Transcript of Module 1 Public Hearing on 29 June 2023

(10.00 am)

Lady Hallett: Yes, Mr Keith.

Mr Keith: Good morning, my Lady. The first witness this morning is Sir Jeremy Farrar, who is joining us online.

Sir Jeremy, could you be sworn, please, or give the affirmation. If you follow the instructions from the usher.

1. Sir Jeremy Farrar

SIR JEREMY FARRAR (affirmed).

(Evidence via videolink)

Questions From Lead Counsel to the Inquiry

Mr Keith: Could you provide your full name, please.

Sir Jeremy Farrar: Jeremy James Farrar.

Lead Inquiry: Sir Jeremy, thank you for joining us this morning. May I commence, please, with your qualifications.

You trained, I believe, in medicine, with postgraduate training in London, Chichester, Edinburgh, Melbourne, Oxford and San Francisco. You have a DPhil PhD from the University of Oxford.

You were a director of the Oxford University Clinical Research Institute at the Hospital for Tropical Diseases in Ho Chi Minh City in Vietnam from 1996 to 2013.

From 2013 you were Director of the Wellcome Trust, and from May 2023 have you been the Chief Scientist at the World Health Organisation?

Sir Jeremy Farrar: Yes, all correct.

Lead Inquiry: Are you giving evidence today in your personal capacity as opposed to a representative of the World Health Organisation?

Sir Jeremy Farrar: Yes, correct. It’s very important that I’m here totally in my personal capacity, not representing the World Health Organisation or, indeed, previous lives at Wellcome Trust either.

Lead Inquiry: Have you throughout your professional career served as a chair on a multitude of advisory bodies, for governments and global organisations? Were you the founding chair, in fact, of the World Health Organisation R&D Blueprint entity or body, and the founding director of the International Severe Acute Respiratory and emerging Infection Consortium, ISARIC?

Sir Jeremy Farrar: Correct.

Lead Inquiry: Have you received a plethora of honours from a number of governments, institutes and entities?

Sir Jeremy Farrar: Thank you.

Lead Inquiry: Could I commence, please, Sir Jeremy, by asking you some questions about the United Kingdom influenza strategy document, the 2011 strategy, about which a great deal of evidence has been received by my Lady’s Inquiry.

Are you familiar with that 2011 strategy for influenza pandemic?

Sir Jeremy Farrar: Yeah, thanks very much.

Can I start as well by just reaching out with the greatest support for those who have lost lives during the Covid pandemic, affected by the Covid pandemic, families that are still affected and those with long Covid, and particularly also for healthcare workers around the world who put their lives at risk in order to help all of us.

The influenza strategy I think you’re referring to, of 2011 – in 2011 I was living and working in Vietnam, and so I was not directly involved in the development of the strategy, but it was lessons learned indeed after the H1N1 pandemic of 2009, and so I was peripherally involved in parts of it, and also in the Academy of Medicine Sciences’ review of how clinical trials and evidence and data could be gathered in the context of epidemics and emergencies, so peripherally involved in that strategy.

Lead Inquiry: Was there a general awareness of the importance of the strategy to the United Kingdom’s pandemic preparedness for influenza?

Sir Jeremy Farrar: Yeah, I think if you go back – bear in mind I’ve never worked directly within government, I’m sure there are better people than me about – talking about how that was perceived in government, but if you go back to the government risk registers over the years, then pandemic influenza would have been in the top risk of many of those risk registers.

I do think, coming out of 2009, that there was an issue with a sense – and this actually is true after many epidemics, I sincerely hope it’s not true after this epidemic – that actually 2009 H1N1 was not quite as bad as people thought, and there was a danger, globally, including in the UK, of a sort of child that cries wolf, and that actually these were less of an issue than perhaps they were. I think that did influence thinking after 2009 and may have built into why influenza as a pandemic dropped down risk registers around the world after 2011.

Lead Inquiry: There have been a number of references in the course of evidence to the possibility that a degree of complacency was engendered by the H1N1 swine flu pandemic, because it was, by the nature of these things, relatively mild; would you agree?

