4. Professor John Edmunds

PROFESSOR JOHN EDMUNDS (continued).

Questions From Lead Counsel to the Inquiry (continued)

Mr Keith: Thank you, my Lady.

Professor, during the course of the morning, you mentioned the reassuring nature of the messages being put out by government, particularly in late February, early March. Did you attend a NERVTAG meeting, I think on 21 February, where there was a debate about whether or not the risk assessment from Public Health England should be elevated from moderate to high?

Professor John Edmunds: Yes, it was on Skype for Business, and for some reason I couldn’t make myself heard, and –

Lead Inquiry: All right.

Professor John Edmunds: But I heard the discussion and afterwards I emailed my points to the secretariat.

Lead Inquiry: Could we have, please, INQ000119469, paragraph 5 – page 5, paragraph 2.4.

“PH …”

Is that Peter Horby?

Professor John Edmunds: Yes.

Lead Inquiry: “… asked the committee if anyone thought that the [Public Health England] risk assessment should change. No objections were raised however after the meeting, [John Edmunds] emailed to say that he was online but for some technical reason could not be heard. [He] believes that the risk to the UK population (in the PHE risk assessment) should be high, as there is evidence of ongoing transmission in Korea, Japan and Singapore, as well as in China.”

You needn’t deal in detail with how the PHE risk assessment process works, because the Inquiry has already heard evidence about that. In short, however, at that stage it was at moderate, and it indicates, does it not, what the exact risk is on that day? It’s not a prospective forward-looking exercise, it’s at that time, and you believe that as at that time, on 21 February, the risk was high?

Professor John Edmunds: I thought the risk was high. I thought there was a little bit of – I thought the risk was about to be very high and I just didn’t think – I thought this was sending out the wrong message if we said that it was – that it was moderate.

Lead Inquiry: Around this time, in fact about a week or so later, we will see your emails at the beginning of March, you began to form the view, did you not, that we, SAGE, had to take much more radical measures – or perhaps the government had to take much more radical measures to mitigate the epidemic?

Professor John Edmunds: Yes.

Lead Inquiry: Could we have, please, INQ000212036 on the screen. It’s a 12 March email. If we can go down to the – if we can go to the next page, and an email at – I think maybe one more page, to 22.22. Yes, thank you very much. Towards the top of the page, at around about 10.30 on Thursday 12 March from John Edmunds:

“1. The data are crap and hopelessly out of date, so we have little situational awareness. The daily figures are a joke and the [guesstimate] of 5-10,000 cases is probably too low.

“2. The measures just announced …”

Were those the measures announced by the government?

“… will do very little. Not quite sure just how many cases will escape, but I suspect a fair few.

“3. We will have to do a lot more to manage this epidemic. The current plans will overwhelm the NHS almost straight away. We need much more stringent control measures if we want to slow it down. Not necessarily now, but soon. Very soon.”

We will come back to the issue about waves and autumn and winter epidemics and lowering the peak in a moment.

So you plainly raised the alarm there. And if we look, please, at INQ000212 – sorry, no, perhaps if we could go back to the second page, we can see that the debate develops between yourself and Professor Ferguson, and Professor Farrar, Jeremy Farrar.

You debate what NHS England is likely to say on the issue of whether it can cope, and then if you go back, please, to the first page – this is the email that, my Lady, Professor Ferguson was asked about.

“I think the message got across. I still think part of the issue is Chris hoping it won’t be as bad as we say.”

So, between you, you’re essentially debating the emergency, whether or not the government understands the position, and of course what can be done.

If we look at INQ000212037, you debate, right at the top of the page, it commences with the same email string, but it is a different string.

Professor John Edmunds: Apologies.

Lead Inquiry: Don’t apologise. If we could scroll back out, perhaps, and go to the second page, we will see there an email from Jeremy Farrar:

“Are you both comfortable with the plans [the UK Government] have [got] …”

It says “not”, but we think it’s “got”.

“… in place, the pace of actions and the changes they are making?

“Good if we could talk again before SAGE.”

Back one page, please. John Edmunds:

“NO I AM NOT.”

Jeremy Farrar:

“Main concerns?”

Then the “data are crap” email. Then back up the page. Neil Ferguson emails about the “actual surge capacity of the NHS”, and is that to the point that you were addressing earlier about what the impact would be on the NHS of these figures and of course whether there was a surge capacity to be able to deal with it?

Professor John Edmunds: It was never very clear what the surge capacity was, but in my mind, whatever it was, it wasn’t going to be able to cope with the kind of numbers we were talking about.

Lead Inquiry: Is that why you therefore say at the top of the page:

“The potential surge capacity is absolute bollocks. The level of demand at the reak, even with the mitigations planned, are an order of magnitude higher than the NHS can cope with.”

Professor John Edmunds: Yeah.

Lead Inquiry: In this trilogy of emails, all with the same genesis, INQ000212038. The debate continues between the three of you, about whether or not:

“… the [Prime Minister and Health Secretary] are … more aware of what’s coming. But there is [still] a lack of urgency in some quarters …”

Professor Ferguson says:

I think we might push for rapid contingency planning for potential escalation of social distancing – likely cessation of all out of home leisure activity, working from home where possible, school closure.

