5. Professor Carl Heneghan

PROFESSOR CARL HENEGHAN (affirmed).

Questions From Counsel to the Inquiry

Mr O’Connor: Can you please give us your full name.

Professor Carl Heneghan: Carl James Heneghan.

Counsel Inquiry: Thank you. Professor, you have prepared at our request a statement for the Inquiry, which is being brought up on the screen, and I know that you’re familiar with the contents of that statement.

We can see, I don’t ask for this to be brought up on screen, but on the final page of your statement you’ve signed the statement below an assertion that you believe the facts stated within it are true, and that signature was dated 24 September of this year; is that right?

Professor Carl Heneghan: Correct.

Counsel Inquiry: Thank you.

You are a professor of evidence-based medicine at Oxford University. Could you please explain what that discipline entails?

Professor Carl Heneghan: Yes. So evidence-based medicine is the integration of the best available evidence with clinical experience and expertise with patient values, about making decisions about healthcare for individual patients or systems. It largely grew out of about the 1980s when there was a growing recognition that there were severe harms being caused in healthcare –

Counsel Inquiry: Professor, I’m just going to interrupt you. If I could ask you to try to keep your voice slow. I appreciate it’s not an easy thing to do, but it would make everyone’s life a little easier if you could.

Professor Carl Heneghan: In the 1980s, a realisation that the use of poor quality evidence or opinion was harming patients in quite significant numbers and leading to excess mortality. Over time, what’s happened is there has been a change to the use of best available evidence. And a very good example of that, which you saw yesterday in the RECOVERY Trial, you would expect to see randomised controlled trials for the use of interventions in healthcare around drugs and vaccines. That’s the same as well for non-pharmaceutical interventions.

We particularly sit at the top of the tree doing systematic reviews, we try to take – look at all the available evidence, diagnostics, prognostics and treatment effects.

Counsel Inquiry: Thank you. So that’s a taste, at any rate, of that field in which, as we’ve said, you are a professor at Oxford University.

It’s also right, is it not, that you are a member of the Royal College of General Practitioners and in fact still a practising GP alongside your academic work?

Professor Carl Heneghan: Yes, so I qualified as a doctor in 2000 and received MRCGP status in 2005, and I work as an NHS urgent care GP, who basically works right at the frontline, and my speciality is doing visits and I continued to do that right throughout the pandemic.

Counsel Inquiry: Professor, in the time we have this afternoon, I want to ask you about events that took place during the autumn of 2020, in particular a time, as we know, when calls were made to alter the approach to the pandemic. There was a public debate, was there not? On the one hand we heard calls for a circuit breaker lockdown and an increase in the restrictions that were in play, and on the other hand there was argument about reducing the restrictions and, as we’ll come to see, the Great Barrington Declaration.

And as part of that debate, as in fact we’ve already heard, you and others met the Prime Minister in September 2020, and that’s another area that I will wish to ask you some questions about.

Before we get into the detail of those events, I’d like to ask you a little bit more about your expertise in this area, as it stood at 2020, at the outset of the pandemic.

As you know, because I think you have been following the Inquiry, we have heard this week from a series of academics who have spent, in the main, their professional careers researching, analysing the spread of infectious diseases, developing models, to analyse how such diseases are spread and how they can be controlled, and considering large-scale public health issues relating to pandemic preparedness and so on.

You don’t have a comparable type of expertise in this area, do you?

Professor Carl Heneghan: So if you mean do I have a narrow expertise in a single specific disease, the answer is no.

Counsel Inquiry: Well, that wasn’t quite my question. That may be right, but it’s also the case, isn’t it, that you have not studied, over the course of your academic career, preparedness for pandemics, infection control, the way in which viral diseases spread through populations and so on?

Professor Carl Heneghan: Yeah, so let me elaborate on where my expertise lies. You know, it lies in the evidence base in the community, and increasingly what we see now is a realisation that most of what we’re seeing requires a generalist approach, because it’s two areas broadly which you can consider, is non-communicable diseases, things like cancer, heart disease, and then you’ve got communicable diseases, acute respiratory infections, and what’s particularly important is how they interact in the community, and you develop an evidence base. And as we sit here, about 27% of the English population has multimorbidity, that’s two or more chronic conditions. By the time that goes to 65, that becomes over 50% of the population.

Now, you’ll have started to realise in the Inquiry, and we’ve learned, the relationship between multimorbidity and the impact of communicable diseases is interesting and important because of its elevated risk and the exacerbations in the severity of disease that’s caused by that interaction.

My expertise is in how we develop the evidence on diagnostics, prognostics and treatments to look at those areas.

Counsel Inquiry: All right.

Professor Carl Heneghan: And –

Counsel Inquiry: Sorry to interrupt you there, Professor.

I would like just to call up a document, because before we get into the detail of 2020 I’d like to just have a look at the types of matters that you were researching in that period or rather the year or so before 2020.

Could we call up on screen, please, INQ000314600.

Lady Hallett: Whilst that document is coming up, Professor, could I repeat the message: it’s really important that we get your evidence down in full.

Professor Carl Heneghan: Okay.

Lady Hallett: Although I’m not taking every word, I’m struggling, and so I suspect our stenographer is too.

I speak too quickly as well, so I understand the problem.

Professor Carl Heneghan: Apologies.

