3. Sir Mark Walport

SIR MARK WALPORT (affirmed).

Questions From Lead Counsel to the Inquiry

Mr Keith: Could you give the Inquiry your full name, please.

Sir Mark Walport: Yes, I’m Sir Mark Jeremy Walport.

Lead Inquiry: Sir Mark, you gave evidence in Module 1, so let me welcome you back.

Sir Mark Walport: Thank you.

Lead Inquiry: And thank you for the provision of a further statement, and this time the Royal Society report, to which I’ll turn in a moment, in relation to which were the chair of the expert working group.

Sir Mark Walport: That’s correct.

Lead Inquiry: You are well known to this Inquiry. By practice you specialise in clinical medicine and research as a general physician and rheumatologist. You latterly became head of the division of medicine at Imperial College. You were director of the Wellcome Trust from 2003 to 2013, and, most pertinently perhaps, from April 2013 to September 2017 you were the Government Chief Scientific Adviser?

Sir Mark Walport: Correct.

Lead Inquiry: Your successor was Sir Chris Whitty, on an interim basis.

Sir Mark Walport: Correct.

Lead Inquiry: He was followed by Sir Patrick Vallance, as is well known. The current incumbent is Dame Angela McLean, and she took up her post in this year, 2023.

You were also the founding chief executive officer of the United Kingdom Research Institute, if I have the acronym –

Sir Mark Walport: Research and Innovation.

Lead Inquiry: Thank you very much. I began to pause, I wasn’t sure I’d got that one right.

The UKRI is an amalgamation, is it not, of what were formerly known as research councils; it provides funding to researchers, businesses, universities, charities, NGOs and the like in relation to the broad field of science and medicine?

Sir Mark Walport: Broader than that, actually. So it was created by Act of Parliament, came into existence in 2018, and brought together the seven research councils, which cover everything from the arts and humanities to the biological, physical, medical sciences.

It also brings together the UK’s innovation agency, Innovate UK, and also, in the case – and for all those activities is UK-wide. It also incorporates Research England, which provides infrastructure support for English universities.

Lead Inquiry: Could you please, whilst you give evidence – it’s my fault for not reminding you – try to go as slow as you possibly can.

Sir Mark Walport: Sorry.

Lead Inquiry: The reason I ask you about the UKRI is that during this pandemic, although you were no longer the Government’s Chief Scientific Adviser, did you nevertheless attend no less than 54 meetings of SAGE in your role as the CEO of the UKRI? Why was that?

Sir Mark Walport: I did, and it was because an important responsibility for UKRI was funding the research and, indeed, the innovation appropriate to a national emergency. And in the context of that, and actually one of the reasons for the creation of UK Research and Innovation, is that that research included everything from biological sciences around the virus itself right through to the social sciences, funded by the Economic and Social Research Council.

Lead Inquiry: So, by virtue of your attendance on SAGE, you were able to be there as the CEO of UKRI in order to prompt the early and rapid funding –

Sir Mark Walport: Yes.

Lead Inquiry: – of the various pieces of work or research or cumulation of data that SAGE required to be done?

Sir Mark Walport: Absolutely. It was part of, if you like, a two-way transmission mechanism between the mechanism that provided scientific advice through Sir Patrick Vallance and Sir Chris Whitty, so that we could be sure that the research was relevant wherever possible.

Lead Inquiry: As part of your many roles, are you also an elected fellow of the Royal Society, I think a position that you have held since 2011, as well as being its vice president and, wonderfully, its foreign secretary?

Sir Mark Walport: Indeed.

Lead Inquiry: The Royal Society is, I think, the oldest scientific academy in existence, or at least in continuous existence, having been founded in 1660, but it essentially recognises, promotes and supports excellence in science, and is it by virtue of that function that you came to chair the working group that produced the report that you have exhibited for us?

Sir Mark Walport: I was actually asked to chair it before I became the foreign secretary, by virtue of my sort of broad expertise in the area. The foreign secretary bit came later, and reflects the fact that science is global and so the Royal Society from its inception was very international in its outlook to research.

Lead Inquiry: The report that the Royal Society has produced, and it forms the heart of your evidence in this module, was produced and published, was it not, in order to set out in general terms what has been learnt about the effectiveness of the application of what we now well understand to be non-pharmaceutical interventions; is that correct?

Sir Mark Walport: That’s correct.

Lead Inquiry: Did the working group which comprised, I think, six groups of researchers, assemble and examine evidence from around the world in order to be able to determine the effectiveness of that application?

Sir Mark Walport: Yes, that’s correct.

Lead Inquiry: NPIs are usefully summarised at page 20 of your report. They’re very familiar, of course, to this Inquiry. They’re defined in the report as:

“Any measure that is implemented during an infectious disease outbreak to attempt to reduce transmission that is not a vaccine or drug. NPIs can be behavioural, social, physical or regulatory in nature …”

And they can of course be encouraged to be adopted or applied through a variety of approaches from advice and guidance to the force of law. And they comprise masks and face coverings, social distancing and lockdowns, and over the page, test, trace and isolate, travel restrictions and controls, environmental controls, and communications, which, although not a measure, form an essential part of the debate about the efficacy of non-pharmaceutical interventions?

Sir Mark Walport: That’s correct. And of course they all have in common that they’re intended to reduce the transmission of an infectious disease, in this case a virus, by acting to reduce the exposure of people to the hazard which is, in this case, SARS-CoV-2 virus.

Lead Inquiry: At the heart of any examination of NPIs, and of their efficacy, must there be an acknowledgement of the fact that every virus is different, in terms of its forms and degrees of transmissibility, and that the first line of defence, if you like, in relation to dealing with a viral pandemic, particularly a respiratory one, was the application, the consideration of NPIs because there were, of course, in those early days, no antiviral treatment and no vaccine?

Sir Mark Walport: That is absolutely correct. There were no specific medical interventions at that stage.

But it’s important to recognise that not only do different viruses vary, but the coronavirus itself varied over time, and the main driver for the evolution of a virus or, indeed, a bacteria is to reproduce more effectively. And so, in general, infectious diseases tend to become more transmissible, and so the barrier function of, for example, a mask becomes harder and harder as the transmissibility goes up.

Lead Inquiry: In truth, all governments faced a terrible quandary, did they not –

Sir Mark Walport: Yep.

