2. Professor Dame Harries

PROFESSOR DAME JENNY HARRIES (affirmed).

Lady Hallett: I’m sorry (a) you have been kept waiting and that we’re not going to finish you today. I know you have some other important work you ought to be getting on with. We’ll get through as quickly as we can, but I’m afraid it’s not going to be finished today. I’m really sorry.

Questions From Counsel to the Inquiry

Mr O’Connor: Could you give the Inquiry your full name, please.

Professor Dame Harries: Jennifer Margaret Harries.

Counsel Inquiry: You are Professor Dame Jenny Harries, as with Professor Whitty and Professor Van-Tam, I am going to refer to you as Professor Harries simply for brevity.

Professor Harries, you have given evidence to the Inquiry before, you attended and gave oral evidence in June of this year to Module 1, and at that stage two of your witness statements were adduced.

You have kindly prepared two further witness statements which we will adduce now. First of all, your third statement, dated 22 August 2023. Professor Harries, this was a statement that was prepared in response to a letter sent – a Rule 9 request sent to the UKHSA, was it not?

Professor Dame Harries: Yes.

Counsel Inquiry: We’ll come to hear about your role as chief executive of that organisation but we need to make the point, don’t we, that this is a so-called corporate statement.

Professor Dame Harries: Yes.

Counsel Inquiry: So it was prepared by you and others on behalf of the UKHSA.

Professor Dame Harries: Yes.

Counsel Inquiry: Nonetheless it bears your name and we don’t need to go there but at the end of the statement you have signed it saying its contents are true; is that correct?

Professor Dame Harries: Yes.

Counsel Inquiry: Then, secondly, there is a final statement, again in your name, your fourth statement. This statement was prepared in response to a request made to your personally, was it not?

Professor Dame Harries: Yes.

Counsel Inquiry: And as we can see it’s dated 3 October of this year. Again, it’s signed by you with a statement indicating that you believe its contents to be true?

Professor Dame Harries: That’s correct.

Counsel Inquiry: Thank you.

When you gave evidence earlier this year, Professor Harries, you gave a relatively full description of your career, so I won’t go back over the whole length of what has been a distinguished career but in summary it’s right, isn’t it, that you trained initially as a medical doctor. You then had further training and you also held a series of posts in the field of public health medicine?

Professor Dame Harries: Yes.

Counsel Inquiry: Between 2013 and 2019 you were the regional director for the south of England at PHE?

Professor Dame Harries: Yes.

Counsel Inquiry: And at the end of that period you, I think, had an additional role at PHE, that of deputy medical director?

Professor Dame Harries: Yes.

Counsel Inquiry: So your employment at Public Health England ended in 2019, and that was the moment where you were appointed one of the Deputy Chief Medical Officers for England, and you held that role through until 2021 and, therefore, for the first period at least of the pandemic?

Professor Dame Harries: Yes, that’s correct.

Counsel Inquiry: As one of the DCMOs, the other of course being Professor Van-Tam, whom the Inquiry has already heard from, we heard a little from him about the split responsibility between the two posts, and tell me if I’ve got it right, that at least at the time, in early 2020, that we will pick up the story, he was responsible for health protection whereas you were responsible for what has various been described as health improvement or health promotion?

Professor Dame Harries: Yes, that’s a fair description. We would obviously support each other but that was my part of the portfolio, and therefore anything to do with the health protection primarily would go to Professor Van-Tam.

Counsel Inquiry: Again, in headline terms, health protection does include thinking about infectious viruses?

Professor Dame Harries: Yes.

Counsel Inquiry: Whereas health improvement – well, you tell us, what did that –

Professor Dame Harries: But it’s much more to do with supporting things like physical activity, good nutrition, those sorts of things. But also supporting areas of health service, the evidence base for interventions.

Counsel Inquiry: We’ll obviously come to hear evidence from you about what you did, activities that you undertook, the advice you gave during the pandemic. Is it right that that fairly stark distinction between Professor Van-Tam’s responsibilities and yours collapsed to some extent once the pandemic was underway?

Professor Dame Harries: Completely. And I would suggest probably from the end of January, actually. I came back from a very short bereavement period and was immediately into pandemic response and never really surfaced from it until I changed roles.

Counsel Inquiry: You mentioned changing roles, and it was in 2021 that you ceased being Deputy Chief Medical Officer. There’s a little complexity around the detail of you changing your role, but again tell me if I’ve got this right. You were appointed as chief executive of what was a new body –

Professor Dame Harries: Yes.

Counsel Inquiry: – the UKHSA, on 1 April 2021?

Professor Dame Harries: That’s correct.

Counsel Inquiry: But that body wasn’t yet fully operational?

Professor Dame Harries: There was just me and the chair. So that was it.

Counsel Inquiry: So a long way from being fully operational?

Professor Dame Harries: Exactly.

Counsel Inquiry: It became fully operational on 1 October 2021 and at that date it took over, first of all, certain of the responsibilities of Public Health England?

Professor Dame Harries: Yes, mostly the health protection areas.

Counsel Inquiry: Yes. And my note suggests also that some clinical and scientific areas, if that’s a sensible distinction to draw?

Professor Dame Harries: Yes.

Counsel Inquiry: Separately also, in fact, on that date, the UKHSA took over what was NHS Test and Trace.

Professor Dame Harries: Yes.

Counsel Inquiry: You had, in fact, been made head of that body earlier in the year, in May, so there was a period of time where you were, as you say, the sort of titular head of the UKHSA, without operational responsibility, and also head of NHS Test and Trace.

