2. Professor Sir Van-Tam
PROFESSOR SIR JONATHAN VAN-TAM (sworn).
Questions From Lead Counsel to the Inquiry
Mr Keith: Professor, I’m going to call you Professor, rather than Sir Jonathan –
Professor Sir Van-Tam: Of course.
Lead Inquiry: – if that’s acceptable. Could I ask you to give your full name, please.
Professor Sir Van-Tam: Yes, my name is Jonathan Stafford Nguyen-Van-Tam.
Lead Inquiry: Thank you very much, Professor.
Thank you for attending today, we appreciate that you have been made to wait a very considerable amount of time. Thank you also for the provision of your witness statement dated 8 September 2023. There it is. All the contents, the full contents of your statement, will of course be considered. It is a significant and substantial statement running to 146 pages.
You are by profession an epidemiologist, a physician specialising in public health, mainly communicable disease control. Have you spent most of your academic career engaged scientifically on issues of epidemiology, prevention and control of respiratory virus infections and the like?
Professor Sir Van-Tam: Yes, I have. I started my academic career, I guess, in about 1991, and very quickly gravitated to the study of respiratory virus infections, but notably influenza, which has been the dominant public health threat from respiratory viruses for a very long time, and I found this area stimulating and stayed in that area all of my career.
Lead Inquiry: And as a result, Professor, are you the senior editor of the textbook Introduction to Pandemic Influenza, have you published more than 200 peer-reviewed scientific papers, and you hold a plethora of degrees, diplomas, doctorates, fellowships and honorary fellowships?
Professor Sir Van-Tam: That’s correct.
Lead Inquiry: All right.
In terms of the positions that you’ve held, were you head of the pandemic influenza office at the Health Protection Agency Centre for Infections between 2004 and 2007?
Professor Sir Van-Tam: Yes.
Lead Inquiry: You were, and you have been for a long time now, a member of the – well, you were a member of what was then the SPI committee, you were a member of SAGE during the swine flu pandemic; is that correct?
Professor Sir Van-Tam: Yes.
Lead Inquiry: And were you the chair of NERVTAG from its inception in 2014? For how long were you the chair?
Professor Sir Van-Tam: So NERVTAG actually was the kind of successor to SPI, so it wasn’t entirely a new committee, it was more kind of reformatted. But from its inception, which I believe was about 2014, through until the time when I became DCMO, at that point I clearly could not continue in NERVTAG, which has to be a committee that is independent of government.
Lead Inquiry: Then in October 2017 did you become the Deputy Chief Medical Officer particularly concerned with health protection?
Professor Sir Van-Tam: That is correct.
Lead Inquiry: Presumably your portfolio has always been, and was while you were DCMO, a broad one?
Professor Sir Van-Tam: Yes, it’s really covered all the infectious diseases threats, bioterrorism and biosecurity, so very broad, and in the time that I have been in post it’s pulled in other emergencies such as the Novichok attacks, the monkeypox crisis, and various other things, but also including some pharmaceutical pieces, for example the shortage of EpiPens.
Lead Inquiry: Then in March 2022 did you relinquish your position as DCMO and then turn exclusively to the world of academia?
Professor Sir Van-Tam: Yes, I did. I – it was a planned move out of government. I was a full-time academic for another year and I’m now part-time one day a week at the University of Nottingham and self-employed for the other four days.
Lead Inquiry: I’d like to ask you, please, firstly some questions about the role of the DCMO, and with particular regard to the fact that you were the DCMO concerned primarily with health protection.
Is the role of DCMO, and the role of DCMO for health protection, functionally independent from government? Are you allowed to say what you want, within reason, and to express your professional views?
Professor Sir Van-Tam: So the answer to that is in several parts. Yes, absolutely, as a subordinate of the Chief Medical Officer, then I have been given the – you know, the permissions of that office to be independent of government, and feel I – you know, it depends on your Chief Medical Officer, of course, to a large extent, but I feel that Sir Chris gave me very much a partnership of equals, gave me the opportunity, and respected my professional experience, and gave me the opportunity to speak independently.
That having been said, I do not think it would be right, and I’m a traditionalist who understands the chain of command very strictly, I do not think it would be right for a DCMO under any circumstances, other than the serious illness or death of the Chief Medical Officer, to start making comments that were particularly strategic or particularly, you know, wide-ranging in terms of their implications across government without a full and frank discussion, and the normal practice would be for that discussion to happen and then the Chief Medical Officer to make remarks on behalf of our office, occasionally it would be delegated.
Lead Inquiry: So in that sense, Professor, you were accountable to the Chief Medical Officer, and is that why you say in your statement that you wouldn’t issue a piece of evidence, for example, to a core decision-maker, without first satisfying yourself that it was in line with the Chief Medical Officer’s own views?
Professor Sir Van-Tam: Yes, it would depend on the subject. So, for example, if it was something quite technical, on the aerobiology of respiratory viruses and droplet distances and aerosols, then of course I would just, you know, kind of crack on with giving the advice, in the interests of speed and efficiency of government. But if it was something notable or significant, it would only be right for me to channel that through the Chief Medical Officer.
Lead Inquiry: The evidence shows very plainly that during the initial weeks of the crisis, so particularly between January and March of 2020, you took the lead, by virtue of your role as DCMO for health protection, on the initial phase of the response to the pandemic. How did that come about?
Professor Sir Van-Tam: Yes, so that is – it’s basically business as usual within the Chief Medical Officer’s office. We would not have expected Sir Chris to track all of the infectious disease happenings around the world, that would fall to me and whichever private secretary was looking after me. It would fall to me to make the liaisons with Public Health England and with the wider health protection community, for example CDC in Atlanta. And then, at a certain stage, if this was something more than the routine or the trivial, to then start to have a conversation with the CMO about that.
So it came about because it was routine, I think is the answer.
Lead Inquiry: Give us, please, also a broad idea of what your important position at that time comprised. You presumably gave a great deal of advice regularly to the Secretary of State in the Department of Health and Social Care, to DHSC junior ministers, and to the DHSC itself. Presumably you also were asked to respond to requests for advice from central government, from the Prime Minister and other ministers, and by – and from officials in the central government machine, if I may call it that. Is that a fair summary?
Professor Sir Van-Tam: The answer to that is really in two parts. In kind of peacetime, the DCMO’s role would be to, for example, observe the Joint Committee on Vaccination and Immunisation, observe NERVTAG, work closely with policy officials looking after vaccine and health protection policy, look after global public health with that policy official team. But the amount of contact with the Cabinet Office and with Number 10 and other government departments would be relatively sparing at that point.
That of course changed as the magnitude of the SARS-CoV-2 crisis, you know, unfolded in front of us. But in normal times, there would be not that much contact at all, but that changed over time.
Lead Inquiry: Were you, for example, regularly attending Number 10 Downing Street and therefore present in many of the decision-making meetings which took place there, or was that something that was ordinarily left to the Chief Medical Officer?
Professor Sir Van-Tam: I can’t recall that I ever went to the – to Number 10 Downing Street before the pandemic started, and I can’t recall going to Downing Street for a meeting other than the 5 pm press conferences. I may have got that wrong, there may have been one or two occasions when I went to a Number 10 meeting, but really my contact with Number 10 was very constrained and related to those press conferences. So I really wasn’t in much of the discussion that I know you have been asking other witnesses about.
The other thing I kind of want to say is that quite early on in the crisis, although, as you rightly point out in those early days I was really quite significantly involved in the kind of alerting, once the kind of machinery of government, SAGE, COBR, had started to move, then one of the other things that I moved to very quickly, partly in conjunction with the Government Chief Scientific Adviser, Sir Patrick, was getting ready and building up the momentum for the Vaccine Taskforce. And of course that started quite early officially, in April, and it really became the very dominant part of my work for, I would say, the rest of my time in government.
So whilst I was involved in many of the things you’ve talked about with other witnesses, it was pretty peripheral in relation to their roles, and I was beginning to really focus very hard on getting vaccines for the UK as fast as possible.
Lead Inquiry: You may have been attractively modest about the extent of your role, Professor, because the evidence makes plain that you were seen as a source of expert advice in particular as well on technical aspects of virus transmission, and you were hugely concerned not just with vaccines but with the development of therapeutics –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – and all the issues that surround those two important areas. Is that fair?
Professor Sir Van-Tam: That’s very fair.
Lead Inquiry: All right.
In terms of the significant structural bodies of which we’ve heard a great deal of evidence, COBR, Covid-S, Covid-O, four nations meetings, were you regularly in attendance at those meetings or were they fairly infrequent?
Professor Sir Van-Tam: Yeah. So let me go through those.
COBR would be really one where my presence would be required only when Sir Chris was not available or had specifically delegated that I go to it. I can’t think of an occasion when Chris said “I’m not going, you go”, but I can think of at least one occasion where he was unavailable.
I may have been in the outer room at COBR, not participating, but observing, on one or two occasions, because of course, you know, these are things that don’t happen very often and there’s a lot of learning for a – somebody who’s still relatively junior in government, as a DCMO to kind of learn stuff from observing in COBR.
Lead Inquiry: All right.
Professor Sir Van-Tam: Next one –
Lead Inquiry: Covid-S, Covid-O?
Professor Sir Van-Tam: I don’t recall being in many Covid-S meetings, they’re the ones designated S because of the presence of ministers. I have lost count of the number of Covid-O meetings that I have been into. There could be several every day at one point or another. And really, you know, you lose track of this, you’re so tired and you’re so overwhelmed by the workload, you literally go from one meeting to another, wherever your diary manager sends you next.
Lead Inquiry: The evidence shows that you also attended a very significant number of SAGEs.
Professor Sir Van-Tam: Yes.
Lead Inquiry: In particular you were present on the SAGE 18 meeting of Monday 23 March, about which I’ll be asking you questions. Is that a fair summary?
Professor Sir Van-Tam: That’s fair.
May I make a little comment about SAGE?
Lead Inquiry: Please.
Professor Sir Van-Tam: So I think the primary purpose of SAGE was for the government to garner a range of scientific opinions from independent experts, which to my mind it did very effectively, but – and who knows, you know, in another time, another world, I might have been on SAGE by virtue of being a professor at the University of Nottingham. However, I was on SAGE – partly, of course, for my scientific knowledge and advice, but I was still a DCMO, my boss, Sir Chris, was co-chair of SAGE, and it was important that those independent scientific voices were in the room rather more than a kind of, you know, replay of the Chief Medical Officer office opinion.
So I would say that whilst I was certainly on SAGE, and I don’t dispute any of the dates you could pull forwards about when I attended, I would say that my role was relatively muted, although I would say what I needed to say.
Lead Inquiry: Whilst on the subject of SAGE, Professor, you refer in your statement or you use these words in your statement, that “SAGE was strongly influenced by bio-mathematical modellers”?
Professor Sir Van-Tam: Yes.
Lead Inquiry: What did you mean by that?
Professor Sir Van-Tam: I meant that their information, in terms of providing reasonable trajectories and possibilities for what could happen as the epidemic waves of the pandemic played out, I felt that was really important, and I thought they had really unique skillsets.
Now, the context to that, and it’s very important, is that I can only think of three people who served on SAGE in 2009 during the swine flu pandemic and again on SAGE this time, and that was Professor Ferguson, Professor Edmunds and myself. So over that period, I had come to learn and understand and trust the outputs from the modelling groups. I was very reassured that actually what came to the table was a kind of consensus from multiple different modelling groups working independently across the country, Warwick included, and that’s why I make that point in my statement.
