Coronavirus: lessons learned to date Contents

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3Lockdowns and social distancing

75.Much of the impact of covid-19 during the first wave was determined by decisions made during the early weeks of the pandemic, between January and late March 2020. The seriousness of the threat to the UK was recognised in January when the Government’s Scientific Advisory Group for Emergencies—SAGE—was convened and met on 22 January 2020.97 It is important to record that all decisions taken during those initial weeks were taken in a fog of uncertainty. The UK did not know to what extent covid-19 had entered the country, how many people it was affecting, how quickly it would spread, and what would be the consequences in terms of illness and death. What the UK did know was bleak: from the experience of China and Italy, it was clear that covid-19 was a highly infectious virus, with profound consequences for health, and for which there was no cure nor effective treatments. This meant that the only tools available to affect the spread of the pandemic were isolating people who had contracted the virus and their contacts, and, more generally restricting contacts between people, collectively known as non-pharmaceutical interventions, or NPIs.

76.The veil of ignorance through which the UK viewed the initial weeks of the pandemic was partly self-inflicted. As we examine in depth in Chapter 4, the UK failed to turn an early lead in developing a test for covid in January 2020 into a testing operation that was adequate for the needs of the country—depriving scientists and policymakers of crucial granular data. Our Committees heard that the UK did not take enough advantage of the learning and experience being generated in other countries, notably in East Asia.98 The approach the UK took was particular, and in some respects exceptional.

77.The initial UK policy was to take a gradual and incremental approach to introducing non-pharmaceutical interventions. A comprehensive lockdown was not ordered until 23 March 2020—two months after SAGE first met to consider the national response to covid-19.99 This slow and gradualist approach was not inadvertent, nor did it reflect bureaucratic delay or disagreement between Ministers and their advisers. It was a deliberate policy—proposed by official scientific advisers and adopted by the Governments of all of the nations of the United Kingdom.100 It is now clear that this was the wrong policy, and that it led to a higher initial death toll than would have resulted from a more emphatic early policy. In a pandemic spreading rapidly and exponentially every week counted. The former SAGE participant Professor Neil Ferguson told the Science and Technology Committee that if the national lockdown had been instituted even a week earlier “we would have reduced the final death toll by at least a half”.101

78.As a result, decisions on lockdowns and social distancing during the early weeks of the pandemic—and the advice that led to them—rank as one of the most important public health failures the United Kingdom has ever experienced. This happened despite the UK counting on some of the best expertise available anywhere in the world, and despite having an open, democratic system that allowed plentiful challenge. Painful though it is, the UK must learn what lessons it can of why this happened if we are to ensure it is not repeated.

The initial policy: flattening the peak

79.There has been considerable debate as to whether the early policy of the Government was one of seeking to achieve so-called “herd-immunity”. The US Centres for Disease Control and Prevention defines community immunity/herd immunity as:

A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community. Also known as herd immunity.102

80.Non-pharmaceutical interventions such as lockdowns, and the testing and isolation of covid cases and their contacts, are tools of temporary application. Once they are lifted, there is nothing to stop transmission resuming. When Sir Patrick Vallance said at a Government press conference on 12 March 2020 “it’s not possible to stop everybody getting it and it’s also actually not desirable because you want some immunity in the population. We need to have immunity to protect ourselves from this in the future”103 he was, in a sense, merely stating what were thought to be the facts of the time. Sir Patrick, and Ministers, have insisted that this statement was not a policy to seek herd immunity but a description of the situation. Matt Hancock wrote, as Secretary of State, on 14 March 2020:

We have a plan, based on the expertise of world-leading scientists. Herd immunity is not a part of it. That is a scientific concept, not a goal or a strategy. Our goal is to protect life from this virus, our strategy is to protect the most vulnerable and protect the NHS through contain, delay, research and mitigate.104

81.From our evidence this appears to have led to a policy approach of fatalism about the prospects for covid in the community: seeking to manage, but not suppress, infection. This amounted in practice to accepting that herd immunity by infection was the inevitable outcome, given that the United Kingdom had no firm prospect of a vaccine, limited testing capacity and there was a widespread view that the public would not accept a lockdown for a significant period.105 That said, an initial unwillingness to consider seriously and act on the approach being taken in Taiwan, Singapore or Korea was a serious error. But even without an effective test and trace system earlier, social distancing and locking down would have bought much-needed time: time for vaccine research to bear fruit; time for treatments to be developed that could mean that experiencing covid-19 was less serious; time for test and trace systems to be developed and made effective so that the prevalence of the disease could be lowered without the entire population being restricted. The loss of that time was to prove fatal to many. It would, however, be an overstatement to say that the Government and its advisers were promoting the acquisition of covid-19 to accelerate herd immunity in the population. But, in early Spring 2020, given that no alternative strategy was being implemented, that was the effective consequence. It was principally the threat of the NHS being overwhelmed that forced—belatedly—a change in direction.

82.So in the absence of a vaccine or an effective treatment being available at first, the UK faced a choice of doing everything possible to halt the virus, or seeking instead to moderate the pace of its spread. The UK chose the latter.106

83.Even as late as 12 March 2020, as noted in paragraph 80, Sir Patrick Vallance, Government Chief Scientific Adviser, told a Government press conference that it was not possible to stop everyone being infected, and nor was that a desirable objective. The following day in a media interview Sir Patrick said that the aim of policy was:

To try and reduce the peak, broaden the peak, not to suppress it completely. Also, because most people, the vast majority of people, get a mild illness, to build up some degree of herd immunity as well so that more people are immune to this disease and we reduce the transmission at the same time we protect those who are most vulnerable from it. Those are the key things we need to do.107

This reflected the views of the 23 people who participated in the SAGE meeting on 13 March, where the Group “was unanimous that measures seeking to completely suppress spread of Covid-19 will cause a second peak.”108 In practice this meant that social distancing policies were introduced gradually over a period of weeks.

84.The Government’s action plan of 3 March indicated that there was no intention to bring in a lockdown as strict as had been implemented in some other parts of the world. The action plan, under the heading ‘the Delay phase - next steps’ said:

Action that would be considered could include population distancing strategies (such as school closures, encouraging greater home working, reducing the number of large-scale gatherings) to slow the spread of the disease throughout the population, while ensuring the country’s ability to continue to run as normally as possible.109

That approach meant that events that may have spread the virus proceeded—such as the football match between Liverpool FC and Atletico Madrid on 11 March—the day the coronavirus was categorised as a pandemic by the WHO—with a reported crowd of over 50,000110 and the Cheltenham Festival of Racing between 10 and 13 March, attracting more than 250,000 people.111 Subsequent analysis suggested that there were an additional 37 and 41 deaths respectively at local hospitals after these events.112 However, it is not clear whether those deaths were as a result of attendance at the events themselves or associated activities such as travel or congregation in pubs. The timeline at pages 11 and 12 of this Report sets out some key events in the UK’s experience of handling covid-19.