Sir Jeremy Farrar: Yeah, I do agree. I was in Mexico as part of a WHO group in May of 2009. In May of 2009 the city of Mexico in four hospitals within a square kilometre were full of mostly young people with very, very severe influenza, and for many of us who have been concerned, and remain concerned, that one of the greatest risks is an influenza pandemic of some ilk – going back to 1918 – it was entirely appropriate, in my view, in 2009 to raise the flag that this was going to cause a major global problem.

In reality, as you rightly say, the severity of H1N1 in 2009 was less than expected and therefore I think there did come a degree of complacency that actually the world was safer against an influenza pandemic than perhaps had been previously thought, and there was a lot of criticism at the time about things like stockpiling of the drug oseltamivir. Personally I think that criticism was unwarranted and that actually influenza remains, among – with others, but remains one of the greatest risks to humanity. And as we now watch H5N1 pandemic in animals circulate around the world in an unprecedented way, influenza is never going to go away as a threat to humanity.

Lead Inquiry: Sir Jeremy, whilst you give evidence –

Lady Hallett: Could we slow down?

Mr Keith: Could you slow down a little? We obviously want to hear what you have to say and it’s important that your evidence is recorded by our hard-working stenographer and it’s quite difficult if you go too fast.

Sir Jeremy Farrar: Apologies. It’s a nervous occasion to be part of.

Lead Inquiry: Well, it won’t be for very long, Sir Jeremy, so I’m sure you’ll survive.

My Lady has heard considerable evidence about the inherent unpredictability of respiratory viruses and therefore the inherent unpredictability of the characteristics of a pandemic which may ensue from a widespread pathogenic outbreak. Putting it in blunter terms, it’s impossible to know with any degree of certainty what characteristics the outbreak may have, which viruses, respiratory viruses, may eventuate, and therefore what one has to guard against.

Was there a general sense at all, as far as you could tell, after 2011, that there had been a failure to focus on, in the government guidance and the government policy in the United Kingdom, on the inherent unpredictability of respiratory viruses and, therefore, on the risks of a non-influenza pandemic?

Sir Jeremy Farrar: Yeah, I think that would be true in the UK. I think it would be true globally as well. If you go back in the last 20 years – I mean, I started working on emerging infections in 1999 with an outbreak of something called Nipah virus in Malaysia –

Lead Inquiry: Sir Jeremy, please slow down, you’re going very fast again. You have to steel yourself to go slower than you otherwise would.

Sir Jeremy Farrar: If we look from 1999 to 2019, that 20-year period, and just look at the number of regional or global events that have led to major disruption, SARS-1, which I was involved in in Vietnam, H5N1, Zika, MERS, another coronavirus, the pandemic of 2009, and many others as well, it is clear that we’re living in an age of – a pandemic age, where, as Mike Ryan at the WHO has said, we’re living in an age which is going to have more frequent and more complex pandemics. Yet it is extraordinarily difficult when governments are faced with dealing with the challenges of day to day to also put in place those critical infrastructures, resilience and surge capacity and spare capacity, that would allow to deal with the unexpected, but inevitable, disruptions that are going to occur.

So I think in the UK and around the world, despite the warnings of the last 20 years, there has been a complacency about the need to prepare for these sorts of major disruptive events which go well beyond health to the whole of society, and the UK, yes, was complacent in regard to planning for that.

Lead Inquiry: Is it your view that epidemics will become more frequent, more complex, perhaps, and harder to prevent and contain as a result of the well known issues of changing ecology, urbanisation, climate change and increased travel and movement of human beings?

Sir Jeremy Farrar: Yeah, you’ve hit the major features that I would have outlined, absolutely. These are features of the 21st century. They’re not going to go away. It would be a grave mistake, in my view, to see each of these episodes I’ve outlined – some of them, but there are more – to see each one as a discrete episode. They are telling us something far deeper about how the world is changing, biodiversity loss, environment, climate change, urbanisation, trade and travel as you say.

Lead Inquiry: Slow down.

Sir Jeremy Farrar: And what I’d like for us to move away from is thinking that this is a discrete episode which we can put in a box and think about, and think more about the systemic way that we need to address these more frequent and more complex events.

If we look at Ebola in West Africa in 2014, the Ebola virus had not changed, people had not changed, what had changed was the social circumstances in which it happened, not in villages that could be isolated and quarantined and an epidemic brought under control quickly, but in major capital cities and across borders, and that more frequent and, indeed, sociologically more complex epidemics and pandemics is what we will face in the future.

