The UK sees a change of leadership on September 6 2022, with Liz Truss selected by Conservative Party members to replace Boris Johnson as the UK prime minister. Johnson’s term of course coincided with the emergence of the COVID pandemic, a global crisis that required skilled national leadership. Did Johnson deliver on this? Although there were a few redeeming features to his government’s pandemic response, I would argue that – overwhelmingly – he didn’t.
Let’s start with preparedness. One component of any pandemic response should be the knowledge gained from preparedness activities. And, as the pandemic began to unfold in early 2020, Johnson reportedly missed five meetings of the government’s Cobra emergency committee.
Prior to Johnson becoming prime minister, the UK had carried out simulation exercises and considered a range of likely policy responses. But their findings were largely ignored.
For example, Exercise Cygnus considered a scenario in which the UK was faced with a respiratory pandemic. Cygnus concluded that “the UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient”. But most people were unaware of the existence of this report. It took determined journalism, legal action and an intervention by the information commissioner for it to be published.
There was also Exercise Alice, which looked specifically at the impact of a highly-transmissible coronavirus. It highlighted the potential impact of “undetected cases” and “large-scale spread” of any such virus. Recommendations included policies around quarantine and community surveillance. These recommendations also appeared to be largely ignored.
Shoddy deals, poor productivity
Further highlighting the lack of preparedness, hospitals faced shortages of personal protective equipment (PPE), and many of the items received were of low quality or were simply unusable.
These failures were at least in part down to government-level decisions to award contracts for supply of PPE to companies that had no appropriate track record. The mechanism to access these government contracts was ruled to be unlawful in the high court.
In one case, work to supply vials for COVID tests was awarded to a company run by the former proprietor of then health minister Matt Hancock’s local pub.
Separately, treasury minister Lord Agnew resigned in January 2022 over the government’s actions to write off £4.3 billion in fraudulent COVID loans.
Then there was the the “Test and Trace” programme, which was set up by the government at great expense. Notably, the project involved 35 companies, many of whom had little or no background in public health or diagnostics. With a budget of £37 billion, its performance was described by parliament’s own Public Accounts Committee as “muddled, overstated, and eye-wateringly expensive”.
The testing programme, led by former telecoms executive Dido Harding, was further criticised by parliament for being too slow to scale up capacity, despite other countries managing to perform well in this regard.
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A string of failures
As the first lockdown ended in the summer of 2020, the government launched a new programme to encourage people to return to pubs and restaurants, Eat Out to Help Out, which ran across August 2020. At this time, community transmission in the UK was lower than it had been for several months, and new cases were predominantly arising in institutional settings such as hospitals and care homes.
In my view, Eat Out to Help Out was a very bad idea. Evidence suggests the scheme was responsible for between 8% and 17% of all new COVID infections detected across the time it was running.
With these chains of transmission in place, cases continued to increase significantly across the autumn of 2020. This then led to Christmas 2020, perhaps one of the biggest failures of governance during the pandemic.
The government went against the scientific consensus, instead inviting scientists with fringe views around acquiring herd immunity by natural infection to meetings with Johnson and other ministers. The impact of the winter social mixing was disastrous, with thousands of COVID deaths, along with the widespread emergence of the alpha variant.
In the spring of 2021, the Royal College of Nursing criticised the government for its slow response to updating infection control guidelines once there was evidence the virus was transmitted through the air.
Breaches of trust
There were promises to distribute vaccines to lower-income countries that were not met. By October 2021, less than 10% of the promised 100 million doses had been provided to these poorer nations.
Trust in Number 10 was badly damaged in May 2020 when it was revealed that Johnson’s chief adviser Dominic Cummings had breached COVID guidelines by driving with his wife and son from London to Durham, while he and his wife possibly had COVID symptoms. Cummings was sacked by Johnson in November 2020.
In late 2021 and early 2022, Johnson repeatedly denied rules had been broken around the series of Christmas gatherings held by government staff. The police later confirmed Johnson had indeed breached his own rules by attending a gathering to celebrate his birthday. Johnson was issued with a fixed penalty notice, along with his wife Carrie Johnson and then-chancellor, Rishi Sunak.
The prime minister’s ethics advisor, Lord Geidt, resigned in June 2022, after conceding the prime minister may have breached the ministerial code of conduct over “partygate”.
Amid these failures, there were important positives. The UK was the first country to approve and administer a COVID vaccine. This followed significant government investment in research and development, not just for vaccination, but also for assessing therapeutics, such as through the Recovery study.
Meanwhile, investment in genomics has supported surveillance and monitoring for new variants. The availability of free COVID tests allowed for testing to become both routine and widespread for a prolonged period. This data was reported using real-time tools such as the COVID-19 dashboard.
The government has arguably performed well when it comes to investing in science to support the urgent generation and reporting of new knowledge.
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But even with the rapid vaccine rollout, and the early introduction of booster doses, other countries rapidly caught up with and overtook UK in terms of coverage. By December 2021, numerous other high-income countries had vaccinated a greater proportion of their eligible population than the UK.
COVID vaccines for children were also slow to be approved in the UK compared with other countries. This allowed misinformation groups to push false information about vaccine safety. Combined with other factors such as limited health promotion, this appears to have contributed to a slow uptake in children.
Not a positive legacy
By August 2022, the UK had confirmed more than 200,000 COVID deaths and close to one million hospital admissions. The cumulative number of confirmed deaths per million people is higher in the UK than most other high-income countries.
Additional important burdens include long COVID, and indirect impacts on other areas of health such as increased NHS waiting times.
Overall, many failures of national governance have led to avoidable disease and excess deaths. The incoming prime minister, and her government, must ensure that the UK is better prepared to navigate any future public health emergencies. The consequences of the COVID pandemic, beset with national policy failures, will be felt by the UK public for many years to come.
Michael Head has previously received funding from the Bill & Melinda Gates Foundation and the UK Department for International Development.