Pandemic Preparedness - Summary of findings from the first two weeks of Module 1 of the UK Covid 19 Inquiry

We have come to the end of the first two weeks of evidentiary hearings in Module 1 of the UK Covid Inquiry, which is examining the UK government’s preparedness for a pandemic. Here is a quick summary of some of the key findings so far. 

Summary of week 1 and 2: 

It has quickly become apparent that the UK did not have a ‘whole system’ plan for a pandemic. The only existing plan was drawn up in 2011, and was for a pandemic flu, rather than other diseases such as coronaviruses. Essentially, this means that the UK planned for either a limited outbreak of a high impact, low-spread virus (like Ebola) or an influenza pandemic. It is very hard to stop the spread of influenza pandemics, so much of the Government’s pandemic planning was for a ‘reasonable worst case scenario’, in which 750,000 people (2.5% of the population) would die of the pandemic. As such, planning was focused on how to handle the situation once it had become a catastrophe (for example how to manage overrun mortuary facilities) and not how to prevent such a high death toll from arising in the first place. 

Not only did the UK government fail to plan for an emerging disease pandemic, it also failed to learn lessons from South East Asia and Western Asia, where various community and healthcare measures had successfully prevented the spread of SARS and MERS. Two of the experts giving evidence to the Inquiry, Bruce Mann and Professor David Alexander, said that in January 2020 the UK was ‘wholly unprepared’ for a pandemic. 

Although the UK was considered internationally to have relatively good risk monitoring systems, we did not have the capacity to scale up ‘capabilities’ such as mass testing, mass contact tracing and the ability to cope with a surge in demand for public services, and health services in particular, in the event of a crisis. 

When asked why the UK had failed to prepare for a non influenza pandemic (i.e a pandemic that could feasibly have been slowed or mitigated through non- pharmaceutical interventions such as mass testing, tracing and lockdowns)), each politician’s response so far has been to blame ‘group think’, by which they mean an institutional failure to ‘think outside the box’ or invite critical voices into the fray to challenge assumptions about how best to prepare for a pandemic. 

Professor Chris Whitty (Chief Medical Officer for England and Chief Medical Advisor to the UK)  pointed to the fact that SAGE and COBRA  are crisis management bodies, and as such don’t meet between crises, resulting in an institutional blind spot when it comes to preventing crises from occurring in the first place.  More generally, he claimed that systems for delivering scientific advice to the government are significantly better suited to identifying threats than to advising on policy responses to threats. He also explained that there is a lack of radicalism in SAGE advice, as its role is to present the central position of a range of scientists to policy makers. 

Sir Patrick Vallance (Chief Scientific Advisor to the UK government between 2018 and 2023) also stated that there hasn’t been a huge appetite for scientists to raise issues that are not already of interest to the government. Instead, bodies such as SAGE are called into meetings to react to issues already of concern to policy makers.  

Questions remain as to whether or not scientists giving advice to policy makers were already considering the feasibility of political action being taken, consciously or unconsciously, given a political culture characterised by reluctance to spend large (or relatively small) amounts of money to mitigate crises that may never happen. As Sir Patrick Vallance, Professor Chris Whitty and Dame Sally Davies  (Chief Medical Officer to the United Kingdom from 2010 until 2019) pointed out in this week’s hearings, this is a political decision that we as a nation must take into careful consideration.  

The ‘group think’ defence of the politicians who have given evidence so far is also somewhat undermined by the fact that government knew we were underprepared for a pandemic since at least 2015, when David Cameron warned the international community of the possibility of a newly emerging disease with the fatality rate of Ebola (70%) and the infectivity of measles (90%). In 2016, a report on the findings from Exercise Cygnus explicitly stated that the UK was underprepared for a pandemic, particularly in regards to ‘capabilities’ and scaled up ‘capacities’ in health and social care. 

David Cameron (Ex PM), George Osborne (Ex Chancellor) and Jeremy Hunt (Ex Minister for Health and the current Chancellor) were at pains to explain that austerity measures and the underfunding of public services in the decades leading up to the pandemic did not hamper our ability to respond to the pandemic. In fact, George Osborne went as far as to say that he was in ‘no doubt that the UK’s public finances following the financial crash [austerity] had a positive effect on the UK’s ability to respond to the Covid 19 pandemic’, a claim that has been refuted in each and every expert report given to the Inquiry so far. They instead insist that a regrettable ‘group think’ prevented them from planning for a non -influenza, high impact pandemic (in other words the spread of a high fatality virus, but one that could be mitigated through non pharmaceutical interventions.But, as Dame Sally Davies stated in the Inquiry, the capacity for public health and other systems to rise to the challenges posed by the Covid 19 pandemic was greatly reduced by cuts to public funding. For example, the UK is at the bottom of the table of comparable countries when it comes to numbers of doctors and nurses, Intensive Care Units, hospital beds, ventilators and respirators.  Moreover, the Civil Contingencies Act places the duties to respond to civil emergencies including pandemic crises on local bodies, rather than on central government, which is problematic not least because Local Authorities have suffered funding cuts of over £15bln in the years between 2010 and 2020.

This issue is compounded by the fact that civil contingencies planning capacity was diverted from pandemic preparedness towards ‘Operation Yellowhammer’, tasked with planning for the event of a ‘no deal’ brexit. This goes some way to explaining why we suffered the world’s 6th worst death toll, despite being rated highly on the Global Health Security Index, which doesn’t take into account political decision making around the prevention of health and other social inequalities. It has also emerged that far too little consideration was spent on the impact of health and social inequalities on pandemic resilience, or structural racism and other forms of discrimination, despite it being well known within the scientific and policy making communities that pandemics thrive on, and deepen, social inequalities.

Unsurprising, many of the more important revelations emerged under questioning from lawyers from CBFFJ UK and CBFFJ Northern Ireland. They have made joint submissions to question every witness in the Inquiry so far, and have only been permitted to question a handful. Recordings of each of the hearings can be found here: https://www.youtube.com/@UKCovid-19Inquiry. 

What happens next?

In the coming weeks and months we will be campaigning to bring these failures to the attention of the media and politicians, so that (as has often been the case until now), policy makers can never claim to be unaware of what is needed to make sure the UK is prepared for the next pandemic.