3. Professor Yvonne Doyle

PROFESSOR YVONNE DOYLE (sworn).

Questions From Counsel to the Inquiry

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

Professor Yvonne Doyle: My name is Yvonne Doyle.

Counsel Inquiry: Thank you. Professor Doyle, you provided at our request a witness statement for the Inquiry. We can see the first page of it is on screen now. We don’t need to look at the last page, but you have signed that last page of the document below a statement indicating that you believe the contents of the statement are true, with the date of 17 October this year. Are the contents of the statement true, Professor?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: Thank you.

Professor, you set out some considerable detail about your career in that witness statement. In summary, it’s right, isn’t it, that you are by training a medical doctor?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: You have acquired a range of qualifications over your career, and indeed you have held a series of appointments in the field of public health?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: That includes a series of roles acting as a director of public health for various local and regional authorities in England?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: In June 2019, you were appointed as the medical director and director of health protection for the organisation Public Health England, or PHE?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: From February to July 2020, you were PHE’s senior responsible officer for the input of your organisation into the response to the Covid pandemic?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: And I think it’s right that you remained in post at PHE until that organisation was dissolved in October 2021?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: And you then became the director for public health at NHS England, and you stayed in that role until you retired earlier this year?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: Professor, as with other witnesses today, we will be asking you questions relating to PHE’s involvement with the pandemic, but we will do so conscious that many of those issues touch on much broader areas that will be the subject of further examination by the Inquiry at further modules, in particular issues relating to test and trace and also PPE.

So we will be endeavouring today to ask you questions around the interface, if you like, between the activity of PHE and core political and administrative decision-making during the pandemic.

Before we get into those issues, can you give us, Professor, a brief outline, first of all, of, in general terms, PHE and what it did back in the days when it existed, and more specifically its role in relation to combatting infectious disease?

Professor Yvonne Doyle: Yes. PHE was remitted to undertake four main functions: the protection of the population, including the instigation and curation of specialist – certain specialist infection services, particularly laboratories, the oversight and the implementation of programmes on wellbeing, and health improvement of the population; the surveillance of disease and the curation of various disease registers; the support to the NHS, particularly on the reduction of inequalities in the NHS, but also on value and support to clinicians; and finally, the development and ensuring of the development of the workforce in public health.

Counsel Inquiry: So I think it’s clear from what you’ve said that where there is a novel infectious disease that needs to be combatted in this country, that can engage several or perhaps even all of those areas that you just described?

Professor Yvonne Doyle: Yes. And you asked about its particular role in infectious diseases, where there were several subfunctions. First being the oversight and management and running of the specialist laboratories, the development and the execution of field services for the control of outbreaks, the running of the emergency service, training and testing, training particularly, and exercising, and then specialist areas in radiation, chemicals and environmental health, which were based at Chiltern.

Counsel Inquiry: Now, we’ve said, Professor, that your role that you were appointed to in 2019 at PHE was that of medical director and director of health protection. Give us a sense of the scope of your duties in that role.

Professor Yvonne Doyle: Well, the organisation had changed somewhat, it’s in my statement, that before 2018 the whole health protection service encompassed both the national infection service, the laboratories and the field services, and health protection teams, and then also the chemicals, radiation and environment services, and an important surveillance service which I should have mentioned actually as part of its core health protection function.

Now, in 2019 that changed, in the appointment of a national infection service director, and my role remained as the health protection director and medical director, but my responsibilities for health protection were mainly to oversee the whole – that the whole system held together, we co-operated for health protection, but also specifically to manage the chemicals, radiation, environment and emergency planning services.

Counsel Inquiry: I see.

Could we look briefly at paragraph 8 of your statement, please, Professor, it’s on page 3.

Professor Yvonne Doyle: Yes.

Counsel Inquiry: You describe in this paragraph, in the six months or so after you joined PHE, having to deal with a series of outbreaks of other diseases, we’re talking before 2020 now, so not Covid, but as listed here, listeria, what was then called monkeypox but which we have now been told is Mpox, and also Lassa fever.

I don’t want to spend a great deal of time talking about other disease outbreaks, Professor, but it may be that dealing with those outbreaks was more typical of the more that PHE regularly undertook in those days than Covid, which we’ll come to talk about.

If that’s right, can you just give us a sense of the work that PHE undertook on those issues in 2019?

Professor Yvonne Doyle: That’s correct. So these would be the more spectacular end of health protection outbreaks, or emergencies. There were 10,000 incidents a year that the health protection service looked after as well, which were much more local, many of them actually did relate to areas that were affected eventually by Covid.

These were very special outbreaks, they absorbed a lot of resource. The listeria outbreak, sadly patients died in the NHS, but the complexity of what we had to deal with there in terms of the food chains that we were dealing with was immense and took a lot of time. It took eight weeks, really, for that whole incident to work its way through, and there was still work afterwards.

Mpox, at the time monkeypox, was one case. Again, a very complex case, needed a lot of contact tracing. Dozens of people had to be contacted on a travel basis. And it also called up the elements of the high-consequence infectious disease work.