“Oh and surveillance is a mess. So we don’t really know what is happening.”

That’s a fair summary?

Professor John Edmunds: That’s what we were talking about time, yeah.

Lead Inquiry: The debate between yourselves and also at SAGE at that point focused to some extent also on what the consequences would be of trying to completely suppress what you knew to be the first wave of the pandemic; is that right? And on what the dangers would be thereafter of suppressing a wave, whether it would come back as an uncoiled spring –

Professor John Edmunds: Yeah.

Lead Inquiry: – and so on.

SAGE debated whether or not the measures which would have to be contemplated would have the result of completely suppressing a wave in a way which meant that it would bounce back later. I’ve mixed my metaphors, but you understand the point?

Professor John Edmunds: That was the concern, yeah.

Lead Inquiry: Mr Halpern, who is the director of the Behavioural Insights Team in the Cabinet Office, at INQ000188731, page 16, paragraph 73, comments on the nature of that debate. He says:

“… during the meeting [and he is referring to a meeting of SAGE] Stephen Powis and Patrick Vallance questioned the modellers on why they were so sure that suppression of the virus … was not viable. The response from Graham Medley and John Edmunds was that suppression was not viable because as soon as a lockdown was lifted the virus would spike back up, implying there was no point. Graham Medley and John Edmunds, both stated that they were 100% sure about this. This gave me great concern …”

He expresses the observation that this may have indicated an over-confidence in the model, and so on.

Was SAGE clear that if the first wave was to be suppressed, inevitably there would be a second wave, it would re-emerge like an uncoiled spring and have the obvious consequences?

Professor John Edmunds: Yes, because there was no – if you just, you know, stopped the circulation of the virus for a while and then stopped doing that, of course it would come back. There was no kind of magic about it. Especially if we implemented a lockdown relatively early, which is what we were talking about here, then you wouldn’t have a lot of immunity in the population, it would be very few in the population who would be immune. So the – when the epidemic came back, which it surely would – yeah, it surely would – then it would increase then at more or less the same rate as before because there would be very few people who would be immune.

What we didn’t anticipate was the huge changes in behaviour that – we couldn’t predict the huge behaviour changes, so were we right that it would bounce back? Well, clearly we were, because it did. And not just did it do it here, but it did it everywhere, because, you know, everyone who did it and then eased the restrictions, it came back.

So were we right in the big picture? Yes. I think it came back slower than I was anticipating, I think possibly many of us, because we didn’t know how behaviour would change when restrictions – I think everybody expected when, you know, the pubs were opened again, they would be packed, and they weren’t.

Lead Inquiry: Is it out of this debate about what the consequences would be of suppression of the first wave that the debate on herd immunity emerged, because another way of going about it would be not to completely suppress the wave in a way that allows it to spring back up, but to manage it, so that some part of the population might, have become infected, have immunity, and therefore the consequences would be less severe in terms of the magnitude of the second wave?

Professor John Edmunds: I mean, obviously these are related issues and we would have discussed them together. I don’t – yeah, I don’t see the exact link between those two things, but yeah.

Lead Inquiry: It’s –

Professor John Edmunds: We were discussing these things, of course, yeah.

Lead Inquiry: Was it your view, and Sir Patrick Vallance in his evening notes believes that it was, that you were saying: but if you mitigate, if you don’t completely suppress, there is this possibility of some degree of herd immunity; it is a byproduct of mitigation?

Professor John Edmunds: Exactly. So eventually then people will become immune through those mitigation policies, which is what we were concentrating on at the time.

Lead Inquiry: In the event, the impact, the likely impact upon the NHS required of course the full maximum lockdown?

Professor John Edmunds: Yes. We were – it was so urgent, you know, the pressure. Projecting forward, you could see that the NHS would come under severe strain very quickly, and so action had to be taken. And although it’s an extreme action, you know, in many respects regrettable, I think it was a necessary evil.

Lead Inquiry: In order to be able to answer the conundrum as to how, if you imposed a complete suppression, you would have a wave which would then re-emerge later –

Professor John Edmunds: If you just released that –

Lead Inquiry: If you released it?

Professor John Edmunds: Yeah.

Lead Inquiry: And because there was a recognition that it would be extremely difficult to maintain a full suppression lockdown for any real length of time, as you describe in your statement, the SAGE and the London School of Hygiene team and yourself came up with a potential solution, which was to have or try to put into place a series of background social distancing measures which would, over time, dampen down the level of incidence, and have periodic lockdowns to try to bring the top level, the peak, down whenever it was required?

Professor John Edmunds: Yeah, that was the – I thought – I thought we were kind of in a – we were stuck between two dreadful alternatives, one being this sort of mitigation policy that would still result in a huge wave and huge numbers of deaths, versus the other one, which – you know, these things were talked about rather – in a very polar way at the time, and actually still are – versus the other one, which was we just go into lockdown and we stay there. And of course, until when? So you had to do that until you – you were gambling then on a vaccine being available, so it was a kind of open-ended – open-ended lockdown. Both of those seemed to me pretty dreadful alternatives, but for very different reasons.

