25.The Government told us that its initial response to the covid-19 pandemic built upon its preparations for an influenza pandemic. It gave the examples of its emphasis on good infection prevention and control practices (via advice on hand and respiratory hygiene), and its use of a draft pandemic influenza Bill in preparing the Coronavirus Act 2020 (which, amongst other things, allowed for the return of retired healthcare workers to the frontline). It also said that pandemic influenza plans assisted “surveillance and modelling” (without giving details). Separately, the Government stated that similarities between influenza and the covid-19 virus allowed “certain elements” of the UK’s influenza pandemic preparedness plans to be tailored or adapted as part of the covid-19 response. The Director of the Civil Contingencies Secretariat told us the UK used “an awful lot” of its influenza planning work.
26.The Government acknowledged, however, that the pandemic’s effects were worse than foreseen, and that the UK’s capabilities to respond “have been and are still being rapidly scaled up”. Some witnesses suggested that the unknown nature of coronavirus as a disease explains the difficulties that the UK faced in responding. Lord Sedwill told us that “like everyone else”, the UK was “learning about covid as we went along” and judged:
I would not say that we did not pre-plan, but we were dealing with a disease that had characteristics different from any other disease that we had seen before and different from the pandemic flu, which was the example for which we had prepared.
And Roger Hargreaves, Director of the Civil Contingencies Secretariat, explained that:
Covid-19 has been very different because of asymptomatic transmission, the time spent in intensive care units and the absence of an immediate vaccine. It is a more straightforward process in the context of pandemic flu. [ … ] There are lots of things that build a picture of why we were so highly regarded, but [ … ] we were dealing with something that no one expected.
27.On the other hand, some commentators underlined that some actions could be taken to prepare the response to any infectious disease, thereby undermining the significance of the difference between influenza and coronavirus. Some responses to disease are ‘pathogen blind’, such as supportive hospital care and non-pharmaceutical interventions (like quarantine, isolation and contact tracing), even if others are ‘pathogen specific’ and require customisation to an individual disease, such as vaccines and therapeutics. Dr Jennifer Cole believed risk should be considered in relation to its impact on individuals and society, rather than over-focusing on the “characteristics of the risk actor”.
28.Furthermore, although impacts on the UK were limited, highly consequential coronavirus outbreaks themselves had occurred prior to the covid-19 pandemic: the outbreak of severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS) in 2012. These diseases were less transmissible than covid-19, but with a greater fatality rate.
29.Government departments receive support from the Cabinet Office to plan and prepare for civil emergencies—specifically, to build up the “capabilities” necessary to “deal with the consequences of emergencies”. The Cabinet Office’s ‘Resilience Capabilities Programme’ aims to support a “broad and generic set of capabilities” across departments, to be “applicable across multiple risk scenarios”. We discuss below the level of response capabilities in practice, examining the covid-19 pandemic in three areas—detection and containment, supplies and communications.
30.Detecting a disease and containing its spread are ‘the basics’ of good infection control. The Biological Security Strategy committed to
rapidly and effectively detect, characterise and report the presence and nature of harmful biological material, or pest and disease outbreaks that have the potential to represent a significant risk or threat to the UK or UK interests.
‘Detect’ is one of the four ‘Pillars’ of the response outlined in the Strategy. The UK has systems for detecting new risks to public health and animal health (‘disease surveillance systems’), led by individual agencies and departments. Public Health England responded to over 10,000 disease outbreaks and emergencies in England in 2018–19, including meningitis, measles, E. coli and the UK’s first case of monkeypox.
31.Emergency response generally requires the ‘scaling up’ or speeding up of existing functions. In the context of the covid-19 pandemic, the UK faced significant difficulties in scaling up its testing and contact-tracing system, as documented by other select committees. A point of controversy has been Public Health England’s decision-making and capacity to scale up the role of tests significantly in the early stages of the pandemic. In September, the Government highlighted that, “as with most public health agencies globally, PHE has not had the at-scale response capacity we have needed to handle a full-blown pandemic”. Some commentators have questioned whether the abolition of Public Health England (announced in August) reflected failures on testing and contact-tracing, and if so whether PHE was responsible for that. Clara Swinson of DHSC doubted that any agency would have been able to “turn on” the capacity needed to do 500,000 tests a day and believed future decisions would be needed on “how much capacity you have ready to go at any time and how much you switch on”.