Lead Inquiry: In truth, I wasn’t asking you to express your views on the validity or worth of modelling or their work. It’s only that the use of words such as “SAGE was strongly influenced by bio-mathematical modellers” might suggest that you were making an observation there about the relative lack of influence of other disciplines, perhaps infection control experts or community health control experts or public health clinicians, as opposed to the modellers.
Professor Sir Van-Tam: I wasn’t making that difference.
Lead Inquiry: That’s not the point you were making, all right.
Then, finally, did you attend most NERVTAG meetings?
Professor Sir Van-Tam: Well, I attended most NERVTAG meetings at the beginning, when NERVTAG were kind of synthesising the kind of pretty limited data coming out of China and then a few other countries in South East Asia.
As I said earlier, once kind of the momentum of my vaccines work built up, you know, it became more and more difficult to just be in two places at once, and I literally had to kind of send – send a private secretary to sit in on the NERVTAG meeting or, indeed, just get the read-out afterwards. It wasn’t that I wasn’t following what NERVTAG were saying, but I couldn’t physically be there to shepherd every single item as time went on.
Lead Inquiry: Professor, I want to ask you about a sensitive matter which you’ve raised in your statement concerning the demands, the unprecedented workload that was placed upon you and the consequence of what you describe as extremely hateful messages received by you from the public, by email, some of which has led to the police becoming involved:
Professor Sir Van-Tam: Yeah.
Lead Inquiry: Did you, as a result of the unprecedented demands placed upon you but also on account of these hateful messages, consider your position at any time?
Professor Sir Van-Tam: Yes. So I may begin by thanking the vast, vast, vast majority of the public who when I meet them are just supportive and grateful, and I deeply appreciate that.
The workload was horrendous for all of us at the beginning, it certainly was in the kind of 16 hours a day mark, and it certainly was seven days a week, it was very, very intense. Where I think, you know, it finally got to me was the fact that I might have – yeah, I might have expected that if a crisis happened this was, you know, my responsibility to bear that kind of workload. I did not expect my family to be threatened with having their throats cut. I did not expect the police to have to say, “Will you move out” in the middle of the night, in the middle of the evening, “Will you move out for a few days while we look at this and potentially make some arrests”. You know, we didn’t move out because of the cat, as it happened, we didn’t want to leave the cat. But it was a very stressful time indeed. And, you know, my family didn’t sign up for that.
I only make this point because I’m so worried that if there’s a future crisis, people will not want to sign up for these roles and these jobs, because of the implications that come with them.
Lead Inquiry: If I may speak on behalf of myself, thank you for bringing that to the Inquiry’s attention.
Moving on to two final preliminary subjects, your statement refers to the close collaboration throughout the pandemic between the Office of the Chief Medical Officer and the counterparts in Scotland, Wales and Northern Ireland, and a considerable amount of evidence has been heard about how, at the medical level, the CMO, OCMO, DCMO level, there was extensive collaboration.
Do you consider that that degree of collaboration of co-operation between the devolved administrations was appropriate and that it worked well in face of the unprecedented demands of this pandemic?
Professor Sir Van-Tam: So clearly this was a virus like most others that doesn’t respect international borders, doesn’t respect, you know, where you live in the UK to any great extent, and I felt that the medical colleagues in the devolved administrations had very much become my friends by the end of the experience, which is probably the kind of quickest way to give you some sense of how close and how bonded we felt as a group of professionals battling with the same kind of common cause in mind.
So, yeah, I think it worked very well.
Lead Inquiry: Was there also extensive co-operation with and collaboration with your international peers and colleagues throughout the course of the pandemic?
Professor Sir Van-Tam: Yeah, well, one of the advantages of having, you know, been in the influenza world for 30-plus years is that you met a lot of people and they’ve stayed with you, in their territories, throughout all of their careers as well, so you have a lot of contacts to pull on. And I had a lot of international contacts and people overseas who I call professional friends, and I’d done really quite extensive work with CDC in the past, in the US, and had really quite strong links with Singapore. But I think my statement gives you a list of all the different countries with which we’ve engaged.
Lead Inquiry: There are very many.
Now, the timeline, and focusing on the first few weeks of the emerging pandemic. I don’t wish to go through all the very many emails that you sent and received or the many meetings and conversations that you had with your colleagues within the Office of the Chief Medical Officer about the emerging pandemic, but just to pick up some of the high points.
If we could have INQ000151286.
You forwarded to your colleague, Professor Sir Chris Whitty, and others, important information that you had received by way of a forwarded email attaching what is called a “ProMED Digest”. We’ve heard evidence about ProMED. Was this a summary of information that ProMED had put out?
Professor Sir Van-Tam: Yes, I mean, that’s right, I’ve just forwarded it straight on. And if you click on the link, you would find that there’s a little bit more, short paragraph, of what the report was coming in from China about this cluster of undiagnosed and slightly peculiar pneumonias.
Now, personally I – it’s very clear, and I forwarded that ProMED email, I think I had probably heard something a couple of days before that. I was at home on leave at the time, so this would be, you know, pretty much my first day back at work. It didn’t add information that, you know, isn’t in the kind of ProMED text, but it was really around the cusp of the New Year that this started to emerge.
And it’s common for me, if I see something that I think “Ooh, yes, I just want to watch this a little bit more carefully”, to forward that to my health protection policy colleagues, not to kind of get them terribly excited at that point – and as I pointed out, you know, there’s a caveat, it’s a bit like a football transfer, there’s lots of rumours and, you know, half truths on it, but just flagging it, you know, that this is something I am going to watch – I am going to watch – over the next few days, not something that I am asking them to watch, merely just register that it’s there.
Lead Inquiry: Three brief points, if I may.
Firstly, the evidence appears to suggest that ProMED is a valuable and consistent source of important information, it does very valuable work, and professionals such as yourself around the world rely to some extent on ProMED’s work?
Professor Sir Van-Tam: It’s informal, there’s a lot of noise in there, but I think it’s valuable.
Lead Inquiry: Secondly, this email quite plainly shows that you’re already reaching out to your professional colleagues around the world, and other emails show –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – all the ways in which you reached out to other countries, this one happens to refer to the US, but is this a good indication of how speedily and effectively this system of international collaboration works?
Professor Sir Van-Tam: I think it is. And it’s also, I guess, on this particular email, an illustration of my, you know, networks, having run a WHO collaborating centre for influenza from Nottingham, and my understanding of NERVTAG and the fact that Dr Dabrera, from PHE, referred to as Gavin in the email, actually tracks viruses for NERVTAG and produces risk assessments on an ongoing basis.
Lead Inquiry: The material shows that you forwarded this email and you also started other email chains with colleagues at the World Health Organisation as well as the CDC, and with other colleagues around the world.
Professor Sir Van-Tam: Yes.
Lead Inquiry: Thirdly, in relation to this email, you’ve used the word “emerge”, information about an “emerging” virus, in the course of your evidence. Subsequently, it became apparent, of course, that there had been cases in China.
Professor Sir Van-Tam: Yep.
Lead Inquiry: Genomic research has indicated that there had been cases for China for some time.
Professor Sir Van-Tam: Yep.
Lead Inquiry: Can you just make plain that this was the emergence, at least insofar as you were concerned and the United Kingdom was concerned –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – of this novel coronavirus, but that of course doesn’t mean to say that there hadn’t been a coronavirus circulating in China for some time?
Professor Sir Van-Tam: You’re quite right, and you’ve picked me up on the word “emerge”, and I think that’s a really good one, and thank you for doing that.
I probably shouldn’t have used the word “emerge”, because I think I’m kind of back-transferring the fact that it was an emerging respiratory virus. This could have been a chemical pneumonitis, it could have been a cluster of Legionella cases that was, within a few days, going to be very rapidly explained as something terribly ordinary. So you’re right.
And on the point about kind of the genomic sequencing, I’m not an expert in this area but I gather that it is perfectly possible, according to the sequencing data, if you kind of back-model it, that this virus might have emerged sooner than this report.
Mr Keith: On 8 January – INQ000151293 – having received information from the CDC, that’s to say the institute in the United States, you sent an email to your colleagues saying:
“I had picked up a whisper from CDC that it was thinking novel (non SARS, non MERS) coronavirus. Indeed this is what [Professor Sir Chris Whitty] (and me) felt was most likely.”
Then in the penultimate paragraph you say:
“Good that there remains no known [person-to-person] transmission.”
Professor Sir Van-Tam: Yes.
Lead Inquiry: Briefly, did you make that reference to person-to-person transmission because one of the most vital pieces of information in the early stages responding to a possible epidemic or pandemic is to know the nature of the transmission between people and whether or not, of course, it’s sustainable?
Professor Sir Van-Tam: Yes, absolutely. And just to qualify, “good that there remains no known person-to-person transmission” doesn’t mean there is none, it means that there are no credible sources or descriptions of person-to-person transmission on the date that the email was written.
Lead Inquiry: Yes.
9 January. INQ000236466, on pages 2 to 3, in the middle of an email string, you say in the first paragraph in your email to Chris Whitty:
“… notably … zero reported case fatality so far, though 7 of 59 cases with severe disease is a significantly high 12% case-hospitalisation rate in my view, such that established person to person transmission would cause serious hospital surge pressures on a par with a severe panflu virus.”
So without going into all the many issues or questions that that sentence gives rise to, can I just focus on the significantly “high 12% case-hospitalisation rate”.
It’s not possible, is it, to know from the number of people who are hospitalised or who may die from a pathogenic outbreak, the full extent of the outbreak, because you don’t – that doesn’t tell you how many people have got mild symptoms or no symptoms, and therefore constitute the body of the iceberg?
Professor Sir Van-Tam: Correct, yeah. And all we can go on at this point and be very clear about is that these are very small numbers, these are 59 cases, we don’t know what the level of case ascertainment is in total, but, in a kind of worst-case scenario, if these were genuinely the 59 cases, then 12% of them requiring hospital care is not insignificant.
Lead Inquiry: It tells you lot about the possible severity of the virus and it indicates something – because if you’ve got a large number of hospitalisations a large proportion of those people infected in confirmed cases hospitalised – something about the possible degree of transmissibility?
Professor Sir Van-Tam: It could do. It doesn’t really tell you anything about transmissibility, it tells you about severity.
Lead Inquiry: All right.
Professor Sir Van-Tam: And it is caveated very clearly on the very small numbers, seven out of 59, which, you know, if you worked out the 95% confidence interval on that 12%, it would be pretty wide based on a total denominator of 59. So, you know …
But the audience I’m talking to, you know, possibly the top epidemiologists in the country, will know this, and will understand what I’m saying through that.
Lead Inquiry: There’s a reference then in the second paragraph to “our three triggers”. Is that a reference to the triggers to which in fact Sir Chris Whitty spoke –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – being triggers revolving around whether or not transmissibility extends to – up to family level, the degree of transmissibility, to the possibility of healthcare workers becoming infected and falling ill, and also to geographical spread?
Professor Sir Van-Tam: Yes.
Lead Inquiry: Are those the triggers?
Professor Sir Van-Tam: Yes, indeed. And I think Chris was very clear yesterday about his kind of concerns that maybe “triggers” wasn’t quite the right word, but we all use words sometimes in the heat of a crisis that we don’t mean, and I don’t think he was saying that there were specific triggers for anything beyond heightened concern. However that’s defined. It’s difficult to say.
Lead Inquiry: On 13 January you attended a NERVTAG meeting as an observer, according to your statement. The minutes are INQ000021307.
An important part of this meeting, if we look at page 6, is the issue of risk. The current PHE risk assessment for this virus was presented, and then there’s a number of elements.
Professor Sir Van-Tam: Yes.
Lead Inquiry: And the conclusion which NERVTAG reaches.
