The UK should have been a world leader in tacking Covid-19. It has universal healthcare delivered through a single, joined-up system, a historically strong public health community and outstanding government scientists and scientific advisers. Instead we lead the world in the worst league tables: Covid-19 cases and deaths. The initial response from the UK government was too late, but eventually action came. Boris Johnson’s address on 23 March was a strong and clear call to unite and take action together to tackle the epidemic. The whole country visibly got behind the efforts, and by early April there were clear signs the epidemic was slowing.
However, the lack of a clear long-term strategy soon became obvious. Government policies have been reactive, based on short-term tactics aimed at media concerns and on short-term visible gains. This lack of strategy is clear to see. The devastating impact on care homes was entirely predictable, yet still there is no clear strategy of mitigation and future protection. On testing, the much-vaunted targets of 100,000 or 200,000 daily tests will achieve nothing on their own. Testing needs to be an integral part of strategic efforts to control the epidemic. Whole sections of the NHS ground to a halt with no attempt at strategic planning, and general practice, which should and could have been at the forefront of efforts to control the pandemic, has been largely ignored and left to its own devices.
In the face of a global pandemic, the government has pursued its policies in isolation. Travel policies are out of line with neighbouring countries, Britain failed to be part of successful EU efforts to secure PPE supplies, and instead of using an internationally tried and tested tracing app, it wasted time and resources trying to develop its own. Most recently we have seen a lifting of lockdown measures while new infections are estimated to be 8,000 per day and with no effective case-finding system in place – patently a decision taken against scientific advice.
Public confidence is critical to beating this epidemic because the key tools – social distancing, contact-tracing and self-isolation – only work if people fully engage. Two factors have massively dented public confidence, threatening control efforts. First, the obvious lack of a clear long-term strategy, which creates the impression of a government that is not in control. Second, a series of political mishaps. The health secretary blaming PPE shortages on NHS staff. The prime minister’s confused address to the nation on 10 May. And a top government adviser – Dominic Cummings – breaking the very spirit of collective action needed to defeat the epidemic.
If we are to control this epidemic, we need the whole country to be united in a collective effort. To achieve this we need to restore trust in the government. A starting point would be an unequivocal apology for the mistakes made so far. For each major error we need a clear plan in place for how the negative impact will be mitigated. We then need a clear long-term strategy for minimising the future impact of the epidemic, covering the possibilities of us getting an effective or partially effective vaccine, or no vaccine at all. This strategy needs to be explained to the whole population, and as new measures are announced, they must be presented as part of this overall strategy.
First, the government needs to be transparently guided by the scientific advice. When policy goes against that advice, as it appears to have done with recent relaxations in the lockdown, we need a clear justification. As a scientist I accept that there will be times when wider political or economic considerations mean the chosen policy goes against the science. But we need to know the rationale to build and maintain public trust.
Second, we need a strategic, systematic approach to testing for Covid-19 with all results linked to people’s NHS health records. This would allow us to understand how the virus is circulating in the community, in institutions, schools and workplaces, and what measures are needed to control it. Third, we need much clearer international cooperation with our partners in Europe and beyond. Fourth, we need a clear plan to minimise future damage and suffering in the care sector. And, finally, we need a clear plan to restart the currently paused functions of the NHS and engage general practice in the fight against the virus, for example as an integral part of the crucial contact-tracing initiative.
Only with a clear strategy will we be able to unite the nation in a collective shared response to the epidemic, with everyone accepting that there will be hardship and discomfort, but that together we can beat this. The alternative could leave us facing years of continued devastation. Without collective, united action underpinned by a clear long-term strategy, I fear for us all.
• Liam Smeeth is dean of the Faculty of Epidemiology and Population Health at the London School of Hygiene and Tropical Medicine