32.Dr Jennifer Cole suggested that PHE’s hospital laboratory capacity had been scaled down prior to the covid-19 pandemic. Retired microbiologists have pointed to the abolition of the Public Health Laboratory Service (PHLS) in 2003 and the Health and Social Care Act 2012 as triggers for reductions in the number of laboratories within the non-NHS network. Valerie Bevan, Chair of the British Society for Microbial Technology, has similarly written that the PHLS had a network of more than 50 laboratories, but that, from 2003, this was “dramatically reduced in favour of centralisation as a cost-saving venture”, which reduced capacity for large-scale testing.
33.Contributors to our inquiry have questioned whether, ahead of time, the Government had considered how it might expand these capabilities after an outbreak of serious diseases, other than flu. The 2017 National Risk Register foresaw that the UK’s specialist epidemiology and microbiology capabilities would play a key role in detection, by identifying, characterising and responding to infectious diseases. However, industry associations ADS and CBRN-UK (whose members have chemical, biological, radiological, and nuclear detection capabilities) suggested that the Government’s engagement with industry had been “patchy”, and that companies’ virus contamination mapping capabilities had not been used. Dr Patricia Lewis from Chatham House called it a “very big failing” that the UK did not engage in population testing early in the covid-19 pandemic, and Sir Patrick Vallance spoke of “flying blind” in the absence of data. The LSE IDEAS Centre argued that the Government’s focus on preparing for an influenza pandemic might have caused it to overlook important capabilities for detection, warning:
Preparations for outbreaks of flu, a disease with a brief incubation period, directed more attention to hospital capacity than the infrastructure of laboratories for testing, effective contact tracing capabilities, and local reporting systems needed for diseases with longer incubation periods that can be contained by testing and tracing contacts.
34.Some contributors suggested that the Biological Security Strategy put insufficient focus to detecting and containing disease within the UK. Dr Opi Outhwaite said:
The ability of diseases to spread globally is not limited to any particular areas of the world [ … ]. This is not an issue that can be viewed as happening in ‘other’ parts of the world. It is not clear that this understanding was fully internalised prior to covid-19.
The LSE IDEAS Centre similarly argued that the Biological Security Strategy was over-focused on controlling diseases in other countries. Professor Christian Enemark pointed out that, while vaccines and drugs are considered part of the response to a disease in the Strategy (“pharmaceutical responses”), there was limited consideration of non-pharmaceutical actions that the public might need to take, with no reference to terms such as ‘social distancing’, ‘lockdown’, ‘isolation’ or ‘quarantine’.
35.There have been no large-scale exercises to test the UK’s detection and containment capabilities in the case of a disease outbreak since 2010 (see Chapter 5).
36.The Biological Security Strategy’s ‘Detect’ pillar only mentions the role of border detection in the context of animal health and plant health. Dr Outhwaite criticised the UK’s demarcation between public health policies and animal health policies, which manifested in the “limited interaction” between the 2011 Pandemic Preparedness Strategy and the 2018 Biological Security Strategy. She pointed out that the animal health sector has valuable expertise in pre-entry and point-of-entry detection checks, but the UK made limited use of this, with few attempts to pursue pre-entry health checks or consider a quarantine for entrants in the early stages of covid-19. This, she argued, made it harder to undertake a rapid assessment of first cases and their contacts. The combination of high travel volumes, few restrictions on international arrivals and a lack of testing allowed covid-19 (SARS-CoV-2) to be introduced to the UK on at least 1,300 separate occasions by the time of the first lockdown.
37.The Biological Security Strategy emphasised the importance of early disease detection efforts. Professor Paul Rogers complained that the Government did not do enough to detect or contain the virus in January and February 2020, despite the WHO’s warning of human-to-human transmission risks on 13 January. Dr Cole also questioned whether the UK’s plans were “focused more on taking the hit” than on preventing a spread in the number of cases—seeing “massive gaps in prevention planning” in terms of case identification.
38.In 2015, the Government stated that it had learned lessons from biological incidents overseas, including the Ebolavirus outbreak. Some witnesses believed, however, that the importance of test, trace and isolate systems—shown by previous outbreaks of SARS and Ebola—was not one of those lessons. Others underlined that there were limits on the validity of such transnational comparisons.
