The House of Commons Science and Technology Committee and Health and Social Care Committee have today published their report examining the initial UK response to the COVID-19 pandemic.
Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, Respiratory Sciences, University of Leicester, said:
“The House of Commons report: ‘Coronavirus: lessons learned to date’ published 12 October 2021 accurately highlights the failures of the UK’s initial response to the COVID-19 pandemic – but with some important omissions.
“The later success of the UK RECOVERY trials and Oxford-AstraZeneca COVID-19 vaccine development and rollout are acknowledged, but are irrelevant to the early failure to control the virus – and these ‘successes’ will not bring any of the 130,000+ who have died back to life. Many of these deaths were preventable had prompt and sufficient action been taken earlier.
“Even whilst the report highlights all of these shortcomings – the main question is what will be the UK government’s response? Governments will change over time and the messages will be lost – like the previous lost SARS-related and MERS-related pandemic response reports recently highlighted in the media:
“Having worked on respiratory viruses over the last 20 years in various countries around the world – the behaviour of this virus in terms of how it has spread and now its evolving seasonality/endemicity, is not really a surprise. Nor was the rapid, comprehensive response of the East/Southeast Asian countries (with their past experience) versus the more reluctant, slow and naïve response of Western countries (though I was surprised that Canada’s response was not quicker and more effective – given their previous experience with SARS 2003).
“Watching the UK’s experience with the COVID-19 pandemic was a bit like watching a child play with fire – a child that, unfortunately, did not listen earlier to more experienced voices and warnings from East/Southeast Asia (unlike Australia and New Zealand) – and as a result has been burnt badly in the process.
“We can only hope that this experience and this (and other) reports will not be lost or forgotten by the time the next pandemic arrives – whichever government is then in power.”
Prof Sally Bloomfield, Honorary Professor, London School of Hygiene and Tropical Medicine, said:
In response to “Is there anything missing”:
“The report makes no reference to the notable failure to engage and communicate effectively with the public about “hygiene interventions” and their importance Although preparedness plans acknowledged the vital role of public behaviours in the early stages before other measures were put in place, little effort was made to establish whether and to what extent the public understand how hygiene measures work to reduce infection risks, or assess the extent to which social distancing, ventilation, face coverings, mask wearing and contact surface hygiene might contribute OUTSIDE healthcare settings. As a result, much effort was made in telling us how to wash our hands, but no information on “when” to do it. At first the public were told masks were not effective, but this was then reversed. Being told “hands, space, face” fostered a view that hand washing is the most important intervention. Was this intentional? The public failed to understand that, since no single measure is 100% effective, minimizing infection risk depends on adopting all of these measures.
“It is important, in preparing for future epidemics, pandemics, tackling AMR etc and for developing a “selfcare” culture, that the public’s poor understanding of risk and of what hygiene is and how it differs from cleanliness must be addressed.”
Prof Sian Griffiths, Emeritus Professor, the Chinese University of Hong Kong, and co-chair of the Hong Kong government’s SARS inquiry, said:
“The report is an important reminder that we need to learn from the mistakes made in responding to a pandemic and to ensure that steps are actively taken to make sure they are not repeated in the future. Amongst the key messages there is important recognition of the role of, and failure to adequately engage with, local public health teams and their communities – not only in test and trace but in considering the needs of vulnerable communities. Experience of the pandemic demonstrated the effectiveness of local engagement, which was left too late, and the report recommends that in the futures test and trace should be locally driven with the ability to draw on central surge capacity. This will require investment. The report also highlights the lessons to be learnt from the greater impact of the pandemic on vulnerable groups. The heavier burden amongst black and ethnic minorities who suffered disproportionately high death rates underlines the need for an urgent and long term strategy to tackle health inequalities. The higher death rate amongst other vulnerable groups, particularly those with learning disability additionally highlights that “plans for future emergencies should recognise that blanket restrictions to hospital may not be appropriate for patients who rely on an advocate to express their requirements”.”
Dr Michael Absoud, Honorary Reader, Department of Women & Children’s Health, King’s College London, said:
“The joint Health and Social Care, and Science and Technology Committees report on coronoavirus lessons to date, highlight the inverse care law as it particularly applies to: (i) children and (ii) autistic people and individuals with learning disabilities.