Lady Hallett: If you could just slow down a bit.

Professor Carl Heneghan: Mm-hm.

Mr O’Connor: Professor, as you know, because you’ve seen this document today, it’s actually just an extract from your website.

Professor Carl Heneghan: Yeah.

Counsel Inquiry: On your website you list the peer review publications that you have published down the years, and these are the publications from 2019, 2018, 2017 and so on, in other words the years running up to the pandemic.

If we can look briefly, one can see, for example, on this first page, in the last few months of 2019, papers that you published included papers about urinary tract infections, shoulder pain, a couple of papers about bacterial infections in older people.

If we can go over to the next page, please, there are papers there, are there not, about heart attacks, strokes. There is a paper towards the bottom about sodium valproate, which I think is a drug used to treat epilepsy; is that right?

Professor Carl Heneghan: Yeah.

Counsel Inquiry: If we go over to the next page, childhood cancer in Egypt, cardiovascular risk, about halfway down the page there’s a paper on hypertension. And looking at these papers, you seem to have had a particular interest in high blood pressure; is that right?

Professor Carl Heneghan: I need to answer the question in full, so –

Counsel Inquiry: Well, let me just look at one or two others and then you can respond.

If we look over at page 4 there are papers about people who suffered strokes, the effects of statins in the elderly. Towards the bottom of the page, vitamin D, whether or not it prevents fractures and falls.

Professor Carl Heneghan: Mm-hm.

Counsel Inquiry: Then finally, this takes us to the end of that year of 2019 on page 5, for example another paper about hypertension, something about sleep-wake disturbance and ocular disease. And at the top of the page there, a paper about the human papillomavirus – I think I pronounced it correctly – which I think is something that can cause warts and in some cases cancer.

So, Professor, the general picture I would suggest, at least looking at your published papers prior to the pandemic, is that you had a sort of general interest in matters relating to primary care, perhaps running in parallel with your practice as a general practitioner, but – let me put the question – but not that detailed interest in viral transmission of diseases that we’ve seen with the other experts?

Professor Carl Heneghan: So, number one, in 2019 you’re referring to my role as editor in chief of BMJ evidence-based medicine, so you’ve referred to a number of editorials, which I will have wrote. Secondly, as you’re referring to, I’m also director of programmes in evidence-based healthcare, which is a global programme that supports DPhil opportunities and Master’s, so when we’re talking about cancer in Egypt, that’s – I’m supervising a DPhil student at that moment in time is publishing in that arena.

But if you go across the breadth of what I – you do go back to 2014, where you start and go: oh, well, with the Tamiflu reviews in the last pandemic where we spent four and a half years doing that evidence. The second aspect is within the respiratory team – is it’s a team effort. So when I am in a position where we’re looking at something and there’s something, for instance, not quite there in a disease specialist, we will pull that to us.

As an example, when we was asked by the World Health Organisation in 2020 to do the systematic reviews on transmission, of which we published 17 papers, there was a microbiologist, a virologist, immunologist, medical statistician, and there is also an expert in the clinical epidemiology of respiratory viruses. So we bring – I bring together a team. But yes, it’s fair to say I have a view, particularly diagnostics, particularly harms. And I would say more so in the elderly I have an interest in the interaction between communicable and non-communicable diseases . So, for instance, some of those diseases we see, like diabetes, has a huge impact when you look at acute respiratory infections in the community.

It’s also important to realise, what does the community respiratory transmission look like when you understand there are 30 different pathogens that can cause viral immunity in the community in the UK. That broad understanding allows me to then use the evidence-based approach to come and say what’s the best available decision we should be using for a decision or action.

Counsel Inquiry: Professor, I think really we’re not disagreeing over very much at all, you describe a broad approach, which is different from the very specialist experience and practice of some of the other experts we’ve heard.

Just finally on this, many of the experts, the academics who have given evidence this week have sat on either SPI-M-O or SAGE or NERVTAG, and I think it’s right to say that you have not sat on those committees?

Professor Carl Heneghan: No, I have not.

Counsel Inquiry: Thank you.

Let me move, Professor, then, to, as I said, the debate in autumn 2020 about appropriate Covid guidance or regulation.

By way of context, as I’ve said, we saw that cases in that period were rising, there had been a call for circuit breaker lockdowns, others arguing that so-called whole-population measures were inappropriate.

Amongst those making that latter argument were Professor Sunetra Gupta, also of Oxford University, and also yourself.

We have heard that on 20 September, which was a Sunday, there was a meeting with the Prime Minister and the Chancellor which you and Professor Gupta attended. I said “attended”, it was, of course, a Zoom meeting.

Professor Carl Heneghan: Mm-hm.

Counsel Inquiry: The day after, 21 September, we just heard from Professor Edmunds that there was a SAGE meeting but it’s also right, isn’t it, that you and Professor Gupta and others published an open letter on that day relating to Covid regulations? We may look at that in a moment.

Then the third date I wanted to mention was a couple of weeks later, on 4 October, when the Great Barrington Declaration was published.

I would like to start, if I may, with that document, the Great Barrington Declaration.

It’s helpfully been brought up on screen. It’s a relatively short document, and we can take it page by page. We see at the top, after the title, there is a summary which states that:

“As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.”

I’m going to come to ask you about that “Focused Protection” policy.