But it all came together in October when both of those sort of separate elements became operational within the new UKHSA?

Professor Dame Harries: Yes. And that’s important because actually I had no formal control, for example, over parts – although we worked well together and we had formal risk handover, I was not the person responsible for Public Health England, so you may find in my evidence I’m saying I was doing this or I was doing that.

Counsel Inquiry: You were never responsible for Public Health England?

Professor Dame Harries: Until 1 October. I mean, clearly worked with public health colleagues and other people in Public Health England, but I didn’t have any formal responsibility until 1 October.

Counsel Inquiry: Correct. Well, it is complex, Professor, and as we go, of course, if there’s a misunderstanding or we ask you about something at a time that you weren’t responsible for it, you’ll tell us.

Just before we leave UKHSA, it follows from what we’ve been discussing that it’s now been in existence for two years or so?

Professor Dame Harries: Yes.

Counsel Inquiry: In giving evidence to Module 1 I think you either said or at least you agreed with this description of UKHSA: A pandemic preparedness and response super-body which has a permanent standing capacity to prepare for, prevent and respond to infectious diseases and other threats to health.

Professor Dame Harries: That’s true. It has many other roles as well and the scientific one is particularly important, relevant for pandemic preparedness but actually relevant for response to all threats.

Counsel Inquiry: So I know this is one of the issues on your mind at the moment but we have heard other witnesses talk about the certainty that there will be another pandemic sooner or later and the intention is that the UKHSA will be at the forefront of the nation’s response when that happens.

Professor Dame Harries: Yes, and I think it is important that the work that we do on a daily basis – so there will be more than 10,000 public health incidents, so that may be infectious disease, it could be radiation, nuclear extreme events, when those happen – we are dealing with them all the time but we need to be able to surge up. So I wouldn’t like to think we are just a body for pandemic preparedness or we might have a very expensive resource tag with us, I think, doing nothing for quite a while. So it’s a combination of the two: being ready and managing the science at the same time.

Counsel Inquiry: Can you give us, Professor, just some idea of the scale of UKHSA, how many, roughly-speaking, employees does it have?

Professor Dame Harries: So, as you can imagine, over this period we’ve actually had the biggest single reduction in a Civil Service organisation in a single year. So we went from 15 billion down to 3 billion in one year and we’ve reduced again since then. We had 18,000 staff at the start, only 30 per cent of whom were permanently employed and we are now building to a stabilised organisation where we around 5,500 staff, and they will be – just this is very rough figures, around 2,000 of those will be in our labs. They are performing front line services and reference laboratory work and then we have health protection teams around the country as well, and scientists and public health professionals.

Counsel Inquiry: Thank you. I’m sure it is clear but the first statistic you gave, 15 billion –

Professor Dame Harries: Pounds.

Counsel Inquiry: – was not the number of staff?

Professor Dame Harries: Not the number of staff, no.

Counsel Inquiry: Thank you.

Lady Hallett: Annual budget, I assumed you meant by that?

Professor Dame Harries: At the time. It’s now considerably lower.

Lady Hallett: Yes, so it started at 15 billion –

Professor Dame Harries: Yes, our budget is now 395 million, that’s obviously in the public domain.

Mr O’Connor: Perhaps it’s obvious but the explanation for that being that, when you started it, we were still in the middle of the pandemic, all the costs associated, one imagines, with NHS Test and Trace and no doubt other emergency measures which have now been withdrawn.

Professor Dame Harries: Yes.

Counsel Inquiry: Professor, I would like to go again, almost by way of introduction, if I may, to an interview that you gave recently to The Telegraph, I think it was.

Could we go, please, to INQ000280194, and within that document go to, I think it’s page 3, please.

Part of this interview, Professor, you gave an indication of your reflections on the NPIs that were introduced during the Covid pandemic and how you saw their role in a possible future pandemic and so I’d like to pick it up, just the last full paragraph on that page. You said this:

“What we saw with Omicron and later waves of the pandemic, and even now, is that people are good at watching the data and they will take action themselves … you can see it in footfall going down. People actually start to manage their own socialisation, and the viral waves flatten off and come down.”

Then the interviewer intervenes, as it were, with a comparison with Sweden and, indeed, if we go over the page, with South Korea, but he accepts that this is a comparison that you did not make, so perhaps we can put that to one side.

But then he records you as saying that the key is to be transparent about the risks and build trusts with the public, and you said:

“The more people trust the organisation to give them early, accurate, honest and straightforward information, then, yes, the likelihood of us moving to extreme forms of transmission management reduce all the time, whether it be for coronavirus or anything else …”

Now, there are a few questions I want to ask you about that. First of all, is that a comment that you are making, purely with the benefit of hindsight or do we read into your suggestion that we may not need the same degree of prescription in future pandemics a criticism of what happened during the previous pandemic?

Professor Dame Harries: So those particular comments were based particularly around data and what we’ve seen previously and what actually UKHSA is trying to build now are data streams, so dash boards as we had during the pandemic, where people can see what’s happening, they can make their own choices and what they – you know, the public were brilliant through the pandemic and they complied often with mandated requirements. But, actually, what we saw with Omicron was there was no mandation at that time, and if you spoke and highlighted some of the evidence, and they could see it and trusted that data, then they took actions themselves.

