3. Dame Sally Davies

DAME SALLY DAVIES (sworn).

Questions From Lead Counsel to the Inquiry

Mr Keith: Dame Sally, could you give the Inquiry, please, your name.

Dame Davies: Sally Claire Davies.

Lead Inquiry: Thank you.

Dame Sally, thank you very much for your assistance to the Inquiry. You have been provided with a great deal – many documents, and I know a considerable amount of midnight oil has been burnt in preparation.

Whilst you give evidence, could you please keep your voice up so that we may hear your evidence and of course so that the stenographer can hear you for the transcript.

If I ask a question which is not clear, please don’t hesitate to ask me to repeat it.

You provided, helpfully, a witness statement dated 4 May 2023. Could we have, please, INQ000184637, and page 14. There is the statement of truth and the declaration dated 4 May 2023.

My Lady, could that be published?

Lady Hallett: Certainly.

Mr Keith: Dame Sally, you were from 2004 to 2016 the Chief Scientific Adviser to what was then known as the Department of Health, but which became the Department of Health and Social Care, and also Director General for Research in the Department of Health.

You were, between June 2010 and October 2019 the Chief Medical Officer for England.

Between 2014 and 2016, you were a member of the executive board of the World Health Organisation.

Between 2017 and 2020 you were a co-convener of the United Nations Interagency Coordination Group on Antimicrobial Resistance.

Are you currently Master of Trinity College Cambridge?

Dame Davies: Yes, the post that you omitted that would be useful for the Inquiry to be aware of is that, as Chief Medical Officer for England, I was also the UK Government’s most senior medical adviser.

Lead Inquiry: Thank you.

That is in fact where I propose to start. Could you tell the Inquiry, please, something about the role of being the Chief Medical Adviser and being the Chief Medical Officer.

Dame Davies: So, Mr Keith, the Chief Medical Officer is by nature a doctor, a leader, appointed as an independent adviser to government, cross-government and contributing to cross-government as needed or asked, COBR, SAGE – which I’m sure we’ll talk about – with high security clearance that was needed during the Novichok time.

I – when I started in 2010, I was interim for one year before I was appointed through a competitive process. I had no Deputy Chief Medical Officers and no budget for them, despite the fact that my predecessor at one point had had five Deputy Chief Medical Officers and a broad span. The maximum my office came to was 13 people, including those two DCMOs, when I got the money and appointed – for instance I headhunted Jonathan Van-Tam, I appointed the present – Jenny Harries, the present head of UKHSA, both of whom are superb, as you know.

I had a statutory responsibility to write an annual report on the state of the nation’s health in whatever way I chose.

My predecessor focused on patient safety, and I focused, following my first annual report in 2013, on antimicrobial resistance, AMR, which are superbugs. That’s the grand ongoing pandemic, killing across the world 1.2 million every year, the third most important underlying cause of death; and so I imagine as we talk – or I expect as we talk about pandemics, I will be able to show you how difficult it is to raise awareness and get action even when the deaths are happening, and AMR is a very good example of that.

I had a responsibility to communicate as CMO, often known in inverted commas as the nation’s doctor, we saw that during the pandemic but I played my role there, and of course no CMO can cover every area and be expert.

My background is haematology, I’m a sickle cell disease expert as a matter of fact, whereas my successor is an epidemiologist in infectious disease, and my predecessor was straightforward public health with some orthopaedic surgery before. And that’s why we need Deputy Chief Medical Officers, who have different expertises, one in health improvement, one in health security, or protection, so that the office can cover that span.

As CMO for England, I was primus inter pares with the other Chief Medical Officers of the devolved administrations, and met them regularly. I expect you’ll want to talk about that.

I was head of profession for doctors in the government, but part of the collective leadership of medicine with presidents of royal colleges.

So I think that probably gives you a feel for it.

Lead Inquiry: Yes, that is a broad scope, if I may say so, Dame Sally.

Very broadly, within your functions – and you’ve just referred to these two general categories – you were responsible therefore for health protection. In that very broad categorisation, do we include matters such as health emergencies, the risk of infectious diseases, pathogenic pandemics, antimicrobial resistance, all things which pose a threat by virtue of hazard to the health protection of England?

Dame Davies: Mr Keith, I was not responsible, I advised on all those issues, and cared about them, because I care about the public. Patients, for me as a doctor, always came first, but I needed to get the advice from experts such as Public Health England, academia.

Lead Inquiry: I didn’t in fact suggest that you were primarily or –

Dame Davies: Thank you.

Lead Inquiry: – even solely responsible for those areas. I was asking you whether or not the broad nature of the functions that you discharged could be divided into those two categories –

Dame Davies: Yes.

Lead Inquiry: – health protection, and health improvement?

Dame Davies: Yes.

Lead Inquiry: Right.

So under health protection, AMR, health emergencies, pandemic outbreaks, the risk of pathogenic disease and so on, and what is health improvement concerned with?

Dame Davies: Health improvement. Well, one reason we had a bad outcome from Covid – and I presume would get from flu, but we have thankfully not tried it – is because of what you have been told are health inequalities. I would talk about the lack of resilience in the public’s health. 25% of children in year 6 are obese, 60% of adults are obese or overweight, we have high levels of diabetes. It’s – the health improvement is: how does government play a role improving the health of people? Because there is a libertarian view that it’s all down to each of us as individuals and how strong we are, but of course it isn’t about that. It is much more about the structure of our society and how to make the healthy choice the easy choice, whether it’s activity or what we eat or anything else.

Lead Inquiry: Are you able to say what proportion of your time was spent on health protection as opposed to health improvement, or is that an impossible question?

Dame Davies: It’s so varied from month to month. I mean, I’ll take Novichok again, because I mentioned it. Over the period of a month, I did nothing but Novichok, and the Russians poisoning people. But other times I could do more. For instance, when the policy team were thinking about obesity, then they would come and consult me. I discussed with the Treasury the framing and the work on the sugar levy, I set up a challenge meeting inviting Cabinet Office, Prime Minister’s office, as well as our policy teams with academics, around obesity, both to hear the latest evidence but to model to people in government that I could say I didn’t know, “Please help me, please tell me”. And that seemed to me important, not only the information but the style of how you go about making policy.

Lady Hallett: What do you mean by a challenge meeting?

Dame Davies: I got in people who were expert at things and we would structure it so they would give short interventions with slides and then allow policymakers to say, “But we thought this”, or “We want to do this”, my Lady, or then to say “You seem to be going, policymakers, in this direction and our evidence suggests that this doesn’t work, or you’d be better doing the following”. So trying to get a constructive, challenging in a constructive way discussions on some subjects.

Mr Keith: May I now ask you to put the position of Chief Medical Officer structurally into the right place in the overarching nature of the government, by which I mean the CMO does not sit in any government department but was there any kind of administrative structure around you – an office, for example – and to what extent were you obliged to liaise with government departments, whether it be the Department of Health, whether it be the Cabinet Office, the Department for Levelling Up, Housing and Communities, and so on?

