UK COVID Response Report

"On reading," by Simon Wain-Hobson, is a weekly discussion of scientific papers and news articles around gain of function research in virology.

Since January 2024, Dr. Wain-Hobson has written weekly essays for Biosafety Now discussing risky research in virology. You can read his entire series here.

Environs de Grasse, oil on panel 1936, Joseph Marius Avy (1879-1939)

On reading the UK Covid-19 Inquiry Module 1: The resilience and preparedness of the United Kingdom, 18 July 2024.

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This is the first report from the fully independent inquiry into the COVID-19 pandemic set up by then Prime Minister Boris Johnson in May 2021. The inquiry had unusually broad terms of reference and the report makes for grim, yet often fascinating reading. As readers will know, the UK didn’t do too well at handling COVID compared to many other countries of comparable socioeconomic standing.

Its candor makes it a worthwhile read.

It is not possible to do justice to the document in a short essay – the pdf is 240 pages long. Inevitably quotes will be selective. If you’re busy – silly, obvious - do try and read the four page Introduction and the three page Executive Summary which includes recommendations. It is accompanied by huge numbers of references and web links allowing readers to look at the evidence.

The primary duty of the state is to protect its citizens from harm. It is, therefore, the state’s duty to ensure that the UK is as properly prepared to meet threats from a lethal disease as it is from a hostile force. Both are threats to national security. In a mere 48 words, the second paragraph of the introduction says so much. And while On reading is no national security buff, it clears up a nagging point – that a pandemic is a national security issue (New USG DURC policy).

The evidence is overwhelmingly to the effect that another pandemic – potentially one that is even more transmissible and lethal – is likely to occur in the near to medium future. Absolutely, to which must be added the rider that, next time, making a vaccine may be more difficult, something that has been mentioned in a few essays. For those wondering what the medium future is, On reading would hazard 5-20 years, aka in most readers lifetime.

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. If only. ‘Lessons learned’ and ‘never again’ take us back to a previous essay (Two plus two).

The Executive Summary starts with a brutal admission. In 2019, it was widely believed, in the UK and abroad, that the UK was not only properly prepared but was one of the best-prepared countries in the world to respond to a pandemic. This Report concludes that, in reality, the UK was ill prepared for dealing with a catastrophic emergency, let alone the coronavirus (Covid-19) pandemic that actually struck. Ouch! If abroad the UK was looked up to as being prepared, when it wasn’t, what was the state of play in other countries?

The UK prepared for the wrong pandemic. The significant risk of an influenza pandemic had long been considered, written about and planned for. However, that preparedness was inadequate for a global pandemic of the kind that struck. And while coronaviruses have been known for ages – remember common colds? - no coronavirus pandemic has occurred in the modern microbiological era. Flu was the obvious virus with pandemics starting 1918, 1957, 1968, 1977, and 2009. Yet as any virologist knows, there are a number of animal respiratory viruses that could also cross over.

Another variable is urbanization. At the time of Spanish flu, a little more than a century ago, only 14% of the world’s population was urban. Today it’s 56%. And with mass transit systems, respiratory viruses are spread rapidly across millions.

More pithy conclusions are best given as bullet points.

• The UK government’s sole pandemic strategy, from 2011, was outdated and lacked adaptability. It was virtually abandoned on its first encounter with the pandemic. It focused on only one type of pandemic, failed adequately to consider prevention or proportionality of response,

• The institutions and structures responsible for emergency planning were labyrinthine in their complexity.

• Despite reams of documentation, planning guidance was insufficiently robust and flexible, and policy documentation was outdated, unnecessarily bureaucratic and infected by jargon.

• Advisers 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.

Agreed and delighted they said so. ‘Infected by jargon’, ‘failed their citizens,’ ouch! Everyone would love to have the lessons learnt. The route is long and steep, even in 2024. And folk have had problems learning lessons for quite a while.

Moving on is difficult after such bluntness from an entire committee, as opposed to a clairvoyant or dissenting individual.

On reading recommends making a screenshot of Table 1 which summarizes well past epidemics and pandemics. Note the line for Russian flu, notably 700,000 deaths in the period 1977-78. On the right is written China or Russia (not zoonotic). This means human error. This is mankind’s Chernobyl moment that has been mentioned before (Lab associated accidents, Goodness, some sense!).

Note also that the Russian flu virus became endemic. That means that it circulated from 1977 to 2009 as seasonal flu alongside decedents of the Hong Kong flu strain that caused the 1968 pandemic. Apropos seasonal flu,

• There are around a billion cases of seasonal influenza annually, including 3–5 million cases of severe illness.

• It causes 290,000 to 650,000 respiratory deaths annually.

A back of the envelope calculation means that Russian flu was responsible for up to 16 billion infections between 1977-2009. It was cocirculating with Hong Kong flu derivatives so 32 years x 1 billion infections per year/2 or something like 5-10 million deaths worldwide - a Chernobyl moment by any metric.

