About you
3. What is your name?
Name
Professor Sir Ian L Boyd
Resilience and emergency planning
1. Did previous planning adequately prepare us for the current pandemic?
Please enter your response in the box provided.
Why it happened:
- The COVID-19 pandemic was a predictable and predicted event, even if the timing and exact nature of the event could not be predicted.
- There is a need to better understand preparedness for predicted low frequency, high impact events like the COVID-19 pandemic. The National Security Risk Assessment (NSRA), which is a document classified at “Secret” level, is insufficient. The published National Risk Register gives a guide to what the NSRA contains and events like the COVID-19 pandemic are covered by the NSRA.
- However, the UK was no better prepared for COVID-19 than countries which run much less sophisticated risk management processes. This suggests that either the process to develop the NSRA is flawed or the results are not built appropriately in to governmental responses, especially public expenditure plans.
- An alternative explanation for the lack of responsiveness to the NSRA is that decisions were made to ignore the guidance coming from the NSRA. In my view, the NSRA is itself fundamentally flawed and the process by which its recommendations are acted on is also flawed. In future it be done properly.
- The NSRA does not, for example, consider aggregate risk. By considering a set of low probability, high impact events individually, it does not reflects the appropriate level of risk of one of those risks being manifest. The more of those types of risks that exist then the greater the probability is that one of them will happen. Because of global trends in population, connectedness, resource depletion and pollution then the trend is towards greater likelihood of individual risks manifesting, and towards an accumulation of a greater number of risks. This is a very serious problem.
- The COVID-19 pandemic was a predictable and predicted event, even if the timing and exact nature of the event could not be predicted.
- There is a need to better understand preparedness for predicted low frequency, high impact events like the COVID-19 pandemic. The National Security Risk Assessment (NSRA), which is a document classified at “Secret” level, is insufficient. The published National Risk Register gives a guide to what the NSRA contains and events like the COVID-19 pandemic are covered by the NSRA.
- However, the UK was no better prepared for COVID-19 than countries which run much less sophisticated risk management processes. This suggests that either the process to develop the NSRA is flawed or the results are not built appropriately in to governmental responses, especially public expenditure plans.
- An alternative explanation for the lack of responsiveness to the NSRA is that decisions were made to ignore the guidance coming from the NSRA. In my view, the NSRA is itself fundamentally flawed and the process by which its recommendations are acted on is also flawed. In future it be done properly.
- The NSRA does not, for example, consider aggregate risk. By considering a set of low probability, high impact events individually, it does not reflects the appropriate level of risk of one of those risks being manifest. The more of those types of risks that exist then the greater the probability is that one of them will happen. Because of global trends in population, connectedness, resource depletion and pollution then the trend is towards greater likelihood of individual risks manifesting, and towards an accumulation of a greater number of risks. This is a very serious problem.
2. With hindsight, what prevented better advanced planning to deal with the pandemic?
Please enter your response in the box provided.
How it happened:
- Modern free-market economics fails to appropriately cost risks like the COVID-19 pandemic to ensure that society is structured (institutionally, socially and politically) to be prepared for any of these risks materialising. The result is that, as we have seen, there is a large cost to pay when they happen. Many, perhaps all, of the risks within the NSRA will internalise their costs eventually. What we have failed to do is to understand this and to pay the ongoing costs of ensuring we are resilient to as many as possible. This is why the COVID-19 pandemic happened.
- The proximate reason for the COVID-19 pandemic is well documented, involving cross infection of what was probably a virus in a bat to another species and thence to humans. But the ultimate reason was because of the extreme levels of biological connectedness there now is between people across the globe. This forms the perfect conditions for emerging pathogens to spread rapidly. This connectedness is driven by high rates of movement of people, mainly due to cheap air travel. However, it is also part of a syndrome of connectedness involving trade and finance. There are short-term advantages involved in this connectedness, but there is an extraordinarily low appreciation, among governments and people in general, of the risks this brings.
