Transcript of Module 2 Public Hearing on 17 October 2023
(10.00 am)
Lady Hallett: Mr O’Connor.
Mr O’Connor: Good morning, my Lady. Our first witness this morning is Professor Steven Riley.
Professor Steven Riley
PROFESSOR STEVEN RILEY (sworn).
Questions From Counsel to the Inquiry
Mr O’Connor: Do take a seat, Professor. Could you give us your full name, please.
Professor Steven Riley: Steven Riley.
Counsel Inquiry: Professor, you have prepared a witness statement at our request. It’s on the screen now. I know that you’re familiar with the contents of that statement, and it is signed at the end of the statement with your name underneath a statement of truth saying that you believe the facts contained in the statement to be true. Is that right?
Professor Steven Riley: That is correct.
Counsel Inquiry: Thank you.
You are a professor of infectious disease dynamics at Imperial College London; is that right?
Professor Steven Riley: Yep.
Counsel Inquiry: Is that a post you’ve held for some time?
Professor Steven Riley: Yes, I think since 2016.
Counsel Inquiry: We’ve heard from other witnesses, and no doubt you’d agree, that Imperial is one of the main centres of infectious disease epidemiology in this country?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: Also on the staff at Imperial is Professor Neil Ferguson, from whom the Inquiry will be hearing later today.
Professor Steven Riley: Yes.
Counsel Inquiry: You give us some detail of your career in your witness statement, Professor, and we can see, amongst other things, that earlier in your career you worked on the SARS outbreak of 2003?
Professor Steven Riley: That’s correct.
Counsel Inquiry: And you explain that you conducted work at that stage assessing the transmissibility of that particular virus?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: Then subsequently, is this right, you worked for some years at the University of Hong Kong?
Professor Steven Riley: That’s correct, from 2004 to 2010.
Counsel Inquiry: And you explain, therefore, that you were in Hong Kong during the influenza pandemic or epidemic in Hong Kong of 2009?
Professor Steven Riley: That’s correct.
Counsel Inquiry: Subsequently, you have been back at Imperial College since 2010?
Professor Steven Riley: That’s right.
Counsel Inquiry: And you refer to something called the MRC Centre for Global Infectious Disease Analysis.
Professor Steven Riley: Yep.
Counsel Inquiry: Is that a research body entirely within Imperial College or not?
Professor Steven Riley: Yes, that’s entirely within Imperial College, almost entirely within the Department of Infectious Disease Epidemiology.
Counsel Inquiry: Professor Ferguson, is he the head of that centre?
Professor Steven Riley: He – not at the current time, but he was the head of the centre until recently.
Counsel Inquiry: And during the pandemic he was?
Professor Steven Riley: Yes, he was.
Counsel Inquiry: Yes. I’m going to ask you about the pandemic in a moment, but before 2020, I think it’s right that you were a member of SPI-M?
Professor Steven Riley: That’s correct.
Counsel Inquiry: Sometimes referred to as the peacetime modelling committee?
Professor Steven Riley: That’s right.
Counsel Inquiry: Then once the pandemic started, in early 2020, you became a member of SPI-M-O, the operationalised version of that committee, that we heard about from Professor Medley?
Professor Steven Riley: Yep, that’s right.
Counsel Inquiry: Also as the pandemic started, you refer to something called the Imperial College Covid-19 research team.
Professor Steven Riley: Response team.
Counsel Inquiry: Sorry, response team.
Professor Steven Riley: Yep.
Counsel Inquiry: In a few sentences, what was that?
Professor Steven Riley: So that was the group of individuals within Imperial College who started working almost entirely on the response to the pandemic, the scientific – doing scientific studies to support the response, that grew rapidly through the end of January, February and March to try to provide support.
Counsel Inquiry: We’ve heard that Imperial College was well represented on SPI-M-O. Was it that response team that was, as it were, driving the Imperial College efforts in that regard?
Professor Steven Riley: The response team did not only support the UK response and they did not only support SPI-M-O, but yes, lots of people within the team would have been contributing to material that went to SPI-M-O.
Counsel Inquiry: You say it didn’t only support the UK response; were you also involved with assisting other countries then?
Professor Steven Riley: That’s right. So there was work done directly to support WHO, to support US – the US response in some ways, and individual country support through existing bilateral relationships. There was a lot of – a lot of work was done going in many different directions globally.
Counsel Inquiry: Thank you.
Now, we’re now becoming increasingly familiar with the structure of scientific committees. At the time, of course, SPI-M-O reported to SAGE. You were not on SAGE; is that right?
Professor Steven Riley: That’s correct.
Counsel Inquiry: We’ll come to a more recent period where I think you did attend some SAGE meetings, but in your role as academic modeller in the early stage of the pandemic, you were simply attending SPI-M-O meetings?
Professor Steven Riley: That’s correct.
Counsel Inquiry: You also were lead investigator in the REACT programme. We’ve heard something about this programme already. In full, it was the Real-time Assessment of Community Transmission programme, and it went through various phases, but they were all, one way or another, designed to get a richer picture of the extent of transmission of the virus throughout the country?
Professor Steven Riley: That’s correct. So in collaboration with colleagues at Imperial, we had a number of different studies under the REACT umbrella, and I was most concerned with REACT-1.
Counsel Inquiry: And that was the element of REACT which was involved in sending PCR tests or obtaining PCR tests throughout the country, and through that means –
Professor Steven Riley: That’s right.
Counsel Inquiry: – an understanding of the rate of transmission?
Professor Steven Riley: Trying to have as least a biased sample as we could of how many people were positive for SARS-CoV-2 at any point in time.
Counsel Inquiry: Just give us an idea of the scale of that: how many thousands of tests were being done how frequently?
Professor Steven Riley: I think in the end we approached – I think we approached 16 million people and we received, I think, over 2.5 million testable swabs.
Counsel Inquiry: So a lot?
Professor Steven Riley: Yeah.
Counsel Inquiry: Then lastly, and I mentioned this, since October 2021, so some way into the pandemic, your role changed quite dramatically. Tell us about that.
Professor Steven Riley: Yeah, so since October 2021 I’ve been seconded at 90% to the UK Health Security Agency, where I’m part of the group that looks after data, analytics and surveillance.
Counsel Inquiry: So, to all intents and purposes that was your main job?
Professor Steven Riley: Yes, yes.
Counsel Inquiry: Did you continue to be a member of SPI-M-O from that time?
Professor Steven Riley: I did continue to attend SPI-M-O. So I think I did maintain membership. To be perfectly honest, it’s not 100% clear to me in the capacity, but I did contribute to meetings and do attend.
Counsel Inquiry: But presumably you didn’t have the time to be doing the research and the modelling work that you had done previously?
Professor Steven Riley: That’s correct, and I stepped back from the REACT Study when I joined UKHSA.
Counsel Inquiry: It’s in this capacity that there was that caveat about SAGE attendance, because you mention in your statement that later in the pandemic you did attend, I think you said, two SAGE meetings, as, as it were, a UKHSA representative?
Professor Steven Riley: That’s correct.
Counsel Inquiry: We’ve heard something, Professor, about the – I don’t know if “clash” is the right word, “tension” might be a better word, between those academic scientists, if you like, who were members of SPI-M-O, and other committees, on the one hand, and government scientists, government civil servants, who were also part of that system. First of all, do you recognise that description?
Professor Steven Riley: Yes. I think there are different roles. I think acting as an independent scientist providing advice to government is quite a well defined and different role from being – acting as an official for the government and working with those scientists, but also working – potentially working directly with ministers.
Counsel Inquiry: You have experience of, as it were, seeing the workings of these committees from both sides, having occupied both roles?
Professor Steven Riley: That’s correct.
Counsel Inquiry: We’ll come back to that in a little while when I ask you about some of the matters you’ve raised in your statement about the ways of working of those committees.
I want first now to turn to your involvement right at the start of the pandemic, and we heard from Professor Woolhouse yesterday, and indeed from Professor Costello, about their developing understanding of the virus early in those first few weeks, really, in January and early February of 2020.
In your statement at paragraphs 4.11 and 4.12, perhaps we can call them up, you’ve copied a couple of tweets that you sent, I think.
Professor Steven Riley: Yep.
Counsel Inquiry: Which, as it were, record your initial developing understanding of the pandemic.
Professor Steven Riley: Yes.
Counsel Inquiry: So on 9 January, you say:
“It’s better in many ways that this incarnation appears to be less severe once infected. However, our ability to control it is driven by our ability to find cases. If being ‘mild’ makes it harder to find, it _could_ pose a greater health threat.”
Then if we can just look at the other tweet, which is on the top of the next page, I think. So you’re referring to a further report, and you say the characteristics seem to be – presumably this is one of the cases:
“- did not visit the market
“ - returned on the 6th
“- already recovered”
And then you say:
“A version of SARS with a lower infection fatality rate _could_ be a much bigger public health problem.”
Could you describe, perhaps in lay terms, what the concerns you were expressing in those two tweets were, particularly with regard to the lower infection fatality rate?
Professor Steven Riley: Yeah. So thinking back to SARS-CoV-1, the virus that caused the 2003 outbreak, it had a very high infection fatality rate. It wasn’t evident at the time, but afterwards we became sure it really was very high, and it also became evident there was very little transmission from people who – prior to exhibiting symptoms or from that small proportion of people who didn’t actually have symptoms, and it was very small for SARS-1. So when we did a lot of that work, and we kind of did some wash-up work thinking about exactly why we’d been able to control SARS-1, we started to think about properties of similar viruses that would make them much more difficult to control. And I don’t have a really good published reference for this but, recalling those conversations, if it was a bit more mild, and because it’s more mild there’s less severe disease and possibly less disease at all, there’s asymptomatic transmission, that would make stopping it much more difficult. And it’s – the overall impact is about the number of people who were infected times the severity. So the overall impact could be much, much higher, even if it was less severe.
Counsel Inquiry: Exactly. So, I mean, one might have thought that a lower infection fatality rate would be a good thing, but what you’re pointing to is that the milder symptoms make it that much harder to stop –
Professor Steven Riley: That’s –
Counsel Inquiry: – and so even if there is a lower infection rate, it could still involve the deaths of a far larger number of people?
Professor Steven Riley: That’s right. So from the point of view of a virus, when you’re trying to optimise your success, having a very high fatality rate is not necessarily good, from the point of view of the virus.
Counsel Inquiry: Thank you.
Let’s move on. In your statement you make a couple of observations about the work of SPI-M-O during February 2020.
If we could go, first of all, please, to paragraph 2.9. Thank you. If we could enlarge that paragraph. Paragraph 2.9, that’s it.
So just picking it up in the second line you say:
“It is my view that during the early period of the response, some key commissions were too narrow. For example, during February 2020 we were asked for views on school closures and on the impact of other interventions in delaying the peak, and we were asked about reasonable worst-case scenarios. We were not asked about the likelihood that interventions could achieve ongoing containment, nor were we asked about most plausible scenarios.”
Just pausing there for a moment, the term “ongoing containment”, is that a term which also means suppression of the virus, keeping the R number below 1?
Professor Steven Riley: Yeah. I think as it developed later they’re essentially synonyms. At that stage I was preferring the phrase “ongoing containment”.
Counsel Inquiry: But when we see the term “suppression” used in other documents, that’s the same thing?
Professor Steven Riley: Yes.
Counsel Inquiry: If we can keep that in mind, and just go, please, to another paragraph, which is 2.5, on a similar theme, you say that:
“[You] do not believe that SAGE and its sub-groups took sufficient account of international experiences during the early stages of the pandemic. In particular the possibility of a national lockdown should have been actively considered from 23 January onwards.
So bringing those two paragraphs together, you appear to be saying that the thinking was not, perhaps, on a large enough scale, or that you weren’t addressing, in particular, the possibility of a lockdown early enough?
Professor Steven Riley: Yeah, I mean, it was my view then, and I think it’s kind of evident elsewhere in the evidence, that the Wuhan – on 23 January, that was when the public health officials in Wuhan decided to try to contain the virus there. We certainly did not know that that would work and we did not know that that would be a good policy in the end for China, not by any stretch of the imagination, but it was incredibly innovative, although crude, and with lots and lots of negative side effects. It was actually very innovative, because no one had really thought you would go for containment from that point.
So my main point here is not that it would be the right thing for us to do, but it should have been actively considered because the population with the greatest experience of the virus at that point had decided to try it.
Counsel Inquiry: Is that the point you make about international experiences, it’s the comparison with China that you’re talking about there?
Professor Steven Riley: Yeah, so I think that’s one example. I think, you know, somewhat later, you know, much later in this timeline, there were comparisons with Italy as well.
Counsel Inquiry: Yes.
Professor Steven Riley: But for me, because of – because Wuhan happened first, it’s perhaps the most important.
Counsel Inquiry: So that brings us back to what you said in that first paragraph we looked at, that on SPI-M-O you were being asked about modelling school closures and other, perhaps more micro, matters. You felt, did you, that there was a bigger picture that should have been considered even at that early stage?
Professor Steven Riley: Yeah. It’s not to say they weren’t also important questions, but I couldn’t think of elsewhere in the system where consideration was being given to some of those broader questions. So I was frustrated at the time at the narrowness of questions that we were being asked.
Counsel Inquiry: In his evidence yesterday to the Inquiry, Professor Woolhouse referred to February 2020 as a “lost month”, I think it was a quote he picked up from somewhere else. Is it a similar idea that you’re expressing here?
Professor Steven Riley: I think somewhat. I think – I did not know for sure that we wouldn’t consider stringent interventions until very – I became increasingly concerned we were not considering them at the end of February, into the beginning of March. So there was a huge amount of work going on, on lots of different issues, during February, and I didn’t realise that we weren’t actively considering some of these more severe interventions.
So in that respect, then yes, I’d agree, in not considering some things then it was a lost opportunity.
Counsel Inquiry: Moving on, you describe in your statement having conversations with Professor Ferguson during this period.
If we could look, please, at page 13, paragraph 4.21. If we could perhaps look at 4.21 and 4.22 together, that might make it slightly easier.
So first of all you say that you and he discussed the likely speed of the pandemic in the context of vaccine investment decisions. Tell us how those two go together.
Professor Steven Riley: Yeah – a quick comment, that just to say that with Professor Ferguson and many other members of the team, we agreed on many, many things, but that’s not the business of science; the business of – the practice of science is to talk about what you disagree with and trying to figure it out. And I’m emphasising for very deliberate reasons here some of the things that we didn’t agree on.
Counsel Inquiry: And you probably realise, Professor, that quite a few of my further questions will be about things that you and Professor Ferguson did not agree on, so we can – it’s an important point to start with, that there was an awful lot that we won’t be talking about where there was a consensus between you.
Professor Steven Riley: And a lot of that is extremely valuable.
Counsel Inquiry: Yes.
Professor Steven Riley: So, yes, so very early in the pandemic I was involved in some email discussions in very broad terms thinking about the global speed of the pandemic, and I took the view in those early discussions that we couldn’t assume that it would be very rapid in the same – without – and that there may be behaviour change whether mandated or otherwise. So I thought it could be slow enough that it was worth spending a lot of vaccines that might not be ready for nine, 12 months.
Counsel Inquiry: And this idea of yours, of behaviour change, is something that we’ll see that you came back to in a report in early March that we’ll look at.
Professor Steven Riley: Yep.
Counsel Inquiry: But when you say behaviour change, I think what you’re describing is people in society reacting to the pandemic for themselves, as opposed to being told to do things by the government?
Professor Steven Riley: Not quite. So I would – the – we should really talk about them separately.
We can measure pretty well how people are behaving with respect to the transmission of these pathogens, and that may or may not be influenced by government mandation or advice, but it’s kind of important to be clear: it doesn’t matter how the behaviour changes, if people observe the risk and make significant changes to the way that they’re behaving then the rate of transmission will go down regardless of how it happens.
Counsel Inquiry: So perhaps a better way of putting it, the point you were wanting to make, is that even if the government doesn’t, for example, impose a lockdown or other NPIs, it may well be that people will still change their behaviour in a similar way?
Professor Steven Riley: That’s also a point that I make in lots of places, yeah.
Counsel Inquiry: That relates, in terms of paragraph 4.21, to the speed of the pandemic because if people change their behaviour it will slow the pandemic down?
Professor Steven Riley: Yes.
Counsel Inquiry: Then on a related point, we see at paragraph 4.22 you and Professor Ferguson discussed whether that lockdown experiment in Wuhan would succeed or not?
Professor Steven Riley: Yes.
Counsel Inquiry: And what was your view?
Professor Steven Riley: I did not know that it would succeed, whatever a measure of success was, but I thought there was a reasonable chance and a … partly because I wouldn’t have expected them to try unless they thought they had a pretty good chance. So I thought there was a reasonable chance that it would.
Counsel Inquiry: These are discussions that you describe having with Professor Ferguson during late January and into February. It may be that they involved other colleagues at Imperial as well. But are these the types of debate that you’re saying perhaps ought to have been happening at SPI-M-O and SAGE but weren’t?
Professor Steven Riley: I think this was a crucial issue from the very beginning. And I don’t have a clear idea of what was discussed at SAGE. It could have been discussed more at SPI-M-O for sure.
Counsel Inquiry: Lastly on this part, I’d like to turn to page 6 and paragraph 2.12 of your statement, please. You were asked about an observation made in an Institute for Government report to the effect that in the initial months of the pandemic ministers put too much weight on SAGE, relying on it to fill the gap in government strategy and decision-making that was not its role to fill, and you indicate that you agree with that observation.
I think this is one of the aspects where your subsequent experience at UKHSA gives you an insight into the position earlier in the pandemic, before the capacity at UKHSA and other organisations had developed. So can you expand on why you agree with that observation, please.
Professor Steven Riley: Yeah. As you mentioned a few moments ago, I’ve had the opportunity to see the process as an independent scientist feeding in through SPI-M and then as a member of UKHSA, and when I arrived at UKHSA in October 2021 the resourcing around government in terms of supporting policy was probably at its maximum, and I could see the size of teams, the quality of work and the amount of work that was being produced in order to support decisions at that point. And as – you know, under simple assumptions of how much resource there would have been operating during the early phases, trying to support even more difficult decisions, then I think the Institute for Government’s statement is good.
Counsel Inquiry: What follows from that, if the point is that SAGE is doing work that it shouldn’t be doing, because it ought to be really being done by government, does it follow that SAGE either was or might have been actually involved in developing policies that weren’t part of its role, or are you really more talking about a sort of capability issue?
Professor Steven Riley: So I’d probably speak better to the capability issue, and I think there’s a difficult question here about how much standing capacity a government should maintain to provide this kind of support, because it’s – the level of resource in October 2021 was very high, and it’s probably not appropriate – it’s definitely not appropriate to maintain indefinitely. So I think the difficult question here is, and I’ll address the capability rather than necessarily policy, the difficult question is: what are the right mechanisms for the standing level of support and what is the right level of confidence in scalability of support in those early stages?
Counsel Inquiry: Thank you. We can take that down.
I’d like to move on with you, please, Professor, to address the period a few weeks later, in early March of 2020. Just by way of context and summary, we know, do we not, that the national lockdown was announced on 23 March, and that that represented a change in government policy from the mitigation strategy that it had pursued previously, flattening the peak, towards one of suppression or ongoing containment, depending on the terminology.
You were, as we shall see, centrally involved in the discussions at SPI-M-O that led towards that decision, and in fact again, as we shall see, you proposed the pivoting to a policy of suppression right at the beginning of March, and that is what we will look at now.
Can I start on this, please, by asking you to look at your statement. It’s paragraph 5.6 on page 23, starting three lines – actually on this copy it’s a few more than three lines, but five or six lines down, where it says:
“On 1 March 2020, [you] drafted and circulated a report …”
And you give its title, “The potential benefits of ongoing containment”, which we will remind ourselves means suppression.
You say you “hoped [that this report] could become an Imperial College Response team report”. We talked about that team at the beginning, and was it the case that the team generated reports which then went to SPI-M-O?
Professor Steven Riley: We – the team did generate reports that went directly to SPI-M-O. The type of report I’m talking about there is a public report.
Counsel Inquiry: Right.
Professor Steven Riley: So it’s worth a quick comment that, compared to prior outbreaks, the speed and transparency with which the evidence came from academic groups like Imperial was much, much better. So my primary concern was the – us publishing reports on the website because then they were – they could be available to SPI-M and to people all around the world as well.
Counsel Inquiry: Right. But in any event, it was like a badged product of the response team that you hoped this report would become?
Professor Steven Riley: Yes.
Counsel Inquiry: And you mention that it was an early version of a report which was in the end circulated a week or so later, and we will talk through the chronology of all of that.
Dropping down a few lines, the crux of it, you describe, is that you pointed out that a rapid wave, similar to the realistic worst-case scenario, could lead to 464,000 deaths. But by contrast, you were positing that if there was a successful policy of immediate suppression, that could reduce it vastly to only 148 deaths?
