Years of cuts to public services and austerity left our health and care services lacking the capacity needed when disaster struck.
While our world-leading scientific community have led in Covid treatment trials, vaccine development and genomic sequencing, we must now rebuild our public health capability to match our scientific one.
In March 2020, no independent public health expert sat on SAGE. Instead of preventing infection in the first place, the UK based its strategy on avoiding overload on the NHS.
But we lacked capacity too. The NHS entered the crisis, short of 100,000 staff including 40,000 nurses, we had fewer acute beds than 10 years ago. Our PPE stock pile had dwindled. Operations were cancelled and treatments delayed.
But a strategy based on the fundamentals of public health and prevention would have meant we didn’t have to choose between Covid care and cancer care.
Our lack of preparedness was most evident in public health. Years of cuts left local services reduced and overstretched. And yet once in an epidemic, it is local public health professionals who are trained in the techniques of disease containment and who should be leading the response.
They should have been resourced from the start to do case finding and the retrospective and forward contact tracing that hunts down and breaks onwards chains of infection, as happened successfully in South Korea, Taiwan and Vietnam.
Instead the Government spent billions on private sector alternatives who are less effective than experts rooted in communities on the ground. And scandalously those who are sick or need to isolate still aren’t given adequate financial recompense to do so – a fundamental failing of Test and Trace.
We are a rich country with millions of our citizens walking a tightrope of ‘just about getting by’. Covid knocked them off that tightrope – it hit incomes, it spread easily in public facing workspaces, crowded factories and overcrowded housing. It caused severe disease.
If it is unforgiveable that so many were left so exposed, how much more unforgiveable is it now to refuse to invest heavily in public health for the future?
Investing in public health and narrowing health inequity is a guiding mission of mine. It is the lodestar that guides me. Population health and wellbeing must be at the centre of all policies in government.
We can’t precisely predict which disease will take off next or when but we do know that it will come. In the last 100 years we’ve experienced flu pandemics, the emergence and spread of HIV/AIDS, Ebola, SARS, MERS, Nipah virus and Zika virus.
The majority of emerging diseases and almost all known pandemics are zoonoses, caused by microbes of animal origin that ‘spill over’, Jumping from animal to human (and often back again). And this is happening with increasing frequency.
From environmental degradation and biodiversity loss, deforestation, land use change to the exploitation of wildlife – these all bring humans into greater contact with wild animals creating the conditions for increased pathogen transmission between humans and animals.
Given Covid-19 has already cost the world 2.6 million lives and an estimated $28 trillion dollars – and cost the UK billions of pounds – this can be no time for complacency. So what further action do we need to take?
The first action is implementing our core commitment to public health to build a resilient, healthier and fairer society at home and supporting others to do so abroad.
Secondly, given we now understand the dangers of environmental exploitation in driving zoonotic spill overs, tackling climate change and biodiversity loss with a green recovery from the Covid crisis is more urgent than ever.
Next, science remains a cornerstone of a successful future. We need a global alert system to spot outbreaks quickly.
Finally, as Secretary of State for Health, I would report to Parliament annually on pandemics preparedness placing the public health and wellbeing at the heart of everything I do.
Never again should we have Ministers ignoring the science and learning on the job.
Jonathan Ashworth is Labour’s Shadow Health Secretary who addressed the IPPR think-tank. This is an edited version.
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