We previously looked at the lessons from Module 1 of the Covid Inquiry about preparations for future risks. In Module 2 the Inquiry covered how the Government reacted when the pandemic did in fact emerge.
Although much was made of the politicians’ and advisers’ reactions (in some very colourful and entertaining sessions), in this blogpost I look at how contingency plans stand up to contact with reality and how advisers communicated with decision-makers. There are lessons for us all.
- How does the work of futurists to help prepare organisations for sudden, but anticipated, shocks actually play out in practice?
- What can be done to help use the preparatory work best, leading to the most effective actions?
- What lessons are particular to Government and what are more general?
This blogpost picks up points from the evidence given to Module 2 of the Inquiry by Chief Medical Officer Professor Sir Chris Whitty over two days (CW1 and CW2); the then Chief Scientific Adviser Sir Patrick Vallance; then Cabinet Secretary Sir Mark Sedwill and Sir Mark Walport, previously CSA. From Module 1, we refer to testimony from Clara Swinson, DHSC executive committee and a senior sponsor for UKHSA, formerly PHE.
Picking up previous contingency work
As futurists, we spend a lot of time helping people explore alternative futures and develop plans for different scenarios. Module 1 of the Inquiry covered a lot of the preparatory work, and actions from exercises such as Project Cygnus. It seems remarkable how little of that preparatory work made it through into decision-making when the pandemic hit. Many people did not refer to it at all.
In Module 1, Clara Swinson agreed that “the only pandemic scale plan in place at the time that Covid hit was the one set out in the strategy, that was for pandemic influenza”, which flowed from the National Risk Register. The pandemic strategy of 2011 did not include any plans for “non-pharmaceutical interventions” (NPIs) such as lockdown, closing borders, stopping mass gatherings or controls on public transport.
Mark Walport, commented that, despite work on the National Risk Register, “NPIs took place against a significant background of ignorance”.
Patrick Vallance suggested “there should have been an operational plan to have those [NPIs] ready to pull the trigger on as soon as they were needed, and what we see is it takes quite a long time to get those actually working”.
Chris Whitty remarked: “I looked at the pandemic flu plan .. and it was pretty clear that it wasn’t going to give us any particular help, frankly. … The idea there was a respiratory pandemic plan for this kind of pandemic that we could just take off the shelf and follow the playbook, was optimistic at best.”
Whitty went further: “If there had been a plan that was laid out: this is how the playbook should run, it would almost certainly have been the wrong plan and could even have slowed us down, because we’d have then spent ages arguing about whether this was the right plan and adapting the plan. So sometimes it is easier actually to start with a new plan”.
It’s not that surprising that the scenario envisaged and planned for did not exactly match what was happening – few scenario analyses are that accurate. But we would normally advocate at least referring to the plan and identifying what was relevant (such as demand for PPE and body bags) and what was not.
“Reasonable worst case scenarios” (RWCS)
There was a lot of discussion about RWCS with some clear misconceptions.
Firstly, the RWCS were not “scenarios” in the sense that we as futurists would use the word – rich descriptions of alternative and contrasting futures. Instead they were a range of estimates of the number of excess deaths – from 100,000 up to 800,000.
Mark Sedwill found this uncertainty uncomfortable. The RWCS for the worst type of flu pandemic predicted 820,000 deaths. On 31 January Chris Whitty briefed that the probability of the RWCS, was about 10%. Later, Sedwill was discomfited by estimates which changed from 300k to 600k deaths within a day. This led him to wonder whether they could have any confidence about what they were being told – though surely the actions would be much the same. He concluded: “There was too much focus, including in the briefings to Cabinet, on the reasonable worst case rather than from the deep experts, ‘Here’s what I think will happen’ “
Patrick Vallance also seems to view scenarios as something unreal – “The point Professor Woolhouse makes in his email is that it’s not a scenario, it’s not a worst case, it’s something that’s more likely than just something which is a scenario or something which might happen. Would it fully escape China in an uncontrolled way? Or would it be contained in the way that SARS and MERS had been?”
Chris Whitty similarly suggested “Two of four scenarios [were] probably the only ones worth considering….: the first one is China has a major outbreak but brings it under control; the second one is the opposite end, which is the reasonable worst-case scenario, which is that it spreads, and it comes out of China”. “I was concerned that government would think that there was likely to be a middle way, and I wanted to remove that possibility from their planning assumptions”.
He concludes that RWCS is not a helpful concept in a crisis. “You quote the reasonable worst-case scenario, which .. is very easy to calculate. And then they will say: well, how likely is that? To which the answer is: extraordinarily unlikely, and then everyone relaxes…..if that wasn’t the case, it isn’t a reasonable worst-case scenario”. But “people use the term to mean: my central estimate of the bad outcome”.
