July 18, 2024

expert reaction to report from module 1 of the Covid inquiry

Scientists react to the module 1 report of the Covid inquiry. 

Prof Christophe Fraser, Moh Family Foundation Professor of Infectious Disease Epidemiology, Pandemic Sciences Institute, University of Oxford, said:

“The most urgent recommendation from this report is for a much needed overhaul of pandemic preparedness, which will require long-term investment to generate capacity for an effective response to new pathogens.  This is not an abstract recommendation about a theoretical risk.  New pathogens with pandemic potential are constantly being monitored.  Presently, a new strain of avian influenza virus is spreading amongst dairy cows in the USA, sea lions in South America, and has infected many other mammals including sporadic cases in humans, with five human cases reported in one farm just last week.  We don’t know exactly what the risk is of this strain causing a flu pandemic, but we know that the risk of has increased in the last year.  In the event of a severe pandemic, there are many new tools that could be deployed including rapid diagnostic tests, prophylactic treatment, digital contact tracing, and a data-driven response that would lead to precise guidance on avoiding risks and identifying vulnerable groups.  Vaccines can be deployed faster than ever, but we still would need to delay the pandemic wave for at least a few months.  Only with adequate investment can we avoid the mistakes of 2020 and rapidly scale up a response that reduces the risks of uncontrolled spread and reactive lockdowns.  Not all flu pandemics are severe, so we need quick intelligence to right-size our responses.  As the inquiry report points out, the UK’s pandemic plans, last updated in 2011, do not consider the possibility that the pandemic wave could be held back whilst vaccines are prepared.  Those plans are not fit for purpose, as much for flu as for other viruses.  Increasing our capacity for a rapid coordinated scale-up to emerging pandemic threats is urgently needed.”

Prof Thomas House, Professor of Mathematical Statistics, University of Manchester, said:

“There is much to recommend in the report.  However, the claim that can be summarised as “we prepared for flu not COVID” and which was widely made by various commentators makes little sense to me.  The most charitable interpretation I can manage is the claim that the strategy used for SARS1 would have been preferable to the strategy used for influenza A H1N1pdm09, but we don’t respond to all coronaviruses like SARS1 (e.g. MERS merits a different approach), nor was the plan ever to respond to all influenza pandemics as though they were mild.  In fact, large-scale NPIs for outbreak response that we would now call “lockdown” and at the time were called “Targeted layered containment” were proposed during the George W Bush era and shelved by Obama in the US context with other countries somewhat following suit.  There were serious concerns about the implications of such measures for wellbeing (as we saw with the many harms of “lockdown”), whether they would actually reduce transmission, and even if they did reduce transmission whether they would cause worse overall infection impacts.  The idea that we were in a position to ignore all such concerns and rush towards implementation of such unprecedented measures in early 2020 seems problematic for our future pandemic preparedness and a more thoughtful account of the significant early uncertainties involved might have been warranted, rather than simply attributing various expert consensus positions that turned out to be largely correct to “groupthink”.”

Prof John Edmunds, Professor in the Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, said:

“On the issue of “groupthink” there are a few things that may be relevant.  First, this is really just another way of saying consensus.  It is true that the committees tried to reach a consensus on issues, to clarify the advice feeding into government.  Perhaps, a greater emphasis on the level of certainty (or uncertainty), would have been more appropriate, which would have better reflected areas of disagreement.  We did actually do this during the pandemic, but it was not consistently applied in the pre-pandemic planning.

“Second, we were mostly responding to a request.  This tends to narrow down the options.  Perhaps we (particularly the chairs of the relevant committees) should have queried whether we were answering the right questions, and whether there were alternatives.

“Finally, as scientists we are very open to challenge.  We challenge each other all the time.  The process of peer review is an inbuilt challenge.  Then when we publish our work and our workings, we expect them to be challenged by our colleagues.  That is how we progress.  Building this sort of challenge into Government planning is quite a big step, but it needs to be done.  This means being open about the workings as well as the plan, as well as building in the equivalent of the scientific peer-review (aka “red teaming”).”

Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said:

“The Inquiry’s finding that the government’s scientific advisors suffered from “groupthink” is indicative of the broader, systemic problems that exist within the British scientific establishment.  Given the need to rapidly rethink the official pandemic plan, government scientific advisors had to draw on the exceptional scientific talent and skills that undoubtedly exist in the UK.  But UK science was, and remains, overly hierarchical, dependent on slow processes for picking up errors, and prone to fall into the trap of considering those with titles and positions of authority as infallible gods.

“’Following the science’ quickly became a mantra from politicians in early 2020, seemingly to deflect questions about government handling of the pandemic.  But ‘the science’ was merely advice being formulated largely in the dark and based on a very limited understanding of the situation.  Those same politicians had only very recently been re-elected to make decisions and it was their responsibility to ensure that advice came from a variety of sources.  To claim that a bunch of scientists should or could have provided advice on the impact of measures on the economy is ludicrous, especially when the state has a retinue of such experts in the Treasury and other departments.  What advice did they give politicians and how was it balanced against the science?

“Expecting ministers and civil servants who probably lack scientific training to ask the right questions was similarly unrealistic.  The clamour for their attention was extreme and as such they turned to a cadre of senior scientists who arrived at a consensus opinion, which sometimes proved wrong, but that’s not unheard of in science.  As the report correctly points out, a very broad consensus opinion was that a dangerous form of flu would cause the next viral pandemic and so, in the scramble to find an alternative plan, it’s not entirely surprising that they didn’t really know what they were doing.

“We do not know how much dissent there was in various meetings because along with their workings, such information wasn’t minuted and dissenting interpretations and conclusions are not the same thing as grift.”

Prof Sir Peter Horby, Director of the Pandemic Sciences Institute at the University of Oxford, said:

“Today the UK Covid-19 Inquiry has rightly recognised that the UK was ill prepared for the pandemic and is recommending fundamental reform.

“Whilst the UK pandemic plans are criticised, I was pleased to see that Baroness Hallett recognises that systemic weaknesses in the UK played a key role.  Whilst plans are important, “everyone has a plan until they get punched in the face”.  What matters even more than plans is replacing systemic weakness with systemic resilience.

“As such, I tentatively welcome the recommendation to simplify and unify structures, including creating an independent statutory body responsible for whole-system civil emergency preparedness, resilience and response, but it will be important to understand how that will dovetail with UKHSA.

“I also welcome the recommendations to establish (and test) new mechanisms for fast and reliable data to inform responses and to commission ‘hibernated’ and other studies designed to be rapidly adapted to a new outbreak.  This recognises what worked well in the pandemic and the critical importance to national health and welfare of excellent science and sound science advice.

“In short, a quick read suggests the report is giving sound advice.  We now need to see this followed by sufficient long-term commitment and money, not only to fully implement the recommendations of this report but to rebuild the UK’s health, social care, and public health systems.

“Future pandemics are inevitable, and it is critical that these lessons are put into practice.  We were on the back foot in 2020, but we have a once-in-a-generation opportunity to implement these lessons and put humanity on the front foot next time.”

Prof Sir David Spiegelhalter, Emeritus Professor of Statistics, University of Cambridge, said:

“The 2017 National Risk Register did include an ‘emerging infectious disease’ such as SARS and MERS, but the ‘reasonable worst case scenario’ was only ‘several thousand people experiencing symptoms, potentially leading to up to 100 fatalities’.  This was the underestimate of the century – by the end of 2023, over 230,000 people in the UK had died with ‘Covid-19’ on their death certificate.

“Over-focus on a single scenario was criticised in the Blackett Review of High Impact Low Probability Risks in 2010.  Perhaps a greater acknowledgement of uncertainty and variability in 2017 would have been useful.”

Prof Martin Hibberd, Professor of Emerging Infectious Disease, London School of Hygiene & Tropical Medicine, said:

“For pandemic preparedness for disease “X” the scenarios are often based around Influenza, because it is thought to be the most likely to cause widespread disease.  While some Influenzas are known to have high mortality in humans, but are difficult to transmit between humans, others are highly contagious but cause well known illness in humans – and for which we have vaccines.  A new virus that was a mixture between these scenarios would be highly dangerous.  However, a new pandemic Influenza, such as happened in 2009, would be very difficult to control as it is highly contagious, with many people who carry the virus able to transmit with few symptoms.  The pandemic preparedness thus plan for this eventuality, based on previous experience.  Much of the planning for this Influenza pandemic would also apply to other infections, but not to all.  In 2003, the world was affected by SARS-CoV-1, with a high mortality and high potential for transmission.  However, the world was able to contain this pandemic because most people showed symptoms before they could transmit the infection.  For this type of pandemic, different sets of guidelines could be implemented, essentially to prevent the outbreak by isolating infected people before they became contagious.

