By Luke Skinner

“There can be no future unless there is peace. There is no peace unless there is reconciliation… True reconciliation exposes the awfulness, the abuse, the pain, the truth” – Archbishop Desmond Tutu.

We are not ok 

There will be those that want to move on and forget the last few years living under the cloud of COVID-19, however true reconciliation and healing at a societal level is going to require some painful self-reflection from all of us. It is going to need politicians, media, employers, neighbours, colleagues and family members to reflect on words and actions during this pandemic.

It is going to require those in positions of power to admit mistakes were made and make a commitment to do things differently in the future.

There are many in society that will need to confront blind spots in their understanding of the full impact of this pandemic and our response. At a time when public health medicine had a chance to shine, we have many in the public that are now disillusioned and have lost trust and faith in our institutions. Unless we have some significant course corrections in our collective approach this trend is only going to get worse. In this piece, I will outline what I believe are eight points required for healing and moving forward together at a societal level. Failing to address these issues, we are in danger of suppressing the pain and not achieving true recovery from this pandemic.

My disclosures…

It is at this stage that I feel obliged to disclose more about my background.

Even this can be polarising, with some believing you can’t have an opinion unless you are a state-approved COVID expert, and others turning off completely at the thought of another expert spouting their decrees from their ivory tower. As a hospital-based health professional involved in service and facility development, since the beginning of the pandemic, I have contributed to the hospital’s COVID response. I remain proud of my contribution to hospital pandemic business continuity plans, facility enhancements and track and tracing tools to support COVID care. I was one of the first groups to get the mRNA vaccinations. At the time I did so willingly as part of the pandemic effort.

I had no information at hand that questioned the comms that it was safe and effective, and facing Delta I believed that the risk-benefit assessment was in favour of vaccination.

When it came to the booster, however, I took it under duress with the directive from management that I would be fired without complying.

What changed you may ask; well I had tried to keep my pandemic software updated as new information came in. At that point Omicron was known to cause less severe disease, the vaccine was, unfortunately, proving less effective and we understood more of the risks for younger males such as myself. As a health professional, it is quite routine to do individual risk-benefit assessments for treatment, and in my case, I believed it did not stack up. Additionally, it was becoming quite clear that breakthrough infections were common and my initial key driver of preventing transmission was not proving relevant.

I became disillusioned when I could not get answers to basic questions regarding why the mandates remained when the vaccine is not stopping transmission and if I would get my job back once catching COVID and developing natural immunity.

So, after approaching three years of helping to tackle this pandemic as a health professional, I want to share my personal reflections on what I believe is the path to healing society from the pandemic.

1.     Acknowledge the wide-ranging impact 

Individual physical recovery from COVID-19 will likely continue in various forms, from those that are able to navigate it with a few days of sickness, those that face long COVID challenges, and those that sadly lose their battle with COVID. Society as a whole, however, will require quite a different form of healing from this pandemic.

The ailments of this pandemic have not simply been the acute biomedical impacts of this dreadful virus, but the pandemic has also been a degenerative condition on some of society’s core values and cohesion.

The impact of border controls, lockdowns, mandates, and coercion into unwanted interventions have left many families and friendships strained and society with unhealed wounds. It is going to require ongoing conversations to understand each other’s lived experiences of the pandemic. We need an environment where people are able to share their stories without judgement. We need to feel and share in each other’s pain. Unfortunately, many in the government have not modelled this behaviour. It’s time for leadership to acknowledge all those that have been injured by this pandemic, be that from the virus itself, or others injured from adverse outcomes from human interventions. We can’t ignore those whose trauma and existence are inconvenient facts that get in the way of tidy political and pandemic narratives.

2.     Tolerate a range of health choices and diverse opinions 

A defence of actions taken during the pandemic is that governments and institutions made the best decisions they could in the ‘fog of war’ and tried to do good with imperfect information. What we now know, however, is that there were alternative ideas and interpretations of the data that questioned key policies around school closures, hard lockdowns, mandates and natural immunity. These ideas were quashed and worse still, academics and clinicians had their reputations attacked if they questioned the prevailing thinking.

