9. Professor Andrew Hayward

PROFESSOR ANDREW HAYWARD (affirmed).

Questions From Counsel to the Inquiry

Mr Keating: Thank you. Could you give us your full name, please.

Professor Andrew Hayward: Sorry, could you repeat that?

Counsel Inquiry: Yes. Could you provide us with your full name, please.

Professor Andrew Hayward: Professor Andrew Hayward.

Counsel Inquiry: Thank you, Professor, probably a good illustration that we should both keep our voices up. I will do that. Equally, if we can avoid speaking over each other and speaking at pace, to aid the stenographer who sits to my left.

Thank you very much for attending today. Can I echo the apologies as well for keeping you waiting, but we’ve sufficient time to cover the key parts of your evidence today.

Firstly, if we could just deal with the formalities and look at your statement, please, which is dated we could go to page 43, please, we see that is dated 4 September, and you can confirm that you’ve signed the statement of truth?

Professor Andrew Hayward: I have.

Mr Keating: Thank you.

My Lady, if we could have permission for that to be formally published, please.

Lady Hallett: Certainly.

Mr Keating: In terms of professional background, it’s correct you’re here in a personal capacity, but you are a professor in epidemiology and public health at the University College London, UCL; is that correct?

Professor Andrew Hayward: That’s correct.

Counsel Inquiry: And that’s where you were working full-time during the pandemic?

Professor Andrew Hayward: Yes.

Counsel Inquiry: Your employment has changed to an extent since then; you now are primarily employed by the UK Health Security Agency, and you spend 80% of your time there now?

Professor Andrew Hayward: Correct.

Counsel Inquiry: In terms of epidemiology, just to assist the layperson, in a sentence or two, what does that mean?

Professor Andrew Hayward: Well, epidemiology was originally devised, if you like, as the study of epidemics, of which a pandemic is September of this year. It’s in front of us, and if a major example. It concerns really understanding how diseases spread through populations, what causes people to get diseases, really by looking at patterns of diseases in populations compared to different exposures, lifestyle exposures or exposures to infections. And I’d say there is really sort of two broad branches of it, one of which is what I would call sort of more empirical epidemiology where we’re trying to measure these things and draw inferences, and then there’s also another side of it which is the mathematical modelling, where we’re perhaps more concerned with making predictions about the future.

Counsel Inquiry: We’ll probably touch upon the first part of that in a moment. But in terms of the areas we want to deal with today, you’ve provided a comprehensive statement, and I’m not going to deal with every single part, but I’d like to deal with an overview and timeline of your roles.

You were on NERVTAG and SAGE EMG, which we’ll turn to in a moment; secondly, you were involved in a number of significant scientific studies, which we will turn to, again briefly; and, thirdly, some observations you make on the impact of transmission; and, lastly, lessons learned. So dealing with that first topic, and perhasps we could turn to paragraph 5.1 of your statement and your membership of NERVTAG.

We’ve heard already what NERVTAG is but briefly, as set out there, it was originally an expert committee of DHSC, but in due course it was designated as a subgroup for SAGE; is that correct?

Professor Andrew Hayward: That’s correct.

Counsel Inquiry: And your role on the group was a scientist with expertise in epidemiology of acute respiratory infections; is that correct?

Professor Andrew Hayward: That’s right.

Counsel Inquiry: You’ve set out in your statement a number of examples of the type of work NERVTAG was involved in, and that included advice on border control measures, hand washing, PPE guidance, face masks, transmission of new variants; a number of different areas which I’m not going to touch upon. I’m grateful for that information.

But in relation to that, there was one area which you do touch upon at paragraph 5.6, which is social distancing. Do you think this is an area where NERVTAG should have been utilised more upon?

Professor Andrew Hayward: I thought it was an area of extreme importance, and was very concerned that it should be being looked at, particularly during the run-up to the lockdown, as it became increasingly apparent that other measures were not going to control the epidemic. So at that time I raised whether this should be an issue that NERVTAG could look at, and I think at the time I was informed that this was an area that was largely being considered by another group called SPI-M, the modelling group.

