4. Submissions on Behalf of the Government Office for Science by Mr Hill

Mr Hill: My Lady, thank you.

The Government Office for Science is grateful for the opportunity to contribute to this module of the Inquiry. You have heard evidence from two former Government Chief Scientific Advisers, Sir Mark Walport and Sir Patrick Vallance. These brief closing submissions, which will be supplemented in writing, are a distillation of the key aspects of their evidence and identify the key issues they would invite the Inquiry to address when formulating its conclusions and recommendations in relation to future pandemic preparedness.

There is a fundamental overarching issue to which everything that follows is subject, and that is the extent to which we, as a society, wish to devote resources to purchasing insurance against future pandemics.

Although choices on allocation of resources will always remain political ones, this module of the Inquiry provides an opportunity to reflect on the value of insurance against future risks that have the capacity to cause a large number of deaths and profound social upheaval.

In some areas, the value of inuring against future risk is well understood and Sir Patrick gave the example of the armed forces. He observed that money spent on that aspect of the nation’s security is not regarded as wasted if there turns out to be no need to fight a war. The effective protection of society from natural hazards requires a similar mentality and an understanding that natural hazards can be just as devastating as security threats.

In particular, when planning for a future pandemic, it needs to be understood that you may not need everything that you pay for. Innovation, whether scientific or technological, inevitably comes with failure, and that has to be priced in and accepted as part of the process. The success of the development of vaccines and the Vaccine Taskforce has been referred to by many witnesses and indeed was referred to by Mr Jacobs earlier today. In respect of that undoubted achievement, Sir Patrick made the telling observation that it was only by the approval of funding, notwithstanding the very significant risk of failure, that success was achieved.

In the field of pandemic preparation, the concept of value for money has to be broader than traditionally used by government. The conventional analysis, as exemplified by the National Audit Office and the Public Accounts Committee requires revision when applied to the building up of effective resilience against future pandemics.

Turning to the issues of planning and resilience, it is our submission that the approach to risk planning for future pandemics, as reflected in the NSRA and more broadly across government, requires fundamental structural change in at least two respects.

First, the focus should be on capabilities and scenarios, and not specific plans for specific types of pandemic. The response to the emergency that eventuates will inevitably need to be targeted, but the preparation needs to be broad. Predicting the next pandemic with any sort of precision is impossible. There are too many variables. There is little value, we would suggest, in asking whether previous iterations of the NSRA foresaw the right sort of pandemic.

Similarly, there were some suggestions floated during the course of evidence apparently predicated on a belief that it is our powers of prediction that need to be improved. One is that drugs and vaccines effective against Covid-19 should have been stockpiled and would have been with a little more imagination. Yet nobody knew which drugs worked until extensive clinical trials had taken place, and you cannot stockpile a drug or vaccine which does not yet exist.

But what you can do is to assess and build your capability to research, trial and roll out existing treatments when faced with a new hazard. You can invest in your capacity to discover, invent, manufacture and distribute a new treatment or vaccine at speed. You can ask what capabilities will be required to deal with future pandemics, whether those capabilities exist, and how they can be scaled up quickly.

In the particular context of a future pandemic, and based on recent experience, the key areas to address in this analysis include the following:

First, data. Which data will be required, who holds them, how can they be obtained and analysed?

Second, testing and tracing. What capability will we require, and what infrastructure do we have to provide it?

Third, equipment. What will we require, and where will we source it from? What can we realistically stockpile and what industrial manufacturing capacity will we be able to call upon?

Drugs and vaccines. How do we preserve excellence in our scientific research base? How do we translate that research into manufacturing? What manufacturing capacity will we require, and where is that capacity held?

Fifth, diagnostics. The same questions arise, together with the imperative of preserving that which we have now built. How can we ensure that everyday healthcare in this country uses a domestic diagnostic capacity so that it can be pivoted to emergency pandemic response at short notice when required? What support and partnerships do we need to develop with industry?

Sixth, international co-operation. What networks will we be able to call upon and plug in to?

Seventh, vulnerable groups. Where within society are the effects of a pandemic likely to be felt most acutely, and what measures are available to mitigate that impact?

These are the questions of general application that should underpin the NSRA and should, if approached correctly, provide answers that would be adaptable to the next pandemic. They do not depend for their success on correctly guessing what the pandemic will look like. They will lead to a better balance between prevention, mitigation and response. They will identify in advance areas of strength and areas of relative weakness so that they can be addressed before the pandemic, rather than during it.

The second point we make about planning and resilience is an inevitable consequence of the first. The effective formulation and delivery of a resilience plan of the type that I have just described cannot simply be allocated to a single government department on the existing NSRA model. Pandemics require an integrated cross and intergovernmental response. They present funding challenges which cannot be met by a single department, with a single budget from which to meet all of its day-to-day requirements. Nor can the effective oversight and delivery of a plan of this nature be fragmented across the various branches of government with an interest in its constituent elements. It is essential that there is a senior and authoritative single point of accountability and responsibility within government, to drive resilience and implement plans.