Then the repatriation, interestingly, again recurred during the pandemic, because we did have to get very involved with repatriations early in the pandemic.

So these – in many ways, they were spectacular but not typical. What they showed me was that we were running very hot at the end of 2019, we were very busy, and this was just the thin end of a very large wedge of outbreaks.

Counsel Inquiry: Right.

That takes us, then, to 2020. You describe in your statement PHE being first informed of a potentially serious threat of pandemic on 2 January 2020, and can we take it that that triggered early investigative work at PHE?

Professor Yvonne Doyle: Yes. So in fact I was informed on New Year’s Eve by our on-call incident director that he was concerned that there were problems in China and that this could have implications for our ports. But we – certainly from our reports coming from the WHO and elsewhere, we alerted DH and CMO early in January on a precautionary basis, yes.

Counsel Inquiry: A little further on in your statement you describe how in the following weeks, January and going into February I think, PHE developed a test for this new strain, what we know as Covid-19. That, we see referenced in other documents, has been recognised as one of the early successes of PHE in terms of combatting the virus.

Can you explain in a few sentences how that came about?

Professor Yvonne Doyle: Yes. The test was developed in PHE based and using the learning from MERS in 2012 and indeed developed on a multiple platform of viruses, and was able to be stood up really for clinical use by the end of January, which was rapid by the scale of this, given how novel it was and that the actual genomic recipe for it really had only appeared in January.

That was because we had expert virology, which is part of our function, it’s to meant an expert infection service.

Counsel Inquiry: Was that work done by you alone or was it – did it involve international co-operation of any sort?

Professor Yvonne Doyle: It certainly involved international co-operation, but the UK, through PHE, was an important contributor to that. The recipe had come through China, WHO, and GISAID had been able to share that, and there was very quick co-operation with a number of countries, including the UK, Germany, the USA, to get this test functioning.

Counsel Inquiry: You mentioned, I think it was in the context of Mpox, this HCID, as you put it, which stands, doesn’t it, for high-consequence infectious disease?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: In your statement you refer to the fact that Covid-19 was designated as an HCID at a very early stage, on 10 January 2020.

Can you explain to us, please, what that – first of all, designation means, but also what consequences went with it?

Professor Yvonne Doyle: Yes. So high-consequence infectious diseases are designated on the basis of a number of criteria: first and foremost, a high case fatality rate, so a lot of people who get this will die, that’s the assumption; that it spreads – particularly in healthcare settings, but it spreads rapidly; it’s difficult to detect; and it needs a very complicated, enhanced response.

So it would be appropriate entirely for a novel virus of this nature to be designated in this way. The consequence – and it was decided by the four countries, actually. There is a standing four-country infectious disease group of clinicians.

Counsel Inquiry: Just pause there a second. Is that because, as early as characteristics, or was it done on a precautionary basis?

Professor Yvonne Doyle: It was done on a precautionary basis. We didn’t know all of that. But on the other – and there was very little information to go on at that time. However, on a precautionary basis the four countries decided this was the right thing to do.

Counsel Inquiry: Did it become apparent over the weeks, maybe months, that followed that in fact Covid did not warrant that classification?

Professor Yvonne Doyle: Yes. So here was the first balance decision, really. So we were still learning about the virus, but by 28 February there were other consequences, as you’ve asked. For instance, high-consequence infectious diseases require a certain category of lab, a category 3 lab, which means they’re very contained and very limited, and that’s correct, and also only people – certain people who are trained to deal with them, because they may be very dangerous to staff. That dreadfully limits the number of laboratories that can actually engage in this. So, given that we felt that it was more important to have, you know, a huge influx of other help into the laboratory system, we applied – the four countries January, you knew that Covid had all of those applied to de-escalate this to a category 2. And that had to go through a number of – it had to go through a number of committees to escalate and it had to go through those committees to de-escalate.

Counsel Inquiry: We don’t need to get into the detail of that process, Professor, but I think you say, was it on 16 March that in fact that process was complete and Covid was de-escalated so that it was no longer had that classification?

Professor Yvonne Doyle: Yes, that’s correct.

Counsel Inquiry: And as you say, the practical consequence of that was that whereas previously only a very small number of perhaps your high sort of security, if you like, laboratories were allowed to do Covid work, once the disease had been declassified, it became possible for a far larger number of more routine laboratories to work on the disease, including testing?

Professor Yvonne Doyle: Correct.

Counsel Inquiry: We’re going to come to the question of testing in a moment, but since we’re on this subject, in the dairies that we have that were written by the Government Chief Scientific Adviser, Patrick Vallance, there is an entry – I’m not going to bring it up on screen, I’ll read it out – there is an entry on 2 April 2020, so within a couple of weeks of the disease being declassified, where he refers to Crick, and I think that’s the Crick laboratories, having offered 300 scientists, and in his words “and got no response from PHE. Crazy”. That’s his words.

Was there an offer from the Crick laboratories to provide 300 of their scientists, or perhaps laboratory space, to assist you dealing with Covid at that stage?