Lead Inquiry: Just focusing on –

Professor John Edmunds: So this was, I thought, one way of trying to manage the epidemic that wasn’t in either of those two extremes.

Lead Inquiry: Just dealing with one of those options, the herd immunity issue, in outline, is one of the marked downsides of a herd immunity approach, or rather an approach which has herd immunity as a byproduct, that (a) if you allow the virus to flood through any part of the population, there will be deaths –

Professor John Edmunds: Absolutely.

Lead Inquiry: – secondly, practically, it’s extremely difficult to hermetically seal off that other part of the population who you don’t wish to be infected?

Professor John Edmunds: Yeah. I thought that segmentation time of approach, which I can’t remember was discussed – yeah, it had been slightly, I didn’t think that was ever, ever going to be reasonable.

Lead Inquiry: All right.

We therefore come, of course, to the decision of the government to lock down. I’m not going to ask you for your views on the government’s decision-making, because that was a matter for government and, as you’ve rightly said, bar raising the warnings and raising the alarm and telling it how it was, telling the government how it was, it wasn’t SAGE’s role to say: this is what you must do, balancing all these terrible factors.

But as a matter of scientific analysis, do you say in your statement that 16 March was the first feasible date that a decision to go into lockdown could have been announced in a way that was consistent with the scientific knowledge that had then emerged and could have been justified by virtue of that knowledge?

Professor John Edmunds: I thought that that was the date – by that time we had enough data to – we knew – we had seen a glimpse at how bad it was in terms of the cases – you know, so I think it was the first date where you could have made a – it could have been backed up by the evidence.

You could of course have made a decision before. Many countries did go into lockdown without reams of epidemiological data and modelling advice and so on. But I think – so it’s certainly possible to do that. Many countries did. But I think if you wanted to make evidence-informed decision-making, I think it took us to about that time, about that meeting of 13 March, to have the evidence to say, “This – you know, this is where we are”.

Lead Inquiry: There was, after the first wave, in fact in the autumn, a meeting of SAGE, I think a “What did we get wrong, if anything?” meeting. To use a terrible modern expression, a wash-up. And at that meeting did you say to your colleagues that perhaps too much time had been spent by SAGE worrying about the second peak and the debate about the flattening strategy?

Professor John Edmunds: Yes. I felt there was a huge wave of infections just around the corner, and that’s what we needed to deal with, not worry too much about what may or may not happen in the winter.

Lead Inquiry: Turning to the aftermath of the lockdown and the exit, rather, from it, I want to ask you some questions about the position in the care home sector.

The epidemic in the care home sector was obviously recognised at the time, and rightly so. To what extent was the risk to the care home sector, and also actually hospitals, obvious to SAGE as it deliberated on what measures, control measures, might be necessary in order to control this incipient wave of infection?

Professor John Edmunds: It was very clear from early on that the most elderly and most frail members of our society were the most – were at most risk. So it was obvious that there needed to be measures to somehow protect them, whether it was care home residents or people in the community. I was extremely worried about people who were very old and frail and living in the community as well. But also, you know, hospital patients who were also very vulnerable, often. So, yeah, all of this was known, was a major concern.

Lead Inquiry: In April, on 20 April, were you party to an email string from Professor Medley, from whom the Inquiry has heard, to Sir Patrick Vallance, in which concern was expressed about the care home sector and the possible need for some dramatic measures? And was there at the same time active consideration by NERVTAG of what measures might be necessary in order to better protect the care sector?

Professor John Edmunds: We were discussing it, yes. You know, in reflection, I really wish we’d discussed some of these matters before. How much – how much of it was a – we were scientific committees, how much of it was scientific and how much of it was operational? So I think most of it was operational really. But there were issues – there were scientific issues around, for instance, testing, you know, would that – would that offer – how much better protected would different testing regimes be, and so on. So there were things for us to consider and to go through, which we were working through.

Lead Inquiry: In general terms, did you believe that the easing of restrictions, which took place, of course, over a matter of weeks, May, June and July, occurred too early?

Professor John Edmunds: I was very concerned around that time, around the end of May, partly because of what I explained before, we didn’t know how quickly this, what you called a coiled spring, would bounce back, and we were relying very heavily on an organisation that hadn’t – was being created at the time, Test and Trace, and I thought – I was very worried that it wouldn’t be able to – that it – it had – it had to work so perfectly so – you know, straight away from day one, that that – that worried me. At the time I think we had wonderful data by then. The ONS survey had been set up so we knew the level of prevalence in the community. And I think in my statement I said that around that time, around the end of May, it was about one in 600, and so that amounts to about 100,000 people who would test positive in the country. I thought that was an awful lot of people to test and trace potentially.

So, yes, I was very nervous that – that by opening up then that Test and Trace might get overwhelmed and cases might start to climb quickly. As it turns out, they climbed much more slowly, thankfully.

Lead Inquiry: The way in which restrictions were lifted and their timing was, of course, a decision for the government, but did it become apparent from the end of July that there was a trend upwards in the cases, so –

Professor John Edmunds: Yes.

