How the UK prepared for a pandemic 25 years ago – and what it got wrong

How can a government plan for the unexpected – plan, that is, for what the late Donald Rumsfeld called the “unknown unknowns”? It can’t, of course, which may account for the extraordinary degree of patience shown by the public in the face of the shortcomings in the UK’s (and specifically England’s) pandemic response.

On the other hand, preparations for “known unknowns”, in Rumsfeld-speak, can help with the unknown unknowns. The latest releases from the National Archives suggest preparations for something like today’s pandemic were taking place a quarter-century ago. Whatever has gone wrong since Covid emerged, the authorities had been thinking about such matters for a long time.

The March 1997 “contingency plan for an influenza pandemic” sounds quite prophetic: “The following conditions coexisting suggest that a pandemic is imminent – the emergence of a new strain of influenza virus which has a marked antigenic shift – a new virus; a high proportion of susceptible people in the population, ie with no immunity to the new virus either from vaccination or from previous infection with a similar virus; evidence that the new virus can spread and cause human disease.”

Waves of influenza and disease had attacked swathes of the human population before – such as the Spanish flu pandemic of 1918-1920. In the decades following, new diseases, flu and non-flu also emerged in the Middle East with the Middle East respiratory syndrome (MERS), Mexico with swine flu and, again in east Asia with avian influenza and severe acute respiratory syndrome (SARS). Each was alarming and a possibly narrow escape for humanity, given how quickly mutations can develop and jump species as we now know.

The substantive follow-up to the 1997 report took a decade to get underway. It was codenamed Exercise Winter Willow and it simulated a mass outbreak of avian influenza, involving every health authority and other interested parties, with 5,000 participants taking part over some months. The exercise usefully highlighted issues such as “business continuity” and schools closures but had little to say about testing and tracing.

Public health officials were still so concerned that by 2016 a full three-day “desktop” pandemic emergency called Exercise Cygnus was simulated across the UK involving almost 1,000 officials across health trusts, local authorities and devolved administrations. The lessons learned were officially summarised as follows:

“1. The development of a pandemic ‘concept of operations’ would assist in managing a cross-government and multi-agency response, ie how government works with responder

2. The introduction of legislative easements would assist with the implementation of measures that might be employed during a pandemic

3. Public reactions in response to a reasonable worst-case pandemic influenza need to be better understood

4. An effective response would require capability and capacity to surge services to meet demand.”

As the Health Select Committee noted in its insightful 2021 report on the UK’s pandemic precautions, the official focus was on influenza rather than new respiratory syndromes (such as MERS and SARS) and so was arguably too narrow. It would certainly account for some of the complacency and confusion in early 2020 – because scares such as swine flu and SARS had come to nothing.

This was despite National Risk Register assessments identifying a pandemic as the primary threat to the UK, ahead of terrorism or war. Some of the “wrong” personal protective equipment had been stockpiled, for example. However, the committee identified a key weakness irrespective of the nature of the disease: “The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it ‘runs hot’ – with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic.”

That now-familiar terror of NHS collapse in the face of surging cases curiously did not figure as extreme but as a likely danger in past planning. We know better now, though. Don’t we?