2. Professor Neil Ferguson
PROFESSOR NEIL FERGUSON (affirmed).
Questions From Lead Counsel to the Inquiry
Mr Keith: Good morning.
Could you commence your evidence, please, by providing your full name?
Professor Neil Ferguson: Neil Ferguson.
Lead Inquiry: You are, Professor Ferguson, a mathematical epidemiologist, and you have worked on the subject of emerging infectious disease outbreaks for many years.
Professor Neil Ferguson: Yes.
Lead Inquiry: Much of your research has focused on using statistical and mathematical models to understand infectious disease dynamics and control; is that correct?
Professor Neil Ferguson: That’s correct.
Lead Inquiry: As a world-leading specialist in this field, you are the director of the MRC – is that Medical Research Council?
Professor Neil Ferguson: Mm-hm.
Lead Inquiry: – Centre for Global Infectious Disease Analysis?
Professor Neil Ferguson: Well, I handed over that responsibility a few months ago. I’m now director of the School of Public Health at Imperial College.
Lead Inquiry: All right. The MRC Centre for Global Infectious Disease Analysis is at Imperial, is it not?
Professor Neil Ferguson: It is.
Lead Inquiry: And you were the director for a number of years. As you say, you are part also of the Department of Infectious Disease Epidemiology, the School of Public Health, you have also been a director of the Health Protection Research Unit in Modelling and Health Economics, and you hold a number of prestigious fellowships, awards and professional qualifications?
Professor Neil Ferguson: I do.
Lead Inquiry: During the pandemic, you participated in a number of important aspects of the country’s response to the pandemic, because you were, having served many years in fact on SAGE, a member of SAGE. You also participated in SPI-M-O, NERVTAG and another subgroup, EMG, as well as a number of ad hoc task and finish groups?
Professor Neil Ferguson: Indeed.
Lead Inquiry: Was your contribution to this country’s response to the pandemic offered by way of your personal contribution as Professor Ferguson or as part of the Imperial College team?
Professor Neil Ferguson: I think more in the latter. Clearly there were some aspects of the former at times.
Lead Inquiry: It’s very plain from the evidence that over time you contributed very extensively to the body of scientific advice that was provided to the government, and also the Imperial College COVID-19 Response Team contributed by way of the provision of a multitude of reports and papers and pieces of learning to aid the government in its hour of crisis.
In your statement, we needn’t put it up, at paragraph 13 – and I should say you’ve very helpfully provided the Inquiry with three statements, the first of which is a powerful and lengthy piece of work, Professor, weighing in at over, I think, 150 pages.
You say this:
“I believe that scientists have a key role to play in advising policymakers on the potential impacts of different policy choices in a crisis, but that they should not use the public platform offered to them by that role to campaign or advocate for specific policies.”
I want to start your examination, please, by asking you for your views, in a general sense, on the role of scientists, in particular in relation to this pandemic.
What is the basis for your belief that scientists should not use a public platform to campaign or advocate for specific policies?
Professor Neil Ferguson: I mean, it’s a personal view, and I have plenty of colleagues and – who might take a different view. My view is that, I mean, we have expertise to give to inform policy responses, but we are just citizens in society, and for something as consequential as a pandemic, where everybody will be affected by the decisions made, fundamentally, it is for kind of policymakers to make those decisions, not for scientists.
So I’m quite happy to inform policy, but not, certainly in the – as a member, for instance, of SAGE or NERVTAG, to advocate for a policy.
Lead Inquiry: In reality, in practice, was that an easy path to tread?
Professor Neil Ferguson: No. As I outline in my statement, there were many – well, many – there were a number of occasions where those lines got blurred. And clearly we are all human beings and we’re experts on infectious diseases, so we had more sense than many of what was about to happen, both in the spring of 2020 and in the autumn of 2020, and there were occasions where, you know, frustration built up, let’s say, at the apparent slowness of decision-making.
Lead Inquiry: You yourself were not averse to appearing in the press. I think you appeared on perhaps the Today programme, in April 2020, you gave a number of interviews. In reality, was that self-imposed purdah difficult to apply?
Professor Neil Ferguson: I mean, certainly in giving media interviews, for instance, I always try to take the line that it was for, you know, scientists to advise on policies and for policymakers to decide upon them.
Lead Inquiry: Is the basis of your decision in part that you believe that, as a scientist, it’s your role to advise and you have, therefore, no greater right than anybody else to determine policy?
Professor Neil Ferguson: Indeed.
Lead Inquiry: We will be coming back to the specific position of SAGE later, and we want your views as to how that system of advisory – scientific advisory/government policy interface can be made to work perhaps better.
But in a general sense, do you feel that you did confine yourself to the provision of scientific advice, or did you become, despite your best endeavours, irrevocably involved in the determination of policy?
Professor Neil Ferguson: It’s a difficult question to answer. I know I’m associated very much with a particular policy, but as you’ll be aware from the evidence I’ve given in my statement and the statement of others, the reality was a lot more complex.
I was – I don’t think I stepped over that line to say, “We need to do this now”. What I tried to do was, at times, which was stepping outside the scientific advisory role, to try to focus people’s minds on what was going to happen and the consequences of current trends.
Lead Inquiry: Is it, in your view, possible, realistic, to have those scientists who are providing advice to government not engage in substantive debate about the right policy, the right strategy, and to communicate that view to government?
Professor Neil Ferguson: I mean, I think that brings one to something I talk about at some length at the conclusions of my first statement, namely I did feel there was a role that, if we had been more integrated into the operational response, we could have contributed more. And that has happened in the past. That’s a different thing from saying we should be advising or advocating for a policy. It means that if you have more sight of the objectives and constraints under which policy has to be made, you can give more informative advice.
Lead Inquiry: The emails which the Inquiry has, as you are aware, Professor, show that on a multitude of occasions you expressed views about the government’s policy, whether, for example, there was a distinct lack of urgency, concerns about whether or not it was over-wedded to a mitigation strategy. You told Professor Steven Riley, your colleague, he says that “we”, meaning you and others, “were currently driving UK preparedness and planning”, and you express on multiple occasions views about the economic impact of – we’re going to use the word, Professor – lockdown.
That rather suggests that it is impossible for a scientist in your position and the position of your colleagues, who were providing this vital line of advice, not to become engaged, themselves, in expressing views on strategy, on policy, bluntly, what the government should be doing.
Professor Neil Ferguson: I would distinguish between exchanges with fellow scientists, particularly within the Imperial College team, where there was clearly a diversity of views, and we are – we all had our views – and then how you express oneself in interactions on committees such as SAGE.
Lead Inquiry: You expressed yourself in very forthright terms about the economic impact of lockdown. You informed your colleague, Professor Riley, that you’d spoken to, for example, a US federal interest committee about the economic consequences of lockdown. You expressed views about whether or not there was a clear-cut best strategy and whether the government was following it.
My point to you is: should one just not recognise the reality, which is that scientists are placed in an impossible position if they are expected to and they self-impose an obligation not to express clear views on policy outcomes and strategic options and what should be done?
Professor Neil Ferguson: I think there’s a better balance that can be struck in that regard than was struck at certain times in the pandemic. I mean, I read carefully Chris Whitty and Patrick Vallance’s statement and they express some of the same concerns as I do about that disconnect. Do I have a perfect model for it? No.
Lead Inquiry: Do you believe that, in drawing that very difficult balance between providing advice and intruding into policy decision-making, you personally kept to that line?
Professor Neil Ferguson: I do. Clearly I’ve thought in retrospect of whether I should have been more forceful at times. I think where I was comfortable intruding across that line was where I didn’t see evidence of, let’s say, the sort of preparedness to make a, you know, policy option viable – let’s put it that way – rather than saying, you know, “This is the alternative policy which should be adopted”.
Lead Inquiry: Now, you are, by training, a mathematical epidemiologist, and so it’s important that we gain from you a sufficient understanding of the complexities of modelling.
Lady Hallett: Just before you do, Mr Keith, can I just pursue the process by which you give advice to ministers?
I –
Professor Neil Ferguson: Can I –
Lady Hallett: Sorry.
Professor Neil Ferguson: I never gave advice to ministers.
Lady Hallett: No, so you didn’t directly, sorry, advice is given to ministers.
As somebody who has given advice that is then given to ministers, I’ve seen a lot of papers over the years from civil servants that set out the various options, with the pros and cons, and then a recommended option. That wasn’t the format that SAGE advice took, it seems to have had a consensus statement.
Professor Neil Ferguson: Yes.
Lady Hallett: What’s wrong with setting out the options and making recommendations?
Professor Neil Ferguson: I mean, in previous – previous SAGE – previous events where I’ve sat on SAGE, SAGE has been asked to do that. We weren’t asked to do it for the pandemic. So – and reading Sir Patrick’s statement, it appears that that was, you know, the responsibility partly of himself and Chris Whitty and partly of DHSC and the Cabinet Office, presenting the policy options.
We were asked much more narrow questions about the likely impact of individual interventions and clarifying the science and the epidemiology. So at no point prior to, I would say, April 2020 were we asked, you know, what are the strategic options which the government could consider?
Lady Hallett: And do you have a scientific-only based recommended option?
Professor Neil Ferguson: Well, that comes to another issue, that the recommended option will depend on the policy objectives and/or red lines the government wants to set. That’s where, you know –
Lady Hallett: That’s where the needing to know the objectives comes in.
Professor Neil Ferguson: Yes.
Lady Hallett: I follow, thank you.
Mr Keith: Professor, you were asked relatively narrow questions as a member of SAGE about the likely impact of individual interventions, but to a very considerable extent you and your colleagues had no option but to answer those narrow questions rather more widely; is that a fair summary?
Professor Neil Ferguson: In some cases, yes.
Lead Inquiry: Is that why, as we will see in a moment, in March in particular, you became involved so intimately in the debate about the strategic options open to the government, the likely course of events, what their best strategy might be, what might happen, that were way beyond a narrow technical, epidemiological, mathematical, modelling answer?
Professor Neil Ferguson: Yes. I mean, that was really not on SAGE, it was the SPI-M group, which then – and had discussed it before informally. I mean, clearly we did discuss – and we were reviewing what was happening in other countries, we did discuss the policy options and strategies available. But rarely as part of the official business of the group, more as informal conversations between, you know, fellow scientists.
Lead Inquiry: That, therefore, leads one to this conclusion, does it not, that there is something wrong with the system when the formal requests made of SAGE and, to a lesser extent, SPI-M-O, are framed in relatively narrow, technical, commissioned questions: what is your scientific view on X?
Whereas at the same time the email strings between you and your Imperial colleagues, Chris Whitty, Patrick Vallance, Ben Warner (special adviser in Number 10), show that you were engaging much more significantly in the overall policy debate.
Professor Neil Ferguson: Engage I think is fair. I mean, I was certainly aware of the policy debate and I was aware that we needed to have a policy which was actually able to be implemented.
Lead Inquiry: Professor Ferguson, your emails show, do they not, that you expressed forthright views at various times on lack of urgency, on caution on the part of government officials, on whether or not the strategies adopted by the government were leading us, effectively, to ruin? You didn’t hold back in those views.
Professor Neil Ferguson: No, I mean, I had, certainly, concerns.
Lead Inquiry: Why were they not communicated as part of the formal SAGE process, of which you were an important member?
Professor Neil Ferguson: I mean, I think because the formal SAGE agenda was – I mean, the meetings were relatively formal, with a formal process for considering evidence and providing advice. They were not – until much later – generally open debates about – certainly about policy strategy.
Lead Inquiry: The SAGE minutes, of course, are consensual minutes. They reflect –
Professor Neil Ferguson: Can I just?
Lead Inquiry: Yes.
Professor Neil Ferguson: I mean, they weren’t minutes, so –
Lead Inquiry: No, I’ve called them minutes because that is how they are referred to, but they were documents drawn up to reflect a consensus position reached by the group; is that a fair summary?
Professor Neil Ferguson: I think I would agree with how Patrick Vallance has stated it in his evidence, namely they were a central position rather than always a consensus position.
Lead Inquiry: Some of the meetings were – I think perhaps can reasonably be described as fairly tense, quite heated. The 13 March SAGE meeting in particular, the heat of the –
Professor Neil Ferguson: And I think in the September and October as well, but yes.
Lead Inquiry: All right. But the flow of the debate and the range of opinions was never really properly reflected in those consensus documents, were they?
Professor Neil Ferguson: No. I mean, I think if you want to see a better indication of I think how I would like to see such minutes be prepared in future, then the NERVTAG minutes are much more informative.
Lead Inquiry: In terms of transparency, in terms of having a good visibility on what advice the government was receiving, was there not a problem here, that whilst SAGE openly debated these vital issues and was of course constituted to publicly, by way of publication of its documents, give the government advice, you and your colleagues were prone to emailing around each other and emailing the CMO and the Government Chief Scientific Adviser and Number 10 officials and other officials in the working parts of the government your own rather more candid views?
Professor Neil Ferguson: On – I mean, I tried not to do it very much, but there were times where that felt necessary to do.
Can I just correct, I mean, my perception of SAGE is it’s a committee convened to advise the Government Chief Scientific Adviser and, in this case, the Chief Medical Officer to allow them to provide the best scientific advice to government. SAGE itself goes through that conduit.
Lead Inquiry: Indeed. But the use of personal email to speak to individuals in government outwith the SAGE and then the CMO/CSA funnel was a process that had no visibility to it, and of course those emails were not published in the way that the SAGE materials were published?
Professor Neil Ferguson: Yes, and I believe both Chris Whitty and Patrick Vallance engaged – you know, had email exchanges and conversations with many, many scientists across the course of the pandemic outside SAGE.
Lead Inquiry: You say, “I tried not to do it very much”. Is that an expression of – well, perhaps of hope rather than expectation? You did send quite a lot of emails, Professor, did you not?
Professor Neil Ferguson: Yes, I did. I mean, a lot of them were about the science itself, about the changing, you know, situation, our understanding of Alpha, Delta, of the infection fatality ratio, they were pure science. There was a much smaller number which related to policy.
Lead Inquiry: There was still a considerable number relating to the government’s position, the policy, the strategy that was being applied, and your own views on all of that?
Professor Neil Ferguson: There were a number, yeah.
Lead Inquiry: Coming to modelling, could you, in one sentence – I say this more in hope than anticipation or expectation, Professor – summarise the aim of epidemiological analysis and modelling? What is its purpose? What does it seek to achieve?
Professor Neil Ferguson: It aims to quantitatively understand patterns of transmission of an infectious disease in the population, the heterogeneities, the variability in that, and use that insight to inform control policy planning and understanding of epidemic trajectories.
Lead Inquiry: Yes. Professor, is the primary aim of modelling to understand, in the most basic lay terms, the spread of the disease, of the pathogen?
Professor Neil Ferguson: It’s to understand the patterns of spread but also to estimate certain key quantities which relate to that, such as the incubation period of transmissibility and things.
Lead Inquiry: Those are all facets, are they not, of the disease?
Professor Neil Ferguson: Yes.
Lead Inquiry: A second aim of epidemiological analysis and modelling is to work out prospectively, in the future, what might be the impact of measures taken by the government. So it’s not an analysis so much as the painting of a scenario: what might happen if this is done or this is not done. Is that a fair summary?
Professor Neil Ferguson: Yes, the examination of a range of what are technically called kind of counterfactual scenarios about the potential impact of different policy options or other interventions like vaccines and treatment on – on a disease.
Lead Inquiry: Could you give, please, the Inquiry a feel for how – and as you answer, could you please try to keep your voice up, it’s been a bit hard to hear you.
Professor Neil Ferguson: Yeah.
Lead Inquiry: Could you give the Inquiry a feel for how great, wide a field this field, this science of modelling is? The Inquiry has seen a great deal many reports and papers prepared by yourself and your colleagues. Is modelling or has modelling been driven by the well known rapid expansion in computer science, for example, which has enabled you to produce much more complicated and complex work than hitherto?
Professor Neil Ferguson: So I prefer kind of lumping analysis and modelling together, because most of what we did in the pandemic, frankly, was epidemiological analysis rather than modelling interventions.
You’re completely right, the field has grown dramatically in the last 20 years. It’s less about being able to use more complex models, more about a revolution in what’s called Bayesian inference, the ability to calibrate models against epidemiological data in a way which allows them to be used in a more predictive sense – and I use “predictive” in a – I don’t mean literal predictions in that sort of scenario analysis sense – than was possible in the past.
Lead Inquiry: By and large, do all governments in the face of an epidemic rely upon modelling scenarios? How widespread is its utility and use?
Professor Neil Ferguson: So the UK has been in the lead in its use, throughout my career, but I co-hosted, with the World Health Organisation, a meeting across multiple countries earlier this year, including low-income countries, Kenya for instance, and every country represented had some degree of modelling applied to inform its pandemic response.