39.We recognise the Government’s significant efforts during the covid-19 pandemic to scale up the UK’s detection and containment capabilities—in the form of test, trace and isolate systems. However, that task was made harder by a failure to consider how these critical capabilities might be scaled up ahead of time, including detection checks at the border and pre-assessing the availability and adequacy of national laboratory infrastructure for large-scale testing. It is regrettable that these capabilities were not covered in any large-scale testing exercises since the classification of pandemics as a ‘tier-1’ security risk was made in 2010.
40.The failure to plan for the expansion of the detection and containment capabilities may have been the result of an undue focus on an influenza pandemic, rather than diseases with a longer incubation period. It is also, we believe, because the Government continued to doubt that a novel disease could circulate so widely in the UK, despite the 2017 National Risk Register judging it ‘likely’ that an emerging infectious disease would affect the UK in the next five years, and the 2018 Biological Security Strategy identifying multiple drivers that would have made an outbreak more—not less—likely.
41.Before the current pandemic, the UK Government made commitments to stockpile ‘clinical countermeasure’ items for a serious disease outbreak. Clinical countermeasures include antiviral treatments, personal protective equipment (PPE) and ventilators. Some items will be relevant to multiple diseases and are ‘pathogen blind’, such as hospital care (including critical care) and infection prevention and control. The Biological Security Strategy stated in 2018 that the UK maintained appropriate stockpiles of clinical countermeasures for diseases of concern and worked to ensure these were as flexible as possible to provide effective coverage for a wide range of potential scenarios. The Government also told our predecessor Committee in September 2019 that there was PPE in all NHS Trusts. In our current inquiry, the Government said that DHSC collaborates with Public Health England, NHS England and the devolved administrations to guarantee “an appropriate UK stockpile of medicines, consumables and vaccines to deal with specific risks”.
42.However, according to a June 2020 report by the National Audit Office, the Government was unable to overcome shortages of PPE in the early stages of the covid-19 pandemic. The Government’s steps to secure the supply of oxygen, ventilators and other breathing aids allowed the NHS to meet the initial peak in demand for respiratory support in hospitals. But the NAO warned that a focus on PPE stockpiling for an influenza pandemic led to the omission of critical items such as gowns and visors. Helen Ramscar told us that there were also shortages of particular medicines. Several other contributors also highlighted critical gaps in the UK’s supplies of PPE, exposed by the pandemic.
43.The Government acknowledged the challenges it faced on PPE. It explained that, during March, there was a “huge surge” in demand for PPE globally, so that market power moved “decisively in favour of the suppliers” and that some countries banned PPE exports altogether. The Paymaster General told us that the wide demand for PPE across virtually all sectors was not planned for. There had been challenges in ensuring sufficient PPE for frontline workers, such as care workers and police officers. Some witnesses identified a lack of clear responsibility for PPE provision for health and social care staff within private sector providers. Sir Lawrence Freedman described it as a “serious charge” whether the Government could have done more to build up its stocks of PPE. Many contributors to our inquiry made detailed proposals for how the UK’s national stockpiles of critical supplies could be improved.
44.The Government is now taking steps to strengthen the resilience of its supply chains, including by rapidly expanding the domestic production of PPE. In December 2020, the Government reported to us that it was now sourcing PPE from a wide range of countries (reducing reliance on any single country), and that 70% of PPE supplies needed for the period to March 2021 would be produced domestically, up from 1% before the pandemic. The Minister thought the response from community organisations and private companies in changing production lines to produce materials was “incredible”, although the NAO more recently highlighted the uncompetitive nature of many of the procurements which went to untried suppliers. There may also be questions in future over the sustainability of re-deployed production lines.
45.Although, ahead of the covid-19 pandemic, the Government assured our predecessor Committee about PPE stockpiles, many frontline workers experienced shortages in the early months of the pandemic. The Government’s focus was on preparing for an influenza pandemic, but perhaps more significantly it did not anticipate the scale of international competition for insufficient supplies in a global pandemic and how UK supply chains were vulnerable as a consequence.
46.The Government should undertake a review of how it strengthens its supply chains for dealing with future emergencies. It should seek to learn the lessons of the current pandemic, which may include more on-shoring of manufacturing capacity in PPE and other equipment, greater advance stockpiling or pre-negotiated competitive supply contracts. It should also clarify where responsibility lies for PPE provision for healthcare delivered by private sector companies.
