In 2002, Sars, a dangerous coronavirus, spread across the world with a fatality rate of around 10%. Although it was contained relatively quickly, east Asian countries learned from this experience and updated their pandemic preparedness plans. Their governments wanted to be ready if the virus returned. On the other side of the world, the UK didn’t react or adapt. Complacency was at play, especially with the assumption that Britain was one of the most prepared countries in the world for a pandemic.
The consequence, as Lady Hallett’s first report from the Covid inquiry notes, is that the UK government failed in its basic responsibility to its citizens of keeping them safe. The UK had too many preventable deaths, not only from Covid, but also from the shutdown of health services and a long lockdown that would have been unnecessary had public health systems been in place.
There’s not much positive in the report about government preparedness in the years before 2020. It points to the lack of a containment strategy: why was so little planning or thought given to public health infrastructure – namely test, trace, isolate – prior to 2020? Why did officials initially think that the virus was unstoppable when other countries were showing that containment was possible in 2020 (and had shown it was possible with two other coronaviruses, Sars and Mers, in the years before)? Hallett pointed specifically to the health secretaries – Jeremy Hunt, then Matt Hancock – who not only maintained the flawed plan in the years before the Covid pandemic, but also left things in such a state that the wider government was not prepared to coordinate a wider response to what she called “whole-system civil emergencies”.
Those who faced the cost of this were social care and health workers sent on to wards and into care homes without appropriate PPE; people who lost their businesses and income as a result of lengthy lockdowns; the children who faced months of closed schools; and all those whose lives were adversely affected by the pandemic and the kneejerk response to managing it.
On top of the lack of preparedness and strategy, the UK was further hindered by underlying health inequalities. Britain fares badly when compared with other European nations in terms of chronic disease, obesity and poverty, which were all risk factors for hospitalisation and death from Covid. Sizable segments of the population faced health issues that made them vulnerable to becoming severely ill from the disease. There is a longer trail of failure, less directly acknowledged by the report, that leads to the austerity policies in the decade before 2020 that left people poorer and sicker, and public services unable to cope.
Fortunately, the report comes with 10 sharp recommendations and a six-month timeline for a response and a plan of action. At their core is the charge that the bureaucracy governing pandemic preparedness, and who is responsible for what, is too complex. When too many agencies and groups are involved, then no single one is accountable for a response. The report calls for a radical simplification of the system, including a single, independent body responsible for running pandemic-planning exercises every three years and informing the public of the outcome; for assessing health inequalities in the population and identifying at-risk groups; and for ensuring that a diverse set of voices is brought to the table to avoid groupthink. All of these would make the UK better prepared.
This report throws British complacency into stark relief. UK officials and experts were used to going into less developed countries in Asia and Africa to tell them how to do things in health. Britain thought it knew best, instead of learning from the outbreak-response systems these countries had set up over years of managing various outbreaks. When it came time to act, rather than lecture, other countries outpaced Britain immediately because they had a clear plan. Those countries that managed to contain without strict lockdown measures saved lives and their economies, and then quickly pivoted to mass vaccination and opening up in 2021. Just compare the death rates of Japan and South Korea to the UK and Sweden.
We will have another pandemic. It’s not if, but when. Already avian flu (H5N1) is mutating in cows and other mammals in ways we haven’t seen before, increasing the risk of a human pandemic. The report’s call is a powerful one: let’s not let the loss and grief of 2020 to 2022 be in vain. Let’s learn now and do better next time. That’s something that, regardless of your position on the pandemic and the restrictions, we can all agree on.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