Professor Steven Riley: That’s right.
Counsel Inquiry: So was that your sort of core thinking at that stage, you were simply –
Professor Steven Riley: Yeah.
Counsel Inquiry: – positing those two alternatives?
Professor Steven Riley: And it – I mean, as you present those numbers, it looks strange, in – I mean, it felt strange to be writing that at the time, and it still looks a little bit strange to be reflecting on it.
I think on 28 February, WHO China delegation published their report and within that they state China’s policy is to maintain control and restart the economy, so on the 28th China had committed to going full bore for economic productivity and containment.
So, to me, that meant that we had to consider the possibility of ongoing containment without it being unachievable or without it being so bad that we would never want to do it. We had to consider that possibility at that point. And that justifies that very strange looking comparison of what we were apparently planning for versus what one could conceivably think might be an option for us. Might be. Not was, but might be.
Counsel Inquiry: Yes.
Now, you go on to describe, in summary, Professor Ferguson’s sort of negative reaction to this report, and you actually quote him, you say:
“Professor Ferguson’s view at the time was that ‘everyone in policy circles’ knew that R could be brought below 1 …”
Pausing there, do we mean they knew that this suppression policy was a possibility at the very least?
Professor Steven Riley: Yeah, so in the crudest level of success that you could – if your restrictions were severe enough, you could make the incidence start to decline.
Counsel Inquiry: Yes. And then reading on:
“… but that there was no appetite for the draconian measures that would be required.”
Presumably no appetite amongst those people in policy circles, that’s how we take it, is it?
Professor Steven Riley: You will be speaking to Professor Ferguson later today, so …
Counsel Inquiry: How did you take it at the time? Who was he describing, do you think?
Professor Steven Riley: I think I actually mention it just a few lines lower, I put “everyone in policy circles” in quotes, or yeah, I requote “everyone in policy circles” –
Counsel Inquiry: Let’s –
Professor Steven Riley: – because I don’t actually know what that means, and I’m highlighting that that’s kind of important.
Counsel Inquiry: Yes. Let’s drop down. I think the passage you’re referring to is at the bottom of the page, after the tirets. You say:
“Professor Ferguson also commented that we were currently driving UK preparedness and planning and that we were trusted by the government.”
So I think the “we” must mean the – Professor Ferguson and his science colleagues?
Professor Steven Riley: Again –
Counsel Inquiry: All right, we’ll ask him.
Professor Steven Riley: Yep.
Counsel Inquiry: But:
“He added that this was not the same as saying that we never disagreed with government policy or the CMO, but that we did so privately and constructively.”
He certainly seems to be stating there that “we” – take it that you can’t provide us with more precision as to what is meant, but it certainly doesn’t seem to be the government.
This group that he’s describing was in charge of pandemic policy at the time?
Professor Steven Riley: Could you repeat your question? I’m sorry.
Counsel Inquiry: The text says:
“… we were currently driving UK preparedness and planning and that we were trusted by the government.”
Professor Steven Riley: Yes.
Counsel Inquiry: So I appreciate that you don’t want to be drawn on stating what Professor Ferguson –
Professor Steven Riley: Okay.
Counsel Inquiry: – meant by that, but he appears to mean that a group other than the government is driving the policy.
Professor Steven Riley: Yeah. Yes, that is what it appears to be. There’s a lot of – there’s potential importance on the word “driving” and exactly who the “we” are. I agree that that’s – that’s how I would have understood it at the time, but I wouldn’t – as I say, the aspect of Professor Ferguson’s reply that kind of struck me was “everyone in policy circles”, which is why I repeated it back in quotes.
Counsel Inquiry: Yes.
Professor Steven Riley: I think my understanding is clear from how I’ve replied.
Counsel Inquiry: All right. Well, let’s just pick up another part of this, please. If we can go back in your statement to 5.6, here you’re commenting on another observation by the Institute for Government.
Thank you, that’s fine.
You say:
“I agree with the neutral Institute for Government that the desire of ministers to avoid a lockdown framed the advice commissioned from SAGE, and contributed to the delay in considering and implementing [suppression] measures.”
So again, is that something you picked up from Professor Ferguson, and maybe it’s linked to what we were talking about a moment ago, that there was no appetite for lockdown-type measures early in the pandemic?
Professor Steven Riley: Yeah, and I think it’s based on – I went back and – you know, when that opinion from the Institute for Government was put to me, I went back through the emails to see if I, you know, did have useful evidence, and I’ve put in that paragraph, you know, a specific example of how that statement does make sense.
Counsel Inquiry: So stepping back to your earlier observation that the February was a wasted month point –
Professor Steven Riley: Yep.
Counsel Inquiry: – that you weren’t looking at those larger issues of, might suppression work, you were looking at much more – the smaller but important issues, for example, about school closures and so on; is it possible that the reason SPI-M-O wasn’t being asked to consider those matters at that stage was this point you’re making here, which was that there was almost a deliberate decision being taken not to engage with those issues, or –
Professor Steven Riley: That is possible, yes. Yeah, and certainly the sentiment, yeah.
Counsel Inquiry: Moving on in the chronology, then, we were looking at that part of your statement where you describe drafting the note on 1 March, and Professor Ferguson’s reaction, not agreeing with it. I think it’s also right, I’m not going to take you to this part of your statement, but tell me if it’s right, that he indicated around that time that he didn’t want the report to become an official Imperial College response team report. Is that right?
Professor Steven Riley: Yeah. And can you check your dates for that one? But that’s certainly – that discussion did occur – it might be worth checking the dates.
Counsel Inquiry: I think what you say in your statement is that that occurred a few days later, around the 7th and 8th of March –
Professor Steven Riley: Yes.
Counsel Inquiry: – that you prepared a further draft and he said, “Well, I” – it was at that stage that he said he didn’t want it to be an official Imperial College report, and suggested that you publish it sort of separately in a scientific journal?
Professor Steven Riley: That’s correct.
Counsel Inquiry: But we will see that you did go on to provide your note, possibly slightly amended again, to SPI-M-O a few days later?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: So let’s move forward, if we can, to Monday 9 March, so a week or so after you had first drafted the note, and again you refer in your statement to hearing a radio report that morning about a COBR meeting which was due to take place and the suggestion that the Prime Minister would be considering imposing social distancing measures at that stage.
Professor Steven Riley: Yes.
Counsel Inquiry: If we can then, please, go to an email exchange, we see that that was the trigger.
Thank you.
So is it right, then, that having heard that radio exchange, or radio report, rather, that’s what prompted you to send this email that we’re looking at now?
Professor Steven Riley: Yes.
Counsel Inquiry: We can see from the start that it was sent, is this right, to the sort of SPI-M-O group email address and also to Graham Medley, who was one of its chairs?
Professor Steven Riley: No, I think it was sent to the SPI-M secretariat and to Graham. I don’t think this was sent to the full distribution list. I don’t think all my colleagues had the opportunity to comment.
Counsel Inquiry: Okay, that’s helpful, thank you.
If we look at the second paragraph down, we see you stating:
“It is my considered scientific opinion that we should implement school closures and working from home where possible and any other social distancing measure we can for the next three weeks. Starting as soon as possible.”
Professor Steven Riley: Yes.
Counsel Inquiry: You refer to school closures and working from home, but then you say – and everything else.
Professor Steven Riley: Yes.
Counsel Inquiry: Did you in fact mean a lockdown or something equivalent to that?
Professor Steven Riley: Yes. Well, the “any other … measures we can”. I wasn’t aware of what would be possible.
Counsel Inquiry: Well, we’ve heard that the word “lockdown”, which we’re now all so familiar with, wasn’t used at the outset of the pandemic, but I think it’s clear you are describing a broad set of NPIs?
Professor Steven Riley: Yeah. And I try to avoid using the word. I don’t – I don’t think it’s a good word, I think it’s – it sounds, it’s a lot more nuanced –
Counsel Inquiry: Right.
Professor Steven Riley: – than that word leads people to think of when they start discussing it.
Counsel Inquiry: But with that caveat, that’s what you’re suggesting?
Professor Steven Riley: Yeah, yeah yep.
Counsel Inquiry: In the next paragraph, you explain the basis for this suggestion, in effect what’s become described as NHS becoming overwhelmed.
Professor Steven Riley: Yes.
Counsel Inquiry: You say that:
“… business as usual [in other words, without those measures] will likely lead to the (at least partial) collapse of our health service within that time.”
And I think you mean three weeks, that’s the time period that you’re talking about in that context?
Professor Steven Riley: Yes.
Counsel Inquiry: Just looking at the next paragraph, as well as talking about – you’re talking about what should happen, first of all, within the three weeks of your proposed lockdown, and then what might happen afterwards?
Professor Steven Riley: Yes.
Counsel Inquiry: But in that context, you say:
“If you look back three weeks …”
So to, let’s say, mid-February –
Professor Steven Riley: Yep.
Counsel Inquiry: “… the world was a very different place.”
Professor Steven Riley: Yes.
Counsel Inquiry: I wanted to ask you whether what you’re saying there is that this issue about the likelihood of NHS collapse, if nothing changes, was different on 9 March when you sent this email as opposed to the middle of February, three weeks earlier, which here you’re saying was a very different place?
Professor Steven Riley: As a scientific point I don’t think the – there was no new understanding about what the demand would be on healthcare if behaviour did not change. I don’t – I think that’s established by the 1% infection fatality rate and the associated hospitalisation rate. So, as a scientific consensus, I don’t think that changed during that period.
What I’m referring to there, and I’m not being very specific about it, is our shared understanding of what this is going to mean, you know, in and around me and in our community in the UK and probably across Europe and elsewhere, has changed dramatically in the previous three weeks, and I would expect a similar change in understanding, possibly behaviour and attitude, in the following three weeks.
I think from recollection that’s kind of what I was trying to say, but I’m not very precise there.
Counsel Inquiry: Sure. We might come back to that point about the developing understanding of NHS collapse in due course.
Just finally on this email, I think, a rather more general point: you do refer in the third paragraph to numerous models as a basis for your understanding that you’re expressing in the email. But equally, in the final paragraph you make the point that this view you’re expressing is based on something rather broader than merely modelling, if I can put it that way.
Professor Steven Riley: Yeah.
Counsel Inquiry: Is that right? Can you explain what you’re trying to get at here?
Professor Steven Riley: Yeah, so I consider my scientific discipline to be the study of the transmission and control of infectious diseases. That involves properties of the virus –
Counsel Inquiry: Don’t go too quickly, Professor.
Professor Steven Riley: That involves properties of the virus, that involves the behaviour of people, it involves the design of interventions, their effectiveness, their cost effectiveness. It’s a very broad topic, and we use evidence from lots of different sources in order to generate a scientific view, and an evidence-based scientific view comes from lots of different types of evidence.
I think I mention – I do mention the committee being described as a modelling committee, and I’m highlighting there my frustration perhaps at the narrowness that we’ve discussed a moment ago, and I’m saying – I’m claiming a right, as a biological scientist, to give this opinion, somewhat regardless of any specific modelling output.
Counsel Inquiry: Yes. If we can just look, I just want to look briefly at the emails that followed this one. First of all, Professor Medley responded that same morning, did he not?
No, sorry, if we can go back to the document before, but just scroll up within it. That’s it.
At the bottom half of that page there is a response from Professor Medley, and if we can just look, there’s a paragraph starting:
“We have a choice now: Full or Partial.”
By which he means, to use the slang, full or partial lockdown, doesn’t he?
If we can see the two lines below that he’s talking about the full lockdown option, but he says:
“… we will have saved lives but at enormous cost (health, economic etc).”
This is one of the points which we will come on to see again and again, but the objection to a lockdown on the basis of economic impact, and with that in mind, if we can look up at the top of this page, and your response back to Professor Medley, there’s a paragraph starting “To be honest”, you say:
“To be honest, I have not seen any economic analysis of an …”
Then you describe I think an unsuppressed pandemic. But you say:
“… but it keeps being implied to me by Neil and others. I am happy to go sit in a room somewhere and review that evidence or to give an opinion on email. An awful lot of our decisions seem to rely on the idea that the above scenario has some kind of economic advantage over the alternatives.”
Are we seeing here, and I think we see it in other emails, Professor, a level of frustration on your part about assertions being made relating to economic impacts without any evidence being provided to support those assertions?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: Was that a problem which, in your view, continued?
Professor Steven Riley: Yes.
Counsel Inquiry: Thank you. As I say, we’ll come back to that.
So that was the exchange that you had with Professor Medley on that day, and we can see – if we can now go to the next document, please – the next day, so on 10 March, and this again was early in the morning, you sent an email to Sir Jeremy Farrar, who we heard something about yesterday. He was the director of the Wellcome Trust at the time. And we can see that you send him a draft of your paper; is that right?
Professor Steven Riley: That’s correct.
Counsel Inquiry: And essentially you’re asking him for his advice?
Professor Steven Riley: Correct.
Counsel Inquiry: Can you expand on what you were asking him and why?
Professor Steven Riley: So, it felt to me – it must have felt to me at the time that there was a reluctance to put some of these ideas on paper in a very formal way, and I – in the other evidence that I’ve submitted, you can see me having been frustrated with that over, like, the preceding period of time. So at this point I’m considering emailing my paper to the entire SPI-M, where I think it would attract a lot of attention. I didn’t know – I did not know for sure what the right policy was. I felt I should under – if we were doing something that I didn’t understand, that was important, not to – not to be too arrogant, I thought I should understand why we’re doing stuff, and if I don’t, then I was willing to push and push until I could understand why we were doing things. But if it turned out my view actually wasn’t that useful, I could see that this would massively disrupt – potentially disrupt the work of the committee, potentially need a whole load of people to divert and handle it, if you like, in some way, so I could see that this would potentially be a distraction for other people and – and it was a risk, so I was – I valued Jeremy’s opinion and I was asking him whether he thought I should do it.
Lady Hallett: Can I just intervene there? Sorry, Mr O’Connor.
You’re sitting as an independent scientist on a committee but you felt that you shouldn’t send what was a considered but different opinion to the committee? I’m not quite following why you thought you couldn’t.
Professor Steven Riley: Maybe I was wrong, maybe I was overthinking it. I hadn’t had a lot of sleep –
Lady Hallett: I can understand that.
Professor Steven Riley: – in the 48 hours prior to that. But there’s an awful lot of people doing a lot of work and I didn’t assume my view was the only view or completely correct or, in the fullness of time, would be judged as useful, I wasn’t sure that was the case. So I thought this would be disruptive. That was my sense, that it would be disruptive. And, you know, somewhat risky to me. I mean, honestly, in a slightly personal professional capacity, somewhat risky to me, and I was looking for a little bit of advice from someone I trusted.
Lady Hallett: Thank you.
Mr O’Connor: Thank you.
Also, let’s not forget, someone who was himself on SAGE?
Professor Steven Riley: Yes, absolutely, and that’s not incidental to me choosing Professor Farrar.
Counsel Inquiry: Now, we don’t have, as far as I know, an emailed written response from Jeremy Farrar to this email. Did he respond?
Professor Steven Riley: Yeah, I think he did. I then went to sleep for a couple of hours after this and then I decided to send it when I woke up anyway, and I think Jeremy did reply afterwards, but I’d already decided to send it in at that point. And I think in Jeremy’s book he does mention a positive response a little bit later.
Counsel Inquiry: It’s – we don’t need to worry about this, it’s cut off on the version on the screen, but this email to him was sent at 6 o’clock in the morning?
Professor Steven Riley: That’s right, that’s before I – yeah.
Counsel Inquiry: As you say, you did shortly after that then, an hour or two later, circulate the paper to the members of SPI-M-O?
Professor Steven Riley: Yes.
Counsel Inquiry: That then provoked an email discussion which I’m going to take you to. Before we do that, I’d like to take you to the paper itself briefly.
Professor Steven Riley: Yep.
Counsel Inquiry: So for those purposes can we go to –
Professor Steven Riley: Yep.
Counsel Inquiry: We’ve got it, thank you.
Professor, I don’t want to spend too much time going through the detail of the paper, but the passage in bold here is a summary, is it not?
Professor Steven Riley: Yes.
Counsel Inquiry: Is it right to say that in essential terms, like the email that you sent to Professor Medley, you are here calling for a switch from the mitigation strategy to a suppression strategy?
Professor Steven Riley: Yes, that’s correct.
Counsel Inquiry: What this paper does, which perhaps the email didn’t, is to add a level of sort of modelling support for that call?
Professor Steven Riley: It does two things. It certainly does add some illustrative modelling. I think I repeat in this paper in another paragraph that I didn’t believe that modelling was required for that switch, but I thought that it was useful nonetheless. And it also expands on the reasons that I held the views that I did on how behaviour may or may not change. So I – yeah.
Counsel Inquiry: If we just pick this up three lines down, you say:
“The primary benefit of mitigation is that the epidemic will be over more quickly than might otherwise be the case, with the population having acquired herd immunity and also having experienced a relatively low peak.”
What you’re describing there is what is the sort of perceived benefit of the mitigation strategy?
Professor Steven Riley: Yes.
Counsel Inquiry: Squash the peak?
Professor Steven Riley: Yep.
Counsel Inquiry: Get it over with still relatively quickly?
Professor Steven Riley: Yep.
Counsel Inquiry: And achieve herd immunity?
Professor Steven Riley: Yep.
Counsel Inquiry: And you, in this paper, challenge that thesis on two grounds. One is the argument which we were looking at a few minutes ago, which is that the NHS would collapse in the course of that wave; is that right?
Professor Steven Riley: The sheer number of deaths implied by the wave I think is the first point. So the implicit health impact if that wave were to happen is very, very large over such a short period of time.
Counsel Inquiry: Yes. There is a sentence about eight or nine lines down which says:
“We show [that’s presumably in this report] that critical care facilities in the UK would be saturated quickly.”
Professor Steven Riley: Yes.
Counsel Inquiry: Is that the point?
Professor Steven Riley: Yes.
Counsel Inquiry: But then there is a separate point which takes us back to those discussions you were having with Professor Ferguson in January –
Professor Steven Riley: Yes.
Counsel Inquiry: – that maybe the mitigation strategy wouldn’t quite work out as expected anyway?
Professor Steven Riley: That’s correct.
Counsel Inquiry: Can you expand on that?
Professor Steven Riley: Yes.
Counsel Inquiry: Or just explain it.
Professor Steven Riley: So, the benefit – and again, given the numbers in this paper, it’s strange to talk about benefits of strategies with those health impacts, and it felt strange at the time, and I would – you know, anyone watching this now who thinks that we were writing these numbers and not believing them to be strange and understand their implication, that was not the case. It’s just these – this – these were the apparent choices in front of the people looking at it.
So the benefit of a successful mitigation is that it’s over quickly, but the population would have to – could only change their behaviour somewhat in order to land just the right amount of immunity so the virus couldn’t come back. Forgetting about all the other issues about immunity and things. So if you got it just right, you’d have to somehow bring transmission down through changes in behaviour.
If the population responded by changing even more, even more than you wanted them to, they wouldn’t have to change that much more to go down to a threshold where the virus wouldn’t grow, to get R to 1. And that’s a break point analysis, it’s – in olden days of this kind of science, when we used differential equations and not simulations, this was quite a common way of looking at a problem to identify a key parameter and say: what’s the implications of that taking a different value? And at that point the rate at which you would accumulate herd immunity is very, very slow, and you’re operating within an entirely overwhelmed health service.
Counsel Inquiry: So is this right, another way of putting that same point is that if the government went down the mitigation strategy, the problem you’re identifying is that the population might almost lock themselves down, to use a very general term, or at the very least change their behaviour in a way that prevented the virus spreading amongst the community as rapidly as had been expected, which would have that effect that you’ve described?
Professor Steven Riley: That’s also a good summary, yes.
Counsel Inquiry: I just want to take you to two other parts in this report, if I may. First of all, if we can look at page 4, please, this is the final paragraph of the report.
You mentioned, Professor, in answer to one of my questions, that even in this paper, which was dealing with modelling, you made the point that there were other reasons to adopt this course beyond simply modelling. Is this the passage that you had in mind, where you talk about the example of other countries leading to that conclusion as well?
Professor Steven Riley: Yeah, and a very, you know, brief comment on the style. This is – it was drafted with the intent of being a published article that would have readership much broader than just the UK potentially. So that’s – the style then is to go to some very general points at the end. And yes, I think the point I wanted to make here is that even though there was useful evidence contained in the modelling in this report, I didn’t – my view was not that it was necessary, and that actually there were – other evidence was sufficient to arrive at a similar policy conclusion.
Counsel Inquiry: Thank you.
Then if we can just finally –
Lady Hallett: Before you do, could you just tell me what you meant by “fixed-term social distancing”? Sorry, could we highlight the passage again? The penultimate line:
“… [we should] adopt stringent fixed-term social distancing.”