Counsel Inquiry: Yes. We’ve heard about SPI-M. Why was SPI-M sufficient for dealing with this –

Professor Andrew Hayward: Well, I’d hope –

Counsel Inquiry: – rather than using NERVTAG? Forgive me.

Professor Andrew Hayward: – that it could be considered from other perspectives than purely modelling perspectives. So, really trying to think through some of the epidemiological evidence for why social distancing might be needed above and beyond the measures that were happening, and thinking about the science of why that might be, in relationship to our understanding of how Covid transmits and the clinical picture of Covid being one that ranges from asymptomatic to mildly symptomatic disease made me think that the current control measures would not be sufficient, and that there was value in NERVTAG or other groups considering this, and I certainly had thoughts about how I would like to approach looking at that.

Counsel Inquiry: And what do you think the consequence of NERVTAG not being utilised was?

Professor Andrew Hayward: I think it’s – I think we could have added to the pressure to introduce social distancing measures earlier than in fact was done. I think we could have rapidly pulled together some of the rationale for why this was needed now, that would have complemented the rationale of the modelling work.

Counsel Inquiry: My Lady has already heard about one of the subgroups of SAGE, which was the EMG, Environmental Modelling Group. That was set up, the original subgroup was set up in approximately April/May 2020. You weren’t involved in the original subgroup, but then there was another group which flowed from that, which was the EMG group; is that correct?

Professor Andrew Hayward: That’s correct, the EMG transmission subgroup.

Counsel Inquiry: Correct, so you were on a subgroup to the original SAGE subgroup. When were you involved in the transmission subgroup?

Professor Andrew Hayward: Well, initially that started as what was called the Public Health England transmission group which was convened, I think, if I remember rightly, in October, and then it was transposed into a subgroup of a subgroup of SAGE, and its remit was really – rather than the main EMG group, which was looking at sort of theoretical considerations as to how Covid would spread in different environments, understanding things like viral excretion, how it ends up on surfaces, et cetera – this group was really convened to look at the epidemiological evidence, ie more studies of – that had measured how Covid was being transmitted in different populations in different settings, et cetera, and to advise on that.

Counsel Inquiry: I think we may come back to the work of the transmission group in due course, which is probably related to some of your studies. But in relation to your involvement, that transmission subgroup and NERVTAG, you weren’t on the full SAGE group; is that correct?

Professor Andrew Hayward: That’s correct.

Counsel Inquiry: And from your perspective as somebody who was on a subgroup to SAGE, did you have any observations or learnings from your perspective?

Professor Andrew Hayward: I think one of my observations was that, as a member of a subgroup, the agendas of those subgroups were very much set for you in terms of: we were asked to consider specific areas of science related to different areas of policy, but there were limited opportunities to sort of set our own agenda or to, if you like, step back and provide advice on what you think an overall response might look like.

Counsel Inquiry: So your view was that NERVTAG and your involvement was more reactive rather than being proactive?

Professor Andrew Hayward: Yes, I would say that’s true. And I think related to that there was also an issue that it was difficult within a subgroup to see what was going on in the wide range of other groups that were convened, and it was difficult to see what the discussions were, for example, in main SAGE. Even as a member of a subgroup, one didn’t have access to the minutes of those meetings.

Counsel Inquiry: And what would the consequence of that be, that you weren’t aware of what other colleagues in parallel fields were doing?

Professor Andrew Hayward: I think it was that you could – it was difficult to be certain that things were being picked up that should be being picked up. I mean, often one would assume that they were, because of the wide range of committees and the wide range of expertise on SAGE and its subgroups, but you never quite knew that.

Counsel Inquiry: I want to turn, please, to paragraph 4.9, which deals with one of the issues regarding the composition of the subgroups you were involved in and the expertise.

So paragraph 4.9, please. That’s on page 9 of your statement. You refer to good clinical advice being provided to NERVTAG, but you also make some observations regarding the advice from public health experts, which is touched upon in that paragraph.

Perhaps I’m just going to ask you the question: did you think that there was sufficient representation from public health experts in the committees that you were involved in?

