The UK's COVID-19 public enquiry, with Richard Horton

The first module of the UK's COVID-19 enquiry was published in July 2024. The enquiry found that the UK prepared for the wrong sort of pandemic, suffered from groupthink, and ultimately failed its citizens, more than 200,000 of whom died as a result of the pandemic.
 
Editor-in-chief of The Lancet, Richard Horton, joins Gavin and Jessamy to discuss his experiences giving evidence to the enquiry. We reflect on the findings, dissect their meaning for pandemic preparedness, and talk about what the UK government needs to do next.

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Gavin: Hello, and welcome to The Lancet Voice. It's August 2024, I'm Gavin Cleaver, and I'm joined, as ever, by my co host, Jessamy Bagonal. In July this year, the UK's COVID 19 public inquiry released the findings from its first series of hearings. The Module 1 report states that the UK prepared for the wrong sort of pandemic, suffered from groupthink, and ultimately failed its citizens, more than 200, 000 of whom died as a result of the pandemic.

Editor in Chief of The Lancet, Richard Horton, Was called to give evidence to the COVID inquiry, and Jessamy and I sat down with him to discuss his experience in giving evidence, what he thought of the outcomes, and what actions future UK governments need to take to avoid a repeat. Please enjoy our conversation with Richard Horsond.

Jessamy: Richard, thanks so much for joining us. You gave evidence to this module, in fact, that's just been released. And maybe you could take us behind the scenes of what that process was like, how it felt for you. And what it's been like since then, because I know I remember watching it very vividly, watching it.

And what's happened since? Have they been in touch with you? 

Richard: It was excruciatingly scary to be completely honest. Given evidence countless times to House of Commons select committees of various kinds. And that's nerve wracking enough. But this was a different level because you were talking on oath.

And the fact that you went into this inquiry room where there were on your right hand side, families and relatives of people who had died of COVID 19 that put an exquisite sensitivity around the whole proceedings. And then you were swearing on oath. And you realize that this wasn't just an inquiry taking evidence.

This was a proper legally mandated process. So the the level of seriousness about the whole event was was really quite quite impressive actually, because you really felt that this was a process that. One could trust in and that was going to deliver something significant. You go in, you're taken to a room before you give evidence, you sit in this room alone.

And then the barrister who's going to be asking you questions comes in and gives you a little briefing about what he's going to ask you. And then you're called in, you take the oath, and off you go. It was, it and then Baroness Hallett, who of course is chairing it, she would often interject questions herself.

But I, I found the whole the whole process, actually really quite surprisingly impressive. And that's why it's interesting. We're recording this today. Where a report from the CQC on Valdo Calacane has just come out. And this is somebody who had a diagnosis of paranoid schizophrenia and went on to kill three individuals Recently, and of course, the families have been calling for a public inquiry, a judge led public inquiry.

And I must say that having gone through the COVID 19 inquiry, this first module, I'm much more sympathetic now to the idea that a judge led public inquiry as has taken place as is taking place for the post office inquiry currently can create the conditions for a sort of legal inquisition into questions which an ordinary review of the evidence just couldn't possibly do.

So yeah, it gets a vote of confidence from me for sure. 

Jessamy: That's interesting, isn't it? And do you think that's because of the quality? Is it the independence? Is it the whole sort of rigmarole of it? Or 

Richard: I think it's having what also impressed me was the knowledge and the depth of knowledge of the lawyers who were asking you questions.

The witnesses were supposed to be the technical experts, but it felt sometimes and watching the evidence subsequently it felt sometimes that actually it was the lawyers who knew the evidence better than some of the experts. Clearly they've got teams who are researching every single detail of the timeline.

The exact facts, including really quite complex epidemiological scientific information. And they are drawing on that in their questions. So I think it's the quality of the questioning. It's the formality, the legal formality of the process. It is the context that you're doing this, you're accountable to the public, you're accountable to some of the victims who are there in the room and you're trying to make a contribution to improve the process so it doesn't go so wrong again in the future.