“Sir Patrick and I were both pushed on […probabilities of RWCS…], giving what both of us think are spurious numbers about another spurious number, leading to a misunderstanding.”
Triggers
At SAMI we always advocate identifying triggers for action. After doing scenario analysis and building contingency plans, good practice demands maintaining monitoring and identifying when the world is starting to change. You can then re-visit your contingency plans and adapt them accordingly.
In the pandemic, the identification of a Coronavirus outbreak in China, possibly with asymptomatic transmission, should have led to a revision of the pandemic flu plans.
Chris Whitty did at least identify the need for triggers to escalate action. “My view is that any of three triggers would mean we should start taking a close interest in considering the risk to the UK: 1) Healthcare workers dying … ; 2) Evidence of person-to-person spread eg in families; 3) Geographical spread implying a zoonosis is spreading …”.
“In any given week I will get dozens of reports of outbreaks around the world, my colleagues will as well. What you’re trying to do is to essentially pick up the needle in the haystack of that information at the earliest possible stage. That was the reason for having the triggers.”
Whitty’s three triggers are useful and apt. They are hopefully built into future evaluations. What other trigger points exist for different scenarios within the NRR, and how are they monitored?
Communicating with decision-makers
Beyond the triggers themselves, communicating complex science to non-scientists is difficult. Although a pandemic had been top of the National Risk Register for many years, its implications don’t seem to have been grasped as well as other risks. Whitty bemoaned “hard geopolitical threats (eg a terrorist threat risking 100,000 lives) are treated in a different way to ones which are seen as natural threats” and “the system is surprisingly bad at, in my view, responding to threats of this kind which are not in the traditional national security system”. “Do people in the security apparatus in Number 10, Cabinet Office, view the work that the UK Health Security Agency does with the same degree of interest and importance as they would view MI5?”.
Patrick Vallance was more concerned about the extent of scientific knowledge at the top of Government. “90% of Civil Service fast-track [future PermSecs] was arts, humanities, social science degrees, and only 10% was a STEM degree”.
The concept of exponential growth seemed particularly hard to get across. “PM struggled with whole concept of doubling [times] … just couldn’t get it.”. But it wasn’t just him. Vallance recounts: “at a meeting with fellow science advisers from across Europe one of them declared that the leader of their country had enormous problems with exponential curves and the entire phone call burst into laughter, because it was true in every country.”
“Following the science”
Many people were uncomfortable living with uncertainty and liked to “follow the science”, even though scientific knowledge was itself changing rapidly. At first both Vallance and Whitty were pleased to hear the expression: “good, they’re listening to us. Because that’s not always the case in government”. But shortly after, Whitty commented: “Very soon we realised it was a millstone round our necks, and didn’t help government either because it blurred the distinction between the very firm clear demarcation [between science and politics] that must and did occur. There were definitely some that chose the science they wanted to hear.”
Balancing objectives
Underpinning some of the challenges was the dilemma of apparently conflicting objectives – protecting public health while not damaging the economy more than necessary. It seems that that trade-off was not sufficiently considered in the planning. There’s an important general lesson here for contingency planning, which tends to emphasise protecting against a specific threat rather than maintaining a wider balance of objectives.
Although they took into account wider public health issues (such as safeguarding children not in school), Whitty and Vallance were both clear that trade-offs with economic impacts or concepts of individual liberty were political issues on which it was not their job to comment.
In conclusion
Putting aside how Government should react when the next pandemic hits, what can the rest of us learn about how to cope with the onset of a known risk?
The identification of the risk was clear, and the production of a plan reasonable – even if it was addressing a slightly different threat. Decision-makers had their flaws – they always will – so advisers must be able to communicate effectively whatever the audience.
What seems to have been lacking was a coherent pathway from the plan to action. This required much better monitoring and escalation procedures, and an adaptability to refine plans to a new situation. Admittedly, exponential growth provides a challenging background (as late as the beginning of March there were very few UK deaths), but that should have been anticipated – and, clearly, explained better. Even short delays have significant impacts in such circumstances.
Otherwise, all the Futures work and planning is wasted effort. It is a concern that this may be true in many other organisations too – we have seen a lot of Horizon Scanning work that is disconnected from decision-making, and certainly out of the loop in an emergency. Futures work should not be an interesting sideline – it has to be fully integrated into the mainstream. The Covid Inquiry is an important place to learn those lessons, and to provide an impetus for their embedding in future planning.
Written by Huw Williams, SAMI Principal
The views expressed are those of the author(s) and not necessarily of SAMI Consulting.
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