47.Strategic communications are integral to the UK’s national security. Having “accurate, clear and timely messaging” can lead to positive behavioural change and “save thousands of lives” during security crises. In 2012, the Government published a detailed communications strategy, to be followed in the case of an influenza pandemic, which served as guidance for health-related communication in the run-up to a pandemic, during a pandemic and during the recovery phase. Its main aims were to explain the outbreak, to establish confidence in the Government and health and social care services to prepare and manage a response, and to minimise the risk of infection. It committed to creating a full social media strategy, to reach “as wide an audience as possible”. It foresaw Local Resilience Forums (which we discuss in Chapter 4) planning the delivery of communications in their areas. The Communications Strategy noted the importance of the UK Government and the devolved administrations “operating within a cooperative framework”.
48.The report of Exercise Cygnus—an influenza pandemic exercise in 2016 (see Chapter 5)—should also have informed the communications approach during covid-19. That report was not published until 2020, so that what it found and recommended was not open to public scrutiny until now.
49.The Cygnus report found that the public reaction to a reasonable worst case pandemic influenza scenario was not sufficiently understood and that policy decisions in the exercise (for instance on mass burials and ‘population triage’) did not consider the range of possible public responses to their implementation. The Cygnus report recommended the development of pandemic communications plans to give “necessary reassurance” and “adequate levels of information” to the public. It underlined the importance of coordinated messaging to the public from the (then) Department of Health, NHS England, PHE and the devolved administrations. A communications focus group run as part of the Exercise offered other lessons, for instance:
a lack of trust in projections, the requirement of messages to avoid jargon, the choice of spokespeople and the desire for information to allow the public to make decisions about how best to protect themselves.
The Cygnus report praised the communications at local level, which were seen as “more attuned” to the needs of their audiences.
50.It is difficult to make a complete assessment of the degree to which the Government has followed its 2012 Communications Strategy and the lessons from Exercise Cygnus during the current pandemic, and thereby to draw inferences about the Government’s communications preparedness. Aspects of the 2012 Strategy do appear, however, to have been put into practice during the pandemic, for instance:
The Government told us that it used weekly audience and behavioural insights to adjust the messaging of its communications campaign and complement policy responses, allowing it to reach 95% of the UK population on average 15 times a week. The Government also underlined the high recall of its communications, ranging from 75% to 95%, including for the ‘Hands, Face, Space’ campaign.
51.Other aspects in the 2012 Communications Strategy are harder to assess, for instance the content of any social media strategy (if one exists) and whether the Government and the devolved administrations have been “operating within a cooperative framework” (given the differing policy responses that they have adopted at key moments; see Chapter 4).
52.Some contributors to our inquiry underlined the importance of taking into account the public behavioural aspect in communications. Dr Cole said that this is separate from communicating “how the virology, the particle physics or the hard, natural science of it works”, because it involves considering the right messaging for a particular country, or even a given city, sector or age group. She acknowledged the complexity of doing this, at a time of “trying [ … ] to give a message that is broadly acceptable to most of the population and that will lead to most of them doing the right thing”. Security Lancaster similarly argued that providing greater scientific information to the public may not in itself be sufficient to change their views. This perhaps reflects the limits of basing a communications strategy on ‘following the science’ alone. A survey of covid-19 experts in April 2020 highlighted concerns over the behavioural science evidence base of the Government’s communications, although the Government has since told us that it employs communications professionals with a diverse range of skillsets, including those specialised in behavioural science.
53.External commentators have reached mixed assessments of the success of the Government’s approach to risk communication. Some have judged it “good” on information-sharing or to have hit the ‘sweet spot’ in their public messaging. Others have been more critical. A survey of covid-19 experts in April 2020 catalogued more than 100 concerns, including unclear messages and inconsistencies between different parts of Government; uncertainties over the legal obligations of the public; potentially unequal coverage of communities (for instance less access for people with English as a second language); difficulties in adapting recommendations in light of new evidence; and sometimes inaccurate reporting in the media. Our witnesses pointed to the lack of coordinated messages across the four nations of the UK. Professor Colin McInnes judged this as “incredibly confusing, particularly for people who cross borders [within the UK] on a regular basis”. Professor Frederic Bouder, an expert in risk communication, believed that the UK had had a less coherent approach to communications than other countries, and believed it was possible to have differing constitutional arrangements and messaging, provided that there is “some clear co-operation and a fairly united front”. While it is reasonable for there to be disagreement amongst scientists as the evidence base evolves, the sometimes different views released by members of the Scientific Group for Emergencies (SAGE) may also not have helped produce a single communications message.