I mean, as you say, the title for this is a problem which I sometimes have, which is I didn’t say what the title says and the implication is that I did, which is an important point, perhaps, for further conversations but I don’t think the Swedish comparison is necessarily a helpful one. I think when you actually get underneath this and you look to see many countries did very similar things, some of them mandated at some time, some didn’t. Populations are different, dense populations or travel hubs, all sorts of things.

So I think looking is really important but what we have seen in the UK, in our own culture and without mandation, is that people – if people have the information, then they will start to make choices themselves.

Counsel Inquiry: As you say, we can to leave Sweden and South Korea out of it but, nonetheless, as I think you have explained, the point you are making can be boiled down to: next time, if we can get the data right, we won’t need to impose the same degree or the same severity of mandatory NPIs; is that fair?

Professor Dame Harries: I think you will perhaps take – this was full coronavirus on this pandemic with the current population at this time. So we have what we didn’t have at the start of this pandemic was something relevant to our current culture in the last 100 years. So I think we have much more information now and we can use that as evidence. But, if we had a completely different sort of virus, something like Ebola, say, which is a touch transmission, these may not apply. We perhaps still wouldn’t have the information.

But the basic point there is, which I think for me it’s important to be transparent with the information and to share it, and that can sometimes be difficult and we may come onto some of that later.

Counsel Inquiry: Of course it’s right that the next pandemic won’t be identical. It may be very different but, nonetheless, the Inquiry has to do its best to learn lessons from the experience of the Covid pandemic and some of the evidence it’s heard, for example, from Sir Patrick Vallance, he was very clear about the lesson he drew from the experience of the Covid pandemic. His phrase was something to the effect of “Go harder than you like, go earlier than you like, go wider than you like”. That doesn’t seem to be the same as your suggestion here, which is that perhaps we don’t need to go as hard even as we went last time?

Professor Dame Harries: I don’t think they are necessarily different things. I mean, if a trusted individual with data, which the public have access to and can trust, and in a good evidence base, stand up and say, “Actually, this is what we see coming ahead, if we all do A, B, or C”, not necessarily mandated, then we may well be able to all move this curve or whatever we’re looking at this problem out of the way. So I think the “go early”, one of the interesting things is we didn’t have this data at the start of the pandemic and I think that is a really critical point, which I know many witnesses have made. We hadn’t got the granularity of the data for it to be able to reflect potentially with ministers but also with the public.

Counsel Inquiry: I won’t press you any further on that Professor Harries but we will leave it though just to look again at your words, because you do emphasise not just providing data; something a bit more than that, isn’t it? It’s establishing, in your words, a relationship based on accuracy, honesty and straightforwardness about the data with the public?

Professor Dame Harries: Yes.

Counsel Inquiry: Let me move to ask you, as you have inferred, a few questions about some of the public statements you made during the pandemic and, before we get to detail, most of the incidents I’m going to ask you about were things you said during press conferences, or the like, or interviews you gave with the media.

Was that a process you were familiar with in early 2020 or was it quite new to you?

Professor Dame Harries: Definitely not to the extent I became familiar. So every – if you are dealing with public health incidents one would normally be equipped to give a short press comment in relation to whatever incident you are handling to do a media clip, something like that. But I think this process was something that clearly I had not experienced before and I think most people don’t. You go into your job, you don’t expect to be standing at Number 10 next to the Prime Minister or the Chancellor in the middle of a global pandemic.

Counsel Inquiry: When you gave these interviews or spoke at these press conferences, you were doing so in your capacity as DCMO. In doing that, did you regard it as your role, for example, to defend government policy?

Professor Dame Harries: No. So my approach is – and this is quite difficult in terms of practical matters, when you’re doing these, because, as I think you have seen from other evidence, the speed at which policy might change or the availability of information to everybody across the system will vary. So I will not have been in the same meeting that Sir Christopher would have been or other colleagues making strategic decisions, and yet it may well be me that’s standing on the podium.

I think the other important thing is that – and I think many public don’t realise this – when you are there, the way the press conferences were handled, there would be two – I think from memory – two video questions and then questions from the press. None of those would you have any content of before you stood up. So you could be asked anything and I think, going back to your original question, no, I wasn’t. I was there as an adviser but I was also there, I felt, as somebody to try and support public understanding. If you are public health doctor, your patients are the population and so it’s an opportunity to give critical public health messages.

Counsel Inquiry: You said you were there as an adviser. Does that mean you did have some, as it were, some duty to keep in line with the government policy or were you entirely independent and you could say exactly what you thought?

Professor Dame Harries: So I’m an independent adviser, as I think you’ve heard described from CMO and others, but I’m, nevertheless, also a senior civil servant and I – you have to keep those boundaries quite clear. But I think the point about the press conferences is often we will have given public health advice to decisions. The public health advice may or may not have been taken. Ministers, quite rightly, will make a policy choice and then they will announce that policy.

Now, it could be, therefore, that a minister is making a policy which contains all of the public health advice that we had given, or I had given, and that’s probably relatively easy or a minister could give a policy decision, which I may or may not have had much awareness of before I was on the podium, and there will be public health elements within that. And I always tried, in those, to pull out, if you like, the key public health elements that were the right messages to give to the public and the ones they would expect a public health adviser to provide.

Counsel Inquiry: When you refer to the right messages to give to the public, was there ever a sense in which you were trying, as it were, to protect the public, not to tell them all the bad news, to put a positive spin, if you like, on events?

