LONDON — As editor of the Lancet medical journal, Richard Horton has overseen publication of some of the most-cited papers of the coronavirus pandemic, from the first reports from Chinese scientists to the latest on vaccine development. He has also emerged as an outspoken voice on the failures of the global response.
In May, his editorial board — based mostly in Britain — stirred controversy by wading into U.S. politics and advocating that Americans should elect a president “who will understand that public health should not be guided by partisan politics.”
Now Horton is out with a new book, “The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop it Happening Again.” It is an angry work, thrumming with righteous disbelief over mistakes made in the past six months. He accuses President Trump of a “crime against humanity” for cutting World Health Organization funding during a pandemic. He blames British Prime Minister Boris Johnson for thousands of excess deaths.
Horton spoke via Zoom with The Washington Post to explain why he thinks politicians and scientific advisers in the United States and Europe got so much so wrong. He also shared what he expects from research on vaccines and treatments.
This interview has been edited for length.
Q: You published the first papers from Chinese doctors on the front line. The United States has been highly critical of China. What do you think of the Chinese response in those early days?
A: During the first SARS epidemic, Chinese authorities said there was no outbreak. They tried to deceive the world, until the World Health Organization called them out on it. I think China learned you can’t sit on this kind of information for long.
I think during December last year, Chinese authorities tried to chase down what this mysterious pneumonia was, tried to understand the nature of the outbreak. By the end of the month, they realized they had something very serious on their hands.
Q: A team from the World Health Organization is in China now trying to learn more about the origins.
A: We know some of these early cases seem to be linked to the live markets in Wuhan. But some were not. We don’t really understand the lines of transmission of the virus in those early days. There’s clearly a connection between wildlife, the environment, the urban setting. But we don’t really know where the pieces of that puzzle are or how the pieces of that puzzle join.
Q: A mysterious pneumonia arises in December. The pathogen is identified in weeks. Its genetic code is published in January. Now we have two dozen vaccines now in human trials. That seems blisteringly fast.
A: I’ve never seen anything like it in my life. I’ve been at the Lancet 30 years, and I’ve seen many epidemics, many humanitarian emergencies around the world. And I’ve never seen the world’s research community respond so fast.
What’s so impressive is that this has been a truly global collective effort. Every country’s scientists have responded. And so there’s been this global community effort to bring knowledge to the front lines.
You described the book as angry. I was angry, yes. In the early days. And still am, to an extent. But I hope the book’s not fully angry, because I also want to look at the incredible opportunity this pandemic has shown. Before this pandemic, the research community didn’t work as fast or as efficiently on urgent problems. It is phenomenal to go from discovery of a new virus to candidate vaccines in six months. That’s never happened before.
Q: I think you would say that response by the scientific community has been far better than the response of governments?
A: Yes, and that’s one of the reasons I did get angry. I was seeing the research community immediately kicking into action, gathering actionable evidence, for use by policymakers and politicians. And nothing was happening.
That’s not just a failure of politicians. It’s the failure of those medical and science advisers who are giving advice to governments, because I don’t think they picked it up quickly enough, either.
Q: Italy goes into lockdown, then Spain, France, Germany, Britain and parts of the United States. You can see dithering and dawdling. But Boris Johnson tells people March 12 you’re going to lose a lot of your loved ones. A week later, the pubs are closing. A few days later, we’re in lockdown. That’s not fast?
A: In medical terms, it was slow. If you’ve got an acute public health emergency, where the virus is literally growing exponentially in your population, and it’s doubling every three days or so, then you don’t have a week to make up your mind.
Now, let’s think about how you would respond. The World Health Organization declares a Public Health Emergency of International Concern on Jan. 30. You would imagine that the Foreign Office or the Prime Minister’s office would ask its embassy in Beijing to give them an immediate report. Within 24 hours, they would have got the message back: A SARS virus is tipping people into the hospital. No treatment, no vaccine, many people dying. Prediction of a global pandemic.
So that’s sitting on the prime minister’s desk on Feb. 1. You would think they would say: Okay, I need to be getting testing, tracing and isolation systems in place. Have we got personal protective equipment? How are we going to think about physical distancing? What’s our policy on schools? How are we going to stop mass gatherings from transmitting this virus?
All of that should have been discussed within 48 or 72 hours after the emergency was declared. It didn’t happen.
Q: The British government always says: We follow the science. That is comforting. These are smart people. What went wrong?
A: It wasn’t just the United Kingdom, it was all of Europe and North America. The scientists here didn’t take the science coming out of China seriously.
Q: It was the virus ravaging northern Italy that slapped them on the face?
A: Exactly. It was only when the epidemic in Lombardy really took off. That’s when Neil Ferguson [an epidemiologist at Imperial College London] and others recalculated. They doubled the number of people being admitted to intensive care in their models. And they suddenly saw the National Health Service was going to be overwhelmed. That was the critical moment.
Q: When the first Lancet papers came out from the ICUs in Wuhan, one clinician told me they read like something out of Stephen King novels. This is terrifying, they said. And the Chinese are deploying sophisticated medicine.
A: They were doing everything that you would expect to see in a Western medical setting. But, despite all of that, we didn’t believe it. I think there was this judgment. It’s a little like the discussion we’re having about China now. Can we really believe what they say? Are they really competent in being able to manage these patients?
Q: Do you have confidence in the Imperial College assessment that a U.K. lockdown a week earlier could have cut deaths here in half?
A: If we had locked down on March 6 instead of March 23, then we could have absolutely saved 20,000-plus lives.
Q: In your book, you write, “The story of covid-19 in the United States is one of the strangest paradoxes of the whole pandemic. No other country in the world has the concentration of scientific skill, technical knowledge and productive capacity possessed by the U.S. It is the world’s scientific superpower bar none. And yet this colossus of science utterly failed to bring its expertise successfully to bear on the policy and politics of the nation’s response.”
