People’s Covid Inquiry: Did the UK government adopt the right public health strategy?

“We truly did everything we could, and continue to do everything we can to minimise loss of life and suffering”—Boris Johnson, UK prime minister, 26 January 2021

On 24 March 2021 the third session of the People’s Covid Inquiry called four witnesses to discuss the question “Did the government adopt the right public health strategy?”

Anthony Costello

Anthony Costello, professor of global health and sustainable development at University College London, former director of maternal and child health at the World Health Organization (WHO), and member of Independent SAGE talked about public health strategies for dealing with covid-19. Since it is not possible to eradicate the virus the best strategy is to attempt to eliminate it through public health measures, he said. WHO advice about this was very basic – to find the virus, isolate those who have it, trace and test their contacts, and to act fast. But the UK government did none of these things.

One of the UK government’s major mistakes was not acting quickly, said Costello. In February 2020, the government knew there was a likely 80% infection rate and 1% mortality for covid-19, but the prime minister still missed five COBRA meetings. In addition, Costello said that he was deeply shocked that there was no independent public health advisor on SAGE and that policy was being led by people with little experience in public health and contact tracing.

The government did not launch a test and trace scheme in a timely manner, and early on abandoned the idea completely, not even bothering to use the 44 public health labs that were available. In all they failed four times to launch a working test and trace strategy. When a centralised test and trace was finally launched it was not integrated with primary care. Community tracing was ignored in favour of a top-down outsourced system and the 750,000 people who volunteered to help were never used. 

In addition, one of the best primary care systems in the world was totally by-passed in favour of NHS 111. The result of this was that patients were dying without ever having seen a doctor, as we heard in session two.

Michael Baker

Michael Baker, professor of public health in Otago, and a member of the NZ technical advisory group (TAG), discussed New Zealand’s early experience with covid-19. 

New Zealand started out with a strategy of mitigation, but after seeing the success of many Asian countries in controlling the virus, soon moved to a strategy of elimination. Their government acted quickly, and took the bold decision to have an intense lockdown when there were only 100 cases in the country and no deaths. The aim was to eliminate the virus, which was achieved after seven weeks of lockdown. Since then they have enjoyed “zero covid” (defined as 28 days without covid-19 in the community against a background of high level testing) for most of the last year. This has meant very little time in lockdown after the initial episode, with educational activities barely affected

Many high population countries like China, Taiwan, Vietnam, and Singapore have also had successful elimination strategies, refusing to tolerate the virus circulating in the community. As a result they have a much lower mortality than the UK, as well as less economic contraction.

Janet Harris

Janet Harris is a retired public health professional with extensive experience in community contact tracing. When she and others realised that the top-down national test and trace programme was a failure they looked at recruiting and training volunteers to contact trace in local communities and hospitals in and around Sheffield. When they found they were not allowed to do this they sought other ways of working through local communities.

This included support for those having to self-isolate, and building trust in communities that traditionally distrust government, including immigrant and lower socio-economic groups. They felt the best way of spreading public health messages in these groups was by word of mouth, helping to restore trust so that people would co-operate with contact tracing, vaccination and public health messages.

Rehana Azam

Rehana Azam, national secretary of the GMB union, said the government was simply not prepared for the pandemic. When covid-19 struck public services were struggling, with 100,000 vacancies in the NHS and 110,000 in the social care sector, and the system was already at breaking point 

Many GMB members are women and ethnic minority workers on minimum pay and conditions, who don’t have the luxury of working from home. Many felt they couldn’t afford to self-isolate. Azam mentioned one private contractor who was refusing to pay even minimum wages to any worker testing positive.

There was an abject failure to protect workers, firstly through a failure to provide adequate personal protective equipment (PPE) across the NHS, social care, and schools sector. Advice about PPE changed 40 times in six months. Some paramedics on the front line had no protection at all. 

Secondly some employers shirked responsibility for making workplaces safe, and it was up to trade unions to establish covid-19 safe environments and to look at risk assessment especially for ethnic minority workers

The GMB is calling for justice for the families of workers who died, many unnecessarily, and for those who contracted long covid through their work. they also want privatised and outsourced services to be brought back into the NHS along with the care sector.

The government waited too long to act

There were recurring themes in this session. The first was that the government had left the country unprepared for a pandemic both in terms of running down the NHS and in planning for appropriate supplies such as PPE. They left it too long to act when the threat should have been clear from events in other countries. 

An independent public health voice was missing and the government didn’t follow basic public health measures as advised by the WHO. They failed to grasp that aggressive elimination of the virus was possible via these same measures, which have allowed other countries to move on from the pandemic much more quickly. As a result countries like New Zealand and South East Asian countries have minimised deaths and disruption of society, resulting in a much lower mortality rate than the UK, and they have suffered much less of an economic impact. 

New Zealand and countries that took a similar approach have also shown that traditional basic public health measures can eliminate the virus across large regions of the world. If new variants challenge the efficacy of any vaccine the public health measures will still form an ongoing part of prevention strategy. 

Finally witnesses were quite clear that the decision to outsource test and trace and run it as a centralised programme was an expensive and dismal failure. They called for money to be provided for it to be returned to public health and local communities and for it to be integrated with primary care. They were clear that it is not too late to change strategy and regretted the fact that there is no sign of this happening. 

Jacky Davis, consultant radiologist, founder member of Keep our NHS Public, panel member of the People’s Covid inquiry.

Competing interests: none declared.