Professor Andrew Hayward: Well, I think there was – there was input from academics with public health training and expertise, such as myself, but the way that – if you like, the ethos of the committees was to provide scientific advice, and so it was very much focused on academics providing this advice rather than on being able to, if you like, stimulate discussions between academics and people who would be responsible for enacting control measures, so local public health people who’ve spent their lives working closely with communities of varying backgrounds to try to improve their public health. And I think that was, in a sense, a deliberate separation, to have the science then informing the policy, but in general I felt that we didn’t have those opportunities for discussions across those divides.

Counsel Inquiry: Well, let’s develop that a little bit more, because you touch upon this in your statement at paragraph 4.12, and we can look at the last three lines in relation to that. You say this:

“ … greater involvement of service public health colleagues in discussions might have added value in terms of thinking about feasibility of interventions, maximising effectiveness and addressing health inequalities.”

How do you say it would have assisted in addressing health inequalities by having those public health colleagues with frontline experience?

Professor Andrew Hayward: Well, because I think a major part of the day-to-day role of public health colleagues across the country is working very closely with their local communities, trying to understand the different cultures and groups, trying to form connections with those groups in order to help to improve public health, and so they have a very real lived experience of how inequalities play out, and that would be a useful additional perspective within these groups, and would make you, I think, start to think more concretely about specific issues like if you’re doing testing, tracing, isolation, how that’s going to play out in different groups of the community.

Counsel Inquiry: In your experience and your view, is it that that was something which was absent or lacking in the subgroups that you worked upon, that insight?

Professor Andrew Hayward: I felt that there wasn’t really a strong focus on thinking about how different interventions would work differentially in different sectors of the population, and also perhaps how it would have differential harms in different groups of the population; how it might be difficult, for example, for people in very precarious positions, people who have jobs that can’t be done from home, people in overcrowded households, et cetera, how they were going to – you know, how the interventions would play out, and then what more we could do to support people in those positions.

Counsel Inquiry: Thank you.

Lady Hallett: I’m detecting two sources of criticism, and just correct me if I’ve got it right or wrong.

So, one, you don’t have on this group, subgroups, subgroups of subgroups, you don’t have people with the practical experience?

Professor Andrew Hayward: Mm-hm.

Lady Hallett: And, second, that with all the highly specific subgroups of subgroups and separating operation and strategy, you’re not confident that things might not have slipped through the cracks?

Professor Andrew Hayward: From the position in the committee structure where I was, it felt a bit like that. I’d not – I think the main committee in terms of SAGE would have had a much better overview of what all of the subcommittees were doing, but as a member of a subgroup it was difficult to see that.

Lady Hallett: Then, depending upon the membership of SAGE, I think we’ve been told that SAGE didn’t have the directors of public health, people with the practical experience, haven’t we, I think?

Mr Keating: That was an issue which was raised, my Lady, yes.

Lady Hallett: Yes.

Thank you. Sorry, I just wanted to check I had it correctly.

Professor Andrew Hayward: Yes.

Mr Keating: I’m going to move on to our second topic, which is scientific studies, and there’s four we’re going to touch upon: the SAFER programme, which is one of the studies you undertook; secondly, the Vivaldi care home study briefly; thirdly, Virus Watch, and its sister study, Covid health equity study.

So let’s deal with the SAFER study, and that was to measure infection in frontline healthcare workers.

I’m doing it in this order because I think you’ve indicated this is the sort of chronological order, back in 2020, these were undertaken.

So in relation to SAFER study, if we could turn to paragraph 3.11 of your statement, that’s at page 7. And in relation to this, this was a study focusing on the infection in frontline healthcare workers, and you produce an exhibit which we’re not going to turn to but I can summarise it, and indeed you summarise it yourself. This was focused on measuring rates of infection in frontline healthcare workers in a major London secondary care setting, UCL hospital.

Is this a fair summary, that this included regular testing for Covid-19 as well as antibody testing, and findings were that healthcare workers were at a high risk of developing Covid and may themselves have been contributing to its spread?

Professor Andrew Hayward: I think the main finding of that was that healthcare workers were at very high risk. For example, this study started pretty much about the same time as lockdown and already by that time, within Central London, frontline healthcare workers, I think about 20% of them had evidence of infection.

