2. Professor Thomas Hale

PROFESSOR THOMAS HALE (affirmed).

Questions From Lead Counsel to the Inquiry

Mr Keith: Good morning.

Professor Thomas Hale: Good morning.

Lead Inquiry: Could you commence, please, by giving the Inquiry your full name.

Professor Thomas Hale: My name is Professor Thomas Hale.

Lead Inquiry: Professor, thank you very much for attending today and for the provision of your expert report prepared for this module, which relates to the Oxford Covid-19 government response tracker for which you are responsible in part, although you lead the team that has provided and provides that tracker.

You’ve prepared this report for us, it’s INQ000257925, and I believe on the last page – perhaps not the last page, which is page 105, but earlier in that report – you’ve appended the usual declaration concerning – in fact it’s on the second page – you set out the usual understanding of your duty to provide independent evidence and you confirm that you’ve made clear those matters which are within your knowledge and those which are not, and those which are true and those which are not.

Now, you are a professor or you are the professor of global public policy at the Blavatnik School of Government. Is that in the University of Oxford?

Professor Thomas Hale: That is correct.

Lead Inquiry: In essence, are you a specialist in the area or the issue of how political institutions evolve, adapt, to face the challenges, whatever they may be, that they face, globally and in the context of those particular countries in which the governments operate?

Professor Thomas Hale: That’s correct. I focus especially on transborder threats such as pandemics where we need to look at different government responses, compare them and understand how they interact.

Lead Inquiry: Professor, whilst you give evidence, please try to keep your answers as slow as you can humanly make them, it makes it much easier for our stenographer.

Do you hold a PhD in politics from Princeton, a master’s degree in global politics from the LSE, an AB in public policy from Princeton School of Public and International Affairs?

Professor Thomas Hale: I do.

Lead Inquiry: Have you written for many years on these areas?

Professor Thomas Hale: I do.

Lead Inquiry: Thank you very much.

The report, does it fulfil this main aim, which was to research and review the many thousands of articles and pieces of learning which concern themselves with the impact of the various governmental measures which were applied by governments across the world –

Professor Thomas Hale: Correct.

Lead Inquiry: – in response to the pandemic, and based very largely on the information collated by your tracker team?

Professor Thomas Hale: That’s correct. Our project was providing an evidence base for many, many hundreds, indeed thousands, thousands of studies that took place looking at what governments were doing in response to the pandemic and what the effects of their policies may or may not be on different outcomes of interest, such as the health of their populations or their economies.

Lead Inquiry: Your tracker, the project which I think you launched in March 2020, obviously looked around the world at all the various responses that the governments across the world put into place.

Was it one of a number of trackers? Are you the pre-eminent tracker of this information, or were there a large number of other bodies also scouring the position around the world to see how governments were responding?

Professor Thomas Hale: It was the largest of these efforts. There were several of them, which we’ve listed in the appendix, close collaborators and colleagues, each often providing a different set of issues that were the focus. But our project became a focal point for many users of the data because it had a huge breadth, covering 185 different countries around the world, also, in many countries, depth, looking at their subnational jurisdictions, particularly important in places like India or the United States where subnational differences were very significant, also including the subnational jurisdictions of the United Kingdom. And it became very timely, so the data was collected through a team of trained volunteers, who eventually numbered 1,500 in total, a massive team, all using their contextual knowledge from different parts of the world combined with our system, which we trained them in, to create comparable information.

So for those reasons, even though there are many trackers of different areas of policy, this one became an important tool for many governments, for many researchers and for the public at large.

Lead Inquiry: Did many governments during the course of the pandemic in fact, as a result, incorporate information from the Oxford C-19, Covid-19 government response tracker into their own responses, their own analysis and their planning processes?

Professor Thomas Hale: That’s correct. So our data were made available instantly, in real time, on the internet and so were used by many, many governments, researchers, media organisations to create a record of who was doing what and how does it compare to, for example, government’s own plans or actions. And that was indeed the idea: to facilitate learning.

Lead Inquiry: In the United Kingdom, did the two academic leads of the tracker project, yourself and Dr Petherick, assist the United Kingdom Government by way of taking part in or joining the International Comparators Joint Unit, expert advisory group, which provided timely and vital information to the UK Government on what the impacts appeared to be of the various different types of measures applied by governments across the world?

Professor Thomas Hale: That’s correct. Dr Petherick and I had the privilege of serving on this committee beginning from the spring of 2020, when it was created, and then through its various forms until around the middle of 2021, when it ceased its work.