Professor Dame Harries: I don’t think it’s a matter of protection but I think this was a very, very frightening time for many members of the public and, I mean, Jonathan Van-Tam and I took slightly different roles. He had many football analogies, I didn’t. I chose to never use my professorial title right from the start because I felt that, for some members of the public, Dr Jenny would possibly be more familiar, if you like, for people going through a frightening incident.

So sometimes when you are speaking that way, and I can see it in some of the transcripts, you will have to reduce what you’re trying to say to something which perhaps is simpler, less scientifically detailed but, nevertheless, gets a key public health message across.

Counsel Inquiry: One can imagine doctors sometimes holding back on a little bit of the bad news to try and keep their patients’ morale up. Is that sometimes the spirit in which you approached this?

Professor Dame Harries: Not if it was – not if it was necessary. I mean, actually, that probably runs counter to how current doctors should act. There is a duty of candour to your patients but there is a definitely a way of framing it and having a very frightened population at the start of a global pandemic is not helpful. But I think there are many instances you will see, both outside the public briefings and within them, where I have possibly been quite outspoken and then probably had that recognised in the media the day afterwards.

Counsel Inquiry: Let’s look, Professor, at two references, first of all. First of all, can we go to your statement, please – and when I say “your statement”, unless I say otherwise, it will be your fourth statement, your personal statement – paragraph 7.65, starting at page 57.

This relates to not actually a press conference on this occasion but an interview you gave to NBC News on 11 March. The Inquiry has heard a lot of evidence about this period. We are, are we not, in the sort of run-up to the first lockdown, Wednesday, 11 March. If we go over the page, we see an extract from the interview where you said this:

“Timing of an intervention is absolutely critical. If you put it in too early you have a time period where people actually get non-compliant, they won’t want to keep it going for a long time. If you put it in too early it’s going to cause people to disrupt their lives without a long-term effect; if you put it in too late then clearly it doesn’t cut off that top piece of the peak.”

You then go on to refer to an email, which we will look at. In fact, I want to ask you to look at a different bit of that email. So we’ll bear that quote in mind, please, and go to the email, which is INQ000151565. It’s dated the day before that interview we just looked at and if we can go down a little bit further down, please, yes, that large paragraph and the bit we need is four or five lines down.

It’s the passage saying:

“Equally, if you start it [and ‘it’ is a lockdown or NPI] too early, for interventions which need to be quite lengthy not the short-termism being applied in Italy, you will lose goodwill/compliance and they become ineffective because people ignore.”

So, Professor Harries, in those one can see the similarity between what you wrote in that internal email and the interview you gave the next day. But in both, what you were expressing was the idea of the behavioural fatigue, as an argument for delaying the imposition of NPIs, which is something that was being said publicly by Sir Chris Whitty at press conferences around that time; do you agree with that?

Professor Dame Harries: Although I don’t say “behavioural fatigue”, so I would perhaps draw a distinction because I realise one of the interesting things about the Inquiry is that it forces or opens up all sorts of correspondence that I have never seen through the pandemic and the whole debate about behavioural fatigue was completely not known to me until I started looking.

Now, I have looked back, actually, and I think what this comes from – I realise there’s an argument between the behavioural scientists and the others and I recognise that Sir Chris thought that was not a helpful framing to have used but, nevertheless, in SAGE, I think what we are saying here is, and I think it might be SAGE 13, but there’s a section where it broadly says there is a logic, we know people get tired of quarantine, for example, a low robustness for evidence there but – and there is logic to the fact that, if you are holding on to something over a long period of time, people may stop doing it.

That’s not quite the same as fatigue and that point comes out in the next point that SAGE makes and I think this is what I was trying to say here.

One final point, I think, on all of this, which is not included in these sections, is the safety point about when you go into lockdown, which was really important for me. So that might be another point to flag.

Counsel Inquiry: Professor, we can explore this in detail, if necessary, but I just want to press you. It’s, of course, right that you don’t use the words “behavioural fatigue” but then I’m not sure Professor Whitty did in his press conferences. Certainly, if he did, he also used words very similar to the ones that you are describing, everyday words. The basic concept in language that you use in this email, similar to the language you used in the NBC interview the next day, if you start too early you lose good will and compliance, the NPIs become ineffective because people ignore them. Without using the words “behavioural fatigue”, that is exactly the same principle, is it not?

Professor Dame Harries: So my principle was I would use – because actually I wasn’t very often in SAGE, which was one of the problems; I was doing other meetings and I think Sir Jonathan flagged the same issue – I would use the advice that came from there and I think it was SAGE 13, on the day before this, and there are a couple of bullets in that one which describe both the fact that this is not behavioural fatigue but that there is, if you like, a plausible logic to the fact that people will – are unlikely to necessarily maintain the evidence point that they give was around quarantine.

Counsel Inquiry: A day or two after this, Professor, SAGE did address this issue head on, in light of Professor Whitty’s comments. If we can go to INQ000236391, so we see at the top this was SAGE 15 on 13 March, so on the Friday at the end of that week, after your interview, after Professor Whitty had made his comments during the same period of time. If we go to the third page of that document, Professor Whitty referred to this document when he was giving evidence last week, picking it up at paragraph 28:

“There is some evidence that people find quarantining harder to comply with the longer it goes on. The evidence is not strong but the effect is intuitive.”

Is that the point you were referring to that had been picked up, I think, in a paper at an earlier SAGE meeting? It wasn’t in the consensus –

Professor Dame Harries: I think it’s in the bullets, actually, from either the one before or the one before that.