Counsel Inquiry: Well, can I help you in relation to that? Because your article, which I checked, which deals with the study, says this:

“Between 26 March and 8 April 2020 …”

So very early in the pandemic.

Professor Andrew Hayward: Yeah.

Counsel Inquiry: “… 44% of healthcare workers had Covid at any one time.”

Professor Andrew Hayward: That’s correct.

Counsel Inquiry: So a particularly high rate?

Professor Andrew Hayward: Well, over that period, by the end of that study, 44% –

Counsel Inquiry: Yes.

Professor Andrew Hayward: – had been infected, which was higher than we had probably anticipated, and was probably the first study to show such intense transmission within healthcare settings to healthcare workers.

Counsel Inquiry: Am I right in understanding that was published, as you say, in The Lancet and it sort of ensured wide readership and was raised at NERVTAG?

Professor Andrew Hayward: Yes.

Counsel Inquiry: What impact do you consider that study had?

Professor Andrew Hayward: I think it had an impact on a number of things, for example, the use of – widening the use of personal protective equipment to all encounters across healthcare settings. I think it also was critical in leading to the regular testing of healthcare workers, which was an important aspect of control in healthcare workers.

Counsel Inquiry: Our second study in time order deals with the Vivaldi care home study report, and I have been invited to summarise that briefly with you.

It’s an important topic, care homes, my Lady, and one which of course the Inquiry is going to deal with later by way of a further module.

So I’m going to touch upon it briefly, but at paragraph 3.9 you set out that you were a co-investigator into the Vivaldi nursing home core study, and this was where testing took place between 11 May and 7 June. Do those time periods sound correct?

Professor Andrew Hayward: For the initial parts of the study, yes.

Counsel Inquiry: Yes, and the outcome of that study – did you want to previously summarise what the outcome, the headlines of that study was?

Professor Andrew Hayward: Yeah, I mean, this was an attempt to do a survey, in the initial parts, of as many care homes as we could across the country to try and identify what the risk factors for outbreaks in those care homes had been. What we identified, I’d say the main headlines was really the importance of staff in the transmission of Covid in those homes –

Counsel Inquiry: I think we see those at paragraph 3.10, if we move on one paragraph, just to complement what you were saying, Professor. So you mentioned that one of the issues was staff; do continue.

Professor Andrew Hayward: Yeah, so in particular, for example, we found that homes that had greater use of agency staff – so these would be staff who might be working between nursing homes – had higher risk of outbreaks, from which we inferred that they would have been carrying infection from one nursing home to another. Also that homes that were unable to pay sick pay to staff had higher rates of infection, from which we inferred that it was harder for people to not attend work if they were sick, if they were not being paid for that, and that that would contribute to infection.

Counsel Inquiry: How significant were the findings of that study in relation to the understanding of transmission in the home care sector?

Professor Andrew Hayward: I think they were important directly in releasing central government funds to ensure that sick pay was provided to those working in nursing homes and to drastically reduce the use of agency staff. We also found very high levels of Covid within nursing home staff and nursing home residents which also influenced the regular testing regimes there. So I think, yes, it did have an impact.

Counsel Inquiry: So significant in terms of knowledge, insight, but also funding towards agency staff?

Professor Andrew Hayward: Yes.

Counsel Inquiry: And regular testing, or increased testing?

Professor Andrew Hayward: Yep.

Counsel Inquiry: Moving on to the third and fourth studies, which are set out at paragraph 3.4, Virus Watch, and that’s one which you’ve mentioned in your statement at considerable length and that you were significantly involved in – and that’s at paragraph 3.4, thank you – you were the chief investigator in relation to this.

Am I right in understanding this was aimed to provide information on Covid-19 occurrence and risk factors in a large cohort of members of the public?

Professor Andrew Hayward: That’s right, eventually in about 50,000 members. So large, but not nearly as large as some of the other community studies that were subsequently funded.

Counsel Inquiry: You mentioned that that was related to an analysis of occupational health risks, at paragraph 3.3. Is that right, that it considered occupational health risks?

Professor Andrew Hayward: Occupation was one of the key things that we focused on because of the importance of that as a risk factor for Covid.

Counsel Inquiry: In terms of the time period when the Virus Watch study was carried out, am I right in understanding this was between June 2020 up until August 2021?