Lead Inquiry: Just focusing for a moment on how the information tracked in the project was assembled, you’ve mentioned the very large number of volunteers across the world. Did those volunteers have – or were they recruited locally so that they would have the facility, the ability to be able to deploy local knowledge in each country or jurisdiction or subregion when collating the various aspects of the impact of whatever measures might have been deployed?

Professor Thomas Hale: That’s exactly the strategy that was used. So it’s quite important for any kind of comparative exercise to navigate between two fundamental desiderata. One is a comparable system where you can say A is like A, B is like B, which necessarily requires a little bit of abstraction, but also, on the other side, the ability to have real contextual information, to understand exactly what a given policy might mean in a particular context; to use the local language to understand that context, to understand the meaning of a policy, and to combine those two.

So using a team of volunteers – and I would like to really offer, again, our huge thanks for the way these volunteers gave their time during the pandemic to create this global public good – using that combination of expertise, in the local context, with a comparable methodology, is what allowed the data to emerge.

Lead Inquiry: Do we presume that the data, the information about how the various governmental measures were coming into existence and being deployed and what their impacts were, was assembled by viewing official government websites across the world, official news reports, and any publicly available information about what those measures consisted of?

Professor Thomas Hale: That’s correct. So the volunteers were tasked with looking at, say, an official government website where information on different measures and restrictions might be posted, or, for example, where that didn’t exist – and there are certainly many governments around the world where communication around Covid-19 measures were less consistent and clear than in other parts – where the suitable information was sourced from government websites, you know, maybe a less official kind of document but in a posting on a government website, or similar information.

And importantly, the project has recorded these original sources as permanent digital records and so the entire historical archive for each of our data points is there for consideration.

Lead Inquiry: And is that an important feature for the purposes of quality assurance, so that your analysis and your thinking is open to review?

Professor Thomas Hale: Exactly.

Lead Inquiry: Now, the Inquiry has heard a great deal of evidence about non-pharmaceutical interventions, and plainly you’re aware of what they are.

In terms of the sorts of measures that you tracked, in very broad terms, were those measures non – what we would call non-pharmaceutical interventions, but also including the impact of vaccine-related measures, so they were broadly the same but they included the whole field of vaccination?

Professor Thomas Hale: That’s correct. So the project began in the spring of 2020, when the most prominent responses governments were taking to the pandemic were in the form of NPIs, often restrictions on movement or travel or requirements to stay at home. However, as the pandemic evolved, so too did responses to it, and so our project had the imperative of adapting and adding new categories of response as our toolkit against this disease expanded, and that most significantly took the form of measuring the different policies that governments put in place to encourage vaccination, sometimes to require vaccination, and also how some of the restrictions that have been used in the pre-vaccine period, such as travel restrictions, might vary, for example allowing more freedoms for vaccinated individuals than others. So those complexities were important.

Lead Inquiry: Do we have on page 47 of your report the full list of the Oxford Covid-19 government response tracker indicators, that is to say the measures or the policies that were tracked, and we can just see that they can be conveniently grouped into containment and closure, economic responses, health systems, and, over the page, vaccine policies and miscellaneous?

Professor Thomas Hale: Correct. And richer descriptions are available on the link provided on page 47.

Lead Inquiry: It’s important, isn’t it, to identify the limitations on the work that your project was able to carry out? You tracked the measures and you tracked the impact of the measures. But what the project couldn’t do was ever identify, for obvious reasons, the counterfactual position: what would have been the impact if these measures had not been applied in the various jurisdictions; is that correct?

Professor Thomas Hale: Correct.

Lead Inquiry: Is that because, in very general terms, firstly, this is an observational study, you observed what was happening, it’s not a controlled study of what the impact might be, in theory, of an intervention. And, secondly, many of these measures and interventions were being applied simultaneously, and therefore it’s impossible to say what the precise impact may have been or was from any individual particular intervention; is that correct?

Professor Thomas Hale: Indeed. And so with these differential impacts you might find across different NPIs, it’s exceedingly difficult to say: in this particular instance, say, 5% was done by this one, 10% by another. Instead, the knowledge we’re able to glean from the literature is to identify the tendencies that, on average, different kinds of interventions, either individually or in combination, may have.

Lead Inquiry: Of course, if you look at page 47, you can see that the measures are self-defined in very broad terms: school closures or workplace closing, income support, testing policy, and so on and so forth.

Professor Thomas Hale: Mm.

Lead Inquiry: So it’s a very high level assessment, is it not?

Professor Thomas Hale: Correct.

Lead Inquiry: But it’s very useful because it identifies, doesn’t it, how different governments across the world responded in general terms and what the broad consequences were of those particular governmental decisions?

