We need to do better next time

While there has been positives during this pandemic, the Government have acknowledged that mistakes have probably been made along the way. Key lessons need to be learnt and measures implemented so that we are better prepared next time, argues John Baron MP

As someone who has recently lost his mother to Covid-19, I send my condolences to all who are grieving and applaud those on the frontline combating this deadly virus. A pandemic has long been on the radar of those employed by governments to scan the horizon and pick out the looming threats, along with natural disasters, nuclear meltdowns, economic crashes and terrorist attacks. Just as the events of 11^th September 2001 uncovered the shortcomings of the US counter-terrorism effort, so the coronavirus pandemic is exposing the shortcomings in many countries' approach to this particular type of threat. Key lessons need to be learnt and measures implemented so that we are better prepared next time.

An unforgiving media is certainly lambasting the Government for its handling of the coronavirus pandemic in the UK. A fair degree of this criticism is justified, but a more circumspect analysis shows common shortcomings across many countries, especially in terms of sufficient intensive care beds, ventilators and the supply of personal protective equipment (PPE). Despite the lessons of past pandemics and the establishment of a UN body, the World Health Organisation, charged with maintaining global public health, we have failed to contain and cope with this virus.

Despite the popular perception in the UK, the NHS is entitled to point out that by most standards it was well prepared for such an eventuality. Indeed, as recently as October 2019 a wide-ranging international study, the Global Health Security Index, placed the UK second out of 195 countries in terms of preparedness, capacity and proven record to deal with a pandemic – France and Germany were ranked 11^th and 14^th respectively whilst New Zealand, which has been hailed as a global poster child for how to deal with the coronavirus, was ranked 35^th.

Moreover, reports in the German press in February criticised Angela Merkel for her 'Corona Chaos' and contrasted the perceived shortcomings of the German health service's preparedness for an outbreak with the UK NHS' extensive planning and preparation, which was held up as a gold standard. This included a vast national stockpile of PPE, stored within giant temperature-controlled warehouses in northwest England.

It is testament to the size of this stockpile that the NHS is apparently still working through it and it undoubtedly helped get the country through the initial weeks of our outbreak. The contact-tracing of the early coronavirus cases was apparently also a great success, especially in Brighton, even if the subsequent number of cases overwhelmed this effort.

Beyond these initial weeks, criticism arguably becomes more justified. Ministers have acknowledged that mistakes have probably been made along the line, and the decision to scale back contact-tracing and testing now would seem to be one such example, even if it was in line with the best scientific advice at the time. The difficulties in ensuring a steady stream of PPE are an enduring concern, even if it is also acknowledged that nearly all countries are facing their own challenges – President Macron has gone so far as to apologise for PPE shortages.

There have also been positives. Whereas several weeks ago there were real fears that the NHS would collapse under the weight of coronavirus cases, as so tragically happened in Italy, it is clear that this did not happen. The NHS, coupled with the military and other organisations, did a superb job in surging its capacity. It now has about 100,000 beds, including 3,190 unused intensive care spaces. The supply of ventilators has proved more than adequate, not least because doctors have learnt from experience that patients often do better without ventilation – 42% of oxygen-supported beds currently lie empty. The morgues did not overflow.

Meanwhile, the lockdown appears to be having a positive effect, with all indications suggesting we are past the peak and with the Government actively considering how to ease the lockdown while keeping case numbers within the NHS' capacity.  Healthcare treatment for other conditions, including cancer, is restarting.

Yet, just as generals invariably make preparations to fight the last war, so it seems that Western nations prepared to fight the last pandemic, as our healthcare systems and pandemic plans were geared against an influenza outbreak. Asian countries however, schooled by the SARS outbreak nearly 20 years ago, tailored their plans to deal with a coronavirus pandemic and seem to have met with more success – though Singapore is experiencing a flare-up, and Japan is also countering a fresh outbreak. Western planners must be less myopic in future.

As I wrote in my last column, the coronavirus outbreak has highlighted the downsides of globalisation, long supply chains and 'just in time' deliveries, particularly for medicines, protective equipment and testing materials. These work well under normal circumstances, or when just one part of the world is affected. However, when the global system is subjected to a shock, countries can be left dangerously exposed, leading to behaviour usually reserved for wartime.

In January, Beijing stopped the export of certain medical supplies, such as face masks, including those manufactured by foreign companies. Since 1^st January, over 50 governments have introduced export curbs. Germany stopped the export of 240,000 masks to Switzerland. France prevented Valmy from fulfilling its contract and requisitioned face masks intended for export to the UK, and officials in Berlin accused the US authorities of 'piracy' when PPE was seized in Bangkok and diverted to the US. India, a key producer of generic medicines, imposed sweeping restrictions. The EU, which produces half of the world's ventilators, restricted their export.

Countries benefit when their manufacturing base can swing into action to help in the national effort. Germany's testing regime has been exemplary, aided by the large biotech manufacturing plants within its borders, as well as its more flexible and decentralised approach as to who can conduct, perform and analyse tests. By contrast, Public Health England's rigid control over testing has probably acted as a limiting factor, and only recently have private sector laboratories been able to lend their facilities to the testing effort.

The shortcomings when it comes to PPE need to be addressed. This requires a strategic view. The NHS is the third largest employer in the world. Such a market should be able to sustain an increase in our manufacturing capability, if necessary helped by tax incentives. At the very least, global supply chains need to be shortened and made more resilient. Meanwhile, as a country, we should be stockpiling to a greater extent adequate reserves to ensure we are better prepared next time – reserves which would need monitoring to ensure expiry dates were honoured and stocks replaced accordingly.

There will be many lessons for the UK to take on board once we are through this coronavirus pandemic, not least from how our authorities prepared and reacted to the outbreak. It is public knowledge that the Government conducted a pandemic exercise in 2016, Exercise Cygnus. The full report is not in the public domain, so it is difficult to judge whether its assumptions were correct or whether its conclusions were implemented. This will come in time, and we should not shy away from drawing difficult conclusions if required.

It may emerge that part of the problem was that from 2016 onwards the Government's consuming effort was leaving the European Union. This may highlight a further vulnerability to our system of government, in that it is unable to deal with more than one large issue at any one time. This may be a much harder problem to fix than building up an appropriate manufacturing base or stockpiling acres of PPE.

However, we should also not shy away from the big changes necessary to ensure our system can cope with multiple major projects at the same time. The issue is not about the quality of those in charge. By and large, high-calibre people oversee the system. Instead, it is more about changing mindsets and the processes involved. Greater perspective is required.

The world will also have to re-evaluate its relationship with China. Even at this early stage, it is clear that at crucial moments key information was withheld from the international community for the sake of the Chinese Communist Party's prestige, and its virus reporting is so opaque that the British Government no longer includes its data in its official tables. If China is serious about assuming a top role on the world stage, it must also assume the responsibilities which go with it. Transparency on public health, animal welfare, climate change, human rights and other issues is the price for admission to the top table, and the world should hold the Chinese Government to paying up.

Time will tell whether Covid-19 will end the post-1945 era of globalisation – a trading phenomenon which was already under strain in part because it left too many people behind. But whether it does or not and whatever follows, all countries must be transparent on such issues if we are to face the inevitable challenges and 'black swans' we know are coming. We need to do better next time.