54.The Government told us that it has made use of bespoke communications for hard-to-reach audiences and its media partnerships allow for “47 BAME publications” and the translation of “core marketing materials” into 10 different languages, with a further nine languages available on request, and full accessibility formats.
55.The C19 National Foresight Group at Nottingham Trent University, surveying local responders during the period to September, warned of an erosion of national integrity and trust in communications. They noted criticisms about “rhetoric, over-promising and timing (where late night national announcements created negative impacts on the relationship with the public)”. The local responders had advocated greater humility in communications, more straightforward language, open dialogue and a return to weekly or fortnightly briefings in England during the second wave of the disease. They also favoured clearer communication of the Government’s overall strategy for managing the pandemic. Professor Frederic Bouder emphasised the importance of using “channels of trust”, for example trusted third parties such as specialist patient groups were more likely to be believed than government.
56.The importance of social media in pandemic communications was recognised by the Government as early as 2010. The 2012 Communications Strategy outlined elements of a social media strategy, such as signposting individuals to “authoritative information” on social media to avoid the spread of false or misleading information, and the establishment of external partnerships as the basis for “digital engagement work”. It envisaged setting up pathways for “proactive participation in online forums, message boards and so on”. Professor Colin McInnes did not believe the UK Government had the necessary skill or agility to use social media effectively, based on its response to the earlier swine influenza and Ebola outbreaks. He underlined how difficult it is for governments to respond to the fast-moving world of social media narratives during emergencies. He cited the positive example of Public Health Wales, which had been considering social media strategies “as a completely different media form from traditional media strategies” and working not only to partner with influencers but also to “use geo-tagging to identify particular communities”, for instance in the case of localised outbreaks.
57.Our witnesses pointed to the threat of misinformation and disinformation online, particularly anti-vaccination misinformation on social media. Paul Schulte warned of an ‘infodemic’ and called these mis/disinformational problems a “serious British vulnerability”, with malign actors undermining the credibility of governmental responses. He praised the diagnostic and warning role played by the EU Disinformation Lab. Some experts responding to a survey in April also judged that the Government could be doing more to call out misinformation and limit its spread. During the pandemic, false or misleading information has circulated about several aspects of coronavirus, most commonly on social media.
58.Security Lancaster warned that misinformation could affect covid-19 vaccination efforts in the long term. Penny Mordaunt told us that:
We stood up a special unit in the Cabinet Office that is focused on those malicious messages [relating to the anti-vax movement]. It is busy, very sadly, but it is about spotting where that is taking place and ensuring that it is combated and dealt with in the appropriate way. The flip side of that is to ensure that we have good communications ourselves and are retaining public confidence.
Some witnesses repeatedly emphasised that the importance of public trust to tackling misinformation effectively online. Professor Bouder wanted to see “Attenboroughs of vaccination” and more inclusive debate; and wanted international and national health authorities to take more seriously the staffing capacity within social media work.
59.During the covid-19 pandemic, the Government appears to have put into practice aspects of its influenza pandemic communications strategy from 2012. Other parts of that Strategy require fuller implementation, including operating within a “cooperative framework” with the devolved administrations. It is also not evident that the Government has updated its approach to biological security communications on social media since 2012.
60.A clear social media plan needs to be formulated, not only to make use of such channels in a positive way, but also to counter the effects of misinformation and disinformation circulating online. Maintaining public trust in the Government’s overall handling of the pandemic should be an integral part of the Government’s social media strategy. The recently established unit in the Cabinet Office to tackle anti-vaccination misinformation represents a good start.
61.We accept that the novel features of covid-19 would have caused difficulties for any government, and we recognise the hard work and dedication shown by essential workers, civil servants and local responders in responding to the crisis. While the Government has been scaling up critical response capabilities, we are not convinced that the unique nature of covid-19 fully explains the difficulties the Government faced.
62.The job of responding to the covid-19 pandemic has been made harder by insufficient attention being paid to establishing necessary capabilities ahead of time. The Cabinet Office’s Resilience Capabilities Programme is supposed to encourage departments to develop a “broad and generic set of capabilities” that will be “applicable across multiple risk scenarios”. However, some critical capabilities for a tier-1 security risk have either not been considered and/or focused on the needs of a specific risk scenario (an influenza pandemic). The most striking example of this is the UK’s ‘Detection’ capabilities. Despite the Biological Security Strategy emphasising the importance of ‘Detection’ and learning from health emergencies elsewhere, the Government failed seriously to consider how it might scale up testing, isolation and contact-tracing capabilities during a serious disease outbreak on UK territory. It is difficult to avoid the impression that the Government simply did not believe a novel disease other than influenza could circulate widely within the UK. To varying extents, the pandemic has also exposed vulnerabilities in the UK’s strategic supply chains for PPE and its social media communications capabilities.