So no, it was yeah I would say it's, and it's proven, I think with this module one report, it's proven that it's delivered something not just substantive, but really quite transformational. 

Jessamy: Yeah, I agree. And of course, all of this really is about how you know, the state looks after people and you know what we're going to do next time.

And Gavin, this is politics. So I thought maybe you can take the next question. 

Gavin: Oh, yeah. Okay. So in the first module, it's quite striking that it states that the primary duty of the state is to protect its citizens from harm. It's therefore the state's duty to ensure that the UK is as properly prepared to meet threats from a lethal disease as it is from a hostile force.

Boasts a threat to national security As this was something that we talked about a lot in the first year of COVID, when we were doing these podcasts originally, but it's gone off the radar since then. In fact, the election that we've just had, there was very little talk about how such planning might work, for example.

And the topic of the pandemic has been, I'd say to some extent, glossed over. politically, at least. What do you think of that particular comparison about the duty of the state? 

Richard: Yes, glossed over, I would say, completely shoved to one side and ignored consigned to history, a history that nobody particularly wants to talk about.

And all of the individuals, all of us who were involved in this whole episode in our history, None of us have been called to account for it. This is the only process which has tried to do and it's really important. Yes, absolutely. The first duty of the state is to protect its citizens. And what is so refreshing about Baroness Hallett's first module report is that she's very clear.

She pulls no punches. She says unconditionally that the system failed. That was the goal of the system, to protect its citizens, it didn't do and she dissects with numbing, really quite frightening detail, exactly how and why the system failed. And I don't think anybody has written such a powerful indictment of the British state.

That I can recall in 30 years of working at the Lancet. 

Gavin: But it's quite it's quite philosophically interesting as a statement, isn't it? So much of political discourse at the moment is about wars around the world, but yeah, you write glossed over is not the right term for what the COVID pandemic has become.

Is there anything outside of this sort of inquiry, greater political action? 

Richard: It's interesting you mention wars. What she actually says in the report, which is a very important lesson for the state, which is we think about the threat of a hostile other state. which could precipitate a war, we need to be thinking about a virus or a potential future pandemic in exactly the same way as we think about a hostile state.

This, whatever the threat is, it leads to the same outcome, which is a civil emergency. And we have to be prepared and resilient for that civil emergency. And one of the, one of the mistakes was that we we absolutely were not, and she enumerates the reasons why we were not. We just didn't take this kind of threat anywhere near seriously enough.

And she reflects that in her recommendations. Instead of saying this is just an issue for the Department of Health and Social Care. No, it's not. This is not just an issue for the Department of Health and Social Care, this is an issue for the whole of government, for the whole of society, and unless we elevate our level of concern as if we were dealing with a war, then we're going to fall into the same mistakes again in the future.

Gavin: It often strikes me with this pandemic that we were quite lucky that there was such a relatively low mortality rate compared to something like, for instance, the potential for bird flu, which The cases so far that have happened around the world in the most recent outbreak have had a very high mortality rate.

No, I completely agree with you. It's it's something that We saw the way it consumed government and political processes when it arrived. So it's surprising that it's not considered to be a whole government issue in situations like this. Were there any of the recommendations that you found surprising?

Obviously the main, the top line is that we prepared for an influenza pandemic, which didn't happen. But was there anything that you found more, more Interesting or engaging than that. 

Richard: I think there were several dimensions to the recommendations that are worth reflecting on.

First of all, she absolutely, again, sweeps away all existing. This isn't about modifying an existing system. This isn't about tweaking it or optimizing it. This is about getting rid of everything that we've done in the past and literally starting with a blank sheet of paper. Top of the list is. This has to be a cabinet office level coordination leadership.

You have to have the prime minister or the deputy prime minister leading the response. So remember go back to the beginning of 2020 where Boris Johnson was off doing something but he certainly wasn't chairing the Cobra meetings. 

Gavin: I believe he was writing a book. 