While we’re looking at this page, one notes that at the end of the document there is a reasonably lengthy list of signatures which doesn’t include your own, but there is a reference here to 937,000 signatures. Are you one of the 937,000?

Professor Carl Heneghan: No.

Counsel Inquiry: You didn’t sign the declaration?

Professor Carl Heneghan: No.

Counsel Inquiry: Well, if we may, we will simply note the contents of the declaration. I’ll come and ask you why you didn’t sign it.

So if we can go over the page, the first substantive paragraph really just repeats the summary we’ve already noted. There is then a paragraph which refers to the, as it’s said, devastating effects on short and long-term public health of current lockdown policies. Examples are given: lower childhood vaccination rates, fewer cancer screenings, and so on.

Over the page, please, there is a reference to the fact that the understanding of the virus is growing, and in particular it is said that:

“We know that vulnerability to death … is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.”

Then perhaps really the core of the declaration, it’s asserted that:

“As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – ie the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.”

Reading on, it’s said:

“The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death [by inference the young who have been referred to] to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk.”

That paragraph is a description of, it is said, this policy of “Focused Protection”.

Then next paragraph emphasises the need to adopt measures to protect the vulnerable, that’s one half of the equation, and the paragraph afterwards stresses the other half of the equation, which is:

“Those who are not vulnerable should immediately be allowed to resume life as normal.”

Simple hygiene measures are referred to, but then the theme is schools and universities should be open, restaurants and other businesses should open, arts, music, sport and so on should resume. And finally, people who are at more risk may participate if they wish while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.

So that’s the declaration.

Why was it, as you’ve told us, Professor, that you did not sign this declaration?

Professor Carl Heneghan: So you referred to the meeting of 20 September.

Counsel Inquiry: Yes.

Professor Carl Heneghan: Can I elaborate on that meeting, or are you going to come back to that?

Counsel Inquiry: I’m certainly coming back to it, Professor.

Professor Carl Heneghan: Okay.

Counsel Inquiry: I wanted to just use this declaration, this document, as a way of identifying what that policy was before we go back to the meeting.

Professor Carl Heneghan: That meeting, when I – it was announced, was the first time I met Professor Sunetra Gupta, who is a theoretical epidemiologist. Subsequent to that, as you talked about, disease expert, she’s a disease expert in the area of interest, and I spoke to her weekly.

We are broadly in agreement about many areas, but one of the issues that happened after that meeting was it was subsequently leaked to the press, and then I was under pressure from articles calling me an agent of disinformation, abuse on social media, and felt under pressure. I communicated with Professor Kulldorff and – Martin Kulldorff and Jay Bhattacharya and Sunetra Gupta, was asked to sign it, and at the time I was – we was also working on a series of systematic reviews that we felt we were trying to interpret and understand.

I agree with the broad aims of the Barrington Declaration, but I would not let my emotions and opinions run into something when I didn’t have time – because there are one or two areas where you might look at it and go, “I think actually it needs more detail”, and – you know, particularly if you said everybody should return to work as normal. You know, that’s the sort of thing where, given the gravity of what was happening, from an evidence-based perspective I would have derailed it and said, “We need to step back and really consider that issue”. It would’ve took me quite a few weeks with my team to get to an opinion on that.

In doing so, like I said, I agree with the broad themes but by the time it had been published and was out there I think the position was clear and there was no weight to be added by me signing it, and, as I said, I was under considerable pressure in all sorts of different ways, and still trying to inform the debate in the background, as you will see later, with an evidence-based approach.

Counsel Inquiry: All right.

So I think you’ve made the position very clear, Professor, which is that you did agree with the broad terms of the declaration, and you’ve explained the sort of pragmatic reasons why you didn’t sign it.

The evidence that the Inquiry has received is that there are at least three quite sort of high level principled objections to the Focused Protection policy, and what I want to do is go through them with you one by one. And of course if they sort of overlap with any of your concerns about the policy, you will be able to say so.

Just to be clear, once we’ve done that, we’ll go back and talk about –

Professor Carl Heneghan: Okay.

Counsel Inquiry: – the meeting in Downing Street.

What I’m going to do for these purposes is really look at Professor Woolhouse’s statement, because he identified what he regarded as the real problems with the focused protection approach, but I will also take you to Chris Whitty’s statement, because he has said some similar things.

So if we can go to paragraph 175 of Professor Woolhouse’s statement, he says:

“As I understand it, the Great Barrington Declaration … advocated an approach where vulnerable individuals are protected but the virus is left to circulate until enough people have been infected to reach the herd immunity threshold. I had three concerns about that approach at the time, and declined to sign the declaration when invited to do so.”

Then we can see at paragraph 176 he identifies the first of those difficulties or objections, which is that:

“… the size of the resulting epidemic would be so large that the public health burden just in the low risk segment [by that he means the young people] of the population would be enough to overwhelm the NHS, noting that low risk is not zero risk and some of these individuals would develop severe disease.”

What do you say to that?

Professor Carl Heneghan: Which one, the first or both? Sorry.

Counsel Inquiry: Well, I think he is making a single point.

Professor Carl Heneghan: Oh, so what he’s basically coming at is the aspect that what we’ve got to understand from respiratory infections is – the first thing is to say between summer and winter there is a large increase in unplanned respiratory admissions. We go from about 15,000 to about 30,000 every year. The vast majority of the deaths in respiratory infections occur in that winter phase.

