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Editorials

The parliamentary committee report on covid-19 response

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2530 (Published 15 October 2021) Cite this as: BMJ 2021;375:n2530
  1. Deepti Gurdasani, senior lecturer in machine learning,
  2. Martin McKee, professor of European public health
  1. 1William Harvey Research Institute, Queen Mary University of London, London, UK
  2. 2Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to: M McKee martin.mckee{at}lshtm.ac.uk

Have lessons really been learnt?

The Commons Health and Social Care and Science and Technology parliamentary committees have released a scathing report on the government’s covid-19 pandemic response, describing it as one of “the most important public health failures the United Kingdom has ever experienced.”1 The list of failures was long. Ministers had delayed implementing the initial response, partly because they were viewing the crisis through “a veil of ignorance.” Care homes were effectively abandoned.2 A much lauded test and trace system had a “marginal impact on transmission.”

The few successes, such as development of a vaccine, the contribution of the armed forces, and the heroic efforts of NHS staff, are to be celebrated but do not compensate for the mistakes, including the many procurement scandals, that fell outside the report’s remit,3 as well as the many yet to be rectified.

The report is called Coronavirus: Lessons Learned to Date. Unfortunately, important lessons have still not been learnt. The report described how “comparisons with flu, and a fatalistic view of inevitable spread greatly impacted the pandemic response.” This fatalism is still evident, implicit in the acceptance of roughly 800 deaths a week (equivalent to 43 000 a year), far higher than in our European neighbours.4

The report notes how politicians found it difficult to challenge the scientific consensus. But was there a consensus? Many UK scientists, including those who would later create the advisory group Independent SAGE, expressed concern at the time, while those in other countries, such as Italy, spoke out about the risks the UK faced.5 Politicians who did challenge government policy were attacked. In a disturbing account on BBC Newsnight on the day the report was published, Rory Stewart, former Conservative secretary for international development, recalled his question about mask wearing being dismissed by the then deputy chief medical officer.6 His calls to learn from experiences in East Asia or Italy, highlighted in the report as a crucial failing, were also rejected, with the health secretary and cabinet secretary asking him to keep quiet, while his questions about travel restrictions and school closures led to him being attacked as a “hysterical populist,” a view seemingly shared by politicians from all three main English parties.

Ongoing failures

The “exceptionalism” cited by the report is still evident. The UK was exceptional in its removal of almost all mitigations in England when a third of the population was not fully vaccinated. It offered the vaccine to adolescents far later than many other countries, and then only one dose. It has done little to implement mitigations, such as improved ventilation in schools. The consequences of these decisions can be seen in our comparatively poor performance on vaccination now.7

We still lack the transparency called for in the report. We have yet to see the evidence behind key policy decisions such as removing recommendations for masks in schools in May 20218 and the Joint Committee on Vaccination and Immunisation’s view on vaccination of 12-15 year olds.9 Scientific advisory groups still lack international input. The “slow and gradualist approach” lives on, with even simple measures such as masks in schools only put in place after large outbreaks, rather than preventively. As we approach winter with rising cases, around 800 hospital admissions daily, and an already struggling NHS, the government again seems complacent. The effect of the lack of a precautionary approach is clear in the substantial burden of long covid.10

Concerningly, ministers seem reluctant to learn these lessons. On the day the report was published, news coverage began with the words, “We asked the government to join us but no-one was available.” The prime minister was on holiday, recalling his absence from emergency response meetings when the crisis began. The one minister to appear in the media that day, Stephen Barclay, was repeatedly clear that the government was not going to apologise for the avoidable deaths, although other ministers did subsequently.11 The emerging line seems to be that the criticisms were made with the benefit of hindsight.

So what needs to happen now? We need an urgent public inquiry. This cannot wait until spring 2022, given the continuing failures and the need to apply these lessons to current response. Excuses that it would divert efforts of those involved in the continuing pandemic response are scarcely credible coming from a government that has launched major reorganisations of the NHS and public health. This inquiry must be undertaken by independent experts without a vested interest in the results. This means having a chair and substantial membership from abroad. Regrettably, the British medical establishment has struggled to challenge ministers effectively during the pandemic, although it is unlikely that its advice would have been listened to even if it had. But first we need a rapid assessment of where we remain out of line with best practice elsewhere and why.

Finally, this report is not just about covid. It has revealed major problems in how decisions are made within government.12 And given the many challenges that lie ahead, including Brexit, climate change, and much else, those problems are simply unacceptable.

Footnotes

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare that MM is a member of Independent SAGE.

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

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References

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