Professor Yvonne Doyle: Yes, there was. Not to me personally, but there was to senior executives in PHE. And as far as I’m aware, it was welcome. However, there were issues about how testing could proceed on an end-to-end basis. This by the way is not a comment about the Crick at all. But in general, every laboratory wanted to help, small laboratories of every kind, and what they needed to be able to offer was a system of accruing the tests, doing the tests, which they were offering, and then getting the tests back out through usually the NHS but elsewhere into the community or whatever, so that there was what we called an end-to-end service, so that the test was taken and the patient got the response they needed.

Now, as I understand it, not all laboratories could do that either, and the first group of partners who could were the NHS laboratories, and they were recruited pretty quickly by our national infection service directors.

But eventually, the whole testing arrangements really expanded pretty quickly actually after a seminar on 17 March.

Counsel Inquiry: We’ll come back to the question of testing shortly, professor, but thank you for that.

I want to move on to a slightly different subject, and it’s one that we have – the Inquiry at least – considered already today, and that is Operation Nimbus, which I know you have at least some familiarity with.

Could we look, please, at a document, it’s a set of COBR minutes, INQ000056226. Professor, I had intended to ask you previously: were you someone who attended either COBR meetings or SAGE meetings during this period?

Professor Yvonne Doyle: I did attend COBR meetings but not this one, to my knowledge.

Counsel Inquiry: If we look over the page, in fact, on to the second page of this document we can see that it was someone called Nick Phin from Public Health England?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: Can we take it that, routinely, there would have been someone at COBR meetings from Public Health England?

Professor Yvonne Doyle: Usually. It depended on the – obviously what the orientation of the meeting was, but in the period of the pandemic usually there was somebody, but I have to say possibly not at every COBR meeting.

Counsel Inquiry: But you say on occasions it was you, but, as we can see, not this time?

Professor Yvonne Doyle: Not this time.

Counsel Inquiry: We’ve looked at this set of minutes for a number of different reasons. This time can we go, please, to I think it’s page 8. It’s the last page. Yes.

So here is the set of actions from the meeting, and if we look at point 7, we see:

“Public Health England to develop and run a Ministerial table top exercise within the fortnight to consider the range of decisions that may be required in the event of a reasonable worst case scenario.”

So there is a tasking to Public Health England to conduct, as it is said, an exercise. Was that something that, at least within this type of series of events, was unusual or exceptional?

Professor Yvonne Doyle: No, it wasn’t. COBR and government were at – were obviously at will to ask anything of PHE that was in its remit, and exercising was, so in this case that inquiry, that commission would have been taken through into Public Health England.

Counsel Inquiry: We know that what followed from this instruction was indeed Operation Nimbus which took place on 12 February, so just inside the fortnight. Were you involved in organising Operation Nimbus yourself, Professor?

Professor Yvonne Doyle: No, I wasn’t.

Counsel Inquiry: Perhaps we can take it then that you weren’t there, personally?

Professor Yvonne Doyle: I wasn’t there, but my team would have supported the running of the exercise.

Counsel Inquiry: I know that you have at least some familiarity with what happened –

Professor Yvonne Doyle: Yes.

Counsel Inquiry: – on that occasion. We’ve seen the slides that were prepared for Operation Nimbus, the reasonable worst-case scenario, the synopsis, the scenario being a wave in which 800,000-odd people would die in a 16-week period, I think it was.

Are you able to help us with who attended the tabletop exercise, Professor?

Professor Yvonne Doyle: I’m not able to give you exact names, I’m afraid. I know that the NHS, that the Department for Health and senior public health members of PHE were involved, possibly PHE on a basis of running the exercise, and the Cabinet Office would have been, because the Cabinet Office actually took the commission and required PHE to run the exercise. That would not be unusual.

Counsel Inquiry: When you say “commission” there, you simply mean they were the ones who, as we’ve seen from these minutes, as it were, instructed or asked PHE to undertake that exercise?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: Could we look at another document, please.

It’s INQ000273915.

This is, in fact, a document which I think PHE have helpfully provided possibly today, certainly very recently.

Professor Yvonne Doyle: Yes.

Counsel Inquiry: Yes, thank you, and I know you’re familiar with this document, Professor. This is, as we see, a “Summary Note on Exercise Nimbus”, and it says “Novel Coronavirus Preparation”, but I think it’s clear from the content of the note that it was prepared after the exercise had happened; is that right?

Professor Yvonne Doyle: Correct.

Counsel Inquiry: If we can look briefly at page 2, there is a very short and high-level description of what the exercise was about, its aims, objectives, a format.

Then, going on to page 3, please, there is a description of a scenario, which really just reflects what we’ve already seen in the slides.

There is a very brief reference to participants. We see 55 people, including ten to 15 ministers. It appears that people – representatives from the devolved administrations were there. Are you able to help us, perhaps not from your knowledge, but who would you have expected from the devolved administrations to have attended an exercise like this?

Professor Yvonne Doyle: I would expect very senior administrators and ministerial presence as well. I cannot say who was at this meeting, I’m afraid, and I understand that the Cabinet Office retain that information, as we speak.