How did these issues get elevated into sacred cows that we couldn’t openly debate without being labelled misleading?1

We need to be more understanding that facing unprecedented health controls and novel mRNA treatments, there is likely to be a range of informed opinions. With the passage of time, all of us are likely to have been wrong regarding some aspect of the pandemic response and we are certainly not finished with some uncomfortable truths that will be unearthed.

We started with some of this humility, but public health recommendations morphed into mandates, which morphed into the ostracization of nonconformers, which escalated into the criminalisation of the unvaccinated if they accessed restricted workplaces or services.

We need to acknowledge the climate of fear and misinformation that radicalised sections of the public against the unvaccinated and into a misguided ‘pandemic of the unvaccinated’ dogmatism. This ugly radicalisation was exemplified by media articles and public discussion entertaining the idea that the unvaccinated should not have access to universal healthcare.

A small personal example of this unhealthy climate was when I supported my wife during her second drive-through COVID vaccination. I asked the clinician to please aspirate the needle, a process of drawing back on the syringe driver to check if a blood vessel was not mistakenly hit. It is beyond the scope of this article to fully discuss the potential benefits of this technique, but needless to say, it is a fairly common practice.

Sadly, as it deviated from the standard procedure, the request was met with the doctor lumping us immediately as anti-science and spreaders of harmful misinformation, and the conversation ended with him shouting at us. I was left saddened that a fellow clinician had become so sensitised that he could not tolerate a respectful and benign personal request to support the administration of the vaccine. I shudder to think what discrimination and judgement many unvaccinated have encountered when trying to express their preferences when accessing healthcare. Perversely, it has taken most people now catching COVID, regardless of vaccination status, to throw some water on these fires of prejudice.

We need to get better at tolerating a range of health choices and diverse opinions in the marketplace of ideas. Sadly these respectful conversations and dialogue have not been modelled by the political elite. It has been all too convenient to label alternative voices that question the establishment as harmful misinformation. We need to tolerate more scepticism and dissenting voices, many will need to be robustly rebutted, but others will be the seed that advances our understanding or help illuminate blind spots in our thinking.

Since when did Big Pharma companies, previously subject to controversy and legal settlements in the billions, suddenly become above critique?

What safety signals have been missed due to this groupthink?

In the end, this pandemic will be littered with contradictions.

Those that have been able to consume a diet of mainstream and alternative commentary during the pandemic will have the tools to better cope with this. Those that have been loyal to the ‘single source of truth’ will likely be left dazed and disillusioned at the end of this saga, like a cult member stumbling out from the compound into the real world and not quite knowing what to do with themselves.

3.     Lean into, not away from, our core values in times of uncertainty

With the unprecedented impact of the pandemic, many thought it justified to compromise on core societal principles and freedoms in the name of public safety. Government and leadership need to recognise that when facing pressure and uncertainty, this is the very time we need to lean into our core values of liberty, autonomy, informed consent, freedom of information and speech – to be our guide when we can’t see through the fog. When the outcomes are not clear, it’s these values that allow us to navigate difficult times with our integrity intact, no matter the outcome.

Even in the face of a scared populist wanting to trade liberty for what they perceive is safety, we need courageous leaders that don’t compromise.

Don’t err on the side of government control; err on the side of personal freedom. As the full impact of pandemic policies unfold, and initial justifications for compromise crumble, those that thought they had the moral high ground will need to do some soul-searching. Pandemics will come and go, and we need to be left with a society whose foundation we can all rely on.

4.     Humility and trust

To restore public trust the government needs to drop the god complex that it can be ‘the single source of truth’ or that questioning government advice is like questioning the science. When there is risk and uncertainty, there needs to be humility, openness and informed consent. Can we imagine a time when faced with another global health event we go down a maximum trust approach between government and the public?

Can we imagine coming from the government pulpit the humility to share the information that they have, but acknowledge that historically when under pressure we have been subject to bias and influences of corporate and political interests at times of crisis?

Can we imagine a government official encouraging the public to listen to what they say, but also to do their own research so that each person can come to the right decision for them and their family? Informed consent requires an individualised risk-benefit assessment for any given intervention or treatment. We need to have the humility to acknowledge without caution the ‘cure’ can become worse than the disease.

5.    Don’t treat the public like lab rats

We need to recognise that scientists seek controlled environments.