85.At its meeting of 5 March 2020, SAGE reconfirmed an explicitly gradual approach:

There is epidemiological and modelling data to support implementation–within 1 to 2 weeks–of individual home isolation (symptomatic individuals to stay at home for 14 days) and whole family isolation (fellow household members of symptomatic individuals to stay at home for 14 days after last family member becomes unwell) to delay COVID-19 spread, modify the epidemic peak and reduce mortality rates.

In addition, there is scientific data to support implementation–roughly 2 weeks later–of social isolation (cocooning) for those over 65 or with underlying medical conditions to delay spread, modify the epidemic peak and reduce mortality rates.113

SAGE had, however, considered advice to take a more robust precautionary approach. It received a paper, one of three, from the London School of Hygiene and Tropical Medicine on the considerations for non-pharmaceutical interventions. The paper said, with moderate confidence, that “NPIs that reduce transmission substantially should be introduced later but before the peak.”114 The same paper stated that:

• Taking all into consideration, building up of NPIs in terms of intensity during the epidemic has many advantages:
• It provides the opportunity for modification / improvement as we see the epidemic progress, i.e. it is robust to possible futures
• It leaves room for policy modification during the epidemic, and avoids the situation in late summer if an epidemic has been curbed or greatly reduced that a larger epidemic is still expected.115

86.On 9 March 2020, SAGE set out a number of non-pharmaceutical interventions that could in due course be introduced by the Government. SAGE advised that “measures relating to individual and household isolation will likely need to be enacted within the next two weeks to be fully effective, and those concerning social distancing of the elderly and vulnerable 2–3 weeks after this”.116 On 12 March 2020, the Prime Minister said that anyone with a new continuous cough or a fever should self-isolate for seven days.117 Household isolation was announced on 16 March 2020.118

87.It is striking, looking back, that it was accepted that the level of covid-19 infection in the UK could be controlled by turning on particular non-pharmaceutical interventions at particular times. Indeed such was the belief in this ability to calibrate closely the response that a forward programme of interventions was published with the suggestion that they would be deployed only at the appropriate moment.119 In hindsight it seems a dubious and risky assumption to think that a new, unknown and rampant virus could be regulated in such a precise way. Even more so when—due to the early failure to establish a meaningful testing programme—the UK had very little data on the prevalence and spread of the virus across different settings and different groups of people.

88.This was not the only way to proceed, and indeed the UK was an outlier internationally in the gradualist approach that was being taken before late March.120 Countries in East Asia were the first to experience covid-19. Their response was a much more rapid and muscular imposition of social distancing and requirements to isolate.121

89.On 24 February the World Health Organisation published the report of its international mission to Wuhan, and advised that countries should:

(1)Immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19 with non-pharmaceutical public health measures;

(2)Prioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts122

The same report identified the virus as highly contagious, and with a prima facie case fatality rate of 3.8%, rising to over 20% among over 80s.123

90.In evidence to the Science and Technology Committee on 25 March 2020, the Editor of The Lancet, Dr Richard Horton, said that his journal had published articles on 24, 29 and 31 January with an analysis of the situation in China.124 He told the Committee:

Those papers were truly alarming and showed that the disease caused a serious fatal pneumonia. A third of patients who had been reported in those papers required admission to the intensive care unit. The number of deaths that were being described was rising quickly. The authors of the papers were advocating the immediate provision of personal protective equipment and were urging the importance of testing and isolation. They were describing the fact that there was no effective treatment and also emphasising the pandemic potential.

Those were the people from the frontlines of the epidemic at the end of January. Many of us at The Lancet felt that that was a red flag. We have had seven to eight weeks since that time, and February was the opportunity for the UK to really prepare, based on testing, isolation, quarantine, physical distancing, ICU capacity and so on.

I think you described it as being critical and, yes, it was, in the sense that we missed that opportunity. We could have used the month of February, based on what we knew in January. When I look at the evidence that SAGE posted on the website—there is a lot of evidence and it is great that they have been so transparent—what strikes me is the mismatch between the urgent warning that was coming from the frontline in China in January and the, honestly, somewhat pedestrian evaluation of the likely severity of the outbreak in that evidence. That suggests to me that we did not fully understand what was taking place on the frontline. What I also did not understand is why those three papers were not part of the evidence. Those papers were fully available, openly accessible and published on 24 January, 29 January and 31 January. Why they were not part of the published papers that SAGE considered is somewhat mystifying.125

Indeed, a number of European countries went into a national lockdown before the UK did. A national lockdown was announced in Italy on 9 March; in Spain on 14 March; in the Netherlands on 15 March; and in France on 16 March.126

91.The UK policy was to change abruptly. During the days before 23 March, multiple people within the Government and its advisers experienced simultaneous epiphanies that the course the UK was following was wrong, possibly catastrophically so. In his evidence to our inquiry Dominic Cummings told us:

On Friday the 13th [of March 2020], we then started to look through all the information and we started to pick apart all the different graphs. Ben [a No. 10 Specialist Adviser] spoke to Patrick; Patrick said, “I am also extremely concerned. It seems that something has gone fundamentally wrong in the wiring of the system. We have these graphs showing that even on the best-case scenario with the official plan, you are going to completely smash through the capacity of the NHS—not by a little bit but multiple times.”

The evening of Friday the 13th, I am sitting with Ben Warner and the Prime Minister’s Private Secretary in the Prime Minister’s study. We were basically saying that we are going to have to sit down with the Prime Minister tomorrow and explain to him that we think that we are going to have to ditch the whole official plan, and we are heading for the biggest disaster this country has seen since 1940.127

Mr Cummings went on to tell us that other senior officials were recognising that the UK’s approach and epidemiological trajectory was on course for a “disaster”:

At this point, the second most powerful official in the country, Helen MacNamara—the Deputy Cabinet Secretary—walked into the office while we are looking at this whiteboard. She says […] I have come through here to the Prime Minister’s office to tell you all that I think we are absolutely [expletive redacted]. I think this country is heading for a disaster. I think we are going to kill thousands of people. As soon as I have been told this, I have come through to see you. It seems from the conversation you are having that that is correct.” I said, “I think you are right. I think it is a disaster. I am going to speak to the Prime Minister about it tomorrow. We are trying to sketch out here what plan B is.”128

Mr Cummings continued:

On the 14th [of March 2020] we said to the Prime Minister, “You are going to have to lock down, but there is no lockdown plan. It doesn’t exist. SAGE haven’t modelled it. DH [Department of Health and Social Care] don’t have a plan. We are going to have to figure out and hack together a lockdown plan […]”.129

When he gave evidence to us on 8 June 2021, the then Secretary of State for Health and Social Care told us that he had become aware prior to the national lockdown that the previous policy was inadequate:

I asked for a reasonable worst-case scenario planning assumption. I was given the planning assumption based on Spanish flu, and it was signed off at Cobra on 31 January. That was a planning assumption for 820,000 deaths. […]

In the week beginning 9 March, what happened is that the data started to follow the reasonable worst-case scenario. By the end of that week, the updated modelling showed that we were on the track of something close to that reasonable worst-case scenario. I think the numbers were slightly below that, but they were of a scale that was unconscionable.130