Professor Andrew Hayward: Yes, in fact there’s elements of the Virus Watch cohort that are still being followed up as well.

Counsel Inquiry: In relation to the sister study, as you describe it, the “Covid Health Equity” study, can you briefly explain what that was?

Professor Andrew Hayward: The health equity study was really a recognition that most studies tend to have an under-representation of people from ethnic minority groups, and so we aimed to deliberately go as hard as we could to recruit many people from ethnic minority groups so that we could start to draw some inferences from there.

Counsel Inquiry: And roughly at what stage did the Covid Health Equity study commence?

Professor Andrew Hayward: It was a little bit later, but certainly it meant by – we were actively over-recruiting people from ethnic minority groups probably from about October.

Counsel Inquiry: So the position was the first study which we mentioned, the Virus Watch, commenced around June 2020 and that additional work to have a wider perspective and knowledge in relation to those from certain ethnic groups was October 2020.

You mention in your statement the background, by May 2020, that there was reports and information to suggest that there was a greater risk of mortality in certain ethnic groups; isn’t that correct?

Professor Andrew Hayward: That’s correct. We had seen within the NERVTAG committee there had been – we’d been examining some of the reports of hospitalisation from Covid from the national studies of hospitalisation, and it appeared from those reports that there was an over-representation of people from black and Asian ethnic minority groups amongst those hospitalised, that they tended to be being hospitalised at a much younger age, and were more likely to end up in intensive care.

Following that, we – my research group looked at some of the data from that in more detail to try and calculate the – or to estimate the death rates in people from different ethnic minority groups, and we could see from that a very early signal that indeed the rate of people dying in black and particularly Pakistani and Bangladeshi ethnic groups was considerably higher than in the white population.

Counsel Inquiry: In relation to data at that stage, in that period from May, June, July onwards in 2020, were you content regarding the sufficiency of data which was available to you at that stage?

Professor Andrew Hayward: Well, at the same time as we were undertaking that and we were raising some of the results early in NERVTAG, we were also aware that Public Health England were working very hard to get similar and more comprehensive information on this issue, and indeed that report was published relatively soon after that, early in June.

But I think my reflections are that surveillance data really should measure the rates of disease and of hospitalisations and deaths in different subgroups of the population as a matter of routine, so that we’re not having to set up the systems to do that in an emergency situation, because it does take – getting this information is far from straightforward. It often requires linkage of different datasets. For example, most surveillance datasets don’t come with ethnicity information within them, so you have to link them to another dataset like the national census or to hospital data to do that, and these take time.

Counsel Inquiry: Just pause there for a moment. That was the fourth topic I was going to deal with, but whilst that’s fresh in our memory let’s deal with that now in terms of your lessons learned; and one of the matters you’ve discussed really is work in that area to improve surveillance data. Is that right?

Professor Andrew Hayward: Yes.

Counsel Inquiry: It’s touched in your statement just towards the end, if we turn to paragraph 9.20, please, and it’s linked to your current employment. Of course you’re here speaking in a personal capacity, but one of the areas you’re working in, your key learning point is to develop health and surveillance data systems to routinely capture and report on the multiple dimensions of inequalities, and you set out those various inequalities.

If we could draw that out just for a moment, please. If you could just come out into a wider view of the statement, thank you very much, and turn overleaf, thank you.

You mention at the top of the page that UKHSA is developing a health equity and inclusion health surveillance strategy to address these gaps for communicable diseases.

Just dealing with that briefly, first of all, was there a gap in identifying the issues you’ve discussed in terms of impact on certain health inequality areas and ethnicity groups?

Professor Andrew Hayward: There – initially I would say yes, there was a gap, there was work to try and fill that gap fairly quickly, I mean, so by the end of the first wave of the pandemic we had fairly robust data on this. I think if one had been measuring that from the onset, we may have got an earlier signal of that by a few weeks, or possibly more, and that may have drawn attention to those issues and the need to address them earlier.

Counsel Inquiry: So pausing there, the fact that you’ve joined UKHSA in February 2023, and this is your area that you’re developing this strategy, does that suggest that there’s a need for such a strategy?

