Dr Patricia Lewis, Chatham House—
The first onslaught of the 2020 covid-19 pandemic illuminated significant regional and global discrepancies in regard to the state of biosecurity readiness in areas such as testing provisions, personal protective equipment (PPE), and the speed of decision-making. [ … ] In reality few governments were fully prepared and, in years to come, almost all governments and health systems—even those that were well prepared—will ask: ‘how could we have been better prepared, what did we do wrong, and what can we learn?’
9.On paper, at the start of 2020, the UK expected, and was prepared for, a biological emergency—so much so that it received one of the highest scores of any country in an international assessment of the resilience of national health systems. The country scored especially highly in the categories of ‘detection and reporting’ and ‘rapid response’. However, the Government’s domestic response to the covid-19 pandemic has called that readiness into question. Many contributors to our inquiry gave damning assessments of how the UK has dealt with this biological emergency in practice. For instance:
10.This Chapter explores how the Government assessed biological risks prior to 2020, and the extent of preparation it undertook as a result. With the pandemic presenting a ‘test case’ for how well the systems identify and plan for risks, it focuses on the Government’s preparations for a serious outbreak of infectious disease. The dangers posed by other biological risks are considered further in Chapter 6.
11.It is impossible to predict the future, but safeguarding national security requires the Government to assess which risks are most likely to materialise and what their consequences might be, as well as to take action to reduce their impacts. This is the purpose of the National Security Risk Assessment (NSRA). The Government regards the UK as a “leader in risk assessment”.
12.The NSRA process is the starting point for the UK’s crisis planning, led by the Civil Contingencies Secretariat in the Cabinet Office. The process identifies the most significant risks to the UK’s security and organises them into three ‘tiers’, based on an assessment of both their likelihood and impact. The Cabinet Office makes these judgements based on extensive intelligence and information, as well as the contributions of external experts and government departments. The Assessment is updated approximately every two years.
13.The Government has long recognised that biological risks to human health—the focus of our inquiry—represent some of the most serious risks to the UK’s national security. In varying ways, public health crises, including pandemics, were ‘tier-one’ risks (highest priority) in the National Security Risk Assessments of 2010 and 2015. In 2018, the Government identified ‘diseases and natural hazards affecting the UK’ as one of six principal challenges likely to drive national security priorities over the coming decade, stating that:
One or more major hazards can be expected to materialise in the UK in every five-year period. The most serious are pandemic influenza, national blackout and severe flooding.
The Government published a Biological Security Strategy in 2018. This aimed to draw together “the wide range of activity across Government” to protect the UK from biological risks, whether these occurred naturally, accidentally or as a result of deliberate attacks. The Strategy identified four main biological risks to the UK: a major health crisis (such as pandemic influenza); antimicrobial resistance; a deliberate biological attack by state or non-state actors (including terrorists); and animal and plant diseases, which themselves can pose risks to human health.
14.The Strategy did not draw detailed conclusions on the likelihood of individual biological risks materialising, other than stating that the likelihood of many worst case scenarios was “low” overall, especially those involving accidental release of hazardous biological material or deliberate attacks. It did, however, identify several drivers that may increase the chance of biological emergencies over time, including greater international travel, trade and urbanisation, climate change, human encroachment into animal habitats, and others (see Chapter 6 for a fuller examination of these).
15.While regarding many worst-case biological risks to be of a low likelihood, the Strategy assessed their potential impact as “significant”. These included antimicrobial resistance leading to 10 million more deaths each year globally by 2050 if no action was taken, or a major health crisis resulting in hundreds of thousands of fatalities and costing the UK tens of billions of pounds. The Government saw the possible consequences from pandemic influenza as the most far-reaching and significant of such crises.
