Excerpt:

During the pandemic crisis of 2020–2023, it is likely that the successes of biomedical science were more than offset by its failures. These failures continue to undermine once-powerful ideals and hopes for science's role in societal betterment. Here, we dissect the underpinnings of these failures and argue that restoring such ideals first requires systemic reform of science itself.

The considerable successes of medicine during the COVID-19 pandemic pertained to speed, for example, real-time information sharing1, record-time development of vaccines2, and unprecedented rapidity in getting results from some large randomized trials of interventions3, solidly documenting or refuting claims of effectiveness4. On this basis, the visible role of science and scientists in the pandemic response seems worth celebrating. Basic research, translational research and evidence-based research tools all had some bright days during the crisis.

But success was accompanied by major failures. Some of these failures reflected efforts by influential scientists and their political allies to demonize dissenting scientific views and evidence. From the earliest days of the pandemic, despite weak, absent or contradictory evidence, leading national decision makers, facing the urgent need for action5, assured the public that they were adopting COVID-19 policies by ‘following the science’6. A new scientific elite of media-savvy experts from fields like virology and modelling (with or without relevant credentials) gained visibility and influence in political circles. The narrow, reductionist disciplinary and sometimes partisan perspectives7, 8 of these scientists and ‘influencers’ helped justify the COVID-19 policies that allocated sacrifice, privation and suffering across all walks of society and hundreds of millions of lives.

The consequences for education, healthcare, small businesses, social life and democratic politics itself were often disastrous. Consequences were most acutely felt by vulnerable populations, from factory workers to school children, the old and the poor9. Radically different responses to the disease from nation to nation—from draconian lockdowns across all sectors, to relatively permissive and flexible pandemic regimes—made obvious to all that the value of scientific evidence was to support what was politically desirable and possible in different contexts. Rather than politics following the science, science was enlisted to follow the politics.

Supposedly science-based responses to COVID-19 in turn built upon and amplified deeper contradictions at the intersections of science and public health. Some affluent nations with generously funded science, such as the United States and United Kingdom, had been experiencing slow-downs and even reversals of gains in life expectancy that predate COVID-1910, 11. These trends, unthinkable 25 years ago, both reflect and exacerbate pre-existing and entrenched health inequities. For example, life expectancy for men in London's affluent neighbourhoods is 18 years longer than for those in poor areas11. Such disparities have multiple causes, but the political economy of medical science is a critical part of the story12. Investments in health sciences focus overwhelmingly on reductionist, molecular-genetic approaches to cures, which can generate status for scientists and profits for companies, but have minimal benefits for population health and may even widen inequalities. Medical science delivered to society through market mechanisms continually inflates healthcare costs, another driver of inequities. Additional tensions at the science-health interface include misuse of direct products of science itself, such as opioids, and iatrogenic disorders. Indeed, during the lockdown, iatrogenic disease may have acquired new, unprecedented dimensions13. Yet study and communication of these disorders during COVID was too often demonized by high-level decision-makers and their scientific advisors, which in turn clouded our ability to openly debate the balance of impacts of the massive public health interventions imposed across large segments of the society.

Now add the uncertain but plausible possibility that COVID-19 was itself the product of biomedical science14, 15, and an apparently outrageous consequence becomes inescapable: science itself may have become a threat to overall population health.

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