Lead Inquiry: – in the early days of the pandemic, because it was simply not possible to know with any degree of exactitude the nature of the likely spread of the virus, and under that heading one might include a lack of understanding of Covid, of the coronavirus’ reproduction number, whether it was asymptomatic or pre-symptomatic, what its incubation period was, what its latent period was, what its generational period was, how quickly it would double in size and so on, all that was unknown?

Sir Mark Walport: Absolutely.

Lead Inquiry: So to a very large extent the application of non-pharmaceutical interventions took place against a significant background of ignorance?

Sir Mark Walport: Yes, that is absolutely right. And whilst the principles of how non-pharmaceutical interventions work, as I’ve already said, because every infectious disease is slightly different, then policymakers were faced with an extremely difficult challenge, which is new infection, as you say, much not known about it, its clinical features poorly understood, and so – but nevertheless there were signs that this was a dangerous virus, and so important to take precautionary measures, and apply non-pharmaceutical interventions.

Lead Inquiry: Once it became apparent that this was a virus capable of causing death in large numbers as well as severe injury, all governments faced a terrible balance or dichotomy, which was the absence of the imposition of non-pharmaceutical interventions would likely lead to unconscionable numbers of deaths, but the imposition of non-pharmaceutical interventions against that background of ignorance, through no fault of government, would likely lead to terrible cost and damage?

Sir Mark Walport: That is absolutely correct, and so a very strong incentive for policymakers to slow the spread of infection. And of course the other thing at the beginning of this pandemic was that it was not known whether it would be possible to make a vaccine or what medical countermeasures might become available. But there’s not only the direct consequences of the virus in terms of causing illness, but also the indirect consequences in terms of health systems becoming overwhelmed, the danger of the breakdown of other aspects of national infrastructure. And so every incentive to take quite a strong precautionary principle and do the very best possible to slow or, if possible, to stop the spread of infection. And some countries did take a zero Covid approach from very early on. In other words they tried to eliminate the spread.

Lead Inquiry: I’m pleased to say that we shan’t be engaging today, Sir Mark –

Sir Mark Walport: No.

Lead Inquiry: – in the conceptual debate of suppression versus mitigation –

Sir Mark Walport: Correct.

Lead Inquiry: – but that debate is reflective, isn’t it, of one of the many extremely difficult decisions that all governments have to make?

Sir Mark Walport: Correct.

Lead Inquiry: At the time of the commencement of the pandemic, was there much by way – or any objective analytical information or research available to governments as to the likely effects or impacts of this broad range of non-pharmaceutical interventions?

Sir Mark Walport: Well, once it became clear, which it did fairly rapidly, that it was transmitted by a respiratory route, then there was a lot of evidence that if you could keep infected people away from uninfected people, that would reduce the transmission. So every reason to think that non-pharmaceutical interventions would be effective, but how effective was unknown.

Lead Inquiry: Was there a large or any body of randomised controlled trial work or analysis from empirical data as to how in practice any of these NPIs would work?

Sir Mark Walport: No. Minimal information, because so much depends on the transmissibility of the virus, and the details of the route of the transmission. So there was very, very little prior evidence.

Lead Inquiry: Do we therefore take it from that that because governments were forced at great speed to apply non-pharmaceutical interventions at the commencement of the pandemic, there was no opportunity for them to be able to put into place at the same time any sort of system for empirical conclusions to be drawn about how effective the steps were that they were putting into place?

Sir Mark Walport: I think it would have been extremely difficult, certainly in the absence of prior preparation of protocols. And it’s also worth say that if you want to explore the specific effectiveness of one of these non-pharmaceutical interventions, then the perfect experiment is to have a population half of whom do use, half of whom don’t, or use a different one. But it was – policymakers recognised that you need to use non-pharmaceutical interventions in combination, and so there was a priority to introduce measures in combination.

Lead Inquiry: And, bluntly, the governments had to get on with the job in hand –

Sir Mark Walport: Absolutely.

Lead Inquiry: – and do whatever they could to combat the virus –

Sir Mark Walport: Correct.

Lead Inquiry: – with maximum speed?

Sir Mark Walport: Correct.

Lead Inquiry: The study which the Royal Society has therefore carried out is an observational study, is it not?

Sir Mark Walport: It’s a systematic review of the evidence. In other words, it’s to look at all types of evidence. And in some cases there were trials which were deductive, in other words you could compare a group using masks and a group not using masks, but by and large, because non-pharmaceutical interventions were introduced in combination, it was extremely difficult to dissect the relative effects of one non-pharmaceutical intervention against another.

So, to give you a concrete example, when strong social distancing measures are applied, then is the effect due to wearing a mask or to the social distancing? And so the groups reviewed an enormous amount of evidence and came down to a relatively small number of studies, in the hundreds, where it was possible to achieve some deductive information about the effectiveness or otherwise of the non-pharmaceutical interventions. But for those systematic reviewers who are used to working with placebo-controlled clinical trials, they would view the evidence as being far weaker, but on the other hand observational research is important, and indeed, going back through the history of the Royal Society, it’s the way we have learnt about all sorts of things. You can’t always do an experiment, you have to rely on observational data.

So we did the work in two parts, really, which was to try to work out as much as we could about each of the individual non-pharmaceutical interventions, but we also did a number of country case studies, because that gives you a different observational approach to what happens when things are done in combination. You can learn quite a lot from those.

Lead Inquiry: Were those three case studies in fact studies drawn from Hong Kong, New Zealand and South Korea?

Sir Mark Walport: That’s correct.

Lead Inquiry: Finally by way of introduction, the value of the Royal Society’s report to this Inquiry is, if I may say so, self-evident, but for what general purposes did the Royal Society engage this valuable piece of work?

Sir Mark Walport: Erm –

Lead Inquiry: Is it, if I may ask, in order to promote the general learning and understanding of this topic, or did you have an eye towards its use and its importance for the purposes of future crises which might befall us?

Sir Mark Walport: I think the answer is both, actually. So research advances through individual discoveries, but importantly it advances through the aggregation of knowledge derived from a variety of studies.

During the pandemic the Royal Society did convene two committees to provide evidence reviews, and so it was a logical extension of that work that, at a time when it was really important to understand the best evidence that we have on the effectiveness of non-pharmaceutical interventions, it was a timely report to produce.

Lead Inquiry: It’s implicit in what you’ve said already, Sir Mark, that the review comprised a minute examination of studies and reports and research materials from across the world.