Could you just confirm your understanding of what is meant by this risk assessment? Is it an assessment of the risk at that point or is it a prospective assessment, a contingent assessment of the future?
Professor Sir Van-Tam: It’s an assessment of the risk at that point, based upon the extant data at that point, as available to PHE. I think this is a good moment for me to try to contribute to the Inquiry in a way that makes the future better for the UK than the past, and one of the things that I think where the risk assessment system has failed us is that whilst it may be extremely accurate, and I’m absolutely not calling into question the judgement of any of my PHE or wider health protection colleagues about the risk assessment, the problem is that it relates to the current moment and that, unfortunately, when you then try to say “Oh, what does it mean for the future?” you get into massive uncertainty. And that’s part of the problem, possibly why it’s never been done, but equally it doesn’t give any kind of flavour to the less experienced reader about what the range of possibilities kind of is in the future, if you like.
And I think that’s really difficult, because, you know, NERVTAG is tracking new and emerging respiratory virus infections and, you know, often keeps them on the radar because they have some degree of pandemic potential, so you could almost say that everything’s got the possibility of kind of, you know, inflating into a big crisis at some point. So it is difficult and it would be very nuanced to do it, but I think it’s very unfortunate that this can be read as “Oh, well, it’s low, just forget about it”.
Lead Inquiry: And of course an important part of any risk assessment process is the message that is communicated thereby?
Professor Sir Van-Tam: But just to come back on the risk assessments, NERVTAG was very rigorous about these being dynamic, and with every NERVTAG meeting anything that was on the risk assessment chart, as it were, Dr Dabrera would update with the latest information. It was quite a job for him to keep on top of it all but he did a great job.
Lead Inquiry: Now if we scroll back out and go to page 8, paragraph 5.8, we can see a reference to port of entry screening. Port of entry screening was, I think, a matter for DHSC; is that correct?
Professor Sir Van-Tam: I think it was in the beginning.
Lead Inquiry: Yes. NERVTAG noted that the body of scientific evidence and previous experiences indicate that port of entry screening has very low efficacy and the benefit is very unlikely to outweigh the substantial effort, cost and disruption?
Professor Sir Van-Tam: Yes.
Lead Inquiry: The issue of screening, the issue of more stringent restrictions at borders, the issue of closure, quarantine, whatever it might be, screening or restriction, came back to NERVTAG and to you, indeed, and to others, repeatedly, because of course it was an issue that was revisited throughout January, February, March.
Was there any real change, however, in the response of yourself, NERVTAG and those opining on this subject in terms of recognising the very limited epidemiological advantages of border controls and also the very significant practical difficulties?
Professor Sir Van-Tam: I recall that the – and, you know, the science advice on port of entry screening has been fairly consistent all the way through, that it’s pretty inefficient, and it just boils down to the length of a flight, shall we say, for argument’s sake, from Hong Kong versus the incubation period of a typical respiratory virus. If you are infected in Hong Kong just before you board the flight, I can absolutely guarantee you’ll be asymptomatic and you’ll be PCR negative for respiratory viruses when you get off the plane at Heathrow. You’ll become ill, if you’re going to become ill, several days later, when you’re, you know, nicely ensconced back in your domestic setting in the UK. That is the principle of why it only really picks up a tiny fraction of the cases that might enter that way.
Lead Inquiry: On 15 January you advised your DHSC colleagues on the subject of person-to-person transmission – INQ000151316 – and on page 1 you said, in the third paragraph:
“For now we do have [person-to-person transmission] by the sound of it; but it does feel, from the statement made, like H5N1 in 2004 where we did see [person-to-person transmission] that was largely limited to really close contacts … and where the length of the chains of transmission were short … suggesting inefficacy transmissibility between humans.”
Was this an important moment because it was you informing your colleagues that you’d answered the question you’d poled in the earlier email, which is: is there person-to-person transmission?
Professor Sir Van-Tam: Yes, but extremely limited. As a virus that is essentially from another species, when it first encounters humans, if it can cross the species barrier at all, then you get very occasional incursions into humans that can cause very severe disease in the tiny, tiny minority of exposures, or the tiny, tiny number of circumstances in which there is an exposure.
The next, and I’m not a virologist, so you might want a virologist on the stand at some point, but the next kind of evolutionary step of a virus is to adapt to its new host and to – in the process of that it may become more transmissible in its new host. But it won’t just go from can’t transmit to fully transmissible in one step; it will take this kind of interim step – I don’t want to give it a kind of consciousness and a being, but it will take that kind of interim step to be inefficient but capable of person-to-person transmission. And I think that’s what this report refers to.
And as you know we’ve had inefficient transmission person-to-person of H5N1, avian influenza, for several decades now, in fact since 1997 on and off, and that virus has not produced a pandemic. So this is not an interpretable signal that, you know, armageddon is about to happen.
Lead Inquiry: Nevertheless, your statement, Professor, states that on 16 January you first became seriously concerned about the threat that this virus potentially posed to the United Kingdom –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – and you say this:
“By that date, it was clear that this was a novel coronavirus, it was fairly clear that human to human transmission was occurring, and my view was that this would be a significant pandemic.”
And before you answer, elsewhere in your statement you use several words but you emphasised that we would experience a severe pandemic in the United Kingdom.
Professor Sir Van-Tam: Yeah.
Lead Inquiry: So may I just ask you firstly: what did you mean by “would”? Did you mean we might, we may, or we will, or something in between?
Professor Sir Van-Tam: Okay, let me just answer that particular point there.
When I wrote the word “would”, I can’t put myself back, you know, in that time and say what was I thinking when I wrote “would”, but I think I was saying on the balance of probabilities my instincts were telling me that this was going to cause us real trouble and be a pandemic.
Now, the piece of information you’ve put up on the screen, it’s still up on my screen, relates to information from the World Health Organisation, but of course my instincts are based on a lot – things a lot more – wider than that, they’re based upon looking at the news and seeing, you know, just the kind of footage from Wuhan province, Wuhan City, and starting to think this doesn’t look or feel like something that is a small cluster. It’s also based on the fact that, you know, I have 30 years’ experience of communicable disease control and have often been the one in the office who has been kind of picked out, because of my specialist interest, to deal with outbreaks of respiratory viruses. And so this is all very soft but it was my instinct, and I think it’s right to report to you that my instincts were telling me, and I’m sure I had that conversation at home, that we were in for a bad time.
Lead Inquiry: To make plain, Professor, the degree of, or the certainty or lack of it or the degree to which you took this view, you say in your statement:
“… I absolutely understood in my mind’s eye that … it was a matter of when, not if, things would progress.”
Professor Sir Van-Tam: In my mind’s eye, yes. Absolutely. That doesn’t mean at that point that I felt that all the data were in place to prove my point or the instinct, and I think that’s something that you explored with Sir Chris yesterday –
Lead Inquiry: Yes, indeed.
Professor Sir Van-Tam: – and I would like to come back to that, if that’s all right.
Lead Inquiry: I’m going to ask you about that in a moment.
Just on those words, my second question in relation to that sentence was, when you say there would be a severe pandemic, although not there but elsewhere, you refer to in the United Kingdom, is it self-evident that by pandemic you meant a pandemic impacting upon the United Kingdom?
Professor Sir Van-Tam: I did, yes.
Lead Inquiry: Yes.
Professor Sir Van-Tam: A pandemic is a worldwide epidemic, of something novel usually.
Lead Inquiry: Why were you not confident or, putting it the other way round, why were you concerned that the virus would not be restricted to China, that if it left China it would come to Western Europe and to the United Kingdom, and that if it reached the United Kingdom it would not be controlled, all of which are necessary steps in the conclusion there would be, instinctively, a pandemic, you believed, in the United Kingdom and it would be very, very bad?
Professor Sir Van-Tam: I just know how notoriously difficult to control respiratory viruses are, I knew this – by this stage it appeared to be a novel coronavirus, I knew the diagnostics would not be necessarily sophisticated or upscaled anywhere in the world at this point, and just my general experience told me that I didn’t like the look or feel of this.
Lead Inquiry: Indeed, you’re right, you said in your statement that you of course spoke to Professor Sir Chris Whitty about this, the CMO, you’re the DCMO, and your statement records that his response had been to agree that the situation may well escalate but for now we needed to wait and monitor developments closely?
Professor Sir Van-Tam: Yes. Yes.
Lead Inquiry: Before you answer, I just need to put to you something else, another point you make in your statement, which is that in the extremely difficult and complex field of being an epidemiologist, when confronted with information suggesting the spread of a viral pandemic, there are – there is – you describe a spectrum of ways in which you can respond, and there are people who act on instinct more, perhaps there are more people who like to pause and wait and accumulate data, and that’s what you’ve put in your statement.
May we take it that both your positions, your more instinctive one, perhaps Professor Sir Chris Whitty’s desire to accumulate more information, wait and see, both fall within that spectrum of reasonable response?
Professor Sir Van-Tam: Well, that’s right. You get a range of opinions on science, you get a range of opinions on when the data are certain enough to tell you what you’re seeing, and then you have to overlay on top of that personalities. And, you know, much as Chris and I are great friends, and, you know, very dear colleagues, and I genuinely mean that, we are different personalities, and we both say we’re different personalities. You know, I’m the one who chases the ball, Chris is the one who would look at the ball first and make a more qualified and thoughtful decision about whether it was worth chasing.
So –
Lady Hallett: I think he is right, if I may say so.
Professor Sir Van-Tam: So, you know, there is that difference, and I understood entirely that I was conveying my instincts at that point, but I think Sir Chris was entirely right, given his much more profound experience of government, that – you know, he knew when to press buttons that I didn’t. In any case, I was subordinate to Chris and I respect the chain of command, so I was perfectly content with the response that I received, and, you know, it wouldn’t have been possible to kind of wake up SAGE and wake up COBR because I was getting a bit excited about something based on instinct. And there weren’t a lot of data at that point.
That position changed of course very quickly indeed, and it was six days – and the data were changing daily at that point, but it was only six days before SAGE was enacted for the first time, and it was only eight days before COBR was enacted. So I feel the system was kind of at that point beginning to kind of work, if you like.
Mr Keith: May we leave it on this basis, Professor: your instinct appears, if I may say so, to have been more of an epidemiological instinct, it was an instinctive response to the data, such as it was, and it was very limited –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – about the transmissibility and the nature of this pathogenic outbreak?
Professor Sir Van-Tam: Yeah.
Lead Inquiry: But Sir Christopher’s position, perhaps reflective of his position as the CMO, paid greater weight towards the consequences of pressing the alarm button, how quickly the government could be made to respond and made to sit up and take notice and to treat this issue seriously?
Professor Sir Van-Tam: Yes, so –
Lead Inquiry: That’s the divide?
Professor Sir Van-Tam: You’re absolutely right. I don’t think Sir Chris was remotely tardy, but I do think he was doing his job as the CMO, which is different to my job as DCMO, which is more of a kind of sentinel alerting role.
Lady Hallett: To be fair to Sir Chris too, you’re not going to get any government to move on the basis of Professor Van-Tam’s instincts, are you?
Professor Sir Van-Tam: No, absolutely not. Absolutely not. And I didn’t expect it, I was just air – you know, we have a very open office, we don’t – you know, we say what we think, we talk to each other as professional colleagues and Chris has made that very clear that we – you know, professionally, you know, that’s how it should be, and so it’s a safe space to say “Look, I’ve got a bad feeling about this”.
Lady Hallett: Did you say earlier you were involved in the swine flu response?
Professor Sir Van-Tam: Yes.
Lady Hallett: Wasn’t the Chief Medical Officer at that stage criticised for pressing a warning button too soon or too – I can’t remember, was there some –
Professor Sir Van-Tam: I don’t recall that, but – no, I just don’t recall it. Couldn’t comment.
