In the words of the report:
Superficially, this looks clear and in logical order.
Let’s start with the 2011 preparedness plan. The inquiry correctly identifies the focus on a single pathogen (influenza) as one reason for its irrelevance. We would qualify that as the main reason, together with the underlying box thinking.
The U.K. 2011 plan was inspired by the U.S. HHS Pandemic plan, which contained several “critical assumptions”.
Specific assumptions for antiviral drugs include: “Treatment with a neuraminidase inhibitor (oseltamivir [Tamiflu®] or zanamivir [Relenza®]) will be effective in decreasing risk of pneumonia, will decrease hospitalisation by about half (as shown for interpandemic influenza), and will also decrease mortality.”
The Hallett report fails to mention that the plan’s essence was based on the mass use of antivirals (stockpiled at great public expense) to ‘hold the fort’ until influenza pandemic vaccines became available. In the 2009 influenza pandemic, neither was needed and subsequently, when the evidence base for both interventions was shown to be biased and wholly inadequate, no notice was taken despite extensive media coverage.
The pervasive problem with all of these plans is the false confidence that interventions will benefit those who adhere to them. Antivirals have no impact on hospitalisations or mortality unless you look at the infamous industry-funded Kaiser meta-analysis.
In 2016, the U.K. carried out a National Pandemic Flu Exercise to assess its preparedness and response to pandemic influenza, which was close to the U.K.’s reasonable worst-case planning scenario.
The evaluation of the exercise highlighted the strengths of existing plans and U.K. command and control emergency response structures and identified areas where resilience could be further enhanced. Beyond overconfidence, a second fatal flaw in preparedness plans is the arrogance all is well. Inexperienced ministers are looked down on by a system that pretends it is prepared. Groupthink coalesces to provide reassuring messages failing to acknowledge the uncertainties and the lack of evidence to inform decision-making. Consequently, ministers, lacking experience and expertise at the time, are kept in the dark by the reassurance of their advisers.
The inquiry stated, “It is obvious, on the face of the 2011 Strategy, that the UK had devoted its efforts to preparing for an influenza pandemic. Professor Dame Sally Davies, Chief Medical Officer for England from June 2010 to October 2019, could not recall a debate about including non-influenza pandemics in the 2011 Strategy.”
The U.K.’s approach to pandemic and inter-pandemic influenza preparedness psychologically locked the whole world on a single agent but also implied that “normality” was the inter-pandemic time between inevitable further pandemics, which, according to the then-WHO definition, meant widespread death and destruction.
As we pointed out repeatedly, attention to a single pathogen in the best cases (i.e., where there was no commercial intent) indicates the inadequacy and ignorance of those at the helm, specifically Dame Sally Davies and her predecessor Sir Liam Donaldson and in the U.S. Senator Hillary Clinton pushing a bill to protect the U.S. against “the flu”, another interesting and distorting use of the F word.
In the 2011 plan, chapter 4 (which you can read from page 34 of the 70-page document), the “Key Elements of the Pandemic Response” are listed as follows:
You will note the article “the” in front of the word “virus”. In addition, paragraph 4.15 refers to public face mask-wearing.
Despite the uncertainty surrounding the use of masks and some of the other remedies, the DHSC made no effort to commission large, well-designed trials that could diminish that uncertainty. As we all know, the 2011 plan was thrown out of the window post haste when the Government was confronted with mass panic in the spring of 2020.
Paragraph 4.81 highlights the contradiction in the “groupthink” advice.
Contrast this with Sir Mark Walport’s statements to the press:
There is sufficient evidence to conclude that early, stringent implementation of packages of complementary NPIs was unequivocally effective in limiting SARS-CoV-2 infections.
Walport’s review in the Royal Society of Medicine stated: “Lockdowns and face masks ‘unequivocally’ cut spread of Covid.”
Statements of “Sufficient evidence to conclude” and “unequivocally” contradict any need to improve the evidence base for these measures. It’s a shame the inquiry, with all its resources at hand, didn’t pay attention to the irreconcilable statements arising from the group thinkers.
The argument that it is difficult to obtain “good quality data” is a distractor. Evidence-based medicine is hard and requires rigour and, more importantly, funding to address the uncertainties. Pandemics sit outside the norms of how we develop evidence, largely because those at the helm have no idea how rational evidence-based healthcare works.
In paragraph 4.27 paragraph, High Consequence Infectious Diseases (HCIDs) are further raised.
It is not apparent to the Inquiry why the strategies for high consequence infectious diseases and pandemics were so different and disconnected from each other. They ought to have been considered together. If they had, then systems that were routine for high consequence infectious diseases (such as test, trace and isolate) would have been scalable and ready to control the spread of a novel virus with pandemic potential.
The inquiry presumes the answer lies elsewhere. If only we had done XXX. Yet, where is the evidence that test, trace and isolate works to control the spread of an agent and at what health economic cost, given it ended up costing £37 billion? More so, how does the plan apply when the pathogen is immediately downgraded from an HCID?
So what does Lady Hallett propose now? The irony is that the only person cited in the report advocating trials is the arch modeller, Sir John Edmunds. Well, that’s good for him, but he’s forgetting that his models will now have to be premised on RCT evidence and not made up based on assumptions.
“The Inquiry acknowledges that improving the evidence base for such public health measures is not straightforward and requires much more thought within the scientific community.” Turning to the same old group of people won’t solve the problem of having too little evidence to inform decision-making.
Here are the two recommendations:
and
None of these ideas are new. For example, “hibernation” was the mechanism by which pre-pandemic influenza vaccines were developed 20 years ago and then underwent reconfiguration, limited testing and emergency registration on September 27th 2009.
There is no mention of “inter-pandemic” evidence development, health economics, or an assessment of the interventions in the pandemic and their role in future pandemics. The chapter is supposed to be about an “effective strategy”. Yet, box-thinking continues.
This post was written by two old geezers who will not charge you £190,000 a day.
Dr. Carl Heneghan is the Oxford Professor of Evidence Based Medicine and Dr. Tom Jefferson is an epidemiologist based in Rome who works with Professor Heneghan on the Cochrane Collaboration. This article was first published on their Substack, Trust The Evidence, which you can subscribe to here.
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