Counsel Inquiry: We don’t perhaps need to go there but it wasn’t in the consensus statement it was in a paper that was considered at that earlier meeting?

Professor Dame Harries: Yes.

Counsel Inquiry: But they go on to say, this is the later SAGE meeting:

“There is no comparable evidence for social distancing measures that experience suggests it’s harder to comply with a challenging behaviour over a long period than over a short period.”

But then this:

“This no strong evidence for public compliance rates changing during a major emergency. There is, however, a link between public anxiety and protective behavioural change.”

So what they are saying there is just because it’s difficult to comply with NPIs doesn’t mean to say that there will be a fall off in compliance; is that fair?

Professor Dame Harries: I think that’s fair enough and nobody’s experienced this – this wasn’t an intervention that had been applied for 100 years, I think.

Counsel Inquiry: That’s contrary to the point you were making in your interview and in that email, was it not?

Professor Dame Harries: I would say quarantining and self-isolation are both – they have a different technical meaning but the impact is that you have to stay inside, in this case for about 14 days. So I think there is some fall over. I realise that’s not where other people have landed but I didn’t use the word “behavioural fatigue” and actually there is quite a lot of work ongoing now into that because, of course, we’ve come through the pandemic and people are looking at it.

Counsel Inquiry: The next paragraph, lastly:

“Difficulty maintaining behaviours should not be treated as a reason for not communicating with the public about the efficacy of the behaviours and should not be taken as a reason to delay implementation where that is indicated epidemiologically.”

Now, you had advanced it, both in the interview and in the email, as a reason to delay introducing measures, had you not?

Professor Dame Harries: So I don’t agree that – I actually agree with this completely. That was no reason not to move into lockdown.

Counsel Inquiry: So you had been mistaken in your email and your interview?

Professor Dame Harries: I’m afraid I see it a different way because I think the evidence around quarantining, there’s very little – if you ask somebody to quarantine or self-isolate, in fact many people use the words interchangeably, but I was not using that – what I was saying was you have to get the timing right to do it. It wasn’t a mechanism for not going into lockdown.

Counsel Inquiry: Getting the timing right is another way of saying do you go at this point or that point, do you delay or do you accelerate?

Professor Dame Harries: This was not the only factor in that and, in fact, I would say that the main factor, partly because of the work I was doing at the time, of getting the timing right, was around protection for people who were going into lockdown, which I think was a major concern.

Counsel Inquiry: Professor, when Professor Whitty gave evidence last week, he readily accepted that what he had said in public was really unhelpful and he said it was really irrelevant and this idea of behavioural fatigue was really irrelevant to discussions about the timing of a lockdown and it had been unhelpful of him to link it to a lockdown.

Why aren’t you making the same concessions?

Professor Dame Harries: So it may be that actually I’m not seeing the information I’ve given and maybe I need to go and look again and reflect. So the intention is not to use that as a mechanism for not going into lockdown; it is about recognising how people may be feeling about it.

Counsel Inquiry: I am sorry, you will have to explain that.

Professor Dame Harries: So if you are going into a lockdown at a particular time, people will have different emotions about that. There are safety issues, which I think, obviously, are some of the main concerns that I had, but the knowledge of going into lockdown is not – I think we’re talking here about people should have a good communication and various other things. So I don’t think we’re saying – or rather I’m saying it says here should not be treated for not communicating with the public about the efficacy of behaviours. So you do need to communicate before you do that.

Counsel Inquiry: You do need to communicate and, in your interview with the Telegraph you emphasised the importance of accurate, honest, straightforward communication, but isn’t the straightforward way of looking at your interviews at the time and this SAGE minute, that SAGE were telling you that you had got it wrong and that’s what Professor Whitty seemed to accept but you don’t seem to accept?

Professor Dame Harries: I’m not trying to argue with it particularly, I’m potentially seeing it a different way. It perhaps wasn’t what was intended when I said it, so perhaps if I have miscommunicated it then there is an opportunity for me to learn from that.

Counsel Inquiry: Let me go on and ask you about a slightly different matter but it does, in fact, involve us going back to that email that we looked at. In fact, before we do that, the point I want to come to is about comparisons that were made at around this time in March, between, on the one hand the UK and its state of preparedness, and, on the other hand, things that were going on in Italy. We’ll come and look at that email but, before we do, there were two sort of strands of evidence that the Inquiry has heard about reactions to events in Italy.

First of all, we’ve looked at a page in the book that was written by Jeremy Farrar called Spike and it’s up on screen. If we look at page 100 of that book he says, his take on the scenes from Italy, he says:

“The dire situation in northern Italy focused minds in the next SAGE meeting on Tuesday, 10 March.”

So I think that was the day of the email that we looked at. He said he relayed:

“… chilling status reports from his contacts there. It was battlefield medicine deciding who to save and who to leave to die. Doctors being traumatised.”

Then he makes this point:

“This wasn’t China or Korea or any other country 5,000 miles away. This was a sophisticated rich country on our doorstep and the Health Service was collapsing.”

So he seems to be making the point that Italy was comparable to the UK and yet they were having these terrible problems.

I said two strands because we’ve also heard evidence from Helen McNamara that her memory of meetings in Downing Street at this time was one of a feeling that the Italians were overreacting and, to use your words, “a breezy confidence that we would do better than others”.

If we look back at your email of 10 March, Professor, so this is INQ000151565, reading on from the passage we looked at before, so again that large paragraph starting six or seven lines down, you said this:

“Of course, if you have not got good command and control symptoms in your country in relation to health services, eg Italy, or ten-year background of planning for flu, you are probably starting from a rubbish position, but in the UK neither of the above apply.”

