together comprehensive empirical proofs against quarantine but no textbook ever got written. A textbook on quarantine is just one of the many new textbooks needed. Among others, we need textbooks against vaccine mandates, on the drivers of life expectancy, and on Non-Pharmaceutical Interventions (NPIs) such as masks.

2.Prohibit all forms of quarantine and vaccine mandates

Legislation is needed to prohibit not just lockdowns but all forms of quarantine including “focused protection” that was erroneously advocated during the covid episode by the well-meaning authors of The Great Barrington Declaration. In addition, vaccine mandates need to be prohibited by law.

3.Recognise that medicine and public health are entirely different fields

Public health textbooks contain no more than one per cent of medical information: almost everything discussed involves society-wide analysis of disease prevention. To be conducted competently, such analysis must apply the principles of opportunity cost, trade-offs, human factors and cost-benefit analysis, which are core competencies of economists. It is a blunder to place medical doctors – who have no comparable training in such principles, in charge of public health. We need the complete separation of preventative and curative health, with the Chief Public Health Officer always being an economist specialised in wellbeing. Medical doctors should hold the role of Chief Medical Officer, with their remit limited to the treatment of disease.

4.Make the drugs regulator the regulator for NPIs

Even if we get economists as Chief Public Health Officers, we will need a regulator to be the final word on NPIs. On 24 December 2024, I argued that NPIs should be approved by the drugs regulator. NPIs must go through the same rigorous process of evaluation as drugs, a process that must include a cost benefit analysis and analysis of human factors. The science behind each public health intervention needs to be publicly disclosed and widely debated.

Further, we cannot have conditional guidance on NPIs. For example, the 2019 World Health Organization guidelines on pandemic influenza don’t recommend lockdowns but don’t rule them out either, leaving it to local authorities to decide. Such “both ways” recommendations are not scientific. In the heat of the moment, governments will always implement the most extreme option. We need clear-cut guidance.

5.Other things to consider

All public health laws need to be repealed and then re-enacted, afresh, based on the review of public health. Apart from the changes cited above, many other changes would be needed: such as prohibiting the use of the precautionary principle, mandating a cost-benefit analysis for any policy which imposes restrictions or costs on the public. Second, a completely new health system needs to be designed, with separate Isolation Hospitals to deal with serious infectious disease. The presence of such separate hospitals will minimise the panic which typically besets doctors and nurses during every pandemic.

There are many other actions that arise from my public health review, but the ones outlined above are perhaps the most important.