16.A public version of the NSRA (released in 2017) judged that both ‘pandemic influenza’ and ‘emerging infectious diseases’ were likely to occur in the next five years (rated 4 out of 5 for likelihood), but estimated that the potential impact of pandemic influenza would be the more severe. The possible impacts of pandemic influenza were assessed to include “up to 50% of the UK population experiencing symptoms, potentially leading to between 20,000 and 750,000 fatalities and high levels of absence from work”. For other emerging infectious diseases, the projected impacts involved “several thousand people experiencing symptoms, potentially leading to up to 100 fatalities”.
17.The Government has not always been internally consistent as to whether pandemic influenza and emerging infectious diseases were equally likely to affect the UK. Whereas the 2017 National Risk Register found them to be of the same likelihood (4 out of 5), the Biological Security Strategy said that the worst case scenarios of many biological risks are low. Witnesses suggested that pandemic influenza was more likely than emerging infectious diseases to affect the UK.
18.Prior to 2020, the Government had clearly identified the security risk posed by diseases, particularly pandemic influenza. The combined results of National Security Risk Assessments of the last decade, the 2018 Biological Security Strategy and other recent security reviews attest to this, although the reasoning behind the separation of the risks from pandemic influenza and other emerging infectious diseases was not fully clear. The Government did less well with the difficult task of projecting the impacts of emerging infectious diseases (such as coronaviruses). For instance, Gregory Lewis of the Future Humanity Institute (Oxford University), pointed out that the potential fatalities were “under-estimated [ … ] by over 400-fold”, arguing that “the benefit of hindsight is not needed to see this was a very poor assessment of a reasonable worst case scenario”. A former Director of the Civil Contingencies Secretariat, Bruce Mann, also drew attention to the NSRA’s under-estimation of the effects of an emerging infectious disease pandemic. The Government acknowledged that the consequences of covid-19 have been worse than foreseen by its risk assessments.
19.The Government’s risk assessment processes correctly identified the threat posed by biological risks and classified an influenza pandemic among the highest ‘tier-1’ risks to the UK’s security as early as 2010. With hindsight from the covid-19 pandemic, the fatalities from emerging infectious diseases specifically were substantially under-estimated. The Government did project the significant disruptive impacts of pandemic flu. However, although this should have indicated the widespread disruption that could be caused by other infectious diseases, this connection seems to have failed to have been made.
20.The purpose of the NSRA is not only to identify and assess future security risks, but also to generate actions. Specifically, the NSRA is intended to offer evidence to central government and local authorities to “inform and prioritise contingency planning”. The assessment is “shared with policy makers, national and operational planners, and science and technology leads” to inform their future actions. As the Director of the Civil Contingencies Secretariat, Roger Hargreaves, put it, the NSRA and the National Risk Register help to:
tell a story to a community of emergency planners around the country, and to the public at large, about the kinds of risks we are dealing with, their relative weight and how, therefore, they should be managing their work to be prepared at every level of government, not just the centre.
21.Although the NSRA tells this ‘story’ to planners, the exact implications of a risk receiving a ‘tier-1’ assessment are not clear, in terms of the resourcing and preparations that this should entail. Given that pandemic influenza was seen to be the greatest disease-based risk prior to 2020, preparations focused specifically on this risk. The UK Influenza Pandemic Preparedness Strategy, released in 2011, was intended to establish:
a UK-wide strategic approach to planning for, and responding to, the demands of a future [reasonable worst case scenario] scale influenza pandemic within which 50% of the population become ill.
It outlined in detail the required ‘strategic approach’, including: systems for monitoring and surveillance of virus transmission in humans and animals; increasing laboratory capacity; securing vaccine access (when available); accessing supplies of clinical countermeasures (such as PPE for frontline workers and antiviral medicines for treating flu); and the use of surge plans and mechanisms to reduce pressure on primary care services.
22.Disease planning and preparations also featured in security strategies and reviews. The 2018 Biological Security Strategy highlighted the strength of the UK’s day-to-day health systems to respond to a range of biological crises. The 2017 National Risk Register cited ongoing coordination to “share plans and information” across Government departments, devolved administrations, public health agencies and devolved NHS branches (although it did not explain the type of information and plans). It envisaged the following aspects would be part of the UK’s response to a serious disease outbreak:
Similarly, the Biological Security Strategy stated that, in the case of a significant disease outbreak in the UK, day-to-day health systems would be aided by:
extensive cross-Government response arrangements, including detailed contingency plans, to allow effective co-ordination and leadership—reinforced through a regular programme of training and exercises.