Counsel Inquiry: Just then finally on this document, we see under “Actions”, it says:

“Cabinet Office circulated findings internally and implemented the appropriate actions.”

Professor, the Inquiry in Module 1 has seen the documents relating to an exercise called Cygnus, which took place some time before the pandemic, and there are very detailed ex post documents prepared, learnings, recommendations, describing what took place at the exercise and everything that flowed from it.

Would you have expected something detailed by way of report or recommendations to emerge from this exercise?

Professor Yvonne Doyle: Yes, and that would be a normal outcome from – well, output, really, from something like this. The report might be written by our emergency planning team, but the recommendations would be agreed with the commissioner, and the implementation would be assigned to the responsible body, who in this case would have been the commissioner as well.

Counsel Inquiry: You’ve referred to the commissioner, but you mean?

Professor Yvonne Doyle: I mean the Cabinet Office in this case. In other exercises, if I could explain, just to be helpful, recommendations can often be delegated to the most appropriate body within government or the NHS to implement.

Counsel Inquiry: Can we take it at least that PHE has no further material, no detailed summary of the exercise, no detailed recommendations from it, and that, if we were to look for such material, we would need to ask the Cabinet Office and perhaps the contingencies secretariat –

Professor Yvonne Doyle: As I understand it, that’s correct.

Counsel Inquiry: All right. Well, I won’t ask you any further questions about that, Professor, thank you.

Lastly on this early period January/February, can we look at paragraph 98 of your statement. It’s on page 33.

Professor, you state here that your main concern in late January/February 2020 was that your situational awareness advice was not always welcome. You say that this led to a distancing for a period from offering direct advice, and you add that it was never clear which parties were most offended and why, a situation you say you encountered when professional information was presented in good faith to inform the public, and you also say there was general confusion and increasing concern as to who was in charge in government and why delays were occurring in getting, for example, key guidance documents out to the public.

It’s our fault, I’m sure, but that’s all quite vague. Can you put some detail onto exactly what these concerns that you had in this period were?

Professor Yvonne Doyle: Well, they encompass a number of issues which were concerning to me. The first was what I’m relating to here in terms of the distancing, and this is put on paper really to explain that there was a distance between the end of January and quite a bit of February actually, between myself and ministers, particularly the Secretary of State, and –

Counsel Inquiry: Just pause there for a minute. Which Secretary of State?

Professor Yvonne Doyle: The Secretary of State for Health, and it followed a media interview I had done at the end of January where I said straight that there could well be cases in the country, which of course there were about ten days later, and that we were unclear about – but were prepared to consider that asymptomatic infection could occur, very unclear about transmission at that point, and that it would take possibly six months for a vaccine to be developed. I was rather, I think, optimistic about that.

This did not go down well, I’m afraid. It may well my presentation or the way I did that interview or the set of interviews, but I felt it was the truth, I was telling the truth.

The way that was handled was that I was advised not to do any further media, and that the Secretary of State would need to clear all media, which, of course, we agreed to. But also that it was probably best if I just kept a distance for a while until things settled down, which I did.

Counsel Inquiry: You describe the press interviews on a particular day. Did you meet the Secretary of State on that day, or were you simply told that he was not happy with what you had done?

Professor Yvonne Doyle: No, I did meet the Secretary of State on that day and he did make his displeasure clear.

Counsel Inquiry: In what way?

Professor Yvonne Doyle: He asked me not to patronise him.

Counsel Inquiry: What did you reply?

Professor Yvonne Doyle: Well, I apologised, actually. I remember my words, I said, “I really am sorry if you think the science has let you down”.

Counsel Inquiry: Did you think that you had let him down, Professor?

Professor Yvonne Doyle: I did, in that our ethos always is to support our ministers, and this was not a good outcome. So I did feel I had let him down in some way, but I still felt I had spoken the truth.

Counsel Inquiry: From what you’ve said, you weren’t trying to do anything that would either let the Secretary of State down or, indeed, anything other than promote the objectives of Public Health England and the Department of Health?

Professor Yvonne Doyle: Absolutely.

Counsel Inquiry: So what was then the aftermath of this incident?

Professor Yvonne Doyle: I didn’t make any fuss about it. I continued with my job, as – and I was asked to be SRO mid-February to do various elements of the internal management of the incident in Public Health England, and I just continued with my work.

I did eventually stand on platforms in Downing Street and did media in March, and right up to April, and indeed one episode in May. So it did resolve.

Counsel Inquiry: But I think you’ve said that you were told, either by Mr Hancock or others, that you shouldn’t have any direct contact with him for a period of time after this incident?

Professor Yvonne Doyle: Not quite. I was advised by colleagues in the civil service that this would be the best way to calm things down, and I understood that, and I complied.

Counsel Inquiry: But this was at a time when, you tell us, but perhaps you would have expected to have quite frequent contact with the Secretary of State, given the developing pandemic?

Professor Yvonne Doyle: Yes, and had had, actually, very frequent contact up to 2020.