- The COVID-19 pandemic also happened because of a failure in medical intervention. We were powerless to intervene in the spread of the disease except by introducing the crudest of epidemiological controls in the form of behaviour modification (social distancing). This failure is has both a social component and a technical component. Socially, we place much too great a faith in modern medicine to be able to provide technical solutions. Doubtless, much of the early response to the news that a new coronavirus had emerged in China was weighted by a judgement that medical intervention would prevent this becoming a general problem. However, coronaviruses were a known quantity, as are many other kinds of zoonotic pathogens. A problem which exists for finding technical solutions to the infectiousness of these pathogens, such as vaccines and therapies, is that to properly test interventions you need a reasonably high incidence of disease in the population. In other words, while preparatory work can be done, it is difficult to be fully prepared medically for emergent disease. Thus, a future focus on preparing medical solutions would miss the point – i.e. that the primary focus should be on preventing zoonotic disease spread in the first place.
- Modern free-market economics fails to appropriately cost risks like the COVID-19 pandemic to ensure that society is structured (institutionally, socially and politically) to be prepared for any of these risks materialising. The result is that, as we have seen, there is a large cost to pay when they happen. Many, perhaps all, of the risks within the NSRA will internalise their costs eventually. What we have failed to do is to understand this and to pay the ongoing costs of ensuring we are resilient to as many as possible. This is why the COVID-19 pandemic happened.
- The proximate reason for the COVID-19 pandemic is well documented, involving cross infection of what was probably a virus in a bat to another species and thence to humans. But the ultimate reason was because of the extreme levels of biological connectedness there now is between people across the globe. This forms the perfect conditions for emerging pathogens to spread rapidly. This connectedness is driven by high rates of movement of people, mainly due to cheap air travel. However, it is also part of a syndrome of connectedness involving trade and finance. There are short-term advantages involved in this connectedness, but there is an extraordinarily low appreciation, among governments and people in general, of the risks this brings.
- The COVID-19 pandemic also happened because of a failure in medical intervention. We were powerless to intervene in the spread of the disease except by introducing the crudest of epidemiological controls in the form of behaviour modification (social distancing). This failure is has both a social component and a technical component. Socially, we place much too great a faith in modern medicine to be able to provide technical solutions. Doubtless, much of the early response to the news that a new coronavirus had emerged in China was weighted by a judgement that medical intervention would prevent this becoming a general problem. However, coronaviruses were a known quantity, as are many other kinds of zoonotic pathogens. A problem which exists for finding technical solutions to the infectiousness of these pathogens, such as vaccines and therapies, is that to properly test interventions you need a reasonably high incidence of disease in the population. In other words, while preparatory work can be done, it is difficult to be fully prepared medically for emergent disease. Thus, a future focus on preparing medical solutions would miss the point – i.e. that the primary focus should be on preventing zoonotic disease spread in the first place.
Please submit your response in the box provided.
The wrong paradigm:
- The right people and organisations were involved but they were operating within an economic, policy and political paradigm which had systematically ignored its aggregate risk. The effect was to create an unrealistic appreciation of risk throughout society from the individual citizen to the global leaders. Moreover, this "walking blind towards a precipice" goes on. The closest the UK gets to an assessment of its aggregate risk is in the form of the Ministry of Defence "Global Strategic Trends" analysis but this is not a complete view by any means. The alternative would be, perhaps, to use the global money markets and, in a national context, to consider credit rating and bond yields, but this makes the tacit assumption that the market is good at costing in these kinds of risks, and I do not think it can be assumed that it is capable of doing this. In conclusion, even advanced economies have no reliable way of understanding their aggregate risk associated with events like the COVID-19 pandemic. The result is that they mostly do not plan for them and accept that in the event of those risks manifesting, nations will self-insure.
- The right people and organisations were involved but they were operating within an economic, policy and political paradigm which had systematically ignored its aggregate risk. The effect was to create an unrealistic appreciation of risk throughout society from the individual citizen to the global leaders. Moreover, this "walking blind towards a precipice" goes on. The closest the UK gets to an assessment of its aggregate risk is in the form of the Ministry of Defence "Global Strategic Trends" analysis but this is not a complete view by any means. The alternative would be, perhaps, to use the global money markets and, in a national context, to consider credit rating and bond yields, but this makes the tacit assumption that the market is good at costing in these kinds of risks, and I do not think it can be assumed that it is capable of doing this. In conclusion, even advanced economies have no reliable way of understanding their aggregate risk associated with events like the COVID-19 pandemic. The result is that they mostly do not plan for them and accept that in the event of those risks manifesting, nations will self-insure.
