The first report from the UK COVID-19 Inquiry was released in July 2024, concluding that the UK was “ill prepared” to deal with the pandemic, despite assumptions that it was “one of the best-prepared countries in the world”. The Inquiry was established to “examine the UK’s response to and impact of the COVID-19 pandemic” in the hope that lessons can be identified for the future. This first report examines the state of the UK’s “central structures and procedures” for pandemic emergency preparedness, resilience, and response.
Introduction to the report
The Rt Hon Baroness Hallet DBE, Chair of the Inquiry, wrote the introduction to the report. This begins by highlighting that the “primary duty of the state is to protect its citizens from harm”. Therefore, the state must ensure that it is “properly prepared to meet threats” such as that of the emergence of a “novel and potentially lethal virus” in December 2019. SARS-CoV-2 and COVID-19 disease spread quickly across the globe, infecting and killing millions.
“The COVID-19 pandemic caused grief, untold misery, and economic turmoil. Its impact will be felt for decades to come.”
However, Baroness Hallet notes that “the impact of the disease did not fall equally”. Mortality rates were “significantly higher” among people with a physical or learning disability and people with pre-existing conditions. People from some ethnic minority groups and people living in deprived areas also had a “significantly higher risk” of COVID-19 infection and death.
“Beyond the individual tragedy of each and every death, the pandemic placed extraordinary levels of strain on the UK’s health, care, financial, and educational systems, as well as on jobs and businesses.”
In March 2020 the need for “serious and far-reaching decisions” led to a legally enforced ‘stay at home’ order, which Baroness Hallet describes as “hitherto unimaginable”. This “severely curtailed” the life of the UK with myriad implications.
“Societal damage has been widespread, with existing inequalities exacerbated and access to opportunity significantly weakened.”
Baroness Hallet commends the “individual efforts and dedication” of health and social care workers and civil and public servants who “battled the pandemic”, scientists, medics, and commercial companies who “valiantly” developed life-saving treatments and vaccines, local authority workers and volunteers who supported elderly and vulnerable people and vaccinated the population, and the emergency services, transport workers, teachers, food and medicinal industry workers, and other “key workers” who “kept the country going”. Their services will likely be “called upon again”, with “overwhelming” evidence suggesting that another pandemic is on the horizon.
“Unless the lessons are learned, and fundamental change is implemented, that effort and cost will have been in vain when it comes to the next pandemic. There must be radical reform. Never again can a disease be allowed to lead to so many deaths and so much suffering.”
In this context, the Inquiry was established. Consultations followed across the four nations to understand how the “gravest and most multi-layered peacetime emergency” hit the UK and how the government and devolved administrations responded. The Inquiry is conducted in modules; the first of these is Module 1 (Resilience and preparedness). Although other countries have initiated investigations into “many aspects” of the pandemic, Baroness Hallet suggests that this Inquiry has the “force of the law” behind it. She hopes that, if the recommendations are implemented, future loss and suffering can be reduced and policymakers will be “assisted in responding to a crisis”.
Flaws in the system
The Report states clearly that the UK “lacked resilience” in 2020 and entered the pandemic with a “slowdown in health improvement” and widened health inequalities. It was “more vulnerable” thanks to high levels of pre-existing disease and “general levels of ill-health and health inequalities”.
Although the Inquiry “recognises” that decisions about the allocation of resources to prepare for a “whole-system civil emergency” fall to elected politicians who might be tempted to address the “immediate problem”, the Report emphasises that “money spent on systems for our protection is vital” and will be “vastly outweighed” by the cost of “not doing so”. If the UK had been better prepared and more resilient, some of the financial and human cost might have been avoided.
The system of building preparedness for the pandemic “suffered” from some key flaws:
- The UK prepared for the wrong pandemic. Although the risk of an influenza pandemic had long been considered, written about, and planned for, the preparedness was inadequate for the global pandemic that struck.
- The institutions and structures responsible for emergency planning were labyrinthine in their complexity.
- There were fatal strategic flaws underpinning the assessment of the risks that the UK faced, how those risks and their consequences could be managed, and how they could be responded to.
- The UK government’s sole pandemic strategy dated back to 2011 and lacked adaptability. It was virtually abandoned in the face of the pandemic. It focused only on one type of pandemic, failed to adequately consider prevention or proportionality of response, and paid insufficient attention to the economic and social consequences of pandemic response.