Mr Keith: Evidence has been received from other scientists and epidemiologists to this effect: because of the characteristics of a viral pathogenic outbreak, viruses can explode, they can move extremely fast, there is a premium on speed of reaction, because once you get behind the response curve you can find yourself very quickly in very deep trouble. To what extent should an instinctive response, and you’re an expert epidemiologist, have been allowed to push the system further forward or to push it further forward than it was, given the nature of the field in which you practice, dealing with a deadly viral pandemic?
Professor Sir Van-Tam: Well, you’re kind of right, in that, you know, things can get out of control with respiratory viruses very fast, but it does depend upon the doubling time. And, you know, the doubling time for some viruses is very low, not particularly respiratory viruses but the doubling time for some viruses is low. The doubling time in the end, when we had quality data, for SARS-CoV-2 was certainly in the range of sometimes five days, sometimes ten, but that’s the kind of broad range of doubling times.
So yes, there’s a point about moving fast, but you’ve got to understand the doubling time before you can know just how much of a hurry you’re in, and we couldn’t do that at this point.
Lead Inquiry: All right.
Professor Sir Van-Tam: There’s a secondary point that I think is really important for the Inquiry globally in terms of the interpretation of data, in terms of what was coming in from the surveillance system, and when and how people acted.
If you receive data that shows an increase in infections, then you’re actually receiving data on human behaviours that occurred, roughly speaking, seven days ago, and you have a question mark about what happened in the interim seven days. If you receive data on hospitalisations and, you know, they look a bit kind of – a bit fruity, then you’re actually receiving data on exposures to the virus that occurred probably 10-14 days ago. Because we know with SARS-CoV-2 you’re not admitted to hospital the moment you get SARS-CoV-2, you’re admitted when you become breathless, you know, five or seven or even ten days later.
Lead Inquiry: And this is why it is so vital with viral pandemics, viral pathogenic outbreaks, not to fall behind the curve?
Professor Sir Van-Tam: But it’s also why you’re always working with one hand behind your back – tied behind your back, because the data you’re receiving on cases and hospitalisations pertain to exposures that are, by that point historical.
Lead Inquiry: There is always a time lag in the information –
Professor Sir Van-Tam: Indeed.
Lead Inquiry: – that is absolutely required to be able to react –
Professor Sir Van-Tam: And I wanted to land that point, so thank you for that.
Lead Inquiry: In your statement, you say elsewhere that, moving on now, and the government machine having been woken up and numerous COBR and SAGE and NERVTAG meetings having taken place, by February half term you believe you understood that the virus had actually been present in the United Kingdom for several weeks before that. Now, evidence has been received by the Inquiry to the effect that indeed there were hundreds, perhaps many more, seedings in the United Kingdom –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – throughout the February half term, so in a broad sense, you were, if I may say so, absolutely right.
By the middle of February, what view, if any, had you reached, the alarm having been raised, as to the speed with which the government machine as a whole was responding?
And I want you to answer that both by reference to the plans, plans for countermeasures, or plans for border controls or hand washing or school closures or whatever it might be, and also control. Was there a sufficient understanding of the practical limitations of control measures? Sir Chris Whitty has said he was under no illusions that control measures would by and large be affected because there was no scaled-up test and trace system.
So were you concerned by mid-February at the speed of process, the speed of progress of the government, or were you content with the reaction?
Professor Sir Van-Tam: Look, the data were getting worse with each passing SAGE meeting, and I think the minutes of the SAGE meetings speak for themselves on that. The situation was not improving, in terms of, you know, the data that NERVTAG were looking at. I knew that SAGE was properly engaged by this point. I knew that the outputs of SAGE were feeding into central government. I didn’t really have any sight or visibility of what was going on at that level.
Lead Inquiry: Right.
Professor Sir Van-Tam: I’m afraid I can’t really answer the question more than I have.
Lead Inquiry: No, it’s very helpful.
Do we take it, therefore, that you weren’t privy, for example, to the plans coming out of the Civil Contingencies Secretariat on 28 February or the debate on countermeasures in SAGE on 24 February? Those weren’t matters with which you were concerned?
Professor Sir Van-Tam: I can’t recall which SAGEs I was in or not, but if I was in a SAGE or part of a SAGE, because I had other meetings as well, you know, I might – I will have been witness to those. But I certainly wasn’t present when those kind of discussions were taken back in to Cabinet Office or Number 10 to understand, you know, what their kind of official and political response was starting to be.
Lead Inquiry: Having reached the view that you’ve expressed on 16 January and having reached the view that you’ve expressed in relation to the extent of the sustained community transmission of the virus by mid-February, did you reach a view as to the timeliness or not – absolutely open-ended – of the countermeasures that did in due course come to be imposed? So the –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – measures of 12 March, 16 March and 20 March?
Professor Sir Van-Tam: So it won’t really surprise you that I’m pretty aligned with Sir Chris on this. You know, my kind of instinct reaction was “not a day too soon”. With the benefit of hindsight I think I reflect that these measures would have all been better kind of certainly seven days earlier than they were, possibly a little longer than that.
So somewhere in the kind of 7-14-day window, you know, that would have been perhaps a bit more timely.
Lead Inquiry: And is that a reference to all the countermeasures, so those on the 12th and then the 16th and the 20th, and then ultimately, of course, the lockdown, 23rd?
Professor Sir Van-Tam: It’s –
Lead Inquiry: So they could all have been applied a bit earlier?
Professor Sir Van-Tam: Yeah, I think that’s fair.
Lead Inquiry: All right.
Professor Sir Van-Tam: Yeah, I think that’s fair. But particularly, you know, the move into lockdown. But I do appreciate that there were things going on the weekend before which made the data look suddenly much worse than they had previously looked. So I think, you know, there was an element of a change there that really kind of galvanised hearts and minds.
Lead Inquiry: But not a change that in fact sweeps away your observation or your assessment that it could all have been earlier?
Professor Sir Van-Tam: Yeah.
Lead Inquiry: Yes.
Lady Hallett: If you had any of the measures short of the mandatory lockdown imposed earlier, in the 7-14 days, in your expert opinion, was there a chance we could have avoided the mandatory lockdown or is it impossible to say?
Professor Sir Van-Tam: I think it’s largely impossible to say, but I think, for me, the balance of probabilities, looking at just how infectious this virus was proving to be in places like Italy, France, that, you know, there were just – almost certainly no alternatives. And, you know, my view, I don’t know if you’re going to come to it, I’ll just say it anyway, my view is that although there had been lots of expressions about the NHS overwhelm that was possible, overtopping, overwhelming, et cetera, my view is that, as is the same as Sir Chris, we would have first run out of high intensity care beds, and it is possible within a couple of weeks, if we had not acted when we did, that we would have reached a position where the number of people requiring admission with Covid severe enough to warrant hospital care could not have been admitted. With some, you know, pretty awful potential considerations at that point.
Mr Keith: Since you have gone there, we have gone slightly out of the chronology, but that’s no bad thing, Professor, could I ask you to look at a SAGE meeting of 23 March, of course the date that the mandatory stay-at-home order was imposed – INQ000129072 – because in fact you were present at that SAGE, you may or may not recall.
INQ000129072.
And at paragraph 7 these words appear – or rather, perhaps, let’s start at 6:
“6. The NHS is surging bed capacity over the next fortnight, with a focus on London.
“7. The data suggest that London is 1-2 weeks ahead of the rest of the UK on the epidemic curve. Case numbers in London could exceed NHS capacity within the next 10 days on the current trajectory.”
Professor Sir Van-Tam: Yes.
Lead Inquiry: Firstly, that last assessment “could exceed NHS capacity”, was that premised upon no further lockdown or no further stringent measures being imposed, and therefore reliance on the measures from the previous week, that’s to say the 16th and 20th, or case numbers could exceed even if we do impose the mandatory stay-at-home order, do you know?
Professor Sir Van-Tam: Yes, so I don’t know, but the way I interpreted it for sure was that if the current rate of growth continues, case numbers could exceed NHS capacity. Now, NHS capacity has to be something that is a little bit fluid in terms of regions. London was ahead of the curve, I don’t doubt that if London was full, for want of a better word, there would then be an overflow of London patients into other parts of the NHS, you know, because that’s what we do, and that’s particularly what intensive care units do as a matter of kind of routine practice.
And that has implications for places not in London and further out of the city who are behind the curve, who essentially – because people don’t, you know, go into intensive care and come out the next day, they certainly weren’t at this point – that has implications for whether the remaining capacity in the regions, for want of a better word – and, you know, I’m quite sensitive about this because I live in the regions, I don’t live in London – you know, what that does to the remaining capacity.
So “exceed NHS capacity” is possibly a slightly loose term because you can kind of sleep out by region, but it still has implications for the totality of the NHS bed capability.
Lead Inquiry: The material around this time uses, as you’ve already identified, a number of different ways of describing the impact on the NHS, “overwhelming”, “overtopping” –
Professor Sir Van-Tam: Yeah.
Lead Inquiry: – “exceeding capacity”, “straining the surge capacity”, and so on and so forth. Is this the position as you understood it at that SAGE meeting: there was no hard data saying there is a stop point, a hard date by which the NHS will be broken, but that, instead, if the epidemiological trajectory or curve continues in the way that it has, it will inevitably be broken at some indeterminate point in the future, is that the nub of it?
Professor Sir Van-Tam: Yeah, so “hard stop” is a really kind of bad expression for the reasons I’ve given, that, you know, if you’re short of capacity in one area you kind of move out and ship out and sleep out into the other areas, but the NHS is nevertheless finite in the number of staff and the number of beds, and so I think that’s right, I think that’s the –
Lead Inquiry: The correct analysis?
Professor Sir Van-Tam: You did say something else and I’ve forgotten.
Lead Inquiry: No, no, I think that was all I said.
Professor Sir Van-Tam: Okay.
Lead Inquiry: Secondly, obviously on that 23 March only a few days had passed since the measures had been imposed the previous week –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – on the 16th and then the 20th, the household isolation – the individual isolation, then the household isolation, then the request that all non-essential businesses and travel stop and that people endeavour to stay at home.
What was your understanding of what the likely impact of those measures was in terms of the R figure? Because, as Sir Christopher has explained it, it’s not that government was grappling with absolute data as to when or how the NHS would collapse, it is just that if the reproduction figure was not brought below 1, the exponential growth would continue and that point would inevitably be reached.
What debate was there about giving more time for the measures the week before time to bed in and for the R figure to come down in the expectation or hope that it would come down before that future date of collapse of the NHS would be reached?
Professor Sir Van-Tam: Well, if you enact measures on, say, the 20th of the month, then you absolutely – and if everybody complies with the measures on that date, you change exposures from that date, you therefore change case incidence, shall we say, five to seven days later, something like that, so you don’t see the impact of that. You then don’t see the impact of those new cases for another seven days, until they require hospital care, so that kind of takes us into – quite a way into the next month, and by the exhibit you’ve just put up, the doubling time for intensive care unit patients at this point was estimated to be three to four days.
So how can you wait for – to see the results of those measures when you in such a kind of difficult position in terms of bed number doubling?
Lead Inquiry: There was nevertheless some way of assessing compliance or the reaction to or the response to those earlier existing measures because there was some information at the weekend about levels of compliance, and you’ll recall the fact that the press and the television showed large numbers of people attending national parks over that weekend. So there was data about that. Is therefore the position that the quandary the government was in this: nobody could say for sure what the impact had been or would be of the existing measures, no one could know for sure, because, as you say, it would take days if not weeks for the impact to become clear, what therefore the impact would be and that was an unconscionable risk to run? If you don’t know what the beneficial impact had been of the week before, you cannot continue on the basis that you’ve just got to hope it will work, given the characteristics of the viral pandemic?