23.Reflecting on the reasons behind the earlier positive assessments of the UK’s preparedness for an (influenza) pandemic, Roger Hargreaves, Director of the Civil Contingencies Secretariat, told us:
The building blocks that caused the UK to be rated highly were our surveillance and modelling systems; the awareness across the scientific community and the emergency planning population of the criticality of preparing for pandemic flu; the preparedness of our research capabilities; our business continuity capabilities; our ability to carry out advance purchase agreements of potential vaccines.
The Government mainly focused on influenza in its pandemic preparations, but it had recognised the need to prepare for, and respond to, other disease types. It referred in 2015 to having “detailed, robust and comprehensive plans” and the “necessary capacity” to respond to infectious diseases “including pandemic influenza and respiratory diseases”. Likewise, it stated in 2017 that contingency plans existed for “many emerging infectious diseases”. Its Biological Security Strategy also underlined the importance of preparing for a range of disease impacts, rather than concentrating on individual diseases:
We will continue to ensure that we have in place proportionate, flexible and well-tested plans to cover a range of biological risks. While acknowledging the specific challenges presented by particular diseases, these will (where possible) be impact focused and not focused on the characteristics of specific diseases, in order to allow an effective response to new and emerging risks.
24.At the start of 2020, the UK had detailed strategies and plans to deal with a significant disease outbreak, but these were mainly focused on pandemic influenza—seen to be the highest-impact disease risk at that time. This was reflected in the dedicated strategy for tackling an influenza pandemic, the recurrent references to influenza in the actions of the 2017 Risk Register, and in the design of the largest biological security testing exercise that occurred over the last decade, ‘Exercise Cygnus’ (see Chapter 5). Nonetheless, in theory, the Government understood the need not to over-focus on a single disease in its preparations. It committed in 2018 to focusing on impacts rather than specific disease characteristics, to enable an effective response to new and emerging risks. It also referred to other contingency plans that it had developed to prepare for infectious diseases beyond influenza.
15 Dr Patricia Lewis ()
16 Specifically, in 2019, the UK ranked 2nd overall out of 195 countries in the ‘Global Health Security Index’. This is a comprehensive assessment and benchmarking of health security and related capabilities across the States Parties to the International Health Regulations (IHR ). Global Health Security Index, ‘’, accessed 11 December 2020. The UK-specific results are at: Global Health Security Index, ‘’, accessed 11 December 2020.
17 In addition to these examples see: Ed Arnold () para 1; LSE IDEAS () section D; School of International Futures (), ‘Expert advice does not turn into action’ section.
18 Professor Christian Enemark ()
19 Dr Filippa Lentzos and Professor Michael Goodman ()
20 Helen Ramscar () paras 2, 2.1
21 Professor Paul Rogers ()
22 Her Majesty’s Government ()
23 Her Majesty’s Government (); Sir Patrick Vallance,
24 Her Majesty’s Government, (November 2015), pp 85–87
25 For biological risks, intelligence agencies collect information on deliberate threats and a wide range of other organisations currently collect information on other risks to public, animal and plant health, including Public Health England (PHE), the Department for Environment, Food and Rural Affairs (Defra), the Animal and Plant Health Agency (APHA), the Veterinary Medicines Directorate (VMD), “equivalents within the devolved administrations” and UK researchers “across the globe”. See Her Majesty’s Government, (July 2018), p 15
26 The Government notes “a number of internal and external experts” play a role in identifying risks. It refers to these groups in written evidence: Department of Health and Social Care’s New and Emerging Respiratory Virus Threats Advisory Group and the Advisory Committee on Dangerous Pathogens. See Her Majesty’s Government ().