Sir Mark Walport: Yes.

Lead Inquiry: One of the core participants has asked the Inquiry to ask of you the extent to which the research covered material produced in or relating to Wales, and I suppose one could draw from that question a wider question, which is: can you say anything about the degree or the proportion of that research material which related to the United Kingdom as opposed to the rest of the world?

Sir Mark Walport: I don’t think I can answer that question specifically. We deliberately looked worldwide, and the, you know, criteria for inclusion was that it was published in English, and so I can’t answer the question specifically with respect to Wales. But I can say, as an example of a study which is actually slightly outside the remit of this, we learnt an enormous amount about the efficacy of the vaccines from studies that were done at a population level in Scotland. So we were more interested in the evidence and its quality than its geographical origins.

Lead Inquiry: Thank you very much.

Could we now then turn, please, to the general findings –

Sir Mark Walport: Yep.

Lead Inquiry: – the conclusions reached by the research done by the Royal Society in relation to each of the NPIs, and we’ll pick up the thread, if we may, at page 28 of the Royal Society report under the heading of “Masks and :outline:`face coverings.”.

In general terms, prior to the Royal Society’s report, there was very little material by way of previous systematic reviews into the effectiveness of the wearing of masks, and by masks I mean cloth and medical and respiratory and the whole range of masks; is that correct?

Sir Mark Walport: That’s correct, yes.

Lead Inquiry: The research looked at available evidence in relation to the efficacy of all masks, as I’ve suggested, respirators, surgical masks and face coverings such as cloth masks; is that correct?

Sir Mark Walport: Yes.

Lead Inquiry: There were a number of – 35 observational studies, in fact, which were looked at. And in relation to the effectiveness of masks in reducing SARS-CoV-2 transmission, if we go over the page, did the majority of the studies themselves conclude that masks and mask mandates, by which I presume you mean mandatory orders –

Sir Mark Walport: Yes.

Lead Inquiry: – to wear a mask, reduced infection compared to those studies that found there had been no effect?

Sir Mark Walport: Yes. So there were 35 studies in community settings. Three of them were in fact randomised controlled trials, and there were 32 observational studies, and then were a further 40 studies in healthcare settings, one of which was a randomised control trial, and 39 observations.

The majority of those studies, the large majority, showed that the masks were effective. And importantly there was a gradient. In other words, respirator masks were more effective than surgical masks, and mask wearing in the context of a mandate, in other words an instruction with more or less legal force behind it to wear masks, was also more effective.

So, if you like, the plausibility of the results was emphasised by that gradient of effect. In other words, you might expect that a very – you know, the sort of masks that you’d wear in a – if you’re exposed to a dangerous toxin is much more likely to be effective than a loosely fitting mask.

I should qualify it by saying that there was information about mask wearing in other infections, and in fact there were evidence syntheses, and we’ve learned about flu as well. So it’s not that there was no evidence, but there was no evidence in relation to masks in coronavirus.

Lead Inquiry: The issue of mask wearing is a particularly vexed one in the context of the general population. To what extent did the research indicate a level of efficacy for cloth masks of the type that the government might order or mandate a population to wear, so non-medical?

Sir Mark Walport: I don’t think there were any of the systematic reviews that could distinguish between, say, cloth masks and surgical masks, so I don’t think we have information to answer that.

Lady Hallett: Was there also, do I remember, conflicting advice about mask wearing and its effectiveness and whether it engendered complacency?

Sir Mark Walport: There are lots of interpretations of the evidence, and, you know, this is one of the challenges with observational data. It could be that those who avidly wore masks of any sort were more likely to socially distance themselves. So there are other interpretations. But nevertheless, and particularly, I think, in the healthcare setting, where people are more likely to wear the masks correctly as well – because anyone who saw mask wearing, a lot of masks were worn underneath the nose where they would do no effect or weren’t fitting properly. So it’s another case where the fact that actually they were shown to be effective in healthcare settings suggests that there were – you know, there was, if you like, a causal relationship between the mask wearing and the protection.

Mr Keith: The next broad group of NPIs that the research addresses is the social distancing and lockdowns on page 31. Under that heading, does the report include recommendations for people to stay separated from other individuals, as well as legal mandates to stay at home?

Sir Mark Walport: There were 34 studies on physical distancing, as opposed to 151 studies that looked at stay at home orders. So the group that did the social distancing and lockdown work divided into, I think, nine different groups of social distancing measures, which included restrictions on mass gatherings, I won’t read them all out, but they’re listed in the report.

Lead Inquiry: Workplace closures, school closures –

Sir Mark Walport: Correct.

Lead Inquiry: – care home measures, mass gathering and physical distancing.

In general terms, and I suggested similarly to Professor Hale before you, perhaps not surprisingly, the research showed that these social distancing measures were associated with considerable, that is to say significant, reductions in community level transmission of SARS-CoV-2?

Sir Mark Walport: That’s correct.

Lead Inquiry: Was there a link found between the degree of stringency in the application of these various measures and the degree of reduction in transmission?

Sir Mark Walport: Yes, broadly there was. So stay at home orders – the more stringent the measure, the more effective. The restrictions on mass gatherings were important. But each of them were effective, and of course quite often these were applied in combinations as well, and I think it’s important, we will come back to it I think, but NPIs work in combinations, that’s the critical thing, but none of them – I mean, physical separation on its own, if one had been able to physically separate people for a prolonged period of time, would have a very profound effect, but would also be possibly unhealthy in other ways.

Lead Inquiry: But a stay at home order –

Sir Mark Walport: Yes.

Lead Inquiry: – will of course encompass necessarily within the effect of such an order a form of social distancing –

Sir Mark Walport: Yeah.

Lead Inquiry: – as well as, depending on the width of the social order – an impact on schools, workplace and –

Sir Mark Walport: Absolutely correct. But of course stay at home orders, you know, have to be modified in order to keep a nation working, so key workers would still have to go to work. But correct.

Lead Inquiry: One of the more important points in this chapter concerns the recognition of the effectiveness of social distancing and the importance of social distancing in care homes –

Sir Mark Walport: Yes.

Lead Inquiry: – because some of the research showed, quite plainly, that the strict cohorting of staff alongside residents, and restrictions on visitors, was associated with significantly reduced transmission, again unsurprisingly?

