How Did Britain Get It So Wrong and So Right?
(Bloomberg Opinion) -- Although everyone knew it was coming, the U.K.’s passing beyond 100,000 Covid-related deaths still gave pause. How Britain ended up with one of the world’s worst fatality rates will be subject to much inquiry in the years ahead.
But how to square this dismal toll with the other aspect of pandemic management of which Prime Minister Boris Johnson is rightly proud: Britain’s global leadership in vaccinations? Already, it has vaccinated more than 7 million people, well ahead of any other European country. The program has gone so well that the government is now worried about pressure to give up some of its supply to let other countries catch up.
How did Britain get it both so wrong and so right?
The question of what went wrong isn’t one Johnson wants to address right now. He managed to sound both empathetic and defensive this week. “We did everything we could,” he insisted. That didn’t stop the hashtag “resignjohnson” from trending on social media.
In the endless horse race of British politics, the question of Johnson’s longevity never ceases to fascinate. Politically, however, the grim death toll may not matter ultimately, according to some theories. We’re wired for optimism bias, after all. Infection rates are slowly coming down and hospitalizations will follow. The days, dark and cold now, will lengthen again and the vaccination triumph — if it endures — will linger in people’s minds. Johnson says he might even start reopening schools in early March.
Opinion polls don’t reflect a prime minister in any great trouble. Perhaps with numbers this large and such global misery, people just feel numb. The day that the U.K. reached 100,000 deaths, Johns Hopkins University announced the 100 millionth infection worldwide. U.S. President Joe Biden has warned Americans they’re likely to suffer more than 600,000 deaths, dwarfing the toll in World War II.
But it would be a mistake for Johnson to hide behind the positives. The rest of Britain’s vaccination program — it has most of the population left to inoculate and will then need to do second shots — and the country’s broader post-pandemic future depends on how well the government absorbs last year’s lessons.
The good news is that many factors behind Britain’s early vaccine success should be replicable. They included a clear strategy, the right organization in charge of delivery — one that was accountable and insulated from political interference — and the right people advising.
The Vaccine Task Force was the brainchild of Chief Scientific Advisor Patrick Vallance, who recognized that the government needed private-sector expertise (though not the kind of contractual free-for-all and apparent cronyism that characterized earlier pandemic initiatives). He tapped Kate Bingham, a biochemist and venture capitalist who’d worked for 30 years with the pharmaceutical industry, and Clive Dix, who has a PhD in pharmacology and more than 20 years of industry experience.
They built a portfolio of vaccines spanning the different formats, and prioritized shots with a reasonable chance of quick approval. They also considered scalability and being able to manufacture vaccines in the U.K. to secure supply. The government put serious money behind them, investing nearly 12 billion pounds ($16.4 billion) in vaccination purchases. Britain’s centralized National Health Service was important in recruiting people for clinical trials and implementing vaccinations. And the nation’s strong medicines regulator, the MHRA, began its own advance planning, considering trial data on a rolling basis and becoming the first regulator anywhere to approve a vaccine.
“I didn’t know much about government, but when you have 58 people cc’d you are not going to be able to make decisions quickly,” Bingham said in December. “We had one shot at getting it right and no time.”
The government’s pandemic failures elsewhere demonstrate Bingham’s acuity. They include overlapping decision-making structures, muddled objectives, politicization and a failure to connect scientific advice with policy. Many of these are found in accounts of what went wrong with the NHS test and trace program.
Despite all of the focus on Johnson, the center of government turns out to have been vastly underpowered in terms of expertise and support structures, while local authorities were often bypassed. The virus also benefited from years of NHS underfunding, which constrained capacity, and deep inequalities in society that left disadvantaged communities worst off.
Having one of the highest death rates wasn’t inevitable, though. Half of the fatalities have occurred since November, which isn’t just the result of a more infectious new variant but also a failure to adapt to it. Some of the blame can be put down to Johnson’s decision making. His chief political attribute, irrepressible optimism, left him unable to make choices when epidemiological data clashed with economic objectives. Delay proved deadly, but delays and U-turns were repeat features of his pandemic response.
Johnson likes to focus on good news and there is plenty now, finally. Britain has built its own supply chains and manufacturing capabilities for personal protective equipment — moving on from an almost criminal shortage in the first wave — and has far better guidance to protect medical staff. Despite the flaws, there is an established testing capacity, including rapid diagnostic tests. The U.K. pioneered treatments such as dexamethasone. It has one of the world’s best genomic sequencing capabilities and leads in immunity research.
But Johnson can’t build on those strengths without understanding the weaknesses revealed by the death toll. “The U.K.’s Covid response doesn’t lack lessons to help it improve its response now and to think about post-pandemic policy,” the Institute for Government’s Catherine Haddon told me. “But it’s the repeated failure to learn from them that’s most troubling.”
This isn’t just a matter for future inquiries, however. A completion of the vaccination program depends on getting the balance of lockdown restrictions right, strengthening test and trace, enforcing compliance on isolation and devising an international quarantine policy that defends against new variants.
The empathy Johnson showed for families who’ve lost members over the past year is an important quality. But an even bigger sign of leadership mettle is acknowledging what went wrong, and changing.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Therese Raphael is a columnist for Bloomberg Opinion. She was editorial page editor of the Wall Street Journal Europe.
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