92.In evidence to the Science and Technology Committee in July 2020, Sir Patrick Vallance, said that SAGE advised the Government to implement the remainder of the menu of options for social distancing measures—in essence a full lockdown—on 16 or 18 March 2020:

When the SAGE sub-group on modelling, SPI-M, saw that the doubling time had gone down to three days, which was in the middle of March, that was when the advice SAGE issued was that the remainder of the measures should be introduced as soon as possible. I think that advice was given on 16 or 18 March, and that was when those data became available. Looking back, you can see that the data may have preceded that, but the data were not available before that. Knowledge of the three-day doubling rate became evident during the week before.131

On 16 March 2020, SAGE minutes show that the group concluded that additional measures, beyond those already in place, were required: “SAGE advises that there is clear evidence to support additional social distancing measures be introduced as soon as possible”.132 Sir Patrick explained that SAGE changed its advice on the basis that case numbers were doubling every three days, which was quicker than initially thought.133 Moreover, at the same meeting, SAGE considered a paper from Imperial College London academics, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand.134 The paper concluded that “in an unmitigated epidemic, we would predict approximately 510,000 deaths in GB and 2.2 million in the US, not accounting for the potential negative effects of health systems being overwhelmed on mortality.”135 It was widely reported that this paper was a key factor in the Government’s decision to impose a full lockdown.136 SPI-M-O had also produced a consensus view that “general social distancing and school closures to case isolation, household isolation and social distancing of vulnerable groups would be likely to control the epidemic […]”.137

93.It seems astonishing looking back that—despite the documented experiences of other countries; despite the then Secretary of State referring to data with a Reasonable Worst Case Scenario of 820,000 deaths;138 despite the raw mathematics of a virus which, if it affected two-thirds of the adult population and if one percent of people contracting it died would lead to 400,000 deaths—it was not until 16 March that SAGE advised the Government to embark on a full lockdown (having said on 13 March that “it was unanimous that measures seeking to completely suppress the spread of covid-19 will cause a second peak”)139 and not until 23 March that the Government announced it.

Border controls

94.The UK did not impose blanket or rigorous border controls at the onset of the covid-19 pandemic as compared to other countries, particularly in East and South East Asia.140 Instead, the UK implemented light-touch border controls only on countries and regions where there was a recorded high incidence rate. While the UK initially focused on China, Iran, South Korea and Italy, a significant number of cases came from elsewhere. A study found that 33% of cases during the first wave were introduced from Spain and 29% were introduced from France.141 The number of seeding events that occurred early in the pandemic, coupled with the lack of data, made the lockdown almost inevitable.

95.By contrast, other countries implemented more rigorous border controls which were more effective at suppressing the virus and preventing the need for long and repeated lockdowns. However, even though it is not straightforward to make direct comparisons between countries, and it is yet to be seen how countries like New Zealand will fare when their borders are opened, it is reasonable to say that a more precautionary approach would have been beneficial at the start of the pandemic.

Reasons for the delay in full lockdown

96.In the paragraphs that follow we consider some of the potential explanations of why the initial decision-making on lockdowns was wrong, and what lessons can be drawn for the future from this.

Should the Government have unilaterally taken a precautionary view in the first weeks, despite the SAGE advice?

97.The UK’s structure of scientific advice in emergencies, in which a group is formed of relevant experts (SAGE) to advise the Government is a prominent feature of our arrangements—much more so than in many other countries. Initially, participation in SAGE was not disclosed, nor the papers on which its advice drew, nor the minutes of its meetings. Following pressure, including from the House of Commons Science and Technology Committee, and supported by the Government Chief Scientific Adviser Sir Patrick Vallance,142 details of papers considered by SAGE were published from 20 March 2020; the individuals participating in SAGE were published from 4 May 2020; and minutes from 29 May 2020.143 Publication revealed that SAGE comprised a large number of scientific experts of high standing—over 85 individuals are listed as having participated in SAGE since its first meeting during the pandemic.144

98.SAGE provides advice to Ministers, whose responsibility it is to make policy decisions. However, witnesses to our Committees confirmed that during the early months of the pandemic the Government acted on the scientific advice it was given. Sir Patrick Vallance, for example, told the Science and Technology Committee on 25 March 2020 that there had been no significant disagreement between the Government and its scientific advisers on anything material.145

99.We accept that it is difficult for Ministers to go against a scientific consensus among the body set up to provide scientific advice during a national emergency. We also understand the reluctance to introduce measures with significant negative economic impact. But the early weeks of the pandemic expose deficiencies in both scientific advice and Government action. In the early days of an emergency, formulating the best scientific advice is challenging: there are, for example, inevitable lags in acquiring and analysing data. Other countries took early decisions that were more seen as those of Government leaders rather than from established scientific evidence146 and it is possible that this provided a greater licence to take decisions more quickly, and on a more precautionary basis than happened in the UK—contributing to better overall outcomes.

Was there sufficient challenge to scientific advice during the first weeks?

100.Several witnesses to our inquiry, reflecting on the early weeks of the pandemic, were rueful that they did not sufficiently question and challenge the advice they were being given. We heard that challenging an established scientific consensus was difficult. Dominic Cummings told us:

It was clear through all the meetings with PHE and everybody that everything was going wrong; everything we pushed, everything we probed—everything was wrong, bad, terrible.

But I was incredibly frightened—I guess is the word—about the consequences of me kind of pulling a massive emergency string and saying, “The official plan is wrong, and it is going to kill everyone, and you’ve got to change path,” because what if I’m wrong? What if I persuade him [the Prime Minister] to change tack and that is a disaster? Everyone is telling me that if we go down this alternative path, it is going to be five times worse in the winter, and what if that is the consequence?147

101.The then Secretary of State, Matt Hancock MP, made the same point regarding the difficulty of challenging a scientific consensus.148 On 28 January 2020, SAGE said that testing asymptomatic individuals would “not be useful”.149 However, at the same meeting, SAGE went on to say that there was “limited evidence of asymptomatic transmission, but early indications imply some is occurring.”150 Matt Hancock told us that he thought asymptomatic transmission was occurring, but he found it difficult to challenge the scientific consensus:

I was in a situation of not having hard evidence that a global scientific consensus of decades was wrong but having an instinct that it was. I bitterly regret that I did not overrule that scientific advice at the start and say that we should proceed on the basis that there is asymptomatic transmission until we know there is not, rather than the other way round. But when you are faced with a global consensus, and you do not have the evidence that you are right and the scientific consensus is wrong, it is hard to do that.151

We also note that Nobel Laureates Sir Paul Nurse and Sir Peter Ratcliffe wrote to the then Secretary of State to warn about asymptomatic transmission and the need for testing in April 2020. However, they did not receive a substantive response until July and only then from a correspondence clerk rather than the then Secretary of State.152 We continue to await a response from the Department on why action was not taken on asymptomatic transmission and testing earlier.153

102.We accept that it is difficult to challenge a widely held scientific consensus. But accountability in a democracy depends on elected decision-makers taking advice, but examining, questioning and challenging it before making their own decisions. We find it surprising that the fatalistic assumptions behind the initial scientific advice were not challenged until it became clear the NHS could be overwhelmed, particularly given alternative strategies were being pursued visibly and successfully in East Asian countries. We heard that ‘red teaming’ and structured challenge was used within the national security community, which may also be of benefit to the scientific community.154 Kate Bingham also pointed out that the Government may have benefited from more scientists within the Civil Service155 We acknowledge that the then Secretary of State told us that he had challenged scientific advice regarding asymptomatic transmission.156 However, this came after the key moments in mid-March when challenge was needed most, and after the WHO had warned of asymptomatic transmission.