There is an element that you cannot reduce the risk to zero for anybody. Some of the respiratory pathogens will affect younger people much more so: influenza, RSV. The coronavirus was very much to the elderly population.

I think the problem is if you say we’re going to have no approach whatsoever, that was not the approach that was being undertaken by Sweden. That actually there were subtle reductions in mobility in the population. So, for instance, they didn’t have mass gatherings, they didn’t – they had reductions in people attending restaurants and public houses. You couldn’t stand at a bar, for instance. So they didn’t have no effect.

Counsel Inquiry: Can I just interrupt you there? Is this one of these areas where you didn’t agree with the Great Barrington Declaration? We’ve looked at it.

Professor Carl Heneghan: Yeah.

Counsel Inquiry: It’s very clear that really, beyond hand washing, for that younger segment of the population they would live their lives as normal. Are you saying that you didn’t agree with that?

Professor Carl Heneghan: Well, I think that the idea of live life as normal in the face of an emerging risk is not possible, because everybody will attenuate their risk in some way.

So, for instance, if you are a young person and you have a grandma who’s 85, 90, you have to attenuate your behaviour, because if you’re going to take your illness, irrespective of whether it’s coronavirus, it could be a common cold, it could be highly harmful for that elderly person. So I would expect younger people to change their behaviours in some ways to match the risk that is presented.

Counsel Inquiry: Thank you.

So are you agreeing with me that you do not agree with the broad proposal in the Great Barrington Declaration that young people should live their lives as normal?

Professor Carl Heneghan: And I think what’s happening there is –

Counsel Inquiry: Professor, could I ask you for a yes or no answer, please.

Professor Carl Heneghan: Yes, I am.

Counsel Inquiry: Thank you.

I’m going to move on to the second of Professor Woolhouse’s propositions. He said:

“… it wasn’t made clear how well the vulnerable segment could be protected from infection in practice.”

Here, of course, he is referring to the older segment of the population.

“It certainly couldn’t with 100% and that meant a further, also potentially very large, burden on the NHS.”

Now, Professor, before you answer, we’re going to come to your paper that you produced for the Downing Street meeting, and we will see in there a number of measures are encouraged to protect the vulnerable population.

The point that Professor Woolhouse is making is that it just isn’t possible to provide a sufficient level of protection to protect them when the rest of society is not taking those measures, and it may be that that rather chimes with the point you just made about young people visiting their grandparents?

Professor Carl Heneghan: So when you decide to lock down, one of the key issues is what happens is you equalise the risk across all the age groups, and in doing so the theory says, and actually the practice is, you actually can increase the risk of those in the most vulnerable category.

As an example of that, in the first wave care homes – 45% of care homes had outbreaks and in some parts of the north it was 55%. What – the argument about the younger population, those least at risk, which is what happens now, is that as they go about their daily life, they will build up a wall of immunity and reduce the susceptible population, and in doing so that means the elderly actually gain an advantage. But if you’re telling me you lock down and the elderly are at less risk, that didn’t happen, as you saw in the first wave and in the second wave, that actually there is not a clear relationship between reducing the risk in the young people and your ability to suppress the virus in areas like care homes.

Counsel Inquiry: Professor, I’m going to interrupt you, I think we might be at slightly cross-purposes.

Professor Carl Heneghan: Okay.

Counsel Inquiry: You’re now talking about whether lockdowns of the whole population are effective, but I’m asking you about whether this policy of focused protection is effective, and the criticism that was made by Professor Woolhouse and, amongst others, by Chris Whitty, is that this idea of – we’ve heard various descriptions – cocooning, segmenting, shielding, that vulnerable section of society, it may be a very attractive idea in principle, but, to use Chris Whitty’s phrase, it’s entirely impracticable, it simply won’t work?

Professor Carl Heneghan: Well, that’s – I think that’s an opinion, and it comes from people’s opinions. It’s not rooted in evidence. So, for instance, in care homes there is evidence, for instance in the US, what they call greenhouse homes, smaller homes, less mortality, more clinical care reduces mortality, more nurses reduces mortality. So there are many areas you could sit in a room, but what you can’t do is come off the top of the head with how you would look at this and propose this, but there is evidence to suggest how you might go about this. It is not an evidence-free zone, as these people suggest. However, if you want to integrate and understand how you might go about it, I would argue that’s where you need a generalist who can talk to you about what’s happening in the community and how you might go about that.

I’ll give you –

Counsel Inquiry: Can I just interrupt you there, Professor? Again, can I ask for a yes or no answer: do you agree with the objection that Professor Woolhouse is making to the Great Barrington approach; yes or no?

Professor Carl Heneghan: No.

Counsel Inquiry: I’m going to move on to the last of his objections, which goes to this question of herd immunity which, as we saw, is really the sort of bedrock of the Great Barrington Declaration, isn’t it? Because the whole approach assumes that the younger segment of the population will acquire herd immunity through infection, and you have just referred to what you describe as the advantage of that, because it provides protection to the older population as well.

The point that Professor Woolhouse makes here is that there was an assumption in the Great Barrington Declaration that there would be what he describes as “solid post-infection immunity”, and that therefore “herd immunity threshold could be reached in a matter of months”.