63.The Government should introduce annual reporting to Parliament by a responsible minister—such as the Chancellor of the Duchy of Lancaster—on the state of national preparedness for top-tier risks in the Risk Register. This should be compiled in consultation with industry experts on supply chains. The report to Parliament should be prepared by a new task force that we recommend below, with responsibility for resilience capabilities and for leading the UK’s biological security efforts (see paragraph 99). The task force should regularly report on:
a)the national stockpile of critical items (including their condition, suitability for use and applicability across a range of risk scenarios) and the domestic manufacturing capacity of strategic supplies;
58 Her Majesty’s Government ()
59 Her Majesty’s Government ()
60 Department of Health and Social Care, ‘’ (5 November 2020)
61 [Roger Hargreaves]
62 Her Majesty’s Government ()
65 [Dr Jennifer Cole]; Dr Gregory Lewis () para 1.2; Oral evidence taken before the Defence Committee on 14 July 2020, HC (2019–21) 357, [Professor David Alexander]
66 Dr Gregory Lewis () para 1.2
68 Gwendolyn Gilbert, (May 2020)
69 Her Majesty’s Government, (July 2018), p 23
70 Disease surveillance systems for zoonotic diseases and possible emerging infections are respectively led by Public Health England for public health risks and by DEFRA for animal health risks. These systems aim to detect possible outbreaks and infections early, for example using “horizon scanning and epidemic intelligence activities”, diagnostic techniques and risk assessments. See Her Majesty’s Government ().
71 Public Health England, (July 2019), p 11
72 [Roger Hargreaves]
73 For instance, the Commons Science and Technology Committee identified shortcomings in the UK’s testing capacity and contact-tracing capabilities during the covid-19 pandemic. Specifically, it criticised the decision to focus testing within a limited network of laboratories in the early stages and concluded that the UK’s limited capacity for contact-tracing had contributed to the postponement of full contact-tracing in early March. See , 18 May 2020, pp. 8–11, 13–14.
74 Department of Health and Social Care, ‘’ (15 September 2020)
75 Health and Social Care Secretary, , speech (18 August 2020)
76 New Statesman, , 19 August 2020; Economist, , 22 August 2020
79 Brian Duerden, Geoff Ridgway, Rod Warren, Peter Hawkey, , p.15
80 , The Guardian, 6 April 2020
81 Cabinet Office, (2017 edition), p 35
82 ADS and CBRN-UK () para 3.1
85 LSE IDEAS () para D2
86 Dr Opi Outhwaite ()
87 LSE IDEAS () paras D1, D2
88 Professor Christian Enemark ()
89 Her Majesty’s Government, (July 2018), p 23
90 Dr Opi Outhwaite ()
91 Dr Opi Outhwaite ()
92 Louis du Plessis et al, (October 2020)
93 Her Majesty’s Government, (July 2018), p 14
94 Professor Paul Rogers ()
95 Dr Jennifer Cole,
96 Her Majesty’s Government, (November 2015), para 4.131
97 [Professor Harman]; [Dr Jennifer Cole]
98 For example, Professor Colin McInnes, ; Penny Mordaunt, ; Lord Sedwill, ; Mr Ed Arnold ().
99 Dr Gregory Lewis () para 1.2
100 Her Majesty’s Government, (July 2018), p 26
101 Written evidence received by Joint Committee for Biosecurity and human health inquiry, Session 2017–19, Her Majesty’s Government () para 38
102 Her Majesty’s Government ()
103 National Audit Office. . HC 367, Session 2019–2021, Summary
104 Helen Ramscar () para 2.8. Specifically, she cites sedatives (propofol), opioid painkillers (fentanyl and alfentanil), muscle relaxants, and drugs for critically-low blood pressure.
105 Dr Patricia Lewis, ; Dr Jennifer Cole, ; Emergent BioSolutions () paras 10–13; ADS and CBRN-UK () para 4.3; Hamish de Bretton-Gordon ().