So are you the expressing your own view, as those scenes unfolded in Italy, that, really, there was no comparison between the UK system and Italy, and that Italy’s health system was rubbish?

Professor Dame Harries: Sorry, I don’t think I was declining the position the health system quite to that extent but the issue is not the health system fully but the command and control system. So one of the things which the UK has, albeit we clearly can see it needs improving, is a direct line of sight from central government, right out through health protection systems, right out to each local authority, and I think, from what I remember, that was one of the issues that was being highlighted about the Italian system, that it didn’t have the opportunity, if you like, for overflow into other parts. It was quite compartmentalised.

I would have to check on that but I think that was it. So my sense at the time was, about this time which was 10 March, the whole data thing started to change. I think I wasn’t in SAGE that day and, as you say, the pitches which started to come from Italy looked fairly unbelievable and people started to talk about – particularly, I think, with care services and as questioning why that was, and my understanding was, at the time, from the conversations, that part of it was that, if you like, the mutual support. So rather than have a single national system, which you could move people around and manage the peak, that this was not possible under the Italian system.

Counsel Inquiry: Do you think that what we might see here, your email on 10 March, might indicate that you were guilty of at least a degree of overconfidence at that stage?

Professor Dame Harries: I think looking at this now – I mean, clearly, we all learn with hindsight. I think probably I had read too much into the differentials of the health system and accounted for some of the problems at least that they were having, from the way of the system was organised rather than the fact, actually, that the virus was going to be so problematic, and I think that’s what I understood Jeremy Farrar was describing in his book as well.

Counsel Inquiry: As it turned out, neither the UK’s command and control systems nor our planning for flu served very well, did they?

Professor Dame Harries: No, along with many other countries.

Counsel Inquiry: Let’s go to a different document, please. This is INQ000274060. This an extract from a press conference you gave a week or so later on 20 March and it relates to the PPE and a question from Francis Elliott of The Times:

“Can you update us with how we are doing with protective personal equipment? There is obviously something that is deeply concerning.”

The answer you gave:

“The country has a perfectly adequate supply of PPE at the moment. That encompasses quite a wide range of different gowns, masks, gloves, all sorts of things. There have been, I think, some differential deliveries, if you like, in some areas, which has caused a degree of concern recently. That is completely resolved now”, and then you go on.

It wasn’t right, was it, that the problems with PPE had been completely resolved as of 20 March?

Professor Dame Harries: So the first statement that – sorry, this is one of these areas where I need to clarify what my responsibility was. I had no direct responsibility for PPE at all and when I go into these conferences I had to rely on information that was provided to me. So on this one, my understanding was – and I think that is actually still correct – that we did have a national supply of gowns, masks, gloves and other things. The difficulty was I had been told that a new supply system for getting them around the country, so there wasn’t differential distribution, was resolved and that turned out to be not the case.

In fact, I apologised as soon as I could when I was next on the stand, which I think was probably not until about ten days later, which is a relatively unusual thing to do from a political stand but it was something I felt I needed to do.

Counsel Inquiry: We’ve heard, Professor, detailed evidence that the problems with PPE not only were still going on at that time but, in fact, in different ways and different types went on for months into the pandemic. For example, we’ve seen an email exchange involving Helen McNamara at around this time, raising concerns about PPE for women and that not having been taken up but then being pursued in Number 10.

We saw yesterday the letter from Sadiq Khan to Dominic Raab and Matt Hancock, raising issues about supply chains and PPE on 13 April, so nearly a month after this.

Right at the start of our hearings, we saw a letter from BAPIO, which described a survey they had done of their members with a very high rate of dissatisfaction with PPE, people being disciplined for complaining about PPE, and so on.

So it simply wasn’t the case that there was no problem with PPE –

Professor Dame Harries: There was no national shortage of PPE. That is factual and I think is there. There was a distribution issue around PPE but I think the important point for me here is this is an operational issue, which was not my responsibility at all, as were many areas, which I would be asked about.

So when I go onto that stand, I have to rely on the piece of information which somebody has given me and that was why, actually, when I went on to the stand I think it was 31 March, and probably, I think contrary to advice, apologised directly to the public and said I’d made an error. That was my understanding at the time.

Because it was entirely – it’s important that, if a piece of information is wrong, that you correct that piece of information and that was the information I had been given. I have no operational responsibility for this at all.

Counsel Inquiry: Let’s move on, Professor, and look back your statement, please, paragraph 1.54, page 54. So we move forward now. I think it was 20 March, wasn’t it, and so we’re now in April, almost a month later. This was an observation you made at another press conference and we can see it in quotes there, where you said:

“The UK, regardless of the position we may be in now or commentary, has been an international exemplar in preparedness, so the fact there is a pandemic influenza stockpile is considered a very high quality mark of a prepared country in international terms.”

Now, I think we’ve just established that, by 19 April, whatever you did or didn’t know a month earlier, you knew that there were continuing problems with PPE, did you not?

Professor Dame Harries: Yes.

Counsel Inquiry: You said that you had apologised by then for your earlier statement?

Professor Dame Harries: Yes, that’s true.

Counsel Inquiry: But yet you still referred in the context of your assertion that Britain was –

Professor Dame Harries: This was not –

Counsel Inquiry: Why don’t you just let me ask the question first and then you can answer it?

Professor Dame Harries: Sorry.