He says – and I think it’s clear he is talking about back in 2020 – he was concerned that this might not be the reality, in which case the threshold might not be reached for years or not at all, and therefore the strategy would fail.

He goes on, and he is clearly now talking about his current state of knowledge:

“We now know that post-infection immunity does not give 100% protection, that individuals can be re-infected multiple times …”

It may be that some people in this room know what he is talking about.

“… and that the herd immunity threshold is almost certainly unattainable.”

He says:

“This undermines a core premise of the Great Barrington approach.”

Is he right about that?

Professor Carl Heneghan: Before answering, I need to be clear, where does it say “solid post-infection immunity” in the Great Barrington Declaration?

Counsel Inquiry: Well, Professor, it must be right, mustn’t it? We looked at the Great Barrington Declaration. The premise there was that the younger population who were living their lives normally would catch Covid, would thereby gain immunity, and that corporately that segment of the population would attain herd immunity.

If they’re not going to attain immunity, having caught Covid, then the policy just doesn’t work, does it?

Professor Carl Heneghan: So that’s a misunderstanding of the Barrington Declaration and what the authors were proposing. Having spent two and a half years with Professor Gupta, I’ve never heard her make that statement.

What happens in reality – there are a number of other circulating pathogens, like rhinovirus, for which we know this; there are also other circulating coronaviruses like 229E and OC43 – that when you get an infection, you will get an immune response that will be of variable nature and will last for a certain period of time, up to about 12 months, possibly 18 months.

But as you’ve secondly understood, these pathogens have the ability to escape your immunity. That’s where the variants come in. So if you look at rhinovirus, there are about 150 different variants that exist.

So what happens is, what you’re describing is the position we find ourselves now, with all of the other viruses that have been post-pandemic, there will come a position where a part of the population will have immunity and that will dampen it down from going to the 60%, 70% that was thought would happen in the models. That figure is roughly around 30% of the population.

So as you transit into winter now, you are susceptible to a number of different viruses and you will re-catch them, but some people are not susceptible and that’s why we will still have waves of infection, we will have problems in the NHS – 17 of 20 years we’ve had a winter crisis – but a part of the population will be not susceptible and therefore we won’t get these massive waves that are in the models.

Counsel Inquiry: I see. So is what you’re saying that the Great Barrington Declaration never suggested that there would be, as it were, complete immunity amongst that younger segment of the population? Is that – yes or no?

Professor Carl Heneghan: I am saying, yes, it never said that.

Counsel Inquiry: All right.

There is one more point I want to ask you about the Great Barrington Declaration, Professor, and that’s an issue which isn’t mentioned by Professor Woolhouse, although it’s related to one of them.

We’ve spoken about the risk that the younger segment of the population would themselves catch Covid and suffer acute symptoms from it. That was the first of Professor Woolhouse’s objections.

But there is another point, which is that already by the autumn of 2020, when the Great Barrington Declaration was published, it was becoming understood – it was already understood – that a significant group of people who caught Covid would go on to suffer long-term sequelae from it, a post-viral syndrome, which of course we know as Long Covid.

That risk, which affects young people and old people alike, was another reason, was it not, why the proposal in the Great Barrington Declaration was flawed?

Professor Carl Heneghan: So all of the acute respiratory infections that circulate in the community have the potential to cause long sequelae. Now, your influenza increases your risk of stroke, heart disease, bacterial pneumonia, meningitis, RSV, bronchiolitis, risk of a hospital admission, and then there are others like glandular fever that can give a long immune response.

The question you’re asking me, which is what you need to ask, is: to what extent does an infection with a coronavirus lead to increased complications and long-term outcomes compared to the other acute respiratory infections? Because they do have a significant impact on morbidity and mortality, particularly in those with comorbidities and multimorbidities. So if you’ve got a pre-existing disease like heart failure, it will be worsened to the point where it can have a significant impact on your morbidity and mortality.

If you’ll let me –

Counsel Inquiry: I’m just going to interrupt you, because I think we’re diverting from the question a little bit, Professor. We have heard expert evidence about post-viral syndromes, we know they exist; I would like to focus very sharply on Long Covid, please.

Professor Carl Heneghan: Yes.

Counsel Inquiry: Just coming back to my question, it wasn’t – the existence of Long Covid, where significant numbers of people suffer very serious long-term sequelae, including people in the younger population, wasn’t that another reason why the policy of letting that group of people, as it was said, live their lives normally was flawed?

Professor Carl Heneghan: It can be used as an argument, but I think if you’re going to take an evidence-based approach, you really have to define what you’re on about and quantify what you’re on about and then I can truly answer the question. But it is an argument that people would put forward for one reason for having alternative views to try and suppress the virus.

Counsel Inquiry: Thank you.

Lady Hallett: I’m sorry, Professor, I’m not following. Why isn’t – and I understand an evidence-based approach, it’s my approach, it has been as a lawyer throughout my working life.

Why isn’t the fact that we now have evidence that you have post-viral long-term sequelae – and Long Covid is the example here being given – why isn’t that evidence for your evidence-based approach?

Professor Carl Heneghan: Because when you compare that – as the evidence has just emerged in the last month, if you compare that to other acute respiratory infections, what you’re interested in is to what extent you get more of something with the coronavirus.