Sir Mark Walport: Yes. I think that’s exactly right. I think that none of this is surprising when you think about the first principles of stopping an infected person infecting an uninfected person. But that is absolutely right: in care homes, if you could restrict the movement of care workers, for example, between different care homes or between different populations, that reduces the chance of anyone infected, in this case an infected care worker, infecting large numbers of people. So that’s important.

Equally, if you have got people in a care home who are infected, then keeping the staff that look after them separate from uninfected people is important.

Lead Inquiry: Test, trace and isolate.

Sir Mark Walport: Yep.

Lead Inquiry: Quite plainly, again, there were a number of papers and research articles to which the report had regard, and some of that material in fact comprised detailed data from the United Kingdom, did it not?

Sir Mark Walport: Yes, particularly the app that was used on the Isle of Wight.

Lead Inquiry: Was that when the government introduced by way of experiment a non – I think it was a non-Apple, non-Google app, and they applied it across the Isle of Wight to see what the response would be and whether or not it was effective in ensuring compliance with –

Sir Mark Walport: That is correct.

Lead Inquiry: – social distancing.

Sir Mark Walport: The evidence overall is strong that if test, trace and isolate is applied early, and effectively, then it’s actually quite a powerful measure, and we may come back to it when it comes to the discussion of Korea.

But almost all of these interventions – the other thing we haven’t specifically talked about is sort of the force of transmission. In other words, when there are a very large number of cases in a community, so the exposure goes up. And in the case of test, trace and isolate, when you’ve got very many cases then it’s very difficult to apply it at a national level. So with all of this, early application is important.

Lead Inquiry: That’s a point, if I may suggest, of enormous importance in the case of the United Kingdom, because the position was, wasn’t it – and it’s well established – that there was no significant or comprehensive test, trace, isolate system in the United Kingdom in the early days?

Sir Mark Walport: Yes.

Lead Inquiry: What the evidence from South Korea, along with New Zealand, Australia and a number of other countries shows, that if there is in place such a system, it becomes possible for the government to be able to control the spread of the virus before it runs away?

Sir Mark Walport: Yes. I think that is correct. It is, of course, difficult to extrapolate between different countries, because of course the application of all of these non-pharmaceutical interventions depends on all sorts of social and cultural issues as well.

Lead Inquiry: Of course.

Sir Mark Walport: Korea was very well prepared because it had had the outbreak of MERS in 2015, and I think it’s fair to say that not only the government was more prepared but the community was aware of what happens when you have a dangerous virus in your country, and so they were able to adopt – so testing on its own with sort of voluntary isolation doesn’t work nearly as well as if you’ve got very systematic testing, coupled with the tracing and the isolation. Those are the key other elements.

Lead Inquiry: Therefore is the key feature to a system, a comprehensive scaled-up system of test, trace, contact and isolate –

Sir Mark Walport: Yeah.

Lead Inquiry: – that it is necessary but not sufficient, because it may only work either at the beginning of a pandemic or during the course of a pandemic below certain levels of incidence, that is to say the spread of the virus or the level of incidence of the virus has to be below a point at which the system of test and trace can work in practice?

Sir Mark Walport: Yes.

Lead Inquiry: If the level of incidence is too high, no system of test and trace, however sophisticated, could get on top of the problem?

Sir Mark Walport: When the level is very high, then, you know, essentially you end up testing, tracing and isolating the whole country, which is where you need – you get to lockdown measures. So it is exactly as you describe, it’s when you have geographically limited and low levels that you can remain able to test at sufficient scale and bring it under control without locking down everyone.

Lead Inquiry: We may never know what the effect would have been had the United Kingdom had a comprehensive scaled-up test and trace, isolate system at the beginning, but is there anything that can be said about the levels of incidence, the incidence – the level of spread of the virus, in the early days in the United Kingdom?

Sir Mark Walport: Well, the one thing we do know is that in February of 2020 there were about 1,500 independent importation of cases which was across the whole nation from people who’d been away during the half term school holidays in Italy, Spain and Switzerland, who had been on skiing holidays, and because they were a young and fairly fit population, they managed – the sort of severe morbidity wasn’t really seen in that population. So the UK was hit in a very widespread way very early. We didn’t have tests nearly as early at scale as Korea did. So a lot of this comes back to the evidence I gave actually in Module 1, which is: the real challenge for nations is to be prepared.

Lead Inquiry: Of course. And were genomic studies in fact subsequently carried out, in particular a main study in the summer of 2020, which was able to trace back the genetic origin of a large number of infections –

Sir Mark Walport: Yes.

Lead Inquiry: – in the United Kingdom to viral infections in France, Spain, and Italy?

Sir Mark Walport: Yes. That is correct. And as a result of that we knew that these were independent introductions.

Lead Inquiry: There was what is known as a widespread – well, a spreading, a wide spreading of individual separate infections across the United Kingdom?

Sir Mark Walport: Yes. I think it’s – may go slightly beyond this report, but there were important sort of chance events in different countries that altered their experience of the disease, and obviously those countries that are extremely well connected global transport hubs were at more – had more exposure early on.

Lead Inquiry: You make the point on page 35, in addition, that even where Covid-19 cases are higher, so even where there is a higher incidence, test, trace and isolation may still have an important role to play, because of course it can still suppress – perhaps only around the outer margins – but it can still suppress the virus, even if it’s not able to completely control its spread?

Sir Mark Walport: Well, that comes back to the need for the combination of measures, and so … but, I mean, you need a very high intensity of testing if you’re going to be able to effect it when there’s – the question is really whether the outbreak is geographically localised or whether it’s spread.

Lead Inquiry: Well, that leads us on very neatly to the next broad area of NPIs, travel restrictions and controls across international borders. Does that cover, in fact, quite a wide range of measures from screening –

Sir Mark Walport: Yes.

Lead Inquiry: – checking people’s temperatures when they come across a border or looking for signs of fever, all the way across the spectrum of measure to shutting a border or only allowing people in with full isolation and quarantine?

Sir Mark Walport: It does, and it includes a quarantine as part of it as well. So shutting a border completely is extremely difficult for almost any country in the world, because we all – most countries depend on the importation of goods and services, and so how do you deal with the necessity for people to come in? And of course quarantine is then a very powerful tool for that.

Lead Inquiry: Starting at one end –

Sir Mark Walport: Yeah.

Lead Inquiry: – does the research show that screening measures were particularly effective in controlling the spread of the virus?

Sir Mark Walport: Screening measures were very weakly helpful, because of the incidence of asymptomatic infection.

