27 January 2021updated 01 Feb 2021 7:57am

Matt Hancock understands, unlike the PM, that in a health crisis, there’s no “best of both worlds”

The Prime Minister’s approach has led to many more deaths than might otherwise have occurred and to unnecessary economic damage.

By Stephen Bush

The UK’s vaccine roll-out stands apart from the rest of the British government’s response to the crisis – and not just because it has been a success. One way of explaining this is to see the Conservative government as the lucky beneficiary of a series of benign inheritances.

Britain is a centre of pharmaceutical excellence. Our healthcare regulator, the MHRA, won between 20 and 30 per cent of all contracts from the European regulator before the UK voted to leave the EU. That expertise facilitated the UK’s rapid approval of the AstraZeneca and Pfizer vaccines, which in turn enabled the swift purchase of vaccine supplies. The National Health Service’s centralised structure is well designed to manage a complex logistical operation and to distribute doses around the country.

But the successful vaccine programme is not solely a product of the UK’s well-established advantages, and it would not have happened had ministers made different choices. What has distinguished it from the rest of the British government’s pandemic response is the superior understanding displayed by the Health Secretary, Matt Hancock. The UK spent heavily on a number of research avenues and vaccine projects, which meant that by mid-November it was third in the world in terms of vaccine pre-orders per capita.

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That gamble has been validated in two ways. Inevitably, not every vaccine project has succeeded, but the UK has been better able to weather the failure of some of its investments than other states. Hancock’s largesse also compensated for parsimony elsewhere: the government’s reluctance to pay the costs of further restrictions on trading in the run-up to Christmas means that the UK has experienced a much larger outbreak than it otherwise would have done, and is facing a longer lockdown.

What Hancock understands, and Boris Johnson does not, is the difference between a health crisis and a normal political challenge. The art of leadership is often about finding the solution that allows you to do most of what you want, while keeping your party and the public onside. But in public health, there is no option that allows you to have the “best of both worlds” – the middle ground brings all of the downsides and none of the benefits.

The government’s belated embrace of international quarantine is a case in point, with arrivals to Britain from some countries potentially facing a ten-day stay in a nearby hotel at their own expense before they are allowed “properly” to enter the country. This would hammer tourism and aviation, because it makes leisure travel unviable. It is also too short a period of time to prevent people incubating and spreading the virus. Or, as one civil servant put it: “The Treasury’s position is that contraceptives are too expensive. The Health Secretary’s position is that we should buy everyone a condom. So government policy is that we buy everyone a condom but tell them to take it off halfway through.”

One reason the government’s strategy on vaccines has avoided such disastrous halfway measures is that while it has spent generously, the actual sums involved are fairly small. The UK’s estimated total outlay on development and deployment up until December was less than it spends every month on the furlough scheme.

The trouble is that securing and maintaining the benefits of this successful vaccine strategy requires a broader, international approach – one that costs more and is harder to defend politically. The vaccines appear to perform well against the mutations that have emerged thus far. But the reality is that while there is an uncontrolled outbreak anywhere in the world, the prospect of new and more dangerous strains of the virus, and with them a return to punishing lockdowns, remains.

The British government can do two things to prevent a new variant leading to a fourth lockdown. The first involves building on a Theresa May-era legacy: the Vaccines Manufacturing and Innovation Centre in Oxfordshire, which when complete will facilitate the swift development and deployment of new vaccines. With more funding, this could future-proof the United Kingdom against later Covid-induced lockdowns.

The second involves increasing, not decreasing, British generosity to the Global South. (As it stands, the government aims to slash the foreign aid budget from 0.7 per cent of GDP to 0.5 per cent, though a growing and well-organised group of dissenters on the Tory benches may prevent this.)

Within the government, influence over coronavirus policy has shifted decisively towards ministers who have argued that the government should act swiftly and rapidly, such as Hancock and Michael Gove, and away from Rishi Sunak, the Chancellor, who was acclaimed early in the crisis. Yet it’s far from clear whether the Prime Minister has absorbed the key lesson of the past year, which is that in a pandemic it is better to act decisively rather than to seek middle-of-the-road solutions between two competing options.

Johnson shows no signs yet of being willing to intervene effectively on one side or the other. Measures that neither stem the flow of infections nor allow the normal functioning of the economy, such as the ten-day quarantine, still emerge from the government with alarming regularity.

The biggest issue of the past year isn’t that the Department of Health has been right and the Treasury has been wrong; it is that No 10 has repeatedly tried to have it both ways. This approach has led to many more deaths than might otherwise have occurred and to unnecessary economic damage. If Johnson wants to atone for the failures of 2020, he should demonstrate he understands that fact.