- Emergency planning generally failed to account sufficiently for pre-existing health and societal inequalities and deprivation in society. There was also a failure to appreciate the full extent of the impact of government measures and long-term risks, from both pandemic and response, on ethnic minority communities and those with poor health or other vulnerabilities, and to engage appropriately with those who know their communities best.
- There was a failure to learn sufficiently from past civil emergency exercises and disease outbreaks.
- There was a damaging absence of focus on the measures, interventions, and infrastructure required in the event of a pandemic, including a system that could be scaled up to test, trace, and isolate in the event of a pandemic. Despite extensive documentation, planning guidance was insufficiently robust and flexible and policy documentation was outdated, overly bureaucratic, and infected by jargon.
- In the years before the pandemic there as a lack of adequate leadership, coordination, and oversight. Ministers, who are frequently untrained in the specialist field of civil contingencies, were not presented with a suitably broad range of scientific opinion and policy options, and failed to challenge sufficiently the advice they were given.
- The provision of advice could be improved. Advisors and advisory groups did not have sufficient freedom and autonomy to express dissenting views and suffered from a lack of significant external oversight and challenge. The advice was often undermined by ‘groupthink’.
“The Inquiry has no hesitation in concluding that the processes, planning, and policy of the civil contingency structures within the UK government and devolved administrations and civil services failed their citizens.”
Recommendations
The Report recommends “fundamental reform” of the approach to whole-system civil emergencies and emphasises that the recommendations must be implemented “in concert” to produce necessary change. The recommendations are:
- Each government should create a single Cabinet-level or equivalent ministerial committee (including the senior minister responsible for health and social care) responsible for whole-system civil emergency preparedness and resilience, to be chaired by the leader or deputy leader of the relevant government. There should also be a single cross-departmental group of senior officials in each government who oversee and implement policy on civil emergency preparedness and resilience.
- The lead government department model for whole-system civil emergency preparedness and resilience is not appropriate and should be abolished.
- The UK government and devolved administrations should develop a new approach to risk assessment that moves away from reliance on reasonable worst-case scenarios towards an approach that assesses a wider range of scenarios representative of the different risks and the range of each kind of risk. It should also better reflect the circumstances and characteristics of England, Scotland, Wales, and Northern Ireland as well as the UK as a whole.
- A new UK-wide whole-system civil emergency strategy should be established and subject to a substantive reassessment at least every three years to keep it up to date and effective, incorporating lessons from civil emergency exercises.
- The UK government and devolved administrations should establish new mechanisms for the timely collection, analysis, secure sharing, and use of reliable data to inform emergency responses, such as data systems to be tested in pandemic exercises. A wider range of ‘hibernated’ and other studies should also be commissioned to be rapidly adapted to a new outbreak.
- The UK government and devolved administrations should hold a UK-wide pandemic response exercise at least every three years.
- Each government should publish a report within three months of the completion of each civil emergency exercise summarising the findings, lessons, and recommendations, and publish within six months of the exercise an action plan that outlines specific steps to be taken in response.
- All exercise reports, action plans, emergency plans, and guidance from across the UK should be kept in a single UK-wide online archive, accessible to all involved in emergency preparedness, resilience, and response.
- Each government should produce and publish a report to their respective legislatures on whole-system civil emergency preparedness and resilience at least every three years.
- External ‘red teams’ should be regularly used in the Civil Service to scrutinise and challenge the principles, evidence, policies, and advice relating to preparedness for and resilience to whole-system civil emergencies.
- The UK government, in consultation with the devolved administrations, should create a UK-wide independent statutory body for whole-system civil emergency preparedness, resilience, and response. This body should provide independent, strategic advice, consult with voluntary, community, and social enterprise sector at a national and local level as well as directors of public health, and make recommendations.
Initial reactions
Professor Adam Kucharski of the London School of Hygiene and Tropical Medicine told BBC News that the findings would require action.
“We’re going to face more pandemic threats in future.”
Professor Kucharski urges answers to “what do we want a good response to look like” and “what do we need to be putting in place now to ensure that response is feasible”. Dr Saleyha Ahsan, who worked in hospitals during the pandemic and is now part of the COVID-19 Bereaved Families for Justice UK group, commented that it felt like there had been “zero planning” and the rules changed “on a daily basis”.
“It was ridiculous…It felt like we were making do and the people who were being pushed to the front were healthcare workers.”
For Dr Ahsan, it is “so important” to understand “where things went wrong and who was responsible”.
To read the full report, click here. Pandemic preparedness and response are key concerns at the Congress in Barcelona this October, so get your tickets to participate in these discussions, and don’t forget to subscribe for more updates.