Dame Davies: So the Chief Medical Officer sits in the Department of Health, now DHSC, supported by a small team, as I said, only 13 in total in the Department of Health, working mostly on health with health, but working also with the Cabinet Office, Number 10, and other departments.

I did quite a bit of work with DfID and the Foreign Office, because of global health. Not only do I care how people live and their health round the world, but our best insurance to nasty things coming here is making sure they don’t overwhelm those countries and then move.

Lead Inquiry: Before you were Chief Medical Officer, as I summarised earlier, you were Chief Scientific Adviser in the department – what was then the Department of Health. Is the role of Chief Medical Officer equivalent at all to the role of a departmental Chief Scientific Adviser, or does it have a greater degree of independence?

Dame Davies: Oh, the CMO has, at least as I was, total independence of thought and ability to advise. The Chief Scientific Adviser is there to advise their department, and in that role I would try and help policy teams and ministers know what the latest science was, or if they’d commissioned something, look at it for some sanity or recommend peer reviewers.

Of course, it was me in – I was appointed in 2004 at director general level – who persuaded government to let me set up the National Institute of health research, so that we had much more applied research and science and so that we could develop the infrastructure that then saved many lives, of the NIHR managed – note “managed” – clinical research networks, which were the networks that ran all the trials that gave us treatments that worked, ran the trials to show whether vaccines worked. So I, as CSA, did most on setting up NIHR and making it effective and deliver for the nation and the nation’s health more than looking inwards.

Lead Inquiry: As the Chief Scientific Adviser to the Department of Health and as a Director General in the Department of Health, were you more closely concerned, therefore, with workstreams, with work being done within the Department of Health as opposed to the discharge of your functions latterly as Chief Medical Officer?

Dame Davies: No, I ran the R&D directorate, but I didn’t have any other directorates. I attended the board and things like that and contributed, but they are moderately independent, managed. I was performance managed by the chief – by the permanent secretary, and of course I think you will have heard something about holding, but the whole point of how we commission research in this country is that the politicians can not only set the budget but decide on big areas they want investment, but they can’t decide where the money goes.

Indeed, one of my clashes with ministers was when they didn’t like a recommendation that I had to clear with them, which had been put – advised by an international panel, and I had to say, “It is your right to overrule me, but if you do I will resign”. I was not overruled.

Lead Inquiry: No one in this country could be unfamiliar now with SAGE, the scientific advisory group connected with emergencies. What is the role of the Chief Medical Officer when it comes to SAGE, where SAGE is dealing with a major health emergency?

Dame Davies: So when I started in 2010, the pandemic 9/10 of flu was declared over. In fact, in that first winter of Christmas 2010/2011, I realised I was in wave 3 of the flu pandemic. We’ve also reviewed how things had gone in the 9/10 pandemic, and one of the things that came out of it was that the SAGE had been chaired by the government’s Chief Scientific Adviser, and though our Chief Scientific Adviser – me at that time – had gone to SAGE, this wasn’t a very good way of knitting together all the different bits of advice and trying to make it as effective as it should be.

I would sit there and listen in SAGE to people talking about, “Well, is it safe to transfuse blood” or something, and I’d say, “But we have an expert committee, SaBTO, we have to ask them because they know what they’re talking about”.

So we then discussed it and over the next couple of years came to an agreement that when there was a medical emergency or an emergency with health impact, that the CMO would co-chair.

Lead Inquiry: So in fact you participated in SAGE in a number of different roles and with a number of hats on, because you were initially –

Dame Davies: Yes.

Lead Inquiry: – a participant in SAGE because you were the Department of Health Chief Scientific Adviser, that was in relation to swine flu, the 2009 pandemic, then in relation to Ebola you were on SAGE, or rather pre-SAGE?

Dame Davies: Yes.

Lead Inquiry: Then after that, you participated in the SAGE that was convened to deal with the Novichok poisoning in Salisbury and Amesbury because by then you were the Chief Medical Officer of England?

Dame Davies: Correct.

Lead Inquiry: Is it part of the role of the Chief Medical Officer to provide technical insight and guidance and of course advice to SAGE as well as chairing it or co-chairing it in the event of a major health emergency?

Dame Davies: Well, as CMO, I’m quite careful about what I really know and what I don’t, so if it came into my personal expertise, I would put it in, but in general I went to those meetings briefed not only by Public Health England and other experts but also aware of the situation in the NHS, and so I was there bringing that understanding and the kind of common sense as a doctor who had worked with patients and the system for many, many years.

Lead Inquiry: So to some extent a clinical view as well?

Dame Davies: Yes.

Lead Inquiry: You’ve said, Dame Sally, you’ve reminded us that you’re an expert in haematology; where a CMO co-chairs a health-convened SAGE, may that SAGE call upon not just the assistance, the expertise of the attendants at that particular meeting – so in your case your haematological experience – but the expertise of everybody at the meeting but also of a number of other bodies, subcommittees and advisory groups who may be staffed by experts in other different fields?

Dame Davies: I was very strong that we should, where we had an existing expert committee, call on them, and we did.

Lead Inquiry: Could we have on the screen INQ000204104.

Would you please help us, Dame Sally, with getting our bearings in relation to some of the bodies which advise in the field of health emergencies.

This is what’s now familiarly become known as the spaghetti chart, but it is a schematic representation, Dame Sally, of most, not all of the bodies concerned in pandemic preparedness and response structures in the United Kingdom and England – this is not the chart relating to Scotland, Wales or Northern Ireland – and it faithfully attempts to recreate the position as at August 2019.

It’s actually quite difficult to alight upon any particular name in the mass of names and bodies, but towards the top of the page in yellow you will see COBR, the Cabinet Office Briefing Rooms, and underneath that you will see the Chief Medical Officer, England, and that was you at the relevant time.

To the right, Government Chief Scientific Adviser. Did the Government Chief Scientific Adviser co-chair SAGE in the event of a health emergency?

Dame Davies: Yes.

Lead Inquiry: And underneath the CMO and the GCSA, we can there see SAGE, Scientific Advisory Group for Emergencies.

What were – because we’re going to hear a great deal more about them in due course – SPI-B to the left and SPI-M-O to the right?

Dame Davies: So I should say that it was the Government’s Chief Scientific Adviser who was the senior chair, because their office provided the secretariat for SAGE and they ran all the other SAGEs.

The SPI-B was a group that could be set up on behaviour, so trying to advise on how the public might respond to various issues. It arose during the Ebola 14/15 time when we realised that anthropologists and ethnography were terribly important to the response and was reconvened thereafter when SAGEs were needed, definitely in Covid.

SPI-M is the modelling subgroup, O because during Covid it was active, out of an emergency it’s just SPI-M. It brings together modellers – here we’re talking about infectious diseases but you can model any emergency, whether it’s flooding or anything else from the relevant departments – with academics coming in, and the objective was to bring their different models and come with a consensus agreement to SAGE that then generally the GCSA would take into COBR the modelling.

