The Interview: Francois Balloux

Rowan Pelling and Peter Phelps interview epidemiologist Francois Balloux, self-declared “militant corona centrist” and director of the UCL Genetics Institute, about Covid-19 and how public discussion of the pandemic became so toxic and polarised

Photo: Dom Smaz / Hans Lucas

“It was probably a major mistake to stage a pandemic in a US election year,” says Professor Francois Balloux. His deadpan delivery means it takes me a second to realise he’s joking. But this is exactly why my editor, Peter Phelps, and I have asked to interview him: humour is short on the ground in the public discourse on covid policies, but somehow Professor Balloux manages to maintain a GSOH, including a keen eye for absurdity, in the most trying circumstances.

For those readers who haven’t come across him in the pages of the Guardian or Daily Telegraph, Balloux is director of the UCL Genetics Institute, professor of computational biology at UCL, and former associate professor of infectious disease epidemiology at Imperial College London.

He’s also one of many advisers to the government on the contagion. If you wonder how all this translates into action, his profile on the UCL website elucidates:

“Our core interest is to use genomic data to reconstruct the past population history of a variety of organisms. We work on the reconstruction of infectious disease outbreaks and epidemics of human and wildlife pathogens.

Over recent times we have been increasingly focusing on the factors that allow some lineages to be more successful than others. One aspect of this work is the prediction of drug resistance and virulence factors. Our work spans a large spectrum ranging from the fundamental (eg reconstructing historical plague pandemics) to the applied (eg tracking nosocomial infections in a hospital ward).”

None of which stops Twitter trolls telling Balloux he’s totally unqualified to give an opinion on Covid-19, or that he wants to kill everyone. The reason I know this is because I’m one of his 147.6 thousand Twitter followers and he’s generally the first person I turn to in the morning for an overview of the latest covid updates because – guess what? – the well-informed are back in fashion.

There’s a maddening tendency to talk about “the science” as if it were one settled, unified body of facts and wisdom

Experts took a hard knock during the Brexit campaign when Michael Gove declared the people of this country had “had enough” of them. But if SARS-CoV-2 has taught us anything it’s that citizens threatened by a killer virus can’t cram enough expertise onto their smartphones.

If you’re on Twitter, the chances are you’re following a raft of specialists: epidemiologists, virologists, immunologists, pulmonary health consultants, statisticians, critical care doctors and ICU nurses.

There’s a maddening tendency to talk about “the science” as if it were one settled, unified body of facts and wisdom, akin to a creed, but almost everything to do with Covid-19 is disputed by some expert, somewhere across the globe, as you might expect with a “novel” virus. 

Inevitably, this has led to brutal polarisation. Some prefer to follow what’s become known as the “Zero Covid” camp, with its emphasis on worst-case scenarios, strict lockdowns, mask and vaccine mandates and (although this now seems impossible) a desire for total eradication.

Then there are Great Barrington Declaration disciples, who their foes often call “Let it Rip” merchants. These people advocate shielding the elderly and vulnerable, while keeping most things open as usual. The general gist is you let the epidemic work its way through the population, building up “herd immunity” in the process.

Both sides back vaccinations (true “anti-vaxxers” are a different, odder camp altogether), though the GB types tend to be less keen on multiple boosters or giving jabs to young people. The Zero Covids call the Let it Rips eugenicists and the latter camp scorn Zero Covids as delusional puritans, who relish the drama of shutting everyone down. 

Balloux says the bio was a reaction to “the polarisation of the discussion, which I think has become insane

Against this toxic background, you may understand why I was delighted last autumn when I came across Balloux, whose Twitter bio was music to my ultra-liberal ears: “a militant corona-centrist”.

Now that Phelps and I have the twinkling, bearded Professor (who bears a passing resemblance to a slightly younger Eric Cantona) briefly captive via Zoom from his home in Geneva, I ask what he’s trying to signal with his Twitter cri de coeur for the centre.

Balloux says the bio was a reaction to “the polarisation of the discussion, which I think has become insane.” He reflects that in the early stages of the pandemic there was still a debate “at all levels” before the discussion broke down “and it led to a lot of anger, animosity, resentment.”

It’s clear he’s still perplexed about how two such extreme poles were formed as people debated topics as different as pandemic modelling or methods of transmission. Balloux found he sometimes agreed with one camp, sometimes another, but disliked the shouting. “And then I felt I wanted to just create my mini-movement, a bit tongue-in-cheek, to place myself outside of the very borderline dogmatic groups.” 

Phelps wonders what the divisions have felt like off-Twitter, within the scientific community. Balloux replies that there’s always been a tendency for public health to be quite politicised – and there’s nothing wrong with that if it means defending the rights of minorities, or similar objectives.