Professor Steven Riley: So that’s – I’ve mentioned – I mentioned three weeks. I thought that there should be a time limit imposed on any stringent social distancing, not because we knew for sure what the impact would be by that time, but because earlier imposition had such high value that essentially the information that we would gain would put us in a different place at some known future time. Because …
Lady Hallett: And what measures exactly did you mean by stringent social distancing?
Professor Steven Riley: So I think I’d probably go back to the email that I’d sent the previous morning for the meaning, so it was school closures, work from home, and whatever else we had, and I didn’t really know what we might have at that point.
Lady Hallett: Okay, thank you.
Mr O’Connor: Professor, you don’t like using the word, but may we use the shorthand –
Lady Hallett: Lockdown.
Mr O’Connor: – lockdown?
Professor Steven Riley: You may.
Mr O’Connor: Could we then turn to page 6, please.
Now, could we get as close as we can to the graph on the right-hand side, please.
Professor, there is a reason we’ll come back to why this graph may be of some extra significance, but for the purposes of the report – well, perhaps you can tell us in summary what these different lines show?
Professor Steven Riley: Yeah, and this is obviously – this is intended for my scientific colleagues. I mean, it’s not the most accessible presentation, it’s on a log scale, so powers of 10 on the vertical axis rather than – rather than the linear scale. And the red line is showing some hypothetical completely unmitigated, no behaviour change, massively rapid epidemic, and it goes very high. The blue line is what I viewed as, again hypothetical, perfectly landed mitigation.
Counsel Inquiry: Just pausing there, that’s the sort of squashed peak aim that –
Professor Steven Riley: Yeah.
Counsel Inquiry: – at one stage the government was trying to achieve?
Professor Steven Riley: And it’s not that squashed. That’s – we’re looking at infectious disease incidence for a whole country on a log scale here. That’s a – you know, that’s – you don’t normally need to do that.
And then the cyan line there is the output from the model which shows if people’s behaviour was strictly triggered by ICU being saturated. And this is – this is a scenario. I didn’t think – it’s not a forecast. I didn’t think that that – those features of the line would play out exactly as are on there, but it’s a – I thought it was a very useful scenario.
Let’s say we were going to let the thing spread until we saturated ICU but then everyone is like, “I’m not going to carry on behaving the same because I’ve no longer got a ventilator available to me”, you’d get this kind of short cycle bouncing around at a very low level. So the key thing here is the height of the cyan line is quite low.
Counsel Inquiry: So that’s the turquoise line, and that’s the –
Professor Steven Riley: Sorry, turquoise, yeah.
Counsel Inquiry: – sort of unilateral decision within the population to dramatically reduce their movement that’s – the problem that you were identifying potentially?
Professor Steven Riley: Yeah, yeah. If every time the ICU was saturated we all changed and reduced and then we started back again, that’s what it would look like.
Then the green line is the scientifically kind of trivial – let’s say we managed to bring the R down and keep it down, then it’s the green line.
Counsel Inquiry: Thank you.
So that’s your report, and as I indicated, when you circulated, it generated a debate amongst the members of SPI-M-O, and particularly you and Professor Ferguson.
So we can turn to that now, please, and that is INQ000269369. Thank you.
So we’ve gone first to this page, where – do we see here, halfway down, Professor – so we’ll recall that it was 6 in the morning when you sent that email to Sir Jeremy Farrar, I think you said that you thought about it a bit, maybe had a cup of tea, and then two and a half hours later you are deciding “I’m going to send this to the whole committee”?
Professor Steven Riley: That’s correct, yep.
Counsel Inquiry: So that’s what you’ve done and that’s the report we’ve just looked at?
Professor Steven Riley: Yes, correct.
Counsel Inquiry: Then if we can go forward, please, or scroll up to the next page, within less than an hour, we see Professor Ferguson’s response, which is not a positive one, Professor. I wanted particularly to pick up on the third paragraph, where he says:
“I do feel strongly that we should focus on providing an evidence based assessment of what the policy choices are and their likely impacts, rather than advocate for a particular policy. At least in our role on SPI-M.”
Professor, this is a point that you expand on in your witness statement, the issue about scientific advocacy or scientific evidence. What was the difference of opinion here and what was your take on it?
Professor Steven Riley: So I think we should be very careful describing a view as advocacy and another view as evidence-informed scientific opinion, and I think – I don’t think I say so explicitly here or in the other evidence but I think I probably show, I felt that I had an evidence-based opinion that covered recommendations on interventions. As I’ve mentioned before, our scientific discipline includes the study of interventions and I had an evidence-informed opinion for one intervention over another.
I think here Professor Ferguson has chosen to describe my view as advocacy, and by implication the view of others as being more valid or more based in evidence. And I think that’s what – that’s my understanding of what Professor Ferguson is saying here.
Counsel Inquiry: Linked to that then is also the point which is debated in these emails about whether a proposal such as yours should be made without explaining exactly how it’s going to work?
Professor Steven Riley: Yeah, and that is a different – that’s a different point, but linked. We disagreed on that, and I don’t think that’s any more complicated than my view was, having studied interventions against respiratory viruses for many – my view was that other countries had decided to adopt this approach without necessarily knowing exactly how it was going to work, but acknowledging that the timing, the speed with which you adopt it is important. So there is a trade-off there between knowing exactly how it’s going to work out for you, but – or doing it quickly, and my view was it was justified to move quickly, even – and again, even if we didn’t really know exactly how it was going to work.
Counsel Inquiry: It might also be thought that the mitigation strategy that was in place, and which, as we will see, Professor Ferguson was defensive about, I mean, there were also some quite serious doubts about how that was going to work at the time?
Professor Steven Riley: Yeah, I think that’s true.
Counsel Inquiry: Let’s move on in the exchanges, if we can, which are all – in fact, if we can move to page 3, there is an exchange between the two of you about this point about the extent to which the workings of a policy need to be demonstrated.
Then I want to come to – thank you – this one, which – we can see we’re now on the next day, it’s 11 March now, and so the first paragraph is the continuing debate about exactly what your role is or the role of you and Professor Ferguson and SAGE and the government and so on. But I want to come particularly to the second and third paragraphs, where Professor Ferguson said:
“I would also note that there is now significant momentum behind the current strategy. A huge amount of effort is going into operational planning right now. Government is aware of the projected incidence, health system demand and mortality impact. Though I … would like to be reassured that the Cabinet is aware of what that will look like in reality.”
Then this:
“The current view is that – with difficulty – this can be handled. Policy will not change unless we can demonstrate convincingly (rather than rhetorically) that the strategy will fail, and/or propose a concrete ‘better’ alternative. There is limited appetite for intense social distancing policies – it has taken considerable work to move the government to the likely current strategy.”
The first point to be made is Professor Ferguson is not keen to move away from the mitigation policy. What did you understand by his language of, as it were, having in the first place moved the government to that strategy?
Professor Steven Riley: I honestly can’t remember focusing on that at the time. I understood – so, through February I didn’t know what the government would do when the virus arrived, and, you know, it wasn’t clear that they weren’t considering really stringent interventions. To me. So it was – during the very end of February and the beginning of March it became more clear that they were – that the government was focusing much more on mitigation. So I didn’t really know whether there had been a move or a change – or I didn’t – I didn’t know what had gone on at higher levels during February at all, and I didn’t – I didn’t notice that at the time.
So with all due respect, you can ask Professor Ferguson.
Counsel Inquiry: Yes. Just one other point on this, before we move on, the paragraph above. He says:
“Government is aware of the projected incidence …”
So that’s the anticipated mortality rate of the mitigation strategy.
And also “health system demand”. The inference there is that, on the one hand, you’re saying an awful lot of people are going to die and the health service is going to be saturated; Professor Ferguson seems to be saying the government know that but they want to do the strategy anyway?
Professor Steven Riley: That’s correct. What you’re saying is correct.
Counsel Inquiry: Yes.
Just one other point on this set of exchanges I’d like to ask you about, and for those purposes I think we need to go back to the first page of the document.
Yes, thank you. Sorry, let me just make sure I’ve got the right reference here.
(Pause)
Counsel Inquiry: Yes, thank you. So you say:
“I understand your view.”
This is – sorry, let’s just be clear about this, this is Professor Ferguson.
Professor Steven Riley: Yep.
Counsel Inquiry: He says:
“I understand your view. But just bear in mind the Treasury advice is that 6 months of intense social distancing – sufficient to achieve R<1, is predicted to drive deep recession and massive business failures and job losses.”
Then he refers to talking to someone from the US federal interest committee, and so on.
Do we see here again an example of the economic impact of lockdown being used to challenge that possibility?
Professor Steven Riley: Yes, we do, and can I comment on my –
Counsel Inquiry: Yes.
Professor Steven Riley: – response?
Counsel Inquiry: Yes.
Professor Steven Riley: People who were supportive of lockdown did not for one moment think that it wouldn’t have lots of massive negative consequences, but the point I make here in reply to Professor – to Neil is that we don’t have a counterfactual, we don’t – there seems to be an unstated implicit assumption that if we don’t do something we’re going to have a better economic outcome and a better outcome across all those other different dimensions, and I – I didn’t know why people assumed that.
Counsel Inquiry: So there are two points, perhaps. The first is the one you’ve made, which is that it’s all very well to say that a lockdown will be very costly, but how expensive will that turquoise unsuccessful mitigation policy – or even the successful mitigation policy be?
Professor Steven Riley: Yep.
Counsel Inquiry: But the second is: did you actually see these Treasury forecasts or Treasury modelling that you occasionally are being told about?
Professor Steven Riley: That’s correct, yeah, that’s another point, yes.
Counsel Inquiry: And in that regard, can I take you to a further document, please, INQ000103475.
So this is an email from several weeks later, the end of March, so we’re into lockdown by this stage, and you’re discussing, on this occasion with Professor Medley and Professor Woolhouse, some further aspects of social distancing policy.
In fact if we can go to the next page, please, it’s the paragraph starting “There are no easy choices here”, you say:
“There are no easy choices … While understanding that the stated government objective is to save as many lives as possible, economic impact is also important. But has any other branch of government done a detailed assessment of what the economy would look like with a prolonged period of virus circulation at or near maximum NHS capacity?”
So that’s the counterfactual point again. But you go on to ask:
“Is there a treasury team to whom we can send a plausible set of scenarios and ask directly how much better one scenario might be than another? We have a _little_ bit of time and this question has arisen many times.”
So did you get an answer to that question as to whether there was a Treasury team you could engage with?
Professor Steven Riley: I don’t think that I did. I think I may have put in my statement that I searched and was unable to find any answer. Or it may have been a slightly different email. But I don’t think – I don’t believe I did.
Counsel Inquiry: Moving away from this particular email, your general experience of that time when you were sitting on SPI-M-O as an academic scientist, did you ever find the answer to this question of: where was the economic modelling that you could look at to help understand your advice on policy change?
Professor Steven Riley: No, I did not.
Counsel Inquiry: Thank you.
My Lady, I see the time. I’ve got just a couple more quick topics to cover and then I might suggest we have a break in about five minutes’ time.
Just moving on with the chronology, Professor, the report was sent to SPI-M-O, and I think we know that it was discussed at a SAGE meeting, possibly on the same day.
Professor Steven Riley: That’s correct.
Counsel Inquiry: That then was 10 March. We will hear in due course plenty of evidence about what happened for the remainder of that week in Downing Street, and in particular a series of meetings that took place on Friday, 13 March, and then over the weekend that followed, which were all central in the decision that was in the end taken to lock down.
Dominic Cummings has provided evidence to this Inquiry about those discussions in Downing Street which have included a picture of a whiteboard that was used at those meetings, and it’s helpfully been brought up on the screen.
You comment in your statement you’ve seen this – this wasn’t the first time; I think it’s been in the public domain for some time – and you thought that you could see your own work reproduced on this whiteboard.
Professor Steven Riley: So I think there are some similarities. So in terms of some of the points that are noted, and it is difficult to read here, but they comment on an increasing fatality rate once hospitals are overwhelmed, which wasn’t a common feature of the models at the time.
Then the actual plots that are there, they have some – they have some similarities, some features that are quite similar to the way I presented my results.
On a log scale, the seeding – the way that you start the epidemic if you use a log scale means that you get a down and then an up on that left-hand side, so both of those curves are a down and up. And then actually on the mitigation, the second curve on the whiteboard there, you can see it’s two straight lines joined by a curve, which is – that’s what an epidemic on a log scale looks like. So there’s – and then I think in the bottom right that kind of looks like a discussion of how an epidemic is progressing up against some thresholds.
So – and I – and I do want to also add that during that week there were many voices within – I’m sure some within government and certainly many voices outside of government which were making very similar points, with excellent clarity. There was lots of input that week.
Counsel Inquiry: Yes. Yours wasn’t a lone voice, certainly, as that week developed.
The other part of the narrative that we should perhaps make clear is that Dominic Cummings was at that SAGE meeting where your paper was discussed a few days earlier.
Professor Steven Riley: I think I checked the minutes and a member of his team, Ben Warner, was at that meeting. I don’t know if Dominic Cummings –
Counsel Inquiry: Sorry, you’re right, that was it, it was Mr Warner.
Thank you, we can take that down.
Then lastly for the moment before we have a break, Professor, I want to ask you about a report that was published by the Imperial College response team the next week, so after your report was circulated, after Friday, the 13th, after that whiteboard, the next week there was a report published known as Report 9, and we can see from the top that Professor Ferguson’s name is the first name on the list of authors, and was he the principal author of this document?
Professor Steven Riley: Yes. Yes, he was.
Counsel Inquiry: We do see your name, the penultimate name on the list.
Professor Steven Riley: That’s right.
Counsel Inquiry: So you were also involved?
Professor Steven Riley: That’s right.
Counsel Inquiry: I’m not going to ask you about this document in any detail, Professor, because we will be dealing with it with Professor Ferguson, but I did just want to ask you about the last two or three perhaps.
So if we can go to page 16, please.
So just in summary, the penultimate paragraph, there is a striking sentence:
“We therefore conclude that epidemic suppression is the only viable strategy at the current time.”
So we saw those emails the week before where Professor Ferguson had been resisting your suggestion of a pivot towards suppression, but by the time of this report he has himself changed his mind and is advocating for that policy; is that right?
Professor Steven Riley: That’s correct.
Counsel Inquiry: In the paragraph that’s at the top of that section we can see why he is now saying that suppression is the right policy, and that is because of the NHS overwhelm problem –
Professor Steven Riley: Yes.
Counsel Inquiry: – in summary.
Then this, the paragraph between those two:
“In the UK, this conclusion has only been reached in the last few days, with the refinement of estimates of likely ICU demand due to COVID-19 …”
I want to ask your view about that paragraph. You of course, as we see in the report, had been saying from your email to Professor Medley, and then in the report, that NHS overwhelm was a reason for moving to suppression. You had been saying that for a couple of weeks. And indeed the Inquiry has heard Professor Woolhouse saying he was worried about the NHS being overwhelmed from the end of January, and Professor Medley saying that everyone became aware that the NHS would be overwhelmed during February at least. So is it right, in your view, that this conclusion was only drawn just a few days before this report?
Professor Steven Riley: No. And I have checked back through my files, I did comment kind of heavily on a version of this. The version I commented on didn’t contain this paragraph, but I did receive a copy prior to publication, so I did see this before it went out and, you know – so perhaps I missed this at the time, but I don’t agree with that characterisation of how the evidence changed.
Counsel Inquiry: In fact if we go to page 20 of your statement, paragraph 5.1, you expressed the view, perhaps unsurprisingly in light of the documents we’ve been looking at, that the first national period of – you’ve allowed yourself to use the word “lockdown” there, “should have been introduced on or around 9 March”. Is that still your view?
Professor Steven Riley: Yes. I felt – and I do remember having discussions at the time and certainly thinking this, that once we had lab-confirmed deaths in ICU with no travel history, no obvious connections to any out-of-country social networks, even a handful of those would indicate that we were – we would be rapidly progressing in our epidemic. I think – yeah.
Counsel Inquiry: Just to be clear, on the basis of the answer you’ve just given, and of course the documents, this view that you’re expressing here is one that you had at the time, not just with hindsight?
Professor Steven Riley: That’s correct. I mean, the – I think the introduction to the note circulated on the 10th kind of captures this, even if it’s not stated explicitly.
Counsel Inquiry: Yes.
Lastly, Professor, on this, your view, please: if a lockdown had been implemented two or so weeks earlier, what can you say about the different effect that might have taken place?
Professor Steven Riley: So we’ve got a lot of data about how social mixing changed over this period, and actually the – on or around 16 March seems to be when everybody did start to change their behaviour. So I think the best way to talk about this is to say: had we achieved that rapid reduction in mixing earlier than the 16th, then the peak height would have been lower and the area under the curve for the first wave would have been less, and potentially quite a bit less, and the area under the curve is proportional to the number of deaths, in a very kind of crude but useful way.
Mr O’Connor: Yes. Thank you.
My Lady, would that be a convenient moment?
Lady Hallett: Can you remind me of the date of the report that said “this conclusion has only just been reached in the last few days”?
Mr O’Connor: Yes, sorry, Report 9. Is it the 16th?
Lady Hallett: 16th, thank you.
Mr O’Connor: I suspect we’ll hear more about that report, my Lady.
Lady Hallett: I thought we might, but I just wanted to make a note there.
11.40, please.
(11.23 am)
(A short break)
(11.40 am)
Lady Hallett: Mr O’Connor.
Mr O’Connor: I’m grateful, my Lady.
Professor Riley, I’m going to move now away from the chronology of events during the pandemic and ask you finally a series of questions about the way in which the structure for providing scientific advice to government worked during the pandemic, and following up on some observations you’ve made in that regard in your statement.
I’d like to turn first to paragraph 2.4 of your statement, which is on page 4, and here you comment on that part of the system whereby the advice of the subcommittees or the evidence from the subcommittees is passed up to SAGE, SAGE is chaired by the Chief Medical Officer and the Government Chief Scientific Adviser, and then it’s they who act, to use a word you’ve used, as the bridge for providing that advice on to policymakers within government.
You say here that that aspect of the system had strengths and weaknesses. You emphasise that the two people who held those roles during the pandemic were highly effective in digesting and synthesising evidence, and therefore, as you say, the process by which they acted as a bridge was a strength, because they could ensure quality and coherence of the scientific evidence.
“However [you say], regardless of the capabilities of individuals, it is my view that they must also have acted as a slightly unrealistic bottleneck if their role was to be the primary arbiter of scientific opinion.”
What do you mean by “slightly unrealistic bottleneck”?
Professor Steven Riley: So my understanding of the process is that onwards from SAGE it is primarily the CMO and GCSA who take that forward. I think Stuart Wainwright described this in his testimony, there is written minuting of SAGE and then the oral communication of CMO and GCSA going forwards. So what I’m – my comment here is that, looking at the volume and complexity of the scientific information that was funneling into that SAGE process, I – the fact that it went forward through such a restricted mechanism to the most senior levels of decision-makers does seem like a bottleneck.
I acknowledge there will be working-level relationships all around SAGE as well, but I think the formal structure is also important in addition to those working level contacts that will also propagate information.
Counsel Inquiry: And do you – if you’re right, what you say has obvious sense about it, do you have any ideas as to how that bottleneck might be removed?
Professor Steven Riley: I think there are examples in other countries where they have broader panels meeting directly with ministers in a more formal way, and I would again emphasise there’s lots of informal communication that will be going on around this process, so at a very basic level something that has more people involved in the formal communication, because it just seems like two isn’t – it’s an enormous load on two individuals.
Counsel Inquiry: As you say, the system as it stands, you have the debate at SAGE amongst that broad group of people, fed into by the subcommittees, and debate above that at the policy level, but just those two people acting as the link between the two, and if one was to have some sort of larger organisation where policymakers and scientists, more than just those two, could communicate about the scientific advice, that might be a better approach?
Professor Steven Riley: I think it might be, yes.
Counsel Inquiry: Moving on, Professor, in fact on the same page of your statement, paragraph 2.6, you refer to a lack of diversity amongst SAGE and its subgroups, illustrated – sorry, during the early months of the pandemic, and you say that’s illustrated by the under-representation of women on SAGE and its subgroups during that period, although you go on to say that that was corrected as the pandemic progressed.
What about diversity in terms of representation of other ethnic groups?
Professor Steven Riley: So, just to comment, I’ve not reviewed data on this. This is a topic where, you know, looking at the number of people attending meetings and their diversity characteristics is a very valuable exercise. I have not done that, so I’m commenting from my impression, and that’s actually what I was doing here in the statement. And I’m suggesting that looking at gender was a – illustrated the overall lack of diversity, not – I’m not saying that’s the only important aspect of diversity.
Counsel Inquiry: No.