If we look at page 8, by way of a demonstration of a very user-friendly diagram, this, for example, provides a chart by colour of school closures during the Covid-19 pandemic as at 24 October 2020, and it shows those countries in which no measures in relation to school closures were imposed, those in which they were recommended, those in which closures were required but only at some levels, and then those countries in which all levels of schools, so all ages, schools were closed?

Professor Thomas Hale: Correct.

Lead Inquiry: And you can see the broad thrust of it. All right.

Turning to the summary of your research of, as I’ve said, the scientific literature reporting on the information collated by your project and by your tracker, page 11 of your report, are there a number of general findings that you draw from your review of these thousands of studies reporting on the data which you’ve collated? So, in essence, what everybody did.

Firstly:

“Speed matters.”

And we’re going to come and look at these in turn.

Secondly:

“Strength matters.”

Those two observations I think are self-evident, that their meaning is clear. Third:

“Effective use of test, trace, and isolate measures limits both health impacts and the need for restrictive policies.”

By “restrictive policies”, do you mean more stringent policies?

Professor Thomas Hale: Correct.

Lead Inquiry: Stringent measures.

Fourthly:

“Economic support bolsters compliance.”

By that, do you mean the provision of economic support by government, for example by way of support for those who are self-isolating, tends to improve the ability or the degree to which a population will comply with a particular measure?

Professor Thomas Hale: Yes.

Lead Inquiry: Fifthly:

“Prolonged restrictions can have costs.”

What sort of costs, in very broad terms, did you have in mind by that phrase?

Professor Thomas Hale: There are many potential costs. The ones we focused on, because they were a source of great interest in the literature, were around mental health impacts, around domestic violence, around learning outcomes for children, and of course for the economy. Of course there are many others as well to consider.

Lead Inquiry: So now dealing with each of those broad findings in turn, firstly, speed matters. It may be thought to be self-evident, but what is the broad consequence of a timely, that is to say a rapid, adoption of a non-pharmaceutical intervention? That is to say, the imposition of a social restriction or a distancing method or a mask-wearing measure or a full stay at home mandatory order.

Professor Thomas Hale: So the long experience of managing infectious disease of all kinds shows very clearly that because such diseases tend to spread in a non-linear and, in the case of Covid-19, rapid fashion, early interventions, when the prevalence is low, are critical to restrain further spread. Once spread has reached a certain scale, and therefore because more spread means, in exponential logic, more and more spread, at a certain speed, it’s much harder for any policy to have the same effect it would have had at a lower level of spread.

Therefore, speed matters. And, for example, one of the studies we looked at show that a single day of delaying a mass gathering ban, so something like concerts or sporting events, a single day of delay had an impact of perhaps a 7% increase in the cumulative death toll during that wave. So one day, 7% increase, quite a significant importance for speed.

Lead Inquiry: Does your report refer to a number of studies that show, by reference to measures taken during the first five days and also some other studies which show the effects of the implementation of NPIs in general terms during the first 10 to 14 days, can have a very significant impact or did have a very significant impact on the transmission of the virus?

Professor Thomas Hale: Correct. Most of the studies show there was a two-week lag between when a policy might come into effect and when you might notice the impact of that on the number of cases, which is tied to the time it takes the Covid-19 disease to incubate and spread.

Lead Inquiry: I’ve described it, perhaps a little cheekily, as self-evident. It is obvious, though, isn’t it, that if you apply a measure, a restriction, because it takes the effect of some sort of restriction, it is bound to have a beneficial impact in terms of limiting the transmission of the virus?

But on account of the way in which a viral outbreak or a virus disease will spread, what is the particular significance, what is the particular need for acting fast?

Professor Thomas Hale: It’s precisely to stop before it starts. Once it’s become so widespread that you are inevitably going to have some degree of non-compliance leading to further spread, it’s too late for those measures to have the kind of clampdown effect they would have had if it were just a few people. So it’s a simple kind of fact, mathematical logic of exponential growth, that once you have passed the point of a certain threshold of spread, it’s not going to be feasible to bring that down without a very prolonged and intense level of restriction.

Lead Inquiry: Did the tracker and did the reviews, the literature reviews of the tracker and the data that it collated, reach any conclusions in relation to individual NPIs beyond that of the one concerning the banning of mass gathering, to which you’ve already referred, including matters such as school closures? Was there a significant link between the closing of schools and a reduction in the transmission of the virus thereafter?

