Why Britain Failed Its Coronavirus Test - The Atlantic - 0 views
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Britain has not been alone in its failure to prevent mass casualties—almost every country on the Continent suffered appalling losses—but one cannot avoid the grim reality spelled out in the numbers: If almost all countries failed, then Britain failed more than most.
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The raw figures are grim. Britain has the worst overall COVID-19 death toll in Europe, with more than 46,000 dead according to official figures, while also suffering the Continent’s second-worst “excess death” tally per capita, more than double that in France and eight times higher than Germany’s
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The British government as a whole made poorer decisions, based on poorer advice, founded on poorer evidence, supplied by poorer testing, with the inevitable consequence that it achieved poorer results than almost any of its peers. It failed in its preparation, its diagnosis, and its treatment.
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In the past two decades, the list of British calamities, policy misjudgments, and forecasting failures has been eye-watering: the disaster of Iraq, the botched Libyan intervention in 2011, the near miss of Scottish independence in 2014, the woeful handling of Britain’s divorce from the European Union from 2016 onward
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What emerges is a picture of a country whose systemic weaknesses were exposed with appalling brutality, a country that believed it was stronger than it was, and that paid the price for failures that have built up for years
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The most difficult question about all this is also the simplest: Why?
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The human immune system actually has two parts. There is, as Cummings correctly identifies, the adaptive part. But there is also an innate part, preprogrammed as the first line of defense against infectious disease. Humans need both. The same is true of a state and its government, said those I spoke with—many of whom were sympathetic to Cummings’s diagnosis. Without a functioning structure, the responsive antibodies of the government and its agencies cannot learn on the job. When the pandemic hit, both parts of Britain’s immune system were found wanting.
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Britain’s pandemic story is not all bad. The NHS is almost universally seen as having risen to the challenge; the University of Oxford is leading the race to develop the first coronavirus vaccine for international distribution, backed with timely and significant government cash; new hospitals were built and treatments discovered with extraordinary speed; the welfare system did not collapse, despite the enormous pressure it suddenly faced; and a national economic safety net was rolled out quickly.
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One influential U.K. government official told me that although individual mistakes always happen in a fast-moving crisis, and had clearly taken place in Britain’s response to COVID-19, it was impossible to escape the conclusion that Britain was simply not ready. As Ian Boyd, a professor and member of SAGE, put it: “The reality is, there has been a major systemic failure.”
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“It’s obvious that the British state was not prepared for” the pandemic, this official told me. “But, even worse, many parts of the state thought they were prepared, which is significantly more dangerous.”
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When the crisis came, too much of Britain’s core infrastructure simply failed, according to senior officials and experts involved in the pandemic response
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Like much of the Western world, Britain had prepared for an influenza pandemic, whereas places that were hit early—Hong Kong, South Korea, Singapore, Taiwan—had readied themselves for the type of respiratory illness that COVID-19 proved to be.
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The consequences may be serious and long term, but the most immediately tragic effect was that creating space in hospitals appears to have been prioritized over shielding Britain’s elderly, many of whom were moved to care homes, part of what Britain calls the social-care sector, where the disease then spread. Some 25,000 patients were discharged into these care homes between March 17 and April 16, many without a requirement that they secure a negative coronavirus test beforehand.
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There was a bit too much exceptionalism about how brilliant British science was at the start of this outbreak, which ended up with a blind spot about what was happening in Korea, Taiwan, Singapore, where we just weren’t looking closely enough, and they turned out to be the best in the world at tackling the coronavirus,” a former British cabinet minister told me.
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The focus on influenza pandemics and the lack of a tracing system were compounded by a shortfall in testing capacity.
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Johnson’s strategy throughout was one that his hero Winston Churchill raged against during the First World War, when he concluded that generals had been given too much power by politicians. In the Second World War, Churchill, by then prime minister and defense secretary, argued that “at the summit, true politics and strategy are one.” Johnson did not take this approach, succumbing—as his detractors would have it—to fatalistic management rather than bold leadership, empowering the generals rather than taking responsibility himself
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“It was a mixture of poor advice and fatalism on behalf of the experts,” one former colleague of Johnson’s told me, “and complacency and boosterism on behalf of the PM.”
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What it all adds up to, then, is a sobering reality: Institutional weaknesses of state capacity and advice were not corrected by political judgment, and political weaknesses were not corrected by institutional strength. The system was hardwired for a crisis that did not come, and could not adapt quickly enough to the one that did.
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Britain’s NHS has come to represent the country itself, its sense of identity and what it stands for. Set up in 1948, it became known as the first universal health-care system of any major country in the world (although in reality New Zealand got there first). Its creation, three years after victory in the Second World War, was a high-water mark in the country’s power and prestige—a time when it was a global leader, an exception.
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Every developed country in the world, apart from the United States, has a universal health-care system, many of which produce better results than the NHS.
