When I became health secretary in 2007, the chief medical officer, Liam Donaldson, took me aside to explain why there was bound to be a pandemic soon. Between 1918 and 1920, the H1N1 virus that became known as Spanish flu was responsible for more deaths than the first world war. There had been a flu pandemic about 30 years before that and another, Asian flu (H2N2), would kill up to 4 million 40 years later.
“It’s running a bit late, but one’s sure to come along any minute,” he told me in his reassuringly soft Teesside accent, as if we were standing in Whitehall waiting for a number 11 bus.
Liam had been instrumental in shaking politicians out of their torpor not only here but, through his role at the World Health Organization (WHO), around the globe. It had been his report on infectious diseases in 2002 that sparked Britain’s efforts to prepare properly for what was to come. That report led to a ministerial committee on pandemic planning and in turn to a national response framework approved by parliament.
In January and February 2007, 5,000 doctors, nurses, police officers, soldiers and civil servants took part in Operation Winter Willow, a rigorous rehearsal for the real thing.
The expected pandemic struck two years later, when the dreaded H1N1 reappeared for the first time since 1918. This time it was called swine flu and, while affecting up to 1.4 billion people, thankfully it proved to have a milder impact than expected. It was in essence another rehearsal, albeit a full dress one in which 457 Britons lost their lives.
I have no experience of dealing with the kind of crisis that this administration has had to face over the past year. But I do know that a pandemic remained top of the government risk register as the greatest threat to our citizens – greater than terrorism, a biological attack, nuclear accident or a severe weather event – and I do know that we had a detailed and proved plan to deal with it.
Swine flu (as well as Sars five years earlier) should have added to our store of knowledge and because it wasn’t “the big one” it should have led to us redoubling our efforts in advance of the next pandemic, which in all probability would be.
In the first part of Failures of State, the Sunday Times reporters Jonathan Calvert and George Arbuthnott set out to answer the question of how a country whose level of preparedness had been among the best in the world should have been so unprepared when Covid-19 struck.
One entirely valid point made by Jeremy Hunt, among others, is that we had prepared for a flu pandemic rather than a coronavirus. But there are more similarities than differences between the two. Both are respiratory diseases emerging from a novel virus. Both require detailed plans for containment through isolation, quarantine and contact tracing. And, crucially, both require substantial stocks of personal protective equipment. In any case, given that it had been 16 years since Sars and 11 since swine flu, we should have been well prepared for both.
Calvert and Arbuthnott suggest that a combination of austerity and “the government’s one-eyed obsession with Brexit” had eroded our defences. There had been another scaled-down rehearsal in 2016, codenamed Cygnus, after which the official verdict was that Britain’s preparations were by now inadequate for the “extreme demands” of a pandemic. It was a danger signal that seems to have been ignored.
The result is chronicled here in meticulous detail: out-of-date stock that should have been replenished, respirators with an expiry date of 2012, no gowns, visors, swabs, body bags or eye protection. Nurses having to improvise PPE with black bin liners.
As for containment, our borders remained open (despite warnings from the scientists) to the extent that large numbers of students returning to Britain from China early in 2020, at a time when we knew all about Wuhan, weren’t even temperature tested, let alone quarantined. Such measures, crucial to the pandemic plan, were described by our government as “symbolic gestures”.
Not only did Boris Johnson lockdown three weeks too late, he spent those weeks lurching around hospitals shaking hands with staff too polite to spurn him, joining an 81,000 crowd at Twickenham for England v Wales and talking to Phil and Holly on daytime TV where, having forced a handshake on a shocked Phillip Schofield, he explained to the nation that “stopping big gatherings doesn’t work in stopping the virus as well, perhaps, as people think…”.
It is understandable for a leader to worry about the economic effects of lockdown. But as the authors of this book point out, the economy could only thrive if the virus was kept in check. We had the worst of all worlds.
Calvert and Arbuthnott painstakingly piece together the evidence. Some of their sources are whistleblowers inside Downing Street and the NHS; some are the few members of the public who managed to get on to hospital wards and into care homes to see their relatives. There is much that we already knew, although most of this was revealed by the two journalists themselves, in their Sunday Times pieces through the year. Bringing everything together presents a damning indictment. And the authors go further: delving into the Clinical Information Network to demonstrate that critically ill patients really were denied access to intensive care because resources were so inadequate; exposing how the government originally pursued a policy of herd immunity (which Johnson described as “taking it on the chin”) and, most graphically and incriminating of all, setting out the awful truth about social care.
On 25 February last year, Public Health England (PHE) told staff in the care home sector that there was no need for masks, as it was “very unlikely that anyone receiving care in a care home or the community will become infected”. In fact, the virus was spreading like wildfire at that moment, with 1,600 new infections, of which PHE had identified only 23.
A few weeks later, 15,000 mainly elderly patients were discharged into care homes and community placements in order to free up hospital beds. All regulatory requirements were suspended to facilitate this mass discharge. Fewer than a third of the 6,435 people discharged into care homes were tested. We now know that at least 623 of them were already carrying the virus. Those particularly susceptible to catching Covid had been placed in an environment where they were most likely to contract it.
The result of this maladroitness? Over the course of 2020, a Briton had more than twice the likelihood of dying from the disease as a German. Britain had almost 20 times the number of cases per head of population and 40 times the number of deaths than China, where the pandemic began. On New Year’s Eve alone, more deaths from the virus were recorded here than in Australia over the entire year. There were more deaths in England in an hour on that same day than the total death toll in New Zealand. Singapore got on with implementing what had been our pandemic plan while the New York Times described the place where it had been constructed as Plague Island.
Will these “failures of state” damage Johnson electorally? Perhaps not. The vaccine has given him a metaphorical as well as an actual shot in the arm. After all, when the second world war was over people understandably wanted to celebrate D-day rather than dwell on Dunkirk.
Alan Johnson served in five cabinet positions in the governments of Tony Blair and Gordon Brown and was secretary of state for health from 2007 to 2009. His first novel, The Late Train to Gipsy Hill, will be published by Hachette later this year