As the COVID-19 pandemic ravaged the globe, one question loomed large: was the United Kingdom prepared to handle a crisis of this magnitude? The answer, according to a scathing first report from the UK COVID-19 Inquiry, is a resounding no.

The comprehensive 220-page report, led by The Rt Hon the Baroness Hallett DBE, paints a damning picture of the UK’s pandemic preparedness and resilience prior to 2020. Despite a history of major outbreaks like SARS, MERS, and swine flu, the report concludes that the UK was “ill prepared” for a catastrophic public health emergency, lacking the infrastructure, planning, and leadership to mount an effective response.

“Never again can a disease be allowed to lead to so many deaths and so much suffering,” Baroness Hallett writes in the introduction. The stark findings raise urgent questions about how countries can better prepare for future pandemics – and what lessons the UK and other nations must learn to avoid repeating the same tragic mistakes.

A History of Epidemics

Epidemics and pandemics are not new phenomena. Humanity has grappled with deadly outbreaks for centuries, from the Plague of Athens in 430 BC to the 1918 Spanish flu pandemic that killed an estimated 50 million people worldwide.

In more recent decades, the world has faced a string of emerging infectious disease threats, each providing a stark preview of the devastation a novel pathogen can unleash. The 2002-2003 SARS outbreak, the 2009-2010 swine flu pandemic, and the ongoing MERS coronavirus crisis in the Middle East all offered critical lessons about the need for robust preparedness.

“Pathogens that have the potential to cause a pandemic are not unknown,” notes Professor Jimmy Whitworth, an expert witness who testified before the Inquiry. “Pandemic influenza has long been considered the single biggest predictable pathogen risk.”

Yet despite this historical precedent, the UK government and its devolved administrations in Scotland, Wales, and Northern Ireland failed to heed the warnings. The report finds that in the years leading up to COVID-19, the UK was overly focused on preparing for an influenza pandemic, neglecting the possibility of an outbreak caused by a novel coronavirus or other emerging infectious disease.

“The significant risk of an influenza pandemic had long been considered, written about and planned for,” the report states. “However, that preparedness was inadequate for a global pandemic of the kind that struck.”

Institutional Failures

At the heart of the UK’s pandemic preparedness failures were deep-seated flaws in the country’s systems and structures for managing civil emergencies. The report paints a picture of a labyrinthine, duplicative, and poorly coordinated network of government agencies, advisory bodies, and devolved administrations responsible for readiness and response.

“The institutions and structures responsible for emergency planning were labyrinthine in their complexity,” the report states. “There were fatal strategic flaws underpinning the assessment of the risks faced by the UK, how those risks and their consequences could be managed and prevented from worsening, and how they could be responded to.”

A key issue was the UK’s reliance on the “lead government department model,” which placed the Department of Health and Social Care (DHSC) in charge of pandemic preparedness, despite the fact that a pandemic has wide-ranging societal impacts that extend far beyond the health sector. This siloed approach prevented a truly cross-governmental, whole-of-system response.

“Risks are allocated to individual government departments, irrespective of whether they may cause a whole-system civil emergency,” the report states. “There are clear limitations to this. While pandemics are the responsibility of the [DHSC], it is clear that they have the potential to trigger social and economic crises that require a wider response from a greater range of institutions at the national, regional and local levels of government.”

The devolved administrations in Scotland, Wales, and Northern Ireland faced similar structural challenges, with complex, overlapping systems that lacked clear lines of accountability and coordination. In Wales, for example, the report describes a “labyrinthine” array of committees, teams, groups, and sub-groups responsible for preparedness and resilience, resulting in “inefficiency, ineffectiveness and a lack of focus.”

Flawed Risk Assessment

Underpinning these institutional failures was a deeply flawed approach to assessing the risks facing the UK. The report identifies five major flaws in the government’s risk assessment process:

1. Overreliance on a single “reasonable worst-case scenario” for an influenza pandemic, to the exclusion of other potential pandemic threats.