Lead Inquiry: – the incidence, the level of incidence, the spread, the number of infections, had been brought right down by the lockdown, it was at a relatively low level at the end of the restrictions, but it wasn’t low enough to stop the trend and the level coming back up?

Professor John Edmunds: Well, you only need one case. And, you know, we didn’t – we brought it down to a very low level, it was about one in 3,000, if I remember rightly, something around that, which is very low, so many communities would have had zero cases, for instance. Many at that point. And we never – we have never, even to this day, got the incidence or the numbers anywhere close to that level. So we had pushed it to a very low level, and – but then of course it did start coming – it started increasing straight away, as it were. The – I was watching the case numbers, as you can imagine, this was my job, and the final – it was 4 July, there was this sort of – “freedom day” was 4 July, you know, and the cases starting coming up on kind of 5 July.

Lead Inquiry: At the end of July did you write to the Government Chief Scientific Adviser?

Professor John Edmunds: I did.

Lead Inquiry: INQ000228590. I may have unfairly called for a document which I hadn’t in fact told our brilliant support staff that I was going to. In any event, you wrote to the Government Chief Scientific Adviser on 27 July, essentially saying the trend is back up –

Professor John Edmunds: Yeah.

Lead Inquiry: – cases are rising.

In August – don’t worry, you can take it off the screen, thank you – the Treasury launched the Eat Out to Help Out campaign. I’m not going to ask you questions about the overall merits of it, the Treasury has a number of points and issues and arguments that it would probably deploy in support of that scheme. But in terms of the public impact of that scheme, in terms of the overarching necessity to apply a precautionary approach of the type that you described earlier, were you concerned about that scheme?

Professor John Edmunds: To be honest, it made me angry. And I’m still angry about it.

It was one thing taking your foot off the brake, which is what we’d been doing by easing the restrictions, but to put your foot on the accelerator seemed to me to be perverse. And to spend public money to do that when 45,000 people had just died. I couldn’t – you know, I don’t want to blame Eat Out to Help Out for the second wave, because that’s not the case, but just the optics of it were terrible, I just thought – and really my feeling was, yes, I – the pub and restaurant sector really needed support, I wasn’t against that at all, they did need a great deal of support, but this was not really just supporting them, they could have just given them money, this was a scheme to encourage people to take an epidemiological risk. It only applied if you went into the restaurant and ate in the restaurant –

Lead Inquiry: It didn’t apply to takeaway –

Professor John Edmunds: It didn’t, no.

Lead Inquiry: You have now mentioned the issue of whether or not epidemiologically it contributed to a rise in infection in the areas where people were taking up the scheme in large numbers.

And to make it clear, there is very little or there is only weak epidemiological evidence to show that infections in the areas in which people took up the scheme went up significantly. Your point is about the optics of it.

Professor John Edmunds: Exactly.

Lead Inquiry: And why –

Professor John Edmunds: – change people’s behaviour. And we were measuring people’s behaviour at the time, and there was a change in people’s behaviour in August, and I don’t – I wouldn’t say that it was Eat Out to Help Out but it was contributing, it was all part of – I mean, government messaging more generally was about getting back to normal and getting – going back to work and so on.

Lead Inquiry: On 10 September you were asked by SAGE to chair a working group to review where essentially we’d got to in terms of the reintroduction of possible further new non-pharmaceutical interventions. Did you report to SAGE and produce a paper on basically what might need to be done to try to re-reduce, to lower the level of incidence, which by then had gone up?

Professor John Edmunds: Yes, the incidence was going up very clearly, hospitalisations had started to go up, unfortunately we were starting to get outbreaks in care homes again, and so, you know, something needed to be done, in the classic phrase, and I remember Chris actually initially saying, “Come up with a batting order”, I remember his very phrase, and so I was asked to put this report together on – I was asked on the 10th, I brought it back to the SAGE meeting a week later, where we got a lot of discussion and input from many SAGE members, and then further discussion and input over the weekend of – around the 20th, and it went back to SAGE as a sort of – for final sign-off. There was a special SAGE actually just to look at this on the 21st, on Monday, the 21st.

Lead Inquiry: Let’s have a look, INQ000212102, please. The heart of it is in paragraph 2. In essence, because “COVID-19 incidence is increasing across the country in all age groups”, that’s paragraph 1:

“2. A package of interventions will need to be adopted to reverse this exponential rise in cases. Single interventions by themselves are unlikely to be able to bring R [back] …”

I interpose that word:

“… [back] below 1 … The shortlist of … (NPIs) that should be considered for immediate introduction includes:

“a. A circuit breaker …

“b. Advice to work from home for all those that can.

“c. Banning all contact within the home with members of other households (except members of a support bubble).

“d. Closure of all bars, restaurants, cafes, indoor gyms …”

And so on.

“e. All university and college teaching to be online unless face-to-face teaching is absolutely essential.”

So a relatively stringent package. You make it absolutely plain that it was for immediate introduction, and single interventions are unlikely to work on their own?

Professor John Edmunds: Correct. There’s two aspects to this.

Lead Inquiry: Please.

