Why did we fail to prepare for the pandemic?

If we do not re-examine what we did before the start of the COVID-19 pandemic and learn lessons, then how can we expect to be better prepared for the next one.

Photo by Anna Shvets: https://www.pexels.com/photo/hands-with-latex-gloves-holding-a-globe-with-a-face-mask-4167544/

Today marks five years since the World Health Organisation first characterised COVID-19 as a pandemic. The UK’s Covid inquiry has been hearing testimony for well over two years now. We have had modules on core UK decision-making and political governance (Module 2), the impact of Covid-19 pandemic on healthcare systems in the 4 nations of the UK (Module 3) and vaccines and therapeutics (Module 4) and procurement (Module 5). But the very first module that the inquiry heard evidence on was resilience and preparedness (Module 1) and as we reflect today on five years since the official beginning of the pandemic, it is this module which it seems most appropriate to revisit. If we do not re-examine what we did before the start of the COVID-19 pandemic and learn lessons, then how can we expect to be better prepared for the next one.

Nominally the guiding ethos of the inquiry is not to lay the blame at anyone’s door. Instead its focus is to learn lessons from the mistakes we made in preparing for the covid pandemic so that we are better prepared for the next one. The inquiry shares this premise with my second book How to Expect the Unexpected. My focus in the book is to highlight the mistakes people have made when making predictions in the past, to identify the root causes of these failures and to suggest strategies which mean they are not revisited in the future or, better still, are rendered completely unrepeatable.

When it comes to thinking about the future, my thesis is that every plan we make represents a wager against the world’s uncertainties. Preparation is no different. The degree to which we prepare represents the trade-off between what we are willing to sacrifice now to hedge our bets against the vagaries of future.

In thinking about pandemic preparedness we can draw lessons from other areas of disaster emergency planning. In the UK, for example, we don’t routinely prepare for earthquakes because the chances of experiencing large-magnitude earthquakes in this country are extremely low. In contrast, Japan routinely spends upwards of 3% of its annual budget on disaster risk management. Since strengthening disaster preparedness began in Japan in the late 1950s, average annual deaths have been reduced from the thousands to the low hundreds.

In How to Expect the Unexpected I argue that although it is impossible to predict exactly when the next earthquake will hit. Despite this, seismologists are confidently able to predict the frequencies of earthquakes in shock-prone areas and we are able to use that knowledge to help us to prepare and prioritise resources. Public health scientists had been telling the same sorts of stories as the seismologists prior to the pandemic. Perhaps because almost no-one alive in 2020 had experienced a global health emergency on the same scale as the covid pandemic, many of their warnings went unheeded.

In his inquiry witness statement, Richard Hughes, the Chair of the Office for Budget responsibility summed the situation up as follows: “While it may be difficult to predict when catastrophic risks will materialise, it is possible to anticipate their broad effects if they do. The risk of a global pandemic was at the top of government risk registers for a decade before coronavirus arrived but attracted relatively little (and in hindsight far too little) attention ...”

It's clear from the evidence the inquiry has heard thus far that in period leading up to the appearance of covid attention was diverted from pandemic preparedness and towards Brexit. Emma Reed, the civil servant who took over responsibility for preparedness at the Department for Health and Social Care in 2018, said in her evidence that preparing for a no-deal Brexit took precedent over ensuring adult social and community care were bolstered. For a whole year between November 2018 and November 2019 the cross-government Pandemic Flu Readiness Board did not meet once, side-lined by Brexit preparations.

The inquiry has also heard that only 8 of the 22 recommendations of the 2016 pandemic preparedness exercise – Cygnus - were fully implemented by the time the pandemic hit. Professor Dame Sally Davies – the chief medical officer (CMO) during Cygnus – specifically drew attention to a shortage of medical ventilators at the time. Despite this, six weeks after the UK’s first covid cases Matt Hancock was pleading with British manufacturers, “If you produce a ventilator, we will buy it. No number is too high.”

Despite David Cameron and George Osbourne’s protestations that the austerity programme they implemented during their tenures did not leave the country ill-prepared ahead of the pandemic, others have presented evidence to the contrary. Dame Sally Davies, argued that the UK had “disinvested” in public health infrastructure, which directly affected public heath resilience and left the UK “at the bottom of the table on the number of doctors, number of nurses, number of beds, number of IT units, number of ventilators.” Dame Jenny Harries, then head of the UK Health Security Agency, testified that public health budgets were reduced as a result of austerity leaving public health protection services “denuded”.

Although the warnings were there, it’s clear that they were not heeded. Officials choose to distribute resources to other projects. Choosing not to prepare for a given eventuality is an implicit prediction about the future. Failing to stockpile personal protective equipment or build health service capacity are the actions of a country implicitly betting against a pandemic. Fathoming the future is not just about the ‘positive’ predictions we explicitly formulate, but also the ‘negative’ predictions we don’t. The latter, by their absence, are often harder to spot, but as we have seen with the UK’s pandemic preparations, their failure can be equally damaging.

This piece is adapted from my Indie Voices article.