Lead Inquiry: Could you just elaborate, please, on that?

Sir Mark Walport: Yes. So if you have someone that you’re screening on the basis of the fact that they have a temperature or they’re coughing at the border, that will only pick up people who have symptomatic infection. On the other hand, it may be that there are people who are either infected but have no symptoms, or in fact are in the earliest days of an infection, and even a PCR test might not become positive for two or three days after they’ve crossed the border. So simply health screening on its own, even with a one-off PCR test at the border, will leak, people will leak through who have the infection.

Lead Inquiry: And standing back, of course every government which is considering any sort of border measure has to grapple with the conundrum of what the impact would be of the imposition of border measures in terms of trade, travel, and that presents an even greater problem for those countries like the United Kingdom which are more interconnected and engage in greater levels of trade than some others?

Sir Mark Walport: Yes, that is correct, and there’s also the question of the prevalence of the virus in the country that people are coming to, compared with the country they’re coming from. So if you’re coming from a country which has the same variant at the same level, border controls won’t have much efficacy. On the other hand, if they’re coming from a country with a much higher rate of the virus, then they are potentially very important and also when you’ve got new variants emerging you may be able to slow them down.

Lead Inquiry: And if a country already has Covid established in it, stopping individual members of the public travelling into that country will be like – well, allowing them in might be, I think it’s been described as throwing a lit match onto an already raging fire.

Sir Mark Walport: Yes, but with the exception that if there are new variants emerging, then that may still be relevant. But I think the real point about the travel measures is that, again, you have to implement a comprehensive package for them to be effective. And I think New Zealand is quite an interesting example we’ll come to, where they have the advantage that they’re geographically isolated – I mean, basically you get there by plane or occasionally by boat, ship – but they found, even with the most stringent application of border controls, there would still be influx into the country. So, for example, at the border it may be that a border official or someone supervising a quarantine facility could become infected and carry the infection into the country. So border controls are only effective in the context of other stringent measures as well.

Lead Inquiry: So that we may be clear, in those small number of countries where rigorous border closures enabled those countries to keep a tight grip on the virus and, by and large, thereafter to avoid long, stringent –

Sir Mark Walport: Yes.

Lead Inquiry: – national lockdowns, for example, those border closures were coupled with other NPIs, but in particular TTI, test and trace?

Sir Mark Walport: Absolutely, it was test, trace and isolate coupled with border controls, and of course it was found that long periods of quarantine were more effective than short, that compulsory quarantine was more effective than voluntary quarantine, and later on in the pandemic it was found that you could probably reduce quarantine times if you did daily testing. But effective quarantine, if you’re trying to keep your border as a barrier, is – was an essential feature as well.

Lead Inquiry: The next broad area is that of environmental controls, on page 39. In the general scheme of things, if the rubric or the aim is to control the spread of a virus, how important are environmental measures such as air cleaning devices, ventilation, surface disinfection, screens and so on?

Sir Mark Walport: I’d say that, disappointingly, this was the area where there is the weakest experimental evidence, and there are a small number of observational studies that show – appear to show the effectiveness of environmental measures, and that’s everything from reducing the number of people in an environment to increasing ventilation.

Again, everything that is known about the transmission of infection says that one way of reducing the exposure to exhaled virus is to increase the ventilation, so having open windows, increasing air flow, but there is remarkably little rigorous evidence that could be adduced, and I think it’s one of those cases where absence of evidence should not be taken to be evidence of absence. In other words, because we can’t demonstrate it doesn’t mean that there wasn’t an effect.

Lead Inquiry: So we must leave it on the basis that there may well have been some beneficial outcome, but it’s impossible to quantify it?

Sir Mark Walport: I think that’s right, and of course one of the purposes of the report was to provide recommendations for how we might fill evidence gaps in the future, and there is a clear opportunity to gather evidence when it comes to environmental controls.

Lead Inquiry: Then the impact of communication.

Was that – you’ve already described how that’s not strictly a measure or an NPI, but it’s an extremely important facet of non-pharmaceutical interventions because unless the community adopts and complies with them, then their efficacy would be significantly underwhelmed.

Sir Mark Walport: That’s correct.

Lead Inquiry: Was this a topic in which you looked specifically at the United Kingdom position?

Sir Mark Walport: We did, because the cultural context of communication is so specific, so we restricted ourself in this case to the United Kingdom.

Of course communication interfaces with all sorts of other cultural aspects of society, so for example social cohesion, altruism, all sorts of features of society.

So we did restrict ourselves, and the evidence is that people did largely comply, so the communication was working overall, although there were certain features about the communication such as the trusted communicator, persuasion rather than coercion, a number of features like that that were more likely to engender trust, because trust in the communications is extremely important, and the corollary of trust is trustworthiness, and so communicators who were seen to be trustworthy were, by and large, well trusted.

Lead Inquiry: Two points arising therefrom, please, Sir Mark. Firstly, was trust found to be the most common factor in terms of impacting upon the effectiveness of communication?

Sir Mark Walport: I think it’s a major factor, but clarity, consistency, a balance between, whilst being authoritative in, as it were, the reliability of the information, not being too controlling. So … but, I mean, all of that in a way integrates into –

Lead Inquiry: Trust?

Sir Mark Walport: – trust.

Lead Inquiry: I in fact was reading out the words of the report itself, Sir Mark:

“Trust was the most common factor impacting communication effectively.”

Sir Mark Walport: Yes. Absolutely.

Lead Inquiry: Thank you.

Secondly, could you just elaborate, please, on the importance of knowledgeable and trusted local groups and leaders as communicators? So in the particular context of members of ethnic minorities, how important is the existence of knowledgeable and trusted local leaders in the communication of NPIs and the promotion of trust?

Sir Mark Walport: I think one can extrapolate from advice, say, on vaccines to NPIs, because I think there is a sort of common denominator; and certainly when it comes to improving uptake of vaccines, then there’s pretty good evidence that people trust people who they feel are like them, in similar cultures, more. So it is important to have that communication distributed and reflecting the diverse nature of a community.

Lead Inquiry: Three subissues, if I may.

Firstly, how important in the development of trust and promulgation of effective communication is the need of consistent messaging and the absence of conflicting or changing messages?

Sir Mark Walport: I think that there is little doubt that consistent messaging is extremely important, and that then takes us to how uncertainty is communicated as well. And uncertainty is sometimes communicated as: X has one opinion and Y has a completely opposite one, and that then sends very confusing messages.