“When COVID-19 pandemic started, it was initially unclear which type of pandemic it would be, and even now it is clear that it does not fit exactly into either category.  However, it is clear that countries that tried to prevent transmission, following more along the lines of the 2003 SARS outbreak control measures, and wait for science to provide measures to protect the population (such as vaccines), did better at protecting the population from the COVID-19 disease.  To make this work though, with a difficult disease like COVID-19, immediate and strong actions were required.”

Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:

“The report of UK Covid-19 Inquiry on its work during Module 1 is admirably clear about the flaws it has identified in the UK’s pandemic resilience and preparedness.  Science and scientific advice feature heavily in the Inquiry’s assessment both of the problems and possible solutions.  It matters that we learn these lessons because, as the Inquiry has fully taken on board, the view of many scientists – myself included – is that another pandemic is inevitable, and it could be considerably more challenging even than Covid-19.

“Firstly, preparedness planning was overly about flu.  Covid had some similarities with flu – they are both respiratory pathogens – but it is different in key respects that should have led to a response that focussed more on test, trace and isolate and protecting the most vulnerable.  Instead, the UK relied heavily on social distancing.  Unfortunately, because Covid is more transmissible than flu, the social distancing measures implemented – culminating in lockdown – had to be far more severe than any of the planning had anticipated.  This was an obvious flaw given the research that had been done in the preceding years to identify other kinds of threat.  Coronaviruses featured regularly in those threat assessments, but planning in the UK retained its focus on flu.

“Secondly, government risk assessments were inadequate in that they failed to consider the wider impact of the pandemic beyond public health.  The report confirms that no work had been done to understand and mitigate the socio-economic harms done by lockdowns, which made it almost impossible to know whether or not they were a proportionate response to the crisis at hand.  For the future, the report recommends “consideration of the interventions that can and should be deployed to prevent a lockdown”, though it does not take lockdown off the table entirely.

“Thirdly, the report cautions against groupthink among advisors, including scientific advisors.  There are two main problems here.  One is that scientific advisory groups did not set their own agendas, instead they reacted to requests from government.  In the future, greater autonomy of advisory committees is needed; as I told the Inquiry myself: you can’t always trust governments to ask the right questions.  The other problem lies within the committees themselves in that they paid too little attention to minority or dissenting voices.  To change that, we need to move beyond the consensus model for delivering scientific advice to the aim of giving government a range of scenarios to consider, not just the one deemed most likely.

“Finally, the report has some important points to make about data and research needs for future pandemics.  It emphasizes that this work should be done not only at pace during an emergency – important though this is – but, as far as possible, the groundwork should be done between pandemics.  This is a clarion call that many UK funding agencies have already heard, but it is vitally important that momentum is not lost as memories of the pandemic years fade and other priorities dominate the science and policy agendas.”

Prof Tom Solomon, Director of The Pandemic Institute and of the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, said:

“Although both influenza and the Covid virus are transmitted by the respiratory route, there are important differences.

“Influenza viruses only infect people for a few days before people show symptoms (this is called the incubation period) and most infected people do have symptoms, and transmission to others is mostly by coughing and spluttering droplets onto them.

“In contrast SARS-CoV-2 (the COVID-19 virus) infects people for a longer incubation period before they show symptoms (even up to 2 weeks), during which time they can pass the virus on to others without knowing about it.  Indeed many people infected with this virus never show symptoms at all.  In addition as well as passing the virus to others by coughing and spluttering, SARS-CoV-2 is also transmitted as tiny virus particles floating in the air for a long time, which can infect people who are not close to an infected individual.

“Of course we know all this now but we didn’t know when this new virus was emerging at the end of 2019.

“Because of these differences in the biology of the viruses, SARS-CoV-2 was much more difficult to contain and approaches such as testing people who have no symptoms, tracking down their contacts, and asking all of these people to isolate were much more important for the coronavirus then they would have been for an influenza virus outbreak.”