Professor Sir Van-Tam: So I understand the question entirely. What I don’t think I can do is give you the kind of technical answer you require, which I think the modellers would need to give you, about what their views were about the likelihood of those phase one measures, if that’s the right word, having the desired impact.
Lead Inquiry: I –
Professor Sir Van-Tam: I wasn’t –
(unclear: multiple speakers)
Lead Inquiry: I don’t wish you to speak on behalf of the modellers –
Professor Sir Van-Tam: No, and I can’t really give you an answer then.
Lead Inquiry: But was this not a debate that was taking place within SAGE on that day: how do we weigh up the prospect that the phase one measures are going to work to get us out of the hole against the risk that if we don’t act now with further more stringent measures it will be too late?
That’s the crisis, that’s the dichotomy?
Professor Sir Van-Tam: Yes, I’ve pledged to be truthful and I will, and I can’t remember.
Lead Inquiry: All right.
Can I now raise just some separate disparate areas. That Coronavirus: action plan, of 3 March –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – did you have a hand, Professor, in its drafting or its promulgation?
Professor Sir Van-Tam: I undoubtedly received a copy of it to make some kind of track changes and suggestions to it. In fact I think if you were able to kind of look at the email records you would probably see that that was the case.
It was another job to do. I was rather more focused on specific jobs I had to do connected with fighting the virus than writing about – writing a glossy pamphlet about how I was going to, you know, play my role in it or how the government was going to do it or – so I’ll be perfectly truthful with you: it was another job that probably wasn’t very welcome at the time, and, you know, I just thought well, you know, see it through.
Lead Inquiry: May –
Professor Sir Van-Tam: Let others do it.
Lead Inquiry: May I ask you this. You’ve told us how you’d already reached the view in mid-February that –
Professor Sir Van-Tam: Yeah.
Lead Inquiry: – there was sustained community transmission, essentially containment had been lost, you must have wondered around about 2 March, when you were contributing to the final draft: why am I writing – why am I assisting the drafting of a document which is based on the premise that containment has not yet been lost, and indeed the government didn’t announce it was lost until 12 March?
Professor Sir Van-Tam: The drafting of government documents takes forever and a day, and, you know, it wasn’t really something that I was focused on or really had the kind of mental and professional energy to worry about.
Lead Inquiry: All right.
Lady Hallett: I’ve written down “I was focusing on actions not planned – not words”.
Professor Sir Van-Tam: Yes, I was, I’m afraid.
Mr Keith: Well, that perhaps is a very useful description of certain publications.
My Lady, is that a convenient point?
Lady Hallett: It is, certainly. We take a 15-minute break, Professor, so I shall return at 3.25. But we shall complete your evidence today, I promise.
(3.12 pm)
(A short break)
(3.25 pm)
Lady Hallett: Mr Keith.
Mr Keith: Professor, mass gatherings.
Professor Sir Van-Tam: Yes.
Lead Inquiry: I detect a quiet groan. It was an issue upon which you advised the Secretary of State for the Department for Culture, Media and Sport in late February, and you also provided advice to DHSC colleagues at the same time. You met with officials in the DCMS in early March, you provided further advice and further papers for a number of government departments in the middle of March, 14 March.
So you were, to a considerable extent, the go-to person on this issue. In summary, scientifically, epidemiologically, was there a consistent line of advice given by the OCMO to the effect that banning mass gatherings or closing sporting events or sporting occasions would be unlikely to make much of a difference epidemiologically?
Professor Sir Van-Tam: Yes. I mean, our – our position, my position has always been that mass gatherings, particularly outdoor ones, are – if you cancel them, they’re a very limited epidemiological effect. And if you take into account the kind of pathways around them, it is the activities around them that is, you know, potentially more concerning, in relation to kind of pubs, bars, restaurants, et cetera.
But even so, in relation, for example, to – you know, I know you’ve already discussed a couple of big sporting events in different countries with various witnesses. In terms of the kind of totality of movement between countries, the effect of kind of cancellation of these events is really, epidemiologically, quite small. I have also heard Sir Chris’s comments, and I have to say I think he’s got a very valid point, that there is a political layer above this, around the optics and what the continuation of mass gatherings means, signifies to the public, you know, because – you know, when the football’s over there’s not much left to do in life, as it were.
So from that perspective –
Lead Inquiry: Well, I have to interrupt you there, Professor. That is your personal view.
Professor Sir Van-Tam: Yes, indeed. Yes. But the point is, you know, it’s very symbolic for a lot of people, what these mass gatherings are, and I think Chris summarised it very well, I don’t think I can add to that.
Lady Hallett: Can I just ask you one extra question, Professor, I think it’s something Mr Weatherby was asking about earlier, and that is: but what if your football match involves a whole bunch, thousands of people flying in from another country where there is a hotspot of infection or hotspots of infection?
Professor Sir Van-Tam: So that partly depends on whether there are lots of other people coming in through kind of routine tourism and so forth from that other country, and it really depends on whether you have a belief that the virus is already seeded here in the UK, and whether that additional movement would really be an amplification in relation to what is already going on under the surface in your own country, particularly in those kind of early months when we know we couldn’t test at the capacity required to understand the UK case burden.
Lady Hallett: I’m no scientist, but aren’t you just raising the risk? It’s not going to help matters.
Professor Sir Van-Tam: I think it’s perfectly fair to say that it won’t help matters, but equally it isn’t going to have a – it just isn’t going to have a significant negative impact either in relation to the totality of what else is going on.
So it’s back to this point that I think there is – it’s always very difficult in this space to separate out the optics from the actual epidemiological effects. But, you know, I refer – I can recall emails from other – other experts, I think Professor Ferguson, Professor Edmunds, also agreeing that the effect of mass gatherings is –
Mr Keith: Professor Ferguson in fact was asked to advise specifically on this point and we’ve seen the evidence.
Professor Sir Van-Tam: Yes.
Lead Inquiry: When you say “political” and you referred to the “optics”, do you mean in fact that, in terms of the public health message that went out, the continuation of mass sporting events was, with hindsight, ill-advised, it just sent the wrong message?
Professor Sir Van-Tam: It was unhelpful, it was unhelpful.
Lead Inquiry: You can’t talk about closing primary schools and allow sporting events to continue, can you?
Professor Sir Van-Tam: It was unhelpful.
Lead Inquiry: All right. Then secondly this, just on the epidemiological side, there is some suggestion in the material that whilst it’s clear that outdoor sporting events epidemiologically are insignificant because they’re outdoor, there may have been an underestimate of the epidemiological consequences of queuing to get into games or perhaps using public transport or the use of trains, and, as my Lady has observed, that’s one way perhaps in which people may be coming together to go to a game and therefore there was an epidemiological risk there which perhaps wasn’t fully appreciated at the time this advice was given?
Professor Sir Van-Tam: Whenever you get people gathering together in conditions of close contact, low ventilation, with this virus, you’re likely to get transmission.
The … the however many tens of thousands one could get into a stadium will be dwarfed by the however many millions that are gathering in pubs to watch it on Sky TV. So, you know, there’s a broader context here of what the sporting event generates in terms of people coming together, quite often to drink alcohol, which we know reduces social barriers, to observe a sporting event.
Lead Inquiry: Indeed. The easing of restrictions.
Professor Sir Van-Tam: Yes.
Lead Inquiry: On 26 May you contributed to a joint letter to Simon Case, the then permanent secretary in Number 10.
Professor Sir Van-Tam: Yes.
Lead Inquiry: Could we have INQ000069418.
Professor Sir Van-Tam: Yes.
Lead Inquiry: In essence, in general terms, you and your colleagues were writing to the government to say this. You are aware that different government departments are eager to restart their industries, you’re obviously acutely aware of the damage and harm that is being done to the health and welfare of societies by virtue of the restrictions, but you nevertheless felt it important enough to warn that the combined effect of seemingly incremental and narrow easings raised an essentially intolerable risk that the R reproduction number would run out of control again.
Why was it necessary to write this letter as opposed to just continue to contribute to the sum of government learning by the advices that you were giving with your colleagues day in, day out, at meetings, by email and so on and so forth?
Professor Sir Van-Tam: Yeah, okay. So the actual restriction, the easing of restrictions that was happening was happening on a piecemeal basis, government by government department kind of setting by setting by setting, and it was relatively easy to justify for an individual setting that, you know, this was kind of okay to ease restrictions. However, when you put all of those together, there was a risk. I didn’t – your words were “intolerable”, they’re not mine, but there was a risk that this would all go too fast.
Lead Inquiry: Well, you say “severe risk” –
(unclear: multiple speakers)
Professor Sir Van-Tam: Yeah, “intolerable” is not a word, I don’t think –
Lead Inquiry: All right, well –
Professor Sir Van-Tam: But there was a risk that this would all go too fast, and there was a risk that – we knew there would be further waves of infection, epidemiologists knew that, at some point. There was a risk that if you kind of let it go, let it kind of rebuild and get a lot of momentum, you would then enter the next wave from a fairly high level and therefore have less warning and therefore with more consequences.
So that was the kind of science reasoning behind the letter. Why the letter rather than just continuing to co-operate? And I think that was about, certainly for me, and I can only speak for my signature on the letter, I wanted to leave a mark in the sand here.
Lead Inquiry: Why was it necessary to leave a mark in the sand if you were, as were of course, the DCMO giving advice on a daily basis to government with your colleagues?
Professor Sir Van-Tam: Because people like you have come back to it now and it’s kind of on record that I was concerned enough to write a formal letter to Cab Sec at this point because of those concerns that I’ve already relayed to you and the room.
Lead Inquiry: But they were concerns that you would have been ordinarily expressing in the course of your day to day meetings, because all of you were exclusively concerned, of course, with the pandemic and with the easing of restrictions and the debate that was going on?
Professor Sir Van-Tam: Sometimes a letter is needed.
Lead Inquiry: Why was it needed?
Professor Sir Van-Tam: As I said, to lay down a trail in writing that was incontrovertible that we wanted to say that this needed to be taken very carefully.
Lady Hallett: That suggests you didn’t think your oral advice was being taken sufficiently seriously.
Professor Sir Van-Tam: I think … I think it could partly suggest that, but it could also partly reflect the kind of fragmentation of decisions across different sectors, and therefore possibly the Cab Sec, not being an epidemiologist that I’m aware of, not being able to crystallise the net result of those individual sector liftings and frame that in terms of the national epidemiology.
So, you know, I don’t think it was because we’d kind of felt we’d run out of road in terms of, you know, getting traction with officials from other government departments, not at all, but I just think it was more about the totality and somebody who is responsible for the totality actually being presented with that concern.
Mr Keith: Professor, it is common ground, it’s well established, that, as these things go, the level of prevalence remained relatively high or at least not very low throughout the course of the summer months. We came out of the restrictions with the prevalence still at a relatively significant level, and that didn’t change. Then in September, there was a debate, which we’re not going to go into, about the necessity for circuit breakers, then the introduction, instead, of a tier system in October –
Professor Sir Van-Tam: Yeah.
Lead Inquiry: – and then ultimately the lockdown at the beginning of November.
Professor Sir Van-Tam: Yeah.
Lead Inquiry: In general terms do you assess that this warning, which is what it surely was, because the last paragraph shows what might happen if control is lost, was generally heeded?
Professor Sir Van-Tam: You know … I suppose the epidemiology really just speaks for itself at this point –
Lead Inquiry: But could you tell us, please.