Lead Inquiry: The role of modelling in the United Kingdom was plainly a vital one. It’s obvious from Professor Riley’s reports of early March, your own and the ICL report, Report 9 of the middle of March, that the mathematical modelling work product played a vital role.
What about Far East and Asian countries? So it’s well known and common ground, if you like, that South Korea developed a diagnostic test around about the same time as the United Kingdom. They of course were aware of the incipient outbreak, as we were, and they – the evidence shows – put into place rapidly a very sophisticated test, trace, contact, isolate, support system to keep control of the virus.
Do you know to what extent those governmental choices made in South Korea were determined by mathematical modelling?
Professor Neil Ferguson: I think mathematical modelling was one input into it. I think a larger input was their experience of the MERS coronavirus outbreak in – which was very disruptive, a few years before the pandemic. And that led them to implement legal measures to allow a sort of contact tracing which we never got close to being able to employ. I mean, using – tracking individuals’ mobile phones, government having real-time access to all banking transactions.
So I would – I’m happy to talk about how Korea achieved what they did, but it’s not just as – I mean, it wasn’t simple kind of boots on the ground contact tracing.
Lead Inquiry: But to what extent, and you may only be able to answer quite generally, to what extent were those practical steps taken by government? And they were practical steps, they were non-pharmaceutical measures.
Professor Neil Ferguson: Yeah.
Lead Inquiry: Non-pharmaceutical interventional measures.
To what extent was the decision to take those steps, to put those measures into place, being driven by the conclusions, the demands of epidemiological mathematical modelling?
Professor Neil Ferguson: I mean, I can’t answer specifically for South Korea, but in many places, Hong Kong might be another example, Singapore, where I know more about it, mathematical modelling was certainly an input in terms of projecting likely trajectory of the epidemic and hospital demand.
Lead Inquiry: Putting it perhaps unfairly and a little bluntly, Professor, you don’t need mathematical modelling if you’re a government to know that if the virus spreads to your land and is out of control and cannot be contained, you’re going to have a very serious problem indeed?
Professor Neil Ferguson: I mean, once you know what the infection fatality ratio and the reproduction number of the virus is, you can get away with, I would say, very simple models, and as you say, maybe for – you know, intuition to some degree about what the consequences would be. You still need that epidemiological analysis, though.
Lead Inquiry: You mentioned there the need to know the infection fatality ratio. We’ll come back to that in a little detail later. But that infection fatality rate, that is to say the knowledge of the number of people – the ratio of the number of people in the population who will die amongst those who have become infected, was an issue which you, particularly with ICL, were looking at alongside the infection hospitalisation rate throughout the second half of February and the early part of March?
Professor Neil Ferguson: Yes.
Lead Inquiry: That was a separate workstream, if you like, from the pure epidemiological mathematical modelling?
Professor Neil Ferguson: Yes. The two are very – obviously very tightly linked.
Lead Inquiry: In general terms again, we’ll come back to the detail later, you became aware by mid-February, 10 February in fact, which is when you produced or Imperial College London produced its first report on the infection fatality rate, you became aware of a broad understanding of what the number of deaths amongst those infected could be, even though you were unable for many weeks later to bottom out exactly what it would be?
Professor Neil Ferguson: Yes. We had our first estimates at around that time. Indeed, I gave a Today programme interview where I explained the consequences of that.
Lead Inquiry: Indeed.
So you didn’t need epidemiological mathematical modelling in mid-February to know that the number of deaths amongst an infected population was potentially very high indeed?
Professor Neil Ferguson: No.
Lead Inquiry: No.
Modelling, epidemiological modelling, is of course complex. Does it depend upon a number of different pieces of information or variables in order to enable the system to produce a sensible and workable product at the end of it?
Professor Neil Ferguson: Yes. I mean, mathematical models, even the most sophisticated models of epidemics, are highly simplified representation option of much more complex phenomena, of course, but over many years we’ve learned that certain key quantities are particularly important. So, basic quantities are things like the reproduction number and the infection fatality ratio, but also understanding which subgroups in the population are most at risk of either infection or severe consequences.
Lead Inquiry: By contrast to working out more bluntly and more broadly the number of people who are likely to die amongst an infected population, modelling of how a virus transmits through that population requires information to be understood on how that infection works, so how an infection progresses in a person and how variable it might be; correct?
Professor Neil Ferguson: Yes.
Lead Inquiry: So that would require you to know something about the latent period, the infection period, the incubation period, symptoms and the like.
You also need to know quite a lot, don’t you, about the consequences of infection, so clinical severity, how many people are going to require hospitalisation or an intensive care unit bed?
Professor Neil Ferguson: Yes, and we worked on all of those things you’ve just listed.
Lead Inquiry: You need to know the reproduction rate, how rapidly the virus spreads, you need to know about viral loads, how easy transmission is, whether there are people who superspread; you need to know about the demography, age distribution, health, how it all impacts upon a population; and you need to know something about likely population behaviour, how will people respond to being infected, and living in a country that is –
Professor Neil Ferguson: Yes, the latter we know very little about in any sort of predictive sense, and I should say, whilst everything you list there is correct, in reality if you’re doing this in real time, that information builds up slowly.
So one tends to take data from related diseases – and here we used a mixture of SARS, MERS and influenza data – before – you know, parameter estimates, and applied them to Covid, before having all of those available estimates, otherwise it would be the end of the epidemic by the time you knew everything.
Lead Inquiry: You also need to know about what the effectiveness is likely to be of intervention, so you need to work out what the impact will be of antiviral treatment, for example, I don’t know, dexamethasone, which was a UK-invented brilliant treatment. You need to know about the impact of vaccines. You need to know the impact of non-pharmaceutical interventions. You need to know the impact of immunological aspects; you know, once you get infected might you be reinfected? And you need to know about viral genetics: will the virus change?
So putting all that together, a system of government response that rests upon and waits for answers to be given by mathematical modelling is likely to be a fairly drawn-out and, you used the word yourself, slow process?
Professor Neil Ferguson: Well, I don’t think that’s necessarily the case. You … everything you list is important, but not all equally important and not equally important at the same time for decision-making. I mean, I see modelling more as a tool for synthesising different sorts of information together, to draw conclusions. And, yes, initially you’re doing that on the basis of very little data. If you’re referring to: do we need to have a playbook before we have very much information, a policy playbook which is automatically enacted? I wouldn’t disagree with that, and clearly in that respect Korea and the UK differed markedly in what their policy playbook was.
Lead Inquiry: The issue of whether the government had a playbook, so a list of strategies or policies that would be automatically introduced if a red line was crossed or if certain trigger events happened, is another debate.
I want you, please, to focus on what you believe was the impact in terms of the government’s overall response of waiting for the outcome of such modelling.
You are aware that on 28 January at SAGE SPI-M was directed to provide assistance and advice as to how, in general terms, the government could respond to the virus, whether it could control it, what it would do.
The point I want to make to you is: by directing quite a relatively large or quite a relatively important part of its response upon the outcome of the modelling, we built into this response system a delay, because you didn’t have the information, you didn’t know enough about the virus, you didn’t know enough about NPIs, the genetics, the behavioural aspects, to be able to produce work product for a while?
Professor Neil Ferguson: Yes, 28 January, but I would also comment that 28 January we didn’t have an estimate of the infection fatality ratio either.
Lead Inquiry: No, indeed not. You didn’t start to investigate that or be able to understand the likely parameters of the infection fatality ratio until 10 –
Professor Neil Ferguson: Well, that’s when we – we were working on it throughout January, but …
Lead Inquiry: We’ll come to that a little later.
Do you agree, though, with the proposition that by waiting for the product of mathematical modelling there was then baked into, built into the response system a delay?
Professor Neil Ferguson: Not entirely. I mean, I think the more general question was around how long you wait to clarify, have uncertainties around the new threat reduce before making a decision. So it was a broader issue about the certainty with which we could characterise this new threat which I think played a bigger role.
Now, modelling clearly played a part of that, but I don’t believe it was the most significant issue.
Lead Inquiry: But it’s clear, isn’t it, that the modelling process had to await a great deal more information, which was information that became gradually apparent through the beginning of February, the rest of February and the beginning of March, to be able to produce the worked-up scenarios, the thinking about what the impact would be of the various options the government might have had at its disposal, for example?
Professor Neil Ferguson: Yes, there was kind of certainly lots of iteration of those scenarios, I would agree.
Lead Inquiry: You are aware that a number of other scientists have questioned the reliance upon modelling as part of the government’s response?
Professor Neil Ferguson: I am.
Lead Inquiry: What do you say to what Professor Woolhouse has said, for example, by way of the over-reliance upon modelling and the fact that you don’t need modelling or epidemiological modelling, certainly not mathematical modelling, to be able to understand that you have to try to control a virus and put practical measures in place to stop it?
Professor Neil Ferguson: I mean, I would agree with that last quote, certainly. I think modelling gives some benefits in terms of understanding the likely absolute magnitude of the impact of different interventions, which in its absence you are rather guessing at.
Lead Inquiry: Can we just now debate the scope of the modelling. You’ve referred to the fact that the mathematical modelling produced answers in relation to what the impact might be of non-pharmaceutical interventions. To what degree of detail or specificity could those models go or did they go? For example, a number of the core participants ask in their Rule 10 questions about the degree to which models focused on the impact of shielding methods, on the impact of non-pharmaceutical interventions on ethnic minorities, and on the elderly. Was it a necessary part of the modelling that all these sectors of the population were considered and the impact upon them understood?
Professor Neil Ferguson: So, to explain, rarely do you actually include in a model the operational details of how a policy is implemented. So, typically, if we were modelling, for instance, shielding, then it is modelled as a reduction in contact rates in a certain subsection of the population, for instance the elderly, by a certain amount, and you might look at how much that varies. How you translate that operationally into policy is really for public health specialists.
So we certainly looked at age and shielding. I don’t think any of the models, up until quite late in the pandemic, stratified by any other, you know, sociodemographic, you know, category, other than age, and we can get into why that was, but there were a number of reasons, mostly around data and computational feasibility.
But just to put – it’s – they’re not in some sense Sim City simulations of people walking around, I mean, they’re much, much higher level than that.
Lead Inquiry: So the answer is there was a general understanding of course of the likely impact of whatever intervention you were modelling upon such sectors, but there were no models specifically designed to look at in detail what the impact would be?
Professor Neil Ferguson: I mean, looking – none of the models looked at the – let’s say, the indirect consequences of interventions, they were all focused on the impacts, potential impacts on virus transmission and health consequences.
Lead Inquiry: That’s because the primary aim, to come back to your earlier evidence, of modelling is to work out the spread of a virus, its transmission, how it works, how it operates, and the likely impact of whatever measures are taken in a broad sense to combat it, and that primarily concerns clinical aspects, or how many deaths, how many people are hospitalised?
Professor Neil Ferguson: Yes.
Lead Inquiry: Is that a fair summary?
Professor Neil Ferguson: Yes.
Mr Keith: Good.
My Lady, is that a convenient moment?
Lady Hallett: Certainly. I’m sorry we have to break, but I think you were warned you would have to be here some time, Professor, so if you will forgive us, we will now break for lunch and I shall return at 1.55.
(12.57 pm)
(The short adjournment)
(1.55 pm)
Lady Hallett: Mr Keith.
Mr Keith: Professor Ferguson, just a few more questions on modelling.
A further point or issue raised by Professor Woolhouse is his belief that there was a default assumption that the only drivers of behavioural change were the imposition and relaxation of government-imposed restrictions. What he states is that the modelling presumed that the only way in which future behaviour of the population would alter would be as a direct result of the government-imposed restrictions themselves, as opposed to being spontaneous. So, for example, the population changing its behaviour in advance of a lockdown because it can see the lie of the land.
Is there any basis for the belief that your models did not pay appropriate attention to spontaneous behavioural changes and relied exclusively instead upon behavioural change brought about by government restrictions themselves?
Professor Neil Ferguson: So, I mean, models don’t distinguish between whether there is messaging to encourage the population to change behaviour and mandate to force them to do so.
Models model changes in contact rates in the population which suppress transmission, so there’s no prior assumption made about whether something is an advisory measure or a mandatory measure.
With respect to spontaneous behaviour change, and which is a slightly different thing, there you’re saying –
Lead Inquiry: Professor, I’m sorry to interrupt. Could you please try to go a little slower. You’re speeding up. It’s my fault, but I must try to restrain you.
Professor Neil Ferguson: With respect to spontaneous behaviour change, that’s a much more – so how do populations respond to risk, a perceived risk in the population. There are no – well, there is lots of speculative modelling of how that might happen, but no validated models or no validated models, frankly, of that type of behaviour. I mean, this is something I highlighted all the way back in 2006 in an essay in the Nature journal, but – there is research under way but it’s still in its infancy and it’s actually a very difficult thing to predict.
So, no, the models didn’t try to anticipate how populations would completely spontaneously respond.
Lead Inquiry: The modelling is designed to ascertain what might happen, and behavioural changes are a significant driver of what might happen. Does it therefore matter in modelling terms whether the behavioural change is spontaneous or mandated?
Professor Neil Ferguson: Not in terms of its effect on contact rates, no. But of course it’s hard – may be harder to predict what voluntary change will do in terms of the magnitude of change of those contact rates compared with mandatory changes.
Lead Inquiry: But whether a population spontaneously changes its behaviour is hugely relevant, isn’t it, to the policy debate about whether a lockdown is therefore necessary?
Professor Neil Ferguson: It is certainly very relevant to the debate around the extent to which mandatory versus voluntary measures are required, yes.
Lead Inquiry: I’m going to call it a lockdown. You call it mandatory, Professor, but we all know we’re talking about a lockdown.
Now, just finally on the question of modelling, there are important passages in your witness statement in which you speak of the care that must be taken in assessing the consequences of or the value of scenario modelling.
Scenario modelling, what might happen if we do this, is not a direct or an accurate guide as to what will happen, because the outcome is entirely dependent on what steps you take to meet the eventuality.
Professor Neil Ferguson: Agreed. And beyond that, throughout the pandemic we never had a sufficiently precise understanding of the exact impact of any one intervention to be able to make firm predictions.
Lead Inquiry: In truth, Professor, it is a very complex but broad science.
Professor Neil Ferguson: Yes.
Lead Inquiry: It must be put into its proper place as a tool for guiding governments to respond; would you agree with that proposition?
Professor Neil Ferguson: I would agree with it, yes.
Lead Inquiry: The way in which SPI-M-O looked at models and the way in which the government responded to models was dependent, wasn’t it, upon a process of taking a number of models together? So if, for example, the government wanted a medium-term projection of what the outcome might be, the impact might be of, say, closing schools, did it seek a specific model from a particular research institute such as Imperial College London or did it rely upon an ensemble, an amalgamation of reports, models from the various institutes who provided them?
Professor Neil Ferguson: So just to clarify there, I mean, you’re talking about two different things. The medium-term projections were things updated every week and they were as close as we got to forecasts. They weren’t true forecasts, because we assumed things stayed the same. And there, upwards of 10, 12 different models were combined in a formal, statistical sense. The second aspect is the use of modelling for, let’s say, scenario modelling of intervention options, and typically what happened during the pandemic there is that the question was posed to SAGE, to SPI-M, a request came in, and modelling groups which were capable of answering the request did. So typically a rather smaller number. Typically ourselves, the London School of Hygiene and Tropical Medicine, and Warwick University later in the pandemic.
Lead Inquiry: Is it therefore the position that there was never a single Imperial College model, there were a multitude of different types of models on different issues, addressing different eventualities produced by Imperial, and there were models, similar models, produced by a number of other bodies as well?
Professor Neil Ferguson: Indeed.
Lead Inquiry: I raise that, Professor, because of course the press and the public attention which has been focused upon the role of Imperial.
Now I’d like to ask you some questions, please, about the strategy or the approach to the pandemic for which you advocated in the early part of February.
The Inquiry has heard evidence that the government strategy had, prior to the pandemic, been based on a pandemic influenza strategy, in particular a document from 2011. On account of the focus on influenza pandemics, on the advent of the pandemic, had there been any modelling of long-term, large-scale non-pharmaceutical interventions such as stay at home orders, closure of workplace across the country, quarantining and the like? Or was the modelling in existence relatively limited?
Professor Neil Ferguson: So there had been modelling of – of the use of layered, as they were called, non-pharmaceutical interventions in relation to an influenza pandemic, which included things, for instance, like home working, but none of the modelling considered scenarios where those interventions would be used for the duration that they were used during the Covid pandemic.
Lead Inquiry: So may it be said that the strategic reliance upon a flu pandemic approach had an impact upon the availability of learning about the possible measures that might be deployed to meet a coronavirus?
Professor Neil Ferguson: I think one can exaggerate too much the idea that we were following a pandemic flu playbook, certainly on the scientific front. I worked on both SARS and MERS coronavirus extensively, we were quite aware of the biological and potentially epidemiological differences. But I would argue the single most important difference between Covid-19 and something like SARS-1 was that a high proportion of those infected have relatively mild symptoms, some no symptoms at all, which talks to the relative effectiveness of different types of control measures at controlling the community spread of the virus.