The influence of modelling during the pandemic

103.In his evidence to the Science and Technology Committee during the early weeks of the pandemic, on 25 March, the Editor of the Lancet expressed concern that mathematical modelling was playing too influential a role in UK scientific advice.157 The prominence of modelling and projections was, and still remains, an important part of the UK’s response to covid-19. Models can be useful and informative to policymakers, but they come with limitations. As Professor Neil Ferguson told the Science and Technology Committee in June 2020, “Models can only be as reliable as the data that is feeding into them.”158 However, we know that—especially in the early stages of the pandemic—there was an acute shortage of good data.159 There was also a limited understanding of the virus early in the pandemic. Key questions, such as the length of immunity conferred by infection, were unknown and hampered accurate modelling.160

104.Evidence to the Science and Technology Committee from other academic disciplines included scepticism of the weight being placed on mathematical models during the pandemic. For example Professor Sir John Kay, Economist and Fellow in Economics, St John’s College, University of Oxford, told the Science and Technology Committee in June 2020 that models did not necessarily respond well to change and should not be used to make predictions:

economic models tend to work pretty well as long as nothing much changes, which does not help them to be a great deal of use. What really matters from this point of view is understanding the nature of the underlying change. […]

In my view, the use of economic models and other models is not so much to make predictions as to give people better insights into what is going on, and that is the way in which models ought to be used.161

Professor Carol Propper, Professor of Economics, Imperial College London and President of the Royal Economic Society, illustrated that assumptions in models had not always borne out and there was a need for up-to-date data:

To give one more example of the need for that data, when we shut down hospitals we did not realise we would have a 50% drop in A&E attendances. Clearly, that has been accompanied by some people who should not have gone to A&E not going to A&E, which is good. On the other hand, some people with things like heart attacks and minor strokes, who should have gone to A&E, did not go. We did not anticipate that, and we have no realtime way of tracking it.162

Sir John also indicated that simple models could be more helpful: “A model that focuses on the key parameters is a lot more useful than a more complicated one that tries to bring in everything”.163

105.Sir John also highlighted concerns about how different academic disciplines did not collaborate sufficiently on models.164 Professor James Poterba, Mitsui Professor of Economics, Massachusetts Institute of Technology, explained to the Science and Technology Committee that the consequence of this was that some costs were not factored into models earlier in the pandemic:

Many in epidemiology and in the health services area have realised that the economic cost of some of the policies their models suggested were very important to understand, and consequently they have become very concerned about building some more economics into those models in various ways.165

106.Professor Chris Whitty noted that he preferred advice to be given on the basis of observed data, telling the Science and Technology Committee in November 2020: “It is important to say that a lot of the advice that I have given is not based on significant forward modelling. It is based on what is happening and what is observable.”166

107.Yet despite this, throughout the pandemic, detailed modelled projections have assumed a great prominence and have evidently had great influence on Government decisions. Indeed, the publication of the Imperial study of 16 March, is often cited as one of the main triggers for the abandonment of the initial policy of flattening the peak of covid, and its replacement with the one of suppression, in line with many other countries.167

Assumptions about behavioural compliance

108.Another potential reason for the late lockdown was the behavioural advice that was being tendered to the Government. Behavioural advice is tendered to the Government through SAGE’s sub-group, the Scientific Pandemic Insights Group on Behaviours (SPI-B).168 SPI-B’s first publicly known input into SAGE was on 25 February 2020 on the risk of public disorder.169

109.The initial action plan did not consider the possibility of ceasing all non-essential contact. Dominic Cummings told us that the idea of behavioural fatigue was a part of “false groupthink”:

One of the critical things that was completely wrong in the whole official thinking in SAGE and in the Department of Health in February/March was, first of all, the British public would not accept a lockdown and, secondly, the British public would not accept what was thought of as an east Asian-style track and trace-type system and the infringements of liberty around that.170

The then Secretary of State for Health and Social Care also indicated to us in June 2021 that “the clear advice at the time was that there was only a limited period that people would put up with it—would put up with lockdown.”171 On 9 March 2020, Professor Chris Whitty told a Government press conference:

It is not just a matter of what you do but when you do it. Anything we do, we have got to be able to sustain. Once we have started these things we have to continue them through the peak and that is for a period of time, and there is a risk that, if we go too early, people will understandably get fatigued and it will be difficult to sustain this over time.172

Further, on 10 March 2020, SAGE said that:

A balance needs to be struck between interventions that theoretically have significant impacts and interventions which the public can feasibly and safely adopt in sufficient numbers over long periods.173

However, SAGE later said on 16 March 2020—the meeting where the scale of the epidemic became apparent—that its advice on interventions should be based on NHS needs, not on public compliance:

SAGE agreed that its advice on interventions should be based on what the NHS needs and what modelling of those interventions suggests, not on the (limited) evidence on whether the public will comply with the interventions in sufficient numbers and over time.174

110.It transpired that the UK public were very compliant with the eventual lockdown measures.175 Professor Chris Whitty also said in November 2020:

Across the board, my reflection is that the great majority of people—and this is reflected in all the polling and a variety of other things—both intend to stick to the rules and do stick to the rules to a remarkable degree. To go back to Patrick’s point, were that not the case, we would be in a massively worse place than we are at the moment. My expectation is that R would have shot right up if people had not massively reduced the number of people they have contact with, had not stuck to all the things we need to do in individual actions they can take—such as hands, face and space—and businesses had not done a huge amount to try to make them Covid secure. Without that, we would be in a very difficult place compared with where we are now.176

111.The restrictions eventually imposed on the UK public because of the pandemic were unprecedented. Even in wartime there had been no equivalent of the order to make it a criminal offence for people to meet each other and to remain in their homes other than for specified reasons. In advance, it may not have been unreasonable to assume that the public would have a limited tolerance of such draconian restrictions. But that assumption turned out to be wrong. In the event, compliance with social distancing measures was at a level and for a duration beyond what was anticipated. If a belief that people would not comply delayed a full lockdown, and caused an initially limited set of non-pharmaceutical interventions to be adopted, this was a poor guide to policy.

Was scientific advice sufficiently internationally diverse?