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Yet from its beginnings, the NHS has occupied a unique hold on British life. It is routinely among the most trusted institutions in the country. Its key tenet—that all Britons will have access to health care, free at the point of service—symbolizes an aspirational egalitarianism that, even as inequality has risen since the Margaret Thatcher era, remains at the core of British identity.
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In asking the country to rally to the NHS’s defense, Johnson was triggering its sense of self, its sense of pride and national unity—its sense of exceptionalism.
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Before the coronavirus, the NHS was already under considerable financial pressure. Waiting times for appointments were rising, and the country had one of the lowest levels of spare intensive-care capacity in Europe. In 2017, Simon Stevens, the NHS’s chief executive, compared the situation to the time of the health sevice’s founding decades prior: an “economy in disarray, the end of empire, a nation negotiating its place in the world.”
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When the pandemic hit, then, Britain was not the strong, successful, resilient country it imagined, but a poorly governed and fragile one. The truth is, Britain was sick before it caught the coronavirus.
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In effect, Britain was rigorously building capacity to help the NHS cope, but releasing potentially infected elderly, and vulnerable, patients in the process. By late June, more than 19,000 people had died in care homes from COVID-19. Separate excess-death data suggest that the figure may be considerably higher
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Britain failed to foresee the dangers of such an extraordinary rush to create hospital capacity, a shift that was necessary only because of years of underfunding and decades of missed opportunities to bridge the divide between the NHS and retirement homes, which other countries, such as Germany, had found the political will to do.
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Ultimately, the scandal is a consequence of a political culture that has proved unable to confront and address long-term problems, even when they are well known.
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other health systems, such as Germany’s, which is better funded and decentralized, performed better than Britain’s. Those I spoke with who either are in Germany or know about Germany’s success told me there was an element of luck about the disparity with Britain. Germany had a greater industrial base to produce medical testing and personal protective equipment, and those who returned to Germany with the virus from abroad were often younger and healthier, meaning the initial strain on its health system was less.
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However, this overlooks core structural issues—resulting from political choices in each country—that meant that Germany proved more resilient when the crisis came, whether because of the funding formula for its health system, which allows individuals more latitude to top up their coverage with private contributions, or its decentralized nature, which meant that separate regions and hospitals were better able to respond to local outbreaks and build their own testing network.
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Also unlike Britain, which has ducked the problem of reforming elderly care, Germany created a system in 1995 that everyone pays into, avoids catastrophic costs, and has cross-party support.
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A second, related revelation of the crisis—which also exposed the failure of the British state—is that underneath the apparent simplicity of the NHS’s single national model lies an engine of bewildering complexity, whose lines of responsibility, control, and accountability are unintelligible to voters and even to most politicians.
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Britain, I was told, has found a way to be simultaneously overcentralized and weak at its center. The pandemic revealed the British state’s inability to manage the nation’s health:
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Since at least the 1970s, growing inequality between comparatively rich southeast England (including London) and the rest of the country has spurred all parties to pledge to “rebalance the economy” and make it less reliant on the capital. Yet large parts remain poorer than the European average. According to official EU figures, Britain has five regions with a per capita gross domestic product of less than $25,000. France, Germany, Ireland, Austria, the Netherlands, Denmark, and Sweden have none
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If Britain were part of the United States, it would be anywhere from the third- to the eighth-poorest state, depending on the measure.
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Britain’s performance in this crisis has been so bad, it is damaging the country’s reputation, both at home and abroad.
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Inside Downing Street, officials believe that the lessons of the pandemic apply far beyond the immediate confines of elderly care and coronavirus testing, taking in Britain’s long-term economic failures and general governance, as well as what they regard as its ineffective foreign policy and diplomacy.
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the scale of the task itself is enormous. “We need a complete revamp of our government structure because it’s not fit for purpose anymore,” Boyd told me. “I just don’t know if we really understand our weakness.”
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In practice, does Johnson have the confidence to match his diagnosis of Britain’s ills, given the timidity of his approach during the pandemic? The nagging worry among even Johnson’s supporters in Parliament is that although he may campaign as a Ronald Reagan, he might govern as a Silvio Berlusconi, failing to solve the structural problems he has identified.
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This is not a story of pessimistic fatalism, of inevitable decline. Britain was able to partially reverse a previous slump in the 1980s, and Germany, seen as a European laggard in the ‘90s, is now the West’s obvious success story. One of the strengths of the Westminster parliamentary system is that it occasionally produces governments—like Johnson’s—with real power to effect change, should they try to enact it.
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It has been overtaken by many of its rivals, whether in terms of health provision or economic resilience, but does not seem to realize it. And once the pandemic passes, the problems Britain faces will remain: how to sustain institutions so that they bind the country together, not pull it apart; how to remain prosperous in the 21st century’s globalized economy; how to promote its interests and values; how to pay for the ever-increasing costs of an aging population.
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“The really important question,” Boyd said, “is whether the state, in its current form, is structurally capable of delivering on the big-picture items that are coming, whether pandemics or climate change or anything else.”