Lead Inquiry: Because you were looking technically at research emanating from the United Kingdom, was one of the findings of the report that government guidance in the United Kingdom – which had, as we know, changed multiple times, and of course changed across devolved administrations as opposed to the United Kingdom – led to the potential for non-compliance, simply because people became either confused or desensitised?

Sir Mark Walport: Yes. I’m not sure that the evidence is that rigorous on that, but I think it’s a reasonable interpretation of what happened.

Lead Inquiry: Thirdly, to what extent is an absence of scientific certainty damaging to the efficiency or efficacy of communication? So, putting it bluntly, to what extent does a population need to know the scientific basis for what it’s being told in order to make it comply?

Sir Mark Walport: Well, but that’s an interesting question, but it goes back to the start of the pandemic and even at the end there were huge numbers of things we didn’t know, and actually an important part of the communication is to communicate what is not known as well as what is known.

So, whilst everyone would like perfect answers as soon as possible, we started with hardly any specific answers, we had generic answers, and so that I think is a sort of more general issue of communication of uncertainty and the communication of science in general.

It’s the whole nature of science to be sceptical, actually, to want further evidence. And I think the evidence is actually that the public, and there isn’t one public, but public audiences did accept and understand the fact that there are things which were not known.

Lead Inquiry: The say the whole nature of science is to be sceptical; was it you who described scientists as licensed dissidents in –

Sir Mark Walport: No, it wasn’t me, but –

Lead Inquiry: It could have been?

Sir Mark Walport: It could have been, but it wasn’t, no.

Lead Inquiry: Therefore, in conclusion on this part of the report, do you call, in fact on page 44, for governments in future to convey information clearly with consistent messages, there we are at the top right-hand corner –

Sir Mark Walport: Yes.

Lead Inquiry: – to convey information by trusted sources such as health authorities, but in fact there’s a reference back to knowledgeable and trusted local group leaders?

Sir Mark Walport: Yep.

Lead Inquiry: And, thirdly, there must be a proper balance struck between authoritarianism and optional –

Sir Mark Walport: Yes, those were the summary of the evidence review there. That’s correct.

Lead Inquiry: You then turn, or rather the report then turns to a cross-national comparison of NPI effectiveness. You are aware, of course, of the report from Professor Tom Hale?

Sir Mark Walport: Yes.

Lead Inquiry: You may indeed have seen his evidence earlier today. In broad terms, are the conclusions from the Royal Society report very similar, although they come at it from a different angle, to the conclusions reached by Professor Hale to the effect that the more stringent an NPI, the more effective it is likely to be, and also that the availability of comprehensive scaled-up test and trace and isolation measures are likely to be of the very greatest importance in being able to keep control or to regain control of a virus?

Sir Mark Walport: Yes. I read Professor Hale’s report, I was sort of locked away in a room out there whilst he was giving his evidence, so I didn’t hear it, but I enjoyed his paper and actually I was pleased that it was very complementary to the paper produced by the Royal Society, so he came from the observational angle of looking at policy implementation in different countries across the world and correlating it with Covid cases –

Lead Inquiry: When you say complementary, I should just make plain, you mean it went –

Sir Mark Walport: It complemented –

Lead Inquiry: – very well alongside it –

Sir Mark Walport: Yes, correct.

Lead Inquiry: – complemented it, rather than being very nice about it?

Sir Mark Walport: Yes, correct.

Lady Hallett: Complement with an E.

Sir Mark Walport: Yes, with an E.

Mr Keith: Yes, indeed.

Sir Mark Walport: Exactly. I did my research on a system of proteins called complement, with an E, and people used to misspell it all the time, so …

But, yes, and of course the angle from the Royal Society report was to do a systematic review of the evidence directly, but when it came to our national case studies, they fit more with the approach that was taken by Professor Hale.

Lead Inquiry: Could we then turn briefly to those three case studies –

Sir Mark Walport: Yep.

Lead Inquiry: – that’s to say Hong Kong, New Zealand and South Korea.

I don’t want you to give an account of how the Hong Kong authorities proceeded throughout the whole –

Sir Mark Walport: No.

Lead Inquiry: – course of the pandemic in relation to their imposition of NPIs, but focusing on the broad thrust, the – and painting it in a very general term, in a very general way, the Hong Kong authorities applied, very early on, stringent NPIs because of boundary closures in early February, a full quarantine policy, either at home or in a hotel, from March for travellers arriving from Europe and North America, and then from July quarantine for all arriving persons. Is that a fair summary?

Sir Mark Walport: Yeah.

Lead Inquiry: And therefore they were able – or rather the virus never escaped their control?

Sir Mark Walport: It escaped – they were able to keep it under control, so, yes, it didn’t escape in the sense that it was there –

Lead Inquiry: Indeed.

Sir Mark Walport: – but at very low level.

Lead Inquiry: And where it popped up, the system for test and trace and in particular isolation was able to deal with outbreaks of the virus over time?

Sir Mark Walport: Yes, that’s correct.

Lead Inquiry: But where Hong Kong suffered terribly was that when these stringent NPIs were lifted, it became apparent that the levels of vaccination in the population were not as they should have been, there were very large numbers of elderly members of the Hong Kong population who were not vaccinated and so when in particular Omicron broke through –

Sir Mark Walport: Yes.

Lead Inquiry: – they were vulnerable and they died in very large numbers?

Sir Mark Walport: That is correct.

Lead Inquiry: So Hong Kong is a very good example of the beneficial impact of go early, go hard in terms of the early imposition of stringent NPIs?

Sir Mark Walport: That is correct.

Lead Inquiry: With vaccination?

Sir Mark Walport: That is correct, and of course that was the remarkable thing about this pandemic, which is that within a year of the pandemic starting there were vaccines that stopped people dying. So, yes, but that’s a correct analysis.

Lead Inquiry: New Zealand recorded its first case of Covid-19 on 28 February, not entirely different to the United Kingdom, but two weeks later on 14 March it was announced that anyone entering the country must self-isolate for 14 days, border controls became increasingly tightened until the point, at 9 April, when only New Zealand citizens and residents were permitted to enter the country at all, and even they had to undergo a 14-day quarantine.

Sir Mark Walport: Yes, a compulsory quarantine which was observed, as it were, yeah.

