What price resilience? August 2020

As part of FIRE’s call for a Charter for Resilience, FIRE’s Security Correspondent Dr Dave Sloggett proposes the creation of a National Resilience Fund to better prepare the UK for future national emergencies

In formulating a policy towards creating a national resilience capability, it is clear that one thing is indisputable: prevention is always cheaper than cure. It is a point illustrated dramatically by the Covid-19 crisis. For countries like Taiwan, Singapore and several others the lessons they learnt from the past SARS and Swine Flu epidemics served them when Covid-19 struck. By being ready they had developed a core national resilience to what they saw as a likely future event.

While there are some things that makes it is easy to be sympathetic towards the UK government, such as the sheer volume of tactical and operational problems that a pandemic such as Covid-19 creates, there is one thing that is very difficult to forgive. That is the lack of basic preparation at the strategic level for a disease that was always going to happen.

Precursor Pandemic Alerts

Of itself that is a massive oversight and an illustration of classical myopic thinking. Given the 2003 SARS outbreak and then Swine Flu in 2009 and the problems with Ebola and Zika – the mosquito-borne viral disease with neurological and immune complications associated with its infections in human beings – surely a pattern has emerged in even the most politically inept ministers that should have flagged up the potential for another major pandemic to occur. The natural world is a massive reservoir of disease that we have not begun to understand in any great detail so it’s obvious that a number will be capable of migrating from animals to humans, with highly unpredictable results.

Given this simple fact, being prepared for some kind of new pandemic is an obligation on government, not a nice to have. Governments cannot rely on people being steadfast. Churchill’s famous dictum that “if you are going through hell, keep going” does not resonate with a population whose expectations have been set by their current standards of living.

Just because the Spanish Flu happened nearly a century ago, there is no excuse for ministers or officials to ignore what is obvious. It took scientists until 1942 – 24 years to develop a vaccine for the disease which caused nearly 500 million people to die across the world. The virus itself was not even recognised until 1933. We are fortunate today that scientists are able to quickly isolate the genome and create a model of the virus that enables it to be attacked so that a vaccine can be developed.

One notable benefit has been the way the Internet has enabled scientists the world over to share their research. It is a point that its inventor Sir Tim Berners-Lee would be pleased to see, instead of the harmful and destructive societal impacts that emerge from the ubiquity of social media and its ability to propagate fake news to those ready to believe anything that appears on Twitter.

Another innovation has been the acceptance of pre-print papers instead of those that have been fully peer-reviewed. This has helped the response. Science, however, can only take a number of shortcuts.

But is this a basis for resilience? Simply saying whatever virus arrives we have the international science base capacity to quickly solve the problem is not an answer. Given the vast range of possible future pandemics that live in the animal kingdom, that seems to be shaky ground. The Japanese proverb “fall seven times but stand up eight” is not a great guide for how we should approach things of such national strategic importance.

Even with the rapid response of science to the current outbreak, nearly ten million people have caught the disease and nearly 0.5 million have died at the time of writing. In 2003 it took weeks to get samples moved from China to America, having to overcome a vast array of bureaucracy placed in its way losing many thousands of samples on tarmac awaiting clearance.

If a minister consulted with anyone with a basic grasp of mathematics, specifically probability theory, they would be told on the basis of the outbreaks of various flus and other serious diseases across the world that in an era of highly connected travel the next pandemic would spread like wildfire.

The idea of choosing not to be ready for what was obvious – 100 percent likely – is folly. With the death toll in the United Kingdom passing 40,000 and possibly going to grow even further should a second wave occur; the situation is serious to say the least.

With ministers using the current situation to push-back on the timetable for some kind of inquiry, saying they are too busy dealing with the current outbreak, it is possible to suggest that there will never be a good time for lessons to be learnt. So, we might as well do this now, while we are in the middle of the crisis, rather than postpone judgement day.

