The following is an edited version of Kamran Abbasi’s remarks at a UK Pandemic Ethics Accelerator event on 23rd May 2022, discussing the place of values in public policy during a pandemic
Dr Kamran Abbasi is a doctor, journalist, editor and broadcaster. Following five years in hospital medicine, working in various medical specialties such as psychiatry and cardiology, he moved into senior editorial roles at the British Medical Journal. In January 2022 he became Editor in Chief.
When thinking about how to approach the question of values in the COVID-19 outbreak in the UK, I begin with the values that we hold at The BMJ and consider how these played out in the pandemic. Our values are openness and transparency; being evidence based; being patient-centred; and being courageous. I think values are very important, and I remind our editorial team of them on an almost daily basis.
Openness and transparency
Turning to the pandemic, we can see many instances in which there was no openness and no transparency. Take, for example, the government contracts that were awarded. Information emerged slowly and belatedly, and after intense inquiries from a number of people to get at what happened. These contracts run into hundreds of millions, potentially billions. So, a lot of money was awarded with a complete lack of transparency. We now realise that this went to many parties, individuals, or corporations that were entirely unsuited to delivering on the contracts.
Another area of lack of transparency was around science policy. Even though, we, in medical journals, often have an inside track, we were left baffled as to where science policy was coming from. The advice was often attributed to government’s Scientific Advisory Group for Emergencies (SAGE), and also the Joint Committee on Vaccination and Immunisation (JCVI), but it wasn’t always clear how much any advice was reinterpreted by politicians. Although policy makers regularly said they were “following the science”, it wasn’t clear what science they were following.
I think the test of transparency and openness was thoroughly failed.
Looking at whether policy was evidence-based, I think we can say that it probably wasn’t. We don’t know what the government was taking as its scientific advice. However, we know that there was existing international evidence, from the countries of East Asia for example. Anyone who attended conferences about SARS in that region could not escape discussion of their experiences and what they learned had worked well and didn’t work so well. The idea that somehow the UK and other major countries were unaware of that evidence or those experiences, or were unable to use what was already known about handling pandemics, or that the challenge of responding to a pandemic somehow came as a bolt from the blue, is not credible.
To take the example of asymptomatic transmission of SARS-CoV-2, and the recent judgments relating to what happened in care homes: the government tried to deny that it knew about asymptomatic transmission. Yet this was something people were talking about at the beginning of the pandemic. If you’d read the evidence or spoken to anyone about the experience of East Asia, and of other pandemics, you would understand that asymptomatic transmission is possible and needs to be catered for. To pretend that this evidence did not exist is certainly not following the evidence.
There are many such examples. So, it’s clear policy-makers did not live the value of being evidence-based.
All the progress that had been made towards making decision-making more patient centred in health systems, including in the UK, went out the window with the pandemic. We went back to the bad old days in which patients were told what needed to be done to them. They were instructed, there was no co-creation, or listening to the patient voice and the patient experience. And it wasn’t just the patient voice that wasn’t heard. The voice of frontline staff was also largely ignored. So we failed too on this third value.
You might say that the government, or governments were courageous in their policy making, in that they withstood a good deal of criticism. Perhaps they did, but I would say they haven’t been truly courageous. For example, it would have been courageous to have held a public inquiry early on in the pandemic: to hold a learning-oriented public inquiry, where we learn from our past experiences and modify policy in the wake of them. The UK government, particularly in relation to decision-making for England, did not want to do that because they didn’t want to be shown to have failed on the pandemic. I think that not opening up or facing your mistakes, being unaccountable and being seen to be unaccountable is a lack of courage. This has been a major failing of the political classes during the pandemic, and it needs to be fixed.
Hence, I argue that the values that we hold dear at The BMJ, values that are important for health and wellbeing, were absent during the pandemic.
Other questions of values
The other issue to highlight is a lack of learning. We failed to learn from international experiences. Countries behaved as if they were isolated and unconnected to other countries. That isn’t the case. The pandemic was a global event which affected nations across the world. Learning from the evidence and experiences which are readily shared was crucial. In any case, what any one country did had an impact on another country. An isolationist approach was a terrible and grave mistake.
The final point, I’d like to highlight, is the impact of the pandemic on inequalities. In many health systems, not just the UK, inequalities were worsening pre-pandemic. The pandemic simply accelerated that deterioration. Now we have a cost of living crisis, and yet there seems still to be an absence of political will to tackle these inequalities. I think that we will continue to pay for these mistakes for many years to come.