Chapter 5 is 29 pages long and usefully describes the immobility and maelstrom of bureaucracy engulfing pandemic preparedness. 

The underlying theme is box thinking. 

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The term “pandemic flu” is mentioned 17 times, and the Inquiry makes many good points, such as the loss of institutional memory and lack of testing development without going into the reality of what happened. The effectiveness of physician interventions such as isolation and travel restrictions is assumed. As our readers know, there is little evidence that these measures work against endemic respiratory viruses. It was clear that SARS-CoV-2 was endemic on 8 April 2020 when we wrote, ‘What the current situation boils down to is this: is economic meltdown a price worth paying to halt or delay what is already amongst us?’

The opening paragraph (5.1)states, ' Learning from experience underpins proper planning: it should include learning what has worked and what has not worked in the past, recognising gaps in the system and remedying any flaws.’   Perhaps in the module 2 report, we’ll revisit this issue of what worked with SARs-CoV-2 and the more than 200 different policy interventions.

The Inquiry also reports that “there was no exercising of measures such as mass testing, mass contact tracing, mandated social distancing or lockdowns.” But this misses the point. Futile Dad's Army exercises do nothing to understand what works and what doesn’t. Cost-effective analyses are what you require. Once you have reliable effectiveness estimates and harms (not models, please), then you must carry out credible economic analyses of the relationship between societal costs and benefits. Think of a blanket that does not quite cover the bed with two people in it (not wrapping masks, of course). If you pull it one way. one person will be snug, the other not covered or covered insufficiently. This is the reality behind economic logic: resource scarcity.

Are you groaning because taxes are on the up? Think of the 37 billion wasted on mass screening or think of the equivalent stolen in fraud of Covid relief schemes. The latter sum probably being an underestimate.

While in the Report, there are many referrals to economic costs and one recommendation for a cost-benefit analysis; there is no specific mention of the need for a health economic analysis that sets out the cost consequences. For instance, what we want to know is the cost of closing schools over the short, medium and long term and what size of effect is required to offset the trade-off.  It wouldn’t have been amiss if the Inquiry had called in NICE to advise on assessing cost-effectiveness. NICE would have told the Inquiry to start ‘with collaboration with systematic reviewers to develop evidence syntheses for input into economic models.’ an approach, that would think outside the group, outside the box. 

The Inquiry also mentions a reluctance to disclose information, especially the results of the long lists of “exercises” or “pandemic preparedness stress testing.”

“The approach to exercises had been allowed to become bureaucratic and ineffective. The UK government and devolved administrations were overly focused on conducting exercises and producing reports, rather than on learning the lessons and implementing their recommendations.”

The TTE Office has a simple rule of thumb for assessing treatments. 

They have high-quality evidence for safety and efficacy that matters to patients—get on with it, then. 

They are safe but have yet to demonstrate efficacy—do the research then. 

If they have not met the standards of evidence for safety—get rid of them, then.

It's relatively easy, but if you throw in a few bureaucrats, advisors, and a government department, they often have no clue about what works, particularly what is “safe and effective”. Governments need to be seen as doing something, no matter whether it works or not. No one reads these government reports, but as they collect dust on the shelf, it says you’ve done your job.  

Chapter 5 does not mention the most important logical aspect: the ability or willingness of all those involved in decision-making to ask questions of public health bodies and so-called experts.

We will leave you to read the 29 pages. You may be interested in the Inquiry's post-hoc examination of the SARS, MERS, and Ebola outbreaks. Given that no searching questions were asked during the Inquiry and those giving evidence were mainly establishment figures, we are not sure there is much else to be learned from this chapter.

The chapter makes three recommendations. The first asks for more exercises at least every three years. Perhaps we could ask the BBC to televise them—they may make for fun TV.

The second asks for more reports. Odd, given the Inquiry considers “administrations were overly focused on producing reports. So more focus on producing reports that will no doubt gather more dust on the shelf.

Finally, recommendation 8 focuses on - yes, you've guessed it-  more reports.  

To say we are perplexed is an understatement. The recommendations are vague and contradictory. Why yet more reports? The Inquiry missed the opportunity to ask for a reduction in the uncertainties to work out what works and what doesn’t. However, whatever is recommended will require yet another report.

This post was written by two old geezers who will not charge you 190,000 Pounds a day for a report.