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What went wrong in the UK’s covid-19 response?

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1309 (Published 24 May 2021) Cite this as: BMJ 2021;373:n1309

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  1. Martin McKee, professor of European public health
  1. London School of Hygiene and Tropical Medicine, UK
  1. Martin.McKee{at}lshtm.ac.uk

One day we may know, but Boris Johnson is in no hurry

In May 2020, Sarah Wollaston, Mike Gill, and I called for a rapid inquiry into the British government’s response to the covid-19 pandemic.1 This would have been an opportunity to learn lessons and not to repeat them. At that time, we knew that the UK’s response to the news of an emerging infection had been slow, leading to tens of thousands of avoidable deaths. We were anxious that this should not be repeated. Our call was ignored and the events of March 2020 were repeated in December 2020 as the prime minister, anxious to be seen to “save Christmas,” dithered as a new variant, B.1.1.7, spread rapidly. More recently, he delayed imposing a ban on travel from India until 23 April 2021. The reasons remain obscure. Bangladesh and Pakistan had been placed on the red list on 9 April 2021 despite having much lower incidence rates. Television screens in the UK were full of horrendous pictures from India, with people dying in the streets. Of course, the prime minister insisted that this had nothing to do with his desire to sign a trade agreement with India and we must take his word for it. The consequences of enabling entry of the B.1.617.2 variant, now rising rapidly in several parts of the UK, are still unclear, but it does seem like the same mistake is being made yet again.

The prime minister has, at last, agreed that there will be an inquiry. It will begin in spring 2022. The reason he gave for the delay is that “we must not inadvertently divert or distract the people on whom we depend in the heat of our struggle against this disease.” We are to believe that the government’s abolition of Public Health England and the creation of successor bodies, which will require many of those essential public health staff to reapply for their jobs, will somehow not be a distraction. Similarly, the government’s planned reorganisation of the NHS will be simple and straightforward. The prime minister has given few details except that it would be “independent,” something that he has not elaborated on.

Public inquiries are designed to answer three questions: what happened; why did it happen and who is to blame; and what can be done to prevent it happening again? The prime minister has implied that the inquiry will be a statutory one, held under the Inquiries Act 2005, as he has said that it will have “the ability to compel the production of all relevant materials and take oral evidence in public, under oath.” This means that it is likely to take quite a long time. Once the inquiry chair and panel have been appointed, they will spend some time agreeing terms of reference. There will be many legal complexities to resolve. The Grenfell Tower inquiry was delayed as the attorney general considered the balance between witnesses speaking freely and the potential for self-incrimination. The sheer volume of material that will have to be examined will create further delays. The Iraq War inquiry, perhaps the most comparable, stretched to 12 volumes containing 2.6 million words. That inquiry took seven years to report, during which one of the panel died. Indeed, it is not uncommon for public inquiries to lose key members. The Independent Inquiry into Child Sexual Abuse, which commenced in 2015, has gone through four chairs and is still in progress, although it has made several thematic reports. Often, these delays mean that any report will appear long after those involved have left office. In this case it would be optimistic to expect a report before 2028. It is to be hoped that there is no further pandemic in the meantime.

Although the newly announced inquiry is unlikely to provide anything much of value for some years, it is important that it takes place to uphold the principle of accountability. There are, however, some important considerations. Firstly, the scope of the inquiry. It is already apparent that there were failures at many levels, set out in detail in several accounts. We know that the prime minister was not fully engaged at the beginning of the pandemic, with his attention focused on other political and personal matters; the chaotic events around the Brexit negotiations also revealed a deeply dysfunctional state. But how well was the machinery of government functioning, and will the inquiry cover decision making structures and processes in central government?

Unlike inquiries in some other areas—such as the Iraq War, where defence is a matter reserved to Westminster—the devolved administrations played a major role in the response, often out of step with England. Presumably their actions will also be scrutinised so will they have a say in the appointment of the chair and panel?

Another area that was problematic was procurement, especially of testing and tracing capacity and personal protective equipment. This is an area where there could be criminal prosecutions, given growing evidence of, to say the least, questionable use of public funds. How will the legal matters that arise be dealt with?

One reason the UK suffered so greatly seems to be the weaknesses of social safety nets, with many people leading precarious lives, unwilling to risk losing income if they came forward to be tested and had to isolate, or living in crowded housing that created the conditions for spread. This is in part the consequence of austerity measures adopted since 2010. Will these fall within the scope of the inquiry?

Fortunately, those who want to fix some of the things that went wrong, as opposed to attributing responsibility to individuals and institutional structures, do not have to wait. Already quite a few of the problems have been identified in evidence given to parliamentary committees, such as that on Management of the Coronavirus Outbreak, being undertaken by the Health and Social Care Committee. Other valuable insights come from the report and hearings of the All Party Parliamentary Group on Coronavirus. There is also the People’s Covid Inquiry, organised by Keep our NHS Public. At an international level we have the report of the Independent Panel on Pandemic Preparedness and Response. The Westminster government has shown no sign that it will pay attention to any of them, however.

Unsurprisingly, the prime minister’s seeming lack of curiosity about what went wrong or of any sense of urgency has been heavily criticised by, among others, the Covid-19 Bereaved Families for Justice group, which had threatened the government with judicial review if it failed to hold an inquiry, and the All Party Parliamentary Group, whose members have called for inquiry members to be selected by a cross-party committee with involvement of the devolved administrations.

Although we are just over a year into the current Westminster government, it is clear that the prime minister is focusing on the next election. He is repealing the Fixed Term Parliaments Act to allow him to call an election at a time that is most advantageous to him. He is also introducing a requirement for voters to present photo identification, widely seen as copying US policies on voter suppression. There is no way that his inquiry will report before the next election.

This is a prime minister who seems uncomfortable with the concept of accountability. He is notorious for not answering parliamentary questions or, if he does, to mislead and fail to correct the record. There are continuing unanswered questions about his adherence to parliamentary standards. We can debate how important these matters are and the prime minister has always argued that they are not what the public is interested in. But his government’s ability to suppress the pandemic, especially in the face of a new and rapidly increasing variant, is of interest. In fact, it is a matter of life and death and we need to be reassured that he has learnt some lessons.

Footnotes

  • Competing interest: MM is a member of Independent SAGE and has given evidence to the All Party Parliamentary Group on Coronavirus and the People’s Inquiry on Coronavirus. He is a commissioner and chair of the Scientific Advisory Board of the WHO Commission on Health and Sustainable Development, inquiring into the post-pandemic situation.

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