Lead Inquiry: Does it follow, Sir Jeremy, that from the vantage point of governments, and with a view to the necessary and important process by which risks are identified, assessed and planned for, that there must be a much greater focus now, both in light of Covid and of course because of the increased general risks to which you’ve referred, upon: firstly, identifying multiple scenarios, as opposed to just influenza; secondly, focusing additionally on how to prevent catastrophic consequence as opposed to managing catastrophic consequence; and, thirdly, thinking more and to a much greater extent about the necessary countermeasures that may need to be deployed?

Sir Jeremy Farrar: Yeah, absolutely. The first thing I’d say is what you have before a crisis hits will to a large extent determine your ability to respond to it. If you have deep inequalities in your society, if you have a large degree of ill health in terms of health issues, if you have health services which are stretched to the limit, if you have fragmented government approaches such that each individual vertical structure considers its area but there’s a challenge to sort of look at the all-of-society perspective, then trying to cobble together a horizon approach, an all-of-government, an all-of-society approach in a set of vertical systems is extraordinarily difficult.

And tabletop exercises will get you so far, but you need to be working in those systems all of the time if you want those systems to work when a crisis hits, and I think we need to think more strongly about how totally disruptive all-of-society events, of which this is a good example, will be dealt with as a cross-government whole-of-society approach rather than just as a single ministry approach.

Lead Inquiry: A vital component in the whole-of-society approach is, of course, having adequate scientific advice as well as, and alongside, an adequate and sufficient research base. Could I focus firstly, please, on the issue of the scientific advisory networks which are available in the United Kingdom.

You were a member of SAGE, the stand-up – that is to say, the committee which is stood up in the event of emergencies – in relation to Zika and Ebola; is that correct?

Sir Jeremy Farrar: Correct.

Lead Inquiry: Have you had extensive experience throughout your long career of dealing with the scientific advisory structures in the United Kingdom beyond SAGE?

Sir Jeremy Farrar: Yes.

Lead Inquiry: Evidence was given by Professor Sir Chris Whitty that the UK science advisory system, whilst complex and not perfect, is considered to be one of the stronger ones internationally; would you agree?

Sir Jeremy Farrar: Yes.

Lead Inquiry: What must be done to ensure that that remains the position in terms of resourcing or funding or a continuing focus on understanding the vital importance of scientific advice?

Sir Jeremy Farrar: So I would agree with those comments, and I have been involved – in some of your introductory remarks – with a number of other governments around the world, of all economic levels of growth and depth of scientific background. My view is that the construct of having a Chief Scientific Adviser in every ministry, close to the minister, close to the system, close to the senior civil servants, not just structured in a crisis but there every day, and learning to bridge the cultural and language complexity that is there within different disciplines, and different ways of working and different educational backgrounds and everything else, building that structure to be permanent, to be functioning all the time and, critically, providing value and utility to a government machinery all of the time, is, I believe, critical.

I’ve argued with many other countries – not argued, discussed with many other countries that actually the UK system of scientific advice in every ministry brought together under a chief scientist network, together providing mutual support to each other, is absolutely critical, must be maintained, must be strengthened. The very best people in science should be encouraged to go into it and – on the rotational basis, so that they can retain their scientific expertise and skills, and then network together through the chief scientists. That, to me, is the best system in the world and everything should be done to maintain it, not for crisis time but for all the time, to deal with the day-to-day issues as well as being able to respond when a crisis inevitably hits.

Lead Inquiry: It’s plain, Sir Jeremy, that in the particular context of dealing with the Covid pandemic, SAGE and the scientific advisory structures in the United Kingdom Government drew to a very large extent, of course, upon biomedical expertise. Because of the need to consider at speed and in very difficult circumstances the consequences of societal measures, social restrictions, mandatory quarantining, and so on and so forth, it may be the case that there was an absence of sufficient expertise from non-biomedical professionals, that is to say economists and behavioural scientists or social scientists, and experts not from the world of health, and not from the world of science, but from the social sciences.

Would you agree with that? From your experience of SAGE, do you think that it is, in a general sense, sufficiently diverse?

