Politics: the wrong type of disease

13/10/2021

More than 18 months after I first intimated that the government, in attempting to control the Covid-19 epidemic then rampaging through the country, was following the wrong plan, the joint Health and Social Care and Science and Technology Committees have come to the same conclusion - almost.

In their report, formally published yesterday, they tell us that there was an "overreliance" on pandemic influenza as the most important infectious disease threat. This, the committees say, "meant that the emphasis of detailed preparations was for what turned out to be the wrong type of disease".

However, to suggest that there was an "overreliance" is a significant misstatement. As I pointed out in my post, dated 25 April 2020, this hardly described what amounted to an obsession with pandemic influenza, in which SARS-like diseases (of which Covid-19 was one) had been written out of the picture.

This, in my view, is the single most important strand of error. It not only skewed the initial response to the epidemic, but also ensured that neither the personnel, the equipment nor the systems were available to mount an effective response. Furthermore, locked into their influenza paradigm, the first responders were schooled to react in a way that would maximise the spread of the disease.

The significance of this is easy to understand. Anyone planning a water-pistol duel will go equipped and prepared to squirt water. If the spat turns out to be a tank battle, it's a safe bet that you're going to get creamed.

With that in mind, I worked out the timeline of the planning failure and added my findings to the latest edition of Scared to Death published in August last year. More recently, I sent a version to the Committees, only to have it completely ignored.

Instead of focusing on the lack of effective planning as the primary point of failure, the Committees chose to highlight "decisions on lockdowns and social distancing during the early weeks of the pandemic - and the advice that led to them", asserting that these must "rank as one of the most important public health failures the United Kingdom has ever experienced".

Knowing that the media would find it hard to resist such a bold claim, this amounts to classic misdirection, diverting attention from the core failure. So successful has this been that the Guardian used the "failures" quote for its headline, referring to the focus on "the wrong type of disease" only in a caption to a picture, rather than in the main text.

The Telegraph was another paper taken in by the misdirection, reporting only that the report "also concluded" that Britain's pandemic planning was "too heavily based on influenza, and had failed to incorporate lessons from outbreaks of Sars, Mers and Ebola". But missed entirely by this paper – and the bulk of the media – is the singular fact that the control models for influenza and SARS are almost polar opposites.

In dealing with influenza, health teams had available a range of anti-viral drugs, well-rehearsed treatments, and the expectation of a vaccine available within six months of the pandemic strain being detected. Thus, beyond measures to ascertain the presence of the disease in the country, a test and trace programme, as a precursor to containing the disease, was regarded as "a waste of public health resources".

On the other hand, with Covid-19 (the manifestation of SAR), there was no immediate expectation of pharmaceutical interventions – either anti-virals or vaccines – leaving a mass "test and trace" programme as the main proactive option. Covid controls could not be folded into an influenza plan. They had to be developed and resourced separately – necessitating the advance planning.

However, with the commitment to the influenza model and no provision for SARS, the capability for carrying out a mass test and trace programme had been dismantled. The national resource had been allowed to wither away, almost to the point of extinction, the number of trained personnel available dropping from thousands to mere hundreds.

One does not have to be at all cynical to speculate as to why the Committees did not wish to emphasise this strand of failure, which left the lockdown as the only viable policy alternative. One chair of the joint committees which has launched this report is Jeremy Hunt, a former health secretary.

It was he who was cited in The Times on 23 April 2020, complaining that the "Whitehall pandemic strategy [was] focused too much on [the] flu threat", rather than on a previously unknown disease like the 2003 SARS outbreak. No, the Committees have acknowledged this, but Hunt has not admitted his culpability.

He was, of course, not the originator of the errors which were to send us down the wrong path. These go way back to the period after the threat of SARS emerged in 2002 and after 2005 when the WHO instructed members to prepare a specific response to SARS, warning that this disease could become a public health emergency of international concern.

The initial response was down to the Blair administration, under the aegis of two health secretaries, initially John Reid, who was in office until 6 May 2005, and then Patricia Hewitt, who seemed more concerned with initiating a ban on smoking in public places.

This pair, presiding over the departmental response to the WHO instruction, failed to distinguish between SARS and pandemic flu, accepting the conflation of the responses to two very different diseases into one document. So began the fatal confusion which was to skew the 2020 epidemic response.