Richard: Indeed, he was using his early period of his new prime ministerial position to catch up on a book contract that he had not he'd not fulfilled.

previously. Indeed. So you need to have the, you need to have a cabinet office committee leading this similar committee of civil servants across all departments supporting that cabinet office leadership. At the same time, you need to get rid of, and this is for the scientists. So we focused on the idea of a reasonable worst case scenario, one worst case, one scenario.

That was a big mistake because that's what led us into thinking about flu and not being prepared for anything else. Baroness Hallett says, throw that out. We need to think about multiple scenarios, multiple risks, and multiple ranges of risks. And There's a much more complex pattern that she's asking us to consider, but that's what she's recommending, and indeed it's true, if we had not thought about just an influenza virus, but we'd thought about a coronavirus, or something like Ebola, or any one of the viruses or bacteria that might be a threat to human health, we need to have those considered.

She says, don't just do it once because the strategy we were basing our response on was from 2011. You need to update this every three years. But I think for me, the really interesting recommendation, one that I certainly hadn't considered is this notion of red teams. And she says that because the bit another big mistake was that everybody fell into groupthink.

We have some of the best scientists in the world in the UK. on all these different committees. And yet, everybody coalesced around one idea, one response, and that led us down the wrong path. So how do you challenge groups and can this is where this notion of red teams comes in. In other words, people who are specifically tasked groups outside the system of decision making and giving advice to government groups that are specifically tasked to think differently, to challenge the received opinion.

And what she says in her report is that actually this notion of red teams that should do this challenge should be adopted, not just in the situation of a civil emergency, but across government. And I do think actually it's she makes such a persuasive case. And I think we all know in our daily jobs that kind of discussion where somebody challenges the consensus and says have we thought about something else what if we did it a different way what if it could be such and such something else that's the cause of this that Having more people in the room to challenge and think produces a better decision, a better outcome, and specifically tasking people with challenging that group saying, I think that's the, if I had to single out one innovation in her report that could make the biggest difference, I think it's that proposal for red teams.

Gavin: If I could play devil's advocate for a second, there was, to some extent, a challenge of the groupthink, but it was definitely not the right kind of bread team that you're talking about. If you remember later on in the pandemic when Rishi Sunak had more of the Prime Minister's ear, he repeatedly invited in the authors of the Great Barrington Declaration to advise on lockdown policy.

So how do we then ensure that it's the right sort of red team? 

Richard: That's a really good example. Because that was, the people who were the advocates of the Great Barrington Declaration, indeed, were called into 10 Downing Street to advise Boris Johnson. And they got a platform that they should never have had.

But that said, I do think the problem is we need to be open to all ideas, even if we don't necessarily agree with those ideas, because this is also about building public trust. She doesn't go into this in this report, because this is module one. It's about preparedness and not the response.

But one thing we saw during the response that there was, I won't say catastrophic, but there was a serious loss of public trust amongst some parts of the community, especially regarding wearing masks, about social distancing, and even about vaccine uptake. I saw some of it myself in London. I went to several meetings where you saw people who were vehemently against the mRNA vaccine standing up and having literally thousands of people almost worshipping their every word.

So there were, there was a significant problem there. Why did we lose trust? We lost trust partly because We didn't open ourselves up to a conversation with the public about the safety of the vaccines, about why we should be using the vaccines in the way we were using them, about the uncertainties we had about the vaccines, for example, amongst children.

So we were very directive about what we were telling the public, which is completely understandable in a public health emergency. But I think looking back, we probably needed to have admitted our uncertainties quicker and engage the public more with those uncertainties. Because we lost people. We lost a lot of people.

And there were ideas circulating, for example, that the vaccine wasn't safe among pregnant women, which were really just wrong. and were ultimately extremely damaging. So even though I didn't like the Great Barrington Declaration, I think opening ourselves up to listen to the views of other people, and having conversations with people, Respecting different views and not dismissing them is probably one important lesson.

Jessamy: I think that's right, isn't it? Because it's not only just about trust either, because there were, lots of periods and examples where actually the scientific community were unsure. And having these types of challenges to the kind of prevailing accepted knowledge is very useful to be able to really delineate and articulate why that might be wrong.