112.We have referred to early evidence from Dr Richard Horton, the Editor of the Lancet, who was concerned that SAGE in its early months was taking insufficient account of international perspectives. At the time he gave his evidence, Dr Horton, like the rest of the public, was not aware of the membership of SAGE. Now we are, and it is notable that of the 87 people listed as having participated in at least one meeting of SAGE, all bar one person (Dr Pasi Penttinen, European Centre for Disease Prevention and Control) are from UK institutions.177

113.It is a characteristic of the best UK scientific institutions, and the people that work in them, that much of their research involves extensive international collaboration. However, for a virus that has affected every country in the world and which was experienced first by other countries, it is also right to consider whether our scientific advisory bodies are sufficiently international. This question arises not only in the context of the early decisions on lockdown but, as we will see in Chapter 4, Public Health England’s failure to evidence any formal evaluation of the test and trace policies of countries which had experienced covid before the UK.

114.Dr Horton expressed concerns about the evidence base that SAGE in its early meetings drew upon. Referring to scientists in East Asia, Dr Horton told the Science and Technology Committee:

If I had been Chair of SAGE, I would have wanted to go to those scientists on the frontline saying, “Please come and tell us your experience. What is coming for us in the UK? Why are you sending this warning signal?” because it is not there in the SAGE evidence.178

Local lockdowns: the tier system

115.Although introduced several weeks after it should have been, the national lockdown brought in on 23 March succeeded in reducing the incidence of covid across the country, so that from May 2020 national restrictions were eased. However, tougher restrictions were maintained in areas where infections were higher. For example, the City of Leicester remained in lockdown measures from July to September 2020.179 The North West of England had stubbornly high levels of covid throughout the summer, and restrictions were imposed on Liverpool, Greater Manchester, Blackburn, and eventually the whole of the region on 29 September 2020.180

116.The Government sought to agree with local leaders the package of restrictions that would apply in particular areas. However, the consequence of this approach led to political differences between national government and some local leaders as to what measures were appropriate for their area—most prominently, the Greater Manchester Mayor, Andy Burnham, and the Government being in a state of disagreement for 10 days during October before restrictions were imposed unilaterally.181

117.By mid-September 2020, case rates were rising across the country, but there were significant local differences. For example, on 30 September, the incidence of covid ranged from 607 per 100,000 population per week in East Sussex, to 4,318 in Knowsley.182 To rationalise the increasingly disparate sets of restrictions being imposed on different places, on 12 October 2020, the Prime Minister announced a three-tier system of local restrictions:183

• Tier 1 maintained the rule of six184 and a 10pm curfew for hospitality;
• Tier 2 did not permit indoor gatherings (including hospitality) but allowed gatherings of up to six people in outdoor settings; and
• Tier 3 a ban on household mixing and hospitality being closed. Retail, schools, and personal care remained open.

118.As we discuss in Chapter 4, there had been hopes that by Autumn 2020 an effective test, trace and isolate system—promised to be “world-beating”—would allow covid levels to be contained without recourse to extensive lockdown restrictions. Indeed the business case that the Test and Trace organisation put forward for Treasury approval cited the enormous savings that would result from being able to avoid a second lockdown as justifying the expenditure of £12bn requested from the Exchequer in September 2020 (the budget and expenditure of Test and Trace subsequently increased).185 As with the early failure of the test and trace system in February and March 2020—then under PHE’s management—to be of material assistance in stopping the spread of the pandemic like in East Asian Countries, the national test and trace operation failed once again to deliver the contribution it promised to avoiding social distancing measures from being required to take up the strain.

119.The experience of the tiered system during the autumn was, however, unsatisfactory. In the absence of effective contact tracing, the regional restrictions proved not to be anywhere near watertight enough to prevent infections spreading, compounded by delays in getting test results. Professor John Edmunds, Professor of Infectious Disease Epidemiology and a participant of SAGE, told us that he had concerns about what the tiering system would result in and that he would not have followed such a strategy:

What worries me a little bit is where the strategy leads at the moment. If you think it through, the targeted strategy—the tiered strategy—leads to a high level of incidence everywhere.

Let’s say that tier 3 works and keeps the reproduction number at about 1. I do not think anybody really thinks it will reduce it to less than 1. Let’s assume that it manages to get the reproduction number to about 1. That means that in Liverpool, Manchester and the north-west, we will keep the incidence at that high level, which is putting hospitals under strain and causing significant numbers of deaths. We are going to keep it at that high level for the foreseeable future.

A few weeks later, the midlands goes into tier 3, so we then keep the midlands at a high level of incidence for the foreseeable future. London is shortly thereafter, and we keep London there. The logical extension of this means that we all end up at a high level of incidence, where hospitals are really under strain and we have large numbers of deaths. For me, that is the logical conclusion of the strategy we are following. I would not follow that strategy.186

120.Professor Dame Angela McLean, Chief Scientific Adviser to the Ministry of Defence and a participant of SAGE, told the Science and Technology Committee in February 2021 that the tier system waited until prevalence was high before any action was taken, implying this was a flaw with the tier system:

What we did with the tier system was we waited until prevalence—the number of people in a place—was high before putting it into a more restrictive tier. We should have said, “Ah, look, in this part of the country the number of infections is starting to grow”—we have a rather exquisite tool for measuring that—and put it into a higher tier while its prevalence was still low.187

Dame Angela’s point was also noted in SAGE minutes. On 19 November 2020, SAGE said that “evidence shows that the earlier and more rapidly interventions are put in place, and the more stringent they are, the faster the observed reduction in incidence and prevalence.”188

121.Another problem with the tiered restrictions that were implemented during the autumn of 2020 was that it was not fully clear what criteria would cause a particular area to be placed in a given tier, nor what would be required for it to exit a particular tier. At times, these decisions felt arbitrary and untransparent. The newly-formed Joint Biosecurity Centre was the source of data and analysis on which these important decisions were made. However, the Joint Biosecurity Centre is a particularly opaque organisation, lacking even the transparency that had come to be displayed eventually by SAGE.189 Dr Clare Gardiner, who was appointed Director of the Joint Biosecurity Centre in June 2020 (but who has now resigned from the post) told our inquiry:

The sorts of data that we look at are case rates and positivity–the number of people who have tested positive–in different age groups. […] we are also looking keenly at the number of people being admitted to hospital.190

122.There has also been a lack of transparency over the scientific case for particular interventions. After the initial, broad lockdown had been lifted specific prohibitions were introduced in later months. Such restrictions were typically justified by Ministers as being scientifically based. But supporting scientific reasoning and evidence was usually lacking. For example, no SAGE paper, or scientific evidence, was published to support the imposition from 24 September 2020 of a 10pm curfew on pubs—a decision that affected the livelihoods of many people in the hospitality sector.191

123.Scientific advice was cited in justification for increasingly fine-grained restrictions—with which some of the Government’s scientific advisers were often visibly uncomfortable. When Sir Patrick Vallance, the Government Chief Scientific Adviser, was asked on 3 November why children’s outdoor sport was banned, despite by then widespread evidence that outdoor transmission of covid was very rare, Sir Patrick said:

They have had advice from us in terms of the
general principles and some of the areas, but, as I say, not down to
individual specific activities like that, and the same is true on the medical side as well. […]

Chair: Would you advise that children’s outdoor sports should banned?
Sir Patrick Vallance: As Chris said, we just do not go down to that level of individual activities.192

124.The two months between September 2020 and 31 October 2020 were an unsatisfactory period in which the comparative simplicity of the rules in place from the evening of 23 March onwards were replaced by a complex, inconsistent, shifting and scientifically ambiguous set of detailed restrictions. The rules had previously been a matter of broad national consent, but that sense of national solidarity began to erode, as the uncomfortable stand-off in Greater Manchester showed.