To take the example of Exercise Alice, this did address containment and mitigation and did provide an opportunity to develop capabilities that would have been valuable when the pandemic struck. But there is simply no point in running exercises like this without having someone responsible for co-ordinating and overseeing the response, and being responsible for ensuring that actions are followed through.

A clear structure of accountability and responsibility will address the tendency to believe that, as long as the report has been written, the problem has been resolved. It will create an institutional memory and repository of relevant information which will be preserved when officials and ministers inevitably move on. It will ensure that documents and plans relating to resilience are kept under regular review and remain within their sell by date rather than being allowed to drift into obsolescence.

Crucially, from a science perspective, it will provide a clear docking point within the government for scientific advice during normal times.

Both Sir Mark and Sir Patrick spoke of the need for scientific advisers to be proactive and go beyond simply answering the questions set by government. That approach will only be effective if there is a clear and direct route by which such advice can find its way to the right person’s desk.

There is, therefore, a need for reform and improvement in the structures for planning, preparation and resilience.

In contrast, the existing structure for the delivery of science advice during an emergency is clear and fit for purpose. COBR commissioned SAGE, and the GCSA provides the link between SAGE and COBR. During the pandemic, SAGE could commission sub-groups such as SPI-B and SPI-M to undertake specialist pieces of work. Each department has or should have its own CSA, and each devolved administration should have its own Government CSA. They have a direct line of communication with the UK GCSA who supports them and leads the CSA network.

The SAGE model allows for flexibility and a tailored response to the emergency that is being faced. It enables the right people to be assembled from the appropriate disciplines. Many other countries adopted similar models in recognition of the effectiveness of the UK’s arrangements and the Inquiry will recall in particular the evidence of Sir Jeremy Farrar in this regard.

This is not said complacently, and the Inquiry has heard of the ongoing work within the Government Office for Science to strengthen and improve SAGE’s processes. We also see the force in ensuring that representation of the devolved – sorry, representatives of the devolved administrations are invited from the outset to SAGE meetings where emergencies concern them. SAGE is the appropriate forum for this link rather than the CSA network.

These structures work well, and we would invite your Ladyship to reject any suggestion that they should be changed further. In particular, adding mandatory representation of all the devolved nations’ Health CSAs to the CSA network would risk actively harming a body that has developed organically into a highly effective means of cross-governmental collaboration and one that concerns the full spectrum of science advice, not just health. We would urge your Ladyship to resist any invitation to stray into areas beyond the pandemic to try to fix that which is not broken.

In addition to these two structural matters relating to the mechanics of pandemic planning and building resilience, there are three broader issues that we would invite the Inquiry to consider.

First, Sir Patrick advocated the establishment of an academic institute for pandemic preparedness. He envisages a hub and spoke model where experts from across relevant fields could bring together their expertise and identify further areas for research. The model would allow for an exchange of ideas from epidemiologists, virologists, clinicians, behavioural scientists, data scientists, engineers, economists, educationalists, and others. The UK has a rich and active research base, an institute for pandemic planning could draw from its full breadth and depth.

Second, the role of public health infrastructure in prevention and mitigation. As Sir Mark explained, and as some of the expert evidence commissioned by the Inquiry has illustrated, the lack of priority accorded to public health over several decades has meant that much of the traditional infrastructure for the control of infectious diseases has been lost. As a result, when the pandemic struck, the capacity for testing, tracing and isolation had to be built largely from scratch. The UK could not, for example, replicate the initial South Korean response to the pandemic because it had not made the investment South Korea had made in its public health systems.

A better developed, better funded public health system, delivered at a local level and including a large cohort of community health workers, would have a double benefit in this context. During peace time, it would improve the health and access to healthcare of the general population, including vulnerable and marginalised groups. In the event of a pandemic it would provide a readymade infrastructure and workforce that could pivot to testing and tracing.

The Inquiry has made clear its concern about the important issue of inequality of impact and outcome, and rightly so. That is not an issue that can be addressed during the course of a pandemic. It has to be dealt with at a structural level in advance. A high quality and properly resourced public health system is essential to achieving this.

Finally, whilst there are plainly steps that we can take at a national level to improve our planning and resilience, it has to be kept in mind that the effective response to a future pandemic will inevitably be an international endeavour. The 100 Days Mission is centrally important in this regard in respect of inventing and manufacturing diagnostics, vaccines and therapeutics. Other areas of co-operation are also required, notably in surveillance and initial public health response. It is important that any structural changes made at national level dovetail with the work that is being done on the international plane.

Although the hearings in respect of Module 1 are now at a close, we appreciate that the work of the Inquiry on the issues of resilience and preparedness will continue. The Government Office for Science will of course continue to provide the Inquiry with whatever further assistance and support it may require as it completes this important aspect of its work.

Lady Hallett: Thank you very much indeed, Mr Hill, very helpful.

Next is Mr Block. Oh, right back there.