And actually that did happen with the Great Barrington Declaration. The scientific community rallied around that and actually were, much more forcefully able to articulate why they disagreed with the well, then perhaps they had been before it had been. 

Richard: I think that's absolutely right.

That's true. The challenge did lead us to engage more forcefully. I think But I think there are, there were points of genuine uncertainty and different perspectives that I don't think we always explained well to the public. I think this issue of vaccination among, in children was one of them.

I think if you came from a public health perspective there was a view that we need to vaccinate as much of the population as possible. That's the best way to literally shut the virus out of our communities and to shut down transmission. But if you're a pediatrician, I think the view was very different, which was don't give a vaccine to a child.

if it's not protecting the child. If you're just giving the vaccine to the child to protect the community, that's not a good enough reason because you've got to take the risk benefit into account. And that was the debate that was taking place behind the scenes, but often When I heard public health representatives or pediatricians on the radio discussing this was not made explicit and there were two very different philosophies behind the debate.

And so it appeared like we didn't know too really what we were talking about when there were these public debates. We did, but we weren't explaining that there were different fundamental ideas behind the advice that was being given. I think we in science and medicine need to be much more transparent about our thinking, about the philosophies that underlie our thinking and recommendations.

And sometimes we're not And that's, I hope that in subsequent modules, some of that some of those subtleties come out. 

Gavin: It's a super difficult balance to strike, isn't it? Because so much of the early pandemic was us saying not say the government saying, follow the science. This is the scientific consensus.

This is what we're going to do. But then when the public sees that on one hand with those daily conferences where people just say, follow the science repeatedly, and they see on the other hand, the differing opinions within the scientific community, 

Richard: there's no such thing as the science. 

Gavin: No, exactly. There are multiple.

And I think perhaps that wasn't as actually particularly well explained. 

Richard: It wasn't well explained at all. But I'm sympathetic to those who had to communicate these messages. We're in the middle of a, of an emergency. We don't really know the threat that we're dealing with as well as we would like to.

And so we're trying to give as clear directive. information and advice as possible. Did we, could we improve on that? I'm sure we could, but at the time the state, people have come out so strongly against lockdown saying that lockdown was the absolute worst thing we could have done and we should never do it again in the future.

Go back to those weeks in February of March 2020. We should have had the stay at home order Way before March 23rd, which is when we brought it in the UK, the evidence was there. But we didn't respond fast enough, but to say that lockdowns were not the right intervention just flies in the face of everything we know about a virus being transmitted in the community.

And if you go back and read Daniel Defoe, it was, they did lockdowns at exactly the same time several centuries ago, people isolated themselves away in their houses when there was the Great Plague. It's the only way to shut down. person to person transmission, which is your principal goal. So there are things that we could have done better admitting uncertainties, but at the same time we shouldn't lose sight of some of the important public health messages.

I do hope some of this comes out in the subsequent modules. 

Gavin: Yeah, I think a lot of the subtleties of non pharmaceutical interventions were lost as well, weren't they? Because lockdown has now become this sort of catch all term. I often think how striking it was, Jessamy, when you and I spoke to Jeremy Hunt at the height of the pandemic.

And he said, actually, what we would have done if we were, going on the sort of model that happened in Singapore, for example, is we would have gone harder and faster on lockdowns, which is now by this point, three years politically down the line, the opposite of the message that the Conservative Party is delivering.

Richard: Just on that, there's another important recommendation in Baroness Hallett's first report. And that is that when we're thinking about devising a strategy, a pandemic response strategy. And we're thinking about the different scenarios. Instead of just focusing on the health outcomes, we should also take account of the impacts on society and the economy.

And I think that's, that was another mistake in retrospect, that we focused only on one dimension, without taking account of the wider impacts of the pandemic. And that did lead us, I think, at various points, to we got into all these complicated arrangements about how many people you could have in the house, the rule of six, or the rule of whatever it was.

It got incredibly complicated to the point, almost absurdly 

Gavin: yeah, I'll never forget the substantial meal dick tap, for example, in 

Richard: That's right. That's right. And also people literally being arrested for two people. I remember two women who went out for a run together and they had a cup of coffee in their hands and they were stopped by the police and fined because they violate.