Professor Andrew Hayward: I think there is. The pandemic has brought into sharp relief the importance of thinking about inequalities among multiple dimensions and the need for us to develop our systems to be robust in that respect, and, yeah, I’m pleased to be working on that now.

Counsel Inquiry: And the last point in relation to this is: am I right in understanding that the first part of your work is to review all the different – your phrase, I think, is – surveillance outputs and to identify where there is gaps with a view to trying to fill those gaps at this second stage of your work?

Professor Andrew Hayward: That’s correct, and not just for respiratory infections but across all the infections that we conduct surveillance on.

Counsel Inquiry: I’m just going to return back to the two studies we were discussing, which was the Virus Watch and the Covid Health Equity study, and the final question in relation to this is how that work impacted any decision-making or improved matters. Can you assist in relation to that?

Professor Andrew Hayward: Sorry, could you repeat?

Counsel Inquiry: Of course I can. So in relation to your work for those two studies, jumping back in the narrative in relation to the Covid health equity study, and this is the one where you had –

Professor Andrew Hayward: Yeah.

Counsel Inquiry: – the 50,000 volunteers, what benefit did that work bring?

Professor Andrew Hayward: So I think there were perhaps three main areas of benefit.

One was undertaking studies that looked at the role of occupation, that could show the real importance of people being involved in frontline workforces, healthcare and other service industries or ones where we had public contact in driving the risk of infection, and the big differential infection rates between those who could work from home and those who couldn’t work from home, and we were able to raise those which I think stressed the importance of the value of work from home interventions, but also the value of protecting people who couldn’t work from home through other non-pharmaceutical interventions in the workplace.

The other area that we really looked at was different settings, and so trying to understand where people were catching Covid, and so, for example, we looked at, during the second lockdown, we could see clearly the importance of leaving home for work, using public transport to go for work, and at that stage also just going to the shops were important risk factors for Covid.

As soon as we saw the opening up of society, we started to see that things like going to pubs, going to restaurants, going to other public spaces was also becoming increasingly important in transmission of Covid, and so we were able to feed that into the picture about trying to understand which settings were important. And I think that became particularly important, as there was so many restrictions on different sectors of society, for trying to understand which sectors were important.

And so unfortunately these data take a long time to accrue, so I think perhaps it was more important in informing the – what was it called – the roadmap out of the second wave of the pandemic. But I think this early information on, really, the critical importance of the difference between those who could work from home and those who couldn’t was important in being able to advocate for stay at home advice.

Counsel Inquiry: Thank you.

The final area – and I’m very grateful for your patience – is really to draw upon your perspective and expertise as an epidemiologist. And you mention – you make a number of comments regarding transmission of the virus and the effect on social distancing, and perhaps we could turn to paragraph 7.9, please, of your statement in relation to this. You make a few comments regarding the likelihood of a sizeable winter wave. Where we are in the time period is mid-2020, coming out of lockdown 1, and can you help us in relation to the work you did in preparing for, preparing awareness for the winter of 2020?

Professor Andrew Hayward: Well, I think one of the important parts of that was there was a report commissioned from the Academy of Medical Sciences that was entitled “Preparing for a challenging winter”, that was really aimed to raise awareness of the fact that it was extremely likely that we would have another large wave of infection over the winter period that could potentially be even larger than the wave that we’d already seen, and the need for intense preparation for that, including –

Counsel Inquiry: So – forgive me.

Professor Andrew Hayward: Yeah.

Counsel Inquiry: You continue, I spoke over you.

Professor Andrew Hayward: – including both how the health service should prepare itself for it, but also there was a particular emphasis on the need to work closely with communities to develop the interventions for non-pharmaceutical interventions, for example, and how we can gain insights from that to help to reduce inequalities.

Counsel Inquiry: So we’ve touched upon this report already briefly, the Academy of Medical Sciences report, “Preparing for a challenging winter 2020/21”, and that was dated 14 July 2020. How high profile was that report during the summer of 2020?

Professor Andrew Hayward: Well, I think it was, would have been widely known about amongst the advisory groups and the government, as well as it was reported in the media fairly considerably as well.

Counsel Inquiry: And you were involved, of course, in that report; isn’t that correct?

