The dust is settling on the UK House of Commons report, produced jointly by its Select Committees on health and on science and technology, about the initial handling of the COVID-19 pandemic. Predictably, the government’s critics have used its 20/20 hindsight to argue that many lives would have been saved if only they had been in charge. The report’s main value, though, is in demonstrating precisely how the promised future public inquiry should not proceed. There may be therapeutic value in airing grievances but this does not help us understand what has happened.
Over the last 50 years, social scientists have learned how organizations fail. There is a substantial body of work from studies of construction failures, nuclear accidents and, most notably, the explosion of the Challenger space shuttle. The lessons have even been applied to reduce errors in surgery. You would not know any of this work existed if you read the report. But it provides an essential foundation for the inquiry.
The core finding is that the world is full of accidents waiting to happen. This is the natural state of things. Mostly, these events do not occur because humans build proportionate prevention into their daily actions. But some risks are so novel or have such serious implications that we should go further. We need systematic ways of identifying gaps in our knowledge, filling them and then thinking about how to improvise in the face of new challenges.
In the early 2000s, the UK government did just that by creating a formal process of risk assessment. Which hazards were so important that the nation should make special efforts to prepare for them? The pandemic influenza plan, published in 2007, was one response. That plan worked well in the 2009 pandemic and was only revised in minor ways when reviewed in 2011.
As soon as it was published, though, that plan was going out of date. Its authors could only identify the possible points of failure at that time, deal with these and try to provide principles for managing anything they had missed or which emerged subsequently. These principles included regular exercises to test the continuing relevance of the plan.
The inquiry, then, must investigate how the plan had unraveled by 2020. Exercise Cygnus, in 2016, had shown the need for revision. The 2007 planners had assumed relationships and resources in the health service, central and local government that had been broken up or stripped out after 2011. Organizations did not know they had a role, documents had been lost and key people had retired or been made redundant. Why did revision not happen?
Part of the answer is the Brexit vote in 2016 and the redirection of civil service efforts to implementing it. Many things were put on hold simply because there was no-one to do the work. Brexit had greater priority than fixing pandemic risk management. But the system was now waiting to fall over as soon as it was pushed. Both Select Committee chairs share political responsibility for the decision to prioritize Brexit. The inquiry must look at how the civil service came to neglect risk management and the lessons of the pandemic simulations.
The inquiry also needs to ask how leadership came to be assumed by the Department of Health rather than the Civil Contingencies Secretariat in the Cabinet Office. This was a distinctive feature of UK planning in 2007. A pandemic was a whole-society challenge requiring a whole-of-government, whole-of science response. How did it come to be owned almost exclusively by biomedical science and public health? The Committee report replicates this bias.
The report has other limitations. Its witnesses are not challenged on the assumption that European countries could have copied South Asian models. No attention is given to the alternative models offered by Sweden and other Nordic countries. There is an underlying British exceptionalism as if no other European country was just as confused about how to act in extreme uncertainty: French social scientists have described an identical ‘elite panic’.
But there is one big issue that neither the pandemic plan nor the joint committees captured. This is the degree of risk that ordinary people are actually willing to accept in order to lead the rich everyday life that we have always taken for granted. What is a proportionate cost in health and mortality for the ability to go more or less where we choose, when we choose and with whom we choose? How much damage to children’s social, linguistic and educational development is reasonable in response to a mild infection in a vaccinated population? Are the critics right in claiming that the objective should be zero mortality from any infection? Infections have been the price of living in large-scale human societies since forever.
Tolerable risk is central to contemporary thinking in health and safety. The inquiry should be ready to deal robustly with the idea that biomedicine can deliver immortality or that there were magic answers available in February 2020.
Robert Dingwall is a former government adviser and professor of sociology at Nottingham Trent University
A slightly edited version of this text was published in the Daily Express 18 October 2021