It was on 16 January 2020 that Devi Sridhar first sounded the alarm over Covid-19. “Been asked by journalists how serious #WuhanPneumonia outbreak is,” she tweeted. “My answer: take it seriously… previous outbreaks have taught over-responding is better than delaying action.”
Far from being a “black swan event” — something unpredictable and severe — Covid-19 was grimly inevitable. “There were a lot of warnings, we knew that this was going to happen,” Sridhar, 37, said when we met recently in a café in Edinburgh. “Some people said it came out of nowhere. That’s not really true.”
Back in June 2018 Sridhar, who is professor of global public health at the University of Edinburgh, warned at the Hay Festival: “Our biggest health challenges are interconnected… The largest threat to the UK population is someone in China who’s been infected from an animal… and gets on a plane to the UK.”
Sridhar’s prescience transformed her into one of Britain’s most prominent commentators once Covid struck, attracting both devotion (regular marriage proposals) and hatred (she was sent white powder and a used face mask in the post). In her new book, Preventable: How a Pandemic Changed the World & How to Stop the Next One, Sridhar distils the lessons of the time.
The first chapter explores the murky origins of the virus: did it emerge naturally or leak from a laboratory? “This is going to get me into trouble but I lean more towards the lab leak,” Sridhar told me, “because of the Chinese government’s reluctance to let an independent audit take place. They have not allowed a team to come in and open their books. What are they trying to hide?
“And we haven’t found the animal reservoir. It could be that we find it tomorrow but we found it quite quickly with Mers and camels and it was the same with Sars and civet cats, yet we haven’t found it [for Covid-19] two years in.”
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It was not until 23 March 2020, more than two months after Sridhar’s warning, that the UK government imposed a lockdown. Though the successful vaccine programme has improved Britain’s pandemic record, its per capita Covid death rate remains one of the highest of any major western country. Why did the UK fare so poorly?
“First you had Boris Johnson missing the five Cobra meetings, which meant the top leadership was just absent,” Sridhar said. “As other countries such as South Korea were acting, Britain was turning its head completely the other way.”
Sridhar is also fiercely critical of Sage, the government’s official scientific advisory body, which reinforced Johnson’s complacency. She derided “the groupthink that led to the whole ‘herd immunity, we’re all going to get it’ [attitude]. And also not believing there would be a vaccine and thinking reinfections wouldn’t happen, this idea of ‘just let it cut through’. The advice to the over-70s early on was simply not to go on cruise ships, can you believe that?”
At the outset of the pandemic, Sridhar joined the Scottish equivalent of Sage and forged a close relationship with Nicola Sturgeon. (As she reveals in the book: “I was also studying to become a personal fitness trainer, and Sturgeon even agreed to become my first client.”) Perhaps unsurprisingly, Sridhar favourably contrasts the Scottish government’s Covid strategy with Johnson’s, praising Sturgeon’s consistent and clear communication, the decision not to outsource test and trace and the cautious approach to ending lockdown restrictions.
She concedes, however, that “our death rates aren’t very good. We could have obviously done better but I think a lot of that has to do with the underlying vulnerability of the population.” She cited Scotland’s high poverty and obesity rates: “We were never going to look like a Denmark because our population isn’t healthy like a Danish population.” (Her next book will explore health inequalities.)
Sridhar also referenced the “very limited” powers of the Scottish government. Does she believe an independent Scotland would have fared better? “It’s tricky to say, this is a political question, but I think a more devolved response would have fared better,” she replied diplomatically.
Devi Lalita Sridhar was born and raised in Miami, Florida, by an Indian family. After achieving a degree in biology from the University of Miami at the age of just 18 she became the youngest person in the US to be awarded a Rhodes Scholarship to the University of Oxford.
Her devotion to public health stems from the death of her father from cancer when she was 17. “Even as a teenager I could see that health was the definition of true wealth,” she recalled in an interview with the Lancet in 2020.
Her father, Kasi Sridhar, who died of leukaemia and lymphoma aged 49, was a lung cancer specialist at the University of Miami. “You don’t take anything with you when you die,” his daughter told me when we spoke back in October 2020. “All you take is your legacy of what good you have done in the world.”
For our most recent interview we met the day after Johnson and Rishi Sunak were issued with fines by the police for breaking lockdown rules (12 April). Does Sridhar worry about the consequences for public trust and health policy?
“I think it’s going to be difficult if we ever have a more dangerous Covid-19 variant or anything in the future. People feel they’ve been made fun of, they’ve missed funerals, they missed being with their loved ones when they were dying or giving birth.”
But while some worry that Johnson’s government now lacks the legitimacy to impose restrictions in response to a new variant or pandemic, Sridhar sees other options. “People are going to rely on scientists and they’re going to rely on the media and the NHS to make decisions on how they respond,” she said. “I don’t think we’d have a free-for-all.”
Though many have declared the end of the pandemic, Sridhar is “very concerned” about the potential for a “game-changing variant”. She explained: “You talk to virologists and they say Omicron is milder just by luck. There’s no evolutionary pressure for it to be milder, the evolutionary pressure is for it to be more transmissible.”
It is possible, in other words, for a future variant to be both more transmissible and more virulent. Until we achieve a “sterilising vaccine” — one that blocks transmission — herd immunity is likely to remain a distant dream as we enter what Sridhar calls “the age of reinfection”.
As an early champion of “zero Covid” — a strategy of eliminating transmission of the virus — Sridhar became the bête noire of lockdown sceptics. More recently, having advocated “living with the virus” by harnessing vaccines and antivirals, she has faced cries of betrayal from those who still believe zero Covid is an achievable goal. How does she respond?
“I’d say, ‘Which country are you pointing to?’ South Korea and New Zealand are living with Covid, Hong Kong and Taiwan are pivoting away from zero Covid. The only place you can really point to is China, and it’s struggling with really strict lockdowns that take children away from parents who test positive, and killing off cats and dogs.”
Rather than Covid, the risk that keeps Sridhar “awake at night” is a more transmissible variant of Mers (or Middle East Respiratory Syndrome) because “its fatality rate is so high [35 per cent]. It kills young people and we don’t have a vaccine yet.”
Though she is praised as a formidable communicator, Sridhar insists she has no political ambitions (“No!” she exclaimed when asked). Instead, she said, “I would love to do kids’ TV, CBBC, because it forces you to really understand something and get to a very simple level and kids are so interested and curious about the world.
“When I’m in complex advisers’ meetings and they’re showing models, I will ask stupid questions — ‘What does that line mean?’ — because once you understand it you can communicate it to others.”