Professor Thomas Hale: Yes. So as was mentioned, the exact impact of any single measure in a given instance is always going to be difficult to say, because they tend to come in packages. But on balance, the literature shows, as you would expect, policies that are more effective at presenting people from meeting each other are going to be the ones that have the greatest impact on cases, hospitalisations, and eventually deaths. So stay at home measures were obviously one of the most strong – we observed, one of the strongest overall tendencies to do. But school closures, workplace closures, also seemed to have this effect.

Lead Inquiry: What about mask wearing?

Professor Thomas Hale: Mask wearing is indeed one of the factors that has been shown. I think I would – I note the Royal Society’s report on this fact, showing quite a clear balance of evidence that the right kind of mask wearing in particular has reduced transmission.

Lead Inquiry: When you say the “right” type of mask, do you mean medical masks, respirators, as opposed to cloth masks?

Professor Thomas Hale: That does seem to be where the evidence shows, yes.

Lead Inquiry: Now, you’ve used the word “stringent”. In the context of border measures, for example, is there a link between the efficacy, the effect of a particular measure or border measure and the ruthless degree or the stringency by which such a measure has to be applied?

Professor Thomas Hale: For border measures, it’s important to think slightly more broadly about the role they might play alongside others. So oftentimes restrictions on international travel were geared not at clamping down on local spread but, for example, at preventing new entrance into a population for example of a new variant. So I might suggest that there – it should be assessed in a different way. But yes, on average, we see a tendency for stronger restrictions on travel to be associated with reductions in the spread of the disease.

Lead Inquiry: And is that fairly obvious, because with border measures, with restrictions on travel, there is a range of measures which could be applied, from screening for symptoms of the virus, whether you’ve got a temperature, whether or not you’re showing signs of fever, all the way across to a full-blown closure of your border?

Professor Thomas Hale: Correct.

Lead Inquiry: And if you apply a border measure which is less stringent, for example a temperature check or a screening, it is much more likely to allow the virus to continue to enter any particular country because the nature of that sort of measure is extremely hard to police and to enforce and to –

Professor Thomas Hale: Correct. And it’s really the most stringent measures, for example closures or required long periods of quarantine, say in hotels, that show this particularly high effect on transmission.

Lead Inquiry: I’ve already asked you about the generic difficulties of trying to apply a counterfactual position and of trying to drill down into the impact of specific measures. Is it for those reasons that you can’t express a view, for example, as to what the specific impact might have been in the United Kingdom of banning mass gatherings earlier? For example, you’re aware of the Six Nations matches which were held in February and March, a football match between Atlético Madrid and Liverpool and so on, and a racing festival at Cheltenham. Does the data and the literature provide you with any answer as to what might have been the impact had those large mass gatherings not taken place?

Professor Thomas Hale: A study could be done, a modelling study, which would have tried to use mathematics and statistics to create a counterfactual for comparison, but no, we can’t look back in an observational way and say: had this been done earlier, definitely this would be the impact. Rather we can say is: let’s look at all of the countries in the world, see which ones imposed this kinds of mass gathering bans, what the impact was on their disease situations and then try to interpolate that to the UK. That’s the level of evidence that we can provide.

Lead Inquiry: Turning to the second topic, strength matters. Plainly some measures are more stringent, more ruthless than others. Stay at home orders, by virtue of their mandatory nature, are amongst the most strong policy interventions, are they not?

Professor Thomas Hale: Correct.

Lead Inquiry: Does the data and the review show, not surprisingly, unsurprisingly, that stay at home orders had the greatest impact in terms of the policy impact? They had the greatest consequence?

Professor Thomas Hale: To the extent we can distinguish individual policies, as we’ve discussed, yes, they do seem to have a very large impact.

Lead Inquiry: Similarly, did the closing of schools and the limiting of mass gatherings also have, as these things go, more effective impact than other less stringent measures?

Professor Thomas Hale: So some of the – it would depend on the level of closure. So some mass gatherings for example were not completely banned but were allowed to occur with, say, a 2-metre rule or other kinds of mitigating factors, so we would say a more stringent measure is one at the top of our scale, not so much about the intervention – kind of intervention but rather the degree of stringency to which it was applied.

Lead Inquiry: Perhaps again self-evidently, the benefit of a more stringent measure was, it would seem, not just a reduction in transmission but also a better outcome in terms of health and death rates?

Professor Thomas Hale: Correct.

Lead Inquiry: Did that general proposition apply throughout the pandemic? So in the latter stages of the pandemic, across the world, do stringent measures have the same general impact as they did in the earlier stages of the pandemic, and if not why not?