Proposed circuit breaker

125.Throughout September and October 2020, case numbers and hospitalisations continued to rise nationwide. As the virus started to spread and a second wave appeared to have started, SAGE advised on 21 September 2020 that a two week ‘circuit breaker’, a short and sharp lockdown, could return incidence to manageable levels.193 However, the Government resisted that advice and continued to take localised action. This was a key moment when the Government significantly diverged from the scientific advice it received. On 24 September 2020, SAGE said:

SAGE previously advised that a 2 week ‘circuit-breaker’, where more stringent restrictions are put in place for a shorter period, could have additional impact. A shorter break of a week or less is likely to be less effective in reducing the number of infections and slowing the growth of the epidemic.

However, while a single circuit breaker has the potential to keep prevalence much lower than no intervention, it is not a long-term solution. Long-term control of the virus will likely require repeated circuit breaks, or for one to be followed by a longer-term period with measures in place to keep R at or below 1. Longer-term sustained measures will also be essential.194

126.In evidence to the Science and Technology Committee in November 2020, Sir Patrick Vallance added that the intention of the circuit breaker was to enable the test and trace system—which in September had once again been found to be inadequate—to be more effective:

The advice in September was about a circuit breaker with the intention of driving the numbers back to how they were in August, going back to the discussion on test and trace, because that means you have a greater chance of test and trace being effective. That takes more of the load in managing the disease and you may have to do fewer in terms of other non-pharmaceutical interventions. That is the logic behind that suggestion […].195

Professor Chris Whitty suggested that the case for a circuit breaker was not conclusive, reflecting “there is a lot of uncertainty in these things.”196

127.Dominic Cummings told our inquiry that Downing Street held a meeting on 20 September 2020 for the Prime Minister to hear both sides of the argument. He explained that Professor John Edmunds put forward the view that the Government should impose another lockdown while Professors Gupta and Heneghan put forward an opposing view. Professor Gupta and Professor Heneghan have subsequently written to us to highlight their view regarding that meeting, including, in their view, that a number of claims that Dominic Cummings made about their presentation to the Prime Minister were incorrect.197 Following that meeting, Mr Cummings explained that the Prime Minister was not persuaded about the need to impose another national lockdown.198

128.It is impossible to know whether a circuit breaker would have had a material effect in preventing a second lockdown, given that such an approach was pursued in Wales, which still ended up having further restrictions in December 2020. But it seems that Ministers were mistaken in the weeks after the first wave abated in taking an optimistic assumption that the worst was behind us.199

The second lockdown

129.On 31 October 2020, the Prime Minister announced tougher nationwide restrictions in England—the second lockdown.200 The UK public were once again told to “stay at home”. However, unlike the first lockdown, schools remained open. The Prime Minister announced the second lockdown to the House of Commons on 2 November (having announced it to the nation on 31 October), where he imposed a clear time limit on the lockdown:

Let me stress that these restrictions are time limited. After four weeks, on Wednesday 2 December, they will expire, and we intend to return to a tiered system on a local and regional basis, according to the latest data and trends.201

On 2 December 2020, the second lockdown ended, and England went back into the three-tier system. However, case numbers remained high (at 14,879 on 3 December 2020)202 and started rising again. As a result, on 19 December 2020, the Prime Minister added a tier 4 to the tiering system.203 This followed the discovery of the new UK variant (B.1.1.7) of covid-19, or the “Alpha” variant.

130.The circumstances of the lockdown announced on 31 October were controversial. A Downing Street press conference had been hastily convened on the Saturday evening following leak to newspapers of the Government’s likely intention to bring in a further lockdown.

131.At the press conference, modelling projections were presented which warned of a risk to the ability of the NHS to cope with likely hospital admissions unless the proposed measures were taken. Sir Patrick Vallance in evidence to the Science and Technology Committee on 3 November said:

You would expect the number of hospitalisations to breach the first wave probably towards the end of November. You would expect the number of deaths, potentially, to equal, the first wave numbers sometime in mid-December.204

132.However, it emerged during the following days that the modelling that was presented at the press conference was based on data that had been superseded by more up-to-date information. It also emerged that the forecasts did not include the impact of the regional restrictions that had been brought in on 9 October.205 In practice, the advice of the Government’s most senior scientific advisers that the NHS was likely to be overwhelmed if the advised second lockdown was not imposed made it almost inevitable that it would go ahead:

Chair: We come to the importance of the inquiries into these forecasts. Accepting that Ministers decide and advisers advise, in practice, if the advice from advisers to the Prime Minister is that the capacity of the NHS is likely to be overrun within weeks, that is quite difficult advice to gainsay, is it not? That is why there is an interest in understanding the basis of the advice. It is not optional advice in that sense, is it?

Sir Patrick Vallance: That was the forecasting from the NHS. That is what they said.

Chair: It is also what you said.

Sir Patrick Vallance: Yes. It is what we say from the modelling. As I
said, we cannot deal with NHS capacity. I do not have insight into NHS capacity.
Chair: But your advice to the Prime Minister and the Government, based on NHS data and the modelling data, was that this is a serious prospect and a serious risk.

Sir Patrick Vallance: Yes.206

The Kent or ‘Alpha’ variant

133.Whilst it is clear the first lockdown was called too late, it is not however possible to make such a clear cut judgement about the second lockdown from 31 October for two reasons. First, since the advice was taken and lockdown measures were introduced, the counterfactual—what would have happened to infections, hospital admissions and deaths if the second lockdown had not been instigated—is unknowable. The second reason is that unknown to advisers at the time, a new variant of covid (B.1.1.7) which came to be described first as the Kent variant and later as the Alpha variant, was already transmitting within the population. We were eventually to learn that this variant was significantly more transmissible than the initial strain of covid-19.

134.Following genomic sequencing, PHE found that the Alpha variant first appeared in Kent in September 2020 and rapidly became the dominant variant in Kent, and subsequently, the rest of England.207 The new variant was first brought to the attention of the Government on 11 December 2020.208 On 18 December, the Government was warned that the variant was significantly more transmissible than the initial strain of covid-19.209 The eventual knowledge of this new variant and its heightened transmissibility explained what had been observed earlier: that North Kent and neighbouring areas were experiencing unaccountably high and persistent levels of covid infections during the late autumn. For example, on 30 November 2020, the rate of confirmed covid-19 cases in Swale, in North Kent, was 568 per 100,000 population—over three times as high as the UK rate of 154 per 100,000.210

135.Leading virologists who gave evidence to the Science and Technology Committee on 23 December said that the Government had acted quickly in response to the new evidence. For example, Professor Peter Horby, Chair of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG),211 gave a positive assessment of the timeliness of Government action on the new variant: “We sent our first note to them raising a significant concern on the 18th, and on the 19th measures were put in place.”.212 The Government moved to cancel most of the previously announced relaxations of restrictions at Christmas, and thereafter introducing a third national lockdown from 6 January 2021.213

136.The second wave of the pandemic was more numerous in terms of hospital admissions and deaths than the first wave. It peaked on 8 January 2021 with 68,053 new infections per day reported in the UK,214 and on 20 January with 1,820 deaths.215 This wave was dominated by the Alpha variant. The Alpha variant was dominant at the time of the peak infections and deaths, and had represented over 50% of UK covid infections from 4 January 2021.216 Of the total deaths during second wave,217 56.9% took place after the Alpha variant was the dominant form.