Lead Inquiry: All right. When you say SPI-M-O was active, does that mean it was operational, hence O?

Dame Davies: Yes.

Lead Inquiry: And SPI-B is the group in relation to behaviours –

Dame Davies: Thank you.

Lead Inquiry: – and therefore SPI-B.

On the right-hand side of the page, you will see the reference to other government departments and, underneath that box, departmental Chief Scientific Advisers.

You’ve referred already to the Government’s Chief Scientific Adviser, but did major government departments have their own internal Chief Scientific Advisers?

Dame Davies: Almost all of them did, and they met weekly with the Chief Scientific Advisers, so it was a broad network.

Lead Inquiry: At the top left-hand of the page, you will see NERVTAG, New and Emerging Respiratory Virus Threats Advisory Group. Was that a body which reported in to SAGE when required but also permanently gave advice on, as it says on the tin, respiratory virus threats?

Dame Davies: As it says on the tin, yes, new and emerging respiratory threats, not predicting what might appear, they reported in to the department and myself as Chief Medical Officer; we took their advice into SAGE and COBR.

I think you’ve done really well with this, because of course it’s a three-dimensional spaghetti mess.

Lead Inquiry: Yes.

Dame Davies: And I would just say that the Office of the Chief Medical Officer supported the Chief Medical Officer and the Deputy Chief Medical Officer, so I would have put them all together. I would have put them kind of much closer to the Department of Health but not fully in it, and I do want to point out that I worked, as does my successor, very closely with the CMOs in the devolveds as well.

Lead Inquiry: Yes. Well, there is a – yes, there’s no direct link, is there, on the chart between Chief Medical Officers for each devolved nation and the Office of the Chief Medical Officer?

Lady Hallett: I think we’ve got quite a few links, Mr Keith.

Mr Keith: Yes –

Dame Davies: Yes, it’s three-dimensional.

Mr Keith: – but I can’t even pray in aid a dotted line. There is no link at all on this chart.

Lady Hallett: But it is an important connection, Dame Sally, so you’re quite right to point it out.

Mr Keith: So we can see there, Dame Sally, Chief Medical Officers for each devolved nation, and of course that includes all the nations.

Further down the page, so to the right of Chief Medical Officers for each devolved nation but above the big blue box in the middle, there is something called the Moral and Ethical Advisory Group, MEAG. Was that also a permanent body which provided advice on moral and ethical matters?

Dame Davies: No, that was set up much more recently. It may be permanent now, but that was not, as far as I’m aware, present through most of my time.

Lead Inquiry: Right, it is permanent but it wasn’t in place, you’re quite right, throughout the currency of your holding of the post of CMO.

Then in the middle, because this is a health emergency, the lead government department is the Department for Health and Social Care, and within that blue box, just to the right of the marked-up passage, DHSC Chief Scientific Adviser, so there is the CSA for the Department of Health and Social Care.

Dame Davies: Who reported to the CMO, and then if you really want to add to your things, of course the health protection research units that you’ve got bottom left are funded by the NIHR. It was money that I took from Public Health England because I wasn’t happy enough with their research and I didn’t feel that they linked enough to academia, so I took £20 million and, following discussion with them and policy leads, chose subjects and we commissioned a series – and they’re recommissioned every five years – of health protection research units run – commissioned out of NIHR.

Lead Inquiry: Right.

Then just above there, we can see, above the words “Operational response centre”, which is a part of the Department of Health and Social Care which came into existence latterly, you can see “Director of Emergency Preparedness and Health Protection”. That is one of the major directorates in the Department of Health and Social Care, is it not?

Dame Davies: Yes.

Lead Inquiry: All right.

Somewhere on this chart will be Public Health England or the United Kingdom Health Security Agency. Ah, yes –

Lady Hallett: Underneath –

Dame Davies: Bottom left, yes.

Mr Keith: Thank you very much. My eyes are beginning to cross.

Public Health England, DHSC. Could you just very shortly explain what was then the function of Public Health England?

Dame Davies: Public Health England was a result of the Health and Social Care Act, it brought together the Health Protection Agency and a number of other bodies, I think there were about 70, but essentially bringing together health protection and health improvement, both as an advisory body on policy issues but particularly as a delivery body for public health. They had responsibility for assisting local authorities in appointing their directors of public health in local authorities, and they played a major role in pandemics and health exercises.

Lead Inquiry: And, Dame Sally, is it Public Health England that was subsequently abolished and its functions divided between the United Kingdom Health Security Agency, to which you’ve already referred, and a number of other bodies including –

Dame Davies: Yeah.

Lead Inquiry: – DHSC, NHS and regional health authorities?

Dame Davies: Yes.

Lead Inquiry: All right.

Then finally on this chart, towards the right-hand side of the page, up against the departmental Chief Scientific Advisers and all the government departments thereunder, we can see three groups in faint yellow, the UK Zoonoses, Animal Diseases and Infections Group, the Advisory Committee on Dangerous Pathogens, ACDP, and HAIRS, the Human Animal Infections and Risk Surveillance group.

Do they all, broadly speaking, do what they say on the tin?

Dame Davies: Yes.

Lady Hallett: Dame Sally, forgive the comment, but some of us may get the impression occasionally that there’s change for change’s sake in names of different groups or bodies. What was the rationale between bringing together health protection with Public Health England and then separating it again with other bodies? I mean, why?

Dame Davies: My Lady, they were both political decisions. There is a rationale for putting all of the public’s health together, because then you have a critical mass and things like data collection and processing, all sorts of things, can inform each other, and our public health speciality as they train has three pillars, I imagine they call them, that they train in. One is health protection, one is health improvement, one is health services. So people could move between them. So Jenny Harries was doing health protection in Public Health England, I appointed her as my deputy on health improvement, and as a regional director of public health she was rather good, she managed both. So they were trained in all of them. So that was it.

I presume that the splitting – again, going back to what was there before Public Health England – was an effort to really have a, not just a focus but a grip on response for emergencies.

Lady Hallett: Thank you.

Mr Keith: Finally – I think I may have said finally already, but finally finally – there is an important part of the public health structure which is reflected in this chart, which is the local directors of public health, towards the bottom of the page in the middle, below NHS England. Who are directors of public health?

Dame Davies: They are a wonderful – no, a community of some wonderful people who are either doctors or specialists in public health and they have trained in those three areas that I’ve talked about – many of them are epidemiologists – and they are situated in local authorities.

This was a change that was brought in in the 2012 Act. It’s reminiscent of the middle of the last century when public health was a local issue, and public health directors were the local medical officers, and they looked after outbreaks and food health safety and things there.

So it sounds a really good idea, but of course the government gave budgets with them to local authorities and they were very vulnerable and they ended up cut. So I think they have found it a very difficult role.