Prof Jimmy Whitworth, Emeritus Professor of International Public Health, London School of Hygiene & Tropical Medicine, said:

“Baroness Hallet has produced a hard-hitting report that is critical of many aspects of the UK’s preparedness for epidemics, and recommends wide-ranging and radical changes for the future.

“The report lays out clearly how the only pathogen for which substantial planning and preparation existed prior to 2019 was influenza and even then the preparations had been only partially implemented.

“This meant that the response plan was too narrow and inflexible, so the UK was not as well prepared for an epidemic as had been thought.  While the response plan focused strongly on the health sector, it did not adequately consider plans for other sectors such as education, trade and finance.  Consequently it is not surprising that the response plan was discarded very early in the COVID-19 outbreak.”

Prof Danny Altmann, Professor of Immunology, Imperial College London, said:

“I’m impressed by the seriousness and comprehensiveness of this Module 1 report and think Baroness Hallett and the inquiry team deserve huge praise.  As one who has been engaged with and involved in many aspects of the pandemic from the first days of January 2020, I’ve been dismayed by some parts of press and policy-makers denigrating the inquiry as a waste of time and money or as some form of petty personality dispute.  We’ve lived through the worst disaster in our recent history, with upwards of 230,000 deaths, making us one of the most badly affected Western nations.  In terms of responsible governance, if we had lost that number to, say, a Tsunami, we’d have an enormous inquiry to investigate all the nuts and bolts of future mitigation and best practice, so why not even more so for the inevitable likelihood of another viral pandemic.  Events such as this stress-test the machinery of our democracies to the maximum.  This report concludes in strong terms that we emerged very badly from that stress-test, for reasons that are specific and addressable.  Some key ones were lack of ongoing investment in the NHS and operational infrastructure, health inequalities, the poor interface between experts and government, the lack of freedom and autonomy of advisors, and the basic lack of big-data-literacy among policy-makers.  Noting the recommendation for ‘a new approach to risk-assessment’ – we would all sign up to this as key and central, but how to build this approach when it can only be as good as the data and data analysis going into it.”

‘UK Covid-19 Inquiry: Module 1: The resilience and preparedness of the United Kingdom; A report by The Rt Hon the Baroness Hallett DBE, Chair of the UK Covid-19 Inquiry, July 2024’.

Declared interests

Prof Christophe Fraser: “My team receives research funding from the Coalition for Epidemic Preparedness Innovation (CEPI) for work on simulating emerging infections and accelerating vaccine trials.

My team receives research funding from the Gates Foundation and from the US National Institutes of Health for work on HIV.

I am a member of SPI-M and NERVTAG, but responding here in my personal capacity.”

Prof Thomas House: “Thomas House was a member of the SPI-MO modelling sub-committee of SAGE and is currently a member of the DHSC pandemic modelling advisory committee SPI-M.”

Prof John Edmunds: “Was on SAGE, SPI-M and Nervtag.”

Dr Simon Clarke: “I have no conflicts of interest.”

Prof Sir Peter Horby: “Peter Horby is Director of the Pandemic Sciences Institute at the University of Oxford and a regular advisor to the UK Government, including as Chair of NERVTAG during the pandemic.”

Prof Sir David Spiegelhalter: “No conflict of interest I think, except attendance at a single SAGE meeting.”

Prof Tom Solomon: “Director, The Pandemic Institute;

Director, NIHR Health Protection Research Unit in Emerging and Zoonotic Infections;

Chair, Neurological Science, University of Liverpool;

Honorary Consultant Neurologist, Walton Centre NHS Foundation Trust;

Vice President (International), Academy of Medical Sciences;

Censor, Royal College of Physicians of London.”

Prof Martin Hibberd: “I have worked on pandemic influenza, SARS and COVID-19, and advised governments, but not on official government actions except for Singapore (SARS and pandemic Influenza). Thus, I have no conflicts to declare for this.”

Prof Mark Woolhouse: “During the Covid pandemic MW was a member of advisory committees for Scotland and the UK.”

Prof Jimmy Whitworth: “I provided expert witness testimony in Module 1 of the inquiry, and I am quoted in Baroness Hallet’s report.”

For all other experts, no reply to our request for DOIs was received.