So, for instance, the evidence shows things like taste and smell is worse with a coronavirus SARS-Cov-2 infection, but your risk of heart attack or stroke might not be as severe. It could turn out there are specific respiratory complications in people with, like, asthma and chronic airways disease, but it’s incredibly important you say, “What’s the risk compared to the baseline?”, which is other acute respiratory pathogens, and not compare it to the normal population.

I am not saying that the infection leads to no risk. It is quite clear it has severe complications. The question is: how much is that more severe than the other acute respiratory infections for which you don’t have the same restrictive policies, but they do have a severe consequence in the population.

Lady Hallett: I understand the comparison is important, or the comparative analysis is important. What I’m just questioning is the fact that – what Mr O’Connor was putting to you was that we know post-viral syndromes exist, and therefore I was just putting: why isn’t that evidence? It may be there’s more evidence that needs to be put into the balance, but it just seemed to me that it was evident.

Professor Carl Heneghan: Well, yes, so everything exists as evidence, even my opinion exists as evidence within –

Lady Hallett: Not in my world it doesn’t, I’m afraid. Well, not in a court of law it doesn’t.

Professor Carl Heneghan: What you need to do is quantify the size of the effect of the difference, and that’s really important because then that helps you understand where you need to intervene if you’ve had a post-viral Covid infection. That’s incredibly important. What do you treat?

And it’s particularly important in two groups of people: those with pre-existing conditions who have worsened, but also there are some people who would come with no pre-existing conditions and then will have complications, for instance maybe they have respiratory complications. That then helps you understand how to intervene.

Mr O’Connor: Let me just ask you one more question about that, and perhaps you can answer shortly.

You just said that the risk of, in this case, a post-viral symptom needs to be quantified. The Great Barrington Declaration doesn’t mention Long Covid at all.

Professor Carl Heneghan: No.

Counsel Inquiry: Now, I know you didn’t draft it, but do you know whether it was taken into account at all or not?

Professor Carl Heneghan: I don’t know the answer to that.

Counsel Inquiry: All right.

I’m going to move on, Professor, and finally just ask you a few questions about the meeting we’ve referred to once or twice and which we’ve heard about from others.

It was a Zoom meeting on a Sunday in September 2020. The context, as we’ve heard, was a very public debate going at the time about whether there should or shouldn’t be some form of circuit breaker, as it’s been described, and it’s clear from some of the documents that the Inquiry has seen that the meeting – a Zoom meeting, as we’ve said – had a title, which was:

“Should the Government intervene now and if so, how?”

Now, I’m not sure whether you ever were aware of that. Some of the attendees, it looks as though when they were sent the invitation they were told: this is what the meeting’s going to be about.

Was that the case with you, or can you remember one way or the other?

Professor Carl Heneghan: I can’t remember one way or the other, apologies.

Counsel Inquiry: All right.

It’s right, though, isn’t it, that before the meeting – and I know I’m going to ask you about when – but before the meeting, you were asked to provide a short note for the purposes of it?

Professor Carl Heneghan: Correct.

Counsel Inquiry: Now, we know that the meeting took place on Sunday, the 20th. When were you asked to provide the note?

Professor Carl Heneghan: I was asked about roughly in an email around about 7 pm, 8 pm on the Friday. I can’t quite remember the exact time.

Counsel Inquiry: Were you able – or were you told when the note was needed by?

Professor Carl Heneghan: 12 o’clock the next day.

Counsel Inquiry: On the Saturday?

Professor Carl Heneghan: On the Saturday.

Counsel Inquiry: Were you able to meet that deadline?

Professor Carl Heneghan: No, on the Saturday morning I was working in urgent care doing home visits, and I didn’t finish till 1 pm, so I sent them an email and said: can I have till 4 pm, was the agreed timeline for me to submit the one-page submission.

Counsel Inquiry: Did they give you that extension?

Professor Carl Heneghan: Yes, they did.

Counsel Inquiry: All right.

So we’re going to look at the note now but we’ll bear in mind – and I think this is what you’re telling us, Professor – that it was compiled in something of a rush?

Professor Carl Heneghan: It was compiled in something of a rush and it was compiled with my colleague Professor Tom Jefferson, who also had input to the document.

Counsel Inquiry: We’ll look at some of the detail in the note in a moment, Professor, but can I ask you at the outset – and, if you like, in summary – did you argue in writing in this note and then, when it came to it, orally at the meeting in favour of the type of policies that we have been looking at in the Great Barrington Declaration?

Professor Carl Heneghan: I think in reading that you’d say broadly, yes.

Counsel Inquiry: Yes.

If we do look, for example, about halfway down, we see there:

“Aim: to control the spread of acute respiratory illness while minimising societal disruption.”

Professor Carl Heneghan: Yeah.

Counsel Inquiry: So, in summary, a similar approach.

And we see – sorry, if we can zoom out again, we see the bullet points below. Many of them are, as I mentioned, focused on that need to protect the vulnerable, and there are some practical –

Professor Carl Heneghan: Yeah.

Counsel Inquiry: – policies that you were proposing as to how that should be done.

I would like to ask you if I may about a line towards the top of the paper. Sorry, we’ll need to go back. So at the very top after the title there’s a bit in italics about terminology, and then immediately underneath that it says this:

“The current strategy requires acknowledging the virus is endemic and the need to learn to live with Covid.”