Professor Sir Van-Tam: Yeah. You know, it was clear that we were losing control of the virus bit by bit through the autumn again, and it was clear that the tier system, to my mind, was not working efficiently. That isn’t to say that theoretically it couldn’t have worked efficiently, but there were just too many delays in implementing tiered restrictions. Those on top of the fact that your data you’re dealing with, again I go back to the point, reflect exposures two weeks before, or at least a week before. So, you know, you’re already kind of, you know, dealing with yesterday’s data trying to make decisions, so – and the tier system just seemed interminably slow between a decision and the negotiation on the economic packages to enable it to happen. And –
Lead Inquiry: Can we just focus on that for a moment –
Professor Sir Van-Tam: Yeah.
Lead Inquiry: – and could you just further explain that observation. The evidence is that in the October tier system, not the December one, but in the October one, there was a process by which local authorities who were subject to higher levels of tiering could negotiate financial packages.
Professor Sir Van-Tam: I believe so, yes.
Lead Inquiry: Was your concern that there was a delay built into the system between the moment at which the Joint Biosecurity – the Joint Bio Centre would advise that a particular area had to go, epidemiologically, into a higher tier –
Professor Sir Van-Tam: Yeah.
Lead Inquiry: – to the point at which it was actually ordered, because there had to be a process of negotiation in the middle?
Professor Sir Van-Tam: Yes.
Lead Inquiry: All right. And then because of your point about the importance of not falling behind the curve and not knowing what the data in fact shows because the data is a bit old, that gave rise to a very real problem?
Professor Sir Van-Tam: Yes, yeah. And the tier system led to some other problems too. So, for example, Liverpool did really well at one point and managed to kind of – significantly to kind of turn their numbers down, Manchester got into more difficulty, but there were widespread reports of – that, you know, people from Manchester going to nightclubs in Liverpool to circumnavigate the kind of geographical boundary of the tiers. So at a practical level I think it was very difficult to make it work and it probably looked better than it really was, which is why I just don’t think the tier system served us very well at all.
Lead Inquiry: You focused on the events in October, Professor. My question in fact was designed to elicit from you an answer as to the general governmental response from the time at which you sent the letter in May. Was the reality that the warning was not heeded to this extent: control of the disease was lost, the steps taken by government in September by way of the decision not to impose a circuit breaker, the decision in October to have the tier system that you’ve described, failed to do that very – failed to perform the very aim, the strategy which you had identified as being necessary to ensure that there wasn’t a new loss of control and a new second wave?
Professor Sir Van-Tam: Yes, that’s correct.
Lead Inquiry: All right, thank you.
Eat Out to Help Out.
Professor Sir Van-Tam: Yes.
Lead Inquiry: Did you, Professor, were you consulted on that scheme? We’ve asked the same question of Sir Patrick Vallance and Sir Chris Whitty. Were you involved in that?
Professor Sir Van-Tam: Absolutely not. The first I heard about it was, I think, on the TV.
Lead Inquiry: I think that indicates what view you would have taken had you been consulted?
Professor Sir Van-Tam: Say it again?
Lead Inquiry: What view would you taken had you been consulted?
Professor Sir Van-Tam: So had I been consulted I wouldn’t have made any distinction between Eat Out to Help Out and any other epidemiological event that brought different households into close contact with each other for the purposes of socialising, eating and consuming alcohol.
The net epidemiological effect, you know, is kind of agnostic to what’s on the menu, as it were. But I would have said, “This is – this is exactly encouraging what we have been trying to suppress and get on top of in the last few months”. So it didn’t feel sensible to me.
Lead Inquiry: All right.
Finally, two last subjects. Moonshot.
Professor Sir Van-Tam: Yes.
Lead Inquiry: You were on the Moonshot scientific advisory group –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – the first meeting of which took place on 25 August. We’ve heard very little about the Moonshot; what was, briefly, the Moonshot idea or exercise?
Professor Sir Van-Tam: So I’ll give you my best understanding of it, which may not be perfect. The understanding of Moonshot was to try to restore the UK to a point where we had almost no Covid. And to do that, to detect every single case there was kind of cooking or ongoing in the UK at the same time.
Lead Inquiry: A mass test?
Professor Sir Van-Tam: So mass population testing in a very short window of time. Now, I never got to the point where I understood whether this could be done in one day or done in three days, but even three days would be, you know, 20 million people a day, so I never really kind of understood that concept.
But it didn’t make any epidemiological sense to me. Because let us say that your testing day was Monday, yeah?
Lead Inquiry: For a whole swathe of –
Professor Sir Van-Tam: Yes.
Lead Inquiry: – for a whole region.
Professor Sir Van-Tam: For a whole region, yeah, yeah. And there would be a number of people who were exposed to the virus on the Sunday, who absolutely would test negative on the Monday, because they were incubating the organism, who would get a kind of clear result, as it were, by Tuesday or Wednesday, but who by Thursday may well have symptoms.
So actually you would have to repeat this over several days and keep people in isolation from each other to avoid further exposure to kind of get to the point where everyone was clear.
And I just couldn’t see it working. I was sent to the Moonshot meeting, I can’t remember who sent me, but I was told to go along to the Moonshot meeting. And I went along, I tried to offer some, you know, non-negative, constructive comments, but I couldn’t see it working ever.
Lead Inquiry: That’s the epidemiological answer. Practically, as at that time, in August, do you recall whether or not the United Kingdom in fact had a fully scaled-up system of PCR, antigen or free flow tests that would have allowed these sorts of numbers to be tested simultaneously?
Professor Sir Van-Tam: I mean, that’s a memory test and I can’t remember the figures, but my kind of gut feel is no. And of course there were other far more important testing environments such as hospitals and care homes.
Lead Inquiry: Indeed.
Finally, communications. In your statement you refer to the fact that there was a Japanese poster called the “Three Cs” (closed spaces, crowded places and close-contact settings), the merits of which commended themselves to you, and you sent a copy of that poster to the Cabinet Office in mid-June, so not during the lockdown and not “Save the NHS” time, but afterwards.
Professor Sir Van-Tam: No, no.
Lead Inquiry: Why did you send a copy of that poster to the Cabinet Office in mid-June?
Professor Sir Van-Tam: Well, I can’t remember when I first discovered the existence of the Japanese “Three Cs” concept, but it immediately resonated with me. And, you know, all I can say is it resonated with me personally because I felt it would be a way, if we did it right, by which we could coach the public to look at any situation and just, you know, remember three Cs. It’s pretty simple. Literally, is it closed? Corollary: and what’s the ventilation like? Is it crowded? Are you putting a lot of people into that closed space? And is the purpose of them being there to have close contact with each other?
And I felt that you could teach people to self-regulate almost and risk manage their own behaviours, their own exposures, if we could kind of make that concept work in the UK. And I –
Lead Inquiry: Had it been very successful in Japan?
Professor Sir Van-Tam: I can’t give you the answer to that, all I can say is – you know, repeat what you said to me, that it absolutely resonated with me.
Lead Inquiry: All right. You sent it to the Cabinet Office, you were told that it would be considered, this type of messaging might be – it would be explored as to how it could be integrated into the campaign. Did you hear any more?
Professor Sir Van-Tam: No.
Lead Inquiry: You were the DCMO for health protection in the face of this pandemic?
Professor Sir Van-Tam: Yeah.
Mr Keith: All right. Thank you very much.
Lady Hallett: Mr Weatherby.
Questions From Mr Weatherby KC
Mr Weatherby: Professor, I ask questions on behalf of the Covid Bereaved Families for Justice United Kingdom, it represents many bereaved families across the United Kingdom, and for the purposes of the questions I’m going to ask you it’s important to record that some of them are bereaved of healthcare workers and some of them themselves were healthcare workers during the pandemic, including on Covid wards.
Now, on 9 January, so very, very early in the story, you attended a PHE strategic response group where it was agreed that Covid would be treated as a high-consequence infectious disease, HCID, although I think it was formally classified as such a few days later. Is that right?
Professor Sir Van-Tam: I think it’s right.
Mr Weatherby KC: Okay. Well, I have the document, I’m happy to put it up, but I’m trying to –
Professor Sir Van-Tam: No, that’s fine.
Mr Weatherby KC: – work at pace.
The minute of that meeting, I’ll give the reference for the record, it’s INQ000119453, and the minute records that it was recognised that Covid, like SARS, was a virus with “higher airborne transmissibility”, and that would mean, wouldn’t it, that it was recognised that it was transmitted either by aerosol or droplet transmission; is that right?
Professor Sir Van-Tam: So higher airborne transmissibility –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – does mean that it could be transmitted via the airborne route, which includes large droplets and also includes fine particles, also referred to as aerosols.
Mr Weatherby KC: Yes. Thank you.
Professor Sir Van-Tam: But aerosol or airborne transmission is not part of the definition –
Mr Weatherby KC: No.
Professor Sir Van-Tam: – of a high-consequence infectious disease.
Mr Weatherby KC: Thank you for that clarification, I wasn’t in fact suggesting it was.
Professor Sir Van-Tam: No.
Mr Weatherby KC: But that’s what was recorded in the discussion, during which it was agreed between you and the PHE group that it would be in fact classified as a high-consequence infectious disease.
Professor Sir Van-Tam: Yeah, and the reason for that classification at that point was that primarily I think at that point we really did not understand with any certainty the infection or case fatality rate, we didn’t know how lethal this virus was –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – and the HCID classification is used for things which you know are very lethal and used for things which you – where you have uncertainty as to the lethality.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: It’s the way you kind of start with a new organism.
Mr Weatherby KC: Indeed, and in fact the document goes on to say that it was agreed to follow a “safety first principle” –
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: – which I think is what you just helpfully explained to us.
And in fact the discussion and the classification at that stage was then added to by guidance, and again I’ll read it rather than putting it on screen if I may, but I can if you want me to, it’s at INQ000184034, and for the record it’s paragraph 4.3, and the guidance on 15 January that was issued with respect to this –
Professor Sir Van-Tam: Could I have that up, if that’s all right?
Mr Weatherby KC: Yes.
Could we have that up then? I’ll repeat the – it’s INQ000184034.
(Pause)
Mr Weatherby KC: Right. Sorry, could we have the first page up first so we can orientate as to what it is. Thank you.
So it’s the “Wuhan novel coronavirus … infection preferential prevention and control guidance”, 15 January.
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: So could we go to the paragraph that had helpfully already been put up – thank you, 4.3 – the page before, I think, yeah, 4.3.
So what was required was, firstly, an isolation room with negative pressure relative to the surrounding areas, or a neutral-pressure single room, and then a use specifically set out – use of an FFP3 respirator by all persons entering the room. And then, I won’t go through it but you can see it there, full PPE.
Yes?
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: So that’s what was –
Professor Sir Van-Tam: And this is guidance issued by Public Health England.
Mr Weatherby KC: Yeah.
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: But this is sensible precautions for this type of virus, isn’t it?
Professor Sir Van-Tam: It’s sensible and pretty standard precautions –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – for HCIDs at this point in time –
Mr Weatherby KC: Okay. So then move to 21 January and again I think we should have this up, it’s INQ000151342, and this is an email exchange between yourself and a PHE official.
It’s been redacted, so I don’t know who it is, but it doesn’t matter, but it’s an email exchange, and the person confirms that:
“… There is no agreed requirement to stop calling a disease an HCID, in order for confirmed cases to be managed outside HCID centres. Management in specific HCID treatment centres is (deliberately) not part of the agreed definition/criteria for HCID; we do have a line in guidance saying confirmed cases should be transferred to HCID treatment centres, but that could easily be changed when an agreed surge trigger is met.”
