The covid-19 pandemic has brutally exposed inequality in societies worldwide. Older age, male sex, socio-economic deprivation and ethnicity are all risk factors for morbidity and mortality from covid-19. This provides important insights on how to best manage the pandemic. The UK deserves credit for studying the association between ethnicity and covid-19. The government’s decision to commission Public Health England (PHE) to report on a number of variables relating to inequalities in covid-19, but with particular reference to ethnicity, was welcomed. The report was expected to be an important landmark and to provide direction on how to tackle the problem.
Public Health England issued the report in early June to widespread dismay, deep disappointment, and even anger among those working in the field of ethnicity and health. The report had a small chapter which mostly rehashed the epidemiological data that had already been published on ethnicity and covid-19, with no clear recommendations. It was, however, well known that Public Health England had undertaken and written up public consultations with thousands of people, work led by Kevin Fenton, a public health doctor, academic, and long-standing scholar of ethnic variations in health and healthcare.
Public Health England was repeatedly challenged about the missing material, which was presumed to have been removed from the published report at a late stage. They denied this and on 4 June 2020, the Minister for Equalities, Kemi Badenoch, told parliament that PHE did not make recommendations because it was unable to do so. Subsequently the UK government backtracked and have now said that the recommendations will be published belatedly.
Before the initial report was published, I had been asked by PHE to peer review a 64 page document including recommendations led by Kevin Fenton. When the initial report was published, without the recommendations, my conscience was troubled. As a peer reviewer I am bound by a time-honoured code of confidentiality. Equally, as a public health academic and specialist for over 30 years, I felt a deep duty to the public and a loyalty to public health professionals to speak out. Without divulging any details I alleviated the publicly expressed concerns of several colleagues within the ethnicity and health field by telling them that further work was to be published by Public Health England shortly. I also wrote to Christine Jardine, MP for Edinburgh West, as well as my own MP, Deirdre Brock, Edinburgh North and Leith.
In the daily press briefings, questions about the missing material were deflected by the Secretary of State for Health, Matt Hancock, and the business secretary Alok Sharma. They emphasised there was no missing chapter, no missing material, and there was no mention of a second report. In Prime Minister’s question time Keir Starmer, leader of the opposition, questioned Boris Johnson on this matter. The prime minister extolled the virtues of Professor Fenton, and the already published PHE report. By doing this, he clearly linked the two reports. However, Fenton was not named on the initial report and PHE have said that the two reports were commissioned in parallel and have been published separately. There is of course the possibility that ministers were not aware of the missing document.
I was put in touch with the BBC correspondent, Rianna Croxford, who decided to run a story on the missing report. I was interviewed for the Today Programme to explain why the issue was so important. In my view, if we are to successfully tackle the covid-19 pandemic, the most important ingredient is trust between the government, professionals, and the public. Misleading the public erodes that trust, and makes it less likely that the public will follow government guidance on the pandemic.
I have called for, and I now reiterate the need for, a public apology by all those who publicly denied or obfuscated around the existence of a further document prepared by PHE and led by Fenton’s team on covid-19 and ethnic minority groups in the UK.
The matters I have reported go to the heart of confidentiality in peer review in science, the interrelationship between professional and scientific duties, and the relationship between professionals, researchers, scholars and governments. I now call for a widespread debate on these matters. The UK can be rightly proud of many of its achievements in race relations, and in the study and delivery of good health and healthcare for all its populations, including ethnic minority group. But this episode is a stain on its record that should never be repeated. So much praiseworthy work has been undermined by a single inappropriate judgement i.e. to suppress a much awaited and valuable document that the taxpayer generously funded for the benefit of the population. By this misjudgement a potential international triumph was turned into a public relations disaster.
R S Bhopal, Emeritus Professor of Public Health, Edinburgh Migration, Ethnicity and Health Research Group, Usher Institute, Medical School, University of Edinburgh.
Conflicts of interest: None declared.