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The UK must learn from international experiences of the pandemic

So far, the Covid inquiry has considered little evidence from abroad.

By Christina Pagel and Martin McKee

Anyone listening to the evidence given to the Covid-19 inquiry so far could be forgiven for thinking that the UK was out in front, on its own, working out how to respond to the pandemic. While reference has been made to the virus’s emergence in China and the scenes that unfolded shortly after this in Italy, the possibility that we could have learned from other countries has barely been discussed.

This represents both a significant gap in the evidence and a lost opportunity. So far, the questions posed in the inquiry have focused largely on what happened and how it happened, exploring the relationships between scientists, civil servants and politicians. Not enough time has been spent on considering what could have happened – which is surely where we can learn for the future.

Lessons from other countries are clearly within the inquiry’s remit, which includes having “reasonable regard to relevant international comparisons”. Although there has been some written evidence on the international experience, very few questions have been asked of witnesses about that broader context.

There are three areas in which there is much to learn: why we did not draw more lessons from the successful responses of other countries during the pandemic? What can we learn now about how our response compared to other countries? And what we can learn from the way science advice was integrated into policy elsewhere?

Lack of learning during the pandemic

Matt Hancock has described how the “harrowing” account of what was happening in Italy, relayed to him by his Italian counterpart on 13 March 2020, influenced his view on the timing of the initial lockdown. That encounter took place at a G7 meeting, one of the rare occasions in which a British health minister would meet with their European counterparts post-Brexit.

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This relative isolation was reflected throughout the system. The UK was no longer formally linked to the European Centre for Disease Prevention and Control. Some officials did have personal links that enabled them to speak with their counterparts. Patrick Vallance has described what he refers to as “informal” discussions, presumably with other members of the European Science Advisors Forum. It also seems likely that members of Scientific Advisory Group for Emergencies (Sage) had their own scientific networks but it’s important to know whether they felt inhibited in reaching out for advice.

Outside the inquiry, a joint report from the House of Commons science and health committees concluded that “unwillingness to consider seriously and act on the approach being taken in Taiwan, Singapore or Korea was a serious error”.

By May 2020, scientists in many countries were trying to learn from responses adopted elsewhere. There were clear differences that went far beyond the timing of lockdowns. For instance, mask-wearing was widespread from the outset in East Asian countries; testing was increased remarkably quickly in South Korea, linked to very effective contact tracing; care homes were prioritised as sites with a high risk of transmission in Germany and Denmark; isolation centres were established in Singapore, Hong Kong and elsewhere; while Taiwan, Singapore and New Zealand sealed their borders to enable near-normal life for their populations for most of 2020.

This was all readily available information from the summer of 2020 onwards to both policymakers and members of Sage. The Tony Blair Institute released a global comparison at that time specifically to inform the opening up of the UK, while the European Observatory established a Covid-19 Health Systems Response Monitor which tracked policies implemented in Europe and North America. The UK’s Foreign, Commonwealth & Development Office (FCDO), with its worldwide network of diplomatic posts, also created an International Comparators Joint Unit (ICJU). Yet it remains unclear the extent to which these resources were used, or whether insights from other countries were seen as important or useful. Some comments suggest not, such as when the deputy chief medical officer for England Jenny Harries described Italy at the time as being in a “rubbish” position because, in her view, the UK had much more experience in pandemic planning.

[See also: Dispatches from the land of Long Covid]

Lack of learning from international responses today

The purpose of the inquiry is to identify the lessons that will better inform preparations for future pandemics. It has so far focused on issues such as the timing of lockdowns, particularly the first in March 2020. While timing matters, so does what you do during lockdowns to reduce the risk of a subsequent surge. For example, might the UK have used the time to invest in air filtration in buildings, as happened in Germany? Should it have adopted the so-called Japanese three Cs – avoidance of closed settings, crowded settings, and close social contact? This reflected the widespread acceptance in East Asia that the Sars-Cov-2 virus was airborne. This, in turn, might have reduced indirect harms as it would have enabled people to do more in the open air, and it would also surely have made the adoption of the infamous “Eat Out to Help Out” policy much less likely.

Do UK policymakers today believe they have anything to learn? Boris Johnson suggested not when he asserted that the UK was “well down the European table” in terms of Covid deaths. However, as was pointed out to him by counsel, those countries that did worse than the UK were mostly in eastern Europe, which have far fewer resources and weaker life sciences. A more nuanced examination suggests that the UK’s position owes much to the speedy roll-out of the vaccine. Countries in eastern Europe with poor vaccine uptake mostly did much better in the first wave (pre-vaccine) when they did lock down quickly.

It is clear that countries which acted quickly and decisively to reduce the spread of the virus until a vaccine was available did better in both health and the economy. Why did counsel for the inquiry not ask ministers and the new chief science adviser Angela McLean what structures the UK has created to learn from other countries as we continually revise our crisis response plans?

Is Sage the best model?

There seems to have been a complete lack of interest in how science advice worked in other countries. The inquiry has highlighted many concerns about how scientific advice was integrated into policymaking in the UK, including the fact that Sage members were discouraged from engaging with the media or public, and that there was a lack of politicians’ understanding and sometimes interest in the science and Sage reports. This echoed findings from a joint inquiry from the cross-party Health and Social Care Committee and Science and Technology Committee in 2021, which found that science advice was “impaired by a resistance to transparency” and “low levels of input from international experts”.

Are there more effective ways of organising scientific input in a public crisis? How can we know if we don’t understand what other models are possible? For instance, Germany had a more transparent science advice structure than the UK, but France a more opaque one. Scientists in many countries reported difficulties in communicating the science to decision-makers, while the OECD set detailed recommendations for how science advice can work.

The inquiry has much more to do. International experience can also be valuable in the modules yet to come, such as procurement, where a European Commission report identified both good and bad practice during the pandemic; the care sector, where international approaches did differ; and vaccines and therapeutics where, in contrast to the other areas, the UK did rather well. These opportunities to learn from others should not be missed.

[See also: Boris Johnson prioritised Brexit politics over public health]

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