Professor Andrew Hayward: Yes.

Counsel Inquiry: We’ve got paragraph 7.9 in front of us, and it says this, your view:

“I thought that after the first wave of the pandemic it was virtually inevitable that, without widespread social distancing measures, there would be a very sizable winter wave.”

And you express the reasons why you formed that view. Is that correct?

Professor Andrew Hayward: That’s correct.

Counsel Inquiry: What was your view regarding the implementation of restrictions in autumn 2020? Were you someone in favour of further restrictions?

Professor Andrew Hayward: What we could see in autumn 2020, as expected, was that the case numbers were starting to increase. We had extraordinarily good surveillance data by that time from the Covid infection study that allowed us to measure exactly how they were increasing over time, and we could see these early signals.

What we’d learnt from the first wave was that it was really important not to wait until those infections had reached such high levels that you started to see big increases in hospitalisations and deaths, but to act before that in order to reduce transmission; and my view was that by acting earlier you could suppress it to the extent that you would not need to then be as severe or as long in lockdown, and so I felt that it was really important.

There was advice at the time from SAGE along those lines, for example, the recommendations for a circuit break was going to be planned as a limited period of lockdown to coincide with the school holidays, so taking advantage of the fact that already schools would be closed at that time, and it was felt that that could help to suppress the virus. That was not taken up.

We moved, I think, instead into what was called the tier system –

Counsel Inquiry: Just pausing there in relation to that.

So at paragraph 7.13 – the penultimate points, my Lady, in relation to this – so if we could turn overleaf, please. Thank you. You really make the point that when intense restrictions are introduced at high levels of infection, they are likely to need to be more intense and of a longer duration than if they were introduced at a lower level of infection. That’s the point you’ve just been making; isn’t that correct?

Professor Andrew Hayward: That’s the point. So it means that they’ll not only have a bigger impact on preventing hospitalisations and deaths, but they potentially also have a less severe impact on the economy; and so we really felt that earlier intervention was much preferable to later intervention.

Counsel Inquiry: You’ve spoken publicly about this, and I’ve been invited just to raise this, that you’ve spoken publicly on 2 November in relation to the impact that delay had in relation to not introducing any circuit breaker as recommended by SAGE in September 2020; and why did you speak publicly in relation to this?

Professor Andrew Hayward: I felt it was important for the public to understand the value of early intervention, to try and explain the scientific rationale for that early intervention. I also thought it was important for politicians to understand that. I felt that that was also a direct way of communicating with both the public and politicians.

Counsel Inquiry: And what was the message that you spoke publicly about in November 2020?

Professor Andrew Hayward: The message was really about the importance of intervening early and harder to suppress transmission at a stage when it was at low levels. I may have also at that – certainly in other interviews I would have discussed the tier system, which were basically the – even though rates would have been going up across the country, what we were doing was we were waiting for rates to reach quite high levels in certain areas before intervening, and that meant that we were missing opportunities to prevent those hospitalisations and deaths.

Counsel Inquiry: And I think the headline was, you were quoted as saying, “Number 10 could have saved thousands of lives if it followed SAGE advice and issued a circuit-breaker lockdown on September 21st”.

Professor Andrew Hayward: That was my feeling, that was a conservative estimate, and I think that the thing that, even despite the first wave, that people had failed to appreciate is, because of the mathematics of exponential growth, that once you wait for a later stage then you will have – even short delays can make very major differences to the eventual number of hospitalisations and deaths.

Mr Keating: Professor Hayward, I’m very grateful for your attendance today.

I’ve got no further questions, my Lady.

Lady Hallett: I have no further questions.

Thank you very much for your help, Professor.

The Witness: Thank you.

Lady Hallett: Very grateful.

(The witness withdrew)

Lady Hallett: Right, I think that completes the evidence for today.

I’m sorry to everyone that it was a long day with obviously some quite intense evidence, but obviously also extremely interesting.

10 o’clock tomorrow, I think.

Mr Keating: Yes, my Lady. Thank you.

Lady Hallett: Thank you.

(4.55 pm)

(The hearing adjourned until 10 am on Tuesday, 17 October 2023)