Much Cummings but no goings last week. Resignations are so yesterday - reserved for traditionalist civil servants. Sound and fury signifying nothing? No, signifying that suspicions are likely well placed. What more have we learned? What must we do? Here are few suggestions.
Poverty, bad housing and poor nutrition are health issues. The pandemic has highlighted long recognised social causes of ill-health, now linked to ethnicity. Sir Michael Marmot’s seminal work on health inequalities is dramatically affirmed by the skewed social distribution of COVID deaths. Our increasing inequalities are not just deplorable, they are positively dangerous.
First: While the economy is being fixed post-pandemic, social justice must not be an afterthought.
Prevention is not just better than cure, it is a lot less demanding on the public purse. The medical consequences of obesity cost the NHS a fortune and now include the results of enhanced vulnerability to COVID. The cost of another major COVID surge would be ruinous. Changing people’s behaviour is not easy. But smoking has been significantly reduced, people wear seat-belts, and drink-driving brings social censure.
Second: MPs must stop talking about hospitals as if a health service is synonymous with hospital care, and they must back public health.
It was reckless to underfund and overload the NHS leaving no slack in the system to deal with major shocks. Government policy as a result failed to ‘protect the NHS’ in a meaningful sense. It was overwhelmed. The crisis of acute COVID hospital admissions was dealt with by cancelling non-urgent surgery, building up a gigantic backlog, and transferring frail patients into care homes. Without adequate support, under-protected NHS and care-home staff shouldered an intolerable burden. Over 850 NHS staff died from COVID during 2020. There was no ‘protective ring’ around care homes.
Third: Learning from mistakes in our current pandemic, there must be effective pre-planning and resourcing for all types of emergencies.
Changing public behaviour in response to a major pandemic requires trust in those in authority. Lying to people to hide mistakes, coupled with misplaced morale-boosting optimism, destroys trust. This is not Britain in 1940 when sustaining morale was essential for survival. Trust depends on transparency, and competent, timely decision-making, based on government’s willingness to heed expert advice. Experts must not be pressured to give the advice government wants to hear. They are not special beings immune to human failings such as ill-judged deference to authority.
Fourth: To be trusted and gain public compliance in a crisis government policy must be evidence-based and led by expert advice.
A binary opposition between the good of the economy and protection for the public from COVID infection makes little sense. It is, though, relevant for infected low income workers who should have been given government support to quarantine. The Prime Minister and Chancellor opposed lockdowns on economic grounds. It is now commonly accepted that delays in imposing, and over-hasty release from preventive measures, caused thousands of unnecessary deaths. Owing to exponential growth in infection, a two weeks delay can result in two months of far more economically damaging consequences further down the line.
Fifth: Health messages must be clear, evidence-based and err on the side of caution if economic consequences are to be minimised.
Find, test, trace, isolate and support are important ways to reduce transmission of the virus. Local health authorities responsible for public health have the experience, the knowledge and the necessary relationships in their communities to be effective. The farming out of this vital set of responses to SERCO and other private companies was not just a mistake, it was a mistake motivated by ideology. ‘Private Good, Public Bad’ is a belief dear to the Tory back-benches. £37 billion of taxpayers’ money was poured away as a result.
Sixth: The government must adopt a policy of subsidiarity, acknowledging that the most effective level for action is the level nearest to the problem. Action at a higher level should not be taken unless action at a lower level is ineffective.
The UK’s rate of COVID deaths per 100,000 compared to other similar countries is inexcusable. Perhaps a residue of imperial arrogance, there were no signs that those grappling with the COVID unknowns in the early days paid any attention to the experience of Asian countries such as Taiwan, Vietnam and Singapore. Consultation with them might have quickly knocked ‘herd immunity’ theories on the head.
Seventh: When dealing with an unfamiliar global problem, in this case a pandemic, consult and learn from those who have successfully dealt with one.
Britain has the advantage of being an island and the disadvantage of being a transport hub. Having left the European Union and talked a great deal of nonsense about ‘taking back control of our borders’, the present Government failed to do precisely that. Variants rampant in countries whose governance is even worse than our own are spreading. The Indian variant may be 60% more transmissible. India was put on the ‘red list’ two weeks after Pakistan and Bangladesh. Some believe because the Prime Minister wished to visit India in pursuit of a trade deal.
Eighth: Effective border controls and properly monitored isolation of incoming visitors or returnees must be imposed early.
Co-ordination of medical research, promoted by Professor Dame Sally Davies when Chief Medical Officer, 2011-2019, notably by building up a body of expertise on viruses and vaccines, has given the UK a head-start in genome analysis and vaccine production. This was far-sighted thinking within the NHS, a tangible success for public health in Britain. Ministers ought to acknowledge our debt to this preparatory work on vaccine response to COVID, rather than trying to take all the credit for rapid vaccine roll-out in order to deflect attention from their multiple mistakes.
Ninth: Co-ordinated research bringing together the best brains internationally in the field of immunology and vaccines must be encouraged, well-funded and facilitated by government.
The World Health Organisation has never been more needed than today. It has its faults. Like the UN it is only as good as its members and Syria (still led by the brutal Assad regime) is now on its executive board. But the impoverishment and weakness of health systems in the Global South can only be alleviated by international action. This has become dramatically apparent during the pandemic.
Tenth: Starting with the coming G7 meeting, Britain must play a much bigger role in the WHO, especially leading on the dissemination of research findings and supporting centres dedicated to vaccine development and immunology.
The Independent Inquiry announced by the Prime Minister starts in Spring 2022. Dame Deidre Hine who undertook the swine-flu report estimates that it will take at least 2-3 years to complete. Well after the next general election.
See TheArticle 01/06/2021