We got to some ridiculous places here because we were focused only on one outcome. Whereas you have to think and this is also I think what led to the loss of trust in the system. And unless you take account of those broader dimensions, then that's going to lead you into some real problems, which we saw.

So she's arguing very much for much when we're thinking about these multiple scenarios and multiple risks, then think about the multiple outcomes to 

Gavin: Especially taking children out of school for that long, which is already being shown to have a lot of knock on effects on that particular disorder.

Richard: Absolutely. Absolutely. Absolutely. But I think with the children, we were, again, genuinely operating in a sort of, at a moment of terrible uncertainty. Everybody was worried about children going back to school. to homes where there were multiple generations and possibly transmitting to older, more vulnerable generation.

And again, this is another one of her recommendations that in your scenario planning, Think about who the vulnerable groups might be and play out in your scenario, how you're going to deal with those vulnerable groups. Of course, the next virus that comes isn't going to be SARS CoV 2 and this is where we end up, getting into groupthink again.

So now we think, oh, is the next virus going to be a coronavirus? No, it's probably not. It's going to be some other virus, which is going to not affect older people so much. Which it may affect. children more than older people, or women more than men, we don't know, we have no clue what's what it's going to be.

So this is why we have to be very careful about not getting locked into one perspective. 

Jessamy: And maybe I can just Ask you a bit more detail about that, because I was glad that you highlighted those two aspects on, the chapter on risk is fascinating. And then, doing away with all of the sort of pandemic and responsive and preparedness structures.

There's that figure, which is like the most complex figure, no, how anybody navigates that system. Nobody knows that's figure, figure two, definitely take a look at it because it's laughable really. But yeah. The recommendations quite radical in that sense, and we've had, we've got lots of examples in health systems where when you do these types of recommendations, when you implement them, there are lots of unintended consequences.

And how do we think through that in the context of this particular report? Similar to what you're saying, that we suddenly are going to start preparing for coronavirus 3. 0 when in fact it's going to be something totally different and we're going to, we're going to change our perception of risk, but the way that we're changing our perception of risk is based on a coronavirus virus.

So talk us through that. 

Richard: I, first of all, she wants these structures put in place in the next 12 months. . So she, this isn't just for, to exact 

Jessamy: X number. 

Richard: She's really saying, we gotta do this now. She's built in this process of revise your pandemic plan every three years. So that's going to allow us to learn from.

Because one of the other messages is we didn't learn the lessons from all the past pandemic. So between 2011 and 2020, a lot had gone on in the world, and we didn't incorporate that knowledge into our strategy. So we've we're being mandated to do that if you have these reviews every three years. She's also calling for parliamentary scrutiny and accountability.

So again, The strategy that's developed, the plan that's developed has to be reported to Parliament again every three years. And the idea behind that is then that you're accountable to the people's representatives who can then scrutinize what the government's doing. I think that there are the multiplicity of the iterative reviews of the strategy, taking account of global evidence, parliamentary accountability, setting up this independent statutory body that is designed to give advice to government and will be a permanent standing body that can gather the international evidence and feed that into government thinking.

We've got the structures now being recommended that I think do immunize us from the pitfalls that we fell into with COVID 19. The one variable that you can't plan for and I don't say this as a cheap political point, but it is a lot to do with leadership. And if you don't have the right political leader in place, it doesn't matter how many structures you've got in theory, how many committees you've got, how good your plan is, what your statutory body is saying, what your MPs are saying, but if you have a president or a prime minister in place who is not serious and is not listening to the scientists, is not taking advice from independent bodies that are trusted bodies then all of this is a house of cards and falls apart.

So there is an issue about governance and leadership, which she doesn't touch on in this report. And I think that if I had one, one criticism, which is Very unfair to, I think, throw a criticism at this because there's so much that's good in her report. But there is a contingency in this and a sort of unmanageable uncertainty and unpredictability because it so depends upon the person at the top and how serious they are, how respected they are, how competent they are.

