Covid-19 reader: 15 October

Lessons must be learnt from pandemic mistakes

Commons select committees, joint report

‘Decisions on lockdowns and social distancing during the early weeks of the pandemic – and the advice that led to them – rank as one of the most important public health failures the UK has ever experienced.’

This was one of the blunt conclusions of a joint report from the Commons Health and Social Care and Science and Technology committees, published this week after their inquiry exploring lessons learnt to date about the response to the coronavirus.

The cross-party committees said the government had tried to manage the spread of Covid through the population, rather than to stop it spreading altogether – effectively adopting a fatalistic approach that accepted herd immunity by infection was the inevitable outcome. A more emphatic and rigorous approach to stopping the spread of the virus adopted by many East and South East Asian countries should have been considered.

It was also a mistake to stop community testing so early in the pandemic, whether this was deliberate policy or because of inadequate capacity. ‘A country with a world-class expertise in data analysis should not have faced the biggest health crisis in a hundred years with virtually no data to analyse,’ the report said.

Even if this was a result of insufficient capacity, there should have been more challenge to Public Health England to increase testing capacity at the outset. ‘Instead testing capacity appeared to be accepted for too long as a fait accompli,’ the committees said.

There were criticisms for a lack of transparency in the structures for offering scientific advice and too little political challenge to this advice.

The desire to avoid a lockdown was driven by a belief that it would cause immense harm to the economy, normal health services and society. ‘But in the absence of other strategies such as rigorous case isolation, a meaningful test and trace operation, and robust border controls, a full lockdown was inevitable and should have come sooner,’ the report added.

The report also offered praise where it was warranted. Then health secretary Matt Hancock’s setting of 100,000 tests-a-day target was important, although the fact that such a ‘personal initiative’ was needed in the first place represented a significant failure. The expansion of ventilator and intensive care capacity, including the setting up of the Nightingale hospitals, was a remarkable achievement.

But the jewel in the government’s crown was the vaccination programme, encompassing the discovery, purchase and full vaccination of over 80% of the adult population by September 2021. The committees said this had been ‘one of the most effective initiatives in the history of UK science and public administration’. ‘Millions of lives will ultimately be saved as a result of the global vaccine effort in which the UK has played a leading part,’ said the report.

However, there was further criticism of the government and the NHS for the failure to recognise the significant risks to the social care sector at the beginning of the pandemic. The report said this lack of priority for social care was typical of a longstanding failure to give the sector the same attention as the NHS.

Many of the problems were due to long-standing pressures, such as funding and workforce, and needed to be resolved urgently. The report endorsed earlier calls for a 10-year plan for social care to accompany the NHS long-term plan.

The committees said that despite the government’s recent announcement of the new health and social care levy, the level of new investment in social care from 2023/24 remained unclear.

The committee also drew attention to the unequal impact of the virus on different ethnic communities and other groups. This underlined the need for an ‘urgent and long-term strategy to tackle health inequalities’.

In total the nearly 150-page report included 38 recommendations for the government and the NHS.

In a joint statement, Jeremy Hunt and Greg Clark (pictured), the committees’ chairmen – both former Conservative ministers – said the UK response had combined some big achievements with some big mistakes. ‘It is vital to learn from both to ensure that we perform as best as we possibly can during the remainder of the pandemic and in the future,’ they said.

When did life expectancy start to fall?

Imperial College London, research study

Covid-19 has had an impact on life expectancy. Office for National Statistics data shows a decrease in male life expectancy of 1.8 months in England in 2018 to 2020, compared with 2015 to 2017, as a result of the inclusion of 2020 mortality data. This was the first decrease at the national level in 40 years. There was also a big increase in the life expectancy gap between different areas of the country, with mortality rates from Covid-19 tending to be higher in more deprived areas.

However, a new study from researchers at Imperial College London has shown that life expectancy was already on the decline before the pandemic in a substantial number of English communities. In the five years before Covid-19 (2014 to 2019), life expectancy went down in almost one in five communities for women and one in nine communities for men.

The study, published in the Lancet Public Health journal, claims to be the first to analyse longevity trends in ultrafine detail. The researchers tracked life expectancy in communities of around 8,000 people (some 6,791 so-called middle-layer super output areas or MSOAs), while other statistics have tended to look at much larger populations such as local authority districts.

‘There has always been an impression in the UK that everyone's health is improving, even if not at the same pace,’ said Majid Ezzati, a professor of environmental health at Imperial. ‘These data show that longevity has been getting worse for years in large parts of England.’

The study found that in 2002 to 2006 and 2006 to 2010, all but a few MSOAs had a life expectancy increase for women and men. In 2010 to 2014, female life expectancy decreased in 351 (5% of the 6,791 MSOAs). By 2014-19, the number of MSOAs with declining life expectancy was 1,270 (19%) for women and 784 (12%) for men. The researchers call for pro-equity economic and social policies and greater investment in public health and health care to ensure this trend does not continue or worsen.

Taken over the entire study period – from 2002 to 2019, the biggest life expectancy decline for women was a loss of three years for an area of Leeds (from 78.7 to 75.6 years). For men, the biggest fall was of 0.4 years in a part of Blackpool (from 68.7 to 68.3 years). The researchers pointed out that the regions where life expectancy had declined often had lower life expectancy to start with, and high levels of poverty, unemployment and low educational achievement.

Missed target demands greater focus on vaccine equity

World Health Organization, briefing

Some 56 countries – many of them in Africa – were not able to meet the World Health Organization (WHO) target of vaccinating 10% of their residents by the end of September. Reaching further targets will now need a whole-of-government and whole-of-society approach, the organisation said.

In a media briefing this week, WHO director-general, Tedros Adhanom Ghebreyesus said that weekly reported deaths from Covid-19 were at their lowest level in almost a year – although almost 50,000 deaths a week was still unacceptably high. Deaths are declining in every region except Europe, where several countries are facing fresh waves of cases. And deaths are inevitably highest in countries with the least access to vaccines.

The WHO has set a target for 70% of the global population to be vaccinated by the middle of next year, with 40% of populations in all countries fully vaccinated by the end of this year. However, it has now revealed that its initial target (10% vaccination in all countries) has been missed in more than 50 countries.

‘Even more countries are at risk of missing the 40% target by the end of this year,’ said Dr Tedros. ‘Three countries have not started vaccinating yet: Burundi, Eritrea and DPR Korea [North Korea]. About half of the remaining countries are constrained by supply. They have a vaccination programme underway, but don’t have enough supply to accelerate enough to reach the target.’

He called on the countries and companies that control the supply of vaccines to prioritise supply to the Covax and Avat (African Vaccine Acquisition Trust) initiatives.

The WHO published its Strategy to achieve global vaccination by mid-2022 earlier this month. It said that fully vaccinating 70% of the world population would require at least 11 billion doses of vaccine. By the end of September, almost 6.3 billion doses had already been administered worldwide and contracts were in place for most of the remaining 4.7 billion.

‘With global production at nearly 1.5 billion doses per month, from a supply perspective there will be sufficient doses to achieve the global vaccination targets if there is equitable distribution,’ the document said.

The total financing needed to vaccinate 70% of the world population in low and low-middle income countries is estimated to be around US$55bn. The majority of the vaccine doses needed by these countries have been secured through significant investment in Covax, Avat and bilateral contracts. However further funding is needed for in-country programme delivery, estimated to be at least US$8bn.

The strategy calls on countries with high vaccine coverage to swap vaccine delivery schedules with Covax and Avat. Vaccine producing countries are asked to allow the free cross-border flow of finished vaccines and raw materials.