Professor Thomas Hale: So we must recognise that the bulk of the evidence in the available scientific literature is based on earlier phases of the pandemic, that’s when most of these studies were done, because even though it’s now especially self-evident perhaps to us now that these kinds of measures did reduce transmission and therefore cases and therefore hospitalisations, and therefore deaths, that evidence base did not exist in the same kind of robust way for this particular disease when it had recently emerged. So there’s a huge flurry of studies in that first period.

As the pandemic progressed, new research questions around, say, vaccination, drew attention and so there was a wider range of topics that needed to be considered. But overall, the studies that were conducted on NPIs across the period of the pandemic do show consistent results.

As the pandemic progressed, however, one of the most important things to control for – well, two of the most important things to control for were how vaccinated a population was, how vulnerable it was, how exposed it had been, and in the same vein how different variants of Covid-19 were more or less transmissible.

So we expect in a more vaccinated population or one that had been exposed to higher levels of infection before we’ll see less of an effect, because there is not as much vulnerability. And also with a more transmissible version of the virus, it would be important – we’ll see a less significant effect, because more would be needed to achieve less.

Lead Inquiry: So, hoping I don’t do a terrible injustice to your learning trying to summarise it, later during the pandemic, when populations by and large had become more vaccinated, such governmental measures as were put into place at that time would be bound to have less impact and less effect because the populations had by then already become vaccinated and therefore there was, firstly, less need for stringent measures, and secondly, by comparison to the beneficial impact of vaccination, whatever stringent measure you might otherwise put into place would have less impact.

And secondly, as variants came through with different transmissibility features, for example a particular variant might have an impact on young persons and children, the closing of schools at that point would have proportionately, therefore, a greater impact?

Professor Thomas Hale: If that were the case, that would indeed line up in that way. So the overall relationship remains the same – more stringency, more speed, fewer cases, fewer hospitalisations, fewer deaths – but the size of that effect will go down as the population gains more protection through immunity, and the size of that impact will go down as the transmissibility of the disease increases.

Lead Inquiry: Test, trace and isolate measures were applied by a number of governments. It’s common ground, and not open now, I think, to serious debate, that the United Kingdom was not a country that was able to deploy significant test, trace and isolate measures in the early days of the pandemic.

Does your data show that test, trace and isolate measures were, generally speaking, highly effective?

Professor Thomas Hale: Our review of the literature does show this to be the case. Indeed, the evidence base, we must say, though, is harder here, because it’s very difficult to find comparable information across countries on, for example, the percentage of contacts traced each time, with the time it takes to trace those contacts. Even here in the UK we don’t have, necessarily, consistent information about those two key variables over the whole course of the pandemic.

So here there is a slight difference in the quality of the evidence the world has available but the studies that have been done nonetheless very clearly show that effective test, trace, isolate and support measures were very helpful.

Lead Inquiry: Contrary to what I suggested to you earlier, which is that it’s generally not possible to demonstrate the counterfactual position, have there, in this particular field, the field of test, trace and isolate, nevertheless been some studies which did attempt to predict or to show what the position would have been in the United Kingdom had there been more comprehensive levels of testing and contact tracing?

Professor Thomas Hale: That’s correct.

So I would direct you to page 15. We have summarised a study by Panovska-Griffiths et al 2020 which was, as I said before, a modelling study, so using hypothetical parameters to estimate the effect of a counterfactual, and in that case they did show that TTI strategies could have been successful in particular in the second wave of Covid-19 in the UK if they had been more effective at capturing a wider range of contacts and more quickly.

Lead Inquiry: Turning to economic support and the bolstering of compliance, were there a number of studies which showed in general terms that when stronger, so more extensive, more generous, economic support policies were adopted, compliance with whatever social measure, for example self-isolation, that was in place was better?

Professor Thomas Hale: Correct. So there are two categories of studies that are particularly relevant here: first, a number that show that existing levels of economic deprivation or short-term economic shocks reduced compliance; and secondly, and relatedly, when there’s economic support that’s provided, either through governmental programmes such as the furlough scheme here in the UK or, as was the case in many countries, through social organisations, for example in India an extensive social provision of food to vulnerable households, this was very helpful in ensuring greater compliance with NPIs.

Lead Inquiry: The costs of prolonged restrictions is your next theme. Again self-evidently perhaps, the evidence which you looked at strongly suggests that strict and prolonged non-pharmaceutical interventions will have negative impact on mental health, educational prospects, particularly deleterious effects on older adults, and also the increased prevalence in domestic violence?

Professor Thomas Hale: Correct.