Lead Inquiry: I’ve not suggested to you that there was a flu playbook followed scientifically or by Imperial College London, but the point is that, on account of the attention paid to that Tier 1 risk of a pandemic influenza, very little thought had been given, had it not, to how a policy of containment, for example, that is to say shutting down the arrival of the virus and the spread of the virus, might work in theory or in practice?
Professor Neil Ferguson: I would agree with that.
Lead Inquiry: So in the beginning of February, would you say that there was a general doubt expressed by you and others as to whether or not containment would ever work to deal with a coronavirus, the coronavirus that we faced, because there was very little by way of learning or structure to be able to contain the virus when it became apparent that it was spreading?
Professor Neil Ferguson: I think it’s more nuanced than that. I mean, so first of all, obviously globally containment did not work. The – I … I was more sceptical than some that the measures adopted in China would be as successful as they turned out to be. I was – changed my view. That scepticism was altered by the data on the ground from … the – you would have to be more – in terms of the long-term suppression of the virus, I think you’re right in the fact that it hadn’t been well studied, but I don’t think that necessarily affected our evaluation of necessarily feasibility. It did affect the extent to which, for instance, Public Health England was equipped to be able to implement containment measures.
Lead Inquiry: I ask because in your statement you say:
“I felt the Contain phase [and that’s a reference, is it not, to the government’s Coronavirus action plan, mandated contain, delay strategy] never had any significant chance of preventing the infection entering the country or even significantly slowing its establishment here.”
Then you go on to say it was further impaired by the lack of testing capacity, which I’ll come back to.
That would seem to suggest that, at a broad strategic level, the efficacy or the success of a containment policy was always in doubt in your mind?
Professor Neil Ferguson: I would distinguish there between the measures the UK adopted and labelled as the contain policy, and what other countries adopted, which was much more successful. I mean, I’m happy to elaborate on the UK situation.
Lead Inquiry: Yes.
Professor Neil Ferguson: We implemented, which was limited by testing, very limited border controls, and you may come along to that evidence shortly, which were only ever going to prevent a small fraction of, you know, infected people coming into the country, had low sensitivity and then had very limited contact tracing capacity.
Lead Inquiry: Because there was no complete closure of the border, because there was, in the early days, merely symptom screening, and then restrictions imposed by reference to the destination or, rather, the overseas country from which the traveller was coming, and because there was no scaled up or significant testing process, you’re saying containment, that is to say stopping the virus from spreading round the United Kingdom, just didn’t work?
Professor Neil Ferguson: Not using the measures which were adopted at the time, no.
Lead Inquiry: When did it become apparent to you that containment was, to use your words, never going to have a significant chance of preventing infection entering the country or significantly slowing its establishment?
Professor Neil Ferguson: I mean, almost as soon as I heard that measures were – what the measures were and what was being done.
Lead Inquiry: Late January?
Professor Neil Ferguson: Yes.
Lead Inquiry: Why then did you – or perhaps that’s unfair. What did you make, then, of the government’s published strategy a month and a bit later, on 3 March, to have a contain and delay strategy?
Professor Neil Ferguson: I was always unsure quite what contain – as described in that strategy, what contain was intended to actually do.
I mean, that’s why I felt we needed to accelerate planning for other non-pharmaceutical interventions. I would say just in retrospect as well, I mean, there have been a number of studies of this, that community transmission of this virus – I mean Covid in the UK probably started in late January, and that’s been estimated using quite comprehensive genetic analysis. So, put in context, the effectiveness of the strategy.
Lead Inquiry: There was a SAGE meeting that you attended, it’s the second SAGE, on 28 January, where there is a reference in the consensus document to control measures, ideally infection control in healthcare settings and rapid detection of cases.
Why did you not say “I doubt whether any form of containment strategy will work, given the porous nature of the border and the lack of any significant testing capacity”?
Professor Neil Ferguson: Well, actually the example you gave of infection control in hospitals and testing was something I did advocate for. I strongly felt we needed to set up sentinel surveillance for the virus within the country. I mean, there was a period in February, January and February, where it was always being reported publicly that, you know, the UK has 20 cases, for instance, all of whom were travellers. Well, that was axiomatically true, because we were testing nobody but travellers, but – and I didn’t feel it was informative of what the true situation was.
Lead Inquiry: If containment outside the healthcare setting was never likely to work, then why was the government producing a strategy based on containment five weeks later?
Professor Neil Ferguson: You know, to be honest, I mean, I did not have prior sight of that document and SAGE was not consulted about it.
Lead Inquiry: Did you express views around that time, that’s to say the end of January, as to the degree or the likelihood of control measures working or what sort of control measures should be considered?
Professor Neil Ferguson: I might have to be more specific, but yes, I expressed my view of the likely effectiveness of a variety of border measures, and what proportion of cases coming into the country might be detected, and there were initial fairly general discussions about what types of measures might slow spread within the UK.
Lead Inquiry: Could we have INQ000148974, please.
This is an email string, Professor, between yourself and Professor Sir Chris Whitty, copied in to Professor Sir Patrick Vallance and Professor Sir Jonathan Van-Tam, who was then the Deputy Chief Medical Officer.
You can see that the top of the page is a forwarding of a lower email and more substantive debate to the persons I’ve mentioned, and also Professor Edmunds. In the middle of the page, you can see an email from John Edmunds.
Over the page, on page 2, there is an email from you dated 29 January, 11.12:
“… delaying arrival requires either stopping travel from China or very intensive screening and follow-up of travellers. We can provide some crude estimates …
“If you are more referring to delaying the peak of the epidemic via public health interventions, it is harder to produce predictions. There are two broad classes of such interventions … case based such as isolation of cases and contact tracing; and … community level interventions – principally school closure.”
Professor, in principle, there were, of course, other measures which can be put into place to deal with a spread of a disease with an outbreak of pandemic, not just principally school closure.
Why did you not mention the possibility of other perhaps more stringent whole society interventions?
Professor Neil Ferguson: I mean, because the focus of Chris’s email there was on things we could do to delay the peak, and so the evidence – so there’s, as you’ll be aware, almost certainly know, the formal evidence base around different non-pharmaceutical interventions, because they’re rarely used, is quite limited. The one intervention which has been used quite frequently for respiratory virus outbreaks has been school closure.
Lead Inquiry: Where is the debate in this email, though, about: well, this is not a flu pandemic, different measures may have to be considered, depending on the spread of the virus more drastic, stringent, whole-society interventions may have to be considered, and might it be too late anyway to stop the influx of the virus because of the containment debate that you’ve already referred to?
Professor Neil Ferguson: So a couple of paragraphs down you’ll see I discuss, you know, how the different epidemiological characteristics of the virus, whether it’s SARS-like, which we didn’t know at the time, versus more flu-like, ie much more mild disease, would influence the effectiveness of the interventions.
I mean, I was addressing Chris Whitty’s, who is the Chief Medical Officer, direct question rather than saying – giving my view on potential strategy, I would say.
Lead Inquiry: If we could have INQ000047654, this is an email three days later. And if we could have page 5.
It’s between the same, broadly the same participants.
If you would just go back, I’m sorry, one page. It may be that that last part is from Professor Sir Chris Whitty. Yes, it is.
This is the email from you, on page 4, dated 2 February.
“… it is quite likely (but not certain) that there have been a number of undetected importations into the UK … Detection rates are not going to be anywhere near 100%. This doesn’t mean we shouldn’t take the optimistic view that it is still worth trying to prevent more importations, but it does change the assessment of the likely impact of the new measures and therefore the cost-benefit of those measures.”
What was that reference to “cost-benefit balance” a reference to? What did you have in mind when you referred to that balance?
Professor Neil Ferguson: I mean, in terms of the proportion of our Public Health England, resources which should be dedicated to, for instance, targeting travellers versus targeting community surveillance, for instance.
Lead Inquiry: So are you saying that if you apply some sort of border restrictions, you’ve got to consider, as a government, how effective they are, how irritating they are, what they’ll cost travellers and the public, against how effective they will be in stopping the influx of the virus?
Professor Neil Ferguson: Yes.
Lead Inquiry: It does appear, Professor, there that you are engaging directly in the policy debate as to the imposition of a measure and therefore straying beyond the mathematical modelling or the epidemiological modelling side of things.
Professor Neil Ferguson: I was pointing out that, you know, what turns out to be true, the effectiveness of measures would depend on the epidemiological situation. I wasn’t, I don’t think, there expressing any value judgement as to what measures should be adopted.
Lead Inquiry: At the time of these emails, at the beginning of February, was there a general acceptance, Professor, that the virus was unstoppable, that it would inevitably infect the United Kingdom, and that very little could be done to stop it washing through the population?
Professor Neil Ferguson: I mean, again you’ve combined, you know, multiple different concepts there. I think we felt it would be extremely difficult to prevent it entering the UK. You’ll find reference in later SAGE minutes to the potential benefits of more draconian border restrictions in terms of the delay which might be attained. I think at that time we were saying relatively little about – you know, certainly nothing specific about the feasibility of stopping spread within the United Kingdom.
Lead Inquiry: To what extent did you and your colleagues, in particular Chris Whitty, Patrick Vallance, Jonathan Van-Tam, Jenny Harries, believe that the virus, if it spread through the United Kingdom, would result in a wave, a wave of infections, and that it would be practically very difficult, if not impossible, to stop that wave proceeding through at least a significant part of the population?
Professor Neil Ferguson: So I think I’m on record, I think I gave an interview even in late January, or certainly early February, saying that I felt the world was at the beginning of a global pandemic. If the question is did I anticipate the use of intensive non-pharmaceutical interventions to suppress transmission at that point, no, I didn’t. Did I know that they were in theory able to be used? Yes, I mean, I’d studied the use of such interventions both for SARS but, probably more relevantly, in the 1918 flu pandemic in the United States.
Lead Inquiry: But it was apparent, was it not, you were addressing the risk that the virus would enter the United Kingdom, that it would essentially get out of control, and steps would have to be taken to control it? Where is the general debate at this stage of what sort of control measures, NPIs, might have to be considered?
Professor Neil Ferguson: I mean, I think the debate – well, if there was a debate, it was occurring within government. There wasn’t a debate in terms of – well, I mean, my perception is it wasn’t the role of SAGE to, you know, determine strategy, so there wasn’t that debate. You’ll see in all of these instances, and you have many instances, I addressed the questions being asked.
Lead Inquiry: But these are private non-SAGE emails where you’re not bound by the self-imposed constraints of SAGE, you are discussing control measures, you refer to schools, why wasn’t that debate being held in this alternative forum of your communications with your colleagues?
Professor Neil Ferguson: Well, it’s more than just a colleague, if it involves the Chief Medical Officer and both Deputy Chief Medical Officers, it’s a communication between me as an independent scientist and government employees.
Lead Inquiry: Professor, were these SAGE-related communications or were they emails between you, Professor Ferguson, and the CMO, the DCMO, and Professor Edmunds, Jenny Harries ? Who was I think, or became, another DCMO, but Professor Edmunds was not, of course.
Professor Neil Ferguson: I mean, I viewed them as an extension of discussions at SAGE.
Lead Inquiry: In your statement, you say that one of the problems that was encountered at this time by yourself and your colleagues was that there appeared to be no systemic consideration of the costs of control measures or NPIs against the benefits and what the cost might be of inaction, and you’ve referred, of course, there to cost-benefit.
Did anybody take any steps to say, in the context of SAGE or to the government by one of these emails, “We need to have a structure put in place for working out the cost-benefit of the various measures which might, God forbid, have to be considered”?
Professor Neil Ferguson: I don’t believe – I mean, I can’t think of an instance of that happening. I mean, there was some discussion of cost-benefit, but certainly it was – I think we did not – none of us evaluated properly the cost of inaction, let’s say.
I have to say we did not have the capability of doing so. I mean, within the Imperial College group, that – to be able to do that thoroughly would require, you know, a dedicated group.
Lead Inquiry: But these emails show, Professor, don’t they, that you’re not engaging in a dry epidemiological mathematical modelling debate, you are discussing matters of policy here and cost-benefit and the feasibility of particular measures?
Professor Neil Ferguson: Yes, of course. Yes, I mean, there’s some discussion of feasibility.
Lead Inquiry: You referred to your views on whether or not the lockdown intervention in Wuhan was likely to be effective, and again you’ve said that in January 2020, in late January 2020, your view was you had concerns or doubts as to whether it would be effective.
Some of your colleagues were more confident that it would be effective. What was it that caused you to change your mind about the efficacy of the Wuhan lockdown?
Professor Neil Ferguson: I mean, the trends in reported cases and deaths coming out of Wuhan.
Lead Inquiry: Was that information that was available to those other colleagues who took a more confident view of the likely outcome?
Professor Neil Ferguson: I mean, we shared all information internally.
Lead Inquiry: Were some of your colleagues quite strongly of the view that containment had been – was being tried in Wuhan and was at least likely to work to the extent that it was worth trying or investigating further in the United Kingdom?
Professor Neil Ferguson: Yes, a minority of my colleagues, yes.
Maybe I should put it into context. I mean, we rarely had discussions internally of strategy, but of course it did come up, and there were a diversity of opinions expressed by different colleagues.
Lead Inquiry: Another area, again in this theme of the broad conceptual issues, in January and February that was the subject of debate, and you’ve referred to it in your witness statement, was the way in which the government attempted to ascertain what the reasonable worst-case scenario might be.
Why did that matter?
Professor Neil Ferguson: I mean, because the reasonable worst-case scenario is the scenario which the government should be planning to cope with, in theory at least, in any civil contingency, any crisis.
Lead Inquiry: Is the reasonable worst-case scenario a planning tool, if you like?
Professor Neil Ferguson: Indeed.
Lead Inquiry: There was a considerable debate, was there not, on the subject of what the reasonable worst-case scenario should be interpreted to mean and whether or not it was likely that we would find ourselves in a position in which we were in the reasonable worst-case scenario?
To what extent do you think that that debate about a planning tool prevented a more significant substantial debate about the reality of policy responses and what should be done on the ground to stop the spread of the virus?
Professor Neil Ferguson: I mean, potentially significantly. I was always uncomfortable with labelling what I felt was our central estimate as being the reasonable worst case. Because calling it the reasonable worst case, even if in theory policymakers are meant to be planning to it, makes it sound like it’s an unlikely eventuality, whilst in my view it was the most likely eventuality if nothing more was done.
Lead Inquiry: I now want to look at, please, this issue of the infection hospitalisation rate and the infection fatality rate.
In your statement, you tell the Inquiry that the Covid response team of Imperial College London, or maybe Imperial College London, I don’t know whether the response team was already in operation at this time, but in any event ICL produced two reports. They were put the MRC, the Medical Research Council, GIDA website, your website, on 17 and 22 January.
Those reports made extremely important points, did they not, about the under-ascertainment of likely cases in Wuhan? And you concluded, didn’t you, that the number of real cases was likely to be a multiple of those cases which the press and the government announcements in China had indicated?
Why was it so important to get to the bottom of what the reality was of the outbreak in Wuhan?
Professor Neil Ferguson: I mean, it was important for two reasons. First, to understand what the – what stage of an epidemic we potentially were at, how large it had reached and therefore it was the risk of external export of cases. And secondly because, at the time, it wasn’t certain at all whether there was human-to-human transmission going on.
The speculated cause of the outbreak was, you know, exposure of people to a zoonotic source, to an animal source of virus. Now, history tells us that’s plausible if you have a dozen, maybe two dozen cases, but if you’re estimating thousands of human cases, it becomes very implausible, much less plausible, that those were all infected by zoonotic exposure, much more likely that we’re seeing human-to-human transmission. Self-sustaining human-to-human transmission.
Lead Inquiry: The press and government organs in China were reporting on deaths and the numbers of people who were hospitalised, but did that give you any idea of the number of people who might have had the virus in a mild way and were not, therefore, being reported on, or who were asymptomatic, that is to say showing no symptoms at all?
Professor Neil Ferguson: So those first two reports, no, because the basic approach they took was to look at cases being detected in third countries outside China through border screening, and that border screening was typically for symptomatic cases. Some countries like Japan and Thailand especially implemented that border screening very early, but those cases were symptomatic cases, and in several cases were actually hospitalised with quite severe symptoms. So even those analyses, why they produced estimates of thousands of cases, were not characterising the full picture of the scale of the epidemic.
Lead Inquiry: When were you able to ascertain, estimate that there were very large numbers of infected persons who were suffering from the virus, either in a mild way, not requiring hospitalisation, and of course not dying, or who were asymptomatic?
