The red list, and its accompanying hotel quarantine requirements, made their debut in February, amid hopes that vaccines would lead to a domestic nirvana of Zero Covid. We are wiser now. Vaccines prevent severe disease but do not stop circulation of the delta strain. Zero Covid is a fantasy. To quote Government advertising: ‘‘Even if we have been vaccinated, we can still get the virus, and pass it on”. Where to go from here?
As it stands, anyone visiting a country on the UK’s red list must spend 10 subsequent days in a quarantine hotel upon return. Your sojourn will be tedious and will set you back £2,285. The list includes most of Africa, South Asia and Latin America. Recent additions are Montenegro and Thailand. Among the reasons for inclusion are high Covid-19 rates or fear that the country harbours potentially hazardous viral variants.
Here’s why that’s problematic.
Imported cases add little to the UK burden, so high prevalence alone is no justification to red-list a country. Prevalence changes too. India joined the list at the peak of its May delta wave, but its case numbers are 90 per cent lower now. COP26-hosting Glasgow’s rate – 1,046 cases per 100,000 population in the week to September 2 – exceeds that of red-listed Montenegro, at around 700 per 100,000.
How about excluding dangerous variants? India was listed not only due to case numbers, but also owing to its proliferating delta strain. Nowadays, delta accounts for almost all UK cases, so there is little sense fretting about further import.
African countries were added because they host the beta variant. A small South African trial suggested that this evaded the Astra-Zeneca vaccine but this fear is belied by Canadian data, showing that the AZ vaccine does prevent severe disease from this variant. What’s more, beta has declined across southern Africa, displaced by delta. And despite repeated introduction, beta has not spread in the UK’s AZ-vaccinated population.
Latin America is more complex, with several otherwise rare variants. Gamma, prevalent in Brazil, has reduced antibody binding, but there is no evidence that it causes severe disease in the vaccinated. Nor for the mu and lambda variants prevalent in Peru and Colombia. Gamma did penetrate the USA, peaking around May, but then declined as vaccines were rolled out.
I can identify no country with a circulating variant reliably able to cause severe disease in the vaccinated. Nor, given the stepwise way coronaviruses evolve, do I think dramatic vaccine escape is likely. But, if I’m wrong, such a mutant is most likely to begin its career in someone who becomes infected despite being vaccinated, as is common with the delta variant.
They provide the requisite conditions, being unable to stop the parent virus establishing infection and, (by random chance) generating a mutant, but then having antibodies that will impede the parent more than the mutant. The mutant will come to dominate their viral load, being passed to the next patient.
This is not to criticise vaccination – which vitally protects the vulnerable – but it is to spell out how evolution works. And it is as likely in Kew as Kathmandu.
The red list’s proponents cannot point to any critical variant successfully excluded from the UK. Stricter quarantine failed to keep delta out of Australia. What the red list does do is inconvenience families that straddle continents and those seeking long-haul markets for Global Britain.
By discouraging travel, it also drives the impoverishment of those – from hotel housekeepers and waiters to souvenir vendors to safari guides – who serve the tourist trade across the ‘Global South’. With legitimate employment gone and without furlough, they have few places to turn.
In short, the list’s harms continue whilst whatever logic it once had is long gone. The sooner it gets the Red Card, the better.
David Livermore is a Professor of Medical Microbiology at the University of East Anglia and an editorial board member of Collateral Global collateralglobal.org.