On 12 March last year, Boris Johnson announced that attempts to contain Covid-19 would be halted and the country would have to accept the spread of the virus. As a global public health expert, this policy decision was baffling to me. The experience of China, Taiwan, South Korea, Singapore and Hong Kong had already shown us that Covid-19 could be contained through testing, tracing and isolation, border restrictions, social distancing and face coverings. By following this east Asian playbook, England could save lives and avoid harsh, extended lockdowns.
I spent that evening reflecting on the decision. Although I wasn’t an expert in British public health policies (my work focuses on infectious diseases in low- and middle-income countries), it was clear to me that the government was getting this wrong. While other countries had demonstrated that speed was crucial, England’s plan revolved around herd immunity. According to this, the majority of the population would catch the virus. Pursuing herd immunity without a vaccine had never been used for any infectious disease in the past. The consequences of this strategy would be devastating.
Dominic Cummings’ testimony has confirmed how government decisions resulted in one of the highest death rates in the richer world and prolonged economic restrictions. In many ways, the testimony merely affirms what many public health experts suspected at the beginning of the pandemic. In those early days, many of us wanted to understand what the government’s assertion that it was “following the science” really meant. But there was no transparency. We couldn’t tell who was a member of the Scientific Advisory Group for Emergencies (Sage), nor exactly what the government was planning to do. Instead, we had to piece together a picture of what was happening in No 10 and within Sage from conversations with colleagues and journalists.
Cummings’ testimony has exposed how a vacuum of political leadership shaped England’s pandemic response. Relatively less wealthy countries such as Senegal, Greece and South Korea did astonishingly well at managing infections because of their leadership. In contrast, Cummings noted: “It’s completely crackers that someone like me should have been in there, just as the same as it’s crackers that Boris Johnson was in there.” The careful, considered leadership of the Scottish first minister, Nicola Sturgeon, who set up a Scottish Covid-19 advisory group in early April 2020, which operated transparently and published minutes, contrasts starkly with Johnson’s aversion to detail and hard work.
The most frustrating – and darkly predictable – aspect of Cummings’ testimony was his assertion that herd immunity was indeed England’s strategy from February into March, a combination of what the prime minister saw as the simplest solution, as well as the early advice from Sage that this was the only option on the table. Johnson was more concerned with the effects of Covid-19 on the economy and not overreacting, while a careful reading of Sage minutes show that the group saw the infection as uncontrollable. The reliance on complex theoretical modelling over the principles of basic infectious disease prevention was a problem; so was group-think within Sage itself.
It was only when the NHS reached a similar situation to what we’re now seeing in India and Brazil that the government quickly did a U-turn and enforced a harsh lockdown. But there was no plan for what should be done during this lockdown to get ahead of the virus. While other countries used lockdowns to identify cases and build testing capacity, the government instead used this to relieve pressure on the NHS. This was a major mistake: a waste of expensive time that could have been spent on suppressing and eliminating Covid-19 and preventing future lockdowns. In addition, absolutely no border measures were put in place during the first lockdown, which allowed a continual stream of infections to enter the country, even while people remained in their homes.
These early decisions revolved around a tradeoff between saving lives and protecting the economy. This was always a false dichotomy. There was never the option of putting largely vulnerable and elderly people into a plane and watching it crash as the rest of society went on living normally. Allowing Covid-19 to continue circulating among the population would have led the NHS to collapse. Fear of catching a deadly virus would have forced people to change their behaviours and remain at home – thus harming the economy, too. Ministers and their advisers should have instead focused on how they could suppress the virus and buy time to find scientific solutions such as a vaccine. Other countries did this through a combination of firm border measures, a strong system of testing, tracing and isolating, and behavioural changes among populations that were properly informed about the risks of airborne and asymptomatic infections.
Yet the government and its advisers refused to look to other countries. There was a lack of humility and an unwillingness to observe or listen to other parts of the world. Some might say that hindsight is always beneficial. But there was no need for hindsight to see how this would play out. The government already had plenty of lessons it could have learned at the time from other countries that were battling with the virus. In fact, the lockdown restrictions in western countries have been much harsher and longer than those in much of east Asia. Meanwhile, a recent Lancet study showed that countries that eliminated Covid-19 not only saved lives, but enjoyed more personal freedoms, civil liberties and economic stability.
It is painful to relive the horrifying weeks of March 2020 but it’s essential that we now have a proper public inquiry into England’s handling of Covid-19. The families who lost loved ones deserve accountability from our public officials, who must be held to higher standards of performance and decision-making. And we need to learn from these missteps so we can do better in the future. Make no mistake: there will be other pandemics. England must now learn, much like countries that were affected by Mers, Ebola and Sars, to ensure these mistakes are never repeated. And the public must ask itself: what do we expect from our leaders and ministers?