Covid: tracking the error

By Richard North - June 21, 2023

While the Commons was ploughing through the Oaf’s recent past, it was interesting to see that the Covid inquiry, now in public hearing mode, was speaking to another former prime minister.

This one was David Cameron who, according to the Financial Times and diverse media sources, was the first politician to appear before the public inquiry. He won’t be the last.

In between rejecting claims that his government’s austerity programme had undermined the ability of the NHS to respond to the Covid-19 crisis, he had something to say about the pandemic planning process.

“Much more time was spent on the dangers of pandemic flu”, he told the inquiry, “rather than on potential pandemics of other more respiratory diseases – like Covid turned out to be”. And, he managed to add: “I think this is so important because so many consequences follow from that”.

This quote was picked up by the Telegraph which then conveyed something of a tortured soul.

“And I’ve been sort of wrestling with …”, Cameron went on to say, breaking off with the digression: “I think the architecture (to deal with large-scale emergencies) was good – the National Security Council, the National Security Adviser, the risk register and also this new security risk assessment, which was perhaps a bit more dynamic”.

“But”, he said, “that’s where I keep coming back to is, so much time was spent on a pandemic influenza and that was seen as the greatest danger – and we had very bad years for flu so it is a big danger … But why wasn’t more time and more questions asked about what turned out to be the pandemic that we faced?”.

With unusual candour, especially for an ex-prime minister, he then confided: “It’s very hard to answer why that’s the case. And I’m sure this public inquiry is going to spend a lot of time on that”.

Actually, the public inquiry could save a great deal of time, if it was so minded, simply by reading the latest edition of Scared to Death, which explores in detail where and why the planning process went wrong.

The work, which was published in August 2020, relies heavily on posts from this blog and, in particular, a piece written on 25 April 2020, headed: “the influenza obsession”, and others, including my earlier piece on 6 April entitled “the wrong disease”.

If the inquiry chooses to pave its own path to knowledge, it should not have started with Cameron but, as this piece points out, with Tony Blair and his administration. It was during that period, specifically in 2005, that Blair’s then health secretary John Reid first produced a pandemic preparedness plan.

It was there that the trail of errors started for, even though in the same year the World Health Organisation had advised member states, in a change to its regulations, not only to prepare for influenza but also for a lesser-known and more recent condition known as Severe Acute Respiratory Syndrome (SARS for short), the emphasis of the plan had remained on influenza.

At that time, the front-line body responsible for managing the government’s response to a pandemic was the Health Protection Agency (HPA). It had recognised the SARS threat for, in its 2007 annual report, it acknowledged the WHO’s changes to its regulations, made “in the light of the global SARS experience”.

However, the Cabinet Office in its 2008 edition of its National Risk Register thought that the likelihood of a new disease like SARS spreading to the UK was “low”, referring to an outbreak in Toronto, Canada, which had 251 cases in two waves over a period of several months. Possibly because of that, no specific plan for the control of SARS was produced.

Nevertheless, presumably in deference to the WHO, the next two editions of the National Risk Register (2010 and 2013) kept the reference to SARS, essentially unchanged. But by 2015 the two long paragraphs had shrunk to one sentence.

In between, the Lancet in September 2014 argued that emerging infectious diseases were “an important public health threat and infections with pandemic potential are a major global risk”. SARS was prominently mentioned.

However, for no discernible reason, in the 2017 edition of the National Risk Register the reference to SARS disappeared completely. Officially, SARS – as a named disease – had been removed from the list of potential threats to the UK.

It was here that we saw the generic category of “emerging infectious diseases” (EIDs), and even then the threat was downgraded. The consequences were put at “several thousand people experiencing symptoms, potentially leading to up to 100 fatalities”.

Conversely, pandemic flu was deemed the much greater threat. Up to half of the UK population could experience symptoms, potentially leading to between 20,000 and 750,000 fatalities and high levels of absence from work. It was very clear which was seen as the most important.

By then, the pandemic influenza preparedness plan had undergone several iterations, culminating in the 2014 plan, together with the strategic framework. But that, and the 2017 National Risk Register, was by no means the government’s last or only words on pandemic influenza.

In 2015, it had produced a National Security Strategy and Strategic Defence and Security Review, which stated that “disease, particularly pandemic influenza, emerging infectious diseases and growing antimicrobial resistance, threatens lives and causes disruption to public services and the economy”. SARS was not mentioned by name.

In July 2018, the government then published a Biological Security Strategy, drawing together “for the first time” the work that takes place across government to protect the UK and its interests from significant biological risks. And here, writ large, as a threat, was pandemic influenza. SARS was not mentioned.

Finally, there was the 2019 National Security Risk Assessment (NSRA), where the emphasis was entirely on pandemic influenza. The document did refer to the possibility of a respiratory coronavirus outbreak, such as the outbreak of SARS in 2003, but suggested that Middle East Respiratory Syndrome, seen in South Korea in 2015, “poses the higher risk”.

In terms of response, though, it said that the risk had “low confidence”. There was “significant uncertainty”, it added, about the frequency with which an emerging infection may develop the ability to transmit from person to person.

As to the impact, it concluded that there was “some uncertainty” as to whether a different emerging pathogen “would lead to an outbreak similar to those seen previously”. This was hardly a clarion call to action: it was rated “amber” as opposed to the overall assessment on an “influenza-type pandemic” which was rated as “very high”.

Thus, we see a consistent progression, going back a decade-and-a-half before the Covid-19 pandemic, of understating the threat, pointing responders in the direction of pandemic influenza. Even where SARS was mentioned it was dismissed as a low risk.

Cameron, of course, is by no means the only one to have noted the disproportionate emphasis on influenza. On 23 April 2020 in The Times, former health secretary Jeremy Hunt admitted that planning should have focused more on the threat of SARS than an influenza outbreak in its pandemic planning.

In many respects, therefore, we seem to be paying the price of a classic example of a system failure, where no single person can be held responsible.

Hunt, though – as I remarked at the time – was relatively forgiving of the government’s tardy response to the epidemic in the UK, generously asserting that: “No one can reasonably expect governments to have a crystal ball with a brand new virus, so full credit to the government for being willing to learn from international best practice, first on ramping up testing and now on mass contact tracing”.

Bearing in mind that Hunt himself was part of the failed planning process, however, there must surely be an element of back-covering. The government didn’t need a crystal ball. It had been warned by the WHO to prepare for SARS in 2005 and, instead the British government (along with many others, it must be said) chose to lump this very different disease in with influenza.

At the heart of the government’s difficulties was this core error, repeated not once but many times. It was missed by a succession of experts, the civil servants and politicians, none of whom thought to refer back to the original WHO regulations which categorised SARS separately from influenza.

Whether the inquiry is able to track this error back to source remains to be seen, but, in starting with Cameron, it has not made a good start.