Professor Steven Riley: And from recollection, with – you know, in a seria – you know, I would – there is very little ethnic diversity that I’m aware of within the system. So yes, I’d imagine that is an issue that should be addressed as well.
Counsel Inquiry: Do you think that that lack of ethnic diversity within the SAGE and its subgroups, and I take it that it’s fair for you to say that that’s just a sort of observation, it’s nothing sort of scientific about that observation, but taking that as read, do you think that that may have had any actual substantive impact on the way in which scientific advice was provided, bearing in mind of course what turned out to be the disproportionate impact of the pandemic on certain ethnic groups in this country?
Professor Steven Riley: I think it’s entirely possible that it did have an impact, yes.
Counsel Inquiry: And that would obviously be another reason why that aspect needs to be looked at and corrected as soon as possible?
Professor Steven Riley: Yes. It’s a common theme across lots of technical disciplines, that historically there has not been sufficient diversity. It would apply to many organisations, certainly beyond SAGE. It’s a difficult problem to address but it is an important problem.
Counsel Inquiry: Just sticking with the question of diversity for a moment, if we could move to page 38 of your statement, paragraph 11.2, you pick up this theme again later in your statement, Professor.
We should bear in mind, of course, shouldn’t we, that you were not an attendee of SAGE other than those few occasions where you attended it after you joined the UKHSA, but with that in mind you say that you understand that SAGE is an ad hoc committee and is shaped to respond to specific outbreaks, but you say it can be so influential and therefore you float the idea of there being some kind of what I take it to mean a more formal recruitment process than exists at present; is that what you’re driving at?
Professor Steven Riley: Yes, I might contrast – so NERVTAG I believe has an open recruitment process. I think they advertise, people apply, and even though it’s only a proportion of time, I’m not sure it’s even remunerated, but there is a recruitment process that would be similar to any other position, whereas some other committees do not. And what I’m really saying here is, even if you’re not invited to every meeting, there may be benefits in considering that for SAGE. I can imagine there are some – you know, there may be drawbacks with that as well, but given the impact that the committee may have during key times, then that may be something to consider.
Counsel Inquiry: Yes, thank you.
Moving on to a different topic, this is at 5.3 of your statement, page 21. The issue here is what you refer to as groupthink, and you describe a particular moment during the pandemic, in fact during that period that we were talking about before the break, when you were trying to gain an audience for your paper, where you were taken aside and privately assured that you were being listened to, even if perhaps it didn’t feel like that. But you at that point describe raising the question of red teaming, perhaps a fairly well known phrase, whether there was a sort of challenge process built into the structure.
Tell us more about that issue.
Professor Steven Riley: Yeah, so it was at the end of the meeting on the 11th that I’d attended in person and in discussions afterwards I raised the possibility of groupthink, and then – and used the term “red team” to just ask whether anywhere else in government they had a bunch of people in a room trying to figure out if there was a better way to be doing – to be thinking about the stuff that we were doing.
And it was – I was very tired, I was quite frustrated, and I was kind of – I was flailing a little bit, but, you know, that was a thought that occurred to me then: given the stakes here, I hoped at that time that there might be people I didn’t – that we weren’t aware of who were actively considering the same issues.
Counsel Inquiry: We certainly haven’t seen any evidence of management consultants being brought in to SAGE during the pandemic. I take it that nothing came of your suggestion at the time?
Professor Steven Riley: I’m not aware of – no feedback was given to me, and, you know, I wouldn’t have expected it. This was an informal conversation after a long meeting.
Counsel Inquiry: But looking back on it now, and in particular with the extra perspective you’ve gained from UKHSA, do you think there is a weakness in the system here? Do you think that the system would benefit from having some form of formal internal challenge mechanism?
Professor Steven Riley: I think effectively that was addressed very quickly. I’m not sure it was ever – so, yeah, I’m not sure it was ever referred to as a red team existing that hadn’t existed before, but if you look at the structures across government that were – sprung up immediately following March, and certainly by the time I could observe them in October 2021, effectively there were numerous red teams that were capable of providing advice.
So I don’t feel that’s something that was overlooked, beyond that moment I mention there.
Counsel Inquiry: I’m going to move on, just two more topics left. The first is transparency and for these purposes if we look at paragraph 11.1 of your statement on page 38, please.
You here refer to the suggestion that the government, the UK Government, “did not see transparency of evidence as an integral part of managing the Covid-19” question, and you say that in your experience that was a fair criticism, at least in the early stages, but that, perhaps a little bit like the red teaming, the position improved later on in the pandemic.
Why do you say it was a fair criticism early in the pandemic?
Professor Steven Riley: So I think the details – you know, the details of the SAGE considerations weren’t made public initially. The membership was not kind of – I remember a lot of debate about the membership at SAGE. So issues like that I think reduce the transparency.
However, again, you know, my view, even when I was outside of government, is that the level of commitment and resource that was employed after this time was very, very high, and even compared to many other places around the world. So I think that – I think this was a – moving onwards from, you know, April 2020, this was an incredibly strong aspect of the UK response. And just to mention the REACT Study, that was – we were funded by government, worked closely with DHSC and Ipsos MORI, we’d had extreme – we’d had very, very good data, we wrote our reports, we published our reports. So I think that’s an example of something that was very transparent to the public.
Counsel Inquiry: So, so far you’ve described, if I can say, maybe the epidemiological, the infection side of the story, SAGE minutes and papers, not published to begin with but within a few months –
Professor Steven Riley: Yeah.
Counsel Inquiry: – that was all made very public.
Professor Steven Riley: Yep.
Counsel Inquiry: If we can go down, please, to paragraph 11.3, you refer there to Professor Edmunds, who is coming later in the week, stating:
“… that it was a ‘massive failure’ of the government not to share the economic evidence or to explain how this evidence informed its decision-making.”
And you say you agree with that agreement.
Is there a contrast to be drawn between the transparency which came to be adopted in regard to the sort of more infection-based materials on the one hand and the economic evidence on the other?
Professor Steven Riley: Yeah, I think there is an interesting contrast between those two areas of analysis.
Counsel Inquiry: Your view, you seem to agree with Professor –
Professor Steven Riley: Yes, so I think we mentioned it before, I – my view is that there was – I was – I never – there was insufficient public evidence about the potential economic trade-offs with some of the – with many of the policies that were considered.
Counsel Inquiry: On a similar theme, if we could look, please, at page 42, 12.14 of your statement, you again come back to the question of transparency and public scrutiny, here in the context of modelling, and I think what you’re saying here is that perhaps the whole – and this is a broad topic which we will have to cover very quickly, but the headline is that government could do more to explain or could explain better the whole modelling process and how that advice feeds into decision-making?
Professor Steven Riley: This – yeah. Briefly, this reflects perhaps my own kind of professional bias. I try to be very careful, using a phrase “the model says”. I would rather give my view, which is sometimes very heavily informed by a model, other times draws on lots of other evidence. But I think that phrase “What does the model say? The model says this” is sometimes not helpful.
Counsel Inquiry: Yes. Another lesson that could be learnt for the future.
Then just finally, Professor, I want to ask you a few questions about the need, from a scientific point of view, for defined policy objectives against which to set scientific advice. It’s a subject that some of the earlier witnesses have touched on already.
Could I ask you to look, please, at paragraph 11.5 of your statement on page 39. It’s another one of these parts of your statement where you have been asked to address an observation made by the Institute for Government, here about chaotic decision-making.
Picking it up about five lines down, you say you have no comment on whether lack of clarity delayed decisions or made it harder for scientific advisers to provide useful advice, but you go on:
“… on reflection and with hindsight, it may be possible to define objectives that would drive government strategies for some specific scenarios.”
Could you explain what you mean by that.
Professor Steven Riley: Yes, so – and here I am thinking about viral respiratory pandemics to some degree, that we should be able to decide in advance what those objectives would be. And, you know, a particular scenario is where there is a reasonable expectation of a vaccine, and where the way we behave, our social mixing, affects the speed of transmission. That’s a reasonable future scenario. And we – I think it would be good to try to agree collectively what the objectives should be.
Counsel Inquiry: That’s what you explain in the rest of this paragraph, and it’s striking, the objective that you propose, just as an example, to:
“… maximise the number of at-risk individuals who receive an effective vaccine prior to being infected naturally, while minimising any indirect harms of the interventions that [you] employ …”
It’s still at fairly high level, but you think that even that sort of policy objective would help as a structure for scientific advice?
Professor Steven Riley: Yes, yeah, I think that it would, and I think many of the other witnesses have commented on how difficult it was to scope the scientific advice in the absence of that kind of framework.
Counsel Inquiry: So without getting into specifics, even that type of high-level objective was missing in the early stages of the pandemic; is that a fair point to make?
Professor Steven Riley: Yes.
Counsel Inquiry: Then very lastly, Professor, and you’ve already mentioned that these objectives could be at least debated now, if we could go to paragraph 12.15 of your report, please, it’s actually the last paragraph, and you come back to the point about the economic trade-offs of these measures, and the need for co-working. But you say:
“At the very least, with the benefit of hindsight, it should be possible for different disciplines to agree on how they could have better assessed trade-offs between the economy and health at key moments of the acute phase of the … pandemic.”
And:
“If this work were public, it could inspire substantial progress in academic collaborations between health scientists and economists.”
At the beginning of the paragraph you make the point that there is no reason these steps shouldn’t be taken now?
Professor Steven Riley: That’s right.
Counsel Inquiry: Are they being taken?
Professor Steven Riley: There is – there are – I think as Professor Keeling commented on, there are a number of groups that are looking at exactly these economic questions, and there is – I think there is a lot of work going on in this area, some of which I may not be aware of. I’m still not aware of a kind of definitive description of what the appropriate counterfactuals could have been or should have been during kind of March 2020, but they may exist and I’m not aware of them.
Mr O’Connor: All right.
My Lady, those are all the questions.
Lady Hallett: Can I just ask about that?
I’m a simple soul at heart, Professor. Surely if I were a minister and I was asked to provide my objectives, I would say my objectives are: minimise deaths, minimise infections, because people have long-term sequelae, minimise the impact on the economy, minimise the impact on societal wellbeing, mental health, educational opportunities and the like. Wouldn’t I just give you a whole range of extraordinarily high-level objectives, and you might say, “But they’re not compatible, they don’t go together”? How would they help you?
Professor Steven Riley: So if you gave us a very long list of everything that you could be worried about, that probably wouldn’t help. I think even narrowing it down and saying, “I’m going to describe our objectives in one or two or three ways”, that would be a start. And then I think that if you – if from that there was a discussion and you start to put a little bit of qualitative trading off between those objectives, then that would help even further.
So you’re right, if you just list everything you’re worried about, that wouldn’t help, but being – picking two or three things and exactly how you express it, and then perhaps moving on from there, I think could be very helpful.
Lady Hallett: But if I excluded from the list I just gave you, for example, minimise the infection, then I’d be accused, as the minister, of not taking into account those who suffered Long Covid. If I didn’t include educational prospects, I would be accused of not taking into account children. So how do I address all those concerns when I’m making my decision or setting my objectives?
Professor Steven Riley: I mean, it’s really difficult, and I say in a number of places that ministers were presented with the most difficult possible decisions. But if ministers don’t choose a framework then they’re leaving it to everyone else to create their implicit separate frameworks, and we end up with over-emphasising deaths, which is, you know, one criticism of the response, or completely missing some aspects. So it’s – I’m not for a moment suggesting that it’s easy. I’m suggesting it’s a process that’s better gone through in advance for scenarios that you can reasonably expect to arise.
Lady Hallett: I’m glad I’m not the one having to set those objectives, Professor.
Thank you very much indeed, you’ve been extremely helpful. And I think looking back on it, you probably feel you were right to send your report. I don’t think you would have forgiven yourself if you hadn’t. So I appreciate it must have been a very stressful time for all of you, so thank you very much for your help and all you tried to do. Thank you.
Mr O’Connor: My Lady, I have finished, but in fact –
Lady Hallett: I’m so sorry.
Ms Morris, cutting you off, I’m so sorry.
Questions From Ms Morris KC
Ms Morris: Thank you, my Lady.
Good afternoon, Professor Riley. I ask questions on behalf of the Covid Bereaved Families for Justice, and I have just one topic, please, to ask you about, and that’s the use of face masks in the community, a question that’s not only important to the Inquiry but also to the bereaved families.
You mention it at paragraph 4.9 of your witness statement, it’s a side note, an illustration of a paper that you’ve written and a provision of advice that goes forward. I just want to ask you about the specifics, if I may.
I’m not going to ask you to look at the paper, hopefully you’ve got a good recollection of it.
Professor Steven Riley: I do.
Ms Morris KC: It’s dated 20 April 2020, it’s called “Potential impact of face covering on the transmissibility of SARS-CoV-2 in the UK”, and just for the transcript reference, it’s at INQ000236296.
Was this a report that was commissioned by SAGE?
Professor Steven Riley: Yes. So, Professor – the co-chairs of SPI-M-O asked me to write a report.
Ms Morris KC: Thank you. I think we can see from the minutes of SAGE on 21 April, that’s SAGE 27 – again, I’m not going to ask you to look at it, but it’s INQ000062295 – that they did in fact discuss the impact of face coverings, and Graham Medley from SPI-M-O was at that meeting.
Thank you.
So you’ve produced a paper in April 2020 on the use of face masks in the community for asymptomatic members of the public. Is it a fair summary to say that there was no obvious reason why surgical face masks couldn’t be used in closed community settings, for example buses, public transport and shops, based on the limitations you’d observed from the widespread use of face coverings in other countries which had been considered useful and successful in containing Covid-19?
Professor Steven Riley: So I just want to give what I perceive to be the key points of the report, because there was a reason I was asked to do that and it’s because I had looked at some of the evidence from influenza, studies of influenza.
Ms Morris KC: Yes. Pre-pandemic studies?
Professor Steven Riley: Yes, so I went back to look at those, and the key point that I thought I was making in the report was, even though those studies suggested quite low effectiveness of face masks for influenza, there were a number of issues around the design and interpretation of those that said maybe it could actually be better and we shouldn’t necessarily rely too heavily on those as negative results.
Ms Morris KC: That’s helpful, thank you.
Professor Steven Riley: Then if we just come to your question, you asked quite a specific list of things about use in other countries. I don’t know whether I commented on those in the report.
Ms Morris KC: At that time, had you looked at, for example, other East Asian countries and their use of face masks?
Professor Steven Riley: So I don’t recall commenting on that explicitly in the report, so I’m not sure that I did.
Ms Morris KC: Okay. You’ve just touched upon the literature review you did about the influenza use of face masks, so you’re doing this review in April 2020?
Professor Steven Riley: Yeah.
Ms Morris KC: Is it fair to say that if that review had been done in February 2020, of that pre-pandemic literature, the results would have been the same, had you done it in February?
Professor Steven Riley: I think they would have been quite similar. And I believe WHO have commissioned a relatively recent study of face masks for influenza that I think probably was quite similar.
Ms Morris KC: Okay, thank you.
So was it your conclusion that now would be quite a good time to gather more evidence about the efficacy of face masks?
Professor Steven Riley: Yes, I think that’s – yep.
Ms Morris KC: For example by combining it with digital contact tracing?
Professor Steven Riley: I believe I do mention that as an opportunity in the report, yes.
Ms Morris KC: Yes. So this is the advice you’re giving in April?
Professor Steven Riley: Yep.
Ms Morris KC: There may be utility to using surgical face masks in closed community settings?
Professor Steven Riley: Yes.
Ms Morris KC: Thank you.
How did you expect that paper to be used by policymakers? Was it just for SAGE or did you expect it to have any wider impact?
Professor Steven Riley: So it was commissioned as a rapid review over just one weekend, a rapid review to support the discussion at SAGE, and I could see from the SAGE minutes that there was an extensive discussion of face masks and there were clearly many other points raised – I was not there – there were clearly many other points raised in that meeting in addition to the material that I provided in that report.
Ms Morris KC: But from your report, was there any scientific, as opposed to resource, reason not to advise the public to use surgical face masks in closed community settings in April 2020?
Professor Steven Riley: I did not find a reason in the work that I did, no.
Ms Morris: I’m grateful, thank you very much indeed. Thank you, Professor.
Thank you, my Lady.
Lady Hallett: Thank you very much, Ms Morris.
Mr O’Connor: That does bring this witness’s evidence to a close.
Lady Hallett: Thank you, Mr O’Connor. Sorry, I’d missed the one sheet.
Thank you very much again, Professor, really grateful to you.
(The witness withdrew)
Mr O’Connor: My Lady, the next witness is Professor Ferguson.
Lady Hallett: Thank you.
Professor Neil Ferguson
PROFESSOR NEIL FERGUSON (affirmed).
Questions From Lead Counsel to the Inquiry
Mr Keith: Good morning.
Could you commence your evidence, please, by providing your full name?
Professor Neil Ferguson: Neil Ferguson.
Lead Inquiry: You are, Professor Ferguson, a mathematical epidemiologist, and you have worked on the subject of emerging infectious disease outbreaks for many years.
Professor Neil Ferguson: Yes.
Lead Inquiry: Much of your research has focused on using statistical and mathematical models to understand infectious disease dynamics and control; is that correct?
Professor Neil Ferguson: That’s correct.
Lead Inquiry: As a world-leading specialist in this field, you are the director of the MRC – is that Medical Research Council?
Professor Neil Ferguson: Mm-hm.
Lead Inquiry: – Centre for Global Infectious Disease Analysis?
Professor Neil Ferguson: Well, I handed over that responsibility a few months ago. I’m now director of the School of Public Health at Imperial College.
Lead Inquiry: All right. The MRC Centre for Global Infectious Disease Analysis is at Imperial, is it not?
Professor Neil Ferguson: It is.
Lead Inquiry: And you were the director for a number of years. As you say, you are part also of the Department of Infectious Disease Epidemiology, the School of Public Health, you have also been a director of the Health Protection Research Unit in Modelling and Health Economics, and you hold a number of prestigious fellowships, awards and professional qualifications?
Professor Neil Ferguson: I do.
Lead Inquiry: During the pandemic, you participated in a number of important aspects of the country’s response to the pandemic, because you were, having served many years in fact on SAGE, a member of SAGE. You also participated in SPI-M-O, NERVTAG and another subgroup, EMG, as well as a number of ad hoc task and finish groups?
Professor Neil Ferguson: Indeed.
Lead Inquiry: Was your contribution to this country’s response to the pandemic offered by way of your personal contribution as Professor Ferguson or as part of the Imperial College team?
Professor Neil Ferguson: I think more in the latter. Clearly there were some aspects of the former at times.
Lead Inquiry: It’s very plain from the evidence that over time you contributed very extensively to the body of scientific advice that was provided to the government, and also the Imperial College COVID-19 Response Team contributed by way of the provision of a multitude of reports and papers and pieces of learning to aid the government in its hour of crisis.
In your statement, we needn’t put it up, at paragraph 13 – and I should say you’ve very helpfully provided the Inquiry with three statements, the first of which is a powerful and lengthy piece of work, Professor, weighing in at over, I think, 150 pages.
You say this:
“I believe that scientists have a key role to play in advising policymakers on the potential impacts of different policy choices in a crisis, but that they should not use the public platform offered to them by that role to campaign or advocate for specific policies.”
I want to start your examination, please, by asking you for your views, in a general sense, on the role of scientists, in particular in relation to this pandemic.
What is the basis for your belief that scientists should not use a public platform to campaign or advocate for specific policies?
Professor Neil Ferguson: I mean, it’s a personal view, and I have plenty of colleagues and – who might take a different view. My view is that, I mean, we have expertise to give to inform policy responses, but we are just citizens in society, and for something as consequential as a pandemic, where everybody will be affected by the decisions made, fundamentally, it is for kind of policymakers to make those decisions, not for scientists.
So I’m quite happy to inform policy, but not, certainly in the – as a member, for instance, of SAGE or NERVTAG, to advocate for a policy.
Lead Inquiry: In reality, in practice, was that an easy path to tread?
Professor Neil Ferguson: No. As I outline in my statement, there were many – well, many – there were a number of occasions where those lines got blurred. And clearly we are all human beings and we’re experts on infectious diseases, so we had more sense than many of what was about to happen, both in the spring of 2020 and in the autumn of 2020, and there were occasions where, you know, frustration built up, let’s say, at the apparent slowness of decision-making.
Lead Inquiry: You yourself were not averse to appearing in the press. I think you appeared on perhaps the Today programme, in April 2020, you gave a number of interviews. In reality, was that self-imposed purdah difficult to apply?
Professor Neil Ferguson: I mean, certainly in giving media interviews, for instance, I always try to take the line that it was for, you know, scientists to advise on policies and for policymakers to decide upon them.
Lead Inquiry: Is the basis of your decision in part that you believe that, as a scientist, it’s your role to advise and you have, therefore, no greater right than anybody else to determine policy?
Professor Neil Ferguson: Indeed.
