Intended for healthcare professionals

Feature Covid-19

Rishi Sunak’s covid record—and what it tells us about his views on health, wealth, and the value of science

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2715 (Published 16 November 2022) Cite this as: BMJ 2022;379:o2715
  1. Richard Vize, journalist
  1. London

As chancellor at the height of the pandemic, the UK’s new prime minister had a profound impact on its course and outcomes. His actions call into question his judgment about the link between health and wealth, writes Richard Vize

Rishi Sunak’s actions during the covid-19 pandemic tell us a great deal about his attitudes towards healthcare and science—and therefore how these may fare under his tenure as UK prime minister. As chancellor of the exchequer and one of the government’s key decision makers, Sunak had much influence on the course of the pandemic and its economic and other consequences.

Boris Johnson appointed Sunak chancellor on 13 February 2020 after Sajid Javid quit. Sunak had been chief secretary to the Treasury for the previous seven months.1 Two weeks before his promotion the first covid cases had been confirmed in the UK.2 Sunak was one of the quartet of key decision makers during the pandemic, alongside Johnson, the health and social care secretary for England, Matt Hancock, and the Cabinet Office minister, Michael Gove.3

Sunak had to rewrite his first budget hastily to respond to the rapidly escalating crisis before he delivered it on 11 March. He unveiled £12bn of pandemic spending, including at least £5bn for the NHS in England and other public services, alongside £7bn for businesses and workers across the UK.4 Promising to do “whatever it takes” to support people and businesses through the emergency, he added, “Whatever resources the NHS needs to deal with coronavirus, it will get.”5

Within a week Sunak massively expanded government help, with another £350bn in loans and other support,6 followed three days later by the unprecedented furlough scheme, in which the government paid grants of up to 80% of salaries, up to £2500 a month, if companies kept non-working staff on their payroll. The cost of the scheme was initially estimated at £78bn.7

Just 39 days after Sunak’s promotion Johnson announced the first lockdown.

Economy boosters?

The first covid wave peaked in early May 2020, falling from over 5000 confirmed cases a day across the UK to around 545 by 8 July.8 As the threat seemed to ease, Sunak unveiled his Plan for Jobs, to help the economy recover.9 This included bonuses to encourage employers to retain furloughed staff and a £2bn Kickstart scheme to create jobs for young people.

Sunak’s most controversial scheme to boost the economy was Eat Out to Help Out, which ran during August 2020. It covered half the cost of food and non-alcoholic drinks for an unlimited number of visits in participating restaurants on Mondays to Wednesdays, up to £10 per person every visit.10 Over 160 million meals were claimed, costing £849m.11

As well as helping the hospitality sector, Sunak wanted to encourage people to be less fearful of going out. It reflected his concern that pandemic restrictions were crippling the economy and his desire to open up as soon as possible.12

An analysis by Thiemo Fetzer of the CAGE economic research centre at Warwick University, published in the Economic Journal,10 found that areas that had higher take-up of Eat Out to Help Out had a notably higher incidence of infections within a week of the scheme starting and a drop in infections within two weeks of the scheme ending. Fetzer estimated that the scheme may have been responsible for around 8% to 17% of all new SARS-CoV-2 infections during the period it was active, which he says tallies with Public Health England data showing a surge in the proportion of infections traced to food outlets from 5% to almost 20%. He says the public health and indirect economic costs of Eat Out to Help Out “vastly outstrip its short-term economic benefits.”