A: That’s true.
Q: What happened?
A: This is hard. I love America. But it can be very parochial. I think the fact that America sees itself as the greatest country in the world means that it sees itself as impregnable. That view informs not just a response to a pandemic, but attitudes to climate change and other threats.
I don’t think many American public health scientists and government advisers read those papers we published. If they did, I don’t think that they took them seriously. I think there was a very serious miscalculation of the risk by American public health scientists.
I know Tony Fauci well, and his entire career has been forged on the fight against AIDS. He’s a brilliant scientist. He is a brave man. But something went wrong here. I wish I could give you a clear answer as to why, but I can’t. I really can’t explain it.
A: I’m going to change my mind.
Q: Science is nothing but changing your mind.
A: Exactly. I’m just thinking back. I remember talking with some of the HIV scientists in Atlanta in the 1990s and asking: Why didn’t you shout out more under Reagan? Why aren’t you stronger advocates for public health, when you know the evidence on safe needle exchange is so clear?
They said, “You don’t understand how it works here.” They’re all wearing their Navy uniforms and saying to me, “We can’t be advocates.” Because if you’re a government scientist, you’re there to work within the political infrastructure of whatever administration is in power at that particular time. And if the administration is left or right or whatever, you have to fit into that political ambiance, and you can’t step outside it. And if you do, you’ll be out.
Now, fast forward to the administration of Donald Trump, under the particular CDC leadership we have now. It may well have been that there were CDC scientists sitting in Atlanta who read those papers, who understood what was coming. But they’re not allowed to go out there and be advocates.
Q: The best of British science was seriously thinking about deploying “herd immunity” as a defense in March — protecting the vulnerable but letting this virus sweep through the general population. What were they thinking?
A: They were thinking influenza — because the only viral disease that was in the frame, for a pandemic, the only thing we were planning for, was influenza. We weren’t planning for SARS and were not able to pivot quickly enough.
Q: Let’s talk about beating the virus in body. There is some good stuff coming along to help people who get sick fight the virus?
A: There’s some old-fashioned antivirals, not specifically for the coronavirus, and they’re currently undergoing clinical trials. We’ll see whether they have an effect. They may not. It’s likely they either won’t have an effect or the effects will be very modest. Then there are going to be new antivirals more specific to coronavirus — we don’t have any of those that are clearly ready for use. And then there’s going to be a category of drug that’s not actually going to be against the virus, but against the thing that kills you: the cytokine storm. It’s a super massive inflammatory response that goes out of control. So one route to treating this condition is to try to stop that explosion from happening.
Q: That leads us to vaccines. It is amazing that we have three, four types — RNA, DNA, inactivated virus, the crippled adenovirus being trialed by the Oxford group. Are we going to have two or three vaccines ready to go in December or January or February, with 70 or 75 percent effectiveness? Please say yes.
A: So the positive news is that we’re making really rapid progress toward a vaccine. There are something like 200 candidate vaccines around the world that are being developed. There are about 15 to 20 that are in human trials. We have every reason to be optimistic that by the end of this year, we will have identified a vaccine, at least one, that has some measure of effectiveness and is safe. So then it’s going to be a question next year of turning up the volume of production and distributing that vaccine.
Q: Hooray for vaccines!
A: Hang on. A vaccine is not going to take this virus out of our society. A vaccine is never 100 percent effective, 100 percent safe and available to 100 percent of people. We’re not going to get a vaccine to 7 billion people on the planet, and 7 billion people on the planet aren’t going to want to take it. I’m pretty sure we’re going to have a vaccine next year, but that isn’t going to mean we’re going to be able to go back to our fully normal lives.
Q: And not everyone will accept a vaccine? You were involved in an infamous episode here in Britain. The Lancet published a paper by Andrew Wakefield in 1998. It was kind of a foundational paper for the anti- vaccine movement, as it purported to link autism to the mumps, measles and rubella (MMR) vaccine. The paper was retracted, but it had done its damage. How can science address these concerns?
A: Yes, the anti-vaccine movement is mobilizing again. And I see Andrew Wakefield has popped up in the United States and is part of the anti-vaccine movement related to covid-19. There are different elements within the anti-vaccination community. There is the extreme anti-vaccination wing, and you’re never going to convince them with any science. They’re just completely against vaccination. There’s a much larger group of concerned citizens who want to do the right thing, but they’re scared. They see the debate and don’t fully know what to make of it.
We need to be as transparent and honest as possible about the evidence. We need to put every vaccine through the correct safety and effectiveness testing. We don’t cut corners, and we listen to what people are saying. We don’t call them crazy or nuts or any other epithet. Our task should be to build confidence by giving information and answering legitimate questions.
Q: You work at the intersection of where science and research collide with the massive egos of people who want credit for discoveries, for vaccines and antivirals. There are many, many zeros in this game. The pharmaceutical companies are going to make billions of dollars. Are these folks looking after our best interests and not their best interests?
A: I have confidence that the science is going to give us reliable answers. But I’m not confident that the system we have in place is going to deliver a fair outcome. We’re seeing your government and my government buying up vaccines that are not yet ready, not yet available, but buying up options on vaccines to protect their populations. That isn’t the way we should be thinking. We have to have a global response and need to protect those most at risk. We know who those people are. They’re older. People with chronic diseases. They’re from black and minority ethnic populations, and workers in the health system. They’re the people who need to get the vaccine. Not me.
Q: I want the shot.
A: You’ll take it? Okay. But this risk of vaccine nationalism is very real, and it shouldn’t be the strongest or the richest country that gets access to a vaccine first. You and I are going to be fine. But a lot of people aren’t. That doesn’t seem right.