Counsel Inquiry: Were there things that you would otherwise have wanted to say to the Secretary of State that you felt that you couldn’t during that period?

Professor Yvonne Doyle: No, because there were good colleagues who were able to convey that, and deputies stepped in. So we managed to continue the work, and I really felt that the public population should not suffer in any way because of this, and therefore we found ways to continue the work.

Mr O’Connor: Yes.

My Lady, I’m about to move to another topic. I think you had intended to take one more short break. If you were, now would be a good time.

Lady Hallett: Right. Very well, five minutes, no more.

(4.22 pm)

(A short break)

(4.27 pm)

Lady Hallett: Mr O’Connor.

Mr O’Connor: Professor, I want to move back to the question of test, trace and isolate, and it’s right, of course, that contact tracing is a fundamental weapon against the spread of an infectious disease. I think it was the Mpox disease in 2019 where you indicated that there had been quite a significant degree of contact tracing on that occasion.

Professor Yvonne Doyle: Mm-hm.

Counsel Inquiry: It’s also right, isn’t it, that viruses such as Covid-19, where patients are infectious at the presymptomatic stage, are viruses where contact tracing can be particularly important?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: Generally speaking, is there a point at the development of a disease, of a virus, where contact tracing ceases to be effective?

Professor Yvonne Doyle: Yes, it is actually difficult to identify people at presymptomatic stage, if they’re the first case, of course. But contact tracing works best when there are low numbers of cases, particularly in community settings, because it’s then quite reasonable to be able to follow each one and really put the fire out, that’s what contain is about, is stop an outbreak from spreading.

When there are large numbers of cases, it becomes difficult logistically but it also becomes probably impossible to contain, and there are a number of reasons for that. But the first point is that, with small numbers of cases, the hope is that you can actually extinguish the virus at that point from contacting.

What we were looking for and what became very important is where it was clear that there were cases that were called second, third, fourth generation – in other words contacts of contacts of contacts – which were out there which didn’t have a known link to what we understood were the sources of the virus in the community, and that happened predominantly at the end of February, first case was 28 February.

Counsel Inquiry: Yes.

Now, you refer to February and Covid; we know that the World Health Organisation issued a very clear encouragement: test, test, test. There was a suggestion made by Jenny Harries, the Deputy Chief Medical Officer, in March 2020 that that guidance, the need for testing, was something that didn’t necessarily apply to this country. The term she used was that it was guidance that was really for less-developed countries. Is there any force in that at all?

Professor Yvonne Doyle: It wasn’t a strategy that we pursued in Public Health England. Our view was that we would pursue the strategy that we had laid out quite clearly, which was to identify and contain as many cases as possible and all their contacts.

Counsel Inquiry: As you say, at the very outset of the pandemic that’s exactly what Public Health England sought to do. But, of course, we know that the pandemic became far, far larger as those early weeks and months progressed, and what we saw later in 2020 was a population level attempt at a programme of testing and contact tracing.

If we can look, please, at paragraph 26 of your statement, at page 9, do you make the point here, Professor, that that type of contact tracing exercise was something for which PHE simply hadn’t been designed or funded?

Professor Yvonne Doyle: That’s correct, for large scale contact tracing it hadn’t, and, incidentally, the scale of that became clearer later in the pandemic when there were attempts to recruit 18,000 people to contact trace, so that was the scale of what we would have to deal with in a widespread infection within the population.

But to answer your question, at this point Public Health England was still committed to doing everything it could to find every case and contact that it could, within its capacity, and its capacity was still extant, it was still in existence in mid-March.

Counsel Inquiry: Let’s look at a set of SAGE minutes, Professor, if we can go to INQ000052098, please.

We can note, Professor, that this is a set of minutes for a meeting that took place in February 2020?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: Just underneath, we see that these minutes were published some months later in May. Do you see that?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: It’s much smaller writing.

Professor Yvonne Doyle: Yes.

Counsel Inquiry: The Inquiry has heard that in February it was not practice, was it, to publish these minutes, but steps were taken –

Professor Yvonne Doyle: Indeed.

Counsel Inquiry: – some time later to publish them, and that’s why we see the difference there.

There has been some debate about an entry on – I think it’s page 2 of the minutes, yes. Casting our eyes just briefly up the list, up that page, we see that there seem to have been two people there from PHE, Sharon Peacock and Maria Zambon, but not you?

Professor Yvonne Doyle: Not me.

Counsel Inquiry: At paragraph 7, as I say, there is an entry which states, we will recall this was mid-February:

“Currently PHE can cope with five new cases a week (requiring isolation of 800 contacts). Modelling suggests this capacity could be increased to 50 new cases a week (8,000 contact isolations) but this assumption needs to be stress tested …”

Was that correct, Professor?