Lead Inquiry: We will be coming back to the specific position of SAGE later, and we want your views as to how that system of advisory – scientific advisory/government policy interface can be made to work perhaps better.
But in a general sense, do you feel that you did confine yourself to the provision of scientific advice, or did you become, despite your best endeavours, irrevocably involved in the determination of policy?
Professor Neil Ferguson: It’s a difficult question to answer. I know I’m associated very much with a particular policy, but as you’ll be aware from the evidence I’ve given in my statement and the statement of others, the reality was a lot more complex.
I was – I don’t think I stepped over that line to say, “We need to do this now”. What I tried to do was, at times, which was stepping outside the scientific advisory role, to try to focus people’s minds on what was going to happen and the consequences of current trends.
Lead Inquiry: Is it, in your view, possible, realistic, to have those scientists who are providing advice to government not engage in substantive debate about the right policy, the right strategy, and to communicate that view to government?
Professor Neil Ferguson: I mean, I think that brings one to something I talk about at some length at the conclusions of my first statement, namely I did feel there was a role that, if we had been more integrated into the operational response, we could have contributed more. And that has happened in the past. That’s a different thing from saying we should be advising or advocating for a policy. It means that if you have more sight of the objectives and constraints under which policy has to be made, you can give more informative advice.
Lead Inquiry: The emails which the Inquiry has, as you are aware, Professor, show that on a multitude of occasions you expressed views about the government’s policy, whether, for example, there was a distinct lack of urgency, concerns about whether or not it was over-wedded to a mitigation strategy. You told Professor Steven Riley, your colleague, he says that “we”, meaning you and others, “were currently driving UK preparedness and planning”, and you express on multiple occasions views about the economic impact of – we’re going to use the word, Professor – lockdown.
That rather suggests that it is impossible for a scientist in your position and the position of your colleagues, who were providing this vital line of advice, not to become engaged, themselves, in expressing views on strategy, on policy, bluntly, what the government should be doing.
Professor Neil Ferguson: I would distinguish between exchanges with fellow scientists, particularly within the Imperial College team, where there was clearly a diversity of views, and we are – we all had our views – and then how you express oneself in interactions on committees such as SAGE.
Lead Inquiry: You expressed yourself in very forthright terms about the economic impact of lockdown. You informed your colleague, Professor Riley, that you’d spoken to, for example, a US federal interest committee about the economic consequences of lockdown. You expressed views about whether or not there was a clear-cut best strategy and whether the government was following it.
My point to you is: should one just not recognise the reality, which is that scientists are placed in an impossible position if they are expected to and they self-impose an obligation not to express clear views on policy outcomes and strategic options and what should be done?
Professor Neil Ferguson: I think there’s a better balance that can be struck in that regard than was struck at certain times in the pandemic. I mean, I read carefully Chris Whitty and Patrick Vallance’s statement and they express some of the same concerns as I do about that disconnect. Do I have a perfect model for it? No.
Lead Inquiry: Do you believe that, in drawing that very difficult balance between providing advice and intruding into policy decision-making, you personally kept to that line?
Professor Neil Ferguson: I do. Clearly I’ve thought in retrospect of whether I should have been more forceful at times. I think where I was comfortable intruding across that line was where I didn’t see evidence of, let’s say, the sort of preparedness to make a, you know, policy option viable – let’s put it that way – rather than saying, you know, “This is the alternative policy which should be adopted”.
Lead Inquiry: Now, you are, by training, a mathematical epidemiologist, and so it’s important that we gain from you a sufficient understanding of the complexities of modelling.
Lady Hallett: Just before you do, Mr Keith, can I just pursue the process by which you give advice to ministers?
I –
Professor Neil Ferguson: Can I –
Lady Hallett: Sorry.
Professor Neil Ferguson: I never gave advice to ministers.
Lady Hallett: No, so you didn’t directly, sorry, advice is given to ministers.
As somebody who has given advice that is then given to ministers, I’ve seen a lot of papers over the years from civil servants that set out the various options, with the pros and cons, and then a recommended option. That wasn’t the format that SAGE advice took, it seems to have had a consensus statement.
Professor Neil Ferguson: Yes.
Lady Hallett: What’s wrong with setting out the options and making recommendations?
Professor Neil Ferguson: I mean, in previous – previous SAGE – previous events where I’ve sat on SAGE, SAGE has been asked to do that. We weren’t asked to do it for the pandemic. So – and reading Sir Patrick’s statement, it appears that that was, you know, the responsibility partly of himself and Chris Whitty and partly of DHSC and the Cabinet Office, presenting the policy options.
We were asked much more narrow questions about the likely impact of individual interventions and clarifying the science and the epidemiology. So at no point prior to, I would say, April 2020 were we asked, you know, what are the strategic options which the government could consider?
Lady Hallett: And do you have a scientific-only based recommended option?
Professor Neil Ferguson: Well, that comes to another issue, that the recommended option will depend on the policy objectives and/or red lines the government wants to set. That’s where, you know –
Lady Hallett: That’s where the needing to know the objectives comes in.
Professor Neil Ferguson: Yes.
Lady Hallett: I follow, thank you.
Mr Keith: Professor, you were asked relatively narrow questions as a member of SAGE about the likely impact of individual interventions, but to a very considerable extent you and your colleagues had no option but to answer those narrow questions rather more widely; is that a fair summary?
Professor Neil Ferguson: In some cases, yes.
Lead Inquiry: Is that why, as we will see in a moment, in March in particular, you became involved so intimately in the debate about the strategic options open to the government, the likely course of events, what their best strategy might be, what might happen, that were way beyond a narrow technical, epidemiological, mathematical, modelling answer?
Professor Neil Ferguson: Yes. I mean, that was really not on SAGE, it was the SPI-M group, which then – and had discussed it before informally. I mean, clearly we did discuss – and we were reviewing what was happening in other countries, we did discuss the policy options and strategies available. But rarely as part of the official business of the group, more as informal conversations between, you know, fellow scientists.
Lead Inquiry: That, therefore, leads one to this conclusion, does it not, that there is something wrong with the system when the formal requests made of SAGE and, to a lesser extent, SPI-M-O, are framed in relatively narrow, technical, commissioned questions: what is your scientific view on X?
Whereas at the same time the email strings between you and your Imperial colleagues, Chris Whitty, Patrick Vallance, Ben Warner (special adviser in Number 10), show that you were engaging much more significantly in the overall policy debate.
Professor Neil Ferguson: Engage I think is fair. I mean, I was certainly aware of the policy debate and I was aware that we needed to have a policy which was actually able to be implemented.
Lead Inquiry: Professor Ferguson, your emails show, do they not, that you expressed forthright views at various times on lack of urgency, on caution on the part of government officials, on whether or not the strategies adopted by the government were leading us, effectively, to ruin? You didn’t hold back in those views.
Professor Neil Ferguson: No, I mean, I had, certainly, concerns.
Lead Inquiry: Why were they not communicated as part of the formal SAGE process, of which you were an important member?
Professor Neil Ferguson: I mean, I think because the formal SAGE agenda was – I mean, the meetings were relatively formal, with a formal process for considering evidence and providing advice. They were not – until much later – generally open debates about – certainly about policy strategy.
Lead Inquiry: The SAGE minutes, of course, are consensual minutes. They reflect –
Professor Neil Ferguson: Can I just?
Lead Inquiry: Yes.
Professor Neil Ferguson: I mean, they weren’t minutes, so –
Lead Inquiry: No, I’ve called them minutes because that is how they are referred to, but they were documents drawn up to reflect a consensus position reached by the group; is that a fair summary?
Professor Neil Ferguson: I think I would agree with how Patrick Vallance has stated it in his evidence, namely they were a central position rather than always a consensus position.
Lead Inquiry: Some of the meetings were – I think perhaps can reasonably be described as fairly tense, quite heated. The 13 March SAGE meeting in particular, the heat of the –
Professor Neil Ferguson: And I think in the September and October as well, but yes.
Lead Inquiry: All right. But the flow of the debate and the range of opinions was never really properly reflected in those consensus documents, were they?
Professor Neil Ferguson: No. I mean, I think if you want to see a better indication of I think how I would like to see such minutes be prepared in future, then the NERVTAG minutes are much more informative.
Lead Inquiry: In terms of transparency, in terms of having a good visibility on what advice the government was receiving, was there not a problem here, that whilst SAGE openly debated these vital issues and was of course constituted to publicly, by way of publication of its documents, give the government advice, you and your colleagues were prone to emailing around each other and emailing the CMO and the Government Chief Scientific Adviser and Number 10 officials and other officials in the working parts of the government your own rather more candid views?
Professor Neil Ferguson: On – I mean, I tried not to do it very much, but there were times where that felt necessary to do.
Can I just correct, I mean, my perception of SAGE is it’s a committee convened to advise the Government Chief Scientific Adviser and, in this case, the Chief Medical Officer to allow them to provide the best scientific advice to government. SAGE itself goes through that conduit.
Lead Inquiry: Indeed. But the use of personal email to speak to individuals in government outwith the SAGE and then the CMO/CSA funnel was a process that had no visibility to it, and of course those emails were not published in the way that the SAGE materials were published?
Professor Neil Ferguson: Yes, and I believe both Chris Whitty and Patrick Vallance engaged – you know, had email exchanges and conversations with many, many scientists across the course of the pandemic outside SAGE.
Lead Inquiry: You say, “I tried not to do it very much”. Is that an expression of – well, perhaps of hope rather than expectation? You did send quite a lot of emails, Professor, did you not?
Professor Neil Ferguson: Yes, I did. I mean, a lot of them were about the science itself, about the changing, you know, situation, our understanding of Alpha, Delta, of the infection fatality ratio, they were pure science. There was a much smaller number which related to policy.
Lead Inquiry: There was still a considerable number relating to the government’s position, the policy, the strategy that was being applied, and your own views on all of that?
Professor Neil Ferguson: There were a number, yeah.
Lead Inquiry: Coming to modelling, could you, in one sentence – I say this more in hope than anticipation or expectation, Professor – summarise the aim of epidemiological analysis and modelling? What is its purpose? What does it seek to achieve?
Professor Neil Ferguson: It aims to quantitatively understand patterns of transmission of an infectious disease in the population, the heterogeneities, the variability in that, and use that insight to inform control policy planning and understanding of epidemic trajectories.
Lead Inquiry: Yes. Professor, is the primary aim of modelling to understand, in the most basic lay terms, the spread of the disease, of the pathogen?
Professor Neil Ferguson: It’s to understand the patterns of spread but also to estimate certain key quantities which relate to that, such as the incubation period of transmissibility and things.
Lead Inquiry: Those are all facets, are they not, of the disease?
Professor Neil Ferguson: Yes.
Lead Inquiry: A second aim of epidemiological analysis and modelling is to work out prospectively, in the future, what might be the impact of measures taken by the government. So it’s not an analysis so much as the painting of a scenario: what might happen if this is done or this is not done. Is that a fair summary?
Professor Neil Ferguson: Yes, the examination of a range of what are technically called kind of counterfactual scenarios about the potential impact of different policy options or other interventions like vaccines and treatment on – on a disease.
Lead Inquiry: Could you give, please, the Inquiry a feel for how – and as you answer, could you please try to keep your voice up, it’s been a bit hard to hear you.
Professor Neil Ferguson: Yeah.
Lead Inquiry: Could you give the Inquiry a feel for how great, wide a field this field, this science of modelling is? The Inquiry has seen a great deal many reports and papers prepared by yourself and your colleagues. Is modelling or has modelling been driven by the well known rapid expansion in computer science, for example, which has enabled you to produce much more complicated and complex work than hitherto?
Professor Neil Ferguson: So I prefer kind of lumping analysis and modelling together, because most of what we did in the pandemic, frankly, was epidemiological analysis rather than modelling interventions.
You’re completely right, the field has grown dramatically in the last 20 years. It’s less about being able to use more complex models, more about a revolution in what’s called Bayesian inference, the ability to calibrate models against epidemiological data in a way which allows them to be used in a more predictive sense – and I use “predictive” in a – I don’t mean literal predictions in that sort of scenario analysis sense – than was possible in the past.
Lead Inquiry: By and large, do all governments in the face of an epidemic rely upon modelling scenarios? How widespread is its utility and use?
Professor Neil Ferguson: So the UK has been in the lead in its use, throughout my career, but I co-hosted, with the World Health Organisation, a meeting across multiple countries earlier this year, including low-income countries, Kenya for instance, and every country represented had some degree of modelling applied to inform its pandemic response.
Lead Inquiry: The role of modelling in the United Kingdom was plainly a vital one. It’s obvious from Professor Riley’s reports of early March, your own and the ICL report, Report 9 of the middle of March, that the mathematical modelling work product played a vital role.
What about Far East and Asian countries? So it’s well known and common ground, if you like, that South Korea developed a diagnostic test around about the same time as the United Kingdom. They of course were aware of the incipient outbreak, as we were, and they – the evidence shows – put into place rapidly a very sophisticated test, trace, contact, isolate, support system to keep control of the virus.
Do you know to what extent those governmental choices made in South Korea were determined by mathematical modelling?
Professor Neil Ferguson: I think mathematical modelling was one input into it. I think a larger input was their experience of the MERS coronavirus outbreak in – which was very disruptive, a few years before the pandemic. And that led them to implement legal measures to allow a sort of contact tracing which we never got close to being able to employ. I mean, using – tracking individuals’ mobile phones, government having real-time access to all banking transactions.
So I would – I’m happy to talk about how Korea achieved what they did, but it’s not just as – I mean, it wasn’t simple kind of boots on the ground contact tracing.
Lead Inquiry: But to what extent, and you may only be able to answer quite generally, to what extent were those practical steps taken by government? And they were practical steps, they were non-pharmaceutical measures.
Professor Neil Ferguson: Yeah.
Lead Inquiry: Non-pharmaceutical interventional measures.
To what extent was the decision to take those steps, to put those measures into place, being driven by the conclusions, the demands of epidemiological mathematical modelling?
Professor Neil Ferguson: I mean, I can’t answer specifically for South Korea, but in many places, Hong Kong might be another example, Singapore, where I know more about it, mathematical modelling was certainly an input in terms of projecting likely trajectory of the epidemic and hospital demand.
Lead Inquiry: Putting it perhaps unfairly and a little bluntly, Professor, you don’t need mathematical modelling if you’re a government to know that if the virus spreads to your land and is out of control and cannot be contained, you’re going to have a very serious problem indeed?
Professor Neil Ferguson: I mean, once you know what the infection fatality ratio and the reproduction number of the virus is, you can get away with, I would say, very simple models, and as you say, maybe for – you know, intuition to some degree about what the consequences would be. You still need that epidemiological analysis, though.
Lead Inquiry: You mentioned there the need to know the infection fatality ratio. We’ll come back to that in a little detail later. But that infection fatality rate, that is to say the knowledge of the number of people – the ratio of the number of people in the population who will die amongst those who have become infected, was an issue which you, particularly with ICL, were looking at alongside the infection hospitalisation rate throughout the second half of February and the early part of March?
Professor Neil Ferguson: Yes.
Lead Inquiry: That was a separate workstream, if you like, from the pure epidemiological mathematical modelling?
Professor Neil Ferguson: Yes. The two are very – obviously very tightly linked.
Lead Inquiry: In general terms again, we’ll come back to the detail later, you became aware by mid-February, 10 February in fact, which is when you produced or Imperial College London produced its first report on the infection fatality rate, you became aware of a broad understanding of what the number of deaths amongst those infected could be, even though you were unable for many weeks later to bottom out exactly what it would be?
Professor Neil Ferguson: Yes. We had our first estimates at around that time. Indeed, I gave a Today programme interview where I explained the consequences of that.
Lead Inquiry: Indeed.
So you didn’t need epidemiological mathematical modelling in mid-February to know that the number of deaths amongst an infected population was potentially very high indeed?
Professor Neil Ferguson: No.
Lead Inquiry: No.
Modelling, epidemiological modelling, is of course complex. Does it depend upon a number of different pieces of information or variables in order to enable the system to produce a sensible and workable product at the end of it?
Professor Neil Ferguson: Yes. I mean, mathematical models, even the most sophisticated models of epidemics, are highly simplified representation option of much more complex phenomena, of course, but over many years we’ve learned that certain key quantities are particularly important. So, basic quantities are things like the reproduction number and the infection fatality ratio, but also understanding which subgroups in the population are most at risk of either infection or severe consequences.
Lead Inquiry: By contrast to working out more bluntly and more broadly the number of people who are likely to die amongst an infected population, modelling of how a virus transmits through that population requires information to be understood on how that infection works, so how an infection progresses in a person and how variable it might be; correct?
Professor Neil Ferguson: Yes.
Lead Inquiry: So that would require you to know something about the latent period, the infection period, the incubation period, symptoms and the like.
You also need to know quite a lot, don’t you, about the consequences of infection, so clinical severity, how many people are going to require hospitalisation or an intensive care unit bed?
Professor Neil Ferguson: Yes, and we worked on all of those things you’ve just listed.
Lead Inquiry: You need to know the reproduction rate, how rapidly the virus spreads, you need to know about viral loads, how easy transmission is, whether there are people who superspread; you need to know about the demography, age distribution, health, how it all impacts upon a population; and you need to know something about likely population behaviour, how will people respond to being infected, and living in a country that is –
Professor Neil Ferguson: Yes, the latter we know very little about in any sort of predictive sense, and I should say, whilst everything you list there is correct, in reality if you’re doing this in real time, that information builds up slowly.
So one tends to take data from related diseases – and here we used a mixture of SARS, MERS and influenza data – before – you know, parameter estimates, and applied them to Covid, before having all of those available estimates, otherwise it would be the end of the epidemic by the time you knew everything.
Lead Inquiry: You also need to know about what the effectiveness is likely to be of intervention, so you need to work out what the impact will be of antiviral treatment, for example, I don’t know, dexamethasone, which was a UK-invented brilliant treatment. You need to know about the impact of vaccines. You need to know the impact of non-pharmaceutical interventions. You need to know the impact of immunological aspects; you know, once you get infected might you be reinfected? And you need to know about viral genetics: will the virus change?
So putting all that together, a system of government response that rests upon and waits for answers to be given by mathematical modelling is likely to be a fairly drawn-out and, you used the word yourself, slow process?
Professor Neil Ferguson: Well, I don’t think that’s necessarily the case. You … everything you list is important, but not all equally important and not equally important at the same time for decision-making. I mean, I see modelling more as a tool for synthesising different sorts of information together, to draw conclusions. And, yes, initially you’re doing that on the basis of very little data. If you’re referring to: do we need to have a playbook before we have very much information, a policy playbook which is automatically enacted? I wouldn’t disagree with that, and clearly in that respect Korea and the UK differed markedly in what their policy playbook was.
Lead Inquiry: The issue of whether the government had a playbook, so a list of strategies or policies that would be automatically introduced if a red line was crossed or if certain trigger events happened, is another debate.
I want you, please, to focus on what you believe was the impact in terms of the government’s overall response of waiting for the outcome of such modelling.
You are aware that on 28 January at SAGE SPI-M was directed to provide assistance and advice as to how, in general terms, the government could respond to the virus, whether it could control it, what it would do.
The point I want to make to you is: by directing quite a relatively large or quite a relatively important part of its response upon the outcome of the modelling, we built into this response system a delay, because you didn’t have the information, you didn’t know enough about the virus, you didn’t know enough about NPIs, the genetics, the behavioural aspects, to be able to produce work product for a while?
Professor Neil Ferguson: Yes, 28 January, but I would also comment that 28 January we didn’t have an estimate of the infection fatality ratio either.
Lead Inquiry: No, indeed not. You didn’t start to investigate that or be able to understand the likely parameters of the infection fatality ratio until 10 –
Professor Neil Ferguson: Well, that’s when we – we were working on it throughout January, but …
Lead Inquiry: We’ll come to that a little later.
Do you agree, though, with the proposition that by waiting for the product of mathematical modelling there was then baked into, built into the response system a delay?
Professor Neil Ferguson: Not entirely. I mean, I think the more general question was around how long you wait to clarify, have uncertainties around the new threat reduce before making a decision. So it was a broader issue about the certainty with which we could characterise this new threat which I think played a bigger role.
Now, modelling clearly played a part of that, but I don’t believe it was the most significant issue.
Lead Inquiry: But it’s clear, isn’t it, that the modelling process had to await a great deal more information, which was information that became gradually apparent through the beginning of February, the rest of February and the beginning of March, to be able to produce the worked-up scenarios, the thinking about what the impact would be of the various options the government might have had at its disposal, for example?
Professor Neil Ferguson: Yes, there was kind of certainly lots of iteration of those scenarios, I would agree.
Lead Inquiry: You are aware that a number of other scientists have questioned the reliance upon modelling as part of the government’s response?
Professor Neil Ferguson: I am.