Professor Neil Ferguson: So with respect to Chinese – China, that data came from repatriation flights of non-Chinese citizens back to their home countries, and for many of those flights everybody on board was screened with a PCR test irrespective of whether they had symptoms or not. That was a bit akin to the later ONS infection survey, it gave us a measure of infection prevalence at one point in time. And using that, making some assumptions, one could calibrate the scale of the epidemic, the true scale of the epidemic in Wuhan.
Lead Inquiry: As a result of this very clever analysis, and you relied in part upon working out how many flights had left Wuhan and how many people had spread and therefore how many people were likely to be infected, did you and – by you I mean ICL – did ICL and SAGE apply a working presumption from the beginning of February that one-third of infections could be asymptomatic and that asymptomatic cases would be around one-third less infectious than symptomatic cases?
Professor Neil Ferguson: Yes. The first was a reasonable assumption based on data. The second, that there would be less – I mean, less infectious, was a working assumption, we had no direct data for it, but it was consistent with patterns in other respiratory viruses.
Lead Inquiry: And later research and data throughout the course of 2020 and in fact 2021 showed that your estimates were actually pretty accurate?
Professor Neil Ferguson: Yes.
Lead Inquiry: So from early February it must have been apparent to you and to SAGE that if a large proportion, 35%, one-third roughly, of infected persons were asymptomatic, that there was a very great risk that the virus would spread, because if people are asymptomatic you just can’t tell whether they’ve got it, in the absence of testing, and there was no real testing, was there, either at the border of the United Kingdom or in the community, as you’ve described?
So why, at the beginning of February, was SAGE and your own professional colleagues in Imperial College not telling the world as clearly as could be done: the nature of this virus and the nature of the disease is it is almost certain to reach us and in very large numbers?
Professor Neil Ferguson: I mean, I think I – I mean, I’ve referred, I think my 12 February Today programme interview, where I said we were in the early stages of a pandemic, that it was going to be, you know, a global pandemic and that up to 80% of the – if we did nothing, up to 80% of the UK population would get infected in the following few months, and that up to 1% of them might die. I mean, I think that’s quite a clear …
Lead Inquiry: But where is that warning, Professor, in your own private emails to your professional colleagues outwith SAGE, and in the SAGE minutes and the SAGE consensus documents –
Professor Neil Ferguson: I mean, they’re buried in the planning assumptions of the SAGE documents, but those estimates were discussed at length within SAGE meetings.
Lead Inquiry: In the context of planning debate, in the context of –
Professor Neil Ferguson: I mean, I would agree if – if your implication is there was perhaps too much focus on refining estimates and reducing uncertainty, and not enough on, let’s say, operational planning – which of course we did not have visibility of in SAGE – then that might be true.
Lead Inquiry: So you agree that there was too much focus on perhaps the scientific or the data issues, rather than pointing out what must have been apparent, which is a major pandemic was inevitable?
Professor Neil Ferguson: I mean, I think that’s maybe slightly unfair. I mean, we had already a planning – planning scenario which NHS England, PHE, DHSC were meant to be producing, you know, a policy response to, which was in my view fairly catastrophic. I mean, the role of SAGE was to provide scientific evidence into that process, not to come up with policy.
Lead Inquiry: But you, Professor, were, as we’ve seen from these emails, engaging in policy debate?
Professor Neil Ferguson: I was engaging in debate about the likely effectiveness of different policy options.
Lead Inquiry: Having understood that the virus had a very large percentage, 35%, that was asymptomatic, and that there were, in practice – there was very little that could be done by way of containment or control, why was it important to then work out the percentage of people who might die or would die from the infection level? Why did that matter?
Professor Neil Ferguson: Because with a highly transmissible respiratory virus like Covid, and we were estimating an R number of between 2.5 and 3.5, then some basic epidemic theory would tell you that if that virus spread uncontrolled in a population, then over the first, you know, six months or so you would get a very high proportion of the population infected. Not everybody, but somewhere between 60% and 80%. And therefore knowing what proportion of that very large number of people were at risk of dying from the virus was critical to evaluating the public health impact, and also, by implication, what the level of proportionate response should be for the government.
Lead Inquiry: And presumably you would also say, under that heading of the public health impact, what the figures were for the number of persons who might be hospitalised?
Professor Neil Ferguson: Yes, I mean, that took somewhat longer to develop.
Lead Inquiry: When did ICL first estimate the likely infection fatality rate for this virus, an estimate that turned out to be, in fact, extremely accurate?
Professor Neil Ferguson: I mean, the first estimate which wasn’t stratified by age, though we did know about the age distribution of deaths, was 12 February. That was highly uncertain, and then we had a much more refined estimate by, I would say, the first week in March.
Lead Inquiry: Why was it necessary, why did in fact, we can see from the dates, four to five weeks elapse before that vital figure, how many people would die, could be bottomed out, could be certified as being, “This is our final position and this is the figure we can rely upon”?
Professor Neil Ferguson: There was a hesitancy for – by SAGE to rely on any single piece of evidence, and particularly coming from a single group, and therefore there was a desire to have it confirmed by other sources, which is what the London School of Hygiene and Tropical Medicine did to a degree in terms of the analysis of the Diamond Princess data. Then there was a desire to then translate that infection fatality ratio estimate into estimates of the impact on the health service.
If you’re asking why did it take so long, I mean, I was somewhat frustrated as well.
Lead Inquiry: The figure, the IFR figure, was the single most important figure in terms of working out how many people would be likely to die. Probably matched by the IHR figure, working out how many people would require to be hospitalised.
Was there any basis for challenging Imperial College and its estimates on the basis of your professional provenance?
Professor Neil Ferguson: No, but there was challenge on the basis that we were basing it on very limited data from – scraped from Chinese websites at the time, and a limited number of data points on what the infection prevalence was, and so – I mean, SAGE grades, in some sense, evidence and estimates and it was, you know, viewed as being uncertain. I mean, I found that personally somewhat frustrating, but then, you know, I was partly responsible for generating the estimate, but if you look at the minute – as you say, it took several weeks for SAGE and SPI-M to accept the estimate.
Lead Inquiry: You were personally frustrated?
Professor Neil Ferguson: Yes.
Lead Inquiry: You were frustrated because this was vital information which went directly to the government’s ability to respond and to decide what that response might consist of?
Professor Neil Ferguson: Yes. And so I was pleased when it was finally accepted as a reasonable worst-case scenario. But, as you’re aware, that took some weeks longer.
Lead Inquiry: It was only in fact at the beginning of March that your figures for infection fatality rate, a value of around about 1%, were accepted for use as an NHS planning assumption. I think it was formally accepted on 26 February. But there then had to be a meeting, which there was on 1 March, to discuss the accuracy; yes?
Professor Neil Ferguson: Not quite. The meeting on 1 March was less about discussing the accuracy of the IFR figure, but involved clinical colleagues with expertise in respiratory viruses and with intensive care to translate that figure into estimates of healthcare demand. So the proportion of people being hospitalised, the proportion needing intensive care unit, the estimate of how many days they would be in each of those settings.
Lead Inquiry: And broadly speaking, who attended that 1 March meeting which debated the likely –
Professor Neil Ferguson: We hosted it in my office.
Lead Inquiry: Who attended it?
Professor Neil Ferguson: It was attended by Peter Horby, I think maybe remotely, John Edmunds, Stephen Powis I think dialled in to it, some NHS planners. I mean, I’ve provided the full list, I don’t have it immediately to hand.
Lead Inquiry: Around about the same time, these figures for the infection fatality rate and the infection hospitalisation rate were put before SAGE, were they not?
Professor Neil Ferguson: Yes.
Lead Inquiry: So they were debated in fact in the SAGE meeting of 27 February. SAGE was attended, of course, by not just the academic groups but by representatives of the government, of the NHS, Public Health England, and so on and so forth. It must have been apparent to everybody at that 1 March meeting, and at the SAGE meeting on 27 February, that given the fatality rate and given the hospitalisation rate and given the number of people in our population, the number of deaths and hospitalisations would be enormous?
Professor Neil Ferguson: Yes. And more than that, we generated, I mean, model output on that day, spreadsheets, which were provided to NHS England, of the expected trajectory of the epidemic.
I should say those estimates of hospital demand were refined considerably over the following two weeks, because the original estimates were basically based on best clinical judgement rather than data, and it was only – it took – they didn’t change qualitatively but they did change quantitatively in that time.
Lead Inquiry: Some of the greatest brains in the land, Professor, the world experts on epidemiology, virology, pandemic response, were debating these figures. They weren’t going to go down by a multiple of 2 or 3, were they, thereafter? They weren’t going to go down to 1%, or 0.1%? You had correctly identified, broadly, the levels of death and hospitalisation –
Professor Neil Ferguson: Yes.
Lead Inquiry: – that would inevitably ensue?
Professor Neil Ferguson: I mean, as I say, in a qualitative sense, I would agree. I mean, they did adjust by about two-fold in terms of hospital demand, but that wasn’t a qualitatively important amount.
Lead Inquiry: So as at the end of February, the beginning of March, why was no one at that meeting saying, or at SAGE, “Well, hold on, with these sorts of figures for deaths and hospitalisation, it is plain as a pikestaff our system is going to be rapidly overwhelmed”?
Professor Neil Ferguson: I mean, I would say two things there. First of all, before the pandemic, the UK basic pandemic plan for dealing with these particularly extreme events, lethal pandemics, allowed for the fact that health – you know, healthcare demand would exceed the ability of the health system to cope, that emergency measures, surge measures and triage might need to be adopted. So there wasn’t – you’re right that I think everybody at that meeting recognised that the levels of demand were well in excess of standard capacity, but that wasn’t out of line with all previous planning around lethal pandemics.
Lead Inquiry: So, what, those deaths would take place, the hospitalisations would occur and the system would be overwhelmed?
Professor Neil Ferguson: The thing that meeting did not – all that meeting considered what an unmitigated pandemic would look like. So if the government did absolutely nothing. I mean, that was the reasonable worst-case scenario. I think a lot of the work in the following week or two was around the extent to which that could be modified and how.
Lead Inquiry: These were self-evidently matters of life and death. The government did not start contemplating the possibility of the top control measure, the lockdown, mandatory NPIs, until around about the 13th, we’ll put it in a broad way, the 13th to the 16 March?
Professor Neil Ferguson: I wasn’t actually aware of what the government was considering and wasn’t considering at the time. I mean, in terms of what was going on within COBR, I had no visibility of COBR.
Lead Inquiry: But you had hitherto not been averse to emailing your thoughts on policy matters to the CMO, the GCSA, Professor Edmunds?
Professor Neil Ferguson: I mean, the CMO and GCSA, there was a complete Chinese wall between SAGE and COBR, so it was not as if SAGE meetings started with a readout from COBR about what the government were thinking and planning to do. We had almost no visibility of that. In terms of operational planning.
It wasn’t clear, for instance, that exceeding healthcare demand, NHS capacity, was an absolute red line, really until, I would argue, 14 March. In terms of what we – had been communicated to us as independent members of SAGE.
Lead Inquiry: But that elapse of time from the end of February to 14 March is a passage of time which plainly can’t be got back, but it was plainly not desirable, it was not inevitable – you describe in your statement your regret at the fact that it took five weeks to get these figures bottomed out – and then there is another two-week gap or delay before practical measures are started to be contemplated. How can that possibly have happened?
Professor Neil Ferguson: I mean, I think I may put it in my recommendations for learning lessons for the future. The artificial divide between scientific advice and then operational planning and response was a hindrance. We had very little visibility of what was going on in terms of preparedness within government. I would occasionally, at the, you know, margins of SAGE meetings, hear a little, but nothing definitive. I think even more so was the lack of visibility of what government red lines were, what were the absolute constraints that policies had to adhere to, you know, never – I mean, red lines is one way of putting it. Objectives would have been nice as well.
Lead Inquiry: Why, as an expert professor in mathematical modelling and epidemiology, why – if you’ll allow me to say so – as a plainly intelligent human being, why, as a human being, do you need to wait for the government to tell you what its red lines are before you raise the alarm in the greatest way you possibly can?
Professor Neil Ferguson: It depends what – I mean, what do you mean by raise the – I mean, I think I was clear in communicating the magnitude of the threat, in public pronouncements and private pronouncements. But it may be –
Lead Inquiry: Well –
Professor Neil Ferguson: You elaborate.
Lead Inquiry: At the 5 March meeting of SAGE, at which you were a participant, there was a debate about whether there were scientific grounds to move away from containment efforts in the United Kingdom, there was a debate about large gatherings. SAGE concluded there was no evidence to suggest that banning large gatherings would reduce transmission. There was a debate about what the figures were, the IFR, the IHR, the CFR, but there doesn’t appear to be the clearest of messages to the government saying: our figures now show that the number of deaths and hospitalisations are so massive that the NHS and the healthcare system will be overrun.
Professor Neil Ferguson: I mean, that was about the same. It is not minuted, you’re completely right, but that was about the time where both John Edmunds and myself got concerned about the slight air of unreality of some of the discussions and did start talking in the margins of – to members – well, let’s say government attendees at SAGE, saying, you know, “Do you know what this is going to be like?” I mean …
Lead Inquiry: So are you saying there was this debate but it wasn’t minuted? In which case, my next question will be –
Professor Neil Ferguson: There was a –
Lead Inquiry: – how – how – Professor, could something of such import not be minuted?
Professor Neil Ferguson: I mean, I am not the person to ask.
Lady Hallett: Can I just ask, Mr Keith put to you that one of the matters that was debated was whether banning mass gatherings would reduce transmission. As a layperson, it seems to be a rather simple question: if you stop people getting together then they’re not going to get infected. Can you remember what the debate was?
Professor Neil Ferguson: Yes. So the issue is about what proportion of time – maybe I’ll start again. So mass gatherings I think intuitively sound like risky things, because you might have 10,000 people together, but for a virus which transmits through close contact, in fact if you have only one infected person they’re no more likely to generate large numbers of infections than they would be, for instance – in a pub, for instance, or a theatre.
Lady Hallett: So they’re going to infect the people around them?
Professor Neil Ferguson: Around them.
So the question there is about proportionality. There is a tendency to target football matches, for instance, but in fact that’s outside, generally, the transmission risk is low.
If you look at an analysis of where people spend their time, the venues where that sort of transmission is much more likely to occur are hospitality venues, for instance. I mean, this is a point I make, you have it on record in an email exchange with Chris Whitty. So in assessing the generic – in some, sense a busy pub has a hundred people in it, it is a mass gathering, indoor mass gathering, people very close together for many hours. It was my view that posed much more of a risk than occasional outdoor sporting venues, because many more people attend pubs than attend football matches.
Lady Hallett: Thank you.
Mr Keith: I think, Professor, the government was much vexed about the issue of mass gatherings and it repeatedly asked SAGE for its commissioned advice, did it not?
Professor Neil Ferguson: Yes.
Lead Inquiry: So this issue was visited by, was discussed by SAGE twice in late February and then again, as I’ve said, on 5 March. On 27 February you said this:
“I now believe it is more than 95% certain that transmission is already established here, so from that perspective holding the Six Nations matches will make no difference.”
Is that because –
Professor Neil Ferguson: So it’s in the context that the major concern was around people, you know, travelling between different countries. And also, to put it into context, 250,000 people fly into the UK every day, so it is a matter of degree rather than … there are lots of public health measures which will have a small impact, and the tendency is to say, well, we should do everything, but in reality you want to target the measures which are going to be effective.
Lead Inquiry: It’s like throwing, you would say, a lit match upon a fire. If the virus is already established in the United Kingdom, it doesn’t make any difference in general terms whether or not there is a single gathering?
Professor Neil Ferguson: Yes.
Lead Inquiry: But what about, and this is I think what lay behind, perhaps, if I might suggest, my Lady’s question, what about the precautionary principle? You, around about that time, made the very valid point that, on a precautionary basis, closing schools would be justified, because even if you couldn’t show a direct epidemiological link to a reduction in spread and a break in the chain of transmission, it looks good, it looks right, it shows you’re serious about trying to stop the transmission. Wouldn’t that approach apply equally to mass gatherings?
Professor Neil Ferguson: Not to the same degree. It’s not to say there would be no impact of it, but our best estimates of the impact would be it would be much lower than, for instance, closing schools.
Lead Inquiry: Well, that’s a relative answer, isn’t it? I’m asking you in absolute terms: why wasn’t the precautionary principle applied to this same issue of mass gatherings as it was to the closing of schools?
Professor Neil Ferguson: I would say that the question we were asked was what the likely effectiveness of the measure would be. So if you’re asking about effectiveness, I mean, I’ve given you an answer that on its own – as part of a suite of measures of course, these things add up, but on its own, as a single measure, it would have a very small impact on the trajectory of the pandemic.
