Intended for healthcare professionals


The UK’s public health response to covid-19

BMJ 2020; 369 doi: (Published 15 May 2020) Cite this as: BMJ 2020;369:m1932

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  1. Gabriel Scally, visiting professor of public health1,
  2. Bobbie Jacobson, senior associate2,
  3. Kamran Abbasi, executive editor3
  1. 1University of Bristol, Bristol, UK
  2. 2Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MA, USA
  3. 3The BMJ, London, UK
  1. Correspondence to: K Abbasi kabbasi{at}

Too little, too late, too flawed

The UK government and its advisers were confident that they were “well prepared” when covid-19 swept East Asia. The four-pronged plan of 3 March to contain, delay, research, and mitigate was supported by all UK countries and backed, they claimed, by science.1 With over 30 000 hospital and community deaths by 12 May, where did the plan go wrong?2 What was the role of public health in the biggest public health crisis since the Spanish flu of 1918? And what now needs to be done?

What is clear is that the UK’s response so far has neither been well prepared nor remotely adequate (see infographic). The weakness of the preparations was exposed in 2016 by Exercise Cygnus, a pandemic simulation, and the necessary remedial steps were not taken.3 On 30 January, the World Health Organization declared a public health emergency of international concern and governments were urged to prepare for global spread of covid-19 from East Asia.4 Detailed case studies followed showing the need for high levels of mechanical ventilation and high death rates.56 But the UK ignored these warnings.

Delay and dilution

By 11 March, Italy had taken firm public health action and was in full lockdown, followed closely by Spain and France. The UK’s Scientific Advisory Group for Emergencies (SAGE) rejected lockdown, believing that the population would not accept it. SAGE, chaired by Patrick Vallance, the government’s chief scientific adviser, reports into the Civil Contingencies Committee (popularly known as Cobra), which coordinates the governmental response to national or regional emergencies.7

One day later, the government inexplicably announced a move from the containment phase in its strategy to the delay phase.8 Chris Whitty, England’s chief medical officer, explained it was no longer necessary to identify every new case and …

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