Health and wealth in pandemic times: not a zero sum game

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  1. Trish Greenhalgh, professor of primary care health sciences
  1. University of Oxford, UK.
  1. trish.greenhalgh{at}

Pitting economic recovery against public health could be devastating for the UK

Sajid Javid’s policy of “opening up” seems ill timed. Since his appointment on 26 June as the new secretary of state for health and social care, another 100 000 people in the UK have developed covid-19. Hundreds of thousands of adults and schoolchildren, contacts of positive cases, are currently isolating. Sporting events and festivals have been cancelled. Yet, lockdown restrictions—including physical distancing, the “rule of six” for meeting indoors, and wearing masks in public places—are set to be summarily withdrawn on 19 July 2021.

Javid is correct that health depends on a thriving economy. He is correct that measures introduced to contain the virus—including self-isolation by workers and citizens; closure of factories, offices, and shops; and cancellation of public events—will lower economic activity, reducing the circulation of money and hence tax revenue (from which public services are funded).1 He is correct that lockdown has taken a heavy toll on the nation’s mental health and wellbeing, though there is no evidence that suicides have increased.23 He is rightly concerned about vulnerable children.

But since the fundamental nature of the crisis is virological, not economic, we cannot simply “grow our way out of it.” Indeed, against a clear trajectory of exponential growth at the beginning of a likely third wave of covid-19, phrases like an “irreversible road to freedom” appear populist and naïve.

It is more than a year since I debated with economist Andrew Sentence that pitting economic recovery against public health in a crude zero sum game could be devastating for the UK. The highly transmissible and serious delta variant, which may have entered the UK as a result of delayed border closure linked to a hoped-for trade deal with India, will leave much economic damage in its wake.4

The recent announcement that senior executives may temporarily leave quarantine in England if they are undertaking business activities that will bring “significant economic benefit” to the country suggests that the new secretary of state has yet to read Andrew Nikiforuk’s eloquent essay The Pandemic Speaks:

“Your [political] leaders scoffed at what needed to be done, because they deemed such responses extreme. They could not imagine how small individual risks could rapidly amplify into collective tragedies. And so they moved like molasses to limit mobility, and then acted like a spring melt to open things up again, providing me with the advantage time and time again. They all thought they could turn me off like some computer game. My gratitude for such ineptness is truly boundless.”

Drawing partly on previous publications from health economists, I encourage the secretary of state to consider five measures designed to align public health goals with economic ones.15

Firstly, prioritise preventing disease. Sick workers are unproductive, contagious, and costly—especially if they go on to develop the protracted sequelae known as long covid.5 Community engagement is needed to improve vaccine uptake in vulnerable groups.6 The SARS-CoV-2 virus is airborne, so anyone who shares indoor air with an infected person, whether or not within some arbitrary (such as two metre) distance, is at risk.78 In the short term, this means persisting with indoor masking, and attending to ventilation, air filtering, and CO2 monitoring (a measure of stale air).91011 In the longer term, it means investment to change the way public buildings are designed.12

Secondly, protect the poor, who suffer a double burden—they are more likely to catch covid-19 and have an adverse outcome, and are also more vulnerable to the economic impacts of lockdown.13 Until nobody on a zero hours contract has to choose between self-isolating and feeding their family, community transmission of the virus will continue apace.

Thirdly, protect businesses from financial risk. To the extent that businesses lack the resilience to withstand shocks, a pandemic related hit may prove irreversible. A company that closes, for example, may never reopen if the skilled labour on which it depends is lost; a middle aged worker made redundant may never return to employment, and so on.1 Measures to soften this hit—such as interest free loans, deferred taxes, and furlough—are likely to bring dividends in the future.

Fourthly, control profiteering. The pandemic has enabled those seeking to make vast personal profits out of a global tragedy by selling household goods, or substandard protection at inflated prices, or reaping financial gains from opportunistic investment.1415 For everyone who profits, many will be thrown further into poverty.

Finally, strengthen health services—especially primary care. There is a pandemic driven backlog of unmet need in every branch of medicine, with everything from psychosis to cancer being diagnosed at a later, more-expensive-to-treat stage.16 Countries with strong primary care services—based on personal relationships and continuity of care—have better overall health, longer survival, and lower overall healthcare costs than those without.17

As a former chancellor of the exchequer, Javid brings important knowledge of economics to his new brief. Rather than turning his back on public health, he should work quickly and collaboratively with his new department to avert further damage from the continuing pandemic.


Thank you to Martin McKee for advice on sources.


  • Competing interests: none declared.

  • Commissioned, not peer reviewed.

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