Now, Professor, I want to ask you about your description of the virus as endemic at that point.

Tell me if I’m wrong, but there is a distinction, isn’t there, between a virus or a disease which is at a stage of being an epidemic, where it spreads quickly, unexpectedly and unpredictably – it becomes a pandemic if it acts in that way across a very large area, across nations – but that’s on the one hand; on the other hand, an endemic disease is one that is consistently present in a region or population and where its prevalence remains stable and its spread fairly predictable?

Now, that’s what I understand by those terms, but are you saying – or were you saying there – that Covid, in September 2020, was a disease that was stable and predictable?

Professor Carl Heneghan: No, because there’s nothing predictable about acute respiratory infections per se. Across the whole of my 20 years – apart from broad areas, for instance a seasonal effect, which you can understand – they’re highly unpredictable agents, and therefore the point being made is that where we were at, if – and I have to elaborate here, if you don’t mind – we’d gone from March/April to flattening the curve, two weeks to protect the NHS, to an area now where we were talking about zero Covid and suppression. The policy on the table was to reduce infections below 1,000 and then keep Test and Trace to keep it below that level.

What had happened over the summer is, remember, we’re scaling up testing and there was a misperception that actually out there was far less cases. The only cases were the ones that were being detected. Well, actually there’s pre-symptomatic phases, asymptomatic phases, there are also people who don’t turn up for testing.

My experience throughout the whole summer was telling me, right back to March 15th, that there was much wider circulation than this virus is being understood if you’re just looking at the case numbers.

And that’s one of the problems when you’re just research focused and data focused. If you don’t have an ability to triangulate and say what’s happening on the ground, you will read inconsistencies and come to misperceptions in the data.

Counsel Inquiry: Thank you, Professor, but I do just want to press you on this sentence here which you put in the note, albeit drafted in a bit of a rush, for the Prime Minister. You are a scientist, and you used that word “endemic” deliberately, and it does mean, doesn’t it, a disease that is stable and predictable?

Professor Carl Heneghan: Well, not in all – it’s not a clear definition that I would agree with. What it means –

Counsel Inquiry: Well, I’m going to interrupt you a moment.

Let’s just look, if we may, at a graph just to get the context here. It’s INQ000283367. We can see there’s a date there of 1 October. So we see if we look just to the left, obviously, that’s 20 September of that year. There was nothing stable or predictable, as it turned out, about Covid at that date, was there, Professor?

Professor Carl Heneghan: Well, in terms of the seasonal effect, there are predictable natures to January. The second week of January, about seven of the last ten years you will see the highest number of deaths from acute respiratory infections. Most of that occurs in the over 80s.

So within – if you notice my plan is that actually there is a seasonal effect, but actually what’s more so is unpredictable is the fact you’ve got the sharp rise in April/May. I’d say that’s more unpredictable.

There is a generalised predictability to the seasonal effect that starts in about 1 December and goes into January/February –

Counsel Inquiry: I just want to press you though, Professor, because you used that word “endemic”, didn’t you, to suggest it’s no longer an epidemic, it’s no longer unpredictable, growing exponentially; it’s endemic, it’s stable in the community, it’s predictable? And if we look at that graph, you were wrong to use that word, weren’t you?

Professor Carl Heneghan: No. So, you’re using interchangeable terms all the time, which is difficult to follow. Epidemic –

Counsel Inquiry: Just, sorry to interrupt you. “Epidemic” and “endemic” are not interchangeable terms, are they?

Professor Carl Heneghan: Well, “epidemic” and “pandemic” are.

Counsel Inquiry: I wasn’t asking you about “epidemic” and “pandemic”, I was asking you about “epidemic” and “endemic”.

Professor Carl Heneghan: So what in terms of endemic is there’s widespread global circulation of the pathogen that’s gone beyond low level circulation. No acute respiratory infection is predictable or stable, so I would contest what you’re looking at is not my interpretation of the word “endemic”, and I would have had the opportunity at the meeting to explain all of the nuances around those issues of what I meant.

Within the problem of, remember, throughout summer you were scaling up the testing, we were scaling up the testing, so our actual understanding of what was going on was fairly limited until we scaled up the testing.

Counsel Inquiry: I see. I’m going to move on, Professor. You referred to the meeting. I would like to take you to something different, please, which is the Prime Minister’s account of the meeting.

If we could go, please, to INQ000255836, and it’s page 130.

Lady Hallett: The then Prime Minister’s account.

Mr O’Connor: The then Prime Minister’s account.

I know you’ve had a chance to look at this in advance, Professor. We see at paragraph 462 Mr Johnson referring to this meeting and the title, “Should the Government intervene now and if so, how?” He runs through the attendees that we’ve heard something about. We see your name there, as well as actually many others.

He refers at paragraph 463 to the views presented by Professor Edmunds and Professor Angela McLean, who he describes as representing the more conventional epidemiological view, and then he said that Professors Gupta and you were there to present two opposing views, and refers to Dr Tegnell presenting the Swedish approach.

He records, about halfway down the paragraph, Professor Edmunds’s advice, which of course we’ve heard evidence about this afternoon, and Mr Johnson states at the bottom of this page:

“I greatly respected [Professor Edmunds’] views, but had always put him at the gloomier end of the spectrum. I wanted to give the Rule of 6 a chance to work, and to hear some alternative views.”

