Should the UK government have been more prepared for a pandemic?

17th June 2020

COVID-19 will likely define or at least heavily influence a generation. Children use the word coronavirus as if it was part of normal life. The economy is the worst it has been during peacetime and civil unrest is becoming more a part of a standard norm that could reasonably be suggested as influenced by frustrations related to the COVID-19 pandemic. Working practices have changed and social distancing has been a strange and mentally challenging experience that most people will never have experienced before. While it is possible to see mistakes in hindsight, given the level of concern over pandemics voiced by scientists, medical professionals, and the military over the past few years, should the UK government have done more to prevent such a widespread crisis?

In 2019, the National Security Risk Assessment warned of the devastating potential of a flu-like virus. It mentions the need for personal protective equipment (PPE) stockpiles and the requirement for disease surveillance, contact tracing and mentioned the surge in excess deaths that would occur.1 It also mentions the requirement to repatriate British nationals back to the UK. While the nature of a novel coronavirus is that treatments, vaccines and mode of transmission have to be re-identified, the mechanics of responding to a pandemic remain the same. This was something highlighted years before in the 2010 and 2015 assessments alike. COVID-19 is also remarkably like SARS and MERS, both pandemics that scientists are well aware of.

The assessment goes on to say that: fifty per cent of people would be infected, though the real number would be higher due to the number of asymptomatic cases; a pandemic of moderate virulence could lead to 65,600 deaths with the potential cost to the economy of £2.35 trillion; it would take years for health and social care services to recover; there would be significant public outrage at any perceived poor handling of the government’s preparations and response. Though based on a flu-like virus the document explicitly says: “A novel pandemic virus could be both highly transmissible and highly virulent.”

The UK biological security strategy from 2018 also specifically states the global nature a pandemic may take. Pandemics are not restricted by borders and that emerging in one country it would quickly become a global threat and be the “highest impact risk faced by any society”.2 The strategy aims to ‘understand, prevent, detect and respond’ to biological risks as they represent a Tier One threat to national security.

Given the eerily accurate warnings given to government ministers, why was it that many decisions took time to implement? With seeming levels of uncertainty over the last three months on how to handle the pandemic, from implementing a lockdown to the length of time taken to decide whether face masks were necessary, a question to ask is what was it the government were working from? The main reason put forward for the lack of preparedness was not the lack of information but the lack of funding put into preparing for the problem.3 It seems ministers did not want to invest in something they did not believe could really happen during a time of austerity.

How is this possible given the undertaking of a pandemic crisis exercise code-named Exercise Cygnus that took place in October 2016? It accurately portrayed how a virus from south-east Asia would come to Britain carried by returning travellers.4 It involved all government departments, the NHS and local authorities across Britain. It showed how hospitals and mortuaries would be overrun and there would not be enough PPE for doctors and nurses, ventilators or critical care beds. Also that the public would be slow to heed government messages. One view is that the 2009 H1N1 swine flu outbreak was far less severe than initial modelling predicted, putting off ministers from investing in what was not a tangible or likely threat that would lead them open to criticism if it did not materialise. The NHS surge capacity, the ability to deal with sudden demand, was particularly criticised as needing attention but little seems to have been done to plug the gap. Storing PPE and other critical equipment does not seem to have been undertaken for fear of it going out of date and becoming obsolete.

The UK was not alone in being forewarned. In 2019 the Federal Emergency Management Agency in the United States warned ‘that a pandemic caused by a novel strain of influenza would cripple the country‘s response capabilities by driving millions of people into overwhelmed hospitals’.5 The report described in shocking accuracy the ‘social distancing’ and disruption to businesses and emergency services as a result as well as the shortages of medical equipment, hospital beds and healthcare workers.

The US military had been preparing and bracing for a pandemic since 2016.6 A military report published in January 2017 said: “The prevalence of significant disease coupled with instability may result in reduced security capabilities, providing an opportunity for international military conflict, increased terrorist activity, internal unrest, political and/or economic collapse, humanitarian crisis and social change”. While the military respond to external attacks rather than global health emergencies they were able to predict the difficulty in logistics that such a pandemic caused.7

To make matters worse it appears Prime Minister Boris Johnson missed five COBRA meetings in late January and early February just as the COVID-19 pandemic was starting to gain traction.8 While it is common for Prime Ministers to miss meetings it is unusual during a crisis. Also, the UK seems to have been hoodwinked into sending PPE to China in February only to have to ask for it back in March when the pandemic worsened in the UK. China seems to have been stockpiling PPE from countries, such as the US and Australia, in an effort to control the supply.9 10

At the time of writing the UK was ranked fifth in the world with over 297,000 confirmed cases of COVID-19 and the third most deaths of over 41,000.11 It is the worst affected European country by total number of cases and so makes missed opportunities all the more poignant. The government will need to ascertain whether it should have heeded warnings earlier and review whether more could have been done to pre-empt this pandemic. While there are many risks to assess, if more pandemics are likely then it would seem that the government will need to take more seriously the warnings of experts and allocate funding appropriately.