Lead Inquiry: As we’ve seen from the emails, you weren’t averse to going beyond, quite understandably, a narrow issue of what would be the epidemiological answer to questions of policy and measures and efficacy and breaking transmission. Why did you not say –
Professor Neil Ferguson: Well, I would say that is part of the – there’s – talking about efficacy and talking about effectiveness and relative effectiveness is, I think, well within my area of expertise. Talking about should the government therefore do something, is something different.
Lead Inquiry: But you do agree, don’t you, that there are plenty of examples where you do say the government should do something?
Professor Neil Ferguson: I mean, plenty of – I mean, the examples I can think of most in those early days was about just ramping up testing and getting some decent surveillance into place so we knew what was going on.
Lead Inquiry: And control measures and cost-benefit analysis and economic considerations, all the stuff of policy?
Professor Neil Ferguson: I mean, yes. I mean, I would have – compared with past emergencies I’ve been involved in, I saw less evidence of, let’s say, behind-the-scenes government planning.
Lead Inquiry: So I was asking you about the SAGE meeting of 5 March. At that stage, in early March, was SAGE still advising a mitigation as opposed to a suppression strategy?
Professor Neil Ferguson: I mean, SAGE was still considering a mitigation rather than a suppression strategy, yes. I mean, that was the … the government strategy laid out in the 3 March Covid plan was one effectively of mitigation.
Lead Inquiry: What sort of mitigation measures did you or SAGE have in mind on 5 March as being effective in support of the mitigation strategy?
Professor Neil Ferguson: So the first one was – we didn’t have testing, of course, but isolation of symptomatic cases and the households of symptomatic cases.
Lead Inquiry: So just pause there. Telling the population that if you show symptoms you self-isolate?
Professor Neil Ferguson: Yes.
Lead Inquiry: And your family?
Professor Neil Ferguson: And your family self-isolate.
Lead Inquiry: All right. So that’s a –
Professor Neil Ferguson: I mean, that was – and that was indeed the first policy actually announced. Other measures we considered were reducing social contacts and workplace contacts. School closure has already been mentioned. There was an extensive debate around that time about measures which were particularly targeted around shielding the elderly, because it was known that that age group was most at risk. Those were the measures being modelled.
There was also discussion within SAGE as to the particular risk associated with care homes and the need to improve infection control in that setting.
Lead Inquiry: But there was no recommendation made in early March about care homes, was there?
Professor Neil Ferguson: I mean, the risk from care home – of care homes was discussed in – I mean, I raised – actually I can’t remember the precise date, I think it was all the way back in February, the risk of care homes, because there was early evidence of outbreak in care homes from the United States, I think Seattle in the first instance.
Lead Inquiry: You did raise the issue of infection in care homes, and also the issue of nosocomial infection in hospitals, and the evidence shows, doesn’t it, that a large percentage of the deaths suffered in the United Kingdom were in both those places.
Professor Neil Ferguson: Yeah.
Lead Inquiry: But at the beginning of March, although you’ve said you debated care homes, SAGE made no recommendations in fact for restrictions on care homes, other than the general self-imposed obligation to isolate you and your family members in the event of symptoms?
Professor Neil Ferguson: I mean, to be honest, I cannot – I mean, I think it was – in relation to care homes, it was more Chris Whitty and Patrick Vallance agreeing and talking – I think Jenny Harries had a responsibility – within a SAGE meeting and saying that improving infection control in care homes was a priority. Again, I mean, the minutes may not reflect that.
Lead Inquiry: You weren’t confident, were you, at the beginning of March that these relatively limited measures, reflective in fact of in terms of –
Professor Neil Ferguson: Flattening the curve, yes.
Lead Inquiry: Flattening the curve, but also having their genesis to some extent in flu pandemic strategy, because you weren’t talking about lockdowns here or stay at home orders or shutting of workplaces. Were you confident that they would prevent the sorts of levels of death and hospitalisation which you had indicated by the end of February would otherwise inevitably occur?
Professor Neil Ferguson: The best we were able to achieve in – I mean, in modelling terms, but combining these interventions, in a mitigation sense, was a – about a halving of deaths, mostly down to shielding, it’s an open question how successful that would have been as a policy, and maybe a 70%, maybe slightly more if there was spontaneous behaviour change, reduction in healthcare demand. The challenge is that we were talking about levels of healthcare demand which were more than ten-fold above what the NHS could potentially cope with and therefore a 70% reduction was not sufficient.
Lead Inquiry: So why did SAGE recommend and why did you throw your own personal authority behind a recommendation that was, in effect, a half measure?
Professor Neil Ferguson: I mean, say – I would say SAGE was working to the – what we understood was the government policy of wanting to do its best to mitigate the epidemic but not risk a second wave in the autumn.
Lead Inquiry: But the primary objective was surely to prevent death and to stop the transmission of the virus. Why were you waiting for clarity to come about the government’s own strategy? Why did you need to know what its red lines were before you made a perfectly sensible recommendation, “Half measures mitigation are just not going to work we need suppression”?
Professor Neil Ferguson: So the challenge with suppression is what does it lead to. It delays matters at enormous – I mean, enormous – societal and economic cost, but what do you do next? And so the SAGE discussions, such as they were around this issue, were looking in the one-year timeframe or longer, you know, where would the UK be then, and that – I mean, Chris Whitty in particular was concerned about what would be happening in the autumn.
Lead Inquiry: So is this the position: there was a fear on the part of SAGE and its constituent parts, its participants, that if you suppressed, if you pushed R0 down below 1, if you clamped down hard on the virus, it would re-emerge later like an uncoiled spring in a vicious overwhelming second wave?
Professor Neil Ferguson: I mean, that was the initial concern around those measures.
Lead Inquiry: Why was it assumed that there would be a second wave, or rather was consideration given to whether or not measures might have been able to be taken in the meantime in May, June, July, August, September, October, November, to make sure there wouldn’t be a second wave, for example a developed test, trace, isolate and support system?
Professor Neil Ferguson: I don’t remember that being discussed but there wasn’t a lengthy discussion of suppression-type strategies in SAGE until the middle of March.
Lead Inquiry: You say in your statement that:
“[You] did not strongly advise for a switch to a suppression strategy prior to March 13th, in part because of my belief that it isn’t the role of scientific advisers to determine policy … but also because I was very conscious of the huge economic and social costs which would be entailed by long-term and intensive use of NPIs …”
Why was it a concern of a mathematical epidemiologist, no disrespect, to determine matters of economic and social cost and to undertake this cost-benefit analysis?
Professor Neil Ferguson: Well, I mean, first of all, I mean, public health, there is a strong tradition within public health of looking at cost-benefit in the way we operate our health system, in the way we judge the proportionality of interventions. I mean, cost is weighed against benefit, both economic cost and other more, let’s say, nebulous costs.
Lead Inquiry: Professor, where is the emergency call to the government at the beginning of March, two weeks before the 13th when it kicks off, where you say or SAGE says, “We have to turn to a suppression strategy because of the risk of the high levels of death and hospitalisation, but for you, the government, you’ll have to work out the cost-benefit analysis, you’ll have to work out whether the cost of suppression is worth it”?
Professor Neil Ferguson: I mean, I think Chris and Patrick were at every SAGE meeting and were very well aware of that. I wasn’t clear on what was being communicated to government or not, as some of the later emails you refer to make clear.
Lead Inquiry: I said where you or SAGE, not Sir Patrick or Sir Chris, where does SAGE say that, at the end of February and in the first week of March?
Professor Neil Ferguson: I mean, as I’ve said before, the role of SAGE is to answer the questions addressed to it.
Mr Keith: My Lady, is that a convenient moment?
Lady Hallett: It is.
Sorry, it’s time for another break, Professor, you might welcome one as well. 15 minutes, please.
(3.11 pm)
(A short break)
(3.25 pm)
Lady Hallett: Mr Keith.
Mr Keith: So, Professor, we come to the beginning of March 2020, and the government, as you’ve correctly reminded us, publishes its Coronavirus: action plan in which the first stage is contain. And that wasn’t something that you’ve told us was debated with SAGE. SAGE didn’t know that the government was publishing that plan. You must have been quite surprised to see the promulgation of a new plan which contained as its first stage contain, when, as you’ve described very ably to us, you had very real doubts and had had very real duties for a matter of weeks as to whether contain could ever work.
Professor Neil Ferguson: Yes. It was one – probably the only point of disagreement I had with Chris Whitty about the extension of the contain phase.
Lead Inquiry: A couple of days later, on 5 March, SAGE sat, met, and its consensus document concludes:
“There are currently no scientific grounds to move away from containment efforts in the United Kingdom.”
What did that mean?
Professor Neil Ferguson: I mean, there was a debate around containment and Chris gave his view, which was, I think, largely around the fact that – didn’t want the UK to be the first country to move away from that. I mean, I – from memory, I expressed the view which I’ve expressed previously, that I didn’t feel contain was succeeding. To be honest, I don’t know quite where that central opinion, let’s say, of those minutes came from.
Lead Inquiry: Are you saying that because there was a disagreement as to the efficacy of containment, SAGE alighted upon that phrase “there are no scientific grounds to move away from it”?
Professor Neil Ferguson: I mean, you would have to ask the person who drafted it, but yes, that might be …
Lead Inquiry: Professor, you were at the meeting, a most important member of that committee, and you take responsibility, as with all the members, for the documents and the minutes, the documents produced by your committee. What did it mean?
Lady Hallett: Is that right?
Professor Neil Ferguson: No. I mean, we’re not –
Lady Hallett: If you get to approve the minutes – did you get to approve them?
Professor Neil Ferguson: No, not from memory. We get circulated the summary, but we don’t approve the minutes. It’s not like NERVTAG where you edit the –
Mr Keith: Was this document circulated to you at any time before it was published and put into the public domain?
Professor Neil Ferguson: Oh, you always get copies of the summary.
Lead Inquiry: And when you saw this phrase – did you see this phrase in the summary?
Professor Neil Ferguson: Yes.
Lead Inquiry: Right. When you saw that phrase in the summary, which was given to you, did you think to yourself, “Well, that’s not a fair reflection of the debate”?
Professor Neil Ferguson: I thought it was a diplomatic form of words.
Lead Inquiry: To what extent was Sir Chris’s discomfort at the idea that the United Kingdom would be the first country to abandon containment a driver of that conclusion?
Professor Neil Ferguson: I mean, I think it was probably the most significant driver.
Lead Inquiry: By 9 or 10 March, you were extremely concerned, were you not? You had had, for now a matter of four to five weeks, the basic figures in relation to infection fatality rate, infection hospitalisation rate. You could see that the containment policy didn’t stand a chance, and the debate was still raging about whether or not suppression or mitigation was the right way to go.
Professor Neil Ferguson: I mean, I’m not sure that you would say the debate – there wasn’t much debate of that on SAGE itself. I mean, the thing I was most frustrated by was there still seemed to be a residual, I don’t know – a sense I got that some in government hadn’t really comprehended the figures or didn’t think it was going to be as bad as it was going to be. A lack of a sense of urgency, let’s put it that way.
There was also a second challenge, which was it was very difficult to get NHS England to actually state on the record that the health service would be overwhelmed and what their surge capacity was, and in fact the first time they did that was on 13 March.
Lead Inquiry: That was the first occasion on which, to use your words, they put that information on the record, and you challenged them quite strongly at that meeting. But you had known for a considerable time before that meeting, informally, what the impact would be of your figures on the NHS?
Professor Neil Ferguson: Depending on the level of – obviously it wouldn’t be the NHS as normal. I didn’t know anything about what their surge capacity potentially was.
Lead Inquiry: Did you know weeks before they put it formally on the record that the number of deaths and hospital cases that you had estimated would result would likely overwhelm the NHS?
Professor Neil Ferguson: Yes, yes.
Lead Inquiry: Right. You emailed an official, an adviser in Downing Street called Ben Warner. I think you may have spoken to him on the phone to tell him that you were going to email him?
Professor Neil Ferguson: I don’t honestly remember.
Lead Inquiry: All right.
Could we have, then, that email, INQ000196055.
If we go to the second page, please, we’ll chronologically work backwards. We can see an email from you, director, of course, of the MRC Centre for Global Infectious Disease Analysis, and the body of the email:
“Thank you very much …”
Talks about bed demand per day, daily deaths, the peak. And you say this:
“As long as the PM and Cabinet accept and understand this is what is likely to happen and are still ahead to proceed with current plans, then there is a rational basis to that decision which I would say the science supports.”
To what extent, Professor, did you regard yourself as obliged to step out of your SAGE role and express views about government policy and the workings of the PM and the Cabinet in this way?
Professor Neil Ferguson: I mean, it felt uncomfortable, but at the time it felt like it needed to be said, because, yes, as I said, I was increasingly concerned about this disconnect between the numbers we were actually presenting and the reality of what that would actually look like.
Lead Inquiry: In the last paragraph you say:
“But what would be the worst outcome – in my opinion – would be to go for mitigation …”
And that of course was the current plan:
“… (the policy package currently being discussed) and for the health, social and political cost to be judged later to be unacceptable – necessitating a policy pivot in the midst of what will already be a national crisis.”
Did you mean by policy pivot a change to suppression?
Professor Neil Ferguson: Yes.
Lead Inquiry: Complete control of – or, I apologise, reducing the reproduction rate below 1?
Professor Neil Ferguson: Yeah.
Lead Inquiry: A lockdown in practice.
“We might still follow the currently planned measures for the next few weeks, but then much more intensive measures would need to be introduced. Which need to be thought about now.”
At this stage, when you alerted Downing Street to your concerns, what was the thinking in relation to when that wave would likely peak?
Professor Neil Ferguson: I mean, when it would peak would depend on the measures. I mean, in retrospect, we didn’t have a few weeks, as the next few days’ data indicated, but we were – I mean, we’ll come on to the topic of data streams, so …
Lead Inquiry: I’m going to ask you about Colindale, never fear.
What was the thinking about the wave and when it would peak? At this stage, as you were raising –
Professor Neil Ferguson: I mean, from memory, May – May-ish timescale, but obviously there’s a significant build-up, I mean, to something which was six, seven times worse than what we actually saw in April.
Lead Inquiry: Was the reality that the wave peaked significantly earlier?
Professor Neil Ferguson: No, I mean, the wave peaked because of the suppression measures adopted. But the – okay, I understand.
The epidemic, as we learned in the next few days, was at least two weeks further progressed than the surveillance data available at the time I wrote that email suggested.
Lead Inquiry: Was the reason for that (a), as you’ve already identified, the asymptomatic nature of a significant proportion of the virus meant that in the absence of testing it’s difficult to trace where it’s got to, and (b) the lack of understanding, because of the lack of testing, on the number of seedings, the number of places in the United Kingdom that the virus had already got to?
Professor Neil Ferguson: Yes, the epidemic was effectively hundreds of times larger than we had anticipated. Well, to be fair, probably about 30 to 40 times larger.
Lead Inquiry: In essence, because of a lack of a significant sophisticated surveillance and testing system?
Professor Neil Ferguson: Yes, which I would say that – I mean, both Patrick Vallance, myself, John Edmunds and Jeremy Farrar had repeatedly commented on this multiple times in SAGE.
Lead Inquiry: Then if we could go, please, to the prior page, the previous page, page 1, you say at the bottom of the page:
“Dear Ben,
“Good to talk today.”
Which is why I suspect you might have called him.
Professor Neil Ferguson: That probably was on the side of – on the SAGE meeting –
Lead Inquiry: On the margins?
Professor Neil Ferguson: Margins, yes.
Lead Inquiry: Because he attended SAGE, did he not?
“Thank you for sending this over [he says].
“I think the point you make is very valid, important and I will continue to raise it here.”
Then you email subsequently about the Prime Minister’s press conference.
On 11 March there is also an email, INQ000149013, this is an email to Professor Medley and a number of individuals copied in, including Professor Woolhouse in fact:
“See attached for edits. I think this is a little more balanced – especially with respect to the international situation, given the original draft was factually inaccurate in some respects …”
What report was it that you were editing or had edited?
Professor Neil Ferguson: This was a summary of the – which frankly was generated spontaneously by SPI-M members, it wasn’t commissioned, of the relative both benefits and drawbacks of suppression versus mitigation.
Lead Inquiry: It would appear that SPI-M had been discussing the international situation, so it wasn’t just an epidemiological or mathematical exercise, they were looking at the wider picture –
Professor Neil Ferguson: Can I interrupt?
Lead Inquiry: Yes.
Professor Neil Ferguson: I mean, we always looked at data. SPI-M was tracking the epidemic everywhere, and we were reading the scientific literature.
Lead Inquiry: You’ve seen the suggestion in a number of places that SAGE and SPI-M failed to pay sufficient regard to the position overseas and to overseas data, what was happening in particular. Is there any basis for that –
Professor Neil Ferguson: No.
Lead Inquiry: – suggestion? All right.
You then go on to say:
“With respect to ‘wait and see’. We don’t have time. That is akin to a policy pivot when it is too late.”
Is that the same point you were making in your email to Ben Warner?