Lead Inquiry: Therefore although there was a one-month strict lockdown and a whole series of local lockdowns, so attempts to suppress local outbreaks, and a fairly low level of domestic NPIs imposed, New Zealand remained mostly transmission free until late 2021?

Sir Mark Walport: Yes, that’s correct. I think New Zealand provides a very clear illustration of what is needed to make border controls work, because we do have very good data, and what they found was that in spite of having rigorous quarantine there were still cases that were brought into the community by probably people working in and around the borders, and by using testing, tracing and isolation they were able to keep those under control, but from time to time there were then episodes that suggested there was domestic transmission occurring, so you wouldn’t have been able to do contact tracing right back to the border, and under those circumstances they imposed quite strong localised lockdowns.

So I think it’s an extremely good example of how, if you’re going to make border closures work, you have to do a whole lot of other things as well.

Lead Inquiry: And you must make clear, mustn’t you, that – again to repeat perhaps the obvious – we will never know whether the United Kingdom, had it had a developed system for test, trace and isolate and had it had quarantine facilities, and had it had the geographical, the population density and the socioeconomic conditions which apply in New Zealand, would have been able to keep the virus under similar control?

Sir Mark Walport: That is absolutely correct. So we have a much larger population, a much higher population density and interconnectedness, and although we are an island, we are an island with only a short sea barrier to other parts, lots of shipping, and so it is very, very difficult to extrapolate from one country to another.

Lead Inquiry: But what is clear is that the New Zealand imposition of border controls was, by the general scheme of things, applied very early?

Sir Mark Walport: Yes.

Lead Inquiry: And secondly, whether or not it was to do with the early application of those border NPIs, they didn’t appear to have suffered in the same way that the United Kingdom did from multiple, indeed nationwide, seeding of infection in those weeks in February?

Sir Mark Walport: Well, that’s true, but in fact, I mean, the full rigorous quarantining in New Zealand didn’t happen until 9 April, they had a more voluntary policy until then, and of course in the UK by 14 March we’d already had a very substantial introduction of cases, and they did have actually in New Zealand quite a long national lockdown as well. So – but, I mean, the general principle is correct that having controlled the first major outbreak, then after that they were able to maintain it by rigorous border controls coupled with other measures.

Lead Inquiry: And by 14 March, anybody entering the country had to self-isolate for 14 days?

Sir Mark Walport: Yes, that’s correct.

Lead Inquiry: So had there been multiple seedings around that time in New Zealand – and we will never know whether there were or not – there is at least the prospect that that mandatory self-isolation would have had a beneficial impact?

Sir Mark Walport: Yes. What I can’t tell you is how effective that self-isolation was.

Lead Inquiry: Indeed.

Then finally South Korea. South Korea’s population is 51.4 million, so I think 15 to 20 million perhaps shy of the United Kingdom’s, so not entirely unequal in size. It, it is very well known, experienced an outbreak of MERS which had of course, although more localised, a high-consequence infectious disease, had a much higher rate of fatality?

Sir Mark Walport: Yep.

Lead Inquiry: And it had also therefore put into place and developed much more active measures for the control of disease?

Sir Mark Walport: Yes.

Lead Inquiry: The SARS-CoV-2, Coronavirus 2, infection was first identified in South Korea on 20 January 2020. On 23 February, public health authorities raised the infectious disease alert to the highest level, and then combined NPIs were applied over time.

Did South Korea have a very sophisticated and developed system for community based screening, for test and trace, and in terms of contact and isolation, very sophisticated systems for electronic –

Sir Mark Walport: Yes.

Lead Inquiry: – contact tracing?

So people could be traced through credit card or debit card use, through CCTV, through their location –

Sir Mark Walport: Yes.

Lead Inquiry: – because of mobile phone use –

Sir Mark Walport: Yep.

Lead Inquiry: – and so on and so forth?

What was the outcome of the application in general terms of that level of stringent NPI?

Sir Mark Walport: Well, they managed to avoid the need to have a lockdown, so … but they were – it illustrates the necessity of being prepared. So they had learnt a lot, as I said earlier, from the MERS outbreak, they’d strengthened their epidemic intelligence service, and so they were prepared to develop an extensive test, trace and isolate very early. And in fact the sort of kinetics of the South Korean infection was very similar to the UK, I mean, the first UK case was in January as well.

So with a much, much more rigorous enforcement of the tracing and the isolation, they avoided a national lockdown. They had some very large superspreader events around certain religious organisations on a couple of occasions.

Lead Inquiry: But notwithstanding those superspreader events, their system for NPIs or their system of measures enabled them to circumnavigate –

Sir Mark Walport: That’s correct.

Lead Inquiry: – the pandemic in a very different way to us.

They were able, were they not, to gain approval for a diagnostic test at a relatively early stage –

Sir Mark Walport: Yes.

Lead Inquiry: – on 4 February? And does other evidence show that by late March they were testing individual members of the population at a prodigious level –

Sir Mark Walport: Yes.

Lead Inquiry: – way ahead –

Sir Mark Walport: They scaled up –

Lead Inquiry: – of the United Kingdom?

Sir Mark Walport: – way ahead of, I would need to check but I suspect almost every other country in the world. They were very, very fast.

Lead Inquiry: The report draws the threads together in a number of messages, if I may call them that, from page 63 onwards, Sir Mark.

I needn’t, I think, trouble with the summaries that are set out there in relation to the need for going early, go hard, and for the link between stringency and reduction in transmission, because you’ve covered that.

But, on page 64, you make these points: firstly, on the basis of strict early application of NPIs, it is obvious that it was that combination of NPIs that was crucial in terms of efficacy?

Sir Mark Walport: Yes.

Lead Inquiry: Secondly, that the value of a proper test, trace and isolate system is enormous, it is perhaps the core NPI if the aim or the goal is to stop a runaway infection or to try to regain control.

Third, as you’ve already indicated, it is not possible however to reach counterfactual conclusions, “What might have happened here if”, and so on.

Fourth, the key lesson to researchers is to be prepared, because it is only by understanding as fully as we may the impact of non-pharmaceutical interventions will we appreciate the vital importance of test and trace, and of ensuring that a combination of NPIs next time is used at the earliest possible moment?

Sir Mark Walport: Yes. So I’d qualify what you’ve just said, I think, in two ways.