Professor John Edmunds: So, one, the circuit break, this all got – this got – came just with the circuit breaker. The circuit breaker was about reducing the prevalence and bringing it to a low level, because the only way that we’d – you know, when we had been in the lockdown in March/April then we’d reduced the incidence, reduced the prevalence, and that’s what that was designed to do, to bring the incidence right down again. And the other measures which were for a longer term were to slow the growth. So that was – there’s two aspects to it, is what I’m trying to say.

Lead Inquiry: It’s very well known that of course very little of this happened or at least –

Professor John Edmunds: Yes.

Lead Inquiry: – happened in the immediate future after that meeting of SAGE. Around about the same time, about – well, in fact, the day before SAGE signed off on this – and this is an extract from the minutes of that 58th meeting of SAGE on 21 September, the day before you had been asked to attend a meeting with the Prime Minister, on that Sunday. You were invited to attend in order to address a particular question that the Prime Minister wished to be debated. I think in email INQ000212107 you were told that there would be a balanced group of views presented.

Professor John Edmunds: Yeah.

Lead Inquiry: So there’s a –

Professor John Edmunds: It’s from Julian Fletcher at the bottom, I think.

Lead Inquiry: Yes, he is the official in the Cabinet Office, and then you received the invitation, and you forward it to Sir Patrick Vallance, talking about the main SAGE paper that was due. Of course it was due the following day, on the Monday. And then he replies this at 11.16 on the Saturday:

“John

“The meeting is for him to hear a range of views on the forward look (mainly from the ‘let it rip’ brigade). We have tried to put together a balanced group across views and so I think what he needs is your view on future direction of the epidemic rather than policy options.”

What did you understand his reference to the “‘let it rip’ brigade” to be?

Professor John Edmunds: Well, of course there were many people – well, not that many but there were vocal people who took the view that we shouldn’t have locked down in the first place and we shouldn’t be considering that again. So, yeah.

Lead Inquiry: You attended the meeting, together with Professors Gupta and Heneghan, we will hear from Professor Heneghan next, as well as a Swedish expert epidemiologist, Dr Anders Tegnell, and also Dame Angela McLean, who was then or was to become the Deputy Chief Medical Officer?

Professor John Edmunds: No, she was then the Chief Scientist at the Ministry of Defence.

Lead Inquiry: Thank you.

Professor John Edmunds: She was also co-chair of SPI-M-O.

Lead Inquiry: At the meeting, which was attended by the Prime Minister and the Chancellor, as well as other officials, the debate of whether or not to essentially put into place a package of relatively strict non-pharmaceutical interventions, as opposed to allowing the virus to re-emerge and to re-wash through the population whilst segmenting or hermetically sealing off parts of it, to the extent that that might have been possible, was had in front of the Prime Minister.

During the course of that debate, I think you and Dame Angela McLean WhatsApped each other.

Could we have, please, INQ000207199.

We are only concerned with the WhatsApps at the top of the page, dated 20 September, because that’s the date of the meeting, of course, and they commence about 5.30 and the meeting was in the afternoon, so, Professor, these are plainly WhatsApps sent during the course of the meeting.

Dame Angela McLean refers to:

“Are we going to bring up the Seattle fishing vessel.”

Was that a reference to data gleaned from a fishing boat where a number of seamen had been shown to have antibodies –

Professor John Edmunds: And were protected, were well protected.

Lead Inquiry: Earlier infected.

“Angela McLean: Who is this fuckwitt?

“John Edmunds: Every statistic is wrong.

“…

“Angela McLean: Patrick and Chris will discount him later.”

Were those all references to the proponents of the contrary side of the debate, in particular –

Professor John Edmunds: I’m pretty sure it’s the next witness.

Lead Inquiry: Professor Heneghan. All right.

During the course of this WhatsApp string, we can also see a reference to “Dr Death the Chancellor” and Dame Angela McLean saying, “In [ONS] you’d see it”.

Did you understand that those were references to the Eat Out to Help Out campaign of which you’ve spoken about in moderately –

Professor John Edmunds: Honestly it’s so long ago I don’t know.

Lead Inquiry: All right.

Professor John Edmunds: But it could well be.

Lead Inquiry: After the meeting, I think Professors Heneghan and Gupta tried to re-engage battle and to write to say that they had not had a fair hearing and there was further information they –

Professor John Edmunds: Well, I mean, I had interrupted Professor Heneghan at one point because he was making some really basic epidemiological errors, the sorts of ones that we teach our students on day one, and I couldn’t let it go after a while. And so I did interrupt, and so – and that slightly put the wind out of his sails, and – so, yes. And he hadn’t interrupted me, so, you know, it was fair enough that they complained.

Lead Inquiry: I think you described his arguments as half-baked in that email string, but in any event, your argument, your views did not, to use your own words, find favour with the Prime Minister?

Professor John Edmunds: No, I didn’t manage to persuade them.

Lead Inquiry: As we all know, there was a rule of six, a rule of group of six put into place. Was that something that was discussed with SAGE, do you recall?

Professor John Edmunds: No.

Lead Inquiry: There was a tier structure put into place in October. Was the tier structure something that SAGE had positively recommended?