This drive and fixation for sterile laboratories and randomised controlled trials serve them well in the scientific method. However, it does not translate well and should not be applied at a societal level.

Society and public life cannot be treated like a controlled experiment, under strict controlled rules, being enforced by ‘benevolent inquisitors’.

Where epidemiologists, public health officials and scientists may be seduced by the control and power of totalitarian regimes, their impulses need to be brought in check in western democracy. The real world is too dynamic, with too many moving parts for radical interventions like hard lockdowns to not have wide-ranging long-term perverse outcomes. We are only starting to fully appreciate these impacts on our health and economy.

Politicians in the free world need to reassure the public that they have learnt their lessons and these sweeping measures like hard lockdowns and school closures are off the table.

6.     Don’t do medicine via comms messages

Politicians have long used the dark arts of comms messaging to spin information and statistics to influence the public for better and for worse.

Science and public health should not be drawn into this influence, and we have to have our eyes open that a public health crisis can all too easily be co-opted for political ends. The public is hungry for truth, even if it’s messy and complicated. Oversimplified, soundbite public health advice can start to do more harm than good, as it seeks to generalise rather than be individualised. Officials should not misdirect public pressure for certainty into making sweeping medical advice en masse. A dizzying amount of money has been spent on pandemic government comms messages that became for many an intrusive and off-putting background noise.

I recall the disturbing Orwellian experience of my then 4-year-old daughter appearing programmed to blurt out “COVID-19 vaccine” at the cue of hearing the chime of an ‘official COVID-19 announcement’ on the radio.

We need governments to embrace debate and the marketplace of ideas, rather than go on book-burning exercises of alternative ideas to ensure all public officials and media are in lockstep.

Is it too much to imagine having mediated long-form discussions on difficult health policy topics with speakers of opposing views, where we let the public come to their own decisions? Doing medicine via comms results in unhelpful messages like ‘if you leave the house wear a mask’, appealing to a nice black and white approach for mass consumption, but results in ridiculous unscientific outcomes like people gardening in their yards with masks, worried about a gust of wind in the wrong direction from their neighbours.  These simplistic comms become a point of mockery and scepticism as the public begin to contrast it with the realities of everyday life, and more nuanced advice they can find from alternative sources.

7.     Have the right metrics of success – engagement and empowerment, not compliance

We need to do better in how we measure what success looks like in public health initiatives during a pandemic. Fixation on vaccination compliance rates leads us down a path of trying to achieve this at all costs, including coercion through mandates to keep your job. Many in government have not fully taken stock of the human and society fragmentation cost we truly paid for this metric. A better way to measure success is in terms of the engagement of individuals in taking control of their health. The benefits of an empowered public can mean more holistic public health measures can be worked towards, including healthy lifestyle choices.

It is known in medicine that a compliance medical approach is paternalistic. A more mature and sustainable framework looks at patient engagement and self-management.

Clinicians should work hard to have a therapeutic relationship that is reciprocal.

This requires time and effort from clinicians, allowing the patient to engage and input what they value or what to achieve. It acknowledges the patient as their own autonomous person, with their own life experience, who are free to weigh up information and be fully engaged in their own informed consent. This requires far more sophistication than a one sizes fits all approach to medicine, and dare I say individual risk-benefit assessments. It requires the doctor-patient relationship is protected from corporate or government overreach and interference. It requires empowering the public to better understand more in-depth concepts like the difference between absolute and relative risk reduction for interventions, age-specific risk-benefit and numbers needed to treat. It requires giving the public the tools to be able to update their pandemic software as new information comes to light and the virus and its impact changes.

8.     Seek forgiveness

To achieve true recovery from the pandemic, will governments have the humility and moral fortitude to apologise for how they treated some of the population as ‘second-class citizens’ and lost their way? If not, these public officials and politicians will need to move on and hand that over to their successors to do the hard work of reconciliation.

For the rest of us, we need to consider if when trying to win arguments with friends and family during the pandemic, we in fact lost the war for the free and peaceful society that was won at great cost.

We all need the courage to make it right.

Luke Skinner is a New Zealand based health professional with an interest in the intersection between healthcare, tech, research, money and politics. BHSc, PGDipBus Admin.

This article has been republished with permission from Luke’s substack.