There have always been serious tensions between the elite groups controlling Irish healthcare and what we have witnessed this week is just another manifestation of those turf wars.
Six months ago, I suggested here that when the history of the Irish response to the current crisis is written it will undoubtedly reveal multiple layers of disagreement; that despite what appeared to be complete deference to public health professionals, health crises never remain apolitical.
While back in late April, the assertion of Dr Tony Holohan when asked about possible easing of restrictions – “I haven’t made my mind up” – did not seem to raise many public eyebrows, it did underline the extent of the enormous power he and the National Public Health Emergency Team (Nphet) wielded as, in theory, an advisory group, but that was always likely to fray.
The recent controversies have underlined how power is centralised among different power brokers. When reflecting in 1987 on the evolution of the politics of Irish healthcare, political scientist Basil Chubb noted, “There have been and still are four groups of major participants in the shaping of our health services: politicians, senior civil servants, the spokesmen for the Catholic Church and the leaders of the medical profession. Of these, it is the senior civil servants, including very influential medical officers in the Department of Health, who emerge as the real helmsmen.”
The argument that a lockdown now is confronting rather than delaying the inevitable is persuasive, but there is no guarantee Level-5 restrictions would work as desired
While the Catholic Church’s influence is not what it was, and the balance might have shifted between government departments, the calling-in of Holohan to face a probably stern secretary general of the Department of the Taoiseach, Martin Fraser, underlines not only the assertion of political and Civil Service autonomy but also the relevance of another of Chubb’s observations: that when there are serious decisions about public health that cause “anger and anxiety” it is the job of politicians to provide “essential political preparation and mediation which is so necessary for understanding and acceptance”.
Level 5 likelihood
It is highly likely Ireland will move to Level 5 of the Covid response plan soon. Such will be the enormity of that move and its consequences that the row between Nphet and the Government might fade into the background. But the current, too personalised, narrative of Holohan versus the Government obscures an important wider point about the extent of knowledge, consensus and tolerance of diverse views in response to the pandemic.
An easy riposte to those at the centre of disagreements is to call on “warring” sides to desist and return to solidarity and common purpose, but that is deceptive, because there is no unanimity on how to handle this crisis and to pretend otherwise is disingenuous. The argument that to enforce a national lockdown now is confronting rather than delaying the inevitable is persuasive, but there is also no guarantee that Level 5 restrictions would work as desired.
We have repeatedly been told public health policy will be dictated by the evidence and science, but as Luke O’Neill, now the most high-profile biochemist in the country, has often asserted, “the science is not settled” when it comes to this virus.
Another vocal contributor to the debate about responding to the virus is UCC professor in applied pathogen ecology Gerry Killeen, who has predicted repeated waves of the virus for the next four years unless restrictions remain in place and that the solution is to crush rather than flatten the curve, the logic being that not to attempt to crush it through lockdown will drag it out interminably. He maintained at the end of August “unless we change something it will be a thousand [cases] per day and two months after that there is no reason to believe it wouldn’t be 10,000 a day”. Yet Killeen also acknowledged this week “all of us are going to have been wrong about something”.
Genuine concern
Maynooth University immunologist Paul Moynagh has also questioned the strategy of rolling lockdowns: “There seems to be this default notion of responding by going to either local or full lockdown and we need to be more targeted".
Meanwhile, Dr Martin Feeley, who criticised the current restrictions as disproportionate, was forced to resign as clinical director of the Dublin Midlands Hospital Group for expressing his view that the social and economic costs of restrictions are outweighing the public health benefits. Feeley’s concern is what he describes as the “abject fear” people are living in. Many of his peers might disagree with his views, but I am not aware of a single member of Nphet or a senior politician who has defended Feeley’s right to give his opinion as an experienced medic and decried the idea that he should be compelled to resign for doing so.
Undoubtedly there are extremist groups seeking to malevolently exploit this crisis, but in the midst of the current power play we should not turn a blind eye to heavy-handed intolerance of diverse views born of genuine concern for public wellbeing.