Ministers and health bosses are facing questions over how well prepared the UK was for the coronavirus pandemic amid mounting criticism of everything from the speed at which lockdown was introduced to the levels of personal protective equipment and testing.
So what planning had there been and was Professor Anthony Costello, a former World Health Organisation director, right to suggest last week that the authorities had been âtoo slowâ to react and that the UKâs death toll could become the highest in Europe, reaching 40,000, as a result?
In 2011, the then government set out its approach to a coronavirus-like pandemic in a UK Influenza Pandemic Preparedness Strategy.
Planning was driven in part by an assessment of a âreasonable worst caseâ scenario and covered the need to stockpile medicines and equipment, and prepare hospitals for a surge in patients with the disease.
This was backed up by a Health and Social Care Influenza Pandemic Preparedness and Response document produced a year later, which drew from the experience of the H1N1 influenza (swine flu) pandemic in 2009.
In 2013, influenza pandemic guidance was issued for local planners which warned of the possibility of school closures in an outbreak.
Public Health Englandâs (PHE) Pandemic Influenza Response Plan was published in 2014 and highlighted procedures for rolling out stockpiles of personal protective equipment (PPE) as well as the use of âjust in timeâ procurement to supplement them.
Cygnus
Then in October 2016, the government ran a three-day exercise codenamed Cygnus that tested the countryâs ability to handle an influenza pandemic.
The findings from the Cygnus exercise have not been made public, but recent news reports suggested that they revealed a shortage of critical care beds and PPE â and that the subsequent recommendations were not acted upon.
The Government has roundly dismissed those reports and said it was âextremely proactiveâ in implementing lessons learned from the past, including Cygnus, such as shaping âlegislative proposalsâ that informed the Coronavirus Act.
But Dr Patricia Lewis, research director for international security at think tank Chatham House, said: âThe trouble is, if you donât know the results of it how do you know that the lessons learned were applied?â
She said the UKâs response preparations needed greater levels of scrutiny, such as a new legal requirement for the Government to report to Parliament every year on the state of national plans.
This would include stock levels of essential equipment, hospitalsâ ability to cope with a large influx of patients and the findings of any drills or simulations.
Despite saying it has distributed millions of PPE items to health workers, the Government has faced repeated criticism on shortages.
There have been questions over why it had not taken part in an EU procurement scheme and why not all production offers from domestic manufacturers have been accepted.
Health Secretary Matt Hancock has denied that politics were involved in the EU decision, adding that the scheme has not yet made anything available.
He also said checks were needed on offers from UK firms as not all opportunities had been âcredibleâ.
Dr Lewis said that PPE shortages were a âreally shocking state of affairsâ and were one of the basic issues that âparliamentarians need to scrutiniseâ.
She said Parliamentâs National Security Strategy Joint Committee inquiry into preparing for emerging infectious diseases and bioweapons was forced to close last year as the general election was called.
Dr Lewis said some other countries had so far appeared âbetter preparedâ, including South Korea, Taiwan, Vietnam and New Zealand.
Peter Openshaw, professor of experimental medicine at Imperial College, said âreally goodâ preparations under previous Labour governments had helped the bioscience sector respond quickly to the current crisis.
But he said there had been an âunderinvestmentâ in the public health infrastructure and devolution had âfragmented what used to be a world class serviceâ.
He added: âI think the capacity weâve got in terms of being able to test large numbers of samples would be better if we had scaled up rather than really squeezed the investment over the past few years.â
Biotechnology
Prof Openshaw said the countries who had done well during the pandemic were those who had âput biotechnology and bioscience high on their agendaâ.
He suggested that between outbreaks âcomplacency accruesâ among âopinion leaders and the fundersâ, adding that he even had to convince other scientists of the risks posed by Covid-19 in early March.
âAt that time, I was lying awake at night unable to sleep, worrying about just how terrible it was looking,â he said.
He added: âI donât think it was in any way the politicians who were alone in being complacent at all.â
Whether politicians were alone or not, the role of the UKâs political leaders in the early stages of the crisis has come under scrutiny.
On Sunday, Cabinet Office Minister Michael Gove was forced to defend Prime Minister Boris Johnson â currently recovering from Covid-19 at Chequers â amid reports he missed five meetings of the Cobra committee, convened to handle matters of national emergency, in the early stages of the current crisis.
Mr Gove said the idea that Mr Johnson had skipped vital meetings was âgrotesqueâ, emphasising that his leadership during the crisis had been âclearâ and âinspirationalâ.
In the House of Commons on Wednesday, Mr Hancock said the Government was committed to âramping upâ testing and contact-tracing âin a matter of weeksâ.
But Labour leader Sir Keir Starmer said there was a âpattern emergingâ in the Governmentâs response, adding âwe were slow into lockdown, slow on testing, slow on protective equipmentâ.
Foreign Secretary Dominic Raab rejected his comments, saying ministers had been âguided by the scientific advice⊠at every step along this wayâ.
In terms of lessons for the future, Dr Lewis said the Government should reinstate the position of minister for resilience, a role last held in 2018 by Conservative MP Caroline Nokes.
Dr Lewis said: âThe trouble is, as weâre seeing, if you donât have anyone in charge, you end up with things falling between the cracks.â
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