Sir Jeremy Farrar: So I would agree with some of that, but not all of it. Firstly, I think that SAGE is often seen as the names officially on the SAGE list, which I think counts to 30 or 40 people or so. Behind that there were hundreds of people involved. And particularly on some of the areas you mentioned there, behavioural science, for instance, I think the input into – the behavioural scientists into SAGE from throughout my time on SAGE, I thought was of the very highest quality.

Where I think – where I do agree with you is that there was no – there were two things lacking, in my view. One is the SAGE health, public health, behavioural science perspectives on the pandemic were not mirrored with other equally transparent and debated issues that brought the whole of the society elements together, and I believe – I’ve never been in government, but I believe that a better approach would have been to have a SAGE that focuses on its area of expertise, definitely including behavioural science, international perspective, ethics, many of the things you mention, but that would be mirrored, in my view, through the Cabinet Office, with a similar transparent expert group that would consider other aspects that are absolutely critical to an all-of-society response.

I think if you ask SAGE to do all of that, it would become huge, unwieldy, and wouldn’t be able to have the clarity, given in mind that SAGE was meeting, at some points, every 24 or 48 hours. So personally I would do that through the Cabinet Office but have equal transparency with elements that considered other aspects beyond the health agenda.

The second thing I would suggest, and I was part of this in a US group, is that there is outside the SAGE system, but linked to it in a constructive way, if you like, a red team. A red team that would have access to other – the same information but would be able to constructively challenge the thinking from the outside and wouldn’t be within the room at the same time. I thought that worked extremely well when I was part of a similar enterprise in the United States, and I would like to see that set up. Independent SAGE I think tried to do that, but unfortunately, for reasons others can debate, sometimes it became more confrontational than perhaps was constructive.

Lead Inquiry: A red team would plainly be in a position to challenge orthodoxy. Do you mean orthodoxy on the part of the government or orthodoxy – or alleged orthodoxy on the part of the scientists in SAGE or a mirror group who, I think I should tell you, have described themselves in this Inquiry in various terms such as being self-correcting or, on another occasion, as being “licensed dissidents”? Do scientists need to be challenged in that way, or is this a point made more directly against administrators and government employees?

Sir Jeremy Farrar: Science absolutely has to be challenged and I think – unfortunately I’m not aware that beyond the summaries, been released I think at the behest of Patrick Vallance, crucially, it’s a shame that actually SAGE wasn’t recorded in some ways, because I think within the SAGE discussions that I was always part of, there was a very high degree of challenge.

But to have an outside group, a red group, that just puts in questions – have you thought about this? Have you thought about that? Have you considered that? – who are not part of that formal group, I think – my own experience of that is from the United States, and there I thought it was very helpful to be able to do that. It doesn’t diminish the authority or the voice of SAGE but it would give you some of the external challenge.

I think within the Cabinet Office, to me that is where the political challenge of, is this the right thing to do, closing schools, closing economies, whatever it might be, should be held. But I think those need also to be transparent in the same way that SAGE was, with its minutes and summaries, so that people can actually – as a public, can actually challenge those assumptions as well.

Lady Hallett: Mr Keith, are you going further into the mirror group?

Mr Keith: No, I was going to move to the questions –

Lady Hallett: Can I just have a brief summary of what Sir Jeremy means by the mirror group? Which experts? How would it work?

Mr Keith: Yes.

Sir Jeremy, a few moments ago, in response to a question from myself as to whether or not the constitution, the make-up of SAGE was sufficiently diverse, you suggested the possibility of a mirror group, not as part of SAGE itself, because it would become too unwieldy and too large to be convened at speed and in very difficult circumstances, but a separate committee comprising experts, specialists from different professional walks of life. Could you expand on that? You referred to social scientists, economists and others. Is there anything more that you want to say about that in terms of the composition?

Sir Jeremy Farrar: Well, I think the social scientists and behavioural scientists were absolutely fundamental to SAGE itself, so I certainly … but I think a group outside of what I call a red team, that was able to throw in questions into SAGE: have you thought about this? Have you thought about that? Some of that happened informally, through things like, in the UK, the Royal Society, Academy of Medicine Sciences, et cetera, et cetera and obviously in the lay and scientific literature. But having been part, for some time, in the US of that red group, which brought together, yes, epidemiologists, biomedical people, social scientists, economists, people thinking outside the box, that was helpful, I think, in terms of the US approach to this. Which I have to say I believe was not as well constructed and organised as was SAGE, would be my view having seen both operating.