Firstly, the effectiveness of non-pharmaceutical interventions does depend on the transmissibility of the virus, and so no country in the world was essentially able to control it once the Omicron variant came out. That was the point at which China, with its very rigorous restrictions for mobility, just couldn’t achieve it any more. So there is always that.

But that is another argument for acting early, because now that we know that there is the potential for developing a vaccine during the lifetime, then your best chance of doing that is as fast as possible before the virus has had a chance to evolve to be more transmissible, because that’s what they will do.

Lead Inquiry: Just pause there.

Sir Mark Walport: Yes.

Lead Inquiry: One other ancillary benefit of stopping the spread of the virus is to stop, of course, the likelihood of variants but also to stop the prevalence of syndromes such as Long Covid which come, of course, by way of injury from the widespread –

Sir Mark Walport: Well, that is correct, and also to avoid the need for prolonged periods of restriction of people’s liberty with all of the consequences that that brings. So being quick and being stringent is very important.

My qualification of the second comment you made, which is about how we acquire the evidence in the future: that isn’t just for scientists, that is for policymakers as well. In other words, what we need in any pandemic, and indeed for public health as a whole, is high quality data, and so ideally protocols need to be developed for how one might deal with the observational data in a future pandemic, because researchers can’t do it in the context of an environment that doesn’t allow them to.

And so I think working with policymakers to agree potential protocols, to agree the sort of information that’s needed is really important, and ideally this should be international, because you can learn things by comparing country A with country B, with the caveats of all the sort of cultural issues we’ve been discussing.

So … but I think the scientific community, if there had been protocols of the sort that ISARIC, for example, had had in terms of the clinical description that I talked about in my evidence in Module 1, the International Severe Acture Respiratory Infection Consortium, they had protocols that they developed ten years ago, and so were able to activate their studies very, very quickly, within days of the pandemic starting.

Lead Inquiry: To drill down just for a moment in two aspects of that very helpful answer.

Firstly, do you set out in the report the need for therefore systems of accumulation of data and research to be put into place, so you say there needs to be during the interpandemic period –

Sir Mark Walport: Yes.

Lead Inquiry: – the interregnum before the next pandemic, the pre-positioning of national and international research consortia and networks, data infrastructures, methodological protocols and mechanisms for the collection of data? And do you mean by that we need to know in much greater detail what the likely consequences are of viral infection in terms of transmissibility and the epidemiological impact, but also much more about the NPIs which may be deployed in future to be able to combat it?

Sir Mark Walport: Yes, and the analogy is with drugs and vaccines where, because there were protocols that could be applied during the pandemic, we learnt very rigorously and deductively about the effectiveness of, for example, dexamethasone in saving lives in people in intensive care units, in learning which monoclonal antibody therapies were – anti-inflammatory therapies were effective and which weren’t.

In the same way, if we had very good continuous evidence collection during the pandemic, we might learn more in real time about the effectiveness of different measures at different times.

As I’ve described, however, in relation to environmental measures, there are some things one can learn from experimental studies between pandemics. So it’s perfectly possible to understand the distribution of particles of viral size in closed spaces, what ventilation might do. Some of that work is already done.

But at the start we didn’t really know the balance of – the importance of washing hands and cleaning surfaces. We do know that actually enteric infections – so infections of the gut – decreased, and we also know about the effectiveness, to some extent, of the non-pharmaceutical interventions from the fact that influenza and respiratory syncytial virus infections dropped during the pandemic.

But ultimately each infection is –

Lead Inquiry: Is different?

Sir Mark Walport: – itself, yeah.

Lead Inquiry: Lastly, in the context –

Lady Hallett: Is this last?

Mr Keith: Yes, this is the last –

Lady Hallett: It’s just that I’ve been asked to take a break.

Mr Keith: This is the last question.

In the context of your earlier answer about the terrible conundrum faced by governments in relation to whether or not to impose non-pharmaceutical interventions, do you call for a much closer examination of – call for the need for a new structure or a framework or a policy by which the relative benefits and costs of alternative steps which could be taken by a government are examined? So a cost-benefit analysis, what Lord O’Donnell, you might know, has described as a wellbeing cost-benefit analysis?

Sir Mark Walport: Well, I think one of the things we say in the report is that there were costs in other domains of life, economic, people’s wellbeing, education, and those need to be analysed as well. And I wouldn’t dare to tell policymakers what the answer should be, but policymakers will always make the best decisions, one hopes, if they have all the evidence, and so you need evidence on all sides of the equation.

Mr Keith: Thank you.

My Lady, that does conclude the evidence of Sir Mark.

Lady Hallett: Sorry, I wasn’t trying to hurry you.

Mr Keith: No, no, I had referred to the possibility that it was the last and final area about three times.

Lady Hallett: I’m not sure you’re being fair on yourself there, Mr Keith.

Questions From the Chair

Lady Hallett: Can I just ask one question, and this positively is the last.

Given the importance you place or the study – your report places on having a scalable system of test, trace and isolate –

Sir Mark Walport: Yes.

Lady Hallett: – have you got any estimation of what our position is like today here in the UK?

Sir Mark Walport: I think it is not as strong as we would like it to be. But that is a judgement, and I should probably resist it.

Lady Hallett: And I didn’t give you notice of the question, but I thought I’d just –

Sir Mark Walport: I think there is much more to do, and we talked in my last appearance about the work of Dr Kirchhelle, who is one of your advisers, on the history of public health, and I think that the disinvestment in public health, not just in the UK but in the richer countries of the world, needs to be tackled. But that is a personal opinion rather than the sort of – yes. It goes beyond this report, that’s for sure.

Lady Hallett: Thank you very much, Sir Mark, I’m very grateful. I hope we’re not imposing on you too much. I have a feeling we may impose on you again, if we may, but I don’t know, I haven’t checked with the other modules. But I’m extremely grateful to you again for all your help.

The Witness: Thank you, my Lady.

Mr Keith: I very much regret to say that it was Sir Mark’s first question this afternoon –

Lady Hallett: Oh, would we impose on him again?

Mr Keith: – would you be wishing to see him again?

My Lady, that concludes –

Lady Hallett: The problem is we do have a module specifically on health, you see, Sir Mark, so it’s just possible.

The Witness: Okay.

(The witness withdrew)

Mr Keith: That concludes today’s evidence.

Lady Hallett: Thank you all very much indeed. 10 o’clock tomorrow, please.

(3.02 pm)

(The hearing adjourned until 10 am on Thursday, 12 October 2023)