Lead Inquiry: Were there a number of studies which showed that in relation to that latter issue, that of domestic violence, there were substantial increases in domestic violence as a result of the prolonged use of some NPIs, and that was in countries in Europe and in America, across the world?

Professor Thomas Hale: Indeed. And it’s striking to see such consistency in the findings across very different contexts. Indeed, in countries where the previous levels of domestic violence were also quite different, all showed a similar increase.

Lead Inquiry: Again, we’ve heard evidence on this from a number of sources, the application of more stringent non-pharmaceutical interventions also had disproportionate impact on various sectors of the populations in each of the countries, on ethnic minorities, members of ethnic minorities, ethnic groups, women, the elderly, those living alone, and those suffering from comorbidities as well as those who were otherwise economically disadvantaged?

Professor Thomas Hale: That’s correct, and it truly is one of the cruellest injustices of this pandemic that often similar people, similar groups of people who were both vulnerable to Covid were also vulnerable to the effects of actions against Covid.

Lead Inquiry: Some countries have, of course, been praised for the stringency and the rapidity of their non-pharmaceutical interventions, South Korea being one of them, but even in such countries did those non-pharmaceutical interventions strike disproportionately hard upon some sectors of the population?

Professor Thomas Hale: They certainly did, and the elderly population in South Korea, one study showed, was particularly negatively affected by the policies the government put into place. And I’d add that these differential extracts were often exploited by the virus to affect larger populations. So, for example, in Singapore, a country which is particularly effective in managing the disease overall, one large, relatively uncontrolled, outbreak occurred first in a population of migrant workers, who are one of the more marginalised groups in society, and so there the differential impacts were not just an injustice but also a detriment to the country’s overall response.

Lead Inquiry: Turning to page 19 of your report, you then turn to focus upon the United Kingdom Government’s own responses, but in a comparative perspective. By which do you mean that you’ve looked at the NPIs which were applied in the United Kingdom and you’ve compared them in terms of the speed and stringency with which they were imposed by the government here against other countries and in relation to the particular nature of those NPIs?

Professor Thomas Hale: Correct.

Lead Inquiry: Now, at page 21, do you produce a figure, you call it figure 3A, which shows, in respect of England, Scotland, Wales and Northern Ireland, and by the division of particular NPIs, school closures, workplace closures, cancellation of public events and so on and so forth, how many days elapsed between the first confirmed case of Covid in each of those countries and the time, the point at which that particular NPI was imposed?

Professor Thomas Hale: Correct.

Lead Inquiry: And in general terms, do you conclude or does the literature show that for the majority of these NPIs, England, Scotland, Wales and Northern Ireland delayed – or there was a greater elapse of time before the imposition of these NPIs than really the majority of all other countries?

Professor Thomas Hale: That’s correct. I would also draw your attention to the following figure, 3B, which looks at –

Lead Inquiry: We were going to get there.

Professor Thomas Hale: Wonderful.

Lead Inquiry: Well, let me ask you this, Professor: the danger in relying too much upon a chart that shows the delay between the first confirmed case of the virus and the imposition of NPIs, is that the first confirmed case has a degree of variability as to when it might be, and that may depend on a lot of different reasons, and it may also not be a fair reflection of the extent to which the virus has already spread in a country.

So did you, on page 23, compare the position of what delays there had been before the NPIs were applied after the 100th confirmed case in each of the countries?

Professor Thomas Hale: Correct.

Lead Inquiry: And in general terms, what did that chart show about the extent of the elapse of time or, perhaps more pejoratively, delay?

Professor Thomas Hale: It shows very clearly, figure 3B, that in relation to the spread of the virus, restrictive measures across the United Kingdom came into place much more slowly than they were put into place in other groups of comparator countries, different regions, similar – countries with similar political systems, those with similar populations or age profiles, et cetera.

And this is particularly true, it’s really not – the only real place where the United Kingdom’s restrictions were broadly comparable were for the two categories, panels E and H, on protection for the elderly and stay at home requirements, but on every other NPI we looked at, there’s a considerable delay in the UK measures compared to other groups of countries.

Lead Inquiry: Are there two points that must be made, two additional points that must be made, in relation to the chart at 3B: firstly, it might be thought that England had delayed to a greater extent than Scotland, Wales and Northern Ireland because, for example, in relation to school closures, workplace closures and cancellation of public events, the bar chart is longer? But is that because, at the point at which the United Kingdom applied those measures, which it did simultaneously in many places on many occasions, for England, Scotland, Wales and Northern Ireland, by that point in time the virus had been prevalent in England for longer?

