Many countries have already reviewed and reported on the lessons learned from the Covid pandemic. The UK inquiry has been slow to start with hearings currently expected to continue until 2026.
The final report will not be presented until long after the next General Election. It looks both systematic and well planned, but many of the lessons are already hiding in plain sight.
Central government cuts to the local authority public health grant before the pandemic meant that infection control capacity was ‘hollowed out', disabling early and effective local responses to the spread of infection. Health Foundation data shows that by 2021, the public health grant had been cut by 24% in real terms per capita since 2015/16 (equivalent to a reduction of £1bn). These cuts fell more heavily on those living in the most deprived areas of England who saw greater reductions in funding even though they had poorer health.
Public sector data sharing agreements were not fit for purpose as Covid hit. Local authority directors of public health were not allowed to see their ‘NHS owned' Covid test data until many months into the pandemic. With a statutory responsibility to protect the health of their local populations through health data surveillance they were ‘flying blind' into the first few critical months of infection spread.
The commissioning of the national test and trace system was late, poorly planned and neither effective nor efficient in its delivery. The contact tracing element of the National Test and Trace Programme should have been given earlier, and in the first instance, to local authorities to deliver. They already had the trust of, and knowledge about, local communities as well as existing contract tracing capability. They had the capacity to ‘step-up or step down' the staffing of the service as local pandemic waves surged or receded. Local directors of public health should also have been given control over local testing capacity.
Central government's early failure to trust local authorities to deliver came at a very high price for the country. According to the House of Commons Public Accounts Committee report, England's Covid-19 testing and tracing system failed to achieve its main objective—to break chains of transmission and enable people to return to a more normal life—despite an ‘eye watering' budget of £37bn (€44bn; $51bn).The contact tracing service was one of the most expensive health programmes delivered during the pandemic, equal to nearly 20% of the entire 2020-21 NHS England budget.
The national Covid vaccination strategy increased inequalities as it did not take full account of how infection risk was socially and economically mediated in deprived communities. From late 2020, the strategy prioritised the roll out of vaccinations across all areas of the UK at the same rate, focused on the priority groups it judged most likely to die if infected – mainly the old and clinically vulnerable. The problem with this approach was that the virus was not rolling out infection, hospitalisation or death at the same rate across all high-risk groups across all areas of the UK. By February 2021, residents of the north-west region were three times more likely to have been infected by Covid-19 and twice as likely to have died from Covid-19 compared to residents in the south-west region. The JCVI strategy had correctly identified risk if infected but seemed to completely discount population risk of infection. This meant that more deprived, urban, high ethnicity, mainly northern local authority areas with smaller houses, larger families and with more of their population out doing essential front line work during lockdowns had higher risks but lower overall population level vaccination protection. These communities were systematically disadvantaged as a matter of public policy.
Decisions by the Department for Education to take a very centralised ‘one size fits all' approach to the closure of schools will have left many vulnerable families with avoidably higher risks of household transmission from school aged children. By the time any central decision to close schools was taken on the basis of nationally high school age child infection rates, many vulnerable local authority areas had been running with massively higher rates than the national average for weeks.
It is not at all clear how such a nationally centralised strategy could not inevitably increase inequalities in pandemic risk exposure when infection rates varied so significantly by time and place across the country.
These and many other lessons have been learned at a very high cost to us all-we will save future lives by speaking up now. The Covid inquiry has an open invitation to anyone submit their evidence or experience of the pandemic on their website ( www.covid19.public-inquiry.uk ).
I would urge everyone who can, to respond. To quote St Catherine of Siena: ‘speak as if you had one million voices- it is silence that kills the world'.
Professor Dominic Harrison is a former (now retired) Director of Public Health for Blackburn with Darwen