Counsel Inquiry: In the context of your assertion that the UK had been an international exemplar in preparedness, you refer to a pandemic influenza stockpile?

Professor Dame Harries: Yes.

Counsel Inquiry: Why did you do that if you knew about all the difficulties there were with PPE?

Professor Dame Harries: The point I was trying to make here is that, having a pandemic influenza stockpile of any sort whatsoever, which undoubtedly the country did, was considered, not by me – this is an external objective assessment – to have been a very high quality mark of a prepared country and that assessment, I mean, clearly, the world will be reforming how it manages and assesses how good it is but that assessment came in two ways: one was from John Hopkins School of Public Health Global Health Security Index, the UK came number 2, scored 79.9 out of 100, and New Zealand came 54. So I think, you know, there’s some really interesting insight there to be learned.

Then the second one was that the UK had put itself forward to be assessed by a joint external valuation under the IHR, International Health Regulations 2005, and, in fact, was used as exemplar by the WHO for training others.

So I recognise that, in retrospect, this is – you know, feels wrong, almost, when we look back now and see but those were not my assessments at all. They were objective external assessments. So they are clearly areas which, you know, we all need to look at globally, I think and, in fact, WHO is.

Counsel Inquiry: Professor, they were external assessments that had been made before the pandemic?

Professor Dame Harries: Yes.

Counsel Inquiry: The pandemic which, by the time you made these comments in April had been ongoing for several months, yes?

Professor Dame Harries: Yes.

Counsel Inquiry: The experience of the pandemic by April had demonstrated just how far wide of the mark those external assessments had been, had they not?

Professor Dame Harries: So I agree that, in retrospect, this doesn’t look at all encompassing with that but that was what we had been graded as, as a country.

Counsel Inquiry: That may have been true, as a matter of fact, Professor, but we started this conversation with your recent interview emphasising the importance of an honest and straightforward approach in communicating with the public during an emergency. Was it an honest or straightforward thing to do to refer to earlier assessments of pandemic preparedness when events of the previous weeks and months had demonstrated just how serious the problems were and how, frankly, erroneous those earlier assessments had been?

Professor Dame Harries: Could I perhaps just read out what that statement says so it says “The UK, regardless of the position we may be in now or commentary”. So I think I am acknowledging the fact that we don’t have a good position now “has been, in the past, an international exemplar, based on external observations” and the reason for that, in the past, had been because we had pandemic influenza stockpile notwithstanding and regardless of the position we’re in now.

I don’t see those as incompatible. We clearly were not in an exemplary position then but I don’t think that’s what this statement says.

Counsel Inquiry: If in mid-April, well into the first lockdown, events had proved that the preparedness was so far short of what it had been understood to be – and, in his evidence to the Inquiry last week, Professor Whitty said that the pandemic influenza plans were, his words, woefully deficient – why was it something you thought necessary to remind the public of in a Number 10 press conference, that this earlier grading had found the UK to be an international exemplar?

It wasn’t an international exemplar. Events had proved that by then.

Professor Dame Harries: So, I mean, I don’t have the context for this, which is often quite difficult for me to make comments on statements which are provided to me and not with the rest of it but I would perhaps just repeat that it says it acknowledges the poor position we’re in now, regardless of the position we may now be in. I am flagging that historically it had. So I think I’m just saying that there is a problem there and, previously, we thought we got it right because that’s what other people told us.

Counsel Inquiry: Let me move on, and I think is going to be my last set of questions, to one more of your sets of public commentary and, to do this, let’s go within the same statement to page 145, please. Now, we see, first of all, at paragraph 10.18, it’s another of the Downing Street press conferences, this time on 26 March 2020, and we see, set out below in full, first of all the question you were asked and then the answer you gave. These were comments about testing, which, as with the other comments we’ve looked at, were the subject of debate at the time.

The question then: “I don’t think we’ve ever really had a public explanation of why this country decided to stop testing people who were suffering with symptoms of coronavirus when every – well, certainly when the World Health Organization was advocating that as a policy and many other Asian countries have done this with great success?” Your answer, which I will read out, I’m going to suggest perhaps you are making two broad points and I will pause after where I think you sort of end the first one and we can talk about that before moving onto the second. But the first part of your answer then, you say: “So I think I’m going to answer in two different sections, the first one about the WHO comment, so I think the comment you were picking up was Dr Tedros saying ‘test, test, test’, but, in fact, we need to realise that the clue for WHO is in its title, it is a world health organisation, and it is addressing all countries across the world with entirely different health infrastructures and particular public health infrastructures, we have an extremely well developed public health system in this country and in fact our public health teams actually train others abroad, we have supported WHO through their GOARN process, and some of our epidemiologists have gone out to Manilla for example to support the early response in that area, so the point there is that they are addressing every country including low and middle income countries so encouraging all countries to test of some type.”

That’s a point where I think perhaps you go onto the second part of answer. But let’s just focus on that first answer. In fact, the WHO guidance or imperative, “test, test, test”, applied to all countries, did it not?

Professor Dame Harries: It did.

Counsel Inquiry: Not just to certain countries depending on where they sat on wealth or state of preparedness or development or anything else?

Professor Dame Harries: Exactly and, in fact, if I may, I would just like to flag this completely because – two things so far. Firstly, the decision to cease community testing, which I might come back to at the end, it was not my decision it was a full clinical decision from CMO’s office, senior clinical groups, right across the system, for good reason, which I will come back to.