Lead Inquiry: You referred to the 2012 Act. In fiscal terms, and as far as the directors of public health were concerned, did that Act transfer fiscal responsibility for those directors away from central government to local authority, and that of course is why you refer to the fact that local authorities then controlled the budget? So if local authority budgets are cut, equally the budgets of their local directors of public health are cut?

Dame Davies: That was in effect what happened, the budget went from the Department of Health to Public Health England – at least this is how I understood it – and then out to the directors of public health and became part of the local authority budget. Public Health England collected the data and accounted for it, but it was cut by local authorities when they needed saving.

Lead Inquiry: Given what you said earlier about the important functions of the CMO, including health improvement as well as public health, to what extent does the CMO England and Scotland and Wales and Northern Ireland collaborate with and engage with local directors of public health?

Dame Davies: So the structures were different in the other devolveds and they had roles within the NHS, in their NHSs, which I didn’t. I met at least once a year with directors of public health by sharing a conference with the Association of Directors of Public Health; I met the president or chair of the Association of Directors of Public Health more often; I tried some phone-ins, but not many people phoned in. So if I met them, they said, “Oh, so I face” –

Lead Inquiry: “You are the CMO”.

Dame Davies: – “I face very similar issues to you”, because I would talk about how you have to try and persuade politicians to put money into things or to recognise the importance of a policy, and I would talk about how difficult it could be, and they’d say “Oh, that’s exactly what happens to me”.

So we had similar jobs, but I didn’t have a strong relationship.

Lead Inquiry: What about with local authorities more generally? So, for example, my Lady has heard evidence about local resilience forums who play an important part locally in civil contingency, they’re on the bottom of the chart at the bottom left. Were there any meaningful links between the Office of the Chief Medical Officer or the Chief Medical Officer and them?

Dame Davies: No, those links were either with Public Health England or with the EPRR programme.

Lead Inquiry: All right.

And finally on this topic, the devolved administrations. You had regular meetings, did you not, with the CMOs and the deputy CMOs of the devolved administrations, and no doubt you had meetings with the national analogue of Public Health England, so Public Health Wales and the Public Health Agency in Northern Ireland and Health Protection Scotland? Were they all bodies with whom you communicated at some point?

Dame Davies: No. I regularly met in different ways with members of Public Health England. I did not have accountability meetings with Public Health England, that sat with the right director general. I met just with the CMOs. We met four times a year formally, had dinner before to try and build trust, and I involved them in many projects.

So I was asked by David Cameron to write guidelines on alcohol consumption, I asked them to join me – the same with physical activity, the same with the report on screen time – because doing the work together made it much more powerful, it built our relationships for when there were different times, and actually it’s much easier for citizens across the UK if it’s one set of guidelines for the whole of the UK.

So I did quite a lot of work with them, as did my office, and the civil servants, whether from Public Health England or the department, who were leading bits of this work on my behalf.

Lead Inquiry: Thank you very much.

Could we now turn to the issue of risk assessment. My Lady has heard a considerable amount of evidence concerning what is now known as the National Security Risk Assessment process. You were CMO until October of 2019. I think the National Security Risk Assessment for 2019 was approved in July of that year, prior to you leaving the Office of the Chief Medical Officer in October 2019.

Do you recall having any input into or debating or discussing the draft 2019 National Security Risk Assessment?

Dame Davies: I don’t recall, to be honest, but on the other hand a lot of documents went past me – and I don’t have the world’s greatest memory, which is why I’ve had to bring some notes – and if I thought it was all right, it wouldn’t be likely to stick.

Lead Inquiry: A point made by the Cabinet Office, both in writing and orally before this Inquiry last week, was that the risk assessment process – in particular the National Security Risk Assessment for 2019 – was subject to a considerable degree of external validation, checking, and it was examined by departmental Chief Scientific Advisers, I quote, “policy subject experts, external experts”, the Scientific Pandemic Influenza Group on Modelling, the Risk Assessment Steering Group, RASG, and what are known as expert challenge groups, to which you referred earlier.

Did they include the CMO?

Dame Davies: Not that I recall, but if the CSA – at that time was Professor Chris Whitty – was there, I would not feel the need. I trusted him, and he was CSA. I mean, there’s a limit to the duplication.

Lead Inquiry: No, indeed.

The Chief Medical Officer of course after you, as you said, is an expert in epidemiology. One of the major risks, in fact the primary risk, a Tier 1 risk, the highest overall risk in that entire risk assessment process, was of influenza pandemic, of course closely related to the issue of epidemiology.

Do you think there was a case for involving or maybe now involving the Office of the Chief Medical Officer in that risk assessment process in order to ask the right questions, to challenge and to probe?

Dame Davies: I think it … it does depend on who is the CSA and who is the CMO. I would be surprised if I could second-guess Chris Whitty. I did – do know that I made sure that antimicrobial resistance stayed on the list, because I’ve had such trouble trying to raise awareness of this.

Lead Inquiry: In your witness statement, you say – you express your belief that the UK’s preparations for a pandemic of influenza reflected a long-standing bias in our preparations in favour of influenza and diseases that had already occurred with, we now know, an underestimation of the impact of novel and particularly zoonotic disease.

Part of that underestimation or an explanation for that underestimation may in part be found in that risk assessment process, which focused on pandemic influenza as you know, and arguably failed to give sufficient attention to the risks of other pandemic pathogens and of their varying characteristics, which may include different incubation periods, asymptomatic transmission, higher transmissions, greater severity and so on. You’re familiar with the issues.

Why do you think that long-standing bias occurred, and/or was allowed to continue?

Dame Davies: So, I’ve said previously something about groupthink, and there was groupthink, but it wasn’t just us; this was the whole global north, the western world thought that flu was the thing to focus on. Let me be quite clear: we’ve had, in just over a century, four flu pandemics. We will have more, it’s only a question of when. So for me the issue is not: should we not prepare for flu; we must prepare for flu. The question is what else we do over and above that, and clearly we could have done more thinking. So we needed – the system, which included me in that way, needed more challenge.

I tried, I – following a visit to Hong Kong where I learnt a lot about SARS, I did ask unofficially: what about doing a SARS review? And was told, “Oh, no, it won’t come here”. And I found in a document that is – you have – someone’s given me in an evidence pack, INQ000056256, the national research register – national risk assessment from January 2016, that it actually says about SARS, more recently MERS and Ebola, that they were unlikely to present a wider threat to the UK through sustained spread.

So I – I mean, that was what I was being told. I went to Korea, I came back, and I asked for a MERS practice, and we did Exercise Alice that you may come to.

Lead Inquiry: Yes.

Dame Davies: So I did put some challenge into it, but maybe this is the moment to say how sorry I am to the relatives who lost their families. It wasn’t just the deaths, it was the way they died. It was horrible, and I heard a lot about it from my daughter on the frontline as a young doctor in Scotland. It was harrowing, and it remains horrible.

Lead Inquiry: Indeed.