Fetzer told Sky News, “The UK saw a massive explosion of cases in a way that was not seen in other countries. It’s that scheme that has helped to bring about an earlier second lockdown and restrictions on the restaurant sector that it was determined to help economically.”13

Circuit breaker sceptic

Daily cases were rising again before Eat Out to Help Out ended. By early October the second wave was firmly under way, with infections surpassing the peak of the first wave and growing. By mid-November they reached a new peak of more than 25 000 cases in a single day.8

Johnson was being pushed by England’s chief medical officer, Chris Whitty, and the UK chief scientific officer, Patrick Vallance, to implement a short “circuit breaker” lockdown to try to contain the massive autumn surge, save lives, and possibly avert the need for a longer lockdown later.14 The aim was to reduce the R value (the average number of people that an infected person infects) at a time when the Scientific Advisory Group for Emergencies (SAGE) believed that the doubling time for new cases might be as low as seven to eight days.15

A Sunday Times investigation found that the new restrictions were being supported by Hancock, Gove, and Johnson’s chief adviser, Dominic Cummings. But Sunak was vehemently opposed, fearing mass redundancies.14 Sunak’s opposition led to four people being invited to address Johnson and him on 20 September, of whom three also opposed a lockdown: Sunetra Gupta and Carl Heneghan, professors at Oxford University, and Anders Tegnell, architect of Sweden’s controversial policy of avoiding lockdowns.14

SAGE, represented by John Edmunds, professor at the London School of Hygiene and Tropical Medicine, argued that “not acting now to reduce cases will result in a very large epidemic with catastrophic consequences in terms of direct covid-related deaths and the ability of the health service to meet needs.”15

Sunak won. On 14 October he accused Labour MPs of being “detached from reality” for supporting the circuit breaker, claiming they failed to recognise the economic cost.16

A report by the House of Commons Health and Social Care and Science and Technology Committees a year later said, “In this decision not to have a circuit breaker, the UK government did not follow the official scientific advice. Ministers were clearly overoptimistic in their assumption that the worst was behind us during the summer months of 2020.”17

By late October infections were rampant. On 31 October, the day after NHS England chief executive Simon Stevens told the ministerial quartet that hospitals would be overrun across the country if nothing were done,18 Johnson announced a second lockdown to prevent a “medical and moral disaster” for the NHS.19

The second lockdown ended after four weeks in England, giving way to a tiered system of restrictions. Infections immediately surged again.

Surveillance funding withdrawal

Sunak seemed to have learnt little about the value of science from this series of events. In February 2022, as the government moved the country towards “living with covid,” he pushed for the dismantling of the covid testing and surveillance network. Free lateral flow and PCR tests under the NHS Test and Trace programme had been costing around £2bn a month. Sunak refused to provide any more money to continue with testing and surveillance and even opposed twice weekly testing for NHS staff, genomic sequencing to detect emerging variants, and the widely praised Office for National Statistics infection survey, after they were defended by the health and social care secretary, Sajid Javid.20

The BMA wrote to Sunak to defend the ONS scheme, warning that after the end of systematic testing it was the only source of information that could provide an accurate picture of covid.21 In the end the survey, sequencing, and staff testing were continued, but the NHS was forced to pick up the bill.20

Sunak was not a cheerleader for mask wearing. He did not wear one in the Commons, although he said he did on crowded trains,22 and in June 2021 he said he would stop wearing one as soon as legally possible.23

In a Spectator interview in August 2022 Sunak laid bare his scepticism about some scientific advice the government had received. Discussing the early debates about a lockdown, Sunak says: “I wasn’t allowed to talk about the trade-off . . . The script was: Oh, there’s no trade-off because doing this for our health is good for the economy.”24 He claims he was the one in government who pushed the issue of the non-covid impact of lockdown on health and adds that he flew home early from a trip to California in December 2021 to oppose the imposition of another lockdown in response to the omicron variant.

One lesson he says he takes away from the pandemic is, “We shouldn’t have empowered the scientists in the way we did,” adding, “If you empower all these independent people, you’re screwed.”

In response to this interview Edmunds emphasised that SAGE’s role “was quite narrow: to review and assess the scientific evidence to help inform the decision-makers. It did not consider the economic aspects—it was not asked to do so and was not constituted to do so.”25

Edmunds points out that Sunak could have set up an economic equivalent of SAGE to give more weight to that side of the debate.