“Children’s wellbeing has been disadvantaged by banning outdoor play, learning and sport. With the upcoming autumn spending review, it hence follows that recovery and investing in the next generation has to be the most logical next priority.
“The covid pandemic has also bought to light that considerations for people have with learning disabilities and autistic people have been an “afterthought.” The disproportionately high mortality rate for autistic people and those with learning disabilities, is a reflection of historical and ongoing huge gaps in access to care. Furthermore, around 70% had experienced a reduction or cut to the social care support. The newly announced national autism plan needs proper investment to realise it’s aspirations of a more equal society.”
Dr Doug Brown, Chief Executive of British Society for Immunology, said:
“We welcome this joint report from the Select Committees on the UK’s response to the Coronavirus pandemic. Sadly, we are likely to be faced with other pandemic situations in the future and it’s important that we learn lessons from the current situation to improve future responses.
“As the report rightly points out, the UK’s research base has made a hugely positive contribution to hastening control of the pandemic. This includes through the development and rollout of COVID-19 vaccines, in particular the Oxford/AstraZeneca vaccine as one of the most successful outcomes of the UK’s response. Additionally, the coming together of the research community, through a ‘team science’ approach, to speed up our understanding of COVID-19 has also vastly benefitted the UK’s response to the pandemic. These achievements were only possible due to substantial investment and strategic focus on life sciences research in the preceding years. We must learn from this experience to continue to invest in the UK’s science base and deliver on existing Government commitments to increase spending on R&D to 2.4%GDP by 2027. The UK leads the world for the quality of our immunology research and we should be grateful to all the researchers, clinical staff and volunteers who worked tirelessly to increase our knowledge of COVID-19, bringing about significant improvements to patient care and to the vaccine rollout. We now have the opportunity to build on this learning to put the infrastructure, focus and expertise in place to allow us to maintain momentum and plan for a range of future pandemic scenarios.”
Dr Simon Williams, Senior Lecturer in People and Organisation, Swansea University, said:
“One of the biggest mistakes raised by the report was the UK’s slowness to lockdown when cases were clearly spiralling in March last year. The report states that there was ‘a widespread view that the public would not accept a lockdown for a significant period’. However, this was not the case, with many scientists, including some on the government’s own SPI-B, arguing that an earlier lockdown was both necessary and that there was no evidence to suggest that the public would not be able to accept a lockdown. We now know that this was a critical error of judgment. Evidence has shown that the vast majority of the public have been accepting of, and compliant with, multiple long lockdowns, despite how hard it has been for them.
“In my view, another big mistake was the increasingly complex nature of the rules, and the inability of the UK to form a more joined-up approach across the four nations, and even within regions of the same country. This over complicated things and local lockdowns were poorly received. The report states that “from May 2020, Government guidance became increasingly complex and harder to understand, with restrictions varying in different parts of the country. Government communications did not always reflect this nuance, leading to perceived inconsistency and divergent strategies across the four nations of the UK”. This is accurate. Research, including our own, has documented how increasingly confused the public became with differing and changing regulations – something that negatively affected people’s ability to follow to the rules (we called this ‘alert fatigue’ because people started to tire of all the regulation changes and find it hard to know what current restrictions actually were)
“Looking at the UK, the big issue is trust. We know that trust in government is the big factor predicting whether or not people will comply with any new restrictions that might be introduced. As well as some successes, this report reveals the numerous failings that the UK experienced during the pandemic. We have a trust deficit in government’s handling in the pandemic and restoring it will be very difficult. But trying to rebuild public confidence in government’s handling of the pandemic is essential if there is a need to move to ‘Plan B’ and invoke some new restrictions. We cannot guarantee that compliance will be as high this time around.
“Also the report does suggest the heavy focus on vaccination. Rightly so, but we do need to other mitigations are in place along the way if rates of Covid and flu start to rise significantly over the next couple of months.
“Although the report – rightly – notes the early success of the UK’s vaccination roll-out, amongst vulnerable groups in particular, it is not current to suggest that the UK has been one of the most successful, even in Europe, as the case of Portugal attests. We have been slow to offer the vaccine to children aged 12-15 and we have seen how high rates in this age group have been lately.