And then this:
“Personally, I would want to maintain the HCID label if it became more widespread, to maintain appropriate IPC [infection prevention control] precautions and general levels of clinical concern/awareness around the new disease, as long [as] we still think it meets the stated criteria.”
Yeah?
So what that means in summary is that you’re agreeing with the PHE official that once the spread of the virus reaches a particular point it’s not required that they should be – that patients should be within an HCID centre.
Now –
Professor Sir Van-Tam: Not quite –
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: – true.
I think what I was flagging, that the HCID process, if you like, and the use of those very high – high security beds, there was a step down and a known step down to the 500 or so infectious disease beds, which are – again have –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – enhanced infection control, but that there was no provision or understanding about what happened when you got to the end of those 500 beds.
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: And it was very clear that we were going to get to there quite quickly.
Mr Weatherby KC: Okay. Can I take this in stages?
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: So the HCID scheme, if I can put it that way, is that there are – there’s a standing capacity of high isolation beds –
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: – so if there’s a need for isolation the HCID patient is put in there. But it’s well recognised that if there’s more than a small number of such patients –
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: – then that can’t –
Professor Sir Van-Tam: They just can’t function –
Mr Weatherby KC: – completely impracticable to have a standing capacity of thousands of empty beds?
Professor Sir Van-Tam: Indeed.
Mr Weatherby KC: So it starts off with an HCID unit, small number of beds, and then if that isn’t sufficient you then have to open it up?
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: – and you move on to the high dependency unit –
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: – capacity or whatever you have, and you have to use practical means to expand the capacity to the best isolation that you can manage within the capacity that you have; is that right?
Professor Sir Van-Tam: Yeah, that seems okay.
Mr Weatherby KC: Okay. But what is being said here is that although that is fine, what should be maintained are the IPC precautions around that?
Professor Sir Van-Tam: Yeah, so that was personally my view.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: The other factor that was later – you know, I was later made aware of that – is that specimen handling and the whole process of treating patients under kind of HCID rules means that your total capacity is lower and your speed of movement and handling of specimens particularly is lower and more cumbersome, and the classification of HCIDs lies with the Advisory Committee on Dangerous Pathogens –
Mr Weatherby KC: I’m coming to that.
Professor Sir Van-Tam: Good.
Mr Weatherby KC: So the point is that it’s recognised that you have to be flexible about capacity and therefore the HCID classification allows for a surge, a trigger which opens up the capacity and you have to do the best you can with the capacity.
Professor Sir Van-Tam: So I don’t think it allows for it in the sense that it has always allowed for it –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – I think this was new thinking.
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: I think this was a new situation.
Mr Weatherby KC: The guidance we’ve just been to –
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: – sets out the need for the isolation units but not in terms of specifically HCID units, but it does specifically refer to the FFP3s –
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: – and the particular requirements of personal protection for the staff, and that’s the distinction I’m drawing. So that’s the – whether it’s the HCID guidance or not, that’s the guidance that was in place here which I’ve just taken you to.
Professor Sir Van-Tam: Okay.
Mr Weatherby KC: Yes?
Professor Sir Van-Tam: I’m all right so far.
Mr Weatherby KC: Yes. So by the beginning of March –
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: – as we heard from Professor Whitty this morning, there was then a question right at the beginning of March about the biosafety requirements of dealing with samples in labs?
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: So perfectly sensibly the CMO, the Office of the CMO –
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: – then consulted with PHE and the HSE and got the biosafety requirements stepped down so that the testing could be maintained or the analysis of the testing; yes?
Professor Sir Van-Tam: I think so, yeah.
Mr Weatherby KC: Yes.
Then we move to 3 March, and again I’m trying to go at some speed here, so please stay with me, but then a DHSC official messaged that the standing capacity for airborne HCIDs had been exceeded and therefore there was this outward movement from the very high isolation capacity outwards. Now, that you probably won’t remember the date –
Professor Sir Van-Tam: No.
Mr Weatherby KC: – but that was 3 March. I can take you to the document, but I don’t think it’s necessary, but were you aware at this sort of time, the beginning of March, of that happening in accordance with what we’ve just been through in January?
Professor Sir Van-Tam: I can’t remember the date.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: But I entirely expected that we could not –
Mr Weatherby KC: Sure.
Professor Sir Van-Tam: – continue to manage the very fast growing epidemic of hospitalised patients on the infectious diseases network –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – within the infectious diseases network.
Mr Weatherby KC: Yes. But this was – what we’ve just been through, 21 January email, the expectation was that if this did become widespread that this would be necessary, and here we are at the beginning of March, it has been necessary, the plan, such as it was – it wasn’t unexpected?
Professor Sir Van-Tam: No, no, I think I kind of flagged that –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – that there was probably a gap in the plans that didn’t kind of bridge between what we classically envisaged HCIDs to be handling –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – such as Ebola cases, to something that was then becoming a –
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: – persistent and widespread infection.
But let me just add a little bit to that, where the threat of infection to others was changing over time, so it was not exclusively about the healthcare environment, and it was starting to be more about the general community environment. In other words, the opportunities for exposure to the virus were starting to change. Whereas, you know, if you have – you can have the – you can have the infectious diseases unit, the HCID, full of Ebola cases but there’s no risk in the wider community.
Mr Weatherby KC: Yes, okay.
Professor Sir Van-Tam: It’s contained. This was very materially different –
Mr Weatherby KC: Okay, so I’ll now move on to the final part of where I’m headed with this, and that’s 13 March, and NERVTAG met.
I think we need this up. It’s INQ000212195 –
Professor Sir Van-Tam: Oh, thank you.
Mr Weatherby KC: – and that’s 13 March, and if we could, and this is a meeting where the HCID classification is considered. And just to remind ourselves, this is where we’re in the crisis phase, the exponential rise in Covid cases. Okay?
So if we could move to page 4, please, and paragraph 2.5, and this refers to – this is relevant to you, “Action: JVT”, and then:
“JVT noted that the guidance was needed to help relief pressure points on the NHS in England …”
And then there is the example of ambulances; yes?
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: Then if we move on to 2.9, please, the new guidance that’s been proposed is then stepping down from FFP3 proper respirators to the kind of blue surgical masks that many of us are familiar with –
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: – having gone through it. So a real step down in PPE for people who are dealing with Covid patients at that point at the crisis stage.
And then, if I may, 2.10, there’s a recommendation there that the reclassification of Covid from an HCID is considered by the advisory committee –
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: – which you were referring to earlier.
And then finally on this document, 2.11, please, there is an update where you had spoken to Professor Evans, who had advised that HCID statement was discussed “and the committee were unanimous in supporting the declassification … of HCID”.
Now, just to complete the picture – well, first of all, you’ve therefore got the recommendation that it’s reconsidered, and then you’ve got effectively a decision in the next paragraph referred to which suggests that a decision has already been taken. Can you help us with that?
Professor Sir Van-Tam: No, I don’t think that’s the case at all.
Mr Weatherby KC: Have I misread that?
Professor Sir Van-Tam: Well, I mean, clearly they’re sequential minutes, but the minutes aren’t written the moment –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – a NERVTAG meeting is finished. I don’t suppose we have the publication date on these minutes, do we?
Mr Weatherby KC: I’m not aware of that.
Professor Sir Van-Tam: No, we –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – just don’t.
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: That would be worth looking into.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: But likely, having received an instruction from one independent advisory body in the shape of NERVTAG, who were requesting that ACDP looked at this, likely I moved very fast on that –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – and likely this should have been reported –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – as an action –
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: – linked – that I had done really quickly, and this was almost a kind of post-meeting note that –
Mr Weatherby KC: I see.
Professor Sir Van-Tam: – that was the consequence.
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: I just can’t spread any further light on that.
Mr Weatherby KC: No.
Professor Sir Van-Tam: But I – you know, I refute the suggestion that this was a fait accompli.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: I’m extremely fastidious about –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – appropriate procedure, and if NERVTAG had asked for that, I would have asked ACDP –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – in due course.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: This would not be kind of retro-constructed –
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: – as you might have been suggesting.
Mr Weatherby KC: Right. Well, I’m exploring rather than suggesting –
Professor Sir Van-Tam: Yes.
Mr Weatherby KC: – but the one paragraph says –
Professor Sir Van-Tam: It does.
Mr Weatherby KC: – a recommendation effectively –
Professor Sir Van-Tam: Yes, and the next one –
Mr Weatherby KC: – and the next one refers to –
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: – what’s effectively a decision.
Professor Sir Van-Tam: Yeah.
Mr Weatherby KC: And the reason that you were – however it lands – in touch with the professor about this is because they were effectively the decision-making body?
Professor Sir Van-Tam: ACDP.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: Absolutely, yes.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: And it would be worth possibly seeking some supplementary evidence from the ACDP minutes to understand –
Mr Weatherby KC: Well, it may not be –
Professor Sir Van-Tam: – how that happened.
Mr Weatherby KC: It may not matter, but I was then just going to take you to one final document, which is INQ000119498, which is the 16 March document at the top, although it does say 19 March at the bottom, it probably doesn’t matter, but just to orientate us in terms of the date.
But this is the “Four Nations HCID Definition and List Group”, chaired by the head of emerging infections, and I won’t take you through it but this is ostensibly a review of the HCID position and then changes the position at the end of the document, and it – of importance here is that this is a four nations group, so this is where the four nations are brought together.
So in terms of this, first – I’ve got two points on this, just to finish with, but who is actually making the decision here? Is it the professor from the group that you were in touch with on the 13th or is it the four nations group? Were the four nations CMOs involved in this? I mean, what was the process here?
Professor Sir Van-Tam: I am pretty certain – but I can’t answer the question about whether the HCID definitions group was a subgroup of ACDP – but clearly my instruction was to contact ACDP.
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: And it may well be that this is some kind of subgroup of ACDP –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – but the participants are from the public health agencies –
Mr Weatherby KC: Yes.
Professor Sir Van-Tam: – Public Health England, Health Protection Scotland, Public Health Wales and Public Health Agency of Northern Ireland, and therefore quorate, and I –
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: – can’t tell you who they were.
Mr Weatherby KC: But the two dates, the 13th and the 16th, it does seem by the time this review has taken place the decision’s already been taken?
Professor Sir Van-Tam: Ah, look, I can’t –
Mr Weatherby KC: Okay.
Professor Sir Van-Tam: – give you – I just can’t give you any clarity on that.
Mr Weatherby KC: Final –
Professor Sir Van-Tam: If I could, I would.
Mr Weatherby KC: Final point, the upshot of this is that right at the crisis point the classification of Covid is being downplayed and one of the key points, perhaps the key point here, is that healthcare workers, there’s now no requirement for them to have respirators, the requirement is for them to have simple surgical masks.
Why is it that that happens in the eye of the storm, when the cases are going exponentially and healthcare workers are at the highest risk; why is that happening now?
Professor Sir Van-Tam: There wasn’t the clearest understanding at that stage that there was – that fine droplet transmission was dominant, and I can only surmise that the people who wrote the guidance, Public Health England, felt that the predominant route of infections was droplet and, therefore, a surgical face mask was adequate. But I can’t give you a better answer that that.
Mr Weatherby KC: Yes. Well, I mean, you were involved in these discussions. Let me just put this to you: was this decision to reduce the protection for healthcare workers because there simply weren’t enough FFP3 respirators?
Professor Sir Van-Tam: Not by me.
Mr Weatherby: Thank you.
Lady Hallett: Mr Weatherby, I appreciate you have been trying to stick to your time, and I’m very grateful. Did you want to ask the question about why did it take so long for medical masks to be recommended?
Mr Weatherby: I wasn’t going to go there, but thank you.
Lady Hallett: Thank you.