Professor Neil Ferguson: Maybe can I elaborate?
Lead Inquiry: Please.
Professor Neil Ferguson: So the issue of timing of policies is fundamentally different between mitigation and suppression. So for mitigation you’re wanting to implement measures around the peak of the epidemic to effectively squash the peak. For suppression, on the other hand, you want to act as early as possible, because the magnitude of – the wave will come down if those measures are successful, but if an epidemic is doubling every four days, basically a week’s delay corresponds to four times more cases and deaths.
Lead Inquiry: Because of the exponential nature of a virus. But in reality, Professor, and in the event, it just didn’t matter, because measures had to be taken to stop the NHS being overwhelmed in any event?
Professor Neil Ferguson: Yes, I mean, what became clear on the – I think between the – particularly between the 12th and the 15th is that, first of all, the NHS, you know, gave us definitive figures, and secondly that I think – this is more from reading Chris and Patrick’s statement – that it was clearly viewed as unacceptable to have the NHS overwhelmed.
Lead Inquiry: To some extent, therefore, the whole debate about suppression/mitigation was swept away by the realisation that unless the maximum control measure was applied, and lockdown, a mandatory order, the NHS would collapse?
Professor Neil Ferguson: I mean, I would slightly correct you there. I would say there was – other debates were got on to – you know, following – after 16 March. I was actually – the type of measures we modelled in Report 9, which we’ll get to, is much more akin to what was announced on 16 and then 18 March than the mandatory lockdown. The issue around the necessity of the 23 March announcement was around quite how far progressed the epidemic had got by the time measures were introduced. I think this is a point that Mark Woolhouse has raised, that if you act earlier you can act with slightly less intensive measures. Still very disruptive, but not as intensive.
Lead Inquiry: Yes, I put the question on the basis that, in the event, it was, of course, the need to avoid the collapse of the NHS that led to mandatory measures being applied.
The SAGE meeting of 10 March was the first SAGE meeting at which, as you’ve described earlier, the potential risk to the care sector was debated significantly.
Professor Neil Ferguson: I think to the level of being minuted.
Lead Inquiry: To the level of being minuted. And I think the position is that there were no SPI-M-O models before 23 March that explicitly modelled care homes or the impact on the hospital sector?
Professor Neil Ferguson: I mean, that’s true, we modelled – all the models had age-related risk in them, and we were looking at shielding options for the elderly, but no models explicitly represented the care sector.
They did represent hospitals, in some sense, but we didn’t represent nosocomial – hospital-based transmission.
Lead Inquiry: You say in your statement that you were so concerned by the lack of data, and it was in the main a lack of data which had led to you not being able to model the specific sectors, that you sent members of your team at the Imperial College COVID-19 Response Team to PHE’s offices in Colindale. Why did you do that?
Professor Neil Ferguson: Well, I should elaborate. I mean, it’s – we have a close working relationship with what is now UKHSA, and the Health Protection Research Unit you mentioned at the start of this evidence session is a collaborative initiative between Imperial College, London School of Hygiene and Tropical Medicine and then Public Health England. And so we were used to working together. I just became aware that, at that time, there were – the staff were overwhelmed at Colindale in trying to pull the data together for both the central government, for SAGE and SPI-M. I mean, I could tell that from the fact that emails were coming through at, you know, past midnight. So I offered to provide some support in terms of people who could help put in place hopefully a better system.
Lead Inquiry: Then, as we heard earlier from Professor Steven Riley, it’s around that time that he produced the two papers that he did – he is, of course, a member of the Imperial College team – and the first of those papers was considered by SPI-M-O on 11 March.
I think it’s fair to say, Professor, that his reports were not welcomed by you. You were, in your response to him, quite critical of what you saw to be the assumption that what he was recommending would be adopted by the government. You said there will be no appetite for the draconian – such draconian measures. But his approach was, putting aside the policy impact, broadly correct, was it not?
Professor Neil Ferguson: I mean, it was an approach which ended up being adopted in terms of suppression. I mean, the issue – I mean, as you’re aware, there are multiple iterations of –
Lead Inquiry: Yes.
Professor Neil Ferguson: – of that. The first iteration, on 1 March, was, I mean – and I said to him at the time we would include containment options, which are much more similar to what turned into Report 9. I felt there were certain – so, I mean, Steven believed passionately from very early on that the country should lock down. He took a different view of that kind of interface between science and policy, and I accepted that.
So my – I had some particular technical concerns with the final report produced which you’re referring to, just in terms of the – some of the assumptions around, I mean, looking at how mitigation might fail but not looking at, for instance, how suppression might fail.
Lead Inquiry: Putting aside the technical changes and the editing, in broad terms, you saw the reports as intruding impermissibly into policy areas, did you not?
Professor Neil Ferguson: I had concerns at the way that they were written at the time would be seen – particularly if we put them out as an Imperial College report, and I said he was free – I mean, absolutely, obviously, free to do what he wanted with it, but if we put them out as an Imperial College report it would be seen as almost advocating on policy solution.
Lead Inquiry: But you had been advocating on policy in the press, to Ben Warner, to the CMO, CSA?
Professor Neil Ferguson: I mean, what I had been doing is warning – issuing warnings about was the government aware of what their policy was actually going to result in, I think.
Lead Inquiry: Did you debate publicly and with government officials the policy implications of the mathematical and epidemiological advice that you were providing?
Professor Neil Ferguson: Sorry, what do you mean by publicly?
Lead Inquiry: Did you talk about the policy consequences of your modelling in the press or in emails?
Professor Neil Ferguson: No. Not in that sense publicly.
Lead Inquiry: Did you communicate to Ben Warner in Downing Street –
Professor Neil Ferguson: Indeed.
Lead Inquiry: – your concerns about the measures, whether it should be suppression, mitigation, and what should be done?
Professor Neil Ferguson: Well, my – you’ve just covered them, emails to Ben Warner, which wasn’t … I did not view those emails as being advocating for a change of policy, more as saying: are you aware of what the current policy will cause and, you know, clearly, is the Prime Minister aware of that? It was a warning about the consequences.
Lead Inquiry: On 12 March – could we have INQ000149061 – you engaged in email communication with Professor Edmunds and Professor Farrar.
Professor Neil Ferguson: Yep.
Lead Inquiry: The email from you is at the bottom half of the page, Friday, the 13th:
“I think the message got across.”
What message was that? Was that the message at the SAGE meeting on that day?
Professor Neil Ferguson: Yeah.
Lead Inquiry: “I still think part of the issue is Chris hoping it won’t be as bad as we say.”
You expressed that view to your colleagues, Messrs Farrar and Edmunds. Did you say to the CMO himself, “I’m concerned that you appear to have a degree of optimism bias that it won’t be as bad as we all think it will be”?
Professor Neil Ferguson: Not in so many words. What I tried to do was reinforce the support for the estimates we were coming up with. I mean, I think Chris was naturally more, let’s say, conservative at accepting – and they were uncertain estimates.
Lead Inquiry: The email is obviously a conversation between yourself and Jeremy Farrar and John Edmunds. To what extent did you express these views openly in SAGE yourself on 13 March?
Professor Neil Ferguson: So on 13 March what I refer to in the second sentence there is the fact that I actually, I mean, my … I explicitly asked the question of Stephen Powis in the meeting of whether the, you know, what was the NHS surge capacity, which, in some sense, was outside the remit of SAGE, it’s an operational consideration, but by doing so – and then asked him, you know, could the NHS in any way cope with the current plan, you know, policy plans, and he said he would get back to me and did on the exact surge capacity but basically said no, there is no way the NHS would be able to cope.
Lead Inquiry: On 15 March, INQ000048089, page 2, you email Sir Chris and Sir Patrick.
Professor Neil Ferguson: I think it hasn’t updated for me. Ah, okay.
Lead Inquiry: If we could go back, thank you, if you would just go back one page, please, we can see in the middle of the page, email 15 March, 2020, 3.37 am, to Sir Patrick and Sir Chris:
“… I need to sleep now.”
Then, further down the page, figures, your thinking in relation to the impact upon NHS healthcare facilities and demand.
Then over the page, essentially, at the top of the page, you talk about what policy will need to be implemented in order to be able to avoid, as you saw it, and the figures supported you, the terrible consequences on the NHS of your figures of death and hospitalisation:
“The minimum policy will require: closing schools & universities, home isolation of cases, and large-scale intensive social distancing – reducing all contacts outside the home and work by 75% …”
Was that a mitigation policy or a suppression policy, Professor?
Professor Neil Ferguson: I mean, the difference between green and red in the previous table is the difference between mitigation and suppression.
Lead Inquiry: Does this email therefore stand as the point at which you yourself are converted to the merits of a suppression policy as opposed to a mitigation policy?
Professor Neil Ferguson: I think that’s a very different and difficult judgement. I didn’t – I’m on record as saying that I didn’t view any easy decisions here. I think it’s the point at which it was clearly apparent that exceeding NHS capacity was a government red line they did not want to cross, and I was therefore saying these are the policies which need to be implemented.
Lead Inquiry: Around this time, you were engaged in drafting Report 9?
Professor Neil Ferguson: Yes.
Lead Inquiry: Which is the report of which we’ve heard earlier today from Professor Steven Riley. Could we have, please, INQ000270159.
There is a summary on page 1 which, in essence, is this right, states that the result of epidemiological modelling is that, whilst there are two fundamental strategies, mitigation and suppression, the optimal mitigation policy is that policy which you’ve identified in the email of a relatively stringent degree of measure but falling short of a lockdown?
Professor Neil Ferguson: Not quite. So the optimal mitigation policy could achieve maybe a two-thirds reduction in peak healthcare demand and the halving of deaths, which was the “mitigation”. The suppression policy then went further and that’s, you know, where you can avoid exceeding healthcare limits.
Lead Inquiry: Page 2, you say:
“The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available …”
Did you consider the possibility that a sophisticated scaled-up test, trace and isolation measure could provide a degree of succour and support before vaccines were invented?
Professor Neil Ferguson: I mean, that is what was being referred to, or something equivalently effective at reducing transmission, in that sentence.
Lead Inquiry: Well, Professor, you make the point that whatever package it is has to be “maintained until a vaccine becomes available (potentially 18 months or more)”.
Professor Neil Ferguson: And that’s true whether you’re using contact tracing or you’re using – irrespective of the type of non-pharmaceutical intervention one is using. No immunity is building up in – or limited immunity is building up in the population if suppression is working and so the only way of exiting from that policy is when a vaccine is available to generate immunity through that route.
Lead Inquiry: Professor, in this document you were advocating an intensive intervention package by way of reducing contact in the workplace and at home, ensuring a degree of isolation that breaks transmission chains, and you say that package will need to be maintained until a vaccine becomes available.
You’re not there referring to testing. Testing is not a package, is it, which is concerned with –
Professor Neil Ferguson: Maybe I’ll read:
“The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available …”
Lead Inquiry: All right. Why didn’t you say, “The best way of being able to return to life, something approaching normality, after this package is – intervention package is introduced, is to develop, at speed, a rapid test, trace and isolate system”?
Professor Neil Ferguson: I mean, I think – well, we did a lot of work in the following weeks on – on that. It wasn’t, at that time, our top priority. We had a limited amount of time to look at it and I did not want to be making statements which I couldn’t back up.
Lead Inquiry: All right. Page –
Professor Neil Ferguson: I don’t disagree with the concept of having an effective test and trace system and I’m on record at looking – both stating that and looking at it in detail.
Lead Inquiry: Could we have page 16, please.
The middle of the page has the paragraph that we looked at earlier:
“In the [United Kingdom], this conclusion has only been reached in the last few days, with the refinement of estimates of likely ICU demand due to COVID-19 based on experience in Italy and the [United Kingdom] … and with the NHS providing increasing certainty around the limits of hospital surge capacity.”
Was it not the position that you had in fact for a matter of weeks known what the IFR number was likely to be, the hospitalisation number was going to be, you had informal information about NHS capacity, and obviously Professor Riley had produced his own report?
Professor Neil Ferguson: I mean, so I understand what you’re saying, the IFR didn’t change, the hospital estimates did change, they roughly doubled based on what was happening in Italy in terms of intensive care unit demand. Qualitatively, you’re completely right, it didn’t change the conclusion, but in quantitative detail it did change it significantly.
We didn’t have, I should say, we had informal – well, informal feedback from the NHS that it was highly unlikely surge capacity would be available to meet the likely demand, but we weren’t given official figures, let’s say, for what that capacity was going to be until 15 March, or 14 March.
Lead Inquiry: In the event, Professor, the government, as we all know, imposed a lockdown. You make the point in your statement that all interventions have a trade-off between potential impact and cost, and also effectiveness and practicality. A more practical intervention may achieve a higher impact than a more onerous intervention that is poorly adhered to.
Professor Neil Ferguson: Yep.
Lead Inquiry: In your view, if the goal was to prevent the collapse of the NHS, was that lockdown necessary?
Professor Neil Ferguson: This is not a question we can definitively answer. Without doubt the measures announced on 16 March had some effect on transmission, and potentially accelerated by spontaneous behaviour change, but we didn’t have the time to wait and collect the data which would allow us to say, “Yes, they’re sufficient”, or, “No, they’re not”.
Lead Inquiry: But you gave evidence, I can’t go into for legal reasons the evidence you gave, but you have spoken about what the impact might have been if the intervention had been introduced a week earlier.
Professor Neil Ferguson: So I was very careful when I made that statement to the House of Commons select committee, which is –
Lead Inquiry: All right, I’m going to stop you there. For legal reasons we can never debate in a court of law anything that is said or done in Parliament. So I cannot ask you questions about –
Professor Neil Ferguson: Okay.
Lead Inquiry: – the merits –
Professor Neil Ferguson: I will refer instead to the paper we later published on that.
Lead Inquiry: Thank you.
Professor Neil Ferguson: But I said the same at the time, which is moving all interventions back a week. So returning to your point of could things have acted – moved faster in February and March for whatever reason, more clarity on the data, more clarity on NHS capacity, had we moved the 16 March back to the 11th, the 23rd back to the 16th, that was the scenario we were looking at.
Lead Inquiry: My question to you was: if the goal was to prevent the collapse of the NHS, was that lockdown necessary? From everything you’ve said, it must surely follow that it was, because –
Professor Neil Ferguson: I mean –
Lead Inquiry: – you were saying you’ve got to do it otherwise –
Professor Neil Ferguson: So I thought you were distinguishing between what was announced on 16 March and what was announced on 23 March.
Lead Inquiry: No, the 23rd.
Professor Neil Ferguson: Okay. So I think – you know, well, I think both were warranted, but I cannot definitively say whether what was announced on the 16th, maybe in combination with what was defined – announced on the 18th, would have been sufficient in its own right, we just don’t have the data to answer that question.
Lead Inquiry: So what you’re saying is we will never know the exact nature of the number of deaths that would have been saved if a lockdown had been a week earlier; equally we’ll never know whether or not the measures short of a lockdown which were put in place around the 16th, or the 13th in fact, whether they would have worked?
Professor Neil Ferguson: I’m specifically referring to the measures announced by the Prime Minister on the 16th, which was mostly an urging of people to work from home and to reduce social contact. They weren’t mandatory measures but they did have an appreciable effect on population contact rates and behaviour. And I know there’s a certain sector of society who are exercised about the difference between mandatory and voluntary measures, and my response was we will never know in the UK context whether the measures announced on the 16th, and then later with school closure, which is mandatory on the 18th, would have been sufficient on their own. What we can say is that the mandatory lockdown was more effective at reducing contact rates, it had an even higher effectiveness.
Lead Inquiry: How clear are you in that conclusion? Plainly there are degrees of likelihood. If we had only had those measures, the ones imposed on the 16th, how clear is it?
Professor Neil Ferguson: It isn’t, and we didn’t have time to wait for it to be clear.
Lead Inquiry: Has there been any subsequent analysis done, any counterfactual work done afterwards which shows whether or not it was ever possible at all that those measures would have sufficed on their own or are we in the territory of, well, they might well have worked but we’ll never know?
Professor Neil Ferguson: Well, I mean, the policies we actually modelled in Report 9 were considerably less stringent than the lockdown of 23 March, but the reason for that is that the more – you can have a range of different measures which will achieve suppression, but the rate – the speed of doing so differs depending on how stringent the measures are, and if you are concerned about healthcare capacity being overwhelmed in the very short term, you need to implement considerably more stringent measures than if you act potentially earlier and can then later refine measures.
Lead Inquiry: Does your conclusion, your view, depend at all upon Professor Woolhouse’s point, which you have already addressed separately, that there was a failure to take proper account of spontaneous changes in behaviour?
Professor Neil Ferguson: I mean, it’s difficult. What we can do is observe. We had that one week to observe spontaneous changes in behaviour, because most – nearly all the measures announced on 16 March were recommendations, and there was a significant reduction in mobility, in how other measures have – we weren’t, at that point, measuring contact rates but in proxy measures of contact rates. Whether it would have been sufficient though we don’t have enough data to say.
