Those who say that we don’t need a years-long Covid inquiry to deduce that the UK government screwed up the pandemic response are quite right. Prospect’s own “unofficial inquiry” at the start of 2021 made that clear enough. Robert Colville, in the Sunday Times, raises the valid concern that “we are about to spend many years, and many millions of pounds, proving what we largely know”: namely, that while some things (vaccines, most obviously) went pretty well, a lot was handled badly, and all told the UK did considerably worse than might have been expected.
Those responsible for the mess may have long exited the scene of the crime by the time the inquiry publishes its findings—perhaps having first attempted to rewrite history before the official version is recorded. With the inquiry’s wide scope—currently, there are live “modules” on preparedness, decision-making and governance, the impact on healthcare, and vaccines, but more will follow—and its vast stock of witnesses and documentation, a realistic date for the final report can surely be set no sooner or more precisely than “within the decade”.
All the same, there is something to be said for having an investigation of this depth, even if it means the wait is long. For the inquiry, led by former Court of Appeal judge Heather Hallett, will not be solely or even primarily about who was to blame for what went wrong. There are vitally important questions to be answered if we are to stand a chance of doing better next time—there will surely be a next time eventually—and no rush job will get to the root of them. More to the point, some lessons about preparedness are already clear, or could (and should) be quickly made so by bodies other than the inquiry. The glacial pace of Hallett’s assessments would only be a problem if we were to conclude that nothing else was needed.
Let’s first get out of the way the elephant that has just left the room. Perhaps even more than the fiasco of Brexit, the Covid pandemic brought home the perils of an infantilised politics. If we would rather be led through a crisis of this magnitude by a leader who is capable of making fast but considered decisions, who acts with compassion and integrity, who will not disregard their own rules that call for tremendous sacrifice from others and then lie about having done so, who will not consult with scientists who hold fringe views in order to indulge their own libertarian instincts, who will appoint capable ministers, and who will bother to turn up to crucial meetings during the onset, then we would do well not to elect a leader with a long history of deceit, fabrication, self-interest and indolence. Turning politics into entertainment is no joke in a lethal pandemic.
The Johnson legacy is of course not fully expunged with the defenestration of Johnson himself. The attempts by Rishi Sunak’s government to withhold evidence from the Covid inquiry show that a reflexive aversion to transparency and accountability remains ingrained. It seems likely that Sunak’s resistance to lockdown measures will come under close scrutiny, as will his Eat Out to Help Out scheme, which potentially helped the virus to spread in the summer of 2020 before the devastating second wave of the autumn and winter. Let’s hope that the government’s efforts to obstruct the inquiry achieve nothing more than they have so far, which is to remind people why it is so badly needed.
But while the inadequacy of our political leadership and the individual blunders of ministers seem likely to dominate headlines as the hearings continue, there are more important issues for keeping us safe in the future.
In this regard, the scope and goals of the UK inquiry are commendably comprehensive. It’s not clear that other countries are planning anything quite as far-reaching. The pandemic was such a political football in the US that there may be no official inquiry at all. Sweden, meanwhile, has already concluded its investigations into the handling of the pandemic, with interim reports in 2020 and 2021 and then the final report in February 2022. Those conclusions are of particular interest because of Sweden’s relative exceptionalism in not imposing a national lockdown. Was that the right decision? The report concluded that initial mandatory restrictions did not go far enough—for example, restaurants and shopping malls were allowed to stay open—even if more broadly the approach was reasonable. Some scientists have been far more critical of Sweden’s strategy, however.
The Swedish example bears on the impression created both by Sunak’s government and by its short-lived antecedent under Liz Truss that future pandemic lockdowns would be off the table. How well (or not) the UK lockdowns worked will surely be one of the key issues for the inquiry—but here in particular it is vital that the discussion does not fall into the superficiality of many pro and con arguments.
There was never much prospect of modelling our way out of problems that were societal
There can be no generic answer to the question of how well lockdowns work or whether alternatives could be equally effective at protecting public health. Any verdict will depend, for example, on the timing (the UK lockdowns could probably have been more effective, as well as shorter, if they had started sooner), local and national demographics, and exactly what the restrictions entail. One of the key issues for predicting and understanding the pandemic was also one of the hardest to predict and to model: human behaviour. The absence of a lockdown in Sweden did not mean life continued as normal, but that much of the adjustment was instead self-imposed.
There is good evidence that lockdowns saved lives, but a careful cost-benefit analysis for the UK, sheltered from rancorous political posturing, would be of great value—not least because future pandemics could have a different demographic risk profile. We now know that keeping schools open should be a priority where possible—but that would probably not hold for, say, a deadly flu pandemic that targets children.