137.Due to the much higher transmissibility of the Alpha variant, in the absence of a test, trace and isolate system capable of arresting the spread of the virus, a circuit-breaker in September and an earlier, more stringent lockdown, would likely have reduced deaths. Had more stringent social distancing measures been adopted during the autumn they could have reduced the seeding of the Alpha variant across the country, slowed its spread and therefore have saved lives. However, this is something we know now, but was not knowable at the time lockdown decisions were taken during the autumn: the existence of the Alpha variant was known only in December 2020.

138.But these decisions were taken before the existence of the Alpha variant was known. So the justification for an earlier lockdown is greatly influenced by information that was not available at the time. It serves to illustrate that, in a pandemic whose course is unknown, some decisions will be taken which turn out to have been wrong, but which it was not possible to know at the time.

Public health messaging and communication

139.Several public health experts stressed to us that an effective messaging and communications strategy was a crucial part of the response to a pandemic. In July 2020, Sir Paul Nurse argued in evidence to the Health and Social Care Committee that “communication, messaging and keeping trust” should be one of the core focuses of the Government’s strategy.218 This was echoed by Sir Jeremy Farrar, who explicitly linked consistent messaging to public compliance with other NPIs:

Consistent messaging and trust in the messaging is absolutely vital. If you are asking anybody—the community or the public—to do things that they would not normally do, they have to trust the message and the messenger, and that has to be consistent over time.219

140.At the outset of the pandemic, the Prime Minister’s “stay at home” order was accompanied by a public messaging campaign that clearly instructed the public to “stay home, protect the NHS, save lives”. This message was driven by regular televised press conferences from Number 10 Downing Street, during which Ministers sought to emphasise that the response was “built upon the bedrock of the best possible scientific and medical advice”.220 Professor Whitty credited this initial messaging as “absolutely essential in people understanding what needed to happen, and then doing it.”221 The message was clear in both the instruction it was giving the public, as well as plainly explaining why they were being asked to change their behaviour.

141.Much of the evidence to our inquiry has acknowledged that this “Stay at Home” slogan was successful in fostering sufficient levels of awareness and understanding among the public. For example, during this period there was a marked fall in the number of people travelling on the roads and using recreational areas. Written evidence from the Nuffield Trust attributed this apparent success to the “simplicity and ease of recall” of the message.222 According to Professor Devi Sridhar, Chair of Global Public Health at the University of Edinburgh, the public are more likely to comply with instructions that are clear and easy to understand:

You have to take the public with you. The public will comply, not because they are forced to, or because there is military on the streets, but because they want to. People generally want to follow the rules if they understand them.223

142.Evidence from University College London (UCL) showed that during the first lockdown, the simplicity and clarity of public health messaging did indeed translate into high levels of compliance with the stay at home order. According to UCL, during this period “levels of understanding were reported by individuals to be very high” and simultaneously “over 70% of [70,000] survey respondents reported ‘complete compliance’ with guidelines”.224

143.Although the communications strategy in the initial phase of the pandemic was broadly successful, it is worth noting that there was some confusion over who the stay at home order applied to, and there was criticism of the Government’s decision not to provide a British Sign Language (BSL) interpreter on-set at the televised briefings. Similar briefings in Scotland and Wales did include an interpreter, socially distanced from Ministers. In the UK, there are more than 80,000 Deaf people whose first language is BSL.225 The decision not to include an interpreter at these briefings, where important public health announcements were often made, may have reduced their ability to understand the messages provided and in turn potentially decreased trust and compliance among this group.

144.On 10 May 2020, the Government announced that society would begin to reopen in England through a staged series of lockdown easing measures.226 From this point, there were divergent approaches to messaging across the four nations of the UK. To reflect the gradual lifting of strict lockdown measures in England, the Government changed its slogan from “stay home, protect the NHS, save lives” to “stay alert, control the virus and save lives”.227 In contrast, during a press conference on the same day, the First Minister of Scotland emphasised that “we remain in lockdown for now and my ask of you remains to Stay at Home”.228

145.Written evidence to our inquiry suggested that the loss of consistency across the four nations led to confusion, with “messages from numerous national bodies that, at times, appeared to contradict each other”.229 We heard that at this stage, these contradicting messages began to cause confusion. Professor Devi Sridhar, speaking to the Health and Social Care Committee in July 2020, explicitly linked this confusion to infection rates:

One point where you can see that England and Scotland diverged was when England changed in May to: “Stay alert.” Many people did not fully understand what that meant. In Scotland, the message was very clear: “Stay at home.” When we started to see divergence in infection rates and death rates, it was around that time.230

146.The three-tier approach to local lockdown restrictions in England (see paragraph 117) introduced more complexity to Government messaging which was, understandably different in different parts of the country.231 It was therefore unsurprising that this more differentiated messaging strategy meant that levels of public understanding and compliance began to deteriorate. Written evidence submitted by UCL showed much poorer comprehension of the rules than at the beginning of the pandemic. By October, fewer than half of the over 70,000 adults who took part in the survey reported broad understanding of the rules (45%), with just 14% understanding them ‘very much’. Self-reported compliance was consequently also much lower, with just over 40% reporting ‘complete compliance’ with guidelines, compared to 70% earlier in the pandemic.232

147.Written evidence suggested that the inconsistency in Government messaging after the first wave of the pandemic was also damaging to public trust in official information.233 Analysis submitted by Leeds Beckett University showed that most members of the public did not trust information from the UK Government and that they were much more likely to trust information shared by the World Health Organisation.234 The perception that key Government figures, including the former assistant to the Prime Minister, had breached lockdown rules may have further undermined public trust during spring 2020. In oral evidence, Dominic Cummings acknowledged that his widely reported trip to Durham was “a complete disaster” and admitted that it “undermined public confidence in the whole thing”.235

148.Lower levels of public trust and understanding of the regulations also created a gap into which misinformation was able to spread. Research conducted by Ofcom in the first six weeks of the pandemic found that 47% of respondents said they had come across false or misleading information about covid-19 in the last week. Most commonly, respondents indicated that the misinformation they encountered was linked to “theories linking the origins or causes of covid-19 to 5G technology”.236 More recently, a study conducted by King’s College London in November 2020 found that 14% of respondents “believe the real purpose of a mass vaccination programme against coronavirus is simply to track and control the population”.237 Susceptibility to covid-19 misinformation has many causes, but research has found that lower levels of trust in both scientists and Government are associated with increased susceptibility to misinformation.238 This highlights the critical importance of a communications strategy which is clear, consistent and perceived as transparent by the public.