In September of 2019, Johns Hopkins Center for Health Security published a paper entitled “Preparedness for a high impact respiratory pathogen pandemic”. Could we have, please, INQ000198916, I think page 6, please.

The report examined from a well known, renowned body the current state of preparedness, just on the eve of the pandemic, for pandemics caused by high impact respiratory pathogens, that is pathogens with a potential for widespread transmission and high observed mortality.

“Were a high impact respiratory pathogen to emerge, either naturally or as the result of accidental or deliberate release, it would likely have significant public health, economic, social, and political consequences. Novel high-impact respiratory pathogens [so, just pausing there, not just of course influenza] have a combination of qualities that contribute to their potential to initiate a pandemic. The combined possibilities of short incubation periods and asymptomatic spread can result in very small windows for interrupting transmission, making such an outbreak difficult to contain.”

Of course, Dame Sally, a longer incubation period whilst one is becoming infected, which is asymptomatic, so that one doesn’t know one is infected, gives an even greater potential to spread an infection before one becomes aware of the symptoms.

“The potential for high-impact respiratory pathogens to affect many countries at once will likely require international approaches …”

The article goes on to raise a general concern about the lack of global attention and consideration of this threat, and it calls for a general better understanding of levels of preparedness structures and capabilities, and observes that there are notable existing gaps.

In this field of pathogenic learning, it was well understood, wasn’t it, that the next pathogenic pandemic could have very different characteristics, not just influenza but differences in terms of transmission, incubation period and asymptomatic infection?

You must have given a very great deal of thought to this issue. Why did that whole process of risk assessment, of preparing, producing influenza strategies, of preparing workstreams to deal with the consequences and the impact of an influenza pandemic, not address that feature?

Dame Davies: I think the answer is in two halves. So, the first is of course it was this group that said “We in the States were in a wonderful position and top of – along with the WHO – top of the charts for our pandemic flu preparation”, which –

Lead Inquiry: I’m sorry to interrupt, do you mean by there the reference to the –

Dame Davies: Johns Hopkins, yes.

Lead Inquiry: No, the grading carried out under the auspices of the World Health Organisation, the joint evaluation, and also the GHSI chart?

Dame Davies: Yes.

Lead Inquiry: Right.

Dame Davies: So that reassured me as a non-expert, but part of that part of the answer is that first of all I believed that if we prepared well for flu we should be able to pivot pretty effectively, and we can’t prepare for everything. Meanwhile, we did a lot of learning as we went. So after 9/10 there was the Hine review and that 2011 pandemic plan, I came into my role, was to consult on it, to consult widely, and no one said, “Ah, you’ve got it wrong”. We were hoping to update it, or at least the department was intending to in about 2014, but then Ebola came. But we learnt during Ebola about things. We – the Public Health England on behalf of government put in place screening at the airport, looked at and modelled quarantining in a hotel and some other facility which didn’t sound very nice, but they did do pieces of work that I knew we could call on.

I knew that during Ebola, because we would inevitably import some cases, that because of the pressure I put on the NHS, they had had to make sure they not only in 2015 had reliable PPE, but I was assured by their chief medical director that they had been trained to use that effectively. So I went forward believing that we had quite a bit of the other things that we might need in place. Public Health England was advising on the PPE stockpile.

The second part of the answer is: yes, we did not have – the government didn’t do the plans, but we didn’t have resilience either and, as I said earlier, you can’t get a good outcome if you don’t have resilience in the public’s health, resilience in the public health system – it had been disinvested in – resilience in the NHS, and by comparator data compared to similar countries, per 100,000 population we were at the bottom of the table on number of doctors, number of nurses, number of beds, number of ITUs, number of respirators, ventilators. We needed resilience in social care, that was clearly missing, resilience in the life sciences, about manufacturing, we didn’t have that.

The only thing we had resilience in, and I’m very proud of, and it did save millions of lives across the world, was R&D. But if we don’t build those, no plan will work.

Lead Inquiry: Dame Sally, could you just explain what you mean by R&D? Do you mean the clinical expertise, the scientific and research base in the United Kingdom?

Dame Davies: So following Ebola, led by Oliver Letwin, some considerable amount of money, more than £400 million Official Development Assistance was made available and we set up, I think it was £110 million, the Vaccine Network to look at what we could do – and I chaired the first meeting, then Chris Whitty took over – to help prepare for infections that didn’t have vaccines that might occur in low and middle income countries and might spill over.

We funded into Oxford for a MERS vaccine, that was the basis of the successful Oxford/Cambridge/AstraZeneca vaccine that saved more lives probably across the world than the other ones.

Lead Inquiry: Indeed.

Dame Davies: We had – I’m having to think of all the different things. Also we put in place after Ebola a rapid support unit which was co-commissioned out of the London School of Hygiene and Tropical Medicine and Public Health England, on the grounds that if you get – snuff out something that happens quickly, it’s much better and cheaper, and they would go, at WHO or country request, all round the world to help countries on breakouts of Ebola, cholera, things like that. I put in place the research units, we had the research networks to deliver all of the clinical trials.

I know I’ve got more I should tell you, but I can’t remember it all.

Lead Inquiry: Rather than turning this into a memory test, but if I may say so a very impressive answer, we’ll come back to some of the specifics a little later.

Dame Davies: Thank you.

Lead Inquiry: Therefore just standing back, in terms of – to use your expression – the pillars of the United Kingdom’s ability to respond and its response, the three areas appear to be the question of resilience – about which you’ve spoken, if I may say so, very eloquently – the issue of research and development, the scientific and research base which led to diagnostic tests being made available extremely quickly, vaccines, of course, antivirals, clinical treatment, the trials and all the data research from Vivaldi and Zoe and the various systems that were put in place.

Then the third area is, I suppose, countermeasures, the political and administrative system which was designed to prepare the country for a possible pandemic, and it’s in relation to the areas of resilience and countermeasures that you have spoken in the terms that you have in your witness statement.

The pandemic preparedness strategy 2011 to which you’ve referred, INQ000022708, Dame Sally, I daresay that when the strategy came to you for your review – you said you had an input into it – of course it called itself the influenza pandemic strategy, so I don’t suppose anybody was thinking about what other pandemics this strategy document should be designed to address?

Dame Davies: I was not. It was the beginning of my period. I had a lot to learn.

Lead Inquiry: Page 15 says this:

“A pandemic is most likely to be caused by a new subtype of the Influenza A virus but the plans could be adapted and deployed for scenarios such as an outbreak of another infectious disease, eg … SARS in health care settings …”

I pause there, in healthcare settings because SARS wasn’t generally understood to be something that was capable of spreading healthcare settings.

“ … with an altogether different pattern of infectivity.”

Is that the same point that you made earlier, which is that you understood that the strategy was to have a plan for influenza which could then be adapted for the purposes of a non-influenza pandemic?