Right, I think it’s now Ms Heaven.
Questions From Ms Heaven
Ms Heaven: Good afternoon, Professor.
Professor Sir Van-Tam: Good afternoon.
Ms Heaven: I represent the Covid-19 Bereaved Families for Justice Cymru and I just have five minutes so I will take it quickly if I may.
Just one topic from myself and that is in relation to the four meetings convened by Mr Gove in his capacity as Chancellor of the Duchy of Lancaster and your perspective on how useful they were to a four nations approach to handling the pandemic. We understand from your witness statement that you attended some of these meetings, so if I can take it in a staged approach please.
Professor Sir Van-Tam: Yeah, okay.
Ms Heaven: We understand they started around May 2020, that’s the evidence we have.
Professor Sir Van-Tam: I’ll have to go with that, I can’t tell you.
Ms Heaven: In terms of the purpose of these meetings you say in your witness statement, this is paragraph 5.12, that they were chaired by Mr Gove and the purpose was to exchange information and to co-ordinate across the devolved administrations.
So it would seem from that explanation that you’re not suggesting to this Inquiry that Mr Gove was using these meetings to gather views from the devolved administrations to inform UK Government decision-making, that was not the purpose; is that correct?
Professor Sir Van-Tam: No, not really, it was a much kind of – it was a softer exchange of views, I think really mainly by the ministers who were on that call, about kind of what was happening, and literally exchange of views and information. And I was there in the room, really, in case there was a technical question.
Ms Heaven: I’ll come in a minute to some specific examples of what may and may not have been said and jog your memory if I may.
Professor Sir Van-Tam: Okay, yes, of course.
Ms Heaven: Just on purpose – before we move on to that – was it also your understanding at the time that another purpose of Mr Gove’s meetings was essentially to insulate the Prime Minister – the then Prime Minister, Mr Johnson – from having to deal with the devolved administrations? Because, as we know, he thought it was optically wrong for him to have to have regular meetings with them. Was that your understanding at the time?
Professor Sir Van-Tam: I’ve no idea, I can’t answer that question at all. I didn’t enter the meetings with that kind of –
Ms Heaven: No.
Professor Sir Van-Tam: – degree of allegiance to –
Ms Heaven: Well, was that ever discussed in your presence?
Professor Sir Van-Tam: – CDL –
Ms Heaven: Was that ever discussed in your presence?
Professor Sir Van-Tam: No.
Ms Heaven: “This is the purpose of the meetings”?
Professor Sir Van-Tam: Absolutely not, no.
Ms Heaven: So on usefulness, you say in your witness statement that you did witness effective communication between core decision-makers and the devolved administrations, and you cite an example of the meetings with Mr Gove, and I think that there probably isn’t any dispute between the First Minister of Wales in particular, Mr Drakeford, and, I think it’s fair to say, Nicola Sturgeon, they both acknowledge to this Inquiry that the meetings were helpful and constructive. However, I do want to just probe your memory on a few criticisms that in particular Mr Drakeford has ventilated to the Inquiry about the effectiveness and indeed the overall usefulness of these meetings, and really it’s to understand whether you heard any of these complaints being raised in this forum.
But can I check first: do you remember now being in meetings with Mr Gove and Mr Drakeford?
Professor Sir Van-Tam: I definitely recall Ms Sturgeon being present, I’m pretty sure Mr Drakeford was present too, at some points, but it’s just a blur to me now.
Ms Heaven: It’s just a blur. But just thinking about how many you attended, I think you say in your statement that largely it was you that attended?
Professor Sir Van-Tam: Yes, it was.
Ms Heaven: Okay.
So, these are some of the concerns or complaints that Mr Drakeford has given to the Inquiry, and I want just to ask you if each one or any of them –
Professor Sir Van-Tam: If any of them chime, yeah.
Ms Heaven: – you heard him saying that, or indeed any member of the DAs saying that.
So the first one is this: there was a lack – the meetings were ad hoc and there was a lack of formal structure to when they happened; did you hear that complaint?
Professor Sir Van-Tam: No, and part – somewhere in my dim and distant memory I recall these were Wednesdays, at either 5 pm or 6 pm. They weren’t at a terribly sociable time, you know, in terms of family life. And I do – somewhere I think I’m recalling that they were Wednesdays.
Ms Heaven: Next one, please, that there was a concern, and it might be fair to say that this was held quite strongly by Mr Drakeford, that these meetings, whilst helpful, were no substitute for high level ministerial meetings; did you hear that complaint?
Professor Sir Van-Tam: Nothing heard.
Ms Heaven: And this is a very important one, because it might be suggested that this goes to the issue of whether or not there was a coherent four nations approach, and this is that the clarity of messaging was a challenge for all four nations and that more unanimity would be helpful, and that could only happen if the UK Government gave more notice of its decisions and announcements to the devolved governments.
Now that features regularly in written communications certainly between the DAs and Mr Gove. Did you hear that complaint?
Professor Sir Van-Tam: I did not hear that.
As a slightly broader sentiment, I think I heard that there was some frustration about the timing of communication. Equally, I do recall on a couple of occasions that Scotland went first on a couple of points.
Ms Heaven: But certainly I think what you’re suggesting is some of the concern was coming from the devolved administrations that the UK Government was perhaps making decisions and briefing the press without telling them first?
Professor Sir Van-Tam: It doesn’t sound like a totally strange concept, but I don’t recall it from those meetings, I really don’t.
Ms Heaven: So, finally then, did you hear any complaint from any member of the devolved administrations, including Wales, at these meetings about communications?
Professor Sir Van-Tam: I was there in a technical capacity and the answer is I can’t recall but I don’t think so.
Ms Heaven: Okay, thank you very much.
Those are my questions.
Lady Hallett: Thank you, Ms Heaven.
Mr Jacobs, last again.
Mr Jacobs: I don’t mind, my Lady.
Lady Hallett: Don’t worry, Professor, Mr Jacobs is used to having people turn their back on him, he doesn’t take offence, but you have to keep your voice to the microphone, that’s why, I’m afraid. He’s used to it, we’re not being rude to him.
Questions From Mr Jacobs
Mr Jacobs: Professor, I can be, I think, very short, as it happens. My questions are on the same topic as the questions I directed to your colleague Professor Whitty this morning, namely financial for support self-isolation.
Professor Sir Van-Tam: Yeah.
Mr Jacobs: Could I actually just start with this: do you agree with Professor Whitty’s evidence of earlier today as to the importance of financial support for self-isolation?
Professor Sir Van-Tam: I think it was, you know, very easy, or relatively easy, for people in well paid jobs with very good employers who would allow them to self-isolate and who could continue to do their work in a kind of isolated way in the home. But I think it was enormously difficult for people who were not fortunate enough in our society to have those kind of jobs, who had jobs where it was kind of essential, to earn money, to actually be out of the house, and I think this was an essential part of the package.
Mr Jacobs: Professor, my Lady, if you don’t mind me going a very tiny bit off script, I will be very short.
Professor Whitty referred to heated debate within government on the issue. Is that something that you were party or was that really his preserve given his particular involvement in meetings in Downing Street and so on?
Professor Sir Van-Tam: The package of support handed down to people who had to self-isolate who were, for example, self-employed was just kind of way above my pay grade.
Mr Jacobs: Fine.
Can I just ask this then: was this issue on the importance of financial support something that was foreseeable prior to the onset of the pandemic, and I have in mind your own sort of research and expertise –
Professor Sir Van-Tam: So –
Mr Jacobs: – yes, prior?
Professor Sir Van-Tam: I think in influenza pandemic planning, and if you go back to influenza pandemic exercises undertaken by the government, the concept of school closures was pretty well rehearsed – to the extent that anything is ever rehearsed through, you know, a short exercise – but I think the kind of, you know, society-wide kind of lockdown and social distancing measures, particularly ones that were then, you know, applied multiple times during the pandemic in total to kind of put the brakes on each time, I think that was just, you know, way out of – way beyond anything that had ever been planned and therefore – and most of those exercises were about kind of technical issues related to antivirals, vaccines, health service responses. I’m not aware of any response on, you know, any rehearsal or concept of economic support being aired widely before this.
Mr Jacobs: Yes, that’s helpful to understand. I had in mind something slightly narrower.
Professor Sir Van-Tam: Oh, I’m sorry.
Mr Jacobs: You refer in your statement to a 2017 article that you, I think, co-authored about influenza, I think in that specific context in care homes.
Professor Sir Van-Tam: Yes.
Mr Jacobs: And you referred in that article, didn’t you, to care home workers being a group that, given their low pay –
Professor Sir Van-Tam: Yes.
Mr Jacobs: – and insecure work –
Professor Sir Van-Tam: Yes.
Mr Jacobs: – were at high risk of working while sick?
Professor Sir Van-Tam: Yes.
Mr Jacobs: So, in that sense, is it right that the link between insecure work, prevalence of working while sick was something that was understood really from the outset of the pandemic?
Professor Sir Van-Tam: I think it was quite narrowly understood in the context of care home workers and in the context of that being a very historically low pay sector, and in particular – there’s a point there you didn’t mention about the care home worker who works in two or three different care homes because they can get a shift here, a shift there, and together by going to three different homes in a week that makes up the family income; and of course, you know, that’s, you know, kind of epidemiologically not a good idea when there’s a respiratory virus circulating widely across the community.
Mr Jacobs: Thank you, Professor, and I think that may be an issue taken up with other witnesses as well.
Thank you, my Lady.
Lady Hallett: Thank you, Mr Jacobs.
Mr Keith: My Lady, may I detain you just for one moment, which is that: although he’s not made a Rule 10 application, Mr Friedman King’s Counsel has asked very nicely whether or not, based upon something that Professor Sir Jonathan Van-Tam has said in his statement, we would refer back to that article and just elicit a single point which may mean we needn’t put it to Professor Jenny Harries next week.
Further Questions From Lead Counsel to the Inquiry
Mr Keith: Professor, in that 2017 article, did you and your co-authors warn in fact of the potentially devastating consequences of explosive outbreaks in care homes in the context of runaway viral infection?
Professor Sir Van-Tam: I guess we did in, as much that we looked at the literature and we understood the mortality rate. It is possible, when an infectious virus gets into a very vulnerable population who live at essentially quite close quarters to each other – the literature was all about influenza rather than SARS-CoV-2, so there are differences there, but that these were vulnerable populations, extremely vulnerable populations, I think has been known for a very long while and I personally have dealt over the years – and I can’t quite give you the details – as a registrar in public health, with a number of really difficult to control explosive outbreaks of influenza in care home settings, nursing or care home settings.
Mr Keith: Thank you.
Lady Hallett: That concludes the evidence for today.
Thank you very much indeed, Professor Van-Tam.
I don’t know if you heard what I said to Sir Chris Whitty in Module 1, but in relation to the abuse and threats that you described earlier, I’ve come across that kind of extraordinarily awful behaviour in another context and I know the impact it can have upon the recipients, the victims, and the victims’ families, even if they don’t receive threats, which by the sounds of it yours may have done. It’s just too awful to contemplate.
I just want you to be reminded – you probably don’t need reminding, but just in case you do – the vast majority of the population abhor such conduct, and we are enormously grateful to you and your colleagues for the way in which you served the public of this country, of the whole of the United Kingdom, in a time of national emergency. So please ignore the violent, criminal, idiot element and remember the rest of us are grateful.
Thank you.
(The witness withdrew)
Lady Hallett: Sorry, I’m losing my voice.
Mr Keith: My Lady, thank you.
Lady Hallett: 9.30 tomorrow.
(4.27 pm)
(The hearing adjourned until 9.30 am on Thursday, 23 November 2023)