And of course one of those alternative views was yours.

And if we look at the next paragraph, Mr Johnson says that he thought “we put all the scientists through their paces”. He says that by this point he had a much better understanding of the data and evidence, and he certainly thinks that he was able to probe the different points of view that were being presented. And he says he was willing to be persuaded by the lockdown sceptics. But then this, he says he:

“… found that in reality they [that is you] were reluctant to argue any such case, or not very hard. When pressed, the so-called dissenters actually seemed to agree with SAGE’s position and did not present anything compelling to make me think it was sensible to change [his] approach.”

Is it right that at the meeting you more or less agreed with the SAGE approach?

Professor Carl Heneghan: Well, that’s the interpretation of the then Prime Minister.

Counsel Inquiry: It is, which is why I’m asking you whether you agree with it.

Professor Carl Heneghan: The approach at that time was the tier system, which I can’t – I don’t know if that’s what SAGE was proposing.

Counsel Inquiry: Did you agree with the tier system?

Professor Carl Heneghan: Yes, I did at that moment in time, because it was a much better alternative than to the zero Covid suppression argument that was being put on the table, which was to get the cases below 1,000 and keep them there.

In terms of looking at the tier system, what that was attempting to do was trying to find a middle ground between the two positions and match what was going on in Sweden. Which was not an approach that did nothing; it was an approach that was responsible and managed it, so, for instance, as I’ve said previously, with certain interventions but minimise the disruption to society while trying to get your maximum intent in terms of reducing the impact in terms of disease outcomes.

Counsel Inquiry: Yes. Now, Professor, in the course of his evidence earlier today, Professor Edmunds made various statements about you and about the contribution that you made to the meeting, and I’d like to give you a chance to respond to them. There were three points.

First of all, we looked at an email between him and Dame Angela McLean where they described the approach that you and, I think, Professor Gupta were taking at the meeting as “half-baked nonsense”; we looked at a WhatsApp message sent by Dame Angela McLean during the meeting where there was a reference to a “fuckwitt”, and Professor Edmunds I think inferred that that was probably a reference to you; and he also said today that he thought you didn’t understand basic epidemiology.

What are your reflections on that evidence that the Inquiry has heard?

Professor Carl Heneghan: I would never in a professional capacity use such language about other individuals.

It is not unusual to find yourself in disagreement and a position of disagreement. We call it uncertainty. And the job of an evidence-based approach is to try to reduce uncertainties so that you can make an informed decision.

The very fact that you have opposing views shows that you there is a problem within the interpretation and the understanding of the evidence, but it also shows me a position of: that sort of language would mean I would become resistant to any other’s viewpoint or discussion. And I think that’s unhelpful. And it goes back to why we were brought in in the first place, is to try to propose a viewpoint that obviously was not being aired in SAGE, was not being aired at any point of the government advice.

Despite the fact I’d been working for the World Health Organisation, I’d given evidence to the Irish Parliament, I spoke to a number of MPs outside of the Cabinet Office – and I said did the work for the World Health Organisation. So to be clarified as classed at that, you know, just goes to probably the heart of the problem here, because one should always have an open viewpoint about alternative views.

It is – you know, the idea that a statement could provide all of the answers is not something that you would recognise, but what it was proposing was an alternative view, how you might look at the issues, how you might develop an evidence base and test some things you have to, just as we were doing with drugs, and in doing so come to a difference of what the current strategy was.

In the round, I think it’s fair to say that everything that we were proposing and the way we were looking at the epidemiology, remembering up to that point we’d established clearly that many faults in the data, as an epidemiological team, we also would be, and I would be very … the idea we would – so one of the evidence-based approaches, we would be looking at the data trying to understand what was happening.

What I found very difficult was a modelling approach which kept looking into the future and saying “This is what we now predict”, with some certainty. And what comes with certainty is a reluctance to engage in the discussion, in the debate.

Mr O’Connor: Professor, thank you. We’ve seen the contribution you made at that time, and those are all the questions I have for you.

And there are no questions from CPs, my Lady.

Lady Hallett: Thank you very much indeed, Professor Heneghan.

I’m sorry we haven’t had more time, but I think Mr O’Connor has explained: if there are other matters that you wish me to explore, by all means submit them in writing –

The Witness: Will do.

Lady Hallett: – and I will consider them.

So thank you very much for your time this afternoon.

(The witness withdrew)

Mr O’Connor: My Lady, that concludes the evidence for the day.

Lady Hallett: Right.

Well, we’re now in the position where we’re going to take a break from the hearings and return on Monday 30 October, a week on Monday.

When I say we’re taking a break, I’m afraid it doesn’t mean that we’re taking a break from work. I know that the Inquiry team and the core participants’ teams will all be working enormously hard to ensure that we’re ready for the next phase of the hearings, and there’s also a great deal of work going on as far as other aspects of the Inquiry is concerned. So I’m afraid it’s not a holiday break, it’s a break from the hearings solely.

Thank you all very much indeed, and for those who wish to follow proceedings, either in person or online, Monday 30 October –

Mr O’Connor: Thank you, my Lady.

Lady Hallett: – at 10.30.

(4.20 pm)

(The hearing adjourned until 10.30 am on Monday, 30 October 2023)