Chapter 15: Key lessons for future emergencies

Chapter 15: Key lessons for future emergencies

Introduction

¶15.1. Many of the issues identified in this Report – particularly those arising during the first wave of the Covid-19 pandemic in the first half of 2020 – reflect the lack of preparedness discussed in the Inquiry's Module 1 Report.¹¹ Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024 (https://covid19.public-inquiry.uk/documents/module-1-full-report) Such preparation as had been done was for an influenza pandemic and for high consequence infectious diseases on a much smaller scale. Covid-19 was neither. As a result, the response to the pandemic was significantly hampered before it began.

¶15.2. This chapter is intended to assist with the ongoing development and regular review of the UK's preparedness and planning for pandemics and other civil emergencies, highlighting the key lessons learned from events between early January 2020 and May 2022. It is hoped that these lessons will inform preparations for future pandemics and be particularly useful for those responsible for developing and implementing the civil emergency strategy.

The importance of planning

¶15.3. As the Inquiry has been told, including by Professor Mark Woolhouse (Professor of Infectious Disease Epidemiology at the University of Edinburgh):

" [O]n the scale of potential pandemics, Covid-19 was not at the top and it was possibly quite far from the top. It may be that next time – and there will be a next time … we are dealing with a virus that is much more deadly and is also much more transmissible … The next pandemic could be far more difficult to handle than Covid-19 was, and we all saw the damage that that pandemic caused us."²² Mark Woolhouse 5 July 2023 148/5-22

¶It is therefore of vital importance that the issues with processes, planning and policy identified in both the Inquiry's Module 1 Report and this Report are not repeated. In order to minimise the vast potential financial, economic and human costs of future pandemics or other civil emergencies, the UK must be better prepared.

Lesson 1: Anticipate multiple scenarios

¶15.4. Just as a 'ready for flu, ready for anything' approach did not adequately prepare the UK for Covid-19, we should not assume that the next pandemic will be the same or present a similar scenario. The next pandemic may well look very different from both those for Covid-19 and influenza, with key differences in how and how quickly the virus is transmitted and the severity of illness it causes. There may also be differences in the groups that are clinically vulnerable – for example, the vast majority of children were not at serious risk of health harm during the Covid-19 pandemic, but may be more susceptible to other viruses.

¶15.5. As a result, potential scenarios should be analysed both separately and in combination. This will enable governments and other responders to focus on building flexible and practical capabilities and capacity. It is also vitally important that both the short-term and long-term impacts of an emergency, including a pandemic, are considered together and regularly reassessed during the course of the emergency. This will minimise the immediate damage but also ensure that there is an exit plan for emergency support or restrictions.

¶15.6. No plan entirely survives contact with reality, but the more scenarios that are considered and the more responses tested, the greater the likelihood that those making difficult – even impossible – choices will be better placed to react quickly and decisively.

Lesson 2: Anticipate interventions

¶15.7. Understanding risks facilitates more in-depth consideration of the best (or sometimes the least worst) ways to respond. The infection fatality ratio for Covid-19 varied significantly by age, with those aged 75 years and over at much greater risk.³³ INQ000152858_0005 The next pathogen may be most dangerous for another group. The range of potential interventions may therefore be different. It might need only limited measures to slow the spread of a pathogen, but it might also need stringent restrictions to stop its spread.

¶15.8. For example, influenza has a short generation time (the interval between a person becoming infected and when they infect another person) – two to three days – as well as a high proportion of asymptomatic cases. This means that traditional contact tracing is not as useful an intervention for influenza, but it might be a key intervention for other diseases (including, for example, severe acute respiratory syndrome, known as SARS).⁴⁴ INQ000250231_0015-0016 para 85 Less drastic social distancing measures might be appropriate for influenza due to its "lower basic reproduction number".⁵⁵ INQ000250231_0015-0016 para 85 Similarly, the nature of the response required will differ depending on the severity of the disease. Covid-19 had an overall case fatality ratio of between 0.5 and 1%.⁶⁶ INQ000195846_0008 para 25; INQ000207453 The case fatality ratios of SARS and Middle East respiratory syndrome (MERS), at the beginning of the outbreaks (ie before population immunity or clinical countermeasures), were approximately 10% and 35% respectively.⁷⁷ INQ000195846_0008 para 25; INQ000207453 Before the availability of antiretroviral drugs, human immunodeficiency virus (HIV) had a mortality rate of nearly 100%.⁸⁸ INQ000184638_0038 para 5.5; INQ000207453 Any new strategy must be sufficiently flexible to respond to a range of different pathogens.

¶15.9. Following the Covid-19 pandemic, there has been a great deal of information and analysis by a range of experts around the world, about which measures worked and which did not; which were worth the cost and which were not; how best to time measures; and the infrastructure or policies that may be needed to support them. There will also, no doubt, be further options identified in government and other risk assessments. This information should be utilised in any new pandemic strategy to set out plans for potential measures or interventions for assessment and deployment, depending on the circumstances. Those plans should then be aligned with the most likely scenarios to enable optimum timing for action.

¶15.10. That said, any mandatory lockdown must be a last resort, reserved for the most dire scenarios. The wider implications of such restrictions during the Covid-19 pandemic, in terms of the social, economic and educational harm that resulted, were too great – and are still to be fully understood.

¶15.11. Although a pandemic is primarily a public health emergency, all parts of society will be affected – as will also be the case for many other civil emergencies. The strategy should therefore articulate how the positives and negatives of each action or decision have been or will be balanced, in order to enable changes to be made in the event of new or developing information. Although all parts of society will be affected by a pandemic, all major civil emergencies expose and exacerbate health inequalities. People from lower socio-economic backgrounds, those living in areas or regions with higher rates of deprivation, people from minority ethnic groups and disabled people are all much more likely to be severely impacted by a pandemic – both from the virus itself and from the restrictions imposed in response. Restrictions imposed on the whole population will not be experienced equally by the whole population – for example, people from lower socio-economic backgrounds face greater risks of being exposed to a virus because they are disproportionately employed in jobs where working from home is not possible. Understanding and accounting for these inequalities in pandemic planning can help to inform the design of more targeted interventions and allow for more tailored information to be provided to communities at greater risk.

¶15.12. These steps will enable future decision-makers to understand and plan interventions, so that they can be implemented quickly. It will also allow scientific and other advisers to understand from the outset the full extent of the restrictions that the government is prepared to implement to achieve its objectives for the response.

¶15.13. Resilience planning should operate as a continuous cycle. Strategic objectives set a framework for detailed plans and interventions which are then tested (hypothetically in exercises, as well as reviewing the efficacy of those used in a real emergency). This should then be fed back into the periodic review of the overarching strategy and the underlying plans in order to deliver a virtuous circle of continued improvement.