Unfortunately we found in the UK and America found with Donald Trump, two leaders who are utterly the wrong person in the wrong place at the wrong time. And you can't plan for that. 

Jessamy: I did see that there's going to be a mod. There are some modules on governance and on decision making. Obviously, very difficult, actually, to write explicitly what you're saying, but perhaps it, they might come through, hopefully.

Richard: Yeah, we're we have this commission that's looking at pandemic preparedness That's led by Helen Clark Lagida Quigley. And what we're trying to do there is to identify a new set of indicators that could give you some measure of or sense of how prepared a country or region or the world is.

Because all the existing indicators, which we've had before didn't work. And one of the issues that's come up is how do you measure leadership? How do you measure a system of governance and whether it's robust enough? I don't have any, I don't, this commission's in the middle of its work. 

Gavin: I think Plato started writing books on that several thousand years ago.

Richard: You're the perfect person to be answering this question actually, maybe we should be interviewing you for this commission because we need political scientists to be helping us here. What are the qualities of leadership and governance that mean that the public can depend upon that? I don't know how you.

Convert those. Yeah, and how you measure it. 

Gavin: Plato, unfortunately, had something quite similar to the kind of Eton, Bullingdon Club model, which is that leaders must be prepared to be leaders from birth. Is this the Philosopher Kings? Yes, the philosopher king. Yeah, we should then subsequently lie to the public about their statement in life.

So I've never really compared the conservative government to the platonic ideal of governments, but maybe there's a book in that. 

Richard: We need something to fill that gap because That was the critical variable and if you look at the early stages of you know in that first year You The countries that did well, they, it was often the quality of leadership that was interestingly correlated with the countries that did well, whether it's Jacinda Ardern or the leadership in South Korea.

Uh, Yeah, I think that's one issue in preparedness and resilience that hard to define, but important to acknowledge. 

Jessamy: Yeah. We've got two more questions that I think we'd, recreate to get through. So the first one really is trying to extrapolate some of the findings of the report and what this means in the global context.

So there's some quite, damning assessments of how the global health architecture works in terms of surveillance and preparedness. Yeah. And we've seen this process of the WHO pandemic treaty over the last couple of years, which had to be delayed before it was agreed at the last WHA.

You'd think theoretically that this sort of report would make the UK officials that are involved in that process that we hear have, not necessarily been, the most proactive in engaging in negotiating about equity of vaccines or therapeutics. Take, would take that more seriously, would perhaps, give more to the negotiation.

How do you see this inquiry seeding into the WHO pandemic treaty? Is it going to make any difference? 

Richard: I'm not optimistic that it's going to make a difference. The historic diplomatic failure. This year's World Health Assembly that led to the failure to get a pandemic treaty that really was catastrophic because if we were hit with another pandemic, we have no global mechanism in place to solve the problem about how countries work together, how we distribute samples fairly.

And then the countries that have delivered those samples get the benefits of them. So all of the moral principles and practical outcomes are still hanging in the ether. Will this report help? I don't think so. And the reason for that is nothing that's intrinsically wrong with the Howlett inquiry.

It's to do with the forces that undermine the pandemic treaty. And whether this government I would like to think could stand up to those forces more effectively, but I doubt that it will. On the issue, which was most fundamental in the pandemic treaty about the equitable distribution of medical countermeasures.

The reason why that didn't pass was because of the transnational pharmaceutical and vaccine industry and the resistance to relinquishing control of patents. And so while that transnational industry has such a powerful We're not going to get a pandemic treaty is going to require somebody like a president of the United States or the European Union coming together and saying, this we will not accept.

And they're not prepared to do that. The forces that shape the pandemic treaty are because they're not confined within the nation state means that states that nation states are subject to threats and bullying. And they find it very hard to resist those. So no I don't feel optimistic about that.

I think that a strong director general at who can call out industry and has the moral authority to hold governments accountable, that person could play a role. I think it was difficult for Dr. Tedros to play that role on this occasion because he'd come under such huge and harsh pressure from the US government during the pandemic.