Professor Yvonne Doyle: It wasn’t quite correct. I understand what it may have been trying to convey. So the five was five introductions, and these were introductions from abroad. They were not five cases in country, they were five introductions. The paper on which it was based was a modelling paper which looked at a pooled set of data from several European countries, and looked at the genetic variation and the likelihood of onward contacts in this group of people. And the – so the paper was suggesting that five contacts – sorry, I beg your pardon, five introductions would lead to, in each case, the – each generation for each case, up to a fourth generation, would lead to thousands of contacts. So it was a proposition that this would rapidly get out of control. It was basically saying multiple generations will yield very rapid numbers of contacts, very quickly, because of what is known about the transmissibility of this virus.

Unfortunately, that got translated into popular narrative as “Public Health England can only cope with five cases a week”, and this was not the case.

Counsel Inquiry: Well, if that’s right, why were the minutes drafted in that way, but, perhaps more important apply because we know that mistakes can be made, why weren’t the maintenance corrected either in February, shortly after the meeting, or certainly before they were published in May?

Professor Yvonne Doyle: I don’t know and, unfortunately, it was probably our misstep not to have picked this up and corrected it sooner.

Counsel Inquiry: Would you routinely, not you necessarily personally, but PHE as an attender at a SAGE meeting, have been asked to approve the minutes in the way that perhaps is normal in other committee meetings?

Professor Yvonne Doyle: When I eventually attended SAGE the minutes were approved at the next meeting of SAGE, yes. But generally they were written and agreed internally first and then presented to SAGE. And very often the agendas were very pressured and crowded and it simply may have been missed.

Counsel Inquiry: This is obviously important in its own terms, Professor, but there is also a wider question about the accuracy, the comprehensibility of SAGE minutes, because this is not the first occasion where we have found that people didn’t understand what SAGE was trying to say in its minutes.

Do you think it could have been done – there could have been a better process for your organisation but also other organisations agreeing on the accurate and clear content of SAGE minutes?

Professor Yvonne Doyle: It was certainly a cogent lesson for Public Health England that they really could have moved quicker to put this to rights and help, actually, Professor Vallance, you know, who was a very busy person, and his secretariat. I don’t think we picked this up fast enough, and it became into popular narrative, which became very difficult to deal with.

Counsel Inquiry: I want to move on to another subject, Professor, and when I asked you at the beginning of your evidence about the different areas in which Public Health England worked, you mentioned disparities as being one of those issues that you were tasked to addressing. And of course that is something that applied particularly at a time of emergency like the Covid pandemic?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: We’ve heard much evidence now about the very early indications of the disproportionate impact of Covid, probably first of all disproportionate impact on elderly people, but very shortly followed by evidence of disproportionate impact on the black, Asian and minority ethnic communities, particularly in the healthcare sector.

Professor Yvonne Doyle: Yes.

Counsel Inquiry: It’s right, isn’t it, that Public Health England was commissioned, I think by Chris Whitty, to conduct research into those issues early in the pandemic, I think it probably was April or May 2020; is that right?

Professor Yvonne Doyle: That’s correct.

Counsel Inquiry: And that resulted in a report, did it not – thank you, it’s been brought up on screen – called “Disparities in the Risk and Outcomes of Covid-19”.

Professor Yvonne Doyle: Yes.

Counsel Inquiry: Were you involved in any way in either researching or writing this report?

Professor Yvonne Doyle: I was involved, first in identifying the signals, I didn’t do the epidemiology, but I asked my colleagues, as SRO, to find those signals, and then to – we stood up a team to get involved in producing in report for the CMO, yes.

Counsel Inquiry: It was published on 2 June 2020 and if we look at the third page of the report, please, we can see from its contents that it had sections throughout the report on different vulnerable sectors within the population.

Professor Yvonne Doyle: Yes.

Counsel Inquiry: We’ve also heard that, almost as soon as the report was published, there was criticism of it, and we can see if we go to another document, please, INQ000097872.

This is a letter, in fact, to Matt Hancock dated 12 June, so a week or so, ten days after the publication of that report. In summary, Professor, there was criticism that the report which we’ve just looked at, first of all, didn’t contain the input that had been received from inequality and other groups, but more importantly, perhaps, didn’t include any recommendations. One might have thought that recommendations were at the heart of the purpose of a report like this.

First of all, do you agree, and secondly, if so, why didn’t that report contain any recommendations?

Professor Yvonne Doyle: I do agree, and the criticisms were understood, and I was very – very concerned and sensitive about that, as was my good colleague, Professor Kevin Fenton. We did get those recommendations out into the public domain, it took some time, there were six or seven of them, they were challenging to us, and the recommendations eventually went to the minister for disparities and into the Cabinet Office – sorry, to the office for disparities within government, and there were quarterly reports about how that – those recommendations or requests really were being dealt with. So there was some follow-on.

Counsel Inquiry: The short question, though, Professor, is: why were those recommendations not published with the report containing the research on which the recommendations were based?

Professor Yvonne Doyle: Well, initially there were a number of issues that led to these delays. The first was that it wasn’t entirely accepted that the – this kind of qualitative work had the same value as the quantitative work, and therefore, you know, we needed to make sure that everybody understood this was a very balanced piece of work. It was intended to show the epidemiology, but also get the voices of people into this discussion, and also what they were telling us that needed to happen, which was going to be challenging.