2. A focus on dealing with the impact of a pandemic rather than preventing its spread.

3. A failure to adequately consider how a pandemic could trigger a “domino effect” of interconnected risks and crises.

4. Insufficient consideration of long-term risks and the disproportionate impact on vulnerable populations.

5. A disconnect between risk assessment and the development of strategies and plans to address those risks.

“If the assessment of risk is not undertaken properly, the whole approach to preparedness and resilience begins in the wrong place,” the report states. “It should be improved as a matter of urgency.”

The report cites numerous examples that illustrate these flaws. For instance, the UK’s risk assessments consistently identified only two reasonable worst-case scenarios: a severe influenza pandemic and a high-consequence infectious disease outbreak on a smaller scale. The possibility of a coronavirus pandemic on the scale of COVID-19 was never considered.

Similarly, the assessments failed to adequately plan for measures to prevent or mitigate the spread of a pandemic, assuming instead that large numbers of illnesses and deaths were inevitable. As former Health Secretary Matt Hancock told the Inquiry, the strategy was “a strategy for dealing with the disastrous effect of a pandemic” rather than preventing it.

“There was a failure to appreciate long-term risks and their effect on vulnerable people,” the report states. “There was also a failure to appreciate the full extent of the impact of government measures and long-term risks, from both the pandemic and the response, on ethnic minority communities and those with poor health or other vulnerabilities.”

Abandoned Strategies and Missed Opportunities

The UK’s sole pandemic strategy at the time – the 2011 UK Influenza Pandemic Preparedness Strategy – was similarly flawed. The report identifies four major problems with the 2011 Strategy:

1. It failed to adequately consider prevention and mitigation measures to slow the spread of a pandemic.
2. It focused solely on preparing for an influenza pandemic, to the exclusion of other potential pathogens.
3. It did not sufficiently consider the proportionality of potential response measures and their societal impacts.
4. It lacked an effective economic and social strategy to address the wider consequences of a pandemic.

Crucially, the 2011 Strategy was never properly tested or updated prior to the COVID-19 outbreak. The report states that the strategy was “beset by major flaws” and “effectively abandoned” when the pandemic struck, leaving the UK government and devolved administrations without a coherent plan.

“The absence of an update to the 2011 Strategy meant, in particular, that it did not incorporate any learning from the international experiences of the Ebola, MERS or SARS outbreaks, and did not take into account lessons from any exercises that took place after 2011,” the report states.

This failure to learn from past experiences was a consistent theme. The Inquiry examined a series of pandemic preparedness exercises conducted in the UK between 2003 and 2018, including major simulations like Exercise Cygnus in 2016. These exercises repeatedly identified the same critical gaps and weaknesses, yet the lessons were not acted upon.

“Lessons that could and should have been learned were not learned,” the report states. “They were left to be discovered afresh in the next exercise or, as it transpired, when the COVID-19 pandemic struck.”

The report cites a litany of missed opportunities, from the failure to develop scalable testing and contact tracing capabilities, to the lack of planning for mass isolation and border controls. It notes that many of these basic public health measures were successfully deployed by other countries, like South Korea, to contain the initial spread of COVID-19 – yet they were absent from the UK’s preparedness efforts.

“If the lessons had been heeded, and put into the domestic context, the UK would have been better prepared for the coronavirus (COVID-19) pandemic when it struck in January 2020,” the report concludes.

Flawed Advice and Groupthink

Underpinning the UK’s preparedness failures was a scientific advisory system that the report describes as deeply flawed. While the country had access to world-class experts, the Inquiry found that the advice provided to ministers was often constrained, lacking in independence and subject to “groupthink.”

A key problem was the way experts were asked to advise. The report notes that advisory bodies like the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) were often limited to responding to specific, narrowly-defined questions from government departments. This prevented them from considering a broader range of issues or providing more strategic, forward-looking advice.

“The content of the meetings was very much commissioned by [the Department of Health and Social Care],” Professor Peter Horby, a NERVTAG member, told the Inquiry. “There was no expectation or explicit encouragement to consider issues beyond the specific commissions.”

The report also found that there was inadequate feedback and follow-up on how expert advice was received and applied by decision-makers. Many advisers had limited knowledge of the extent to which their recommendations were acted upon, if at all.