But the current level of politicisation has “really degenerated into something quite counter-productive.” He cites the presidential elections in the US and the Brexit vote in the UK as creating political shifts that have bled into views about how to deal with the pandemic; he looks world-weary as he concludes: “I think it’s pretty bad.”

All measures which disproportionately impact poor and BAME communities, who can’t easily retreat to home offices with laptops and reliable wifi

One theme that often crops up on Balloux’s Twitter feed is his bafflement – as someone who’s largely identified as left-leaning throughout his life – that the political left in the UK and the States have backed restrictive measures, such as calls for longer and repeated lockdowns, closed schools and university campuses, working from home, and vaccine passports.

All measures which disproportionately impact poor and BAME communities, who can’t easily retreat to home offices with laptops and reliable wifi. He feels this stance, whereby “we had this complete ideological inversion [is] a big mystery, which will occupy historians for some time.”

School closures exercise him the most, especially in the US. On the day of our interview Balloux had posted a piece revealing children in Uganda hadn’t been in school for    twenty months, with many unlikely to return. But he’s equally haunted by a recent UK news article saying that essentially 100,000 children in the UK were unaccounted for. “Which is just extraordinary.” 

Has the UK has mishandled its Covid-19 policies, or not followed the best scientific evidence? I ask. The effects of the epidemiology, in terms of mitigation measures and public health, have relatively little to do with science, he says, but “a lot to do with ethics and morals.”

Up to a point, the science can tell us “the number of cases, or deaths, or hospitalisations we can expect given Policy A, or Policy B. But it’s far from perfect.” He adds that even if we do take some steering from science, it doesn’t give us guidance on how we should react, or what policies we should enact, “because that’s deeply moral, ethical and also political. But I mean [political] in the noble sense of the word… the decisions should be taken by elected representatives of the population, and not by scientists. Really not.” 

A similarly disputed topic is masks, where “the debate is absolutely insane and toxic.”

Balloux points out that “the topics on which there’s most disagreement and are most hotly disputed and where people really insult each other, are things where we don’t really know.” 

He gives examples, such as whether Covid-19 is more likely to circulate among children whey they’re at school versus when they’re not. “It’s very confusing. We don’t have particularly good data.” A similarly disputed topic is masks, where “the debate is absolutely insane and toxic.”

He says that if we knew for certain (he pulls random numbers out of the air, by way of example), “that cloth masks reduce transmission by three per cent, surgical masks by seven per cent” such certainty would “detoxify the debate”. Instead, the findings are “confusing” and “very little of this discussion is really scientific.” What actually happens is that “people think they’re right for more dogmatic reasons than actually due to any concrete evidence.”  

However centrist Balloux says he is, it’s clear to his Twitter followers that he’s got no truck with the Zero Covid camp. He says he concluded very early, “from February, March [2020] onward that we couldn’t suppress it. Or couldn’t eradicate transmission globally.

And there are only two stable end points – global eradication: it’s gone from everywhere, including from Afghanistan, Somalia, whatever; or it will eventually just infect everyone in the long term.” Quite a few people now agree with those “sensible positions” and that eradication is pretty nigh impossible.

He’s given to reminding people on Twitter that we’d need to contain the spread  not only in humans, but also in the vast animal reservoirs (US scientists recently discovered “shockingly high rates” of covid in white-tailed deer). But the Zero Covid camp was very critical of this position and by the summer of 2020 Balloux says their viewpoint “became some kind of borderline religious belief”, as opposed to what was achievable.

His exasperation is clear when he says that even if the Zeroes throw everything at eradicating Covid-19, “it’s not a reasonable position anymore.” 

In short, Balloux feels people have to accept that the virus will eventually affect everyone “and just join with the other respiratory viruses we have in circulation; there are about 200.” He’s at pains to emphasise he doesn’t mean “let it rip” but trying to balance the difficulties of controlling the epidemic with minimising measures that cause direct and indirect harm.

He’s happy to engage in discussion with anyone who can embrace that complexity and is sanguine that “there can be a huge difference in sensibilities, because we don’t know how to weigh things.” He then offers a suitably complex example, requiring the wisdom of ten Solomons: “What’s the value of, say, the life of an 80-year-old in a care home versus the education of a child?”, adding quietly, “There’s no answer to that.” There are things we can’t respond to “in a scientific way, because these are things we can’t quantify – and different people will put so much different value on different things.”

Just after Christmas he declared he was going to withdraw from Twitter, then changed his mind

You might think Balloux’ determined squatting of the centre-ground would placate his Twitter foes, but it appears to drive many round the bend – infuriating both the Zero Covids and Let-Rippers.