That, I think, needed – those recommendations, those requests did need some discussion internally in government as to who owned them, they were very much about cross-government, they weren’t simply about the NHS. So it did take time, but it did emerge into the public domain and there was a commitment which was followed on. So in that sense, the work had some impact.

Counsel Inquiry: Professor, I’m not going to take you to the recommendations themselves. I know you’re familiar with them. They were contained in a subsequent report, were they not?

Professor Yvonne Doyle: Yes.

Counsel Inquiry: But you know that the Inquiry has heard evidence from Professor Khunti criticising the recommendations, saying that they were too general, they didn’t contain a clear programme of action, they didn’t contain any timeframes for delivery, or methods of implementation. In summary, you’ve already in part defended the recommendations, but what do you say to those criticisms?

Professor Yvonne Doyle: I completely agree that, if recommendations don’t have named organisations or individuals preferably, they don’t go anywhere, and these recommendations were taken through the Race Disparity Unit, which was appropriate, and the Cabinet Office were interested also, because we gave talks across government on it. But I do agree with Professor Khunti that it will take hard work to continue to implement some of this. For instance, there’s a lot of recommendation around fair assessment at work, work that is, you know, culturally well orientated towards people from various communities and so on, and that takes quite a lot of system change. And, therefore, one of my recommendations is that we need to keep this very much in sight, the findings of these reviews, and not lose sight of this, which can be so easy to do.

Counsel Inquiry: If we can just go back, Professor, to that report, so it’s INQ000101218, and look at page 3.

That, you’ll recall, is the contents page, so we see the different chapters of the report. As I indicated, a range, if you like, of vulnerable groups.

We don’t see there a section on disabled people, Professor. Why were they not identified as a vulnerable group who ought to be included in this work?

Professor Yvonne Doyle: Well, people with disabilities certainly had been identified as vulnerable groups throughout the pandemic. We were requested and did undertake a further review of people with learning disabilities and autism, and that was published in the autumn of 2020, and its main purpose was to raise awareness of the vulnerability particularly of this group in terms of mortality, which it did, and that was presented then to – particularly to the interested parties in the NHS and clinicians and others in the care home sector who would benefit from knowing this information.

Counsel Inquiry: Learning disabilities and autism, but what about physically disabled people?

Professor Yvonne Doyle: Well, physical disabilities, they’re – I’m not sure whether they’re actually included in here, but they certainly have come across various groups. It may well have been that we should have concentrated on that particular group as well.

Mr O’Connor: Yes. Professor, thank you very much. Those are all my questions for you.

My Lady, there are, as you know, some questions from core participants.

Lady Hallett: There are.

I think, Ms Mitchell, you’re going first.

Questions From Ms Mitchell KC

Ms Mitchell: I’m obliged, my Lady.

Professor Doyle, I ask questions on behalf of Scottish Covid Bereaved.

You say in your statement that Public Health England has a specific remit from the Secretary of State and that remit includes the UK’s national focal point, and that deals with International Health Regulations, or you ensure that you comply with them.

Given this was a UK remit, what I would like to understand is what part Scotland, be it Public Health Scotland or what you’ve described in your evidence as the standing four countries infectious disease group, what input did Scotland have into that process?

Professor Yvonne Doyle: Well, before 2020, there was, and there continued to be, a four-country group of health protection directors, senior leaders, which my department supported, and the chair rotated. I think it was with Wales just before 2020, but it had been with Scotland. So we were equal partners in that.

We had the four-country infectious disease consultants and the four-country infection prevention control experts who met regularly; we had the regular clinicians’ meetings, which were four countries, during the pandemic; and I chaired, throughout 2021, a four-country genomics group. My purpose there was to ensure that the devolved countries got their fair share of funding for the development of their genomic services.

As well as that, we had regular – every day we had situation awareness with the four countries and, when they wished to join, the Republic of Ireland, and we kept very close contact on an ad hoc basis with our colleagues in Public Health Scotland.

Mr Wilcock: My Lady, thank you, I don’t have any other questions. My other questions were answered earlier.

Lady Hallett: Thank you very much indeed.

Mr Stanton.

Questions From Mr Stanton

Mr Stanton: Thank you, my Lady.

Professor, I’ll be asking you a small number of questions on behalf of the British Medical Association. I apologise for the slightly awkward positioning. Please don’t feel any need to face me.

I’d like to bring to your attention a letter of the BMA as context for the questions I have. The letter is document INQ000097875.

At the fourth paragraph, I’ll just read – I beg your pardon, I should say the letter is addressed to Michael Brodie, who at the time was interim chief executive. You may not have seen this letter before, but it’s possible you have, given your role.

The fourth paragraph reads:

“There are significant and growing concerns about the role of aerosol transmission of COVID-19 in healthcare settings, and the need for wider use of RPE (for example, FFP3 respirators) outside of those procedures designated as aerosol generating. We are therefore calling on [Public Health England] to support the wider use of RPE in other high-risk settings across primary and secondary care.”