This touches on the real reason why the inquiry needs to dig deep if it is to do the job required of it. While some of the reasons for the UK doing far worse in the pandemic than might have reasonably been expected are surely to do with bad governance, there are systemic problems that could not be addressed by a quick assessment of who said what in 2020.
One fact that became quickly apparent was that outcomes—rates of infection and death, as well as the impacts of self-isolation and lockdowns—depended on socioeconomic circumstances. There was never much prospect of modelling our way out of problems that were in large part societal and infrastructural. To understand what happened during Covid, there is no avoiding a consideration of how the NHS has been systematically degraded for years, nor how social inequalities have been worsening due to political choices such as austerity. Professor of epidemiology and public health Michael Marmot, of University College London, has already attested to the inquiry that “the UK entered the pandemic with its public services depleted, health improvements stalled, health inequalities increased and health among the poorest people in a state of decline.” This is why the full picture needs a decadal perspective, and why preparedness and resilience are at least as much political as they are technological issues.
Another important issue for the inquiry will be the lack of an international perspective in our pandemic response, something already lamented by some scientists. There was an apparent reluctance to accept that the experiences of Asian countries with SARS and flu scares had much to teach us; rather, the tone of the discussion at the outset was exceptionalist (and bordered on racist) even among scientists: would freedom-loving Brits accept a lockdown with the same compliance as the populations of the Asian countries? Brexit (which, according to the inquiry testimony of a former Cabinet Office official, took precedence over pandemic preparations) surely stifled dialogue even with our near neighbours.
Oddly, this lack of global vision went hand in hand with a failure to mobilise local knowledge. Martin McKee of the London School of Hygiene and Tropical Medicine, president of the British Medical Association, tells me that far too little heed was paid to the on-the-ground expertise of local authorities, healthcare professionals and care home workers—an echo of what many members of the public have long suspected. Instead, the focus was tilted in favour of one-size-fits-all epidemiological modelling and population messaging. That wasn’t the fault of the modellers, some of whom complained about their lack of relevant data. Yet still there was hubris in the way the “hard science” of computer modelling and the simplistic sloganeering of centralised directives overlooked the valuable resources of local professional and lived experience.
The inquiry was persuaded by its initial consultation to expand its terms of reference to look more closely at the scientific advisory system to government. One popular narrative is that the government’s claim to be “following the science” was a sham, especially once scientific advice was seen to diverge from policy as Johnson tried to resist a second lockdown in the autumn of 2020. There is certainly something in that complaint, but that doesn’t mean this was simply a case of a robust advisory system being ignored or abused by politicians. On the contrary, the system seemed to lack the transparency and autonomy recommended by the Phillips report into the BSE (or “mad cow disease”) crisis of the 1990s.
Of course, the machinery for feeding scientific expertise into policymaking—such as the Scientific Advisory Group on Emergencies (Sage) and the roles of the chief scientific adviser Patrick Vallance and chief medical officer Chris Whitty—was not built to confront a dysfunctional populist government led by a prime minister who flagrantly disregarded his own rules.
But we know now that the system needs proofing against bad-faith actors, with the scientific advisers given more autonomy and a clearer understanding of its parameters. For example, while ministers should not be obliged to do as scientists recommend, the public is surely entitled to know, when the leaders choose not to, what that advice was and why it was disregarded. If, as it seems, there was awareness among ministers and their advisers in the summer of 2020 that Eat Out to Help Out was potentially dangerous, it would be scandalous that those eager to use their allowances in restaurants were not informed of that. Chief scientific advisers of course have a duty to help and support the government, but to what extent do they also have a duty to the public, and what happens when those duties conflict? That is just one of the questions that needs to be asked in the process of creating a more independent and robust advisory system.
The main reason for concern about the long wait for the Covid inquiry to report is that we don’t know how soon we might need to put its lessons into practice. The emergence of bird flu in 1997, SARS in 2003, swine flu in 2009, and MERS in 2012 show that we are living now in constant danger of another lethal pandemic. There is already much that can be done to improve preparedness, from refining and maintaining the surveillance of infectious disease to building up vaccine production capacity and researching the potentially dangerous viruses that exist in animal populations, some of which are far less understood than the coronavirus family. Medical and scientific institutions and professional bodies would be wise to conduct their own audits of how they performed during Covid and how they could do better. The BMA’s (editorially independent) house journal the British Medical Journal has already commissioned a useful series of perspectives; some introspection would be valuable from the likes of the UK Health Security Agency (part of the replacement for Public Health England), the Academy of Medical Sciences (which should now take a longer view than its report of July 2021) and the Royal Society, among others.
Getting ready for the next pandemic is a global affair, and certainly does not depend on a close reading of ministerial WhatsApp messages. It is fair enough that people should want Hallett’s inquiry to provide accountability for the bungled and ducked decisions, the dodgy contracts, the parties and the lies. But ultimately, there are bigger issues at stake.