3. What lessons have been learned which could inform the response to future outbreaks of COVID-19 infection or another pandemic?
Please enter your response in the box provided.
The No. 1 lesson:
- It is essential that the outcome should NOT be to plan just for another pandemic, and especially another pandemic like COVID-19. This would almost certainly not render us resilient to the next global risk, because the next risk will almost certainly NOT be like COVID-19. It is insufficient to, for example, stockpile PPE or increase the number of ventilators in the NHS. These will very likely remain unused during the next emergency while we rue our lack of foresight about some other shortages elsewhere in our response infrastructure. For example, PPE and ventilators are not a lot of use when responding to catastrophic coastal flooding.
Learning how to be resilient:
- There needs to be a national, politically-led understanding that life will be different and recovery to a pre-COVID-19 state is almost certainly not feasible or perhaps it is even undesirable. This is because COVID-19 is not just an event, it is a systemic failure. By many measures, the COVID-19 event was quite minor compared to some risks we face, so we should not be striving to re-build the system which failed so catastrophically with such a relatively mild stressor. The structure of economies - involving complex, globalised supply chains - brings vulnerabilities which are poorly understood and poorly managed. Unsupervised markets do not necessarily build resilience in ways which work in the long-term interests of individual nations.
Correlations with other risks:
- COVID-19 should not increase vulnerability to other national risks, such as those bearing down on us from increasing rates of resource consumption, climate change and pollution. A race to “recover” in ways which simply try to re-invent the kind of economy we had in the past will only increase vulnerability to future risks rather than exploit the opportunity to re-shape policies, institutions and infrastructure in ways which are creating resilience rather than increasing vulnerability. This is going to have to be led by national-level strategic planning, something which has never been a strength of the UK. Under scenarios for the future it may well be that the business cases for major infrastructure projects, such as HS2 and Heathrow development, look a lot less attractive now than they did in the past.
Addressing inequality – creating opportunity:
- COVID-19 is amplifying, or illustrating, inequality and recovery needs to be used as an opportunity to address some of the most fundamental and intractable problems in the UK economy and societal structure. Apart from growing a resilient economy (addressed above), we need to grow an economy which is fairer and which reduces division with society. Large parts of the economy need to be re-built and a lot of public money is going to have to be raised in order to do this. There is an opportunity for social and geographical affirmative action which could make a lasting difference to reducing the divisions across society.
Global political considerations:
- The ways in which the COVID-19 experience will probably shift the appreciation of risk within society will have long-term consequences for the shape of politics. For example, arguably, it puts devolution politics and EU exit politics in perspective as relatively trivial issues. However, its most likely outcome will be greater general risk aversion, and how this will play out in terms of how people spend money, invest, travel and how they value materialism over other kinds of less secular activities is difficult to say. But it could be a pivotal moment which is, in my view, less likely to support further globalisation and is more likely to result in greater levels of nationalism and calls for self-reliance and self-sufficiency where that can be achieved. COVID-19 might trigger the end of the post WWII era of global liberalisation. If so, it is going to be a tough time for many of the global institutions which have grown up within that model – UN and its subsidiary bodies, WTO, IMF, EU (and other trade agreements) etc. It does not bode well for international cooperation. This may be seeing too far but I suggest it is better than a remote possibility. I think it much less likely that the COVID-19 experience will strengthen these institutions or be broadly neutral towards them.
Accepting that we will all be financially poorer but morally richer:
- This is an issue which the political classes are going to have to lead on. It means re-casting the rhetoric about the virtues of economic growth, which have arguably placed us in the current bind, in to one about the virtues of health, welfare and happiness, which do not need to be wholly connected to financial metric of wealth. This is about attempting to re-set the national value system in a way which makes recovery different and easier when seen through the lens of pure metrics of GDP.
