What can we learn from Cummings’ recent interview, apart from what has long been obvious that the machinery of government is broken?

One of the most common questions I get asked by my colleagues from other countries, many of whom trained in the United Kingdom, is how it could be that a country that they recall having had such strong public health capacity could have done so badly during the pandemic. In theory, it should have been extremely well prepared. Just before the pandemic struck, the United Kingdom came second in the Global Health Security Index, just behind the United States. The Index ranked 195 countries on 34 indicators chosen to assess each countries capability to prevent and mitigate epidemics and pandemics. And in many respects, these expectations have been realised. British scientists have excelled in many areas, and not just the much acclaimed development of the Oxford AstraZeneca vaccine. Other examples include the RECOVERY trial, which provided some of the first evidence on what worked and, as importantly, did not work in the treatment of covid-19, valuable insights using observational data, for example from the OpenSAFELY platform, and COG-UK, a world leader in rapid sequencing of SARS-CoV-2. The NHS has also excelled, with a widely admired programme to roll out vaccination. Yet despite these advantages, it has ended up with a death rate far higher than most comparable countries. 

One might hope that the politicians who presided over the situation would show some curiosity about what went wrong. After all, the pandemic is not yet over. Indeed, Boris Johnson, the UK prime minister is embarking on an unprecedented experiment to remove restrictions at a time when cases are soaring, a decision that has been greeted with incredulity by many, both here and abroad. Yet they seem remarkably uninterested in finding out. The prime minister has promised an inquiry, but not for at least a year. His excuse is that this would distract those leading the response to the pandemic, an argument that does not seem to have prevented him from abolishing Public Health England and reorganising the NHS. 

Others do want to find out. The All Party Parliamentary Group on Coronavirus has been conducting its own investigation, while the advocacy group Keep our NHS Public, has organised the People’s COVID Inquiry. Both have collected extensive testimony from those affected by the pandemic, whether as victims of the disease or those caring for them. But these are no substitute for understanding the decision-making process in government. 

Instead, we must depend on glimpses from inside the system. Extracts from Jeremy Farrar’s forthcoming book published in The Times describe “organisational mayhem,” “dysfunctional state apparatus”, and a prime minister described as being in thrall to contrarian scientists and journalists and frequently absent. However, despite Farrar’s closeness to the decision making process, he was a political outsider. What we need is an account from someone who observed the political responses to the pandemic on a daily basis, someone whose relationship to Johnson was as close as, say, John Bolton’s was to US President Donald Trump, able to observe from within “the room where it happened”. That someone is Dominic Cummings, who for many months was one of Johnson’s closest confidantes and who, on the 20 July 2021, gave an hour long interview to the BBC’s political editor Laura Kuenssberg. 

This was not the first time we hadve heard from Cummings. Since leaving Downing Street he has offered exceptionally long commentaries on Twitter on contemporary British politics and, especially, what he sees as the failings of the current government. He has also given evidence to a joint session of the House of Commons Science and Technology Committee and Health and Social Care Committee. So did we learn anything new? Not much. Much of the interview focused on his now notorious trip to Durham when London was in lockdown and he was ill with covid, and on his role in the Vote Leave campaign. In passing, his former colleagues on the campaign trail may have been surprised to hear him ask “Is Brexit a good idea? No-one on earth knows,” while some of the Brexit supporting MPs may not be happy to be described as “morons.” However, our interest is in how Boris Johnson responded to the pandemic. The answer, as Cummings recounts it, is not very well. 

Many of the juiciest quotes had been trailed in advance. Johnson’s initial reaction to the developing pandemic was to avoid precipitous action, a decision widely accepted as contributing to the very many deaths in the first wave. Viewing it as similar to influenza he believed that lockdowns would not work. In words unlikely to appeal to the many older Conservative voters, he saw no need for alarm as “the people who are dying are essentially all over 80”.  Although he did take it more seriously for a short while after he recovered from his own covid infection, this did not last long and his scepticism returned. In messages in Cummings’s possession he said that he did not believe in “all this NHS overwhelmed stuff”, even though he was leading the nation most weeks in the “clap for carers.”

While a failure to understand the seriousness of a newly discovered virus at the start of the pandemic, especially by someone who, according to Cummings, viewed becoming prime minister as “a laughing matter” may be understandable, his failure to reimpose restrictions when cases were rising again in September 2020 is less easy to understand. However, Cummings does offer us three reasons for this hesitation that, again, led to unnecessary suffering and loss of life. First, Keir Starmer, the leader of the opposition, had demanded a “circuit breaker” and Johnson felt he could not be seen to agree with him. Second, many of his own MPs were strongly opposed, with Cummings describing them as having “lost their minds.” Third, The Daily Telegraph, which Johnson reputedly refers to as his “real boss” was against it. Clearly it is difficult to reconcile this account with “following the science.”

So what can we learn from this, apart from what has long been obvious that the machinery of government is broken, and not just in relation to the pandemic response. Sadly, not very much. Much of what Cummings said is supported by other accounts, such as the sources for Jonathan Calvert and George Arbuthnot’s detailed account in Failures of State. In some cases, Johnson’s own words, preserved in WhatsApp messages, offer additional support. But it is inevitably partial and our only hope of finding out something close to the whole truth will be the eventual public inquiry. It is interesting that Cummings, like Jeremy Farrar, wants this to happen as quickly as possible. Johnson, in contrast, seems in no hurry at all. Many observers will draw their own conclusion from that simple observation.

Martin McKee, professor of European Public Health, London School of Hygiene and Tropical Medicine

Competing interests: Martin McKee is a member of Independent SAGE.