Professor, so the first question I have for you is: appreciating that there was considerable uncertainty in the early stages of the pandemic, when did Public Health England first become aware that aerosol transmission was a significant transmission route of Covid-19, including through daily actions such as coughing, talking, et cetera?

Professor Yvonne Doyle: Thank you. So there was always a recognition, well, from fairly early on, that aerosol transmission could occur. I think what changed over the months, and particularly after the summer of 2020, was the work that had been done particularly through SAGE and through its subgroup, and Professor Noakes, of course, and the importance of aerosol – the balance of aerosol transmission versus droplet versus fomite, and, you know, surface transmission. And that balance changed.

Professor Noakes is part of a number of scientists who wrote to WHO and asked them to change their advice on this as well.

But in the early months, we had certainly provided guidance for those who were in the context of what were known to be aerosol-generating procedures, and certainly a precaution around the importance of social – of distancing, and, where at all feasible, the use of face coverings.

Now, that came again to a discussion later in 2020, and I am aware of this letter in 2021 which Mr Brodie received. He did ask for – the guidance that had been produced around this letter was a four-country guidance and it was also NHS and DHSC, so it was the infection prevention and control group who had produced the guidance on what protective equipment was needed and aerosol procedures.

The IPC cell, this infection prevention control cell, was asked to look at that guidance again at the end of 2020, which they did. This also did this in conjunction with the New and Emerging Virus Group, NERVTAG, and they had a good look also at the evidence, because there was a lot of testing going on in various healthcare settings, this was about healthcare, and the testing had shown that actually – this was in the context of the Alpha variant – that there hadn’t been an increase in serious illness among healthcare workers, but that healthcare worker to healthcare worker transmission was important, and therefore a CAS alert had been issued, which I think Mr Brodie was able to advise the BMA, which recommended the strengthening of infection control procedures.

There was obviously an interest in ensuring that those who needed to use the highest level of equipment had access and did so, and guidance was produced on donning and doffing so that they could do so in the most effective way. But I can accept that this remained an area of serious concern throughout the pandemic.

Mr Stanton: Thank you, Professor.

Professor, could you help clarify how infection prevention control guidance is produced? Is it written or was it written at the time by Public Health England?

Professor Yvonne Doyle: Well, it’s not entirely just by Public Health England. There is a national infection prevention control manual, and there is the four-country infection prevention control expert group, and there are a number of subgroups like NERVTAG which also advise on this.

So the infection prevention control guidance takes account of the current evidence, which was very dynamic. It is put together by the infection control prevention – it is agreed by the infection control prevention group. Public Health England will write the guidance, and will brand it with the NHS and with DHSC, but it’s often called Public Health England guidance, but it is more than that.

Mr Stanton: Thank you, Professor.

Professor, did you, over the period of the pandemic, whilst contributing to infection prevention control guidance, detect any reluctance to impose measures that might otherwise have been required for reasons of resource or operational strain that they might place on the NHS?

Professor Yvonne Doyle: The whole pandemic was characterised by no easy decisions and the need to balance the least bad option, and sometimes that related to supplies and sometimes it related to scientific opinion, which wasn’t always in agreement, and sometimes it simply related to the right thing to do that some parties didn’t agree with. But there was always tension in these decisions, there was no easy decision.

So it is perfectly plausible that decisions had to be made that were certainly not optimal in normal times.

Mr Stanton: Might decisions around the provision of FFP3 masks be one of those decisions, do you think?

Professor Yvonne Doyle: Well, I can’t really comment on this in great detail just now, but we were very conscious of the need to ensure that FFP3 masks were used in the places where they were most needed by the people who were – you know, healthcare workers particularly – who were most exposed to dangerous situations, and that’s what a lot of the guidance and the donning and doffing was also put out there to support.

Mr Stanton: Thank you very much, Professor.

Lady Hallett: Thank you, Mr Stanton.

Ms Morris.

Ms Morris: Thank you, my Lady.

My questions are on Operation Nimbus so, at the risk of knocking Mr Menon off his perch, I have also reflected and Mr O’Connor has dealt with the matters that I was going to deal with with Professor Doyle, but we agree with the Inquiry for the need for further inquiry to be made of the Cabinet Office and the CCS in particular in that regard. So, thank you.

Lady Hallett: Very well. Whenever you and Mr Metzer – I can’t remember who else was asking about Nimbus, but anyway, whenever we have the answers to the questions in an agreed form, please let me know and if you wish them to be read out, then I’ll be very happy to.

Ms Morris: It may be for another witness in fact, my Lady.

Lady Hallett: Right, okay. Thank you.

Sorry, Mr O’Connor.

Mr Keith: No. My Lady, that concludes the questioning for this witness, and also for today.

Lady Hallett: Thank you very much indeed, Professor.

The Witness: Thank you, my Lady.

(The witness withdrew)

Lady Hallett: That completes the evidence for today, as Mr O’Connor says, so we return at 10.30 on Monday. Is that right?

Mr O’Connor: My Lady, yes.

Lady Hallett: Thank you all.

(5.00 pm)

(The hearing adjourned until 10.30 am on Monday, 6 November 2023)