How was it that the United Kingdom did so badly during the initial waves of the covid-19 pandemic? This is a question that has puzzled many people, but not, apparently, Boris Johnson, the British prime minister who seems in no hurry to find an answer. He has, finally, agreed to hold an inquiry, but only when the time is right. Holding one now, we are told, would be an unnecessary distraction for those on the front line of the pandemic response, in a way that the abolition of Public Health England and a major reorganisation of the NHS would, somehow, not be. 

Pending this official inquiry, which might report, if we are lucky, by the end of the decade, we must look elsewhere for insights. Given the apparent lack of political leadership, we need to hear from those who were “in the room where it happened.” One of those who, if not always in the room, was near to it, was Jeremy Farrar, director of the Wellcome Trust, and with Anjana Ahuja, a distinguished science correspondent, their new book Spike offers us a glimpse of what went wrong.

There is already quite a lot of material that we can draw on. Many of those involved have given evidence to parliamentary committees, especially the joint hearings of the Health and Social Care and the Science and Technology committees. The book Failures of State, by Jonathan Calvert and George Arbuthnot, is a treasure trove, drawing extensively on interviews with whistleblowers. Similarly, the Institute for Government has described in tragic detail the many failings of the Department for Education. We have also benefited from insights from those affected by government policies, for example, in testimony to the All Party Parliamentary Group on Coronavirus, the People’s Covid Inquiry, and disclosures in the ongoing litigation on procurement by the Good Law Project. And we have the many hours of testimony and, more recently, the lengthy but sometimes cryptic Twitter threads from Dominic Cummings. So what does this book add?

Dominic Cummings had already opened a window into decision making in 10 Downing Street. Of course, his comments should be interpreted with caution given the circumstances surrounding his departure. However, Farrar offers some support for his account, which he reports “adds weight to what I and many others felt at the time.” It was not just that Johnson was preoccupied with his personal problems. There were other gaps at the heart of government. Farrar clearly rated the former cabinet secretary, Jeremy Heywood, having worked with him on Ebola. He was less impressed by his replacement, Mark Sedwill, who Farrar describes as “absent in that role.” This is unsurprising. Sedwill was selected by former prime minister, Theresa May, without following the conventional career path for this post or even undergoing a formal appointment process. Uniquely, he combined what should be a full time role with that of national security adviser. However, Sedwill wasn’t the only key figure missing and Farrar expresses surprise at the absence of Michael Gove, minister for the Cabinet Office. But others were in the room and he is particularly scathing about those responsible for the Great Barrington Declaration, concluding that “their views and the credence given to them by Johnson were responsible for a number of unnecessary deaths.”

Amid what Farrar describes as an “atmosphere of chaos,” it is not surprising that there were so many failures. He describes the bypassing of local public health teams when setting up the test and trace system as a “mistake,” noting that what resulted was “not really functional.” He describes the appointment of Dido Harding to head up the system as a “grave error.”  He is similarly disparaging about Matt Hancock, the then health secretary, who he holds responsible for the high death toll in care homes. He recounts how experts, including one at the Wellcome Trust, predicted that going alone to develop the NHSX app was likely to fail, as it did. He describes how “random decisions … [were] plucked from the sky … [un]informed by any knowledge of public health,” coming “flavour of the month until they crashed and burned.” Given the vast sums of public money spent to so little effect, his comment that what he saw “looked like racketeering” makes a strong case for the involvement of the Serious Fraud Office. 

Farrar does shed light on some of the more controversial aspects of the response. He is clear that SAGE never advocated herd immunity and says that if it had he would have resigned. He accepts that Patrick Vallance’s now famous mention of it in an interview was unintentional when he was under enormous pressure, a view consistent with Vallance’s other comments. Instead, he suggests that this idea may have come from the Behavioural Insights Team in Number 10. 

Given the long history of English exceptionalism, it was perhaps no surprise that there seemed to be a reluctance to learn from elsewhere. A senior official, Jenny Harries, even dismissed World Health Organization advice on testing as inappropriate for a country like the UK with its “extremely well-developed public health system.” Farrar, who spent many years in Vietnam, where he had first hand experience of SARS, bemoans this insularity. He describes Harries’s comments as “a dreadful thing to say” and notes how “the idiosyncratic British approach baffled observers at the WHO,” something I can attest to. 

The book ends with Farrar reflecting on things he wished he had done differently. The list is long and at times he wondered if those who continued to advise a clearly dysfunctional government were “complicit in the outcomes.” His advice for scientists advising on policy includes not to take things on trust, speak truth to power, and challenge optimism and confirmation bias. Yet he still seems to trust Johnson, placing faith in his commitment to support a Global Pandemic Radar. We shall see. 

Farrar also has advice for policy makers. And here he is entering into a political debate, even if he does not concede this. We must invest in health, tackle health and other inequalities, improve our dysfunctional systems of governance, and fix the global health architecture. To which we all say amen. 

Martin McKee, Professor of European Public Health, London School of Hygiene & Tropical Medicine. 

Competing interests: MM is a member of Independent SAGE, which is not mentioned in this book.