Responding to The BMJ’s questions for this article, including whether Sunak struck the right balance between public health and economic priorities during the pandemic, a Number 10 spokesperson highlighted Sunak’s comment at his first prime minister’s questions: “I will always protect the most vulnerable . . . We did it in covid and we will do that again.”

The spokesperson added that Eat Out to Help Out helped protect the livelihoods of 1.8 million people working in hospitality and that businesses had covid safety measures in place such as screens, social distancing, and reduced capacity. She highlighted that £36bn was added to NHS budgets to fund testing, personal protective equipment, and other infection control measures.

Health and wealth: not binary

Jim McManus, public health director at Hertfordshire County Council and president of the Association of Directors of Public Health, emphasises that health and the economy were not binary choices during the pandemic. “I recall an awful lot of people being somewhat simplistic: that it is either the reduction of covid infections, or opening up and keeping the economy going. But we articulated that they were complex choices that required people to think about them in the round. Our view was to enable as much as possible to operate as safely as possible.”

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, believes Sunak did not strike the right balance between public health and the economy: “We now have lots of evidence that countries that were best at controlling covid had the best economic outcomes. UK policies allowed far too many people to become infected, and now we have a labour shortage that is worse than in any other industrialised country.

“Eat Out to Help Out was a disaster. This really calls into question Mr Sunak’s judgment.”

Anita Charlesworth, director of research at the Health Foundation and director of the REAL economic analysis centre, highlights a basic misunderstanding at the heart of Treasury thinking: “The UK had some of the highest excess mortality but also one of the biggest economic shocks from the pandemic, and that economic shock ultimately harms people’s health.

“The more effectively we dealt with the pandemic, the faster and more robust the economic recovery. The Treasury never quite got that health and economics weren’t in conflict.”

Timeline: Rishi Sunak and the covid pandemic

2020

  • 13 February—Sunak is appointed chancellor of the exchequer

  • 11 March—Sunak’s budget includes £12bn to mitigate the effects of the pandemic

  • 17 March—Government unveils £350bn lifeline for the economy

  • 20 March—Government announces furlough scheme

  • 23 March—Boris Johnson announces first lockdown26

  • 8 May—First wave passes its peak

  • 10 May—Lockdown restrictions begin to ease

  • 19 June—Sunak and Johnson attend party for Johnson’s birthday in the Cabinet Room at No 10

  • 4 July—More lockdown restrictions are eased in England

  • 8 July—Sunak unveils the Plan for Jobs

  • 3 August—Eat Out to Help Out scheme begins

  • 5 September—Daily confirmed cases are rising steeply

  • 14 September—“Rule of six” begins in England, restricting size of indoor and outdoor social gatherings

  • 22 September—Working from home and 10 pm hospitality curfew are imposed in England

  • 31 October—Second lockdown in England announced

  • 2 December—Lockdown replaced with three tier system in England

  • 19 December—Christmas mixing rules tightened

2021

  • 6 January—England begins third lockdown

  • 9 January—Daily confirmed UK cases peak at almost 60 000

  • 13 January—Cases are falling steeply

  • 29 March—Stay at home order ends, small outdoor gatherings are allowed

  • 7 April—Cases reach plateau

  • 12 April—Non-essential services and retail reopen

  • 8 June—Cases are rising steeply

  • 19 July—Most legal limits on social contact are removed in England

  • 21 July—Daily cases peak at almost 48 000

2022

  • 5 January—Daily cases peak at 183 000

  • 12 January—Cases are falling sharply

  • 11 February—Sunak denies breaking lockdown rules27

  • 12 April—Sunak is issued with a fixed penalty notice for breaking covid restrictions by attending Johnson’s birthday party in 202028

Footnotes

  • Competing interests: None declared.

  • Commissioning and peer review: Commissioned; not externally peer reviewed.

This article is made freely available for personal use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

References