Re-tasking science:
- If we accept that we have strategic risks (see section above about the NSRA) then we need to explicitly develop scientific capability to tackle those risks. The UK has traditionally shied away from strategically guiding scientific investigation, but delivering science excellence (the oft-repeated mantra of British science) and delivering strategic outcomes in the national interest are not incompatible objectives. The UK needs to task its science base with solving its biggest and most pressing problems, and doing this in a fairly deliberate way and with urgency.
Learning how to recover:
- We need to shift gear to adapt to the long haul towards recovery. The immediate response by governments to the COVID-19 pandemic has been to take control of their citizens and society. Fundamental freedoms have been denied in ways which are unsustainable. Yet, without an effective vaccine, and without effective therapeutics, behavioural modification is the only option available to manage the disease. Therefore, behavioural science is going to have to play an increasing role in disease management. This needs to be focussed on giving back as much control as possible to citizens to run their lives in the ways that they choose by giving the information they need to make rational choices about their risks of contracting or transmitting the disease. The policy role for government will have to be to construct the incentives (and disincentives) in ways which modulate behaviours based on those risks.
- We need to protect the vulnerable. Perhaps up to 16 million people in the UK will remain extremely vulnerable to COVID-19 for a long time to come. Protecting these people is going to take a huge amount of national stamina while losing a grip on these protections to favour a majority who are in the low risk categories would be unimaginable. Bearing down hard early on upon any forms of discrimination and inequalities will be vital to stopping the UK developing in to a two-tier society with those who are vulnerable either having the bear the stigma of their position or having to take the risk of going with the majority and, in many cases, paying a high price.
- We need to play our part in finding solutions. Both vaccines and therapies are needed to deal with COVID-19 but also with other similar kinds of pandemics. Our record on finding effective vaccines for some of the world’s oldest and most deadly disease is not good. The chances of finding an effective vaccine for COVID-19 are perhaps in the order of 50:50. However, it will be important that, when solutions are found, they are shared as equitably as possible on a global scale. Drugs like Remdesivir, and its analogues, could be effective but they are complex and expensive to manufacture potentially limiting their availability. We should be channelling the expertise available to helping to solve this problem with redirection of funding if necessary to find vaccines and therapies, and to helping to verify their effectiveness.
- It is essential that the outcome should NOT be to plan just for another pandemic, and especially another pandemic like COVID-19. This would almost certainly not render us resilient to the next global risk, because the next risk will almost certainly NOT be like COVID-19. It is insufficient to, for example, stockpile PPE or increase the number of ventilators in the NHS. These will very likely remain unused during the next emergency while we rue our lack of foresight about some other shortages elsewhere in our response infrastructure. For example, PPE and ventilators are not a lot of use when responding to catastrophic coastal flooding.
Learning how to be resilient:
- There needs to be a national, politically-led understanding that life will be different and recovery to a pre-COVID-19 state is almost certainly not feasible or perhaps it is even undesirable. This is because COVID-19 is not just an event, it is a systemic failure. By many measures, the COVID-19 event was quite minor compared to some risks we face, so we should not be striving to re-build the system which failed so catastrophically with such a relatively mild stressor. The structure of economies - involving complex, globalised supply chains - brings vulnerabilities which are poorly understood and poorly managed. Unsupervised markets do not necessarily build resilience in ways which work in the long-term interests of individual nations.
Correlations with other risks:
- COVID-19 should not increase vulnerability to other national risks, such as those bearing down on us from increasing rates of resource consumption, climate change and pollution. A race to “recover” in ways which simply try to re-invent the kind of economy we had in the past will only increase vulnerability to future risks rather than exploit the opportunity to re-shape policies, institutions and infrastructure in ways which are creating resilience rather than increasing vulnerability. This is going to have to be led by national-level strategic planning, something which has never been a strength of the UK. Under scenarios for the future it may well be that the business cases for major infrastructure projects, such as HS2 and Heathrow development, look a lot less attractive now than they did in the past.