Professor Thomas Hale: That’s correct. So if we were looking at this in normal calendar time, the different parts of the United Kingdom would look much more similar. If we were looking at this in calendar time, the United Kingdom as a whole would look sort of in the middle of the pack relative to most other countries. But of course the virus doesn’t think about calendar time, it thinks about its own spread. So this chart is showing us, if you will, a virus time perspective, and for decision-making that’s of course the key metric.

Lead Inquiry: The second most important point, perhaps, is that the stay at home requirement was imposed in the United Kingdom, the mandatory lockdown, of course simultaneously or very close in time to the cancellation of public events, workplace closures, school closures and the closing of public transport, because that was the effect of the lockdown, and that is why there is very little by way of a delay in relation to the stay at home requirement in the middle of that page.

Professor Thomas Hale: It’s because, yes, the stay at home measure came into place, you know, on March 23rd, quite close to the 100th case, which was – I think it was a few weeks before that. But other kinds of policies can be(?) put into place in softer forms before that. So it wasn’t a 100% “You must not go to school”, but there were different kinds of suggestions that were being made, recommendations, et cetera, so some of that’s captured here as well.

Lady Hallett: I’m afraid I’m still struggling with the virus time and real-time concept. Could you just run it past me again, Professor, please?

Professor Thomas Hale: Of course, my Lady. So the bottom axis here, the X axis along the bottom, which is a very small number, I apologise, you will see it shows zero on the left-hand, then goes 5, 10, 15, 20. So those are the number of days since the 100th case.

So, for England, that will be – the clock will start – I’m sorry, I don’t have the exact date in my mind, but it started before, because England had 100 cases long before Scotland did, long before Wales did, and before Northern Ireland did. So for each of these jurisdictions, and as well as all the comparators, we’re measuring when they put in place a measure based on how far it was from the 100th case, not when the – what the date on the calendar was.

Lady Hallett: Thank you.

Mr Keith: Or putting it another way, at the point at which the particular measure was imposed for the United Kingdom, the virus had already spread further in England?

Professor Thomas Hale: Correct.

Lead Inquiry: And more time had passed since the first or the 100th case?

Professor Thomas Hale: Correct.

Lead Inquiry: Can we then turn to a different topic, which is on page 24, the comparison between the timing and intensity of UK responses to other countries.

On page 25, to go forward one page, you produce table 4, which is entitled, we can see from the left-hand side of the page, “Policy Strength”. Over time, that is to say the whole period of the pandemic, have you looked at, in these charts, the stringency, the general level of severity of the measures applied by each country and compared them over time with a very large number of other countries across the world?

Professor Thomas Hale: Correct.

Lead Inquiry: So if we look at school closures in the top left, the red line, which I think we can see more clearly than other lines, is the United Kingdom, is it not?

Professor Thomas Hale: That’s correct.

Lead Inquiry: And so we can see that in relation to school closures, in the early days there was a fairly high level of stringency, the United Kingdom was more severe, more strict in terms of the school closures, meaning any possibility of what was being done in relation to schools, but then the red line comes right down to a very low level of stringency and then goes back up.

Similarly workplace closures, on the right-hand side. We can see that in the early days workplace closure was prevalent, of course, in the United Kingdom because of the lockdown, was more strict than almost all other countries or regions, it comes back down but not as far as the lower level of stringency for other countries, and then goes rocketing right back up again, of course, around the time of the second wave?

Professor Thomas Hale: Yeah.

Lead Inquiry: We can see, if you scroll back out, a similar pattern of cancelling public events, restrictions on gatherings, closing public transport, stay at home, but particularly restrictions on internal movement, a very high level of stringency, effectively, during the first wave, and then, relatively speaking, a very considerable drop in the level of severity, the summer of 2020, and then moving right back up again at the time of the second wave?

Professor Thomas Hale: Correct.

Lead Inquiry: What that shows, does it not, is that there was a degree of rollercoaster element in the United Kingdom’s response? By comparison, I emphasise, to other countries, we went right up the scale and reacted, some would say overreacted, at the first wave, then underreacted between waves, and then rocketed right back up again at the time of the second wave?

Professor Thomas Hale: There’s certainly, in the United Kingdom’s response, as in many other countries, I should add, an element of ramping up, ramping down, ramping up, ramping down, and so the metaphor of a rollercoaster does come to mind.

The important difference between this line of – red line showing the United Kingdom as a whole and the other countries. (inaudible) of course, these are averages, the other ones, so there will be, within every one of those lines, a number of countries, some a bit higher, some a bit lower, this is showing the central tendency of these different groups.

