Want the old normal back? It will have to be fought for

The story of the vaccine roll-out has dominated the first half of this year. The drama proceeded on two fronts in Britain: we delighted in the raw number of jabs in arms – at its peak, hitting 500,000 per day – and found solace in the rapid vaccination of close social networks.

After a family Zoom in March, I reflected that everyone on the call (bar me) had had at least one shot. It’s my turn next week. It’s the culmination of a remarkable story reflecting the strength of the biomedical sciences across the West and a symbiosis between innovative minnows (none of the leading vaccines were developed by the “big beasts” in the vaccine field like GSK) and bigger fish.

AstraZeneca had little experience in developing and distributing vaccines. Yet, it took an enormous business risk in teaming up with the Oxford-based startup, Vaccitech, to work on a “vaccine for the world”. If pandemics are the “ultimate stress test”, Britain’s fault lines have been exposed alongside its strengths, and both startling levels of regional inequality and dysfunction at the heart of government contributed to our unexpectedly high death rate.

We also boast some of the top scientific centres in the world, as well as certain institutional advantages: we can run extensive clinical trials at scale through our unified NHS and, as a result, researchers at the RECOVERY trial have established precisely which treatments can help reduce Covid-related mortality. We also have unrivalled genomic sequencing facilities to detect new variants.

The vaccine roll-out also created a kind of mirage on the Covid front. New hope for more freedoms and the promise of a “Great British Summer” were positioned just over the horizon, steadily drawing us on through the brutal winter months.

Well, the summer is here now, and the Delta variant is tearing through unvaccinated young people, and the questions that have nagged at the edges of the public debate over Covid for months are re-asserting themselves with some vigour. How much risk should we tolerate? Who bears the majority of that risk? And what should be done about the condition of the young, who have sacrificed precious formative experiences – and great swathes of education – to protect others?

It is simply not good enough to talk blithely about returning to the “old normal” after a sufficient percentage of the population has been vaccinated. Immunity from vaccines will inevitably wane, especially in those with already weakened immune systems.

Large numbers of people will continue to die of this disease. We will never have a perfect vaccine. Nor will we ever have a perfect testing system to detect and stamp out new infections. How we manage the next stage of the pandemic will decide whether the new ways of life we have fallen into over the past year will persist.

And we will have some hard questions to ask: for example, should we still force children to take time out of school if they have a positive test for Covid but don’t have symptoms if the most at-risk sections of the population have been protected from severe disease by the vaccine?

The choices we make will reflect the true value we place on education, for a “blended” education – half online, half face-to-face, chopped up by periods of isolation – is a poor relation to the rough and tumble of school life and the chance ways that children spark off against each other as they learn new things in new ways.

So should we not be prepared to accept more risk as adults to give children access to the vast panorama of experience afforded by socialising with peers – just as we used to do with the dozens of respiratory viruses that circulate every year in every school? Whether we believe having a temperature, or a tickle at the back of the throat, or even a positive test result, merits self-isolation and the loss of education is a question as much about cultural values as it is about the basic principles of caution and safety.

The State itself now takes a close interest in whether parents decide that their children should “just soldier on”. It is not fully understood how that radical change in the perception of risk will manifest itself over the next few years.

The same concerns apply to testing adults and the acceptance of the risk of other endemic respiratory viruses. The BBC’s Vicki Young reported this week that Matt Hancock believed double-vaccinated subjects may eventually “opt for daily testing rather than isolation if they’re identified as a close contact”.

The NHS comes under severe pressure in any bad flu season. Why shouldn’t we expand the existing GP-led flu surveillance network into a full-on track-and-trace programme? When Covid becomes endemic, it will find its place in the ranks of all those other, familiar risks posed by the spread of infectious diseases. We may find that we no longer tolerate that crappy cough feeling or those dreaded lurgies in quite the same way we once did.

In retrospect, the Zeitgeist of the last 18 months can be summarised in quite simple terms: we have made enormous sacrifices to reduce pressure on our health system, save lives, and protect the NHS. But we have never been quite prepared to fully lock down (public outrage prompted by virtually any attempt to genuinely enforce the byzantine Covid legislation was not feigned). Nor have we closed our borders. International travel has been possible, even though it has been discouraged by the authorities.

The vaccine roll-out consigns some of those dynamics to the past – the government will surely find it harder to engineer consensus for a full lockdown over the coming winter.

But it is naïve to believe the roll-out will herald a return to the “old normal” or anything like it. To many, “living with Covid” implies adding the vaccine to the things we’re already doing – the masks, the sanitising, occasionally getting “pinged” by the Covid-19 app. Living with this virus may not look like the way in which we have come to live with viruses in general. Those who want something approximating the “old normal” will have to fight for it.