Given this pathway and the increasing likelihood that we will face a second wave of deaths what could, and indeed should, the UK government have done to better manage the situation? Some overseas thinking is worth drawing upon.

“Being prepared for some kind of new pandemic is an obligation on government, not a nice to have”

Fully Resilient Society

In Taiwan in the aftermath of the 2003 SARS and the 2009 Swine Flu outbreaks the government decided to instigate a national screening programme. This enables a country to keep up to date with any new disease that appears to cross from animals to humans.

By routinely and randomly sampling blood from across the population, allowing for ethnic variations, a national testing programme would have picked up on the emergence of Covid-19 earlier and even localise it from the beginning. Combined with a working track-and-trace system from the outset and containment was a viable approach. But that investment in a national tracking system was thought unnecessary.

What the government tried to do in Phase One of its so-called plan to contain the virus was always going to fail. With international travel taking Chinese travellers into northern Italy where they met people from Brighton who had gone skiing, the idea of containment was always unlikely to be sufficient.

To be fair to ministers the plan that was laid out did envisage the possibility for containment to fail. Other phases were immediately on their radar horizon and the rapid roll out of the Nightingale hospitals – to create the spare capacity if things panned out badly – showed just how flexible the National Health Service can be when placed under pressure.

The routine cancellation of operations and treatments – a necessary evil to maintain capacity in intensive care units – only postpones the backlog of surgery and other activities to be performed after the crisis has passed. That is not a fully resilient response. What has been achieved, pragmatically, is partial resilience, moving some of the problem forward to be dealt with later. This does not really answer the question as people will die as a result.

This raises the issue of what kind of resilience do we want in society? Do we want a society that is partially resilient or one that is fully resilient? Of course, any strategy that leans towards creating a fully resilient society is going to cost money. As government scientists have consistently reminded us of late, this is all a question of risk. No strategy can be fully risk free. There is simply not enough money or trained people to ensure that can occur.

As a society, however, we can seek to better place ourselves somewhere in the spectrum of possibilities between the medium point of resilience and the high-end. Being completely unprepared, as the UK was in February 2020, is not acceptable. Having to bid for PPE kit in a global market, for example, paying over the odds for equipment that barely passes standards, is not acceptable. People in the NHS paid for that mistake with their lives. Not a trivial point irrespective of someone’s political leanings.

National Resilience Fund

To address this fundamental question governments, like the UK, need to be more transparent about their resilience planning. Costs involved in having spare capacity, such as PPE that needs to be replaced regularly, need to be specifically identified. Like money set aside to deal with flooding, buying large pumps for the Fire and Rescue Service, and defining them as a strategic asset to be used anyway they are required, there should be a National Resilience Fund. This would be at the heart of the national Charter for Resilience, as we have previously outlined in FIRE. It would be money that would be ring-fenced and defined as a legal obligation on future governments.

By comparison with the current estimate cost to the UK economy of around £500 billion pounds and unemployment levels not seen for many years, with the potential for societal disruption and protests, a National Resilience Fund of say £2 billion a year, or £20 billion over ten years, seems great value.

With 30 million, approximately, taxpayers in the UK that is £70 per person a year as a contribution, or 18 pence per day per person. It is possible to wonder who, given the scale of this problem, would argue against a 20 pence per day insurance against another even more challenging outbreak.

There would be many calls on this fund. From defensive scientific research to address what might come down the line to maintain the national track-and-trace facility and to purchase and store PPE and other equipment that would be needed. Maintaining a core nationally capable production capability for things like ventilators and new developments of such equipment would also be a responsible expenditure of money. Above all, ensuring that the emergency services have in-built resilience to any future trajectories of pandemics would also be important.

That in-built resilience would also provide greater national coverage against novel acts of terrorism (either state or non-state based) and national disasters linked to climate change. Such an approach would clearly be based on the idea that prevention is better than cure. A salutary lesson that everyone involved in the response to Covid-19 would no doubt agree is vital we learn as a society.