As a cancer specialist, I’m desperate to ensure the government doesn’t repeat coronavirus mistakes

With intelligent and properly resourced national public health approaches, we may be able to avoid the dreaded second and third waves

Only the fullness of time and a comprehensive independent public inquiry will allow us to judge how the UK government responded to the Covid-19 pandemic.

While some would argue that now is not the time to criticise, I believe we need to understand past mistakes to better plan for the future – and to make sure that, if there is another viral pandemic, we prioritise healthcare from the very first moment.

A clear and obvious error has been a lack of preparedness. Viral pandemics are a cyclical inevitability and always feature on the government’s risk register. Yet the report from Exercise Cygnus, a three-day pandemic simulation involving government and public health bodies in 2016, has not been made public. In June 2017, minutes from the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) made four key recommendations, including strengthening surge capability and hospital capacity. It is questionable whether this advice has been heeded.

Although the NHS has managed to avoid being completely overwhelmed, this has only been possible by stopping virtually all elective activity and turning large sections of hospitals into ITUs and Covid-19 wards. The knock-on effects for patients with cancer, heart disease, strokes and other diseases will add to the death toll related to Covid-19. In cancer care, where I work, diagnostic tests have been delayed and oncologists have had to risk-adapt many of their treatment schedules because of the immunosuppression and increased infection rates associated with cancer treatment.

The lack of PPE and ventilators is another serious example of being ill-prepared and has put the NHS, social care staff and patients at risk. In fact, Public Health England guidelines on the use of PPE appear to have been driven by shortages rather than the WHO evidence. There are even concerns over the decision to downgrade Covid-19 from a High Consequence Infectious Disease (HCID), a category of disease that mandates the government to provide full PPE. None of this has been helped by the bungled, missed opportunity to join the joint EU procurement schemes for such equipment.

Another clear error was the policy of “herd immunity” without a vaccine, which the government has since tried to deny. No one would argue with the policy to “flatten the curve”, but speeches by chief scientific officer Patrick Vallance and chief medical officer Chris Whitty made it crystal clear that a population infection rate of 60 to 80 per cent couldn’t be prevented. This was a clear indication of their thinking that we wouldn’t be able to develop an effective vaccine or treatment in time, and we should allow the infection to work its way through the community in a “controlled” manner. The term “cocooning” was used to describe the shielding of the elderly and the vulnerable from the virus until “herd immunity” had been achieved by infection of younger generations. However, anyone who has worked in care homes and nursing homes knows they are tinderboxes for infection and it is no surprise that high mortality rates are now being reported.

The decision for “herd immunity” will be one of the most important contentious facets of any public inquiry because it may also tie in with the UK’s delayed approach to reacting to the pandemic, compared with many other countries. As Richard Horton, Professor John Ashton and many other experts in the field of public health have said, “February was the missed opportunity”.

It is therefore crucial to know what the Scientific Advisory Group for Emergencies (Sage) and Nervtag were discussing and deciding at the time. The issue of political interference is a critical one because we know Dominic Cummings, the PM’s key adviser, was present and actively participating in secretive Sage meetings. This brings the impartiality of the committee into question and most importantly of all, the role of the prime minister.

One of the most revealing speeches was Boris Johnson’s “Superman” speech on 3 February when he said the UK would take off “the Clark Kent spectacles” to make it the supercharged champion for the free market economy over any healthcare concerns. No wonder, then, we had the “I shook hands with everybody” speech and the This Morning “taking it on the chin” interview, as well as the delays to close huge events like Cheltenham and the Liverpool v Atletico Madrid game.

As we appear to be over the peak of the pandemic, the key question now is, how do get out of this crisis? Only via a highly effective vaccine or new treatment, and that could still be well over a year away. In the meantime, the key is to keep the R0 (replication factor) below one, while simultaneously and carefully releasing the lockdown to restart the economy. We are clearly going to require expert guidance and consensus and we should start by reflecting on whether the composition of current expert advisory committees needs to be bolstered – Professor Anthony Costello has made compelling arguments to increase the representation of Sage.

We have much to learn from success stories such as South Korea, and with such intelligent and properly resourced national public health approaches, we may be able to avoid the dreaded second and third waves.

Then there is the economic calamity that we face. We know that economic hardship is detrimental to population health. A key component of this is wealth inequality, which has been unequivocally shown to cause health inequality and increased mortality. We now have a once in a lifetime opportunity to properly address wealth inequality and repair the global economy at the same time. A global governmental effort to open up tax havens and increase wealth taxes on the super-rich could release funds to help the unemployed and the vulnerable, as well as support and bail out businesses to save and create jobs. It won’t be easy, but the shock to the world that Covid-19 has generated may be the trigger to make this happen. That at least would be a potential silver lining to this tragedy.

Dr Clive Peedell is a consultant clinical oncologist and co-founder and former leader of the National Health Action Party