Lead Inquiry: So those specialists and scientists and professionals are, in terms of their own professional qualifications, mirror images of the constituent parts of SAGE, they’re not from other walks of professional life, they are there to challenge, if you like, the members of SAGE on their own turf?

Sir Jeremy Farrar: No, no, I wouldn’t – no, sorry. Let me clarify. I think in that sort of red group you could easily have a broader sector of society, civic society, industry, people, yes, with expertise and understanding of public health, but also others who would bring a different perspective.

Lead Inquiry: Right.

Sir Jeremy, can I ask you now about your experience, please, of some of the more specialist scientific committees concerned with pathogenic outbreaks.

Have you had dealings over the years with HAIRS, the Human Animal Infections and Risk Surveillance committee, or ACDP, the Advisory Committee on Dangerous Pathogens, or on the now abolished NEPNEI? Are those committees, although you weren’t in government, with which you’ve had any experience?

Sir Jeremy Farrar: No, I was not part of any of those. The greater experience I had was actually outside the UK, as you mentioned, being the founding chair of the WHO R&D Blueprint, advisory and WHO committees and other governments, but I was never involved in any of those that you mention there.

Lead Inquiry: All right.

You’ve referred in the course of your evidence to the growing risks of pathogenic outbreaks, particularly of the viral respiratory kind, and to the growing risks generally because of changes in our environment and our way of life. To what extent is it essential to meet those continuing and growing risks that we maintain as a country capability, that is to say the medical, scientific and social weapons at our disposal to meet a future pandemic?

Sir Jeremy Farrar: So I started off by saying what you have before a pandemic or crisis hits makes such a huge difference. There are many things to question and challenge, and that’s the role of the public inquiry in terms of the pandemic. But I think we can only celebrate the remarkable scientific – and by “scientific” I mean the broad sciences – contribution to the pandemic in the UK and around the world. That – you can’t turn that on in a crisis. You know, we didn’t make a vaccine in 12 months. We made a vaccine because for years before all governments in the UK, of any colour, I would argue as well the Wellcome Trust, the charitable sector, philanthropy, have invested in basic science, in people, in teams and institutions, and if you look through the development of the Oxford-AstraZeneca vaccine, if you look at COG-UK, building off years of work at the Wellcome Genome centre, if you look at the RECOVERY Trial, if you look at when local authorities and others through public health got involved in their communities, through ownership and knowledge of those communities, those were absolutely world leading. Those are the results of decades of investment in fundamental science and its translation, a brilliant regulator. And HRA now, and when it was part of the EMA, is one of the world’s if not the world’s best regulator. They were critical. Understanding ethics.

So this infrastructure in the UK is something the UK should be incredibly proud of, must maintain, and has a critical role to play internationally.

Lead Inquiry: Is that a capability without which it is impossible to scale up the necessary medical and clinical responses in the event of a pandemic? Is that something which must be maintained because, without it, we would not have the building blocks to be able to mount a defence in the event of a pandemic?

Sir Jeremy Farrar: Absolutely agree with that. As I say, the vaccine was not made in a year. If you don’t maintain that capacity, and if that capacity isn’t valued, isn’t funded – it’s not providing value and utility all of the time. We should remember that the Oxford-AstraZeneca vaccine came off a team, Sarah Gilbert, Andy Pollard and many others had been working on those vaccines, they’d been working on typhoid vaccines, they’d been working on meningitis vaccines and were able to pivot. The RECOVERY Trial built off years of investment, particularly from the National Institutes of Health’ research and the clinical trials capacity.

These are absolute jewels in the UK’s crown. They could play, in my view, a bigger role internationally, but you have to maintain them every Monday, every Tuesday, and you have to value them and they must provide value either in enhancing knowledge and our understanding of the world or in translation into products/countermeasures for people in a pandemic.

If we do not retain that scientific infrastructure, then the UK will be woefully underprepared to deal with today’s challenges and tomorrow’s inevitable epidemics.