106 on Claim No. CO/2144/2020, The Queen on the application of (1) The Good Law Project (2) EveryDoctor Limited v Secretary of State for Health and Social Care and Crisp Websites Limited (trading as Pestfix) (1 July 2020)
108 National Audit Office. , HC 367, Session 2019–2021 (12 June 2020), Summary
109 Professor Karl Roberts ()
110 Penny Mordaunt, ; Dr Jennifer Cole, ,
111 Sir Lawrence Freedman () para 13
112 Emergent BioSolutions () para 10; Dr Patricia Lewis (); ADS and CBRN-UK () para 4.3; Dr Beyza Unal and Mr Ben Wakefield ()
113 These countries were China, Malaysia, Thailand, the US, Canada, Germany, Sweden, Saudi Arabia, South Africa, and Turkey.
114 Cabinet Office ()
116 National Audit Office, (13 November 2020) paras 18–20. HC 959, Session 2019–21
117 Her Majesty’s Government, (March 2018), p 34
118 Her Majesty’s Government ()
119 Department of Health, DHSSPS, Welsh Government and Scottish Government, (December 2012)
120 Department of Health, DHSSPS, Welsh Government and Scottish Government, (December 2012) pp 3–8, 11, 16
121 PHE, (2017), p8
122 PHE, (2017), p 17
123 PHE, (2017), p 18
124 PHE, (2017), p 20
125 PHE, (2017), p 19
126 Her Majesty’s Government ()
127 Cabinet Office ()
129 Security Lancaster is affiliated with Lancaster University. It researches ‘socio-technical security’, addressing sociological, behavioural and legal considerations alongside technical threats.
130 Security Lancaster ()
131 This survey was held between 3 and 30 April and run by the Parliamentary Office of Science and Technology (POST). More than 1,100 experts took part. Full results and further information: POST ‘’ (21 May 2020)
132 Her Majesty’s Government ()
133 Hamish de Bretton-Gordon (); Oral evidence taken before the Defence Committee on 14 July 2020, HC (2019–21) 357, [Dr Jennifer Cole]
134 This survey was held between 3 and 30 April and run by the Parliamentary Office of Science and Technology (POST). More than 1,100 experts took part. Full results and further information: POST ‘’ (21 May 2020)
135 Professor McInnes, ; Professor Bouder, , , ; Professor Harman,
138 Cabinet Office ()
139 C19 National Foresight Group, (September 2020) pp 5–6
140 C19 National Foresight Group, (September 2020) pp 6–8
142 Dame Deirdre Hine, (July 2010) p 16
143 Department of Health, DHSSPS, Welsh Government and Scottish Government, (December 2012) pp 13, 24
145 Security Lancaster (); Hamish de Bretton-Gordon (); Paul Schulte (); School of International Futures (). Schulte draws on the work of Claire Wardle to provide these definitions of misinformation and disinformation: ‘Misinformation’: unintentional mistakes such as inaccurate dates, captions, statistics, and misunderstood, yet all the more passionately espoused scientific theories, believed for sociopsychological reasons. Misinformation can also cover ostensible satire, deliberately misrepresented to avoid censorship, and sometimes weaponizing context rather than content, so that originally ironic memes become interpreted seriously. ‘Disinformation’: fabricated or deliberately manipulated, content, including “fake news” and “fake faces”. This often relies upon intentionally created conspiracy theories or rumours, intended to be recirculated in good faith.
146 The World Health Organisation defines an infodemic as “an overabundance of information, both online and offline. It includes deliberate attempts to disseminate wrong information to undermine the public health response and advance alternative agendas of groups or individuals”. WHO, ‘’ (23 September 2020). Joint statement by WHO, UN, UNICEF, UNDP, UNESCO, UNAIDS, ITU, UN Global Pulse, and IFRC.
147 Paul Schulte (). Further examples and research given in this submission.
148 See (accessed 14 December 2020)
149 This survey was held between 3 and 30 April and run by the Parliamentary Office of Science and Technology (POST). More than 1,100 experts took part. Full results and further information: POST ‘’ (21 May 2020)
150 POST, ‘’ (23 April 2020)
151 Security Lancaster (). According to the submission, relevant research is taking place via the Centre for Corpus Approaches to Social Science project, Quo VaDis and its results will feed into initiatives to fight claims/tactics that are reducing levels of vaccination.
153 Professor McInnes, ; Professor Bouder,
155 On problems with ‘unthinkability’ in Government, see Think Unthinkable Ltd ()