“Thinking ahead, one of the most important lessons is not to understand the ability of people to do what is necessary for the greater good of public health. So long as the advice is clear, without mixed messages, and the rationale for adhering to restrictions is also clear, most people will comply with various restrictions, even the harder, ‘higher-cost’ ones like lockdowns.
“Another key lesson is to make sure that the test, trace, isolate system is more efficient from the start and that government provides adequate support for self-isolation. The report notes the failings of the support for those being asked to self-isolate. It is essential for any future pandemics, waves that testing, tracing and isolation is able to nip any outbreaks from the start.
“A final key lesson is to avoid mixed messages and ensure that governments and policymakers across the UK work more effectively together to ensure that, for the good of the UK, policies are joined up and the public are given clear advice and guidance rather than mixed messages, which ultimately undermines compliance.”
Prof Penny Ward, Independent Pharmaceutical Physician, Visiting Professor in Pharmaceutical Medicine at Kings College, London, said:
“This report from the science and technology and health and social care committees summarises the evidence presented to them as they sought to learn lessons from the COVID outbreak and make recommendations for the future. For the most part, the report tells us what we already know and the recommendations made fall short of addressing some key issues. The most glaring omission is the lack of any commentary on the relevance of antiviral treatment in disease management.
“The report is self-congratulatory on the ‘success’ of the vaccine and of the foresight of the Vaccines Taskforce. However we have failed to ensure sufficient uptake of the vaccination among younger adults and teenagers and some higher risk communities – most notably those of African heritage – which is at least one possible reason for the continued circulation of infection resulting in more than 700 hospitalisations and 100 deaths daily, on average in the UK currently. We know from the pattern of infection, symptom elaboration and disease progression that an effective antiviral treatment given early post infection and illness onset will prevent later more severe disease and reduce deaths. A range of oral antiviral medicines and monoclonal neutralising antibodies have been investigated in clinical trials. Several monoclonal antibody therapies have been available in the US and EU early this year but have yet to be deployed in the UK. We know that these products, given early in the course of disease in the ill can reduce the burden of hospitalisation and death. However it seems the UK has determined to provide these only for individuals admitted to hospital; while this may still reduce in hospital mortality, earlier intervention would prevent need for hospitalisation at all and permit the NHS to make some headway on tackling the backlog of treatment needed for other disorders. Although the formation of an Antiviral Taskforce was announced in April we have yet to hear any recommendations from the committee. Its beyond time to hear from them on how their strategy for purchase and deployment of effective antiviral treatments as a supplement for vaccination to enable us, once and for all, to get on top of this epidemic.”
Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:
“The latest House of Commons Select Committee Report on lessons learned from the pandemic covers a number of elements of the UK’s COVID-19 pandemic response. The report discusses in detail events and decisions made during March 2020 and is critical of the “delay” to implementing the first UK-wide lockdown on the 23rd of that month.
“The report concludes that an earlier lockdown would have saved lives. This is likely to be correct but is too simplistic, not least because there is disagreement as to how many lives would have been saved. Recently published analyses have concluded that the additional lives saved due to implementing full lockdown restrictions may have been far fewer than was being suggested at the time.
“Moreover, lockdowns are harmful in their own right. For example, the delivery of non-COVID-related healthcare was severely compromised and this is now thought to have cost many lives of itself. The Select Committee report does not examine these indirect harms in any detail.
“The lesson here is that a decision about when to impose such a drastic intervention as lockdown – and when to remove it – must be evaluated with regard to the balance of harms caused, not by weighing only one side of the scales.
“A reasonable conclusion for the case of the UK COVID-19 epidemic in March 2020 is that the government should have intervened earlier but that intervention did not have to be as drastic as a full lockdown. More sustainable measures implemented in early March could have both saved lives and avoided the worst effects of lockdown.”