Worse, the range of expertise informing pandemic preparedness was heavily skewed towards biomedical science, to the exclusion of critical perspectives from other disciplines like economics, social science, and public health. This resulted in a lack of holistic, systems-level thinking about the wider societal impacts of a pandemic and potential policy responses.

“An effective and long-term approach to preparedness and resilience should therefore include a way for government to have advice available to it, covering a range of specialisms – from scientific to economic expertise – as well as from experts who understand the impact on individuals, businesses and society,” the report states.

The report also identifies “groupthink” as a major problem, with a consensus emerging within government and advisory bodies that the UK was well prepared for a pandemic – a view that was emphatically contradicted by the COVID-19 experience.

“These documents may explain, however, some of the assurances that Matt Hancock MP, Secretary of State for Health and Social Care from July 2018 to June 2021, received,” the report states. “He told the Inquiry that he was ‘assured that the UK was one of the best placed countries in the world for responding to a pandemic.'”

A New Approach to Preparedness

In light of these systemic failures, the Inquiry report calls for a fundamental rethinking of how the UK government and devolved administrations approach pandemic preparedness and resilience. The report makes a series of far-reaching recommendations, including:

1. Abolishing the “lead government department model” in favor of giving the Cabinet Office responsibility for overseeing whole-system civil emergency preparedness across government.

2. Developing a new, more comprehensive approach to risk assessment that considers a wider range of scenarios and their potential impacts, including on vulnerable populations.

3. Introducing a new UK-wide “whole-system civil emergency strategy” that is adaptable, evidence-based, and subject to regular reassessment.

4. Establishing mechanisms for the timely collection, analysis, and sharing of data to inform emergency responses, as well as a broader program of “hibernated” research studies that can be rapidly adapted.

5. Holding regular, large-scale pandemic response exercises that involve ministers, officials, and a diverse range of stakeholders, with the findings and recommendations made public.

6. Creating an independent statutory body to provide strategic advice to governments on whole-system civil emergency preparedness and resilience.

7. Making greater use of “red teams” – external groups tasked with critically examining policies, plans, and advice – to inject independent challenge and prevent “groupthink.”

8. Requiring governments to publish regular reports to their respective legislatures on their approaches to civil emergency preparedness, including cost-benefit analyses and plans for protecting vulnerable populations.

The report emphasizes that implementing these reforms will require a radical shift in mindset and culture, moving away from a narrow, siloed approach to one that embraces systems-level thinking, transparency, and accountability.

“Never again can a disease be allowed to lead to so many deaths and so much suffering,” Baroness Hallett writes. “Unless the lessons are learned, and fundamental change is implemented, that effort and cost will have been in vain when it comes to the next pandemic.”

A Global Wakeup Call

The UK COVID-19 Inquiry’s findings echo similar critiques emerging from pandemic reviews in other countries. In the United States, for example, the 2021 report from the Pandemic Preparedness Taskforce concluded that the country was “underprepared” for COVID-19, citing breakdowns in disease surveillance, supply chain management, and coordination between federal, state, and local authorities.

Globally, the COVID-19 crisis has served as a stark wakeup call about the urgent need to strengthen pandemic preparedness and global health security. International bodies like the World Health Organization have called for sweeping reforms, including the development of a new international pandemic treaty to improve coordination and information-sharing.

As the world grapples with the ongoing impacts of COVID-19 and braces for the next inevitable pandemic, the UK Inquiry’s recommendations offer a roadmap for how countries can learn from past failures and build more resilient, responsive, and equitable systems to protect public health.

“It is not a question of ‘if’ another pandemic will strike but ‘when’,” Baroness Hallett writes. “Unless the lessons are learned, and fundamental change is implemented, that effort and cost will have been in vain when it comes to the next pandemic.”

The stakes could not be higher. As the report makes clear, the cost of inaction is measured in lives lost and societal devastation. By heeding the lessons of COVID-19, governments have a chance to ensure that the next pandemic does not inflict the same tragic toll.