Lead Inquiry: Now, very briefly, some of the high points and low points of the chronology thereafter.
In relation to the May 2020 alert system, and the government’s approach to the relaxation from the then Covid restrictions, have you said in your statement that the strategy failed to learn perhaps the most important lesson from March 2020, namely that acting early saves lives and costs no more economically than acting late?
Professor Neil Ferguson: Mm-hm.
Lead Inquiry: That is of particular application, is it not, to the debate about whether there should have been a circuit breaker in September/October or an earlier lockdown earlier than the date in November on which it was actually imposed?
Did you produce models and documents in September on behalf of ICL but also before SAGE making plain that at various stages various levels of quite stringent NPIs would be needed to slow or reverse the exponential growth in the virus as you saw it to be?
Professor Neil Ferguson: Yes, I did. And I’d like to place it into context, that first of all the efforts between April and September to, in some sense, reduce transmission through other means, through test and trace, through making environments Covid-safe, did have a marked effect. So we were not facing quite the same situation in September/October that we were facing in March 2020. We were facing a growth rate, a reproduction number of more like 1.4, 1.5 rather than one of nearly 3. But it – as all the modelling we had done all the way back in April of exit strategies and lockdown had indicated, it just wasn’t sufficient. So in that context of exponentially growing levels of infection, hospitalisation in September/October, yes, we undertook a lot – well, we undertook, first of all, for SPI-M, along with other groups, modelling of likely scenarios going into the winter and the potential impacts of control policies, anticipating, indeed, even before Alpha was announced, the likely necessity of a third lockdown in January 2021. And – but I also contributed, with Matt Keeling and with John Edmunds, to a table of potential non-pharmaceutical interventions which could be considered by the government if they wanted to escalate from what the current policy was.
Lead Inquiry: As had been foreseen in February/March, because it is part of a viral epidemic, there was a second wave?
Professor Neil Ferguson: I mean, a catastrophic second wave.
Lead Inquiry: Even though there had been Covid-safe measures to some degree put in place and even though there was longer warning of the breaking of that wave, the number of deaths in fact exceeded those in the first wave?
Professor Neil Ferguson: I mean, by two-fold, yes.
Lead Inquiry: And do you say in your statement, therefore, that the policy of acting incrementally and as late as possible, in the end – to prevent NHS capacity again from being exceeded – had a significant impact upon the number of deaths?
Professor Neil Ferguson: Yes.
Lead Inquiry: The local tier system in October 2020 you criticise. You make the point that SAGE and SPI-M-O were not consulted about the introduction of the local tier system, and you describe it as being flawed in its implementation. Was it in essence a form of epidemiological levelling up?
Professor Neil Ferguson: Mm.
Lead Inquiry: Everywhere would find itself inevitably in the highest tier?
Professor Neil Ferguson: Eventually, yes. It was sort of delaying the inevitable, and of course that has a public health, a human consequence in terms of hospitalisations and deaths.
Lead Inquiry: You state in your statement that you fully agreed with the decision to introduce the second lockdown, that is the lockdown in November 2020. There was an issue, was there not, around about 31 October, when slides developed in this ensemble process that you’ve described, prepared by Imperial, Warwick, London School of Hygiene and Tropical Medicine and Public Health England, Cambridge, were leaked, were they slides which were draft documents prepared some time before the leak?
Professor Neil Ferguson: My concern with it is they weren’t any sort of prediction, they were a commission to develop in some sense reasonably bad scenarios for the winter, before the tier system had even been introduced, and they had been superseded by, you know, more recent and calibrated projections of what the epidemic was going to be. So it felt like deliberately pessimistic figures were being produced, and I felt that, you know, that wasn’t the – I mean, the more recent figures were also – I think could have made the point equally well.
Lead Inquiry: The position was that, together with the other research groups, you had prepared documents for a specific purpose, in fact to identify a particular reasonable worst-case scenario, a very pessimistic scenario, and you have had done so some weeks before –
Professor Neil Ferguson: Well, not very pessimistic, somewhat pessimistic.
Lead Inquiry: Somewhat pessimistic. But in the event those slides came to be used –
Professor Neil Ferguson: Almost as if they were predictions, yes.
Lead Inquiry: All right. And there was a considerable press and public turmoil concerning –
Professor Neil Ferguson: Yes.
Lead Inquiry: – the production of those documents.
Finally, in relation to SAGE, which I said I would come back to, drawing together, and you address SAGE in multiple places in your statement, would it be fair to say that you have expressed a number of views about particular aspects of the way in which SAGE operated?
Professor Neil Ferguson: Mm-hm.
Lead Inquiry: Firstly, in relation to its make-up, that is to say its membership, do you have anything to say in relation to whether or not it was dominated by epidemiologists, modellers and behavioural scientists or whether it had a sufficient number of pandemic management experts, public health experts and experts outside your particular field?
Professor Neil Ferguson: So I think it evolved over time. So in the very earliest stages of the pandemic it was a small group. I should say, there were typically always two members of – senior members of Public Health England present to represent public health, so it wasn’t that it was not present, but in terms of independent expertise there were a number of gaps. Many discussions around, you know, why wasn’t economics, more social science represented. And I would have – I mean, I think that would have been to the good.
Lead Inquiry: You have, secondly, addressed this issue of the commission basis upon which SAGE was approached. Would you agree that a byproduct of that basis, that system by which the government approached SAGE and said “Could you please address the following specific issues”, that SAGE did not feel able to raise issues of its own accord or proactively make recommendations to the extent it might otherwise have preferred?
Professor Neil Ferguson: Yes. I mean, I do.
I mean, I frame that in a broader context, that I think SAGE became almost the normative source of public health advice, certainly for the early months of the pandemic, and I don’t think it was ever properly constituted to act in that role.
I mean, I think – my own view is that most countries, not all, but most countries which handled the pandemic better had empowered public health agencies informed by independent scientific advice, but that is the appropriate body which should be informing government policy on something on the magnitude of a pandemic, not a professor from Imperial.
Lead Inquiry: Thirdly, you’ve described how there was a process of reaching consensus. Is it possible that that process of reaching consensus, which reached its fruition in the documents which were produced, may have perpetuated a status quo, it may have led to inaction, because the government, when reading those documents, would have been unaware of the range of views which were actually expressed?
Professor Neil Ferguson: I think that was a risk, and I would certainly recommend that full – I mean, more comprehensive minutes are produced in future, along with a – then probably accompanied by a summary, but minutes could give – true minutes give a much better sense of debate and discussion.
Lead Inquiry: You have described, Professor, how there were occasions when you did not – and these are my words, not yours – speak out when you might have done so, because there was a lack of understanding as to what the government’s aims were, what its objectives were, what it wanted.
Professor Neil Ferguson: I think that was true throughout 2020. 2021, it was much clearer.
Lead Inquiry: There’s next then the issue of “following the science”. Did you feel that the mantra of “following the science” blurred the boundaries between scientific advice and policy decision-making, and also perhaps lead to an unwanted pressure upon SAGE itself?
Professor Neil Ferguson: Yes, because there is no such thing as really “following the science”. I mean, policy is there to achieve – I mean, science informs policy in the sense of saying what is possible, what the likely impacts of both the virus and policies will be, but it doesn’t predetermine a single best strategy, that’s obviously determined by what, you know, what policy objectives you’re trying to achieve.
Lead Inquiry: The evidence shows multiple communications between yourself and the Chief Medical Officer and the Government Chief Scientific Adviser outwith the framework of SAGE. Does that indicate that the funnel by which SAGE’s views were communicated to government through the CMO and the CSA personally were not working as effectively as they might?
Professor Neil Ferguson: I think it more indicates the fact that it’s – in many cases it was difficult to have a free-flowing discussion of technical points within SAGE meetings, in my experience. That was partly rectified, you know, from about April onwards by Patrick Vallance having informal, small-group meetings to talk things through, but most of those email exchanges are around, I mean, you know, Chris or Patrick bouncing ideas, wanting clarification.
I think, thinking more – I think there are better ways of having structures which allow for that in a more formal way than emails, if that was your question.
Lead Inquiry: If you had been satisfied that your views were properly reflected in SAGE, and communicated to the government through the CMO and the CSA –
Professor Neil Ferguson: Yes –
Lead Inquiry: – you would not have, yourself, written directly to a Downing Street adviser, would you?
Professor Neil Ferguson: That is certainly true, yes.
Lead Inquiry: Then finally, what was your view on the diversity of SAGE? Would you agree, Professor, that, as one of the leading lights of one of the most powerful research groups, SAGE may have become too clubbable, too dominated by major teaching and research institutions?
Professor Neil Ferguson: Certainly there was a type. I mean, I think both gender diversity and minority ethnic group diversity could be better reflected in future crises.
As for – I mean, to be honest, I’m sure both Chris Whitty and Patrick Vallance would say this, that you do want the leading experts in their respective fields to be represented on a committee like that, so there is always a preponderance of people from certain institutions.
Lead Inquiry: Lastly, Professor, it is of course well known that you resigned from SAGE on 6 May 2020 for personal reasons. Do you accept, putting aside some of the public reaction, fundamentally damage was done to public trust in government structures because you were seen, wrongly as it happened, to be part of the government and therefore there was a damaging effect on compliance and –
Professor Neil Ferguson: I mean, yes, I breached lockdown rules and I apologised for that and I apologise again, and I think that and later incidents certainly didn’t help with public trust. And I think being – yes, I wasn’t a government servant, I wasn’t a government employee, but I still recognise the consequence of those actions.
Mr Keith: Thank you, Professor.
My Lady, there are a number of Rule 10 questions.
Lady Hallett: I am afraid it’s not quite over yet, Professor, I’m afraid.
Ms Morris, I think you have some questions.
Questions From Ms Morris KC
Ms Morris: Thank you, my Lady.
Professor Ferguson, I ask questions on behalf of the Covid Bereaved Families for Justice. I’m going to ask you on a single topic about restrictions on mass gatherings, which is important as members of the groups that I represent had families who attended those mass gatherings and contracted Covid-19 as a result.
Now, my Lady’s already asked you a question about mass gatherings, and Mr Keith has taken you to the substance of your advice, and that developed by SAGE, and you have been asked directly why the precautionary principle was not applied in the same way that it was to schools. So my remaining question is about the process of the advice around mass gatherings.
I’d like you to look, please, at an email, INQ000047898, please. Thank you.
Just looking at the first paragraph and the attendees in highlight, first, if we may. This is an email dated 27 February 2020. It’s an email from Professor Sir Jonathan Van-Tam to, amongst others, Oliver Dowden – it discusses a meeting between himself and Oliver Dowden, the then Secretary of State for Digital, Culture, Media and Sport, and it includes a summary of the meeting. It’s a minute being circulated after with accompanying comments, you will see on page 2, from yourself.
Can you see there “Comments from modellers”, and your name is the second in bold there.
Have you seen this email before, Professor?
Professor Neil Ferguson: I believe I have, yes.
Ms Morris KC: Thank you.
The meeting itself between Professor Sir Jonathan Van-Tam and Mr Dowden and others was about mass gatherings, and the summary of your views on page 2, we don’t need to look at the substance of it, but do you agree there with the summary that’s provided in the email?
(Pause)
Professor Neil Ferguson: Yes, it’s a reasonable summary.
Ms Morris KC: Thank you.
Going back to page 1, if we may, and just to the beginning of that email, and just highlighting that first paragraph, please, this is the beginning of it:
“Do let me know if you are happy for me to send to DCMS, also please note that I have included the comments from academics/modellers but not sure how happy they will be that their assumption heavy views will be shared but have caveated that their opinions are not based on data.”
My first question is: did you know that this view was being shared?
Professor Neil Ferguson: No.
Ms Morris KC: No. Have you later become aware that it was shared?
Professor Neil Ferguson: Yes.
Ms Morris KC: Roughly when, can you assist?
Professor Neil Ferguson: I mean, I think as part of this public inquiry.
Ms Morris KC: Okay, thank you, that’s helpful.
Do you agree that your view was assumption-heavy, as the caveat indicates?
Professor Neil Ferguson: Given that – at the time, yes.
Ms Morris KC: Thank you. Back to page 2, please, if we may, just before the summary of the modellers, it says in red:
“… please note that there is no data to support the following.”
Do you agree with that caveat?
Professor Neil Ferguson: No data directly for Covid. There was data for other diseases which have similar transmission patterns but not for Covid.
Ms Morris KC: Understood. In providing the view that is represented in this email, had you conferred with colleagues in South East Asia on the issue before providing this view in whatever context?
Professor Neil Ferguson: I mean, certainly we had – I discussed with colleagues, not specifically because of this email or the request but the issue of restricting gatherings had been discussed in – with colleagues around the world.
Ms Morris KC: Thank you.
Professor Neil Ferguson: I should maybe add that we have published analyses of the effect of restricting gatherings of different sizes. I mean, over the course of the pandemic, drawing on experience across multiple countries, and I’m happy to share those if it’s helpful.
Ms Morris KC: Thank you, no, it’s just simply the information that you were pulling together for this summary.
So my point really is that there was a SAGE meeting as well on that date, this is 27 February. We can go to the minutes if you like, but I think you can take it from me that there was a SAGE meeting –
Professor Neil Ferguson: Yes.
Ms Morris KC: – on that day, and both yourself and Professor Sir Jonathan were there. How comfortable are you with your individual views on a topic such as mass gatherings being shared via email as opposed to being shared within the consensus statement of the SAGE minutes?
Professor Neil Ferguson: My preference in all of these, it would have been better for a summary opinion from SAGE or SPI-M, probably including SPI-B, to be written. My understanding, and it is a long time ago, was that Jonathan Van-Tam wanted an urgent and quick opinion rather than having the time to go through the formal process. But I would agree a more considered and consensus view would be preferable, clearly.
Ms Morris KC: Particularly when the two things happen on the same day, is that fair?
Professor Neil Ferguson: Yes, yeah.
Ms Morris KC: The email is on the same day as the SAGE meeting?
Professor Neil Ferguson: I should say it wasn’t unusual, that timescale of getting advice.
Ms Morris: I see. That’s helpful. Thank you, Professor.
Thank you, my Lady.
Lady Hallett: Thank you, Ms Morris.
Ms Gowman.
Questions From Ms Gowman
Ms Gowman: Thank you, my Lady.
Professor, I ask questions on behalf of Covid Bereaved Families for Justice Cymru. First, at paragraph 164 of your statement, you opine that border controls had little impact on the final mortality and healthcare burden. When you made that statement, were you aware of the First Minister for Wales’ requests of the Prime Minister for enforceable restrictions to control the border between England and Wales?
Professor Neil Ferguson: I wasn’t, no.
Ms Gowman: For context, therefore, please can we display exhibit INQ000083851.
These are the COBR meeting minutes from 12 October 2020, and if we turn to page 7 of that document, and specifically turn to paragraph 11, we see an example of the First Minister highlighting his belief that cross-border travel between areas of England with high infection levels and Wales left people situated within low areas of infection in Wales susceptible to increased risk.
Professor Neil Ferguson: So maybe I’ll – so I thought in your original question was in relation to kind of international travel. Okay, it’s a slightly different context, yes.
Ms Gowman: We can see from that document that, despite the concern identified by the First Minister, and said at paragraph 12 to be understood by the Prime Minister, that no regulations were imposed despite that identified risk. Can you see that?
Professor Neil Ferguson: Yes.
Ms Gowman: To your knowledge, Professor, has there been any statistical analysis of the likely impact on mortality and healthcare burden in Wales of not implementing border controls between England and Wales specifically?
Professor Neil Ferguson: Specifically, no. I think there has been some consideration and analysis not by my own – maybe even by my own group, but certainly by other groups, of the extent to which – this is when Covid was endemic in the UK, as it is today, of how the extent to which infections get moved from area to area, so there is some analysis of that. I’m not completely familiar with it all.
Ms Gowman: So when you said within your statement that there was no evidence to suggest that – there was evidence to suggest that border controls would have little impact on the final mortality and healthcare burden, that was not specifically to Wales, and is it fair to say that you can’t comment on the position in respect of Wales?
Professor Neil Ferguson: I think that would be fair. I was thinking of the international borders.
Ms Gowman: Thank you, Professor.
The second topic relates to paragraph 141 of your statement, and the working group meeting convened on 1 March 2020, to analyse key clinical variables for reasonable worst case planning for the NHS, which you’ve already touched upon in your evidence.
It’s right, isn’t it, that there were no academics or NHS clinical leaders from Wales on that working group?
Professor Neil Ferguson: Sorry, remind me of the date again? It’s quite hard to –
Ms Gowman: 1 March. And if it assists, this is –
Professor Neil Ferguson: You’re correct. To my knowledge there were no representatives from Wales in that meeting.
