A new report from two House of Commons committees highlights the UK’s failed pandemic response. Martin McKee unpicks the findings
On 17 March 2020, the government’s chief scientific adviser Patrick Vallance said that keeping the final tally of British deaths from covid below 20,000 would be “a good outcome.” Tragically, the total is now almost 138,000 and is still rising. With the incidence of covid remaining many times higher than in our European neighbours, one might think that Boris Johnson, the UK prime minister would want to know why the country has done so badly on his watch. Yet, he seems in no hurry to find out, and the long-awaited inquiry will only begin to take evidence in spring 2022. Fortunately, he does not need to wait that long. Two House of Commons committees, overseeing health and social care, and science and technology have helpfully provided their own joint report. It makes uncomfortable reading.
The United Kingdom has had some successes to celebrate. The committees praise the achievement of the vaccine programme, which it calls “one of the most effective in the world.” It also commends the NHS for the way that it expanded intensive-care capacity, although it notes that this was at a price, with serious disruption of other services. The Armed Forces come in for particular praise, providing essential logistic support at key moments. But in other areas, the assessment is much less positive.
It begins by considering pandemic preparedness, contrasting the UK’s position in second place in the Global Health Security Index, published in 2019, with the reality which, it notes, “had serious deficiencies.” Perhaps the most important problem identified by the committees was how the government was working to a plan developed for pandemic influenza rather than a coronavirus. This had many ramifications, although it is not clear whether they were aware, when writing their report, that there had been an exercise to test the response to MERS, which the government has fought hard to conceal. They do, however, note the UK’s failure to learn lessons from other countries, and in particular those in Asia that had experienced SARS and MERS. The committees note how the UK’s approach was “particular and, in some respects exceptional,” but not in a good way.
Witnesses to the inquiry painted a picture of dysfunctionality at the heart of government. This will not be a surprise to seasoned observers. However, the scale of the problem set out in the report is truly shocking. The account of working in the Cabinet Office Briefing Room, commonly known as COBR, is revealing. Intended primarily for dealing with threats from terrorism and hostile powers, laptops and phones are banned. However, when participants are depending on access to scientific evidence and data, this means that they are essentially working in the dark. As a consequence, they soon moved into the Cabinet Room, which lacked these constraints.
This emphasis on secrecy had many unhelpful consequences. The principal of “need to know” was, by default, interpreted as placing the burden of proof on those who needed data, including the modellers tasked with estimating the future evolution of the pandemic and the directors of public health and local authorities, who were unable to find out what was happening in the population for whom they were responsible. Just like those struggling in COBR, they too found themselves working in the dark.
The report is especially critical when they come to the initial response to the pandemic. They argue that “The veil of ignorance through which the UK viewed the initial weeks of the pandemic was partly self-inflicted.” Concerning the gradual approach to the initial lockdown, it says “It is now clear that this was the wrong policy, and that it led to a higher initial death toll than would have resulted from a more emphatic early policy” and described the decisions taken at the time, and the advice that led to them, as among “the most important public health failures the United Kingdom has ever experienced,” despite the UK having some of the best expertise available to any government and a democratic system that allowed policies to be challenged.
Turning to the initial response, the report notes how there has been much debate about whether it was official policy to pursue herd immunity. The report notes differing interpretations of statements made at the time, but it does conclude that the policy was based on fatalism, which “amounted in practice to accepting that herd immunity by infection was the inevitable outcome.” Contrasting the UK’s approach to that taken in East Asia, it describes this as a “serious error.” Worryingly, it finds that this was based on what seems to have been a consensus among those advising ministers that such a course was correct, with one exception, a paper that urged acting earlier. Again, the issue of national exceptionalism emerges, with the report noting that the UK was “an outlier internationally.” The UK’s policy would change abruptly, but only once “multiple people within the Government and its advisers experienced simultaneous epiphanies that the course the UK was following was wrong, possibly catastrophically so.” Reading the detailed accounts of what then ensued it is difficult to argue with the committees’ use of the word “astonishing.”
The government has argued throughout that it was “following the science.” Yet there were times when the advice was appropriate, but it failed to follow it, such as when it rejected arguments from SAGE in favour of a “circuit breaker” (although the report describes slightly differing views among senior advisers). But some of the science it did follow was simply wrong. The report catalogues numerous examples of views that were later found to be incorrect. Of course, that will always be the case with the benefit of hindsight. However, it includes accounts by those who say they had concerns at the time, but found it difficult to challenge what they were being told. Others from outside the government’s structures, such as Paul Nurse, wrote to express their concerns, but received no response.
The failure to draw on international expertise comes in for particular criticism, with the report noting how only one of 87 people listed as attending SAGE meetings was from a non-UK institution. The failure by Public Health England to examine what other countries were doing in their test and trace programmes is also noted, something that is especially worrying given that this information was easily available. It is difficult to avoid the conclusion that the UK was, in many respects, oblivious to what was happening elsewhere.
It is only possible to skim the surface of this lengthy, detailed, and persuasively argued report. Other sections address the well known serious failings in areas such as testing and tracing, social care, with the committees clearly unimpressed by its leadership, and the disproportionate impact of covid-19 on ethnic minority communities and those with learning difficulties. Each will repay reading in detail.
The relationship between ministers and advisers is a difficult one. Twenty years ago another British prime minister had to make a decision that would have momentous consequences using evidence presented to him. Then it was Tony Blair advised by the Joint Intelligence Committee about the search for weapons of mass destruction in Iraq. According to the official Iraq Inquiry, the problem was that those providing the evidence, in the Defence Intelligence Service, were unable to challenge how it was being used and the Joint Intelligence Committee, which was interpreting it for the prime minister, was unwilling to.
The inquiry into the pandemic response, when it finally happens, will have much to discuss. This report suggests that the advice to ministers and decision making within government must feature prominently in its terms of reference.
Martin McKee, professor of European Public Health, London School of Hygiene & Tropical Medicine.
Competing interests: MMK is a member of Independent SAGE.