Professor John Edmunds: No.

Lead Inquiry: Did the tier structure –

Professor John Edmunds: We hadn’t discussed it. I mean, I – you know, we discussed it afterwards, we tried to work out whether it would be effective, but it was new to us.

Lead Inquiry: The idea hadn’t come from SAGE?

Professor John Edmunds: No.

Lead Inquiry: And the result of that tier structure was, wasn’t it, it’s been described as an epidemiological levelling up?

Professor John Edmunds: That was how I described it at the time, yeah.

Lead Inquiry: The terrible reality was that the spring uncoiled, the second wave re-emerged, and there was a second lockdown.

By the time of that second lockdown and the peak of the deaths at the end of December and January, the beginning of January 2021, was our surveillance better?

Professor John Edmunds: Oh, we, you know, our surveillance from late May/June was absolutely fantastic. You know, I think it’s difficult to say with any certainty but if it wasn’t the best in the world it must have been one of the best in the world. It was – our situational awareness was fantastic.

Lead Inquiry: We have heard evidence of the ONS –

Professor John Edmunds: Exactly.

Lead Inquiry: – coronavirus Infection Survey, the REACT Study, the multitude of surveys, as well as, by then, a much more developed testing structure?

Professor John Edmunds: Exactly.

Lead Inquiry: And a huge serological – a platform on which all these tests could be ascertained and made .

SAGE had been warning since September, you’ve showed us the report and – the paper that went into that meeting. What is your view as to whether or not that second wave was inevitable or the consequence of not having acted earlier?

Professor John Edmunds: So, you asked me earlier this morning about being – you know, why didn’t we raise the alarm in February or whatever, and I wanted to make sure that that didn’t happen again. And of course our surveillance, as you just described, was so much better, so we did know what was happening. I think – so we had all the information, we knew how to do it – you know, that was what that report on the 21st was all about. So we could have avoided the – much of the autumn wave – we wouldn’t have avoided everything but we could have reduced the incidence. And if we’d have then put the longer-term measures in place, we could have kept it low, you know, over the autumn. Cases would have happened, some people would have unfortunately, have been hospitalised and died, it would have happened, but as it was, we let it go and, you know …

And so when we did eventually – as I’d explained on the 20th with the Prime Minister, I said the decision isn’t to lock down or not, the decision is either you do it now and get on top of this epidemic and control the epidemic or you let it control you, and it will force you into a lockdown at a later date when you’ll have to lock down harder and longer and many people will die as a consequence.

And unfortunately that is what happened: over that autumn from around 20,000 to 25,000 people died, and there’s … some would have done, but there is no reason for that number of people to have died at all. And then we – then we entered the winter phase with our hospitals full, NHS staff having been under stress for months, as opposed to having – you know, they could have been doing routine stuff that autumn and clearing the backlog from the – and that was not the case. And then we got hit by the Alpha wave.

And so on top of all of this pressure, we then had this new virus that was – you know, it took a little while, a couple of weeks to work out, but it was significantly more transmissible. Even worse, though we didn’t know this until January, it was also more pathogenic. So we were – we couldn’t have been worse prepared really.

Lead Inquiry: Why did the lockdown from the beginning of November to the beginning of December not bring the levels of incidence, the overall rate down enough to stop the re-emergence of the greatest part of that second wave, in fact the peak, in January?

Professor John Edmunds: So it wasn’t as stringent as the original lockdown. The key reason: that the schools were open. And I think everybody wanted the schools to be open. But there were other things that had – there had been slight adjustments in who would be key workers and things like that.

Lead Inquiry: Was it long enough?

Professor John Edmunds: Well, if it had been done earlier on, if it had been done, you know, in September, it would have been plenty long enough, or we could have done it around half term, so you’d have had the combination of the schools being closed.

As it was, it happened just after half term, it was really – made no – again, it showed there was no real strategy, no long-term thinking. You know, instead of just bouncing into, you know, a panic decision as opposed to taking a strategic view of it and getting a grip of the epidemic and doing what was necessary when it was necessary.

Lead Inquiry: Is that why, on account of all the things that you say were not done that should have been done and because the consequence is so terrible, you describe in your statement that that second wave was, for you, the worst moment of the epidemic?

Professor John Edmunds: I said it publicly at the time, I really did think it was truly awful. And of course it did – it was. Another 65,000 people died over the next few months.

Lead Inquiry: Alpha –

Professor John Edmunds: Yeah.

Lead Inquiry: – was more transmissible and to a slightly lesser extent more severe, more pathogenic, it was very, very transmissible?

Professor John Edmunds: Yeah.

Lead Inquiry: To what extent did the emergence of Alpha at the end of November and the beginning of December contribute to that terrible level of death –

Professor John Edmunds: Oh, to a great extent, but of course we were starting from such a terrible starting point. You know, we were – with our hospitals full and resources stretched and so on, so it was easy to miss it initially, because cases were so high that how would you pick up – it was easy to miss an increase. If cases had been low you would have seen an increase much more quickly. So it was – we were in such a terrible state when that happened, that was – you know, it may well have happened – you know, the Alpha wave may well have happened anyway, there’s no way of being able to tell that. Of course actually by letting the incidence increase, it made it more likely that we would have – you know, that the virus would be able to mutate. But I think it probably would – I think we’d have probably dealt – but it might have happened – if we’d have been in a lockdown we might have stopped it at source, when it first emerged. Who knows?

