Public health workers, struggling with a new covid-19 variant, cannot be expected to deal with a chaotic end of the Brexit transition too
As 2020 draws to a close, the United Kingdom faces a perfect storm. A new variant of the SARS-CoV-2 virus has emerged with multiple mutations, several of which seem to increase the risk of transmission. This variant is now spreading rapidly from its apparent origins in the South East of England. The health secretary, Matt Hancock, has conceded that it is now out of control and new Tier 4 measures are necessary to deal with this crisis.
All of this is bad enough, but it is taking place against a backdrop of another looming crisis, Brexit. Even if the UK manages to agree a last minute deal, something now seeming very unlikely, it must brace itself for a massive change in how it does business with its closest neighbours, countries on which it depends for a substantial quantity of its fresh food, medicines, industrial components, and services.
The effects are already being seen as stockpiling is creating long tailbacks at ports serving the continent and the island of Ireland, and a new crisis in container management. This can only get worse on the 1st of January, when additional checks are imposed, leading to between 2 and 8 hour delays on every consignment. Yet, even before that starts, neighbouring countries concerned about the new variant of the virus, including Ireland, France, Belgium, Turkey, Israel, and the Netherlands are suspending travel links. A French ban on human-handled freight (such as lorries) has placed Great Britain in a de facto quarantine. As if this was not bad enough, as we move into 2021 there is the risk, increasing in recent years, of extreme weather events including widespread flooding.
Given where we are now, in a country that has shown itself to be seriously underprepared for both a pandemic and extreme weather events, the government’s choices are limited. What it can do, and we believe it should, is to act in the one of these areas where it has some control and ask for an extension to the Brexit transition. This will not be easy, first because of political considerations within the Conservative Party, but also because, having rejected an extension earlier, it would require a change in EU law. Yet, given the costs to both sides of the negotiations, a failure by the UK to ask, even at this late stage, would be reckless, creating an unnecessary risk to public safety.
From the beginning of the pandemic, the UK’s covid-19 response and Brexit have been intertwined. Since 2016, when the pandemic simulation Exercise Cygnus was undertaken, an enormous amount of civil service bandwidth has been consumed by planning for Brexit, a challenge exacerbated by the UK’s failure to articulate realistic negotiating objectives. One casualty was action on the lessons learned from Exercise Cygnus. Then, when the pandemic struck, the government’s attention was diverted by “Getting Brexit Done.” When the government did act, it was too late, a delay that modellers have linked to the country’s extremely high number of infections and deaths. Faced with the rapidly worsening situation in the early part of 2020, the UK government could have asked for an extension to the Brexit transition. The European Union was well aware that agreement of a future trade agreement in only 11 months was extremely ambitious, but British ministers refused to do so. Worse, while the authorities in the rest of Europe were putting in place port infrastructure and developing new IT systems, the UK was failing to prepare, as revealed in frightening detail in a December 2020 report from the House of Commons Brexit Committee.
Public health professionals are, and will continue to be in the forefront of the response to all of these challenges, working through Local Resilience Forums (LRF). Established following the 2004 Civil Contingencies Act, LRFs are the vehicles for ensuring local preparedness. The act was a response to weaknesses revealed previously in responses to a range of national emergencies, including floods, fuel strikes, and Foot and Mouth Disease.
LRFs are expected to address “all risks” in major emergencies. Their planning is based on Reasonable Worst Case Scenarios (RWCS). RWCS for Brexit planning (“Operation Yellow hammer”) were published on 2 August 2019. The RWCS anticipated an autumn 2019 departure from the EU. They also had no expectation that a pandemic would happen, interfering with every piece of national, international, and local planning for Brexit. Brexit on its own, was going to be the biggest ever emergency planning exercise across all elements of civil society and private sector activities. The RWCS were deeply flawed even in 2019. Now, their planning assumptions are unsound and dangerous.
During the current pandemic LRFs, and their constituent members, have been run-ragged, not just in responding to the emerging understanding of this new disease, but also by conflicting and contradictory pronouncements by central government. The C-19 National Foresight group is a cross-government organisation working with partners to support LRFs in response to covid-19. In May 2020, their leaked report criticised the government’s “paucity of information and intelligence,” which left LRFs “isolated from national decision-making and unable to effectively plan and strategise response[s].” C-19 also described “responder community exhaustion,” adding that any additional extreme risk, such as that posed by a crash-out Brexit, would take them to breaking point. The demands on local emergency planners have only increased since then. They can only plan on the basis of the RWCS published 16 months ago and are in a position of responsibility without power. While they should be the key local bodies coordinating, acting, and responding, they, like many others, are awaiting central instructions. Yet, as the leaked C-19 report noted, LRFs described central government as mainly engaged in “broadcasting,” with communication “only one way.” The House of Commons Brexit Select Committee, most recently has doubts about the preparedness of the country for the end of the transition.
Over 40 years the UK economy has become integrated with those in its European neighbours, to an extent that is only now becoming apparent. Beyond the well known problems of looming labour shortages, in health, social care, and agriculture, there are the consequences of the UK government’s decision not to pursue a deal on services as this would breach its pursuit of “sovereignty.” Many high technology products such as medical scanners are now supplied as a bundle with operating or maintenance contracts. Any disruption of maintenance or components could threaten the ability of hospitals to deliver care. Similarly, while much attention has focused on the supply of components for the car industry, similar threats, exacerbated by the rapidly increasing congestion at ports, also threatens supplies of medicines, radionuclides, and medical equipment. In the industrial sector there are a multitude of risks of component or service failures, many of which may only become apparent once they happen. These have the potential to conflate as a “slow burn” economic disaster with widespread impacts on health.
The UK government has been criticised for its serial failures during the pandemic. At least, with covid-19, there is now a light at the end of the tunnel with a vaccine coming on stream. However, the logistics of rolling it out will be extremely complex and there is already evidence that some of the same mistakes made with test and trace are being repeated, in particular the initial exclusion of public health expertise, only to look to them to sort out the problems later. Public health, health services, and the emergency planning community will have enough to do in the next stages of the pandemic. We urge the government to move for an extension to the transition period and remove one major disaster risk it has in its power to avoid.
Maggie Rae, President, UK Faculty of Public Health; Professor, University of Western England.
Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine.
John Middleton, President, Association of Schools of Public Health in the European Region; Professor, University of Wolverhampton.
Competing interests: MMK is a member of Independent SAGE.