Lead Inquiry: Does that infrastructure include matters such as having sufficient laboratory services, for example to be able to scale up mass diagnostic testing in the event of a new pandemic and perhaps a different testing device? What sort of laboratory infrastructure is required to be able to provide that building block to enable us to scale up in the next crisis?

Sir Jeremy Farrar: The testing capacity in the first three months of 2020 in the UK was woefully inadequate. It wasn’t possible to scale that up at the speed that was required and testing got way behind the speed of the epidemic. In epidemics and pandemics there is no point saying “We’re quicker than we used to be” if you’re slower than the speed of the epidemic, and if you get behind that curve, you’ll really struggle to catch up. Remembering that exponential growth, doubling time every two days means, even 48 hours later, you’ve lost – you’ve got behind the curve, and the data you have today is in the rear view mirror, it’s what happened yesterday that you’re seeing, not what happened today.

So unless you have that diagnostic capacity – I would personally like to see a much closer interrelationship between what we call public health, public health laboratories, clinical and NHS facilities, and the broad and very strong research environment in the UK.

Often these are almost competing with each other rather than seeing themselves as part of a common approach, and I think to forge together public health laboratories, local authorities, hospitals and clinical facilities, general practice, primary care and the research endeavour, and make sure that those are working together outside the pandemic and can much better work together in a pandemic, would be a huge progress in terms of our ability to have the resilience in the future.

Lead Inquiry: So drawing those threads together, Sir Jeremy, would you agree that both in terms of research capacity but also infrastructure, laboratories, technicians and the like, is vital –

Sir Jeremy Farrar: Yes –

Lead Inquiry: I’m sorry, I hadn’t quite finished – it’s vital that capability is maintained for not just diagnostic testing but antivirals and also vaccines, to which you’ve referred? So this is a capability which must be maintained across the board for those three pillars, if you like, of pathogenic outbreak response?

Sir Jeremy Farrar: Yeah. I would actually add to that, the social science, the behavioural science must be integrated as part of that, not some separate thing that goes on in other conversations. But we must maintain that all the time.

The only way to maintain it, and if we’re not to repeat the lessons of all of the epidemics I mentioned at the start, the only way we can maintain this is if it is integrated into services and health provision, prevention and treatment every Monday, every Tuesday, every week, every month, because after every previous epidemic, after Ebola, the world said “Never again, we must build these capacities”, and sadly one or two or three years later a pandemic hasn’t happened and they start to be cut. So my view is, instead of creating yet more vertical structures that will somehow be there when a pandemic strikes, build it into systems that are of use every day, people are using them, they provide value to communities, and then they can pivot when it’s necessary.

If we look at COG-UK as a good example, established by Sharon Peacock, it was building off years of public interest in genomics and the Wellcome Trust’s genome centre and institutes like the Crick, Edinburgh, Glasgow, Manchester and others, Birkbeck, these are critical infrastructures, they’re providing value and utility all the time and they have, critically, the people who can pivot when necessary. We must not lose this capacity.

Lead Inquiry: Turning now, finally, to a more administrative or governmental angle, and the issue of countermeasures, is it your view that further work is also required to be done in terms of thinking about, evaluating, working out the consequences of the policy interventions with which we’re now all only too familiar, such as quarantining, social distancing, the efficacy of face masks, airport screening and so on, all of which, of course, came very much into focus during Covid, but perhaps have not been developed in terms of the thinking as far as they might be?

Sir Jeremy Farrar: Yes, I do agree with that, and having listened to some previous interventions and the concern that everything was based around a potential flu pandemic and no other thinking, the things I would say on that: flu remains the number one biggest risk, but we should be thinking beyond flu, in terms of a crisis management system that would be agnostic to what the event was, it could be respiratory, most likely, it could be sexual, it could be through the gastrointestinal – there’s all sorts of scenarios, and instead of getting plugged in to a single outcome which we feel comfortable with, perhaps more important is to think, whilst we will focus on flu, because it’s hugely important and is the most – the highest risk and it remains so, that nevertheless we must have a system which allows us actually to cope with whatever is thrown at us and have the resilience and the spare capacity and not the whole system stretched to its very limit in order not to be able to respond when the demand increases.

So I would like to think more broadly, more like an incident management group than a flu-specific group, without losing the knowledge that flu remains a huge – a huge risk to us all.