I don’t think you could say that the – that that wave was a consequence of what happened in the autumn, it might have contributed, but we would have been in a much better place to deal with it.

Lead Inquiry: The government acted, in your words, relatively quickly, however, in December –

Professor John Edmunds: Yeah.

Lead Inquiry: – realising the consequences of Alpha, a great deal of work was done in ascertaining its transmissibility, its pathogenicity, the severity of the disease, and the government rapidly realised that Alpha had changed the dynamic and therefore there was the third lockdown imposed.

Professor John Edmunds: So it still was a little bit – yes, they did act quick – you know, they did act quickly.

There was a – so the – there was a tier 4 that then arose and was imposed in the south east and London, but there was still a little bit of a sort of shambolic – I remember the schools opened for one day in January and then they were closed. You know, again, hadn’t really thought it through as a government, I don’t think, you know, across the different sectors of government, properly.

But yes, they then acted relatively quickly.

Lead Inquiry: After the final national restrictions were eased in July of 2021, the following summer, you describe how the epidemic settled at a relatively high level. By that, do you mean that the level of incidence again, the general level of infection through the population, plateaued, but by comparison to other countries, and perhaps in particular our Western European friends, at a relatively high level?

Professor John Edmunds: Yeah, it was higher.

Lead Inquiry: Why was that?

Professor John Edmunds: We didn’t have any measures in place, they did, so they had – I say “they”, of course it varied from country to country, but as a general – as a sort of generalisation most countries had some measures in place. Mask wearing was still – was still required. Many countries had kind of a vaccine passport, so you couldn’t get into a bar, for instance, unless you had been vaccinated. Which probably didn’t make much difference to transmission, but made people get vaccinated. So they actually had – so, particularly in their younger population, they had – you know, as I say, I’m grouping, of course, all of Europe or something here, but many of our Western European neighbours had higher levels of vaccine coverage in younger individuals than we did. They had also started vaccinating children much earlier than we did. So I remember at the beginning of term, September of 2021, at that time France, about 80% of – I may have these numbers slightly wrong, but roughly speaking about 80% of their kids had – secondary school age children had had one dose and about 50% had two dose, we hadn’t even started vaccinating our children.

Lead Inquiry: It’s important to note, isn’t it, though, that in terms of – and this is for a later module, but in terms of the United Kingdom’s vaccination programme, its development of vaccines, getting them out there, getting people vaccinated, in a general sense that that was a very considerable success?

Professor John Edmunds: It was, and I think we started absolutely fantastically. We were fast. There were some very brave decisions made about the timing of one and two doses and things early in January of 2021, around then, which were vindicated for sure. I’m not sure we finished quite so well. We were a bit slow to finish the job.

Lead Inquiry: Then, of course, the further variant, the Delta wave, arrived and there were very significant further deaths, were there not, between May 2021 and December 2021?

Professor John Edmunds: There were, despite all the vaccination, and we rolled out then a booster dose in the autumn of 2021 and so on, so – but still I think there’s about 15,000 people died in that – in that long drawn-out – I don’t know whether you would call it a wave because it was just a long drawn-out period of high – of high incidence.

Lead Inquiry: That was going to be my next question.

What link, if any, is there between the continuing high, relatively high level of incidence and the number of deaths that ensued?

Professor John Edmunds: Oh, well, there’s a clear link if you – the higher the incidence then the greater the risk, of course, of someone vulnerable being – acquiring infection, and so yeah.

Lead Inquiry: By the time that the Omicron wave arrived in the winter of 2021, of course, there was a very extensive vaccination programme in place, booster programmes had been initiated for higher risk groups, and, as it turned out, the Omicron variant was not as – you know, it was no worse, it was no more severe or pathogenic than its predecessors?

Professor John Edmunds: It was far more transmissible, and it was able to evade the immune response. So even though we had high levels of immunity in the population mainly through vaccination, it could still spread amongst immunised individuals. So it was – and we didn’t know that it was less pathogenic. There were anecdotal reports, but I’m not sure you can really make government policy on kind of one or two anecdotes. So it took a while to work out – some really nice work by Imperial College and others, PHE and others, to look – to try and work out the risk. And the risk was lower. And thank heaven it was.

Lead Inquiry: I want to conclude just by putting to you some general questions and propositions from the core participants or some of the core participant groups in this Inquiry, which I have not so far addressed.

The Long Covid groups ask whether the 14 April 2020 post-lockdown epidemiological scenarios paper didn’t refer to long-term sequelae, if you can recall?

Professor John Edmunds: I really don’t remember, I’m sorry. I mean, we all knew of course by then this was becoming a – it took a while of course to realise anything about Long Covid. You have to have people to have Covid and then not recover, so it takes a little while for this to be sort of realised, but by then it was starting to become clear.