Prof Trish Greenhalgh FMedSci, Professor of Primary Care Health Services, University of Oxford, said:
“One striking feature of the report as a whole is how it hints at a less than healthy relationship between government and its formal scientific advisory bodies. There is much to digest, but on a preliminary reading it would appear that even senior government ministers were reluctant to push back on scientific advice that seemed to go against common-sense interpretations of the unfolding crisis. It would appear that SAGE, COBRA, Public Health England and other bodies repeatedly dismissed the precautionary principle in favour of not taking decisive action until definitive evidence emerged and could be signed off as the truth. This is shown, for example, in paragraphs 100-101 when both Dominic Cummings (the Prime Minister’s then Chief of Staff) and Matt Hancock (the then Secretary of State for Health and Social Care) are both quoted as feeling unable to challenge a “scientific consensus” even when they believed that a catastrophe was unfolding and urgent action was warranted. In Hancock’s words:
“I was in a situation of not having hard evidence that a global scientific consensus of decades was wrong but having an instinct that it was. I bitterly regret that I did not overrule that scientific advice at the start and say that we should proceed on the basis that there is asymptomatic transmission until we know there is not, rather than the other way round.” (para 101 p 41)
“These heartfelt regrets should prompt an urgent analysis of why, in the memorable words of Andrew Nikiforuk, the precautionary principle “was abandoned like an orphan on the Silk Road”—by scientists as well as policymakers. Uncertainty is a defining feature of crises. As the pandemic continues to kill hundreds each week in the UK, scientific committees are still having angels-on-the-head-of-a-pin arguments about whether the evidence is sufficiently definitive to count as “certain”. Dare we replace “following the science” with “deliberating on what best to do when the problem is urgent but certainty eludes us”? This report suggests that unless we wish to continue to repeat the mistakes of the recent past, we must.”
Dr Bill Mitchell OBE, Director of Policy at BCS, The Chartered Institute for IT, said:
“The report rightly highlights that computational modelling is an essential part of dealing with pandemics and that these models must be developed from high quality input data to have any real value.
“What the report misses is that not all models are equally useful; different methods of creating a model hugely affect how reliable they are.
“For a pandemic model to be used wisely we need to understand the levels of uncertainty and fragility within its predictions. Then, policy makers using these predictions as evidence need to understand what those uncertainties mean in terms they can explain to the public.
“That is equally important to having the right public health data to create the models in the first place.”
Prof Robert West, Professor of Health Psychology, Department of Behavioural Science and Health, UCL, said:
“We can expect Government spokespeople to cherry-pick parts of the report that praised its actions, particularly the gamble that an effective vaccine would be produced. However, there is no escaping the damning conclusion that it failed to take crucial public health advice on key decisions relating to test-and-trace and timing of restrictions and that led many thousands of British citizens to perish. In some countries, this report would lead to resignations. Going forward, the Government has set its face against sensible mitigations that would reduce the ongoing infection rate and it appears to be seeking to normalise a death toll of more than 30,000 per year indefinitely with more than 1 million cases of chronic illness and an additional burden on the NHS of more than 300,000 hospital admissions per year.”
Prof Marian Knight, Professor of Maternal and Child Population Health, Nuffield Department of Population Health, University of Oxford, said:
“We heard on the news this morning that a high proportion of those currently in intensive care and undergoing extracorporeal membrane oxygenation (ECMO), the most intensive form of respiratory support, are pregnant or recently pregnant women. There have been more deaths from covid-19 in pregnancy in the third (Delta) wave of infection than in either previous wave, unlike most other population groups. This stems directly from very high levels of vaccine hesitancy amongst pregnant women, who were not included in vaccine trials until too late resulting in a lack of safety data. Data on whether or not women were pregnant at the time of vaccination was not collected until several months into the vaccination programme. We still have no robust data on the outcomes of pregnancy in vaccinated pregnant women to support other pregnant women when they are making their own choice about vaccination. Yet there is not a single mention of pregnant women and lessons learned in this report. They are once again a forgotten and overlooked group. If they are ignored in reports such as this, how can we ensure that the same mistakes are not made again in the future?”
All our previous output on this subject can be seen at this weblink:
Prof Mark Woolhouse: “I am a member of a SAGE-subgroup (SPI-M) that provided some of the advice commented on in the report.”
Prof Marian Knight: “I lead the UK national Confidential Enquiries into Maternal Deaths and the UK national study of hospitalisation with covid in pregnancy”
None others received