It was very difficult for him to leverage his role in that way. So no, I feel quite pessimistic about the future for a pandemic treaty, I'll be most unfortunately. Okay. 

Jessamy: Let's try and take it back to an optimistic place to end on. You started off praising this inquiry and saying, actually, you were, hopeful that this was, it wasn't just going to go up on a shelf and 10 years, but the UK has got quite a checkered history.

history of inquiries, we do a lot of them. And often nothing happens, nothing changes. We've got a new government in the ideal world, what would you like to see happen? And do you think it's going to happen? 

Richard: We do have a new government. We have a government who has that has a very competent as proven by the first public crisis that we've just had to go through with riots across streets of our cities and the response of the criminal justice system to those riots.

We can debate the details of that, but that's not for this moment. But clearly very successful in dampening the effects of that public disturbance. We have a health, so we have a competent prime minister. We have a Somebody as the Secretary of State in the Department of Health and Social Care, who has clearly built up a very strong reputation in opposition, who I think has the command and respect of the health professions across the country.

And is a is an individual who has made many commitments already to improve the crisis in the national and public health systems. I think we do have the people who can respond to this. I think certainly the scientific community is ready to respond and public health community is ready to respond to this.

I am worried that there are still some individuals in positions in medicine and public health who were part of the failure, the failed system, and it's going to be hard for them perhaps to adapt. But we've got new political leadership, competent political leadership, so I'm very hopeful. This report is supposed to be enacted in the next 12 months, so it's going to require West Streeting to start as soon as the summer is over.

I think On his desk on September the 1st needs to be this report, and he needs to start implementing. 

Jessamy: He's got nothing else going on, so he might as well. 

Richard: Exactly. Exactly. It's tough. It's tough. But I think he has got to respond to this and the, and as we said at the beginning, because this is a cross government initiative, Keir Starmer has got to respond to this as well as the health minister.

And I think if I may just interject one moment of humility here for us, it's very easy for us to criticize everybody else. And I've certainly done my fair share of criticizing everybody else. But one of the points that she makes in her report is that People weren't asking the right questions in the years leading up to 2020.

We weren't either at the Lancet. We fell into the groupthink. It's easy for me now to appoint to an Institute of Medicine report on SARS from 20 years ago, saying that we all needed to take coronaviruses more seriously, and that's true. But was the Lancet, over that 20 years, promulgating the idea that we should look at more scenarios and greater risks?

No, we weren't. And I think now it is up to us also to embrace this report, and part of our role needs to say, Okay. Let's think differently. We have to think differently in the future. It's up to us to hold others accountable for implementing this report and make sure we change as much as they have to change.

Gavin: I think that's exactly right, isn't it? We've all sat in the Weekly Lancet editorial meeting for many years now and before the pandemic, I did not remember pandemic preparedness ever coming up as a topic. 

Richard: No, and certainly not talking about the next virus could be a coronavirus. And we should accept our fair share.

of responsibility of being part of a system didn't think more broadly. And that's a lesson we need to take. 

Gavin: Finally, who would you like to play you in the next Guy Covert? Ha 

Richard: ha! Oh God. Do you know I watched that and was, it was one of the more embarrassing experiences. No, I think editors should be Not seen and not heard, but sit in the background and write 

Gavin: regularly.

I never thought I would be in a work meeting that ended up dramatized on television. 

Jessamy: I love the way we were all running to him, waving paper. 

Richard: If only that was true. If only that was true. It's 

Jessamy: a bit of work, I think. 

Richard: Yeah, people obviously don't know what it's really like here. Yeah. 

Gavin: Anyway, thank you. On that note, perhaps we should end.

Richard, thank you so much for joining us. 

Richard: Thank you, Gavin. Thank you, Jessamine. Thank you.

Gavin: Thanks so much for listening to this episode of the Lancet voice. You can subscribe to the Lancet voice wherever you usually get your podcasts. And for more information about this podcast and all of our other podcast channels, please visit thelancet. com slash multimedia.