Lead Inquiry: What do you say to what Professor Woolhouse has said, for example, by way of the over-reliance upon modelling and the fact that you don’t need modelling or epidemiological modelling, certainly not mathematical modelling, to be able to understand that you have to try to control a virus and put practical measures in place to stop it?
Professor Neil Ferguson: I mean, I would agree with that last quote, certainly. I think modelling gives some benefits in terms of understanding the likely absolute magnitude of the impact of different interventions, which in its absence you are rather guessing at.
Lead Inquiry: Can we just now debate the scope of the modelling. You’ve referred to the fact that the mathematical modelling produced answers in relation to what the impact might be of non-pharmaceutical interventions. To what degree of detail or specificity could those models go or did they go? For example, a number of the core participants ask in their Rule 10 questions about the degree to which models focused on the impact of shielding methods, on the impact of non-pharmaceutical interventions on ethnic minorities, and on the elderly. Was it a necessary part of the modelling that all these sectors of the population were considered and the impact upon them understood?
Professor Neil Ferguson: So, to explain, rarely do you actually include in a model the operational details of how a policy is implemented. So, typically, if we were modelling, for instance, shielding, then it is modelled as a reduction in contact rates in a certain subsection of the population, for instance the elderly, by a certain amount, and you might look at how much that varies. How you translate that operationally into policy is really for public health specialists.
So we certainly looked at age and shielding. I don’t think any of the models, up until quite late in the pandemic, stratified by any other, you know, sociodemographic, you know, category, other than age, and we can get into why that was, but there were a number of reasons, mostly around data and computational feasibility.
But just to put – it’s – they’re not in some sense Sim City simulations of people walking around, I mean, they’re much, much higher level than that.
Lead Inquiry: So the answer is there was a general understanding of course of the likely impact of whatever intervention you were modelling upon such sectors, but there were no models specifically designed to look at in detail what the impact would be?
Professor Neil Ferguson: I mean, looking – none of the models looked at the – let’s say, the indirect consequences of interventions, they were all focused on the impacts, potential impacts on virus transmission and health consequences.
Lead Inquiry: That’s because the primary aim, to come back to your earlier evidence, of modelling is to work out the spread of a virus, its transmission, how it works, how it operates, and the likely impact of whatever measures are taken in a broad sense to combat it, and that primarily concerns clinical aspects, or how many deaths, how many people are hospitalised?
Professor Neil Ferguson: Yes.
Lead Inquiry: Is that a fair summary?
Professor Neil Ferguson: Yes.
Mr Keith: Good.
My Lady, is that a convenient moment?
Lady Hallett: Certainly. I’m sorry we have to break, but I think you were warned you would have to be here some time, Professor, so if you will forgive us, we will now break for lunch and I shall return at 1.55.
(12.57 pm)
(The short adjournment)
(1.55 pm)
Lady Hallett: Mr Keith.
Mr Keith: Professor Ferguson, just a few more questions on modelling.
A further point or issue raised by Professor Woolhouse is his belief that there was a default assumption that the only drivers of behavioural change were the imposition and relaxation of government-imposed restrictions. What he states is that the modelling presumed that the only way in which future behaviour of the population would alter would be as a direct result of the government-imposed restrictions themselves, as opposed to being spontaneous. So, for example, the population changing its behaviour in advance of a lockdown because it can see the lie of the land.
Is there any basis for the belief that your models did not pay appropriate attention to spontaneous behavioural changes and relied exclusively instead upon behavioural change brought about by government restrictions themselves?
Professor Neil Ferguson: So, I mean, models don’t distinguish between whether there is messaging to encourage the population to change behaviour and mandate to force them to do so.
Models model changes in contact rates in the population which suppress transmission, so there’s no prior assumption made about whether something is an advisory measure or a mandatory measure.
With respect to spontaneous behaviour change, and which is a slightly different thing, there you’re saying –
Lead Inquiry: Professor, I’m sorry to interrupt. Could you please try to go a little slower. You’re speeding up. It’s my fault, but I must try to restrain you.
Professor Neil Ferguson: With respect to spontaneous behaviour change, that’s a much more – so how do populations respond to risk, a perceived risk in the population. There are no – well, there is lots of speculative modelling of how that might happen, but no validated models or no validated models, frankly, of that type of behaviour. I mean, this is something I highlighted all the way back in 2006 in an essay in the Nature journal, but – there is research under way but it’s still in its infancy and it’s actually a very difficult thing to predict.
So, no, the models didn’t try to anticipate how populations would completely spontaneously respond.
Lead Inquiry: The modelling is designed to ascertain what might happen, and behavioural changes are a significant driver of what might happen. Does it therefore matter in modelling terms whether the behavioural change is spontaneous or mandated?
Professor Neil Ferguson: Not in terms of its effect on contact rates, no. But of course it’s hard – may be harder to predict what voluntary change will do in terms of the magnitude of change of those contact rates compared with mandatory changes.
Lead Inquiry: But whether a population spontaneously changes its behaviour is hugely relevant, isn’t it, to the policy debate about whether a lockdown is therefore necessary?
Professor Neil Ferguson: It is certainly very relevant to the debate around the extent to which mandatory versus voluntary measures are required, yes.
Lead Inquiry: I’m going to call it a lockdown. You call it mandatory, Professor, but we all know we’re talking about a lockdown.
Now, just finally on the question of modelling, there are important passages in your witness statement in which you speak of the care that must be taken in assessing the consequences of or the value of scenario modelling.
Scenario modelling, what might happen if we do this, is not a direct or an accurate guide as to what will happen, because the outcome is entirely dependent on what steps you take to meet the eventuality.
Professor Neil Ferguson: Agreed. And beyond that, throughout the pandemic we never had a sufficiently precise understanding of the exact impact of any one intervention to be able to make firm predictions.
Lead Inquiry: In truth, Professor, it is a very complex but broad science.
Professor Neil Ferguson: Yes.
Lead Inquiry: It must be put into its proper place as a tool for guiding governments to respond; would you agree with that proposition?
Professor Neil Ferguson: I would agree with it, yes.
Lead Inquiry: The way in which SPI-M-O looked at models and the way in which the government responded to models was dependent, wasn’t it, upon a process of taking a number of models together? So if, for example, the government wanted a medium-term projection of what the outcome might be, the impact might be of, say, closing schools, did it seek a specific model from a particular research institute such as Imperial College London or did it rely upon an ensemble, an amalgamation of reports, models from the various institutes who provided them?
Professor Neil Ferguson: So just to clarify there, I mean, you’re talking about two different things. The medium-term projections were things updated every week and they were as close as we got to forecasts. They weren’t true forecasts, because we assumed things stayed the same. And there, upwards of 10, 12 different models were combined in a formal, statistical sense. The second aspect is the use of modelling for, let’s say, scenario modelling of intervention options, and typically what happened during the pandemic there is that the question was posed to SAGE, to SPI-M, a request came in, and modelling groups which were capable of answering the request did. So typically a rather smaller number. Typically ourselves, the London School of Hygiene and Tropical Medicine, and Warwick University later in the pandemic.
Lead Inquiry: Is it therefore the position that there was never a single Imperial College model, there were a multitude of different types of models on different issues, addressing different eventualities produced by Imperial, and there were models, similar models, produced by a number of other bodies as well?
Professor Neil Ferguson: Indeed.
Lead Inquiry: I raise that, Professor, because of course the press and the public attention which has been focused upon the role of Imperial.
Now I’d like to ask you some questions, please, about the strategy or the approach to the pandemic for which you advocated in the early part of February.
The Inquiry has heard evidence that the government strategy had, prior to the pandemic, been based on a pandemic influenza strategy, in particular a document from 2011. On account of the focus on influenza pandemics, on the advent of the pandemic, had there been any modelling of long-term, large-scale non-pharmaceutical interventions such as stay at home orders, closure of workplace across the country, quarantining and the like? Or was the modelling in existence relatively limited?
Professor Neil Ferguson: So there had been modelling of – of the use of layered, as they were called, non-pharmaceutical interventions in relation to an influenza pandemic, which included things, for instance, like home working, but none of the modelling considered scenarios where those interventions would be used for the duration that they were used during the Covid pandemic.
Lead Inquiry: So may it be said that the strategic reliance upon a flu pandemic approach had an impact upon the availability of learning about the possible measures that might be deployed to meet a coronavirus?
Professor Neil Ferguson: I think one can exaggerate too much the idea that we were following a pandemic flu playbook, certainly on the scientific front. I worked on both SARS and MERS coronavirus extensively, we were quite aware of the biological and potentially epidemiological differences. But I would argue the single most important difference between Covid-19 and something like SARS-1 was that a high proportion of those infected have relatively mild symptoms, some no symptoms at all, which talks to the relative effectiveness of different types of control measures at controlling the community spread of the virus.
Lead Inquiry: I’ve not suggested to you that there was a flu playbook followed scientifically or by Imperial College London, but the point is that, on account of the attention paid to that Tier 1 risk of a pandemic influenza, very little thought had been given, had it not, to how a policy of containment, for example, that is to say shutting down the arrival of the virus and the spread of the virus, might work in theory or in practice?
Professor Neil Ferguson: I would agree with that.
Lead Inquiry: So in the beginning of February, would you say that there was a general doubt expressed by you and others as to whether or not containment would ever work to deal with a coronavirus, the coronavirus that we faced, because there was very little by way of learning or structure to be able to contain the virus when it became apparent that it was spreading?
Professor Neil Ferguson: I think it’s more nuanced than that. I mean, so first of all, obviously globally containment did not work. The – I … I was more sceptical than some that the measures adopted in China would be as successful as they turned out to be. I was – changed my view. That scepticism was altered by the data on the ground from … the – you would have to be more – in terms of the long-term suppression of the virus, I think you’re right in the fact that it hadn’t been well studied, but I don’t think that necessarily affected our evaluation of necessarily feasibility. It did affect the extent to which, for instance, Public Health England was equipped to be able to implement containment measures.
Lead Inquiry: I ask because in your statement you say:
“I felt the Contain phase [and that’s a reference, is it not, to the government’s Coronavirus action plan, mandated contain, delay strategy] never had any significant chance of preventing the infection entering the country or even significantly slowing its establishment here.”
Then you go on to say it was further impaired by the lack of testing capacity, which I’ll come back to.
That would seem to suggest that, at a broad strategic level, the efficacy or the success of a containment policy was always in doubt in your mind?
Professor Neil Ferguson: I would distinguish there between the measures the UK adopted and labelled as the contain policy, and what other countries adopted, which was much more successful. I mean, I’m happy to elaborate on the UK situation.
Lead Inquiry: Yes.
Professor Neil Ferguson: We implemented, which was limited by testing, very limited border controls, and you may come along to that evidence shortly, which were only ever going to prevent a small fraction of, you know, infected people coming into the country, had low sensitivity and then had very limited contact tracing capacity.
Lead Inquiry: Because there was no complete closure of the border, because there was, in the early days, merely symptom screening, and then restrictions imposed by reference to the destination or, rather, the overseas country from which the traveller was coming, and because there was no scaled up or significant testing process, you’re saying containment, that is to say stopping the virus from spreading round the United Kingdom, just didn’t work?
Professor Neil Ferguson: Not using the measures which were adopted at the time, no.
Lead Inquiry: When did it become apparent to you that containment was, to use your words, never going to have a significant chance of preventing infection entering the country or significantly slowing its establishment?
Professor Neil Ferguson: I mean, almost as soon as I heard that measures were – what the measures were and what was being done.
Lead Inquiry: Late January?
Professor Neil Ferguson: Yes.
Lead Inquiry: Why then did you – or perhaps that’s unfair. What did you make, then, of the government’s published strategy a month and a bit later, on 3 March, to have a contain and delay strategy?
Professor Neil Ferguson: I was always unsure quite what contain – as described in that strategy, what contain was intended to actually do.
I mean, that’s why I felt we needed to accelerate planning for other non-pharmaceutical interventions. I would say just in retrospect as well, I mean, there have been a number of studies of this, that community transmission of this virus – I mean Covid in the UK probably started in late January, and that’s been estimated using quite comprehensive genetic analysis. So, put in context, the effectiveness of the strategy.
Lead Inquiry: There was a SAGE meeting that you attended, it’s the second SAGE, on 28 January, where there is a reference in the consensus document to control measures, ideally infection control in healthcare settings and rapid detection of cases.
Why did you not say “I doubt whether any form of containment strategy will work, given the porous nature of the border and the lack of any significant testing capacity”?
Professor Neil Ferguson: Well, actually the example you gave of infection control in hospitals and testing was something I did advocate for. I strongly felt we needed to set up sentinel surveillance for the virus within the country. I mean, there was a period in February, January and February, where it was always being reported publicly that, you know, the UK has 20 cases, for instance, all of whom were travellers. Well, that was axiomatically true, because we were testing nobody but travellers, but – and I didn’t feel it was informative of what the true situation was.
Lead Inquiry: If containment outside the healthcare setting was never likely to work, then why was the government producing a strategy based on containment five weeks later?
Professor Neil Ferguson: You know, to be honest, I mean, I did not have prior sight of that document and SAGE was not consulted about it.
Lead Inquiry: Did you express views around that time, that’s to say the end of January, as to the degree or the likelihood of control measures working or what sort of control measures should be considered?
Professor Neil Ferguson: I might have to be more specific, but yes, I expressed my view of the likely effectiveness of a variety of border measures, and what proportion of cases coming into the country might be detected, and there were initial fairly general discussions about what types of measures might slow spread within the UK.
Lead Inquiry: Could we have INQ000148974, please.
This is an email string, Professor, between yourself and Professor Sir Chris Whitty, copied in to Professor Sir Patrick Vallance and Professor Sir Jonathan Van-Tam, who was then the Deputy Chief Medical Officer.
You can see that the top of the page is a forwarding of a lower email and more substantive debate to the persons I’ve mentioned, and also Professor Edmunds. In the middle of the page, you can see an email from John Edmunds.
Over the page, on page 2, there is an email from you dated 29 January, 11.12:
“… delaying arrival requires either stopping travel from China or very intensive screening and follow-up of travellers. We can provide some crude estimates …
“If you are more referring to delaying the peak of the epidemic via public health interventions, it is harder to produce predictions. There are two broad classes of such interventions … case based such as isolation of cases and contact tracing; and … community level interventions – principally school closure.”
Professor, in principle, there were, of course, other measures which can be put into place to deal with a spread of a disease with an outbreak of pandemic, not just principally school closure.
Why did you not mention the possibility of other perhaps more stringent whole society interventions?
Professor Neil Ferguson: I mean, because the focus of Chris’s email there was on things we could do to delay the peak, and so the evidence – so there’s, as you’ll be aware, almost certainly know, the formal evidence base around different non-pharmaceutical interventions, because they’re rarely used, is quite limited. The one intervention which has been used quite frequently for respiratory virus outbreaks has been school closure.
Lead Inquiry: Where is the debate in this email, though, about: well, this is not a flu pandemic, different measures may have to be considered, depending on the spread of the virus more drastic, stringent, whole-society interventions may have to be considered, and might it be too late anyway to stop the influx of the virus because of the containment debate that you’ve already referred to?
Professor Neil Ferguson: So a couple of paragraphs down you’ll see I discuss, you know, how the different epidemiological characteristics of the virus, whether it’s SARS-like, which we didn’t know at the time, versus more flu-like, ie much more mild disease, would influence the effectiveness of the interventions.
I mean, I was addressing Chris Whitty’s, who is the Chief Medical Officer, direct question rather than saying – giving my view on potential strategy, I would say.
Lead Inquiry: If we could have INQ000047654, this is an email three days later. And if we could have page 5.
It’s between the same, broadly the same participants.
If you would just go back, I’m sorry, one page. It may be that that last part is from Professor Sir Chris Whitty. Yes, it is.
This is the email from you, on page 4, dated 2 February.
“… it is quite likely (but not certain) that there have been a number of undetected importations into the UK … Detection rates are not going to be anywhere near 100%. This doesn’t mean we shouldn’t take the optimistic view that it is still worth trying to prevent more importations, but it does change the assessment of the likely impact of the new measures and therefore the cost-benefit of those measures.”
What was that reference to “cost-benefit balance” a reference to? What did you have in mind when you referred to that balance?
Professor Neil Ferguson: I mean, in terms of the proportion of our Public Health England, resources which should be dedicated to, for instance, targeting travellers versus targeting community surveillance, for instance.
Lead Inquiry: So are you saying that if you apply some sort of border restrictions, you’ve got to consider, as a government, how effective they are, how irritating they are, what they’ll cost travellers and the public, against how effective they will be in stopping the influx of the virus?
Professor Neil Ferguson: Yes.
Lead Inquiry: It does appear, Professor, there that you are engaging directly in the policy debate as to the imposition of a measure and therefore straying beyond the mathematical modelling or the epidemiological modelling side of things.
Professor Neil Ferguson: I was pointing out that, you know, what turns out to be true, the effectiveness of measures would depend on the epidemiological situation. I wasn’t, I don’t think, there expressing any value judgement as to what measures should be adopted.
Lead Inquiry: At the time of these emails, at the beginning of February, was there a general acceptance, Professor, that the virus was unstoppable, that it would inevitably infect the United Kingdom, and that very little could be done to stop it washing through the population?
Professor Neil Ferguson: I mean, again you’ve combined, you know, multiple different concepts there. I think we felt it would be extremely difficult to prevent it entering the UK. You’ll find reference in later SAGE minutes to the potential benefits of more draconian border restrictions in terms of the delay which might be attained. I think at that time we were saying relatively little about – you know, certainly nothing specific about the feasibility of stopping spread within the United Kingdom.
Lead Inquiry: To what extent did you and your colleagues, in particular Chris Whitty, Patrick Vallance, Jonathan Van-Tam, Jenny Harries, believe that the virus, if it spread through the United Kingdom, would result in a wave, a wave of infections, and that it would be practically very difficult, if not impossible, to stop that wave proceeding through at least a significant part of the population?
Professor Neil Ferguson: So I think I’m on record, I think I gave an interview even in late January, or certainly early February, saying that I felt the world was at the beginning of a global pandemic. If the question is did I anticipate the use of intensive non-pharmaceutical interventions to suppress transmission at that point, no, I didn’t. Did I know that they were in theory able to be used? Yes, I mean, I’d studied the use of such interventions both for SARS but, probably more relevantly, in the 1918 flu pandemic in the United States.
Lead Inquiry: But it was apparent, was it not, you were addressing the risk that the virus would enter the United Kingdom, that it would essentially get out of control, and steps would have to be taken to control it? Where is the general debate at this stage of what sort of control measures, NPIs, might have to be considered?
Professor Neil Ferguson: I mean, I think the debate – well, if there was a debate, it was occurring within government. There wasn’t a debate in terms of – well, I mean, my perception is it wasn’t the role of SAGE to, you know, determine strategy, so there wasn’t that debate. You’ll see in all of these instances, and you have many instances, I addressed the questions being asked.
Lead Inquiry: But these are private non-SAGE emails where you’re not bound by the self-imposed constraints of SAGE, you are discussing control measures, you refer to schools, why wasn’t that debate being held in this alternative forum of your communications with your colleagues?
Professor Neil Ferguson: Well, it’s more than just a colleague, if it involves the Chief Medical Officer and both Deputy Chief Medical Officers, it’s a communication between me as an independent scientist and government employees.
Lead Inquiry: Professor, were these SAGE-related communications or were they emails between you, Professor Ferguson, and the CMO, the DCMO, and Professor Edmunds, Jenny Harries ? Who was I think, or became, another DCMO, but Professor Edmunds was not, of course.
Professor Neil Ferguson: I mean, I viewed them as an extension of discussions at SAGE.
Lead Inquiry: In your statement, you say that one of the problems that was encountered at this time by yourself and your colleagues was that there appeared to be no systemic consideration of the costs of control measures or NPIs against the benefits and what the cost might be of inaction, and you’ve referred, of course, there to cost-benefit.
Did anybody take any steps to say, in the context of SAGE or to the government by one of these emails, “We need to have a structure put in place for working out the cost-benefit of the various measures which might, God forbid, have to be considered”?
Professor Neil Ferguson: I don’t believe – I mean, I can’t think of an instance of that happening. I mean, there was some discussion of cost-benefit, but certainly it was – I think we did not – none of us evaluated properly the cost of inaction, let’s say.
I have to say we did not have the capability of doing so. I mean, within the Imperial College group, that – to be able to do that thoroughly would require, you know, a dedicated group.
Lead Inquiry: But these emails show, Professor, don’t they, that you’re not engaging in a dry epidemiological mathematical modelling debate, you are discussing matters of policy here and cost-benefit and the feasibility of particular measures?
Professor Neil Ferguson: Yes, of course. Yes, I mean, there’s some discussion of feasibility.
Lead Inquiry: You referred to your views on whether or not the lockdown intervention in Wuhan was likely to be effective, and again you’ve said that in January 2020, in late January 2020, your view was you had concerns or doubts as to whether it would be effective.