Dame Davies: This was written by my predecessor, who knew much more about this than me. I mean, looking at it now, I still think that some of the plan is, was very useful and can be very useful, but there was more we should have done.

Lead Inquiry: Do you recall any debate, when you were the Chief Medical Officer, on the need to update this single – there was no other strategy for influenza pandemic – this single strategy, or to produce a strategy document relating to non-influenza pandemics?

Dame Davies: No, but I suppose in a way that’s why I wanted, I mean, practices, because do you need something else written and long? What you need is the people who will be involved to learn lessons and know how to put it into practice. So I asked, after the German outbreak of E.coli where a number of children died, that we should do an E.coli exercise; I asked about SARS; I initiated, by asking for it, the MERS one.

Lead Inquiry: As far as you are aware, did anybody stand up and say “Well, this strategy is solely reliant upon a pandemic influenza, there appears to be no strategy document dealing with non-influenza, where are they? Where is that document?”

Dame Davies: I can remember no one saying that to me. I think I would remember that.

Lead Inquiry: In your witness statement, turning now to a different topic, you say this:

“As a system, we need to open ourselves up better to challenge, including from external experts.”

You will know from your comprehensive review of the documentation that the Department of Health and Social Care after the Covid pandemic acknowledges that the department would have benefitted from a fuller understanding of the response by Asian countries, of course the responses to their experiences of SARS and MERS, both of which had had repeated outbreaks.

Can you assist the Inquiry, please, as to – again you must have given this a great deal of thought – how we can better learn from the experience of other countries, other systems, and perhaps overseas experts? Because that appears to have been missing in the system at the time.

Dame Davies: So we need to continue to engage with WHO and through WHO we build relationships with other countries. We have two quite useful systems. One is called GHSI, Global Health Security Initiative, which is G7 health ministers plus Mexico, who have met a number of times and we’ve done exercises with the ministers and their senior advisers. Those have been useful. G20, when Germany was chair we did an exercise in Berlin on Ebola, that was very important for the health ministers, I learnt some things. I actually went and ran one on antimicrobial resistance for the Argentinian G20 that they found very useful. But I also think we need to look at how we bring in external challenge, and it is something about an open policy approach which I was clearly made for, in that I love to have a debate and see if someone can best me and make me change my mind.

Lady Hallett: Do they?

Dame Davies: Occasionally. Yes.

Mr Keith: So, Dame Sally, have you identified, therefore, a second important doctrinal approach, that there can no longer be the level of groupthink to which you referred earlier, but there must be more external challenge and a doing away of what you describe as United Kingdom exceptionalism, the belief – utterly ill-founded – that we know better?

Dame Davies: I absolutely agree, but I would also say that as we do this, we’ve got to remember that we have a limited amount of money and limited people, both in the policy space and in the delivery space, whether it’s the NHS or public health. And so we also have to, while listening with respect to some of our academic colleagues who come up with things and say: yes, but what is the risk of that happening? Is that something that we need to do a special plan for, or can we do – can we amend a plan?

I mean, it’s clear that no one thought about lockdown. I still think we should’ve locked down the first time, though a week earlier. But during that we should have thought: do we need to further?

The damage I now see to children and students from Covid and the educational impact tells me that education has a terrific amount of work to do. We have damaged a generation and it is awful, as head of a college in Cambridge, watching these young people struggle; and I know in the pre-school they haven’t learned how to socialise and play properly, they haven’t learned how to read at school. We must have plans for those.

Lead Inquiry: Well, they, Dame Sally, of course, are all terrible consequences from the lockdown itself, but for the purposes of this module, the position was, wasn’t it, that the possibility of a lockdown itself was neither foreseen nor planned for, that is the reality, isn’t it?

Dame Davies: True.

Lead Inquiry: And it was that failure in the context of planning for a pandemic that is one of the more notable failures in this strategic planning?

Dame Davies: I still – yeah. All right. I’m sorry we didn’t plan for that. I think we – I would prefer to have planned to not get us to that stage, but we didn’t recognise that it could – something could get to that stage and then how would we manage it.

The other thing, another thing which I would say we didn’t plan for was flu has peaks that go for 12 to 16 weeks; we never planned for something that was unremitting for a couple of years, I mean, and may not have gone away yet, we could have some more mutations.

Lead Inquiry: The risk assessment document to which you referred talks only in terms of a 15-week wave.

Dame Davies: Yeah, and the impact of that on both the public but the front lines, we had to think about how we should scale, both scale effectively but then maintain that response. And while I’m on it, we should as a government have – well, I’m not government, but I wish that someone had looked at logistics and thought about logistics and supply chains and data better.

Lead Inquiry: May we come back to that in the context of some of the recommendations from Alice and Cygnus which of course deal with that.

You referred a few moments ago to the failure to think more about how to prevent. Is that a reference to perhaps a further doctrinal error or a strategic error, which was the focus on trying to deal with the assumed catastrophic consequences of an emergency as opposed to trying to prevent those catastrophic consequences from occurring in the first place? What did you mean by that?

Dame Davies: Yes, that was what I was referring to, that we worked on response and I do not remember a conversation about: so how do we stop it getting here? In part because the International Health Regulations of the WHO, to which almost every country signed up to, say that when a pandemic kicks off you do not close the borders. But I did learn during Ebola some important lessons. So the government, David Cameron, wanted to look at closing borders, Public Health England said it wasn’t cost-effective, and what I learnt was there are times when you have to do things that may not look cost-effective because the nation needs them.

Lead Inquiry: May I now turn to Exercise Alice and Cygnus.

You will be of course very familiar with both exercises – not least because the evidence before the Inquiry says that Exercise Alice was prompted by a request from you personally – and it was a tabletop exercise conducted in February of 2016 in London to deal with the assumed large-scale outbreak of MERS coronavirus, and it was a very significant exercise, was it not?

Dame Davies: Yes.

Lead Inquiry: The objectives of the exercise were to plainly observe and confirm the health capabilities and capacities of our country, to explore and report upon the communications and the control mechanisms as to how this emergency would be dealt with, and also public messaging and contact tracing and so on and so forth.

But two very important parts of Exercise Alice and the report dealt with the possible need – I emphasise “possible need” – for mass contact tracing if MERS, the assumed exercise, were to get out of control and not just be confined to health settings, and also the possible need for large-scale quarantining, again if the virus were to get out of control and were to overwhelm the relatively small systems for dealing with high-consequence infectious diseases, which are basically run by Public Health England and specialists who go in and sort out the problem.

Can you recall now why the workstreams that were designed to give effect to the Exercise Alice recommendations, particularly in relation to quarantining and mass contact tracing, don’t appear to have borne fruit?

Dame Davies: No. I instigated it, I felt we needed it. If you look at the report, you will see it was published, written by Public Health England. My understanding was having written the report, which of course I saw, I participated and saw that they would get on and make sure that they addressed the agreed recommendations. It wasn’t me saying “I think you should do this”.

Lead Inquiry: No, it was the report?

