How well prepared was the UK to cope with a pandemic?

A year ago, the first public hearings at the UK Covid Inquiry got underway in an attempt to answer that question.

With the inquiry expected to plough on for years (evidence sessions for Module Three 'Healthcare Systems' - one of nine modules - are not due to begin until September) there was always an understanding that reports for each module would be published on a rolling basis.

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The report for Module Two - covering Government decision-making, but perhaps better known as "the mystery of the missing ministerial WhatsApps" - will not be published until 2025.

For now, we have Module One: the "resilience and preparedness of the United Kingdom", or lack thereof.

A theme running throughout the report, published on Thursday, is that the years leading up to Covid left us hopelessly unprepared because "too much reliance was placed on a single scenario – pandemic influenza".

Modelling anticipated that a worst-case scenario would result in half the population developing symptomatic infections, and that anything from 1% to 4% of these individuals would require hospital care, and 2.5% would die - some 840,000 people.

But there was no expectation that a flu pandemic could be contained.

Consequently, planning was "focused on dealing with the impact of the disease...there was no consideration of the potential mitigation and suppression of the disease".

This was true across the board, not only at UK level but in the devolved nations also.

Scotland "substantially relied, in terms of expert medical and scientific advice, on 'UK intelligence'" and while to "outward appearance, the risk assessments by the devolved administrations were their own documents...their method simply copied that of the UK government".

The Covid pandemic was, of course, caused by a new form of coronavirus.

It fell within the same viral family as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), both of which had resulted in highly deadly but much less transmissible outbreaks of disease.

The experience of SARS in the 2000s influenced the pandemic response in East AsiaThe experience of SARS in the 2000s influenced the pandemic response in East Asia (Image: Getty)

SARS - first identified in China in 2002 - is known to have infected more than 8000 people between 2002 and 2004, and killed around 770, but it was much easier to suppress through contact tracing and quarantine because people were not infectious unless they were showing symptoms.

There have been no known cases anywhere in the world since 2004.

Where the UK's pandemic planning scenarios did look beyond flu they were wrongfooted once again by an assumption that any "emerging infectious disease" would follow this pattern, resulting in no more than around 200 deaths within the UK.

This was a "a significant error" because using SARS as the template "sent the message that planning for a non-influenza pathogen should focus on an emerging infectious disease that would not be sufficiently transmissible to result in a pandemic".

Inquiry chair, Baroness Hallett, also observes that while the UK-wide risk assessments circulating between 2008 and 2019 repeatedly referred to contingency plans having been drawn up to manage a SARS-style outbreak, the UK Government has been unable to disclose any evidence of any such thing despite repeated requests.

She adds: "The Inquiry is not therefore satisfied that such plans ever existed."

A diagram in the UK Covid Inquiry's report on Module One highlights the complex layers of decisionmaking between government offices in the UK and Scotland which affected the pandemic responseA diagram in the UK Covid Inquiry's report on Module One highlights the complex layers of decisionmaking between government offices in the UK and Scotland which affected the pandemic response (Image: UKCovidInquiry)

Focused on influenza, nothing was done in advance to consider how to manage a test-trace-isolate strategy - countermeasures which could have avoided lockdown if deployed at speed and scale, as they were in countries such as Japan and South Korea.

By 2020, "there had not been any debate about quarantining or isolating significant numbers of the population in the context of a pandemic".

The capacity for mass testing and contact tracing "had to be rapidly built from scratch".

Baroness Hallett adds: "The UK government and devolved administrations could and should have invested in this infrastructure in advance of the Covid-19 pandemic, but had not done so."

On border controls, she said the UK Government "had a responsibility to look into this issue [but] failed to do so before the pandemic arrived", while a clash between healthcare being devolved and borders being reserved "created confusion and complications".

It is notable that among the ten recommendations resulting from this module are two specifically geared to ensuring the four nations are on the same page in terms of pandemic preparedness: Baroness Hallett calls for a new "UK-wide approach" to the development of strategy and a commitment to host a "UK-wide pandemic response exercise" at least every three years.

Former First Minister Nicola Sturgeon arrives at the UK Covid inquiry in London on June 29 2023 to give evidence on pandemic preparedness in ScotlandFormer First Minister Nicola Sturgeon arrives at the UK Covid inquiry in London on June 29 2023 to give evidence on pandemic preparedness in Scotland (Image: PA)

Yet, as the evidence to the inquiry also highlighted, there is little point in carrying out exercises unless their lessons are implemented.

In the case of Exercise Cygnus - a three-day simulation of an H2N2 flu pandemic led by the UK Government in 2016 - eight out of its 22 recommendations were incomplete in Scotland by the time Covid struck.

These included fit-testing of PPE and expanding social care capacity.

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The report states: "The governments of the UK, Scotland, Wales and Northern Ireland did not act with sufficient urgency, or at all.

"As the specific example of Exercise Cygnus underlines, lessons that could and should have been learned were not learned.

"They were left to be discovered afresh in the next exercise or, as it transpired, when the Covid-19 pandemic struck."

Meanwhile, the NHS response was hampered by "severe staff shortages" and  significant amounts of hospital infrastructure which were "not fit for purpose", while Britain's unhealthy population left it vulnerable to attack. 

Four years on, with the NHS is under even more strain and record numbers of working age adults economically inactive due to illness, it is difficult to imagine how the health service could ever cope with a new pandemic threat. 

The NHS was already struggling when Covid hitThe NHS was already struggling when Covid hit (Image: Getty)

Several witnesses to the inquiry insisted that Covid was a "Black Swan event" - something catastrophic but unprecedented, and unforeseeable. 

Baroness Hallett does not agree.

After SARS and, in 2012, MERS, the failure to prepare for another coronavirus outbreak at pandemic scale was "a fundamental error". 

Have we learned from that mistake?

The 2022 National Security Risk Assessment has gone some way to rectifying this, she added, by incorporating "more generic pandemic and emerging infectious disease scenarios".

However, she adds cautiously, these improvements "appear still to be a work in progress".