Outcomes

149.The covid pandemic is a global emergency that is not yet over. While the UK’s trajectory may have changed in recent months with vaccines, the vast majority of the world is still grappling with the disease. It would be prudent to reserve judgement on the UK’s performance until the pandemic is over across the world. When that time comes, we will be able to more accurately and fairly judge the UK’s performance against the rest of the world.

150.One of the key ways to measure a country’s success in fighting covid-19 is to measure deaths from covid-19. However, countries across the world measure deaths in different ways. The UK has reported covid deaths as those who died within 28 days of a positive test. The UK also offers statistics on daily deaths with covid-19 on the death certificate. The US Centres for Disease Control includes both confirmed and probable cases and deaths.239 The historian, Professor Niall Ferguson, told the House of Commons Foreign Affairs Committee:

I actually think there is a better way of looking at this, which is to look at excess mortality. We don’t have excess mortality data for all the countries in the world, but if you look at the ones for which we do have data, the UK and the US are firmly in the middle of the table, with 17% or 18% excess mortality, close to Belgium, close to Italy, close to Spain.

Some countries in Europe did slightly better—France, Sweden, Switzerland—but there are a great many countries that did a good deal worse. I won’t recap the countries you are expecting to hear—once again, it is Latin American and east European countries that have the worst excess mortality. Of course, some countries in Europe have done significantly better, to the point, in the case of Denmark, of having no excess mortality, or virtually none in Norway. I think this is probably the best measure to use.240

The UK does record excess mortality, primarily through the Office for National Statistics. When the time comes to compare the UK’s standing amongst the rest of the world, it will be important to choose the correct basis of comparison. Thus far, there has been no international standard in the reporting of deaths.

151.There are also other factors to be considered. Each country has a unique set of characteristics which might have contributed to its health related covid-19 outcomes. For example, the UK has the tenth-highest rate of obesity in the world,241 which is linked to an increased risk of adverse outcomes.242

Conclusions and recommendations

Conclusions

152.During the first three months of the covid pandemic, the UK followed the wrong policy in its use of non-pharmaceutical interventions. When the UK moved from the ‘contain’ to ‘delay’ stage, there was a policy of seeking to only moderate the speed of infection through the population—flattening the curve—rather than seeking to arrest its spread. The policy was pursued until 23 March because of the official scientific advice the Government received, not in spite of it. Questions remain about whether the containment phase was pursued aggressively enough—we believe it could have been pursued for longer. During this period Government policy did not deviate from the scientific advice it received in any material respect. The fact that the UK approach reflected a consensus between official scientific advisers and the Government indicates a degree of groupthink that was present at the time which meant we were not as open to approaches being taken elsewhere—such as earlier lockdowns, border controls and effective test and trace—as we should have been.

153.The flattening the curve policy was implemented by introducing new restrictions only gradually and slowly, acting as if the spread of the virus were susceptible to calibrated control. Modelling at the time suggested that to suppress the spread of covid-19 too firmly would cause a resurgence when restrictions were lifted. This was thought likely to result in a peak in the autumn and winter when NHS pressures were already likely to be severe. In addition, it was thought that the public would only comply with severe restrictions for a limited period, and so those restrictions should not be applied before they were most needed. This approach should have been questioned at the time for a number of reasons:

• it entailed people contracting covid in large numbers with hundreds of thousands of deaths likely to result;
• other countries, in Asia and in Europe, including some with experience of SARS and MERS, had chosen to implement earlier, more comprehensive strategies of non-pharmaceutical interventions, which were having success; and
• suppressing the spread of the virus in the early period would have bought valuable time to consider what was the best way to manage the pandemic in the medium term.

154.There are several possible explanations for what was a significant error in policy and advice early in the pandemic. These include:

• the lack of adequate data on the spread of covid-19, as a result of the inadequacy of the UK testing operation;
• overreliance on specific mathematical models when there were too many uncertainties;
• assumptions about public compliance with rules that turned out to have underestimated the willingness to conform even for long periods;
• the composition of SAGE suffered from a lack of representation from outside the United Kingdom; and
• a preference for a particular UK approach may have been favoured above advice based on emulation of what was being pursued elsewhere.

155.Science proceeds through challenge and disputation, and new theories are tested unflinchingly against evidence. Yet Ministers and other advisers reported that they felt it difficult to challenge the views of their official scientific advisers. Those in Government have a duty to question and probe the assumptions behind any scientific advice given, particularly in a national emergency, but there is little evidence sufficient challenge took place. However, even when UK policy had changed to bring in a comprehensive national lockdown, the role of non-pharmaceutical interventions against covid-19 was complex, inconsistent and opaque for most of the rest of 2020.

156.The second wave of covid infections, hospitalisations and deaths during the autumn and winter of 2020/21 was significantly driven by the emergence of a new variant, known as the Kent or Alpha variant. It is likely that a “circuit break” of temporary lockdown measures if introduced in September 2020, and earlier lockdown measures during the winter, could have impeded the rapid seeding and spread of the Kent variant. However, the existence of the Kent or Alpha variant was not known by the Government until 11 December 2020 so that the justification for taking earlier measures could not rely on information available at the time.

157.Government public health communications are key to the public’s understanding of and compliance with non-pharmaceutical interventions. Initial messaging from the Government early in the pandemic was strong, effective and undoubtedly contributed to the success of the first lockdown. After the gradual lifting of the first lockdown from May 2020, Government guidance became increasingly complex and harder to understand, with restrictions varying in different parts of the country. Government communications did not always reflect this nuance, leading to perceived inconsistency and divergent strategies across the four nations of the UK.

Recommendations and lessons learned

158.In the early days of a crisis, scientific advice may be necessarily uncertain: data may be unavailable, knowledge limited and time may be required for analysis to be conducted. In these circumstances it may be appropriate to act quickly, on a precautionary basis, rather than wait for more scientific certainty.

159.In future an approach of greater questioning and challenge should characterise the development of policy. Ministers should have the confidence to follow a scientific approach themselves—being prepared to take a more robust approach to questioning and challenging the advice given. The Government and SAGE should also facilitate strong external and structured challenge to scientific advice, including from experts in countries around the world, and a wider range of disciplines.

160.In bringing together many of the UK’s most accomplished scientists, SAGE became a very UK body. In future, it should include more representation and a wider range of disciplines, from other countries, especially those which have experienced, or are experiencing, the same emergency.

161.In a pandemic, the scientific advice from the SAGE co-chairs to the Government should be published within 24 hours of it being given, or the policy being decided, whichever is the later, to ensure the opportunity for rapid scientific challenge and guard against the risk of ‘groupthink’. In addition, minutes and SAGE papers should be published within 48 hours of the meeting taking place.

162.The Government, via the World Health Organisation, should make the case for an international standard of reporting covid-19 deaths and a framework for reporting disease related deaths for future pandemics.