Dame Davies: Yeah. From them.

Lead Inquiry: So looking back, does it appear to be the case that the system, for which of course you’re not personally responsible, but the system failed to ensure that within a reasonable amount of time, practically the recommendations of Exercise Alice were put into place, that plans were drawn up along the lines of those recommendations?

Dame Davies: I would have expected them to be. It appears they weren’t.

Lead Inquiry: In relation to Exercise Alice, after it was completed – and in general terms it set out and highlighted a number of areas in which recommendations were made and areas in which improvements were suggested – do you recall any debate at the level of the Office of the CMO as to how progress was being made in terms of putting those recommendations into place?

Dame Davies: No.

Lead Inquiry: All right.

Dame Davies: You must understand I was terrifically hard-worked and actually spent rather a lot of time on another health emergency, the antimicrobial resistance pandemic.

Lead Inquiry: Let me make absolutely plain, the system did not provide for or anticipate that the Chief Medical Officer should oversee this process and make sure it was put into place. I’m merely enquiring as to whether or not the system happened to provide for the CMO to be told of progress and what was happening.

Dame Davies: I don’t recall it.

Lead Inquiry: Jeremy Hunt, in his witness statement – and we’ll be hearing from Mr Hunt tomorrow – says he was not involved in Exercise Alice and neither the department – that’s the Department of Health and Social Care – nor the Chief Medical Officer believe any recommendations from the exercise reached his desk, which rather suggests that he’s asked you or he’s made some enquiries as to whether or not you knew that the recommendations had not reached his desk.

Dame Davies: So I developed a trusting relationship with that particular Secretary of State, and felt that I should get on with my work and go to him when I needed to. I asked for this, there were good recommendations, I don’t think I did take it to him because it seemed to me the work was done, he shouldn’t – he was busy, he didn’t need to worry about it.

Lead Inquiry: You could sensibly presume that the system would be in place to ensure that the recommendations were acted upon –

Dame Davies: Yes.

Lead Inquiry: – and the steps were taken?

Exercise Cygnus was an even bigger exercise, was it not? It was a Tier 1 national level pandemic influenza exercise in October of the same year with near on a thousand representatives, and it was designed to test the United Kingdom’s preparedness in response to a pandemic influenza outbreak commissioned by the Department of Health, and commissioned I think at a stage when you would by then have ceased being the Chief Scientific Adviser in the Department of Health?

Dame Davies: Yeah.

Lead Inquiry: I say this advisedly: you were merely at that stage just the CMO, but you weren’t directly engaged within the Department of Health. To what extent were you aware of the outcome of Exercise Cygnus?

Dame Davies: I was not party to the work in 2014, and in August there was a one-day Exercise Cygnet that set up Cygnus.

Lead Inquiry: Yes.

Dame Davies: Cygnus itself went for three days in October. I was part of that in receiving both briefings, briefing the Secretary of State, and going to the mock COBRs and commenting and advising.

Lead Inquiry: The report makes plain that you yourself had called for more regular programmes of Tier 1 pandemic flu exercises –

Dame Davies: Yes.

Lead Inquiry: – is that correct?

Dame Davies: Along with the permanent secretary, who agreed with me.

Lead Inquiry: It was your position, and you publicly stated it, that it was essential to build on the learnings from Exercise Cygnus to ensure continuity in the country’s preparedness, and you suggested that in future Tier 1 pandemic flu exercises be conducted coinciding with the beginning of every new Parliament, which would ensure regular and significant exercises.

Dame Davies: Yes.

Lead Inquiry: Do you know what came of your public and consistent recommendation to that effect?

Dame Davies: No, but we probably aren’t in a new Parliament and Covid came, but I don’t.

Lead Inquiry: The conclusion from Exercise Cygnus – and my Lady has heard this conclusion stated a number of times – is that the United Kingdom’s preparedness and response in terms of its plans, policies and capability were not sufficient to cope with extreme demands of a severe pandemic that would have a United Kingdom-wide impact.

This was an exercise which, at least indirectly, you had called for, which you promoted and you supported and you wanted such exercises to take place more regularly.

Were you extremely concerned by that conclusion, the conclusion of the process to which you had lent your support?

Dame Davies: I thought it was a correct conclusion, and I hoped that it would spur more work. It did set off some streams of work that I was concerned about, one being how, if our NHS is overwhelmed, should we triage the work, and that piece of work went through and it was in fact that which set – which precipitated or pushed for the need to have a medical and ethical group that you referred to earlier.

Another piece was, as we worked through it and things were clearly out of control, somebody representing a minister, or a minister, or someone would say, “Well, we could take emergency powers for …”, and I highlighted that we should work out what were all these possible emergency powers and draft a draft Act so that we were prepared, and over the next two years that was worked on.

So I had feedback occasionally from the civil services contingency on how that was progressing, very slowly, and the triage work from the NHS, which I saw through to a conclusion and shared with ministers.

The other work I was not particularly party to.

Lead Inquiry: Is that because, Dame Sally, the Chief Medical Officer was not expected and in no way expected to be able to supervise the outcome of the recommendations and whether they were implemented, let alone the workstreams which were designed to give effect to those recommendations?

So some of the workstreams came across your desk because they happened to be within the reach of the CMO.

So, for example, one was drafting a Bill called the draft pandemic Bill to deal with providing the necessary regulatory powers for a pandemic, although in the event, as we all know, the lockdown regulations in the main were promulgated under earlier public health legislation dating back to 1964.

A second workstream was dealing with the medical and ethical consequences flowing from the terrible decisions of hospital staff to triage patients.

A third workstream was dealing with surge capacity.

A fourth was dealing with the impact in prisons.

Were you aware that of the 22 or so recommendations only, I think, a bare majority were actually completed or in part completed?

Dame Davies: No, I wasn’t. But the CMO has strength by being advisory and independent, so there is a limit to what that office can do with only 13 people. The Chief Scientific Adviser has 100 people.

Mr Keith: Thank you.

Would you give me one moment?

(Pause)

Mr Keith: Dame Sally –

Lady Hallett: Are you going on to a different subject?

Mr Keith: I was going to ask one more question, yes.

Lady Hallett: On this one? Right.

Mr Keith: Just generally, and that, in fact, would conclude my examination.

Lady Hallett: Oh, right.

Mr Keith: You have been good enough to provide my Lady with a number of observations and thoughts and suggestions in relation to how this system could be made better. Are there any other general recommendations or suggestions that you’d like to make that we’ve not touched upon yet?

Dame Davies: I – I think there were two issues, as we went through Covid, that I saw that I worried about, and the first was that SAGE is by definition a biomedical model –

Lead Inquiry: Could you explain what you mean by that?