And COVID? Agree entirely, the virus has become endemic so something similar will happen.

On page 8 we read that pandemic influenza is notoriously difficult to predict. Thanks, we do know.

The section Outbreaks of disease is worth the detour. The world is teeming with organisms that have not yet found their way into the human population. Globally, there are thought to exist more than 1.5 million undescribed viruses in mammals and birds, of which about 750,000 are thought to have the potential to spill over into humans and cause epidemics. As of 2020, there were more than 200 known zoonotic pathogens. These range in impact from those that are completely harmless to humans to those with pandemic potential and devastating consequences. Succinctly put and with some echoes of a previous essay (The Queen). And while correct, perhaps anxiogenic for some, the world’s population has never been greater so we’re doing something right in the fight against microbes. We can live with this quote.

While zoonoses are dominant, the report is lucid, noting that the more laboratories there are in the world that are involved in biological research, the more chance there is that leaks from laboratories will occur with ramifications for the population at large. Increased instability between and within nations increases the biological security threat.

Laboratory accidents and the malicious use of biological material are less frequent and less likely to be publicly acknowledged than zoonotic spillover, but their consequences may be just as lethal. We know that for lab accidents there is massive underreporting, and we know why (Lab acquired infections).

Prior to Covid-19, the last major pandemic with significant mortality had been caused by human immunodeficiency virus (HIV), which has killed more than 40 million people worldwide. The report doesn’t let up with short, well-informed statements. Here it is worth noting that without antivirals this number would be at least 5-10 times more. They took a decade to develop and bring to the market which accounts for some of us referring to the period before 1995 as the dark ages.

That said, there is still no HIV vaccine 40 years on. This is why we mustn’t be complacent and think, next time round, all that is needed is to apply the mRNA vaccine technology and it’ll work. Of course, the report spotted this. The next pandemic could be far more difficult to handle than Covid-19 was, and we all saw the damage that that pandemic caused us.

The report embraces the testimony of two infectious disease specialists: The COVID-19 epidemic was unprecedented in recent times, and it would not be reasonable to expect the UK to be fully prepared for a hypothetical epidemic of this size of a previously unknown pathogen. It goes on to say There are proper limits to preparedness and resilience (as there are for security), but improvements, even radical ones, can still be made. It is critical for any government, with the public’s approval, to steer a course between complacency and overreaction.

This is clearly an extremely complex system (Pandemic illusions) which is why open discussion would be very helpful. Indeed, needed.

In the section entitled The international system of biosecurity the report is again as lucid as it is blunt: At present, there is little or no incentive – and much disincentive – for countries to report outbreaks of disease within their borders. The ramifications for doing so include potential economic damage and a certain level of stigma. Recent examples that demonstrate hesitancy to report outbreaks are instructive. They include Saudi Arabia’s disclosure of the Middle East respiratory syndrome (MERS) outbreak and the Chinese government’s disclosure of severe acute respiratory syndrome (SARS). Economic damage and a certain level of stigma probably applies to lab acquired infections, the only difference being the substitution of the word universities for nation states.

The best defence against the spread of pathogens was and remains strong national surveillance and detection mechanisms – as all international systems are ultimately built upon these – and effective collaboration between the various levels of responsibility. When assessing restrictions on some risky virus research, the issue of natural surveillance mustn’t suffer by ricochet. If surveillance turns up an Ebola strain in some unexpected part of the world, research must follow.

If a virus is natural, virologists have to work on it. Society would not understand refusal on our behalf. In this respect On reading aligns with calls for surveillance and work on analysis of dangerous natural viruses. These same people have pleaded in favor of DURC (ex-GOF) flu virus research (Deconstructing the portrait, Going places). What is different is the risk associated with willfully generating more dangerous viruses for humans.

In the section called Streamlining the system of preparedness and resilience four quotes, given as bullet points, illustrate the task before us. Emphasis added.

• No one who gave evidence to the Inquiry was able to offer a substantive rationale for a system that was unduly complex and labyrinthine. The only defence offered for such complexity was that the system was generally well understood by those who had to work within it.

• The system was inefficient. There were too many entities, groups, sub-groups, committees and sub-committees involved with preparedness and resilience.

• The system was prone to operating in silos. The entirety of the system was not reviewed.

• Across the UK, systems had grown to be overly bureaucratic. Instead of focusing on skills, technology and infrastructure, they were focused on creating groups, sub-groups and documents.

Inevitably humans are part of the problem even though another pandemic will strike. Although pandemic prediction is not possible, pandemic preparation is tough to handle and plan for by any account. Accordingly, much discussion is needed with fewer top-down approaches (Pandemic illusions). Everyone must try again. With a touch more humility.

Let’s stop there. Bravo for the candid report! Refreshing and useful.

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Simon Wain-Hobson is an emeritus professor at the Institute Pasteur, Paris, from which he retired in 2021. He and his colleagues were the first to sequence the genome of HIV, and Wain-Hobson has published more than 230 papers on virology and cancer.