Some of your colleagues were more confident that it would be effective. What was it that caused you to change your mind about the efficacy of the Wuhan lockdown?
Professor Neil Ferguson: I mean, the trends in reported cases and deaths coming out of Wuhan.
Lead Inquiry: Was that information that was available to those other colleagues who took a more confident view of the likely outcome?
Professor Neil Ferguson: I mean, we shared all information internally.
Lead Inquiry: Were some of your colleagues quite strongly of the view that containment had been – was being tried in Wuhan and was at least likely to work to the extent that it was worth trying or investigating further in the United Kingdom?
Professor Neil Ferguson: Yes, a minority of my colleagues, yes.
Maybe I should put it into context. I mean, we rarely had discussions internally of strategy, but of course it did come up, and there were a diversity of opinions expressed by different colleagues.
Lead Inquiry: Another area, again in this theme of the broad conceptual issues, in January and February that was the subject of debate, and you’ve referred to it in your witness statement, was the way in which the government attempted to ascertain what the reasonable worst-case scenario might be.
Why did that matter?
Professor Neil Ferguson: I mean, because the reasonable worst-case scenario is the scenario which the government should be planning to cope with, in theory at least, in any civil contingency, any crisis.
Lead Inquiry: Is the reasonable worst-case scenario a planning tool, if you like?
Professor Neil Ferguson: Indeed.
Lead Inquiry: There was a considerable debate, was there not, on the subject of what the reasonable worst-case scenario should be interpreted to mean and whether or not it was likely that we would find ourselves in a position in which we were in the reasonable worst-case scenario?
To what extent do you think that that debate about a planning tool prevented a more significant substantial debate about the reality of policy responses and what should be done on the ground to stop the spread of the virus?
Professor Neil Ferguson: I mean, potentially significantly. I was always uncomfortable with labelling what I felt was our central estimate as being the reasonable worst case. Because calling it the reasonable worst case, even if in theory policymakers are meant to be planning to it, makes it sound like it’s an unlikely eventuality, whilst in my view it was the most likely eventuality if nothing more was done.
Lead Inquiry: I now want to look at, please, this issue of the infection hospitalisation rate and the infection fatality rate.
In your statement, you tell the Inquiry that the Covid response team of Imperial College London, or maybe Imperial College London, I don’t know whether the response team was already in operation at this time, but in any event ICL produced two reports. They were put the MRC, the Medical Research Council, GIDA website, your website, on 17 and 22 January.
Those reports made extremely important points, did they not, about the under-ascertainment of likely cases in Wuhan? And you concluded, didn’t you, that the number of real cases was likely to be a multiple of those cases which the press and the government announcements in China had indicated?
Why was it so important to get to the bottom of what the reality was of the outbreak in Wuhan?
Professor Neil Ferguson: I mean, it was important for two reasons. First, to understand what the – what stage of an epidemic we potentially were at, how large it had reached and therefore it was the risk of external export of cases. And secondly because, at the time, it wasn’t certain at all whether there was human-to-human transmission going on.
The speculated cause of the outbreak was, you know, exposure of people to a zoonotic source, to an animal source of virus. Now, history tells us that’s plausible if you have a dozen, maybe two dozen cases, but if you’re estimating thousands of human cases, it becomes very implausible, much less plausible, that those were all infected by zoonotic exposure, much more likely that we’re seeing human-to-human transmission. Self-sustaining human-to-human transmission.
Lead Inquiry: The press and government organs in China were reporting on deaths and the numbers of people who were hospitalised, but did that give you any idea of the number of people who might have had the virus in a mild way and were not, therefore, being reported on, or who were asymptomatic, that is to say showing no symptoms at all?
Professor Neil Ferguson: So those first two reports, no, because the basic approach they took was to look at cases being detected in third countries outside China through border screening, and that border screening was typically for symptomatic cases. Some countries like Japan and Thailand especially implemented that border screening very early, but those cases were symptomatic cases, and in several cases were actually hospitalised with quite severe symptoms. So even those analyses, why they produced estimates of thousands of cases, were not characterising the full picture of the scale of the epidemic.
Lead Inquiry: When were you able to ascertain, estimate that there were very large numbers of infected persons who were suffering from the virus, either in a mild way, not requiring hospitalisation, and of course not dying, or who were asymptomatic?
Professor Neil Ferguson: So with respect to Chinese – China, that data came from repatriation flights of non-Chinese citizens back to their home countries, and for many of those flights everybody on board was screened with a PCR test irrespective of whether they had symptoms or not. That was a bit akin to the later ONS infection survey, it gave us a measure of infection prevalence at one point in time. And using that, making some assumptions, one could calibrate the scale of the epidemic, the true scale of the epidemic in Wuhan.
Lead Inquiry: As a result of this very clever analysis, and you relied in part upon working out how many flights had left Wuhan and how many people had spread and therefore how many people were likely to be infected, did you and – by you I mean ICL – did ICL and SAGE apply a working presumption from the beginning of February that one-third of infections could be asymptomatic and that asymptomatic cases would be around one-third less infectious than symptomatic cases?
Professor Neil Ferguson: Yes. The first was a reasonable assumption based on data. The second, that there would be less – I mean, less infectious, was a working assumption, we had no direct data for it, but it was consistent with patterns in other respiratory viruses.
Lead Inquiry: And later research and data throughout the course of 2020 and in fact 2021 showed that your estimates were actually pretty accurate?
Professor Neil Ferguson: Yes.
Lead Inquiry: So from early February it must have been apparent to you and to SAGE that if a large proportion, 35%, one-third roughly, of infected persons were asymptomatic, that there was a very great risk that the virus would spread, because if people are asymptomatic you just can’t tell whether they’ve got it, in the absence of testing, and there was no real testing, was there, either at the border of the United Kingdom or in the community, as you’ve described?
So why, at the beginning of February, was SAGE and your own professional colleagues in Imperial College not telling the world as clearly as could be done: the nature of this virus and the nature of the disease is it is almost certain to reach us and in very large numbers?
Professor Neil Ferguson: I mean, I think I – I mean, I’ve referred, I think my 12 February Today programme interview, where I said we were in the early stages of a pandemic, that it was going to be, you know, a global pandemic and that up to 80% of the – if we did nothing, up to 80% of the UK population would get infected in the following few months, and that up to 1% of them might die. I mean, I think that’s quite a clear …
Lead Inquiry: But where is that warning, Professor, in your own private emails to your professional colleagues outwith SAGE, and in the SAGE minutes and the SAGE consensus documents –
Professor Neil Ferguson: I mean, they’re buried in the planning assumptions of the SAGE documents, but those estimates were discussed at length within SAGE meetings.
Lead Inquiry: In the context of planning debate, in the context of –
Professor Neil Ferguson: I mean, I would agree if – if your implication is there was perhaps too much focus on refining estimates and reducing uncertainty, and not enough on, let’s say, operational planning – which of course we did not have visibility of in SAGE – then that might be true.
Lead Inquiry: So you agree that there was too much focus on perhaps the scientific or the data issues, rather than pointing out what must have been apparent, which is a major pandemic was inevitable?
Professor Neil Ferguson: I mean, I think that’s maybe slightly unfair. I mean, we had already a planning – planning scenario which NHS England, PHE, DHSC were meant to be producing, you know, a policy response to, which was in my view fairly catastrophic. I mean, the role of SAGE was to provide scientific evidence into that process, not to come up with policy.
Lead Inquiry: But you, Professor, were, as we’ve seen from these emails, engaging in policy debate?
Professor Neil Ferguson: I was engaging in debate about the likely effectiveness of different policy options.
Lead Inquiry: Having understood that the virus had a very large percentage, 35%, that was asymptomatic, and that there were, in practice – there was very little that could be done by way of containment or control, why was it important to then work out the percentage of people who might die or would die from the infection level? Why did that matter?
Professor Neil Ferguson: Because with a highly transmissible respiratory virus like Covid, and we were estimating an R number of between 2.5 and 3.5, then some basic epidemic theory would tell you that if that virus spread uncontrolled in a population, then over the first, you know, six months or so you would get a very high proportion of the population infected. Not everybody, but somewhere between 60% and 80%. And therefore knowing what proportion of that very large number of people were at risk of dying from the virus was critical to evaluating the public health impact, and also, by implication, what the level of proportionate response should be for the government.
Lead Inquiry: And presumably you would also say, under that heading of the public health impact, what the figures were for the number of persons who might be hospitalised?
Professor Neil Ferguson: Yes, I mean, that took somewhat longer to develop.
Lead Inquiry: When did ICL first estimate the likely infection fatality rate for this virus, an estimate that turned out to be, in fact, extremely accurate?
Professor Neil Ferguson: I mean, the first estimate which wasn’t stratified by age, though we did know about the age distribution of deaths, was 12 February. That was highly uncertain, and then we had a much more refined estimate by, I would say, the first week in March.
Lead Inquiry: Why was it necessary, why did in fact, we can see from the dates, four to five weeks elapse before that vital figure, how many people would die, could be bottomed out, could be certified as being, “This is our final position and this is the figure we can rely upon”?
Professor Neil Ferguson: There was a hesitancy for – by SAGE to rely on any single piece of evidence, and particularly coming from a single group, and therefore there was a desire to have it confirmed by other sources, which is what the London School of Hygiene and Tropical Medicine did to a degree in terms of the analysis of the Diamond Princess data. Then there was a desire to then translate that infection fatality ratio estimate into estimates of the impact on the health service.
If you’re asking why did it take so long, I mean, I was somewhat frustrated as well.
Lead Inquiry: The figure, the IFR figure, was the single most important figure in terms of working out how many people would be likely to die. Probably matched by the IHR figure, working out how many people would require to be hospitalised.
Was there any basis for challenging Imperial College and its estimates on the basis of your professional provenance?
Professor Neil Ferguson: No, but there was challenge on the basis that we were basing it on very limited data from – scraped from Chinese websites at the time, and a limited number of data points on what the infection prevalence was, and so – I mean, SAGE grades, in some sense, evidence and estimates and it was, you know, viewed as being uncertain. I mean, I found that personally somewhat frustrating, but then, you know, I was partly responsible for generating the estimate, but if you look at the minute – as you say, it took several weeks for SAGE and SPI-M to accept the estimate.
Lead Inquiry: You were personally frustrated?
Professor Neil Ferguson: Yes.
Lead Inquiry: You were frustrated because this was vital information which went directly to the government’s ability to respond and to decide what that response might consist of?
Professor Neil Ferguson: Yes. And so I was pleased when it was finally accepted as a reasonable worst-case scenario. But, as you’re aware, that took some weeks longer.
Lead Inquiry: It was only in fact at the beginning of March that your figures for infection fatality rate, a value of around about 1%, were accepted for use as an NHS planning assumption. I think it was formally accepted on 26 February. But there then had to be a meeting, which there was on 1 March, to discuss the accuracy; yes?
Professor Neil Ferguson: Not quite. The meeting on 1 March was less about discussing the accuracy of the IFR figure, but involved clinical colleagues with expertise in respiratory viruses and with intensive care to translate that figure into estimates of healthcare demand. So the proportion of people being hospitalised, the proportion needing intensive care unit, the estimate of how many days they would be in each of those settings.
Lead Inquiry: And broadly speaking, who attended that 1 March meeting which debated the likely –
Professor Neil Ferguson: We hosted it in my office.
Lead Inquiry: Who attended it?
Professor Neil Ferguson: It was attended by Peter Horby, I think maybe remotely, John Edmunds, Stephen Powis I think dialled in to it, some NHS planners. I mean, I’ve provided the full list, I don’t have it immediately to hand.
Lead Inquiry: Around about the same time, these figures for the infection fatality rate and the infection hospitalisation rate were put before SAGE, were they not?
Professor Neil Ferguson: Yes.
Lead Inquiry: So they were debated in fact in the SAGE meeting of 27 February. SAGE was attended, of course, by not just the academic groups but by representatives of the government, of the NHS, Public Health England, and so on and so forth. It must have been apparent to everybody at that 1 March meeting, and at the SAGE meeting on 27 February, that given the fatality rate and given the hospitalisation rate and given the number of people in our population, the number of deaths and hospitalisations would be enormous?
Professor Neil Ferguson: Yes. And more than that, we generated, I mean, model output on that day, spreadsheets, which were provided to NHS England, of the expected trajectory of the epidemic.
I should say those estimates of hospital demand were refined considerably over the following two weeks, because the original estimates were basically based on best clinical judgement rather than data, and it was only – it took – they didn’t change qualitatively but they did change quantitatively in that time.
Lead Inquiry: Some of the greatest brains in the land, Professor, the world experts on epidemiology, virology, pandemic response, were debating these figures. They weren’t going to go down by a multiple of 2 or 3, were they, thereafter? They weren’t going to go down to 1%, or 0.1%? You had correctly identified, broadly, the levels of death and hospitalisation –
Professor Neil Ferguson: Yes.
Lead Inquiry: – that would inevitably ensue?
Professor Neil Ferguson: I mean, as I say, in a qualitative sense, I would agree. I mean, they did adjust by about two-fold in terms of hospital demand, but that wasn’t a qualitatively important amount.
Lead Inquiry: So as at the end of February, the beginning of March, why was no one at that meeting saying, or at SAGE, “Well, hold on, with these sorts of figures for deaths and hospitalisation, it is plain as a pikestaff our system is going to be rapidly overwhelmed”?
Professor Neil Ferguson: I mean, I would say two things there. First of all, before the pandemic, the UK basic pandemic plan for dealing with these particularly extreme events, lethal pandemics, allowed for the fact that health – you know, healthcare demand would exceed the ability of the health system to cope, that emergency measures, surge measures and triage might need to be adopted. So there wasn’t – you’re right that I think everybody at that meeting recognised that the levels of demand were well in excess of standard capacity, but that wasn’t out of line with all previous planning around lethal pandemics.
Lead Inquiry: So, what, those deaths would take place, the hospitalisations would occur and the system would be overwhelmed?
Professor Neil Ferguson: The thing that meeting did not – all that meeting considered what an unmitigated pandemic would look like. So if the government did absolutely nothing. I mean, that was the reasonable worst-case scenario. I think a lot of the work in the following week or two was around the extent to which that could be modified and how.
Lead Inquiry: These were self-evidently matters of life and death. The government did not start contemplating the possibility of the top control measure, the lockdown, mandatory NPIs, until around about the 13th, we’ll put it in a broad way, the 13th to the 16 March?
Professor Neil Ferguson: I wasn’t actually aware of what the government was considering and wasn’t considering at the time. I mean, in terms of what was going on within COBR, I had no visibility of COBR.
Lead Inquiry: But you had hitherto not been averse to emailing your thoughts on policy matters to the CMO, the GCSA, Professor Edmunds?
Professor Neil Ferguson: I mean, the CMO and GCSA, there was a complete Chinese wall between SAGE and COBR, so it was not as if SAGE meetings started with a readout from COBR about what the government were thinking and planning to do. We had almost no visibility of that. In terms of operational planning.
It wasn’t clear, for instance, that exceeding healthcare demand, NHS capacity, was an absolute red line, really until, I would argue, 14 March. In terms of what we – had been communicated to us as independent members of SAGE.
Lead Inquiry: But that elapse of time from the end of February to 14 March is a passage of time which plainly can’t be got back, but it was plainly not desirable, it was not inevitable – you describe in your statement your regret at the fact that it took five weeks to get these figures bottomed out – and then there is another two-week gap or delay before practical measures are started to be contemplated. How can that possibly have happened?
Professor Neil Ferguson: I mean, I think I may put it in my recommendations for learning lessons for the future. The artificial divide between scientific advice and then operational planning and response was a hindrance. We had very little visibility of what was going on in terms of preparedness within government. I would occasionally, at the, you know, margins of SAGE meetings, hear a little, but nothing definitive. I think even more so was the lack of visibility of what government red lines were, what were the absolute constraints that policies had to adhere to, you know, never – I mean, red lines is one way of putting it. Objectives would have been nice as well.
Lead Inquiry: Why, as an expert professor in mathematical modelling and epidemiology, why – if you’ll allow me to say so – as a plainly intelligent human being, why, as a human being, do you need to wait for the government to tell you what its red lines are before you raise the alarm in the greatest way you possibly can?
Professor Neil Ferguson: It depends what – I mean, what do you mean by raise the – I mean, I think I was clear in communicating the magnitude of the threat, in public pronouncements and private pronouncements. But it may be –
Lead Inquiry: Well –
Professor Neil Ferguson: You elaborate.
Lead Inquiry: At the 5 March meeting of SAGE, at which you were a participant, there was a debate about whether there were scientific grounds to move away from containment efforts in the United Kingdom, there was a debate about large gatherings. SAGE concluded there was no evidence to suggest that banning large gatherings would reduce transmission. There was a debate about what the figures were, the IFR, the IHR, the CFR, but there doesn’t appear to be the clearest of messages to the government saying: our figures now show that the number of deaths and hospitalisations are so massive that the NHS and the healthcare system will be overrun.
Professor Neil Ferguson: I mean, that was about the same. It is not minuted, you’re completely right, but that was about the time where both John Edmunds and myself got concerned about the slight air of unreality of some of the discussions and did start talking in the margins of – to members – well, let’s say government attendees at SAGE, saying, you know, “Do you know what this is going to be like?” I mean …
Lead Inquiry: So are you saying there was this debate but it wasn’t minuted? In which case, my next question will be –
Professor Neil Ferguson: There was a –
Lead Inquiry: – how – how – Professor, could something of such import not be minuted?
Professor Neil Ferguson: I mean, I am not the person to ask.
Lady Hallett: Can I just ask, Mr Keith put to you that one of the matters that was debated was whether banning mass gatherings would reduce transmission. As a layperson, it seems to be a rather simple question: if you stop people getting together then they’re not going to get infected. Can you remember what the debate was?
Professor Neil Ferguson: Yes. So the issue is about what proportion of time – maybe I’ll start again. So mass gatherings I think intuitively sound like risky things, because you might have 10,000 people together, but for a virus which transmits through close contact, in fact if you have only one infected person they’re no more likely to generate large numbers of infections than they would be, for instance – in a pub, for instance, or a theatre.
Lady Hallett: So they’re going to infect the people around them?
Professor Neil Ferguson: Around them.
So the question there is about proportionality. There is a tendency to target football matches, for instance, but in fact that’s outside, generally, the transmission risk is low.
If you look at an analysis of where people spend their time, the venues where that sort of transmission is much more likely to occur are hospitality venues, for instance. I mean, this is a point I make, you have it on record in an email exchange with Chris Whitty. So in assessing the generic – in some, sense a busy pub has a hundred people in it, it is a mass gathering, indoor mass gathering, people very close together for many hours. It was my view that posed much more of a risk than occasional outdoor sporting venues, because many more people attend pubs than attend football matches.
Lady Hallett: Thank you.
Mr Keith: I think, Professor, the government was much vexed about the issue of mass gatherings and it repeatedly asked SAGE for its commissioned advice, did it not?
Professor Neil Ferguson: Yes.
Lead Inquiry: So this issue was visited by, was discussed by SAGE twice in late February and then again, as I’ve said, on 5 March. On 27 February you said this:
“I now believe it is more than 95% certain that transmission is already established here, so from that perspective holding the Six Nations matches will make no difference.”
Is that because –
Professor Neil Ferguson: So it’s in the context that the major concern was around people, you know, travelling between different countries. And also, to put it into context, 250,000 people fly into the UK every day, so it is a matter of degree rather than … there are lots of public health measures which will have a small impact, and the tendency is to say, well, we should do everything, but in reality you want to target the measures which are going to be effective.
Lead Inquiry: It’s like throwing, you would say, a lit match upon a fire. If the virus is already established in the United Kingdom, it doesn’t make any difference in general terms whether or not there is a single gathering?
Professor Neil Ferguson: Yes.
Lead Inquiry: But what about, and this is I think what lay behind, perhaps, if I might suggest, my Lady’s question, what about the precautionary principle? You, around about that time, made the very valid point that, on a precautionary basis, closing schools would be justified, because even if you couldn’t show a direct epidemiological link to a reduction in spread and a break in the chain of transmission, it looks good, it looks right, it shows you’re serious about trying to stop the transmission. Wouldn’t that approach apply equally to mass gatherings?
Professor Neil Ferguson: Not to the same degree. It’s not to say there would be no impact of it, but our best estimates of the impact would be it would be much lower than, for instance, closing schools.
Lead Inquiry: Well, that’s a relative answer, isn’t it? I’m asking you in absolute terms: why wasn’t the precautionary principle applied to this same issue of mass gatherings as it was to the closing of schools?
Professor Neil Ferguson: I would say that the question we were asked was what the likely effectiveness of the measure would be. So if you’re asking about effectiveness, I mean, I’ve given you an answer that on its own – as part of a suite of measures of course, these things add up, but on its own, as a single measure, it would have a very small impact on the trajectory of the pandemic.