So as the legend has fallen off the screen, zoom in here, but you will see, for example, that the yellow line is Parliamentary democracies, across the world, and indeed the UK is higher right through to the middle of 2021; after spring 2021 becomes much lower on average, across all these different measures.

Lead Inquiry: You have already taken us to the earlier charts, which showed us much more carefully the delay at the beginning. These charts show overall the level of stringency over time.

Are you able to reach a view as to whether, in general terms, the United Kingdom applied non-pharmaceutical measures only when it became apparent that they were unavoidable, because they were delayed and at the time at which they were then imposed we know in the United Kingdom the NHS was believed to be likely to collapse, and then when they’re lifted there is then a long period of delay before consideration appears to be given to their reintroduction, and then when they are reintroduced, again, because of the passage of time and the lateness, there is a requirement for those restrictions to be ever more stringently reimposed?

Professor Thomas Hale: Correct. So we see this rollercoaster tendency where restrictions are put into place only after it becomes apparent there will be a very severe threat to the health system. That’s after a large amount of community spread has begun. Because it’s so prevalent at that moment, the restrictions need to be more stringent and to be in place for a longer period of time than might have been the case otherwise, but precisely because sustaining high stringency for a long period comes with costs, there’s huge pressure to roll them back sooner rather than later and that leaves, inevitably, some residual virus circulating in the population, which lays the seeds for the next wave to emerge. So this kind of tendency to act too late in the first instance and to take measures away too soon in the second instance does tend to lead to the peaks and troughs that these graphs show.

Lead Inquiry: Do later charts and figures, which I won’t take you to, show that an analysis, putting together some of the threads that you have identified, of those countries which had significant or substantial testing, contact tracing and isolation systems against those countries which were not obliged to impose NPIs at such high levels of stringency because they had effectively delayed, show that the presence of significant testing, contact tracing and isolation measures allowed countries not to have to react by way of the imposition of such severe stringent measures?

Professor Thomas Hale: Indeed. So countries as diverse as Japan, South Korea, Vietnam, others, were able to use testing and tracing measures to maintain a very low level of spread, and, when a new outbreak would emerge, to quickly react to make sure those individuals were not involved in further spreading the virus. That prevented them from getting to the point of a wider population spread, in many instances, that would have required more restrictive stringent measures to control.

So the effective use of these testing measures was a nice way of maintaining a low level of spread and therefore not beginning the rise of the rollercoaster back up the ramp.

Lead Inquiry: Did you also find a link between those countries which had that testing capacity and which were able to avoid relatively stringent NPIs and those countries which suffered the most in terms of excess number of deaths, economic performance, and general health impact?

Professor Thomas Hale: Correct. So the countries that were riding the rollercoaster were referring from a trifecta of large health impacts, high, long periods of stringency, and negative economic consequences, and those that were able to maintain a low level of spread, perhaps through effective TTI measures, were able to have a better outcome on all three of those measures.

Lead Inquiry: Overall, does the literature and the data from your tracker project show that there were some areas of conspicuous success for the United Kingdom: the speed and scope of its genetic sequencing, because that allowed it to be very well placed to assess the emergence of variants and the spread ultimately of the virus; a very considerable and impressive degree of ability to test and survey and keep tabs on the spread of the virus, particularly in the middle and later stages of the pandemic, through surveys such as the ONS COVID-19 Infection Survey; and the speed and extent of the vaccine deployment?

Professor Thomas Hale: Correct.

Lead Inquiry: But the absence of a test, trace and isolation process ultimately led to the data and the findings which you’ve reached in relation to the delay and then the repeated reintroduction of extremely stringent and damaging measures?

Professor Thomas Hale: We do see consistently that countries that performed well, were able to avoid the rise and fall of cases, deaths and restrictive measures, were those that used the testing, tracing, isolation and support measures effectively, alongside other measures.

Mr Keith: Thank you very much.

Lady Hallett: Thank you very much indeed, Professor Hale. An extraordinary project.

The Witness: Thank you.

Lady Hallett: I had no idea projects like that were going on, and I think one of my previous witnesses asked for global comparisons, so extremely helpful, thank you.

The Witness: You’re very welcome.

(The witness withdrew)

Lady Hallett: Shall we break now for lunch?

Mr Keith: Certainly.

Lady Hallett: Because I think this afternoon’s witness is here, but you’d probably like to have a –

Mr Keith: By all means.

Lady Hallett: 1.45, please.

(12.47 pm)

(The short adjournment)

(1.45 pm)

Lady Hallett: Mr Keith.

Mr Keith: My Lady, the next witness is Sir Mark Walport.