27 Her Majesty’s Government ()
28 An influenza pandemic is under the top-tier risk of ‘Civil emergencies’. See Her Majesty’s Government, (October 2010), paras 4.D.1 and 4.D.2
29 In 2015, a ‘Public health crisis’ was one of six ‘tier-one’ risks, and included “disease, particularly pandemic influenza, emerging infectious diseases and growing Antimicrobial Resistance”. See Her Majesty’s Government, (November 2015), p 86
30 Her Majesty’s Government, (March 2018), p 6
31 Her Majesty’s Government, (July 2018)
32 Pandemic influenza comes about due to a new flu virus that is markedly different from recently circulating strains. Individuals are not expected to have immunity to this new virus, meaning it has the potential to spread quickly and lead to serious illness. See Her Majesty’s Government, ’ (24 November 2017).
33 Antimicrobial resistance is a natural process whereby microbes evolve to be able to resist the action of drugs, making them ineffective. Resistance arises from the selection pressure that antimicrobials put on populations of microbes; essentially selecting or allowing those microbes to survive and proliferate, typically through genetic changes. This leads to antibiotics becoming less effective over time and in many extreme cases, ultimately useless. This definition is in ‘The Review on Antimicrobial Resistance, ’, accessed 14 December 2020.
34 Her Majesty’s Government, (July 2018), p 7
35 (July 2018), pp 10–12
36 (July 2018), p 7
37 (July 2018), p 9
38 The publicly available version is the ‘National Risk Register’.
39 The expected impact of pandemic influenza was rated at the highest possible level (5 out of 5); for emerging infectious diseases the impact was assessed as 3 (out of 5). See Cabinet Office, (2017 edition), p 9
40 Cabinet Office, (2017 edition), p 34
41 Explicitly by Roger Hargreaves, and implicitly by Penny Mordaunt, who stated that preparations focused on “likely scenarios”. They may have implied a large outbreak specifically.
42 Both covid-19 and flu are respiratory virus infections, but there are key differences. Influenza has a shorter median incubation period (the time from infection to appearance of symptoms) and a shorter serial interval (the time between successive cases) than covid-19 virus. The serial interval for covid-19 virus is estimated to be 5–6 days, while for influenza virus, the serial interval is 3 days. This means that influenza can spread faster than covid-19. Transmission in the first 3–5 days of illness, or potentially pre-symptomatic transmission, is a major driver of transmission for influenza whereas pre-symptom transmission does not appear to be a major driver of covid-19 transmission. The reproductive number—the number of secondary infections generated from one infected individual—is understood to be between 2 and 2.5 for covid-19, higher than for influenza. (WHO, (March 2020))
43 The number of fatalities is now under-estimated by 600-fold. The 2017 Risk Register foresaw up to 100 fatalities from an emerging infectious disease, whereas the number of fatalities with covid-19 is currently estimated to be over 60,000. See Her Majesty’s Government, ‘’, accessed 11 December 2020
44 Doctor Gregory Lewis () paras 2.1, 2.3. The Government Chief Scientific Adviser told us that the ‘reasonable worst case scenario’ encompasses “something that could happen; it is not likely to happen, but it is the worst case that you think could reasonably appear” ( [Sir Patrick Vallance]).
45 Oral evidence taken before the Defence Committee on 14 July 2020, HC (2019–21) 357, [Bruce Mann]
46 Her Majesty’s Government ()
47 Her Majesty’s Government, (July 2018), p 15
48 Her Majesty’s Government ()
49 Her Majesty’s Government, (July 2018), p 15
51 Her Majesty’s Government (). See also Department of Health, DHSSPS, Welsh Government and Scottish Government, (November 2011)
52 Cabinet Office, (2017 edition), p 35
53 Her Majesty’s Government, (July 2018), p 26
55 Her Majesty’s Government, (November 2015), para 4.131
56 Cabinet Office, (2017 edition), p 35
57 Her Majesty’s Government, (July 2018), p 27