Lead Inquiry: As we’ve seen from the emails, you weren’t averse to going beyond, quite understandably, a narrow issue of what would be the epidemiological answer to questions of policy and measures and efficacy and breaking transmission. Why did you not say –
Professor Neil Ferguson: Well, I would say that is part of the – there’s – talking about efficacy and talking about effectiveness and relative effectiveness is, I think, well within my area of expertise. Talking about should the government therefore do something, is something different.
Lead Inquiry: But you do agree, don’t you, that there are plenty of examples where you do say the government should do something?
Professor Neil Ferguson: I mean, plenty of – I mean, the examples I can think of most in those early days was about just ramping up testing and getting some decent surveillance into place so we knew what was going on.
Lead Inquiry: And control measures and cost-benefit analysis and economic considerations, all the stuff of policy?
Professor Neil Ferguson: I mean, yes. I mean, I would have – compared with past emergencies I’ve been involved in, I saw less evidence of, let’s say, behind-the-scenes government planning.
Lead Inquiry: So I was asking you about the SAGE meeting of 5 March. At that stage, in early March, was SAGE still advising a mitigation as opposed to a suppression strategy?
Professor Neil Ferguson: I mean, SAGE was still considering a mitigation rather than a suppression strategy, yes. I mean, that was the … the government strategy laid out in the 3 March Covid plan was one effectively of mitigation.
Lead Inquiry: What sort of mitigation measures did you or SAGE have in mind on 5 March as being effective in support of the mitigation strategy?
Professor Neil Ferguson: So the first one was – we didn’t have testing, of course, but isolation of symptomatic cases and the households of symptomatic cases.
Lead Inquiry: So just pause there. Telling the population that if you show symptoms you self-isolate?
Professor Neil Ferguson: Yes.
Lead Inquiry: And your family?
Professor Neil Ferguson: And your family self-isolate.
Lead Inquiry: All right. So that’s a –
Professor Neil Ferguson: I mean, that was – and that was indeed the first policy actually announced. Other measures we considered were reducing social contacts and workplace contacts. School closure has already been mentioned. There was an extensive debate around that time about measures which were particularly targeted around shielding the elderly, because it was known that that age group was most at risk. Those were the measures being modelled.
There was also discussion within SAGE as to the particular risk associated with care homes and the need to improve infection control in that setting.
Lead Inquiry: But there was no recommendation made in early March about care homes, was there?
Professor Neil Ferguson: I mean, the risk from care home – of care homes was discussed in – I mean, I raised – actually I can’t remember the precise date, I think it was all the way back in February, the risk of care homes, because there was early evidence of outbreak in care homes from the United States, I think Seattle in the first instance.
Lead Inquiry: You did raise the issue of infection in care homes, and also the issue of nosocomial infection in hospitals, and the evidence shows, doesn’t it, that a large percentage of the deaths suffered in the United Kingdom were in both those places.
Professor Neil Ferguson: Yeah.
Lead Inquiry: But at the beginning of March, although you’ve said you debated care homes, SAGE made no recommendations in fact for restrictions on care homes, other than the general self-imposed obligation to isolate you and your family members in the event of symptoms?
Professor Neil Ferguson: I mean, to be honest, I cannot – I mean, I think it was – in relation to care homes, it was more Chris Whitty and Patrick Vallance agreeing and talking – I think Jenny Harries had a responsibility – within a SAGE meeting and saying that improving infection control in care homes was a priority. Again, I mean, the minutes may not reflect that.
Lead Inquiry: You weren’t confident, were you, at the beginning of March that these relatively limited measures, reflective in fact of in terms of –
Professor Neil Ferguson: Flattening the curve, yes.
Lead Inquiry: Flattening the curve, but also having their genesis to some extent in flu pandemic strategy, because you weren’t talking about lockdowns here or stay at home orders or shutting of workplaces. Were you confident that they would prevent the sorts of levels of death and hospitalisation which you had indicated by the end of February would otherwise inevitably occur?
Professor Neil Ferguson: The best we were able to achieve in – I mean, in modelling terms, but combining these interventions, in a mitigation sense, was a – about a halving of deaths, mostly down to shielding, it’s an open question how successful that would have been as a policy, and maybe a 70%, maybe slightly more if there was spontaneous behaviour change, reduction in healthcare demand. The challenge is that we were talking about levels of healthcare demand which were more than ten-fold above what the NHS could potentially cope with and therefore a 70% reduction was not sufficient.
Lead Inquiry: So why did SAGE recommend and why did you throw your own personal authority behind a recommendation that was, in effect, a half measure?
Professor Neil Ferguson: I mean, say – I would say SAGE was working to the – what we understood was the government policy of wanting to do its best to mitigate the epidemic but not risk a second wave in the autumn.
Lead Inquiry: But the primary objective was surely to prevent death and to stop the transmission of the virus. Why were you waiting for clarity to come about the government’s own strategy? Why did you need to know what its red lines were before you made a perfectly sensible recommendation, “Half measures mitigation are just not going to work we need suppression”?
Professor Neil Ferguson: So the challenge with suppression is what does it lead to. It delays matters at enormous – I mean, enormous – societal and economic cost, but what do you do next? And so the SAGE discussions, such as they were around this issue, were looking in the one-year timeframe or longer, you know, where would the UK be then, and that – I mean, Chris Whitty in particular was concerned about what would be happening in the autumn.
Lead Inquiry: So is this the position: there was a fear on the part of SAGE and its constituent parts, its participants, that if you suppressed, if you pushed R0 down below 1, if you clamped down hard on the virus, it would re-emerge later like an uncoiled spring in a vicious overwhelming second wave?
Professor Neil Ferguson: I mean, that was the initial concern around those measures.
Lead Inquiry: Why was it assumed that there would be a second wave, or rather was consideration given to whether or not measures might have been able to be taken in the meantime in May, June, July, August, September, October, November, to make sure there wouldn’t be a second wave, for example a developed test, trace, isolate and support system?
Professor Neil Ferguson: I don’t remember that being discussed but there wasn’t a lengthy discussion of suppression-type strategies in SAGE until the middle of March.
Lead Inquiry: You say in your statement that:
“[You] did not strongly advise for a switch to a suppression strategy prior to March 13th, in part because of my belief that it isn’t the role of scientific advisers to determine policy … but also because I was very conscious of the huge economic and social costs which would be entailed by long-term and intensive use of NPIs …”
Why was it a concern of a mathematical epidemiologist, no disrespect, to determine matters of economic and social cost and to undertake this cost-benefit analysis?
Professor Neil Ferguson: Well, I mean, first of all, I mean, public health, there is a strong tradition within public health of looking at cost-benefit in the way we operate our health system, in the way we judge the proportionality of interventions. I mean, cost is weighed against benefit, both economic cost and other more, let’s say, nebulous costs.
Lead Inquiry: Professor, where is the emergency call to the government at the beginning of March, two weeks before the 13th when it kicks off, where you say or SAGE says, “We have to turn to a suppression strategy because of the risk of the high levels of death and hospitalisation, but for you, the government, you’ll have to work out the cost-benefit analysis, you’ll have to work out whether the cost of suppression is worth it”?
Professor Neil Ferguson: I mean, I think Chris and Patrick were at every SAGE meeting and were very well aware of that. I wasn’t clear on what was being communicated to government or not, as some of the later emails you refer to make clear.
Lead Inquiry: I said where you or SAGE, not Sir Patrick or Sir Chris, where does SAGE say that, at the end of February and in the first week of March?
Professor Neil Ferguson: I mean, as I’ve said before, the role of SAGE is to answer the questions addressed to it.
Mr Keith: My Lady, is that a convenient moment?
Lady Hallett: It is.
Sorry, it’s time for another break, Professor, you might welcome one as well. 15 minutes, please.
(3.11 pm)
(A short break)
(3.25 pm)
Lady Hallett: Mr Keith.
Mr Keith: So, Professor, we come to the beginning of March 2020, and the government, as you’ve correctly reminded us, publishes its Coronavirus: action plan in which the first stage is contain. And that wasn’t something that you’ve told us was debated with SAGE. SAGE didn’t know that the government was publishing that plan. You must have been quite surprised to see the promulgation of a new plan which contained as its first stage contain, when, as you’ve described very ably to us, you had very real doubts and had had very real duties for a matter of weeks as to whether contain could ever work.
Professor Neil Ferguson: Yes. It was one – probably the only point of disagreement I had with Chris Whitty about the extension of the contain phase.
Lead Inquiry: A couple of days later, on 5 March, SAGE sat, met, and its consensus document concludes:
“There are currently no scientific grounds to move away from containment efforts in the United Kingdom.”
What did that mean?
Professor Neil Ferguson: I mean, there was a debate around containment and Chris gave his view, which was, I think, largely around the fact that – didn’t want the UK to be the first country to move away from that. I mean, I – from memory, I expressed the view which I’ve expressed previously, that I didn’t feel contain was succeeding. To be honest, I don’t know quite where that central opinion, let’s say, of those minutes came from.
Lead Inquiry: Are you saying that because there was a disagreement as to the efficacy of containment, SAGE alighted upon that phrase “there are no scientific grounds to move away from it”?
Professor Neil Ferguson: I mean, you would have to ask the person who drafted it, but yes, that might be …
Lead Inquiry: Professor, you were at the meeting, a most important member of that committee, and you take responsibility, as with all the members, for the documents and the minutes, the documents produced by your committee. What did it mean?
Lady Hallett: Is that right?
Professor Neil Ferguson: No. I mean, we’re not –
Lady Hallett: If you get to approve the minutes – did you get to approve them?
Professor Neil Ferguson: No, not from memory. We get circulated the summary, but we don’t approve the minutes. It’s not like NERVTAG where you edit the –
Mr Keith: Was this document circulated to you at any time before it was published and put into the public domain?
Professor Neil Ferguson: Oh, you always get copies of the summary.
Lead Inquiry: And when you saw this phrase – did you see this phrase in the summary?
Professor Neil Ferguson: Yes.
Lead Inquiry: Right. When you saw that phrase in the summary, which was given to you, did you think to yourself, “Well, that’s not a fair reflection of the debate”?
Professor Neil Ferguson: I thought it was a diplomatic form of words.
Lead Inquiry: To what extent was Sir Chris’s discomfort at the idea that the United Kingdom would be the first country to abandon containment a driver of that conclusion?
Professor Neil Ferguson: I mean, I think it was probably the most significant driver.
Lead Inquiry: By 9 or 10 March, you were extremely concerned, were you not? You had had, for now a matter of four to five weeks, the basic figures in relation to infection fatality rate, infection hospitalisation rate. You could see that the containment policy didn’t stand a chance, and the debate was still raging about whether or not suppression or mitigation was the right way to go.
Professor Neil Ferguson: I mean, I’m not sure that you would say the debate – there wasn’t much debate of that on SAGE itself. I mean, the thing I was most frustrated by was there still seemed to be a residual, I don’t know – a sense I got that some in government hadn’t really comprehended the figures or didn’t think it was going to be as bad as it was going to be. A lack of a sense of urgency, let’s put it that way.
There was also a second challenge, which was it was very difficult to get NHS England to actually state on the record that the health service would be overwhelmed and what their surge capacity was, and in fact the first time they did that was on 13 March.
Lead Inquiry: That was the first occasion on which, to use your words, they put that information on the record, and you challenged them quite strongly at that meeting. But you had known for a considerable time before that meeting, informally, what the impact would be of your figures on the NHS?
Professor Neil Ferguson: Depending on the level of – obviously it wouldn’t be the NHS as normal. I didn’t know anything about what their surge capacity potentially was.
Lead Inquiry: Did you know weeks before they put it formally on the record that the number of deaths and hospital cases that you had estimated would result would likely overwhelm the NHS?
Professor Neil Ferguson: Yes, yes.
Lead Inquiry: Right. You emailed an official, an adviser in Downing Street called Ben Warner. I think you may have spoken to him on the phone to tell him that you were going to email him?
Professor Neil Ferguson: I don’t honestly remember.
Lead Inquiry: All right.
Could we have, then, that email, INQ000196055.
If we go to the second page, please, we’ll chronologically work backwards. We can see an email from you, director, of course, of the MRC Centre for Global Infectious Disease Analysis, and the body of the email:
“Thank you very much …”
Talks about bed demand per day, daily deaths, the peak. And you say this:
“As long as the PM and Cabinet accept and understand this is what is likely to happen and are still ahead to proceed with current plans, then there is a rational basis to that decision which I would say the science supports.”
To what extent, Professor, did you regard yourself as obliged to step out of your SAGE role and express views about government policy and the workings of the PM and the Cabinet in this way?
Professor Neil Ferguson: I mean, it felt uncomfortable, but at the time it felt like it needed to be said, because, yes, as I said, I was increasingly concerned about this disconnect between the numbers we were actually presenting and the reality of what that would actually look like.
Lead Inquiry: In the last paragraph you say:
“But what would be the worst outcome – in my opinion – would be to go for mitigation …”
And that of course was the current plan:
“… (the policy package currently being discussed) and for the health, social and political cost to be judged later to be unacceptable – necessitating a policy pivot in the midst of what will already be a national crisis.”
Did you mean by policy pivot a change to suppression?
Professor Neil Ferguson: Yes.
Lead Inquiry: Complete control of – or, I apologise, reducing the reproduction rate below 1?
Professor Neil Ferguson: Yeah.
Lead Inquiry: A lockdown in practice.
“We might still follow the currently planned measures for the next few weeks, but then much more intensive measures would need to be introduced. Which need to be thought about now.”
At this stage, when you alerted Downing Street to your concerns, what was the thinking in relation to when that wave would likely peak?
Professor Neil Ferguson: I mean, when it would peak would depend on the measures. I mean, in retrospect, we didn’t have a few weeks, as the next few days’ data indicated, but we were – I mean, we’ll come on to the topic of data streams, so …
Lead Inquiry: I’m going to ask you about Colindale, never fear.
What was the thinking about the wave and when it would peak? At this stage, as you were raising –
Professor Neil Ferguson: I mean, from memory, May – May-ish timescale, but obviously there’s a significant build-up, I mean, to something which was six, seven times worse than what we actually saw in April.
Lead Inquiry: Was the reality that the wave peaked significantly earlier?
Professor Neil Ferguson: No, I mean, the wave peaked because of the suppression measures adopted. But the – okay, I understand.
The epidemic, as we learned in the next few days, was at least two weeks further progressed than the surveillance data available at the time I wrote that email suggested.
Lead Inquiry: Was the reason for that (a), as you’ve already identified, the asymptomatic nature of a significant proportion of the virus meant that in the absence of testing it’s difficult to trace where it’s got to, and (b) the lack of understanding, because of the lack of testing, on the number of seedings, the number of places in the United Kingdom that the virus had already got to?
Professor Neil Ferguson: Yes, the epidemic was effectively hundreds of times larger than we had anticipated. Well, to be fair, probably about 30 to 40 times larger.
Lead Inquiry: In essence, because of a lack of a significant sophisticated surveillance and testing system?
Professor Neil Ferguson: Yes, which I would say that – I mean, both Patrick Vallance, myself, John Edmunds and Jeremy Farrar had repeatedly commented on this multiple times in SAGE.
Lead Inquiry: Then if we could go, please, to the prior page, the previous page, page 1, you say at the bottom of the page:
“Dear Ben,
“Good to talk today.”
Which is why I suspect you might have called him.
Professor Neil Ferguson: That probably was on the side of – on the SAGE meeting –
Lead Inquiry: On the margins?
Professor Neil Ferguson: Margins, yes.
Lead Inquiry: Because he attended SAGE, did he not?
“Thank you for sending this over [he says].
“I think the point you make is very valid, important and I will continue to raise it here.”
Then you email subsequently about the Prime Minister’s press conference.
On 11 March there is also an email, INQ000149013, this is an email to Professor Medley and a number of individuals copied in, including Professor Woolhouse in fact:
“See attached for edits. I think this is a little more balanced – especially with respect to the international situation, given the original draft was factually inaccurate in some respects …”
What report was it that you were editing or had edited?
Professor Neil Ferguson: This was a summary of the – which frankly was generated spontaneously by SPI-M members, it wasn’t commissioned, of the relative both benefits and drawbacks of suppression versus mitigation.
Lead Inquiry: It would appear that SPI-M had been discussing the international situation, so it wasn’t just an epidemiological or mathematical exercise, they were looking at the wider picture –
Professor Neil Ferguson: Can I interrupt?
Lead Inquiry: Yes.
Professor Neil Ferguson: I mean, we always looked at data. SPI-M was tracking the epidemic everywhere, and we were reading the scientific literature.
Lead Inquiry: You’ve seen the suggestion in a number of places that SAGE and SPI-M failed to pay sufficient regard to the position overseas and to overseas data, what was happening in particular. Is there any basis for that –
Professor Neil Ferguson: No.
Lead Inquiry: – suggestion? All right.
You then go on to say:
“With respect to ‘wait and see’. We don’t have time. That is akin to a policy pivot when it is too late.”
Is that the same point you were making in your email to Ben Warner?
Professor Neil Ferguson: Maybe can I elaborate?
Lead Inquiry: Please.
Professor Neil Ferguson: So the issue of timing of policies is fundamentally different between mitigation and suppression. So for mitigation you’re wanting to implement measures around the peak of the epidemic to effectively squash the peak. For suppression, on the other hand, you want to act as early as possible, because the magnitude of – the wave will come down if those measures are successful, but if an epidemic is doubling every four days, basically a week’s delay corresponds to four times more cases and deaths.
Lead Inquiry: Because of the exponential nature of a virus. But in reality, Professor, and in the event, it just didn’t matter, because measures had to be taken to stop the NHS being overwhelmed in any event?
Professor Neil Ferguson: Yes, I mean, what became clear on the – I think between the – particularly between the 12th and the 15th is that, first of all, the NHS, you know, gave us definitive figures, and secondly that I think – this is more from reading Chris and Patrick’s statement – that it was clearly viewed as unacceptable to have the NHS overwhelmed.
Lead Inquiry: To some extent, therefore, the whole debate about suppression/mitigation was swept away by the realisation that unless the maximum control measure was applied, and lockdown, a mandatory order, the NHS would collapse?
Professor Neil Ferguson: I mean, I would slightly correct you there. I would say there was – other debates were got on to – you know, following – after 16 March. I was actually – the type of measures we modelled in Report 9, which we’ll get to, is much more akin to what was announced on 16 and then 18 March than the mandatory lockdown. The issue around the necessity of the 23 March announcement was around quite how far progressed the epidemic had got by the time measures were introduced. I think this is a point that Mark Woolhouse has raised, that if you act earlier you can act with slightly less intensive measures. Still very disruptive, but not as intensive.
Lead Inquiry: Yes, I put the question on the basis that, in the event, it was, of course, the need to avoid the collapse of the NHS that led to mandatory measures being applied.
The SAGE meeting of 10 March was the first SAGE meeting at which, as you’ve described earlier, the potential risk to the care sector was debated significantly.
Professor Neil Ferguson: I think to the level of being minuted.
Lead Inquiry: To the level of being minuted. And I think the position is that there were no SPI-M-O models before 23 March that explicitly modelled care homes or the impact on the hospital sector?
Professor Neil Ferguson: I mean, that’s true, we modelled – all the models had age-related risk in them, and we were looking at shielding options for the elderly, but no models explicitly represented the care sector.
They did represent hospitals, in some sense, but we didn’t represent nosocomial – hospital-based transmission.
Lead Inquiry: You say in your statement that you were so concerned by the lack of data, and it was in the main a lack of data which had led to you not being able to model the specific sectors, that you sent members of your team at the Imperial College COVID-19 Response Team to PHE’s offices in Colindale. Why did you do that?
Professor Neil Ferguson: Well, I should elaborate. I mean, it’s – we have a close working relationship with what is now UKHSA, and the Health Protection Research Unit you mentioned at the start of this evidence session is a collaborative initiative between Imperial College, London School of Hygiene and Tropical Medicine and then Public Health England. And so we were used to working together. I just became aware that, at that time, there were – the staff were overwhelmed at Colindale in trying to pull the data together for both the central government, for SAGE and SPI-M. I mean, I could tell that from the fact that emails were coming through at, you know, past midnight. So I offered to provide some support in terms of people who could help put in place hopefully a better system.
Lead Inquiry: Then, as we heard earlier from Professor Steven Riley, it’s around that time that he produced the two papers that he did – he is, of course, a member of the Imperial College team – and the first of those papers was considered by SPI-M-O on 11 March.
I think it’s fair to say, Professor, that his reports were not welcomed by you. You were, in your response to him, quite critical of what you saw to be the assumption that what he was recommending would be adopted by the government. You said there will be no appetite for the draconian – such draconian measures. But his approach was, putting aside