Addressing inequality – creating opportunity:
- COVID-19 is amplifying, or illustrating, inequality and recovery needs to be used as an opportunity to address some of the most fundamental and intractable problems in the UK economy and societal structure. Apart from growing a resilient economy (addressed above), we need to grow an economy which is fairer and which reduces division with society. Large parts of the economy need to be re-built and a lot of public money is going to have to be raised in order to do this. There is an opportunity for social and geographical affirmative action which could make a lasting difference to reducing the divisions across society.
Global political considerations:
- The ways in which the COVID-19 experience will probably shift the appreciation of risk within society will have long-term consequences for the shape of politics. For example, arguably, it puts devolution politics and EU exit politics in perspective as relatively trivial issues. However, its most likely outcome will be greater general risk aversion, and how this will play out in terms of how people spend money, invest, travel and how they value materialism over other kinds of less secular activities is difficult to say. But it could be a pivotal moment which is, in my view, less likely to support further globalisation and is more likely to result in greater levels of nationalism and calls for self-reliance and self-sufficiency where that can be achieved. COVID-19 might trigger the end of the post WWII era of global liberalisation. If so, it is going to be a tough time for many of the global institutions which have grown up within that model – UN and its subsidiary bodies, WTO, IMF, EU (and other trade agreements) etc. It does not bode well for international cooperation. This may be seeing too far but I suggest it is better than a remote possibility. I think it much less likely that the COVID-19 experience will strengthen these institutions or be broadly neutral towards them.
Accepting that we will all be financially poorer but morally richer:
- This is an issue which the political classes are going to have to lead on. It means re-casting the rhetoric about the virtues of economic growth, which have arguably placed us in the current bind, in to one about the virtues of health, welfare and happiness, which do not need to be wholly connected to financial metric of wealth. This is about attempting to re-set the national value system in a way which makes recovery different and easier when seen through the lens of pure metrics of GDP.
Re-tasking science:
- If we accept that we have strategic risks (see section above about the NSRA) then we need to explicitly develop scientific capability to tackle those risks. The UK has traditionally shied away from strategically guiding scientific investigation, but delivering science excellence (the oft-repeated mantra of British science) and delivering strategic outcomes in the national interest are not incompatible objectives. The UK needs to task its science base with solving its biggest and most pressing problems, and doing this in a fairly deliberate way and with urgency.
Learning how to recover:
- We need to shift gear to adapt to the long haul towards recovery. The immediate response by governments to the COVID-19 pandemic has been to take control of their citizens and society. Fundamental freedoms have been denied in ways which are unsustainable. Yet, without an effective vaccine, and without effective therapeutics, behavioural modification is the only option available to manage the disease. Therefore, behavioural science is going to have to play an increasing role in disease management. This needs to be focussed on giving back as much control as possible to citizens to run their lives in the ways that they choose by giving the information they need to make rational choices about their risks of contracting or transmitting the disease. The policy role for government will have to be to construct the incentives (and disincentives) in ways which modulate behaviours based on those risks.
- We need to protect the vulnerable. Perhaps up to 16 million people in the UK will remain extremely vulnerable to COVID-19 for a long time to come. Protecting these people is going to take a huge amount of national stamina while losing a grip on these protections to favour a majority who are in the low risk categories would be unimaginable. Bearing down hard early on upon any forms of discrimination and inequalities will be vital to stopping the UK developing in to a two-tier society with those who are vulnerable either having the bear the stigma of their position or having to take the risk of going with the majority and, in many cases, paying a high price.
- We need to play our part in finding solutions. Both vaccines and therapies are needed to deal with COVID-19 but also with other similar kinds of pandemics. Our record on finding effective vaccines for some of the world’s oldest and most deadly disease is not good. The chances of finding an effective vaccine for COVID-19 are perhaps in the order of 50:50. However, it will be important that, when solutions are found, they are shared as equitably as possible on a global scale. Drugs like Remdesivir, and its analogues, could be effective but they are complex and expensive to manufacture potentially limiting their availability. We should be channelling the expertise available to helping to solve this problem with redirection of funding if necessary to find vaccines and therapies, and to helping to verify their effectiveness.