But this – I was quite surprised at the reaction to this because, at the time, I think around more than 80 countries of the near 200 of the WHO Member States had not recorded a case of Covid. So Dr Tedros was out, exactly, telling everybody to “test, test, test”, and I fully supported it, and so encouraging all countries to test of some type. The problem we had was that many lower/middle-income countries did not have the capacity or capability to test and so he was encouraging them both to get support, which, in fact, the UK had provided, or to start using their tests to see whether they had cases, because we had differential reporting globally and it was very unlikely that some of the countries who had not sent in a positive case were not actually reporting – had cases in their country.

So this has been completely, to my mind, misinterpreted. And, for the record, I was totally supportive of Dr Tedros’ statement. What we will come on to in the next bit is, when you come to the UK, the problem we had was we had “test, test, tested”, and we had no tests left, and then you get onto the: so what were we doing?

In fact, in the next part of the statement, we prioritised the testing and the prioritisation of the testing is exactly the same prioritisation as WHO put out in its statement nine days later, on 21 March.

So I would suggest it’s quite misinterpreted, as it’s been reported across the media.

Counsel Inquiry: Let’s look, Professor, at the second part, as you say, and then we can wrap it up with a few extra questions. The second part, you say:

“When you come to the UK, we made it very, very clear there has been a plan right the way through this which is entirely consistent with the science and epidemiology, we started with a containment phase and every early case of this disease was followed through, every contact was traced exactly as we would do for other diseases but particularly noticing this one and of course your viewers will be very familiar with the fact that we had some very strict and very successful containment facilities, but there comes a point in a pandemic when that is not an appropriate intervention, and that this point really where we moved, we moved into delay, and although we still do some contact tracing and testing for example in high risk areas like prisons or care homes, that is not an appropriate mechanism as we go forward at that point, what we need to do is focus on the clinical management of the patients first and foremost, and then additionally as I’ve said earlier on our health and care staff and first responder staff. So obviously if there was infinite testing facilities, and we are growing them at pace and we will have them, then it moves to the public, but we need to be very careful about focusing where it’s clinically most valuable.”

So, first, let me come back and ask you two or three questions. Firstly, if we can just remind ourselves, the question that you were asked was simply a question saying: we’ve never had a public explanation of why testing has stopped. The simple answer to that question was: we’ve run out of tests, we don’t have enough tests to test everyone anymore, we’re going to prioritise healthcare and other sectors.

Professor Dame Harries: Yes.

Counsel Inquiry: That was the answer, wasn’t it?

Professor Dame Harries: Yes, exactly. It’s exactly what WHO put in their guidance the next week.

Counsel Inquiry: So first of all, why did you think it appropriate, if that was the question, to start talking about the World Health Organization and suggesting that different rules apply to different countries, depending on how rich they are?

Professor Dame Harries: If I may, can I just go back. I wasn’t – that’s an interpretation. I was actually saying those middle – low/middle-income countries did not all have testing capacity and we support them as an organisation and I fully supported WHO “Test, test, testing” but, at this point, we had no more tests. Then in the second part, I am speaking to the public, at this point. So they will be getting quite frightened, seeing the pictures that you’ve alluded to, will be wanting to know that if their loved one goes into hospital, there will be a clinical test for them to diagnose.

If I may, because this is an important point, at this point, we had around 5,000 tests they were prioritised into clinical treatment and so everybody in hospitals, particularly in intensive care units, started to be tested. Now, if you look at the dates for this, the testing picked up a lot of cases, more cases than was anticipated in hospitals and, by this time, you could then start to extrapolate back what that might mean for community infection rates and, if you look at this, you’ll find it’s the same week that the changes in the numbers in SAGE went up.

So this was a high level surveillance system which then allowed us to – for the kind of – with more certainty than was there, I think, which then led to the alerts to ministers and an early lockdown.

So I think if we had not done this, we would have gone into lockdown much later.

Counsel Inquiry: Professor, we’re talking about communication and the way you communicated on that occasion. If the position was that testing had finished because you had run out of tests, why did you say there comes a point in a pandemic where it’s not an appropriate intervention?

Professor Dame Harries: For two reasons: one, the one that I have just given which is I wanted people to be assured that their loved ones would have tests in hospitals. This is – many people were listening to me directly. But, secondly, you will have heard from many other people, so Professor Yvonne Doyle, who I know gave evidence recently, that said there is a point where you no longer test and trace because the peak of the pandemic rises so quickly that it becomes unmanageable. So that point is an important one to signal to people that this is a change in and the “how it’s done” will change.

Counsel Inquiry: But you said yourself, at the end of the answer, and, as we know from history, testing is desirable if you have got the capacity. We know that NHS Test and Trace subsequently became an enormous organisation, you mentioned the billions of pounds that were spent on it.

So the point is not that it’s not appropriate; it’s that there weren’t any tests?

Professor Dame Harries: I think I said both of those things here. It’s not manageable either on the testing and contact tracing, which was the point Professor Doyle made, I think, last week or whenever she was on.

Counsel Inquiry: Saying both things, Professor, is not a straightforward way of communicating with the public, is it?

Professor Dame Harries: I will – I will leave it at that.

Lady Hallett: As will we all. I’m sorry, as I say, we will of course come back. I know you have another issue that’s been getting some publicity today, so I hope that doesn’t build up into a major issue.

10.00 tomorrow. Thank you.

(5.07 pm)

(The hearing adjourned until 10 am on Wednesday, 29 November 2023)