This error was missed by the WHO, by our own Cabinet Office and the European Commission. It was repeated by Gordon Brown's administration in 2007, which focused entirely on a "National Framework for Responding to an Influenza Pandemic".

The faulty planning was then locked into place by the Cameron administration in 2011, under the aegis of Andrew Lansley as health secretary, whose NHS "reforms" were to destroy any last vestige of capability that could have managed a timely and effective response to Covid-19.

Thus, when Hunt took over the department on 4 September 2012, most of the damage had already been done. Nonetheless, he signed off Public Health England's "Pandemic Influenza Response Plan", which was published in August 2014, perpetuating the errors made by his predecessors.

Intriguingly, that year, Hunt's department had also published a Scientific Evidence Base Review on the "Impact of Mass Gatherings on an Influenza Pandemic". There is little if any direct evidence, it said, to support banning mass gatherings, suggesting that only voluntary rather than legislated restrictions could be implemented as part of a package of other public health measures.

Of particular concern to policy-makers was the lack of scientific evidence upon which to base guidance on mass gatherings. This, it was felt, was particularly important given the need to weigh any potential benefits against the economic and social disruption that banning or restricting such gatherings could have on society.

It was this document which raised questions about the "limited evidence" to determine whether respiratory viral prevalence was increased in mass gatherings, when compared to background rates or unexposed groups. These shaped the government's attitude to allowing the Cheltenham Festival to continue, early in the epidemic, and the Liverpool v Atletico Madrid football match at Anfield, Yet the Select Committee report questioned the decisions, without referring to the department's scientific advice.

Following that, the cumulative errors had been compounded by the removal of SARS, as a named disease, from the Cabinet's National Risk Register in 2017, downscaling the generic threat to a mere "100 fatalities". However, this was only one failing in over a decade of flawed decisions.

However, even though Hunt's role in the overall scheme of things ended up being relatively minor, he was in post for nearly six years, first under Cameron and then Mrs May. He handed over in July 2018 to Matt Hancock, who had the misfortune to drink from the poison chalice. During his tenure, Hunt had ample opportunity to change direction, had he seen fit. Under no circumstances, therefore, should he have headed the parliamentary inquiry. He should have been the other side of the table, as a witness to events.

On this, I'm not entirely alone. The Times has it that Chris Skidmore, a former junior health minister, questioned whether Hunt was well-placed to criticise the government, given that he had been health secretary for almost six years.

"This is about having a clear strategic plan, long-term, in place, developed by the Cabinet Office and the Department of Health. It wasn’t there", Skidmore said. He adds: "I find it a bit rich to have a report produced today by a former health secretary who's not willing necessarily to take also part of the blame for actually producing a plan that we needed to have in place when that pandemic happened".

Even the Guardian accepts that both committee chairmen are also former Conservative cabinet members. There can be no pretence that this preliminary review constitutes anything approaching a fully independent verdict, the paper says.

Demonstrating the gulf between what should have been, and the perception of the bubble, Damian Gramaticas, acting as political correspondent on yesterday's BBC TV 6pm bulletin, thought that each of the committees which jointly produced the report being headed by former cabinet ministers made them "very powerful".

And yet, we've been here before. In 2009, on my Defence of the Realm blog, I reported on how defence procurement minister, James Arbuthnot, had presided over the disastrous Phoenix UAV programme for the Army. The drone was so bad that it lasted in service less than seven years - at an overall cost of £345 million. Its removal left the Army with a vital capability gap at the height of the Iraq campaign.

Arbuthnot was later to be appointed chair of the defence select committee, where he ensured that this, and others of the procurement disasters he had handled, never suffered a critical word while he was in office.

To my mind, no former minister should ever be a member of a select committee – the primary function of which is to hold the executive to account – much less hold the post as chair. As such, Hunt is the very last person to lead a "lessons learned" inquiry into the Covid epidemic. His presence simply epitomises a corrupt political class washing its own laundry.

As such, despite this report, we are no further forward. Similar in some respects to the government's refusal to facilitate increased storage of natural gas, the Covid debacle was primarily a failure in the political decision-making process.

The joint committees don't seem to have understood this, and the media have gone with the flow, displaying no more understanding than the MPs on which they are reporting. Thus, no lasting lessons have yet been officially identified. The lessons are still to learn.

Also published on Turbulent Times.