Lead Inquiry: When this debate about mitigation and suppression and levelling the peak or squashing the sombrero was being had, to what extent were long-term health conditions considered?

Professor John Edmunds: They were, actually, considered. This was something that I remember that Chris Whitty was very, very, very keen for us to keep forefront in our mind, that some of these measures would have significant effects on people’s lives, livelihoods, and, therefore, health later on down the track. So Chris was – sorry, Professor Whitty was very – was very keen for us to never forget that and make sure that we tried to take it into consideration. And they did set up a couple of studies to try and look into it early on.

Lead Inquiry: Covid Bereaved Families for Justice Cymru ask: did you receive any data from the devolved administrations which was used in your modelling?

Professor John Edmunds: Yes.

Lead Inquiry: FEHMO ask: do demographic data sources and early statistical modelling typically include ethnicity?

Professor John Edmunds: If you’re looking at the risk, so the risk if you – of severe outcomes if you’re infected, then yes, that’s routinely – that’s routinely looked at. We didn’t look at it in terms of the risk of you actually becoming infected, so it wasn’t in our mathematical models. We didn’t distinguish people’s ethnicity in our transmission dynamic models.

Lead Inquiry: We now know, of course, that there were varying degrees of severity of impact depending on ethnicity. In future, would you agree that that is an issue which needs to be better modelled?

Professor John Edmunds: Absolutely.

Mr Keith: Thank you very much, Professor.

My Lady, those are all my questions.

Questions From the Chair

Lady Hallett: Could I just ask one question, Professor Edmunds.

You have mentioned an awful lot of work, and for which I know the public would be extremely grateful that you and your colleagues were doing. I’ve seen the times of some of the emails; I’m not sure when you lot were sleeping. But there are a lot of groups, committees and subgroups. Was that the right structure? Did they work? In other words, just looking out as the layperson it looks like an awful lot.

Professor John Edmunds: It looks terrible, doesn’t it?

But actually they did work quite well, very well. And it was – some of the key ones that was planned, that had been planned long before, so that SPI-M would feed in to SAGE, that NERVTAG would feed in to SAGE. Because before that they were standing committees and they would feed in somewhere in the Department of Health, but in an emergency they would feed in to SAGE and they did.

And the way of working particularly of SPI-M was planned long in advance that we would always try to have – or SPI-M would always try to have multiple groups looking at the same question independently so that – to give some sort of validation. You know, models, you know, they’re coming – I’m sure they’re going to get overly criticised in the next session and, you know, they are very uncertain. You know, projecting forward, it is uncertain. And so the idea was always to have these multiple groups looking. And that had been planned a long, long time ago and it worked – clicked into gear very well, and the expansion of SPI-M worked to SPI-M-O worked extremely well and it was brilliantly led by Graham Medley.

And the other groups, it made sense. You were talking about ethnicity just now, that wasn’t obvious before the pandemic, that there would be a greater risk in ethnic – maybe we should have thought it through more carefully, but that wasn’t obvious to – certainly to me at least, so an ethnic group – an ethnicity group was set up, and that, and I think that was very important that it was, to get to the bottom of why – why there was a higher risk, so – and other things like that happened.

I think you had Cath Noakes this morning. She – they played a fantastic role of terms of understanding the physics of transmission. We were sort of the population dynamics and they were looking at the kind of, you know, does – how – does ventilation work. And that became – you know, that – suddenly, that – you know, in sort of April, whenever it was, it became obvious that we needed something like that.

So, yes, it looked – at the end it looked like there was this enormous spaghetti, but actually, no, there was a sensible reason for all of those groups. They fed in to SAGE. And, okay, that meant perhaps SAGE did get rather big, but it worked incredibly well, actually, at being able to assimilate all of that information. I mean, you asked me before about the role of the secretariat. I mean, I’m still astounded that they managed to keep all of that together and – and yes, we can criticise the SAGE minutes, they are a bit terse and they are – you know, but all together, the role that the civil service did to support that enormous effort – so there was huge scientific efforts going on but – you know, to bring it together, to make it available to government, it was a huge effort by the civil service. And it worked. So that our government really was – perhaps not at the beginning, not up to March, but after that it really was incredibly well informed.

Lady Hallett: Thank you very much indeed.

If I may say so, Professor, I think you were unduly harsh on yourself this morning. You had a job, and you described it yourself, your job was to provide expert advice to the policy and decision-makers, and if the system is working properly that advice is relayed to them, then they consider advice coming from other quarters about economics and social consequences and the like. I’m not sure you could have done more than you did, consistent with your role at the time, but you obviously did as much as you felt was appropriate. So I’m really grateful to you, I’m sure we all are.

The Witness: Thanks.

Lady Hallett: And I’m afraid you’re not the first and you won’t be the last scientist whose work is misunderstood. It probably goes with the territory, I fear.

Thank you very much.

The Witness: Thank you.

(The witness withdrew)

Lady Hallett: Shall we break now?

Mr Keith: Indeed, my Lady.

Lady Hallett: I shall return at 3.20.

(3.06 pm)

(A short break)

(3.20 pm)

Mr O’Connor: My Lady, our final witness for today is Professor Carl Heneghan.