Those policy interventions that you talk about need a discussion at societal level. The word “lockdown”, none of us had heard of it before about February or March of 2020. The implications of it are huge, and longstanding. We should be able to debate those in the interepidemic periods and come to a societal discussion about what we’re going to prioritise, what we’re going to protect and what we may have to do in order to prevent an event like Covid-19 happening again.

Lead Inquiry: Sir Jeremy, thank you very much.

My Lady, I believe you granted permission to Welsh Covid Bereaved for an issue or issues surrounding the question of face masks to be explored through my own examination.

Sir Jeremy, could I return you, please, to the issue of face masks. The issue of face masks and their efficacy is very much going to be a matter for consideration in my Lady’s Module 2 in this Inquiry, because of course there was a huge debate about face masks once Covid had hit. But in the context of preparedness, may I ask you this: to what extent pre-Covid was the wearing of face masks an issue which was thought about, sufficiently developed, and views reached upon? And an associated question: to what extent was there, pre-Covid, a scientific consensus on the efficacy of face masks, putting aside how effective they actually were?

So was there a standing scientific consensus on the efficacy of face masks pre-Covid? And to what extent had thinking on face masks developed pre-Covid?

Sir Jeremy Farrar: I think in the UK that consensus did not exist, and the effectiveness as well as the efficacy of face masks I do not believe in the UK there was a consensus on that.

Having spent 20 – almost 20 years living in Vietnam through SARS and H5N1, and then watching very closely and being very involved in the responses in China, in Korea, in Vietnam and Singapore, four countries that had previously dealt with SARS-1 and with other emergencies, I think if you asked there, there was a clear consensus amongst the decision-makers, and indeed the scientists and healthcare workers, that face masks had a role in contributing to the public health intervention.

In public health there’s rarely a magic bullet. Public health – the analogy of the Swiss cheese model of having multiple interventions is crucial. If you’re expecting face masks to give you 95 protection against something, you won’t get it. But as part of a series of interventions which includes face masks, includes hand washing and includes clean air and spacing between individuals, and then when you have the countermeasures you’re talking about, diagnostic tests, treatment and vaccines, together they create a Swiss cheese model of what our public health is. Each one contributes a percentage. None of them on their own contribute enough to change the dynamic of a pandemic, but together they can have a very profound impact.

When you talk about countermeasures, often we talk about countermeasures in terms of therapeutics and vaccines and diagnostic testing, but countermeasures need to be seen in the full Swiss cheese model, they need to include social distancing, they need to include masks, they need to include hand washing, they need to include in other epidemic potentials other interventions, for instance, in HIV, condoms, et cetera.

So I think we would be wiser – and the evidence base on face masks, unfortunately whilst we had large clinical trials of therapeutics, the RECOVERY Trial, we had the vaccine trials, we missed an opportunity during the pandemic to gather robust, strong prospective data on non-pharmaceutical interventions, which are a critical component of any response to an epidemic and pandemic until you have those countermeasures that will then change the course of the pandemic.

So what I would plead for is we don’t see countermeasures just as something you inject into somebody’s arm or you take as a tablet, but we see countermeasures in a Swiss cheese model of public health which integrates them all and we find the evidence for how they work on their own and we find the evidence for how they work together.

Mr Keith: Sir Jeremy, thank you very much indeed.

Lady Hallett: Sir Jeremy, thank you very much indeed for your help, it’s been extremely interesting and we’re very grateful to you. Thank you.

The Witness: I wish you the very best with the public inquiry and offer all the support we can to it. The lessons must be learned and we must never be there again.

Lady Hallett: Thank you.

(The witness withdrew)

Mr Keith: My Lady, I think that we can proceed to the next witness straightaway. If somebody would be good enough to sever the link with Sir Jeremy, we will return to the witness box.

Lady Hallett: Just before Ms Sturgeon gives evidence I would like to apologise to those who were inconvenienced by the fact we didn’t call Ms Calderwood on Wednesday morning. It was due entirely to unforeseen circumstances, and I can assure people we gave everyone as much notice as we could, and as we got in fact. So apologies to anybody …

Mr Keith: My Lady, yes.

Lady Hallett: Mr Keith.

Mr Keith: Could the witness be sworn, please.