Ms Gowman: With this in mind, what steps, if any, were taken by the working group, or indeed SAGE, who had commissioned the working group, to engage academics and NHS clinical leaders in Wales to seek to agree a co-ordinated approach on these very important issues that were discussed at the meeting?
Professor Neil Ferguson: I wouldn’t be able to answer for the Chief Medical – I mean, if anything happened it would be via the Chief Medical Officer’s office.
Ms Gowman: Similarly, what steps, to your knowledge, were taken after the meeting to promptly share the important outcomes of that meeting with academics, NHS clinical leaders and decision-makers in Wales?
Professor Neil Ferguson: Again, I mean, the sharing would have been through the four, you know, devolved administrations and CMOs – four nations CMO group, to my knowledge.
Ms Gowman: But from your perspective you didn’t raise the alarm with your counterparts, for example, in Wales?
Professor Neil Ferguson: No, I mean, all SAGE business at that time was official sensitive.
Ms Gowman: In a similar vein, at paragraph 27 of your statement you state that the MRC Centre for Global Infectious Disease Analysis staff were seconded to the UK government departments. What steps, if any, were taken to share the expertise of MRC GIDA with the Welsh Government?
Professor Neil Ferguson: So no … the Welsh – I mean, the Welsh Government and all devolved administrations were represented on SPI-M, and I was party to a number – I would have to go back – a number of conversations which involved them, some of which touched specifically on Wales. We did generate estimates every week of Welsh healthcare demand, the trajectory of the epidemic in Wales and Scotland and in Northern Ireland, not just in England. We just had a limited capacity and we’re based in London, so – and we were working flat out, we couldn’t do any more than we were doing.
Ms Gowman: Thank you, Professor.
My Lady, those are my questions, thank you.
Lady Hallett: Thank you very much, Ms Gowman.
Is it Mr Menon?
Questions From Mr Menon KC
Mr Menon: Good afternoon, Professor Ferguson, I ask a few questions on behalf of some children’s rights organisations.
Firstly, could we have your first Module 2 witness statement on the screen, please, the reference is INQ000249526, and in particular page 123, paragraph 406.
Do you have that?
Professor Neil Ferguson: Yep.
Mr Menon KC: You say, Professor, in that paragraph, that SAGE was never explicitly asked to evaluate what policies would lead to minimum use of economically and socially disruptive non-pharmaceutical interventions, and that perhaps a more appropriate use of SAGE would have been to review a range of strategic policy options drawn up by the government and to provide scientific challenges to their suitability in meeting the stated policy goals.
My question is this: if the government had asked SAGE to conduct such reviews of a range of strategic policy options, could SAGE have potentially done so?
Professor Neil Ferguson: Yes. There’s always a limit in terms of bandwidth and capacity but, I mean, I believe in broad terms, and particularly as the pandemic went on and capacity ramped up, yes, we could have done.
Mr Menon KC: Specifically, to give an example, could SAGE have evaluated the social and psychological impacts of non-pharmaceutical interventions on children specifically and provided the government with advice as to their suitability?
Professor Neil Ferguson: So, I mean, this is going outside my area of expertise but I believe SPI-B, the behavioural science group of – or subgroup of SAGE, could have done that, and there were a number – in fact there were quite a number of working groups around, let’s say, the broad both public health and educational effect of non-pharmaceutical interventions on children which I partly participated in, which involved the Department of Education and members of SPI-B and clinicians. But undoubtedly it could be – it wasn’t done in the way which I was suggesting there as a kind of commission to look at different policy options, it was more evaluating the, you know, role of children in transmission.
Mr Menon KC: Thank you.
Secondly, page 69 of the same statement, paragraph 219(a), this is a subparagraph on children and modelling, and you observed that the role of children in transmitting Covid was a topic of much activity and discussion in SAGE during 2020.
Was there any discussion or acknowledgement in SAGE as to the differential impacts of non-pharmaceutical interventions on children as compared to adults?
Professor Neil Ferguson: I think in the initial stages of the pandemic, limited, just because of due to time, I think. The – to be fair, I think I remember Chris Whitty raising it as an issue all the way back in February 2020, but it wasn’t considered in the formal way. I think SAGE became more focused on both inequity of impacts of the pandemic and of interventions as 2020 progressed, but again SAGE was responding mostly to, you know, commissions for scientific advice rather than proactively coming up with a work plan.
Mr Menon KC: Understood. So no modelling done as such; is that right?
Professor Neil Ferguson: So … I’m not sure there are models which can – I mean, so the mathematical models we use to model an epidemic, I mean, model outcomes on health typically. I mean, we have now coupled those models to economic models to model the impacts on the economy. As for modelling impacts on mental health, we haven’t attempted to do that as yet, and in some sense it – impacts on education I think would be, I mean, difficult to model and maybe not impossible, but not something we were ever asked to do.
Mr Menon KC: Thank you.
Thirdly, I assume you were aware at the time that there were social distancing exemptions for children in Scotland but not for children in England from about July 2020 onwards.
Are you aware of any modelling that was done as to the impact of such a relaxation of the rules?
Professor Neil Ferguson: Actually, I mean, when I nodded, I mean, I thought you were going to say something else. I don’t think I was aware – you’ll have to elaborate about what the relaxation was in Scotland for me to comment.
Mr Menon KC: Well, I mean, there were a number of relaxations.
I mean, for example, in July 2020 the need for children under the age of 12 to distance physically from each other was removed, not in England.
In September 2020, children under the age of 12 were exempt from the rule of six when it was reintroduced in Scotland.
I mean, those are just two examples, but there are others.
Professor Neil Ferguson: So I am not aware of certainly SPI-M being asked to look at exempting children from social distancing restrictions in England. I’m not aware really of SAGE discussions of that. So I think the – Patrick Vallance and Chris Whitty will be able to give you a definitive view, but I don’t think it was significantly considered at SAGE.
Mr Menon KC: Finally, page 54, at paragraph 174 of the same statement, please. In this paragraph, Professor, you mention a meeting in February 2020 when school closures was discussed by SAGE as a possible non-pharmaceutical intervention.
Thinking back, I appreciate it’s a long time ago, but was this discussion of school closures before SAGE ever considered, for example, other non-pharmaceutical interventions such as closing pubs and non-essential shops, requiring adults to work from home? Can you help?
Professor Neil Ferguson: Yes. I mean, so case isolation and, you know, quarantine had been discussed earlier, but this was the first community measure which was discussed. The reason being is it was already one of the most commonly – I mean, you’ll be aware that countries in East Asia were already responding to the pandemic and nearly all of them shut schools, and so we were looking at what’s going on in Singapore, Hong Kong and other countries. And there is a – I appreciate the social and emotional and mental health cost and educational cost of closing schools, but there is a rationale to it in many cases, because children have very high close contact rates and connect households together. So if you’re wanting to break chains of transmission, it is an obvious measure to start, and was adopted by nearly all countries in the first few months of the pandemic to varying degrees. A more nuanced understanding of the role of children in Covid transmission then developed.
Mr Menon KC: Subsequently?
Professor Neil Ferguson: Yeah.
Mr Menon: Thank you.
Lady Hallett: Thank you very much, Mr Menon.
Mr Dayle.
Questions From Mr Dayle
Mr Dayle: Thank you, my Lady.
Professor Ferguson, I ask questions on behalf of FEHMO, the Federation of Ethnic Minority Healthcare Organisations. I have five short topics.
Firstly, in the period leading up to the pandemic and in the early stages, did the data sources and modelling you’ve referred to include ethnicity?
Professor Neil Ferguson: Do you mean prior to 2020?
Mr Dayle: Perhaps more specifically in the period of January 2020 up to March/April 2020.
Professor Neil Ferguson: So none – at that time, period none of the data we were provided with on surveillance – well, that’s not completely true. A small portion of the data we were provided on surveillance had ethnicity. It was incomplete in many cases, and therefore of difficult – difficult to use, but most data sources did not provide any information on ethnicity. Neither, therefore, was ethnicity considered in the analysis we were doing at the time.
That situation changed quite substantially over the following, I would say, three to four months, such that we were more able to – it wasn’t a primary focus, but we were more able to look at ethnicity in detailed epidemiological analysis of the impact of a pandemic on different groups.
Mr Dayle: Okay.
In light of that evidence, can I ask you to reflect on that state of affairs: do you agree that ethnicity should have been a part of the mix of data sources that were under study, and included in the work in modelling that was pursued?
Professor Neil Ferguson: Yes, and I should say gender as well, because there were differences by sex in outcomes as well.
Mr Dayle: Okay, thank you.
Secondly, in your first witness statement – and you perhaps don’t have to refer to it – you note that you were not aware of any mechanistic models representing variation by ethnicity and/or deprivation. Presumably you’re referring to economic deprivation. And you cited two possible reasons: one, complexity of modelling required to do so and, secondly, data gaps.
So my questions are: appreciating that you have indicated that this is an area of current research for you at ICCRT, can you share any insight at this time as to whether it would have been possible to carry out such modelling during the Covid pandemic?
Professor Neil Ferguson: I think it wouldn’t have been possible in the first few months, if it had been made – I mean, we just didn’t have time and we didn’t have the data sources. If it had been a priority, then certainly by the end of 2020 it would have been possible if it had been a priority.
I think it isn’t a trivial undertaking because it increases, for the reasons I explain in my statement, the computational complexity of models quite dramatically. But let me put it this way, it is something we’re actively working on and in future epidemics – I hope I don’t see another pandemic – but I would very much hope that it is one of the factors included.
I would also say, I think, as well as differential impacts by minority ethnic group, there were also very significant differential impacts by, as you say, level of economic deprivation which – we would like to be able to capture both, because both pointed to the fact that the poorest in society had the least ability to comply with measures, to work from home, were most exposed to the virus in health settings, in service jobs, and I think that should be better reflected in analysis and modelling going forward.
Mr Dayle: Thank you.
Putting aside issues of modelling complexity and data gaps, are there any other factors that would have precluded ethnicity being considered in the work leading up to the early stages of the pandemic?
Professor Neil Ferguson: I mean, I can’t see of any reasons it wouldn’t be considered beyond those two, but those are kind of quite major hurdles.
Mr Dayle: Thirdly, at paragraph 3.42 of your first statement, you state that the potential for unequal impacts was appreciated by SAGE from February 2020 onwards, and that you believe this was discussed frequently at SPI-B, that you’ve referred to. You refer specifically to care homes, low income households and low income population groups as being discussed in March 2020.
Then you go on in paragraph 3.44 to state that differences in impact between ethnic groups “began to be recognised from early April, once sufficient data accumulated”.
What specific data are you referring to there?
Professor Neil Ferguson: So I’m talking about individual level both case data, hospitalisation data and mortality data. So that data was – only really became available after the initial decision to lock down. I mean, you heard the discussion of the poor data streams. But once we – by late March, early April, we were getting regular detailed lists of cases, hospitalisation – well, hospitalisations were later; cases and deaths, my – some colleagues within the Imperial group were working closely with clinical colleagues in northwest London on detailed health data, so we were able to then look at ethnicity as a risk factor for both exposure and hospitalisation and death.
Mr Dayle: Do you –
Lady Hallett: I think you’ve had your time, I’m afraid, Mr Dayle.
Mr Dayle: Very well.
Lady Hallett: I’m also not clear where these questions are on the ones I approved.
Mr Dayle: My understanding is that they are just a slight rephrase of the ones –
Lady Hallett: You have one more minute, Mr Dayle.
Mr Dayle: Very well. I am most obliged.
Do you recall any data indicating a trend towards potential disparate impacts between ethnic groups coming towards April of 2020?
Professor Neil Ferguson: Yes, I mean, we published some early analyses. Also it didn’t come as any surprise to me. I mean, pandemics build on the pre-existing health inequity, and there is already health inequity between ethnic – inequity between different ethnic groups in the United Kingdom.
Mr Dayle: And had a better data capture system been in place from the onset, does it follow that the disparate impact on some ethnic groups would have been identified sooner?
Professor Neil Ferguson: Perhaps. I can’t be definitive about that, because it also partly depends on how much data has been accumulated.
Mr Dayle: The penultimate topic: you state at paragraph 3.44 of your first witness statement that, despite the ICCRT publishing analysis on 29 April that identified two times higher risk of death for black patients, you believe that SAGE didn’t review or discuss the data on ethnic inequalities until late May, with the first comment not being issued until 4 June; the Ethnicity Subgroup of SAGE was not formed until September.
So two questions: can you share any insights as to why there was such delay in responsive action?
Professor Neil Ferguson: As I think I’ve referred to earlier, SAGE was being bombarded with requests for evidence from government and it was government which largely determined the topics, certainly at that point in time, that SAGE was prioritising.
Mr Dayle: And finally, in your second witness statement at paragraph 22, you explain you have been asked to comment on specific questions regarding considerations of vulnerable groups in modelling. You do not appear to have been instructed specifically to address ethnicity as a vulnerability. However, you were asked to address “whether the public health response was sufficiently targeted at those who were most vulnerable”. In your answer you refer to the elderly and those required to shield, but not specifically to ethnicity.
And my question is: do you consider that more could and should have been done to target minority ethnic communities as vulnerable groups for interventions?
Professor Neil Ferguson: I mean, I think the – the data is complex. A lot of the vulnerability of minority ethnic groups is associated with either occupational exposure or the higher prevalence of comorbid conditions, and so it counts – those conditions, diabetes for instance, were – meant that individuals with those conditions, regardless of ethnicity, were prioritised as vulnerable groups.
So I can’t give a simple answer, but just being of a specific ethnicity, independent of either occupational exposure or comorbidities, I’m not – to my knowledge, I’m not aware of intrinsic differences by ethnicity in Covid vulnerability.
Mr Dayle: Thank you, Professor.
Thank you, my Lady.
Lady Hallett: Mr Dayle, I apologise. We were both right. You were right that you did have permission to ask the questions, I missed a sheet, but I think I was right on the timing. Maybe we have been a bit mean with the timing. So thank you very much for your questions. I’m sorry for interrupting so –
Mr Dayle: Very well, my Lady.
Mr Keith: My Lady, no one is more sorry than myself, other than perhaps Professor Ferguson, at the fact that I have to lengthen the process, or ask for your permission to do so.
We were provided with some six or seven pages of separate topics which we gave assurances to the CPs that CTI would sweep up in the course of a lengthy examination.
We have been prodded by Mr Metzer, quite properly, on behalf of the Long Covid groups that there was an area consisting of four short questions which I did not put to Professor Ferguson.
Lady Hallett: Very well, Mr Keith.
Apologies to our stenographer.
Mr Keith: Indeed.
Lady Hallett: And apologies to Professor –
The Witness: It’s fine.
Lady Hallett: – Ferguson.
Further Questions From Lead Counsel to the Inquiry
Mr Keith: Professor Ferguson, were you aware of the fact of long-term sequelae being likely to be produced, to occur, from previous coronaviruses like SARS and MERS?
Professor Neil Ferguson: I mean, I was aware of – I mean, a lot of viral infections can have long-term sequelae, but the magnitude of those sequelae and the severity associated with the original strain, particularly of SARS-CoV-2, I was – I did not anticipate.
Lead Inquiry: Can you explain why in your modelling you did not model for long-term sequelae?
Professor Neil Ferguson: I mean, in the early months it was – we had almost no data to do so. It took quite a long time thereafter. In terms of modelling long-term sequelae, in some sense it’s a risk associated with each infection, and so the outputs of the existing models can be used to estimate the burden without the models necessarily being dramatically changed.
Lead Inquiry: Would you agree that if you model for death or acute infections in relation to a viral pandemic without modelling for long-term sequelae, a misleading impression may be given?
Professor Neil Ferguson: You are certainly not capturing all the morbidity caused by a pandemic. I would argue that the things we did capture gave a fairly grim picture of the risk Covid paid – posed, rather. We just had no detailed – it took months for detailed data on long – to be collected.
Lead Inquiry: Would you agree that in future, modelling of infectious diseases should include potential long-term sequelae from the outset?
Professor Neil Ferguson: I think long-term sequelae have been – I don’t think this is an issue about modelling, I think long-term sequelae of viral infections have been an understudied area more generally, partly because they are hard to resolve. Covid provided a one-off, in some sense, horrible experiment which highlighted how important they were and is there – has therefore heightened their importance as a research topic.
Mr Keith: Thank you.
Lady Hallett: Thank you very much indeed, Professor Ferguson, that is it.
I note in your statement that you say:
“In all my experience of working on the pandemic I didn’t encounter a government official, fellow scientist or clinical colleague who was not working flat out.”
I think we’ve seen the proof of that in the timing of some of the emails. So thank you very much for all the work that you did during the pandemic, and your colleagues.
(The witness withdrew)
Lady Hallett: 10 o’clock tomorrow, please.
(5.00 pm)
(The hearing adjourned until 10 am on Wednesday, 18 October 2023)