Dame Davies: So it is about science and about health and very practical and evidence-based, and where the behaviour groups by B came in on behaviour, which is much more societal, which is where I’m going. They just opined based on no evidence that the public wouldn’t like lockdowns so they wouldn’t do it. There was no evidence, and what they should have said was, “There is no evidence, you will want to consider …”

And it seemed to me that, sitting outside it all – which gives you some advantages in thinking and challenging, of course – that what we needed to do was balance the biomedical model with the economic and social, that ministers and government need to be presented not only with the biomedical advice but also what’s the impact on the economy, on the social cohesion of our community, and on education. And so we needed, as a nation, a second group advising on all of that, and I – I wondered whether you would use, just as we have the Chief Scientific Adviser, perhaps the Chief Economist from the Treasury and the Bank of England to bring in education, well-being and all of those things, because I don’t think we as a nation considered those issues effectively.

The other very big concern I had as we went through this was data, and how it was handled to help the nation do better. I mean, to find that Public Health England were collecting data into Excel spreadsheets is bad, but then didn’t know they only had 300 lines so data dropped off the bottom, and they didn’t know that they’d lost some patients at one point, is appalling.

But we weren’t, as far as I could see, accessing and using all data. So before I go on, let me just say I was very quiet about Covid, because it seemed to me that a lot of people were commentating, and I know from when I was CMO that you know a lot, because people are synthesising stuff and there is data, and that many people were setting themselves up on experts on television who weren’t and very few external people knew the whole picture, so I was keen not to.

The only time I did make comment was once in The Telegraph and that taught me I shouldn’t do it again. Though the reason I did it, perhaps I could just say this, was because I had written a book. I thought that Covid would start a debate on the health of our public and inequalities and I wanted to contribute to that, and I’ve written a book, and I brought you a copy, my Lady, to give you for your summer reading.

Lady Hallett: Thank you very much.

Dame Davies: Because I thought you might find it interesting about these issues.

So I was quite careful. But the other thing I did do, because I didn’t think we were using data well, is I raised £7.5 million and set up a charity called The Trinity Challenge to look at how we could use data from different sources better, to predict a pandemic, diagnose it, prevent it, manage it, and we got 340 applications from 62 countries, and we have the most amazing prize winners from all round the world, using data differently that could then help our response.

One of the second prize winners was from Cambridge, are mathematicians. 3.4 billion blood counts are done across the world. The print-out looks like when I was a student, which was decades ago. 80% are done on a Japanese technology where under the desk there’s a black box with 70 more parameters. Using data from Addenbrooke’s Hospital in Cambridge from the year before Covid and then Covid, they think they’ve found the Covid signature.

Just imagine, using AI you can find that, so then as people come in you can stream them, you can triage.

The winner was a Thai one, where farmers photograph sick and dead animals and send it to a vet, who then begin to put data together and advise them, because it matters to them economically, but thinking about diseases in animals that could hop to humans, and visit if needed.

So I felt we could use data better and differently, and I think as we go forward we need not only to fund – to work cross-government to make – and it will be statutory, what’s needed – to make the resilience of the public health right, but also we’re going to have to fund much better data, probably in partnership with academics, because governments find it difficult to be at the cutting edge.

I remember quite early in the pandemic some of our Cambridge mathematicians coming to me saying: the modelling’s out of date and it’s for flu, we can do much better. So I asked them to go to the Royal Society, and then they were brought in by Patrick Vallance into the modelling, and then we had much better modelling. But we have to find ways to work much better with the cutting edge of our superb academics.

Mr Keith: May I be permitted to thank you for those thoughts. I should say that they’re all areas which my Lady will be addressing in Module 2, so specifically data, the diversity and make-up of SAGE, and modelling.

But if I may ask you one further question, to tie some of the points that you’ve made to this module and preparedness.

You’ve referred to the fact that the advisers and experts who were having to grapple with Covid may have failed to pay sufficient regard to behavioural change, in essence the issue, if I can put it perhaps rather crudely, the possibility that the country and its citizens would react instinctively to the need to protect themselves from Covid, and therefore an issue arose as to whether or not a lockdown was required, because the populus might just self-isolate naturally and in any event.

Was behavioural change something that had come out of a survey of South Korea’s response to the MERS pandemic, and which was the subject of a specific recommendation in Exercise Alice which was the assumed MERS exercise in the United Kingdom?

Dame Davies: I don’t think I know what you’re getting at. What I would say as came out of both SARS and MERS in Asia was the desire when there’s a respiratory risk to wear a mask, and WHO would not recommend masks because there were no randomised controlled trials. Well, blow me, you can’t do a randomised controlled trial properly because you don’t know whether someone’s infected or not, you don’t know whether they’re wearing them properly or not. But common sense says that wearing masks will give some protection, and actually I think that’s where the science has ended up.

So that came out of MERS and SARS, but that wasn’t what you were getting at.

Lead Inquiry: The issue of behavioural change was something that was flagged up in the Exercise Alice report.

Dame Davies: Yeah.

Lead Inquiry: But very little appears to have been done in relation to taking that thought or that workstream, to use a word beloved of the bureaucracy, further thereafter?

Dame Davies: True, and I think I’m arguing by saying we need a separate committee that thinks about behaviour and society so that it’s not locked into health behaviour people, but is a much broader church of experts.

Lead Inquiry: I’m sorry for turning my back, I do apologise, I was just receiving a message.

My Lady, I believe there has been a request under Rule 10(4) for me to ask a question about Exercise Cygnus, if I may do that.

I think the evidence shows that Exercise Cygnus was originally planned for 2014 but was delayed for a number of reasons. Can you recall why the carrying out of Exercise Cygnus was delayed?

Dame Davies: Well, 14/15 was when we had Ebola, wasn’t it? 14 to 16 was when Ebola was in West Africa. We mobilised – we were asked by the Sierra Leone government to lead or to support them in their response, they had many cases, many deaths – we mobilised a hospital ship, we mobilised military on the ground to build hospitals and diagnosis and treatment centres, we sent NHS staff. I mean, we learnt a lot, but –

Lead Inquiry: But it delayed the exercise.

Was there also not a strike by junior doctors, around about the same time, which impacted upon the operational date of the exercise? If you can’t recall –

Dame Davies: That would not, as far as I’m concerned, have impacted doing an exercise, but I think they were contemporary.

Mr Keith: All right.

My Lady, those are all the questions that I have for Dame Sally.

Lady Hallett: Thank you very much.

Thank you very much indeed, Dame Sally, I’m very grateful, and I shall read your book.

The Witness: Thank you.

Lady Hallett: Summer reading, you said, rather than bedtime reading.

The Witness: Yes.

Lady Hallett: Thank you very much indeed for your help, and for your work.

The Witness: Thank you.

(The witness withdrew)

Mr Keith: My Lady, that concludes the evidence for today.

Lady Hallett: Very good.

Apologies to the stenographer for going on over the hour and a quarter, I hope she’ll forgive us.

Very well, 10 o’clock tomorrow morning.

Mr Keith: Please.

Lady Hallett: Thank you.

(3.30 pm)

(The hearing adjourned until 10 am on Wednesday, 21 June 2023)