Finally, and late, I submitted my witness statement to the UK COVID-19 Inquiry. My reflections are no more or less valid than anyone else's. But this statement was not a voluntary matter. In January, I received a letter asking me to submit my views on the UK's planning, preparedness, and resilience for pandemics between June 11, 2009, and Jan 21, 2020. I did not think this period was within my area of direct experience. The first paper The Lancet published on COVID-19 was on Jan 24, 2020. There are certainly issues I would like to raise about the pandemic after that date. I let the deadline drift past, thinking the Inquiry would receive far more detailed and relevant factual information from “core participants”, such as government departments. What could I add? And then I received a polite but firm lawyer's letter asking me to send my evidence as soon as possible. The Inquiry would not be granting me a second extension. I knuckled down.
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The UK COVID-19 Inquiry is chaired by Baroness Heather Hallett, a retired Court of Appeal judge. This first evidence-gathering phase is called Module 1. There are three initial Modules and more are promised. Module 2 concerns core UK decision making and political governance. Module 3 is about the impact of the pandemic on health-care systems in the four nations of the UK. Preliminary hearings have been held and public oral evidence sessions will take place in June and July. The Modules to come will investigate vaccines, therapeutics, and antiviral treatments; the care sector; government procurement and personal protective equipment; testing and tracing; the government's business and financial responses; health inequalities and the impact of COVID-19; education, children, and young people; and other public services, including front-line delivery by key workers. Plainly, this Inquiry is going to be a mammoth task. It is likely to take several years to complete. Calls for Baroness Hallett to finish her work by the end of this year are utterly impractical, given the scope and scale of her investigation. So the public, although anxious for answers, must be patient. It is essential that facts are carefully established, arguments judiciously weighed, and conclusions fairly drawn. The recommendations of the Inquiry must command the confidence of government and the public if we are to learn the lessons of the past 3 years. But that necessary caution should not prevent some actions being taken now. We cannot wait for Baroness Hallett's final denouement.
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I suggested ten lessons for consideration. The threat of a newly emerging infectious pathogen, such as SARS-CoV-2, is better framed as a syndemic, not a pandemic—epidemics (a virus plus chronic diseases) interacting across social gradients. The UK Government must strengthen national systems of health security—redressing calamitous disinvestments in public health. UK public health authorities must improve the quality, curation, and coordination of data as the foundation for pandemic preparedness and response. The UK Government must review and upgrade its system of science advice to government—creating a simplified, less collusive, and more responsive system that can pivot quickly when a new threat emerges. The UK Government must investigate and improve its health, and public health, system capacities for pandemic preparedness. UK universities and nursing schools must redesign health professional education programmes to equip our health workforce with the knowledge and skills to respond to a global pandemic. The UK Government must implement a set of performance metrics to hold its systems of pandemic preparedness independently accountable. The UK Government must make strengthening trust one of its principal instruments for pandemic prevention. The UK Government must recognise that investments in science are a vital bulwark against future pandemics. And the UK must make global health security one of its central foreign policy objectives. Is the UK better prepared today if another pandemic were to strike? We now have a generation of practitioners and policy makers who have first-hand experience of how to respond. Many of the mistakes made in the early months of COVID-19 would likely not be made again. But the truth is that we are not materially better prepared. Not one of these ten proposals has been adequately addressed. For a country that has such a deservedly respected history in medicine, medical science, and public health, this apathy is as extraordinary as it is disappointing.
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