The latter have a determinedly vaccine-sceptic subset who are deeply disappointed that Balloux supports the shots – and regularly posts graphs demonstrating the vaccines’ efficacy at reducing adult hospitalisation and deaths.

I can’t help wondering if being the target of so much public flak has taken a toll. Just after Christmas he declared he was going to withdraw from Twitter, then changed his mind. “Yes, sometimes it’s tiring to get insulted,” he admits wearily.

At first, he blocked people, but then realised “that was pretty counterproductive because people get very annoyed when they’re blocked, so they get more annoyed.” It also didn’t fit well with the way he feels public discourse should be conducted: “I like people to be free to express their views as long as they’re not completely obnoxious.” Now he doesn’t block anyone, though he confesses, “I mute liberally, because you cannot be under a constant avalanche of insults and abuse.”

One of Balloux’ areas of study involves previous pandemics, so we’re intrigued to know what he’s learned from outbreaks of Ebola or Spanish Flu.

“What I have learned,” he smiles, “is that they end.” And how bad is this one compared to its predecessors? “It’s definitely, I would say, the worst pandemic we’ve had since HIV/AIDs.” Comparing Covid-19 to similar pandemics involving respiratory diseases, he adds: “I think it’s worse than the last three we had: which were 1957, 1968 and 2009.” But not as bad as 1918, “especially if you’re scaling for population size and so on… It’s the worst of the last 100 years, you could say.”

He reminds us it took quite a while for the WHO to declare a pandemic

Phelps notes Balloux has used the term “epidemic” several times during our conversation, rather than pandemic, and asks if we’ve entered a different stage. The professor says all the terms “are pretty loose” and a pandemic “is actually an epidemic that happens in different parts of the world.”

He reminds us it took quite a while for the WHO to declare a pandemic. But currently the discussion is all about when covid “becomes endemic rather than epidemic.” In general, endemic “points to a fairly explosive increase in number of cases.”

It recently dawned on him that, while “endemic in infectious disease epidemiology has a very specific meaning, which I thought was pretty clear,” it’s actually super confusing for us lay people. Since Phelps and I are slightly befuddled, Balloux patiently explains that “the dynamic of the disease is fairly predictable. It can still change.

Case numbers can be higher in winter or lower in summer. But very generally it means that each person who is infected, infects roughly one other.” Having said that, “you see big peaks and troughs.

At a peak, one person on average infects maybe three or four people, so we have this rapid growth.” He cites HIV and malaria as good examples of endemic disease, pointing out they also illustrate the fact that endemic doesn’t necessarily mean “not a problem”. 

So how do we get to endemic? Balloux smiles dolefully and says, “we essentially get there, I’m afraid, by everyone having been infected.”

Then there are endemic seasonal respiratory diseases; “But we know pretty well when they will happen… Each virus actually has a pretty narrow window. Some, like influenza, have two: one in the winter, one in spring. And this is a pretty regular pattern.”

So how do we get to endemic? Balloux smiles dolefully and says, “we essentially get there, I’m afraid, by everyone having been infected.” That’s when we’ll start seeing predicable patterns. He’s the first to admit this is “very painful”, but also stresses that vaccines (especially three doses) dramatically reduce hospitalisation and death, “by around twenty, twenty-five times, let’s say – between three doses versus no dose… And this is not something we expect to wane.”

The protection against infection and transmission will diminish, “because that’s so-called neutralising antibodies that are in the blood and they just go down over time… But the actual protection against severe disease: that stays, for decades.”

I wonder if Balloux’ level assessment of the pandemic – which seem to be the antithesis of scaremongering – goes down well with government (he is, after all, one of their many advisers). He says scientists’ role in policy is generally misunderstood and that they don’t go around saying “You have to do X and Y”. Though he notes drily that, “if you really want your advice to have some weight, you should never tell any politician what to do,” which has shades of Yes Minister’s Sir Humphrey.

Nonetheless, the fact the UK dropped Plan B restrictions shortly after we spoke (waving farewell to covid passports, most mask mandates and working from home) suggests someone was listening to militant corona centrists. Balloux isn’t anti-lockdown measures per se, just believes they have to have clear objectives and be changed or jettisoned when the situation changes: “Some kind of discussion of what we really want to achieve would be useful. And how. And also an acknowledgement of the trade-offs.”

Phelps and I observe that the situation isn’t helped by conflicting bodies, like SAGE and Independent SAGE (created by scientists who thought there was insufficient transparency over the advice) having a Cavaliers vs Roundheads-style dispute. Balloux says people tend not to realise “how transparent and open all the sciences are.

Whether the public was fully prepared to deal with the avalanche of information is another question

It’s quite remarkable that the public gets essentially the same information that ministers get, one or two weeks later.” He points to the effort that’s gone into the public having access to dashboards and multiple reports, believing it’s one of this pandemic’s “few positives… that the population is engaged and involved in something so important.”

Whether the public was fully prepared to deal with the avalanche of information is another question. As Phelps says to an amused Balloux, “We’re all armchair epidemiologists now.” 

We’re keen to know what triggered the professor’s initial interest in epidemiology. Balloux says he studied biology, but didn’t work in infectious diseases for quite a while. “And then two things happened. I lost my sister to HIV/AIDs and then I started becoming more interested in infectious diseases.”

The pain is so visible on his face that the miles between London and Geneva evaporate. (Some of the times I’ve seen Balloux really lose his cool on Twitter is when people try to lecture him on HIV and he has to explain that, as a matter of fact, he knows a huge lot about the virus because of this family tragedy – and still the trolls attack him.)

The other moment that changed the course of this studies occurred when “I was doing some pretty arcane mathematical work. Which I was quite passionate about. But one morning my eldest daughter – I think she was two and a half or three – asked me why I had to go to work, and why I always had to work so much.

And I couldn’t really answer that. It really made me think… why am I actually spending so many hours writing really arcane code and trying to solve very, very complicated equations that actually didn’t really interest anyone and probably didn’t even have a positive impact on anyone’s life?” That was the turning point at which he moved to “more applied” infectious disease epidemiology.

Phelps is keen to know how much ecology plays into the discussion, asking if climate change and other acts of environmental vandalism make diseases like Covid-19 more likely. Balloux points out the whole pandemic comes under the header of ecology, “because ecology is really population dynamics.”

It’s “tricky” to study the patterns and work out if man-made infractions have helped drive the contagion: “there are actually not more pandemics, not more epidemics, not even more people dying from infectious disease now than there were ten years ago, a hundred years ago, a thousand years ago.

If anything, it’s the contrary.” He puckishly muses that the relationship to “biodiversity and habitat conservation is complicated,” since one way of drastically minimising the risk of is by getting “rid of all the animals”.

“Degrading the environment actually leads to some species benefiting from it – some rodents benefit and get close to humans.”

What Balloux is getting at with this extinction event is the fact that, “with very few exceptions”, epidemics are zoonotic – in other words, they involve infectious diseases that jump from animals to humans. HIV, influenza and coronavirus are all passed on by our feathered, bat-winged and four-legged friends.

Warming to this counter-intuitive theme, he says “degrading the environment actually leads to some species benefiting from it – some rodents benefit and get close to humans.” It’s clear Balloux delights in finding the weaknesses in arguments that look good on paper.

Which takes us to the lab-leak theory. Does Balloux give it any credence? He says, “I think there’s a consensus that the virus was not engineered. And we now have found viruses in bats from Laos in Vietnam that are extremely close.”

But he thinks there will likely be an “endless debate” about how the virus jumped to humans. “It could have been direct contact by someone exposed to it, it could have been people collecting samples in the field, or it could have been brought back to the lab, and from there could have escaped.”

He calmly points out lab leaks “are not particularly exceptional” and that after SARS-CoV-1 “leaked three times out of the lab” after the epidemic was over. 

We’re keen to know what Balloux makes of Sweden’s less locked-down pandemic response. He feels it was “pretty unremarkable” as the “mitigations in place were fairly stringent” –except for the fact “the focus was on voluntary measures rather than coercive ones”.

He says other countries followed similar strategies “just more quietly”. I’m a little surprised he isn’t more of a cheerleader for Sweden, as his Twitter feed makes it clear he doesn’t agree with mandates. But then his Twitter side bursts through: “I think the focus on trying to convince people to behave in a specific way rather than enforcing that [behaviour]”, he pauses, “I personally am quite supportive of that. Very supportive of that. And it seems to work very well.”

He’s an outspoken advocate of keeping schools open, arguing the cost to children’s lives, wellbeing and mental health is greater when they’re closed. But Balloux won’t let Sweden off the hook entirely, saying where the Scandinavian country “got it really, really, really wrong – as wrong as the UK, if not worse – is the absolutely terrible failure to protect care homes. Absolutely disastrous.”

What’s really interesting Balloux is the public’s ability to process covid data and information in the public domain, adapt their behaviour and behave more cautiously before politicians have put restrictive measures in place.

He says this explains why so many of the pandemic models were wrong – because the modellers don’t build in features that incorporate people’s ability to observe ill neighbours, growing hospital admissions and grim newspaper reports. In essence, altered behaviour largely predates lockdowns.

The professor thinks this points to the likelihood that, going forward, less coercive mitigation strategies could have the same effect as mandated ones. Although he thinks it should be explored “cautiously” in case governments are tempted to use fear as the driver (doubtless thinking of the UK’s infamous “nudge unit”, where behavioural scientists cook up ways to encourage people to change course). As Balloux says, “It’s easy to spread fear but once people are terrorised, how do you get them out of it?” 

Focus on wearing a mask because you yourself feel it’s a sensible idea, but stop firing energy and ire towards those who don’t

We all agree it’s an ongoing process to slowly edge more anxious people back to normal life. Balloux feels the protection vaccines offer should be one encouraging factor, and the message needs to focus on personal benefit: “If you’re surrounded by people who are not vaccinated, it doesn’t dramatically change the risk that you get infected or not. So I think that should be one shift of the narrative: to not blame people that haven’t been vaccinated. And in the UK it’s such a small proportion, why get so angry?”

He’s inclined to think the same about the furore around masks; that it’s time to change the strong messaging that “we wear masks for others rather than ourselves.” In other words, focus on wearing a mask because you yourself feel it’s a sensible idea, but stop firing energy and ire towards those who don’t.

It’s impossible at this juncture not to ask Balloux about “partygate”, the scandal of No 10’s lockdown bashes threatening to bring Boris Johnson’s days as prime minister to an end.

He’s not that keen to be drawn, saying with wonderfully expressive minimalism: “It’s very sub-optimal.” While he regrets “the loss of trust in authorities”, he does feel there may be one curious upside, but then is in two minds about expressing it.

You can see the train of thought coalescing as he speaks: “I think it’s probably the kind of revelation, with the anger that it generates, that might actually help people to… I’m not sure what word I should use, but… to put in context the previous experience,” of the pandemic.

“And it might, in an interesting way, actually help people to get over the pain and grief and trauma.” He draws out his thesis, saying that when anger is collective and directed “at some kind of sacrificial political figure, it could actually be quite helpful” to get over a mass ordeal.

I tell him that we’ve actually got a piece in this issue on a similar theme – Nick Cohen on the British people’s strangely tolerant relationship with hypocrisy – and Balloux says, “Well, without a minimal dose of hypocrisy, life would probably be unbearable.”

You may now understand why my daily ritual of checking in with Balloux on Twitter has been so reliably educational and amusing. I can’t help wondering if there are any experts he turns to for similar succour.

He lists Stefan Baral, a Canadian-born doctor and scientist, who “opened a vaccine clinic for homeless people and people in shelters. I think he’s vaccinated something like 6,000 people.” Balloux also applauds Baral’s scientific verve and respect for civil liberties: “He’s very, very anti-coercion. He made many enemies. I like him a lot.”

Another recommendation is Müge Çevik, a “really liberal” physician and infectious diseases researcher based at the University of St Andrews. Balloux commends her for trying to “make people aware of the collateral cost of closing schools and of strict restrictions”, advocating a more balanced approach instead.

“It’s true that my life really revolves against covid,” he replies. “In perhaps an extreme way”

He recommends the paediatrician Thomas House, for similar reasons. We are both staunch fans of the anonymous account Amy@scepticalzebra, whose twitter biography includes the lines: “Liberal, left-wing, doctor. Background in philosophy & ethics. Dislikes wine gums. Not an actual zebra.”

The sceptical zebra can be relied upon for sound analysis, reasonable levels of provocation and some of Twitter’s wittiest posts.

It’s time to allow the charming doctor to retreat into his home. Phelps flings one last question at him, wondering if there’s a scientific life for Balloux outside Covid-19. “It’s true that my life really revolves against covid,” he replies. “In perhaps an extreme way. I work in  covid. I’m on social media about covid. I talk to everyone I meet, friends and family, who want to talk covid. So yes, it’s quite relentless at times. And I’m very, very much looking forward to the pandemic being over.”

This may account for his recent thread on Twitter, which started: “Many people are shouting at each other that the pandemic has ended in country X or Y, that it will end soon, one day or never. One intriguing aspect of such discussions is that there is no formal definition of ‘the end of the pandemic’, outside eradication of SARS-CoV-2.” One follower spoke for all of us when he tweeted back: “The end of the pandemic will not be televised.”

People

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1 Comment. Leave new

  • A lot of interesting approaches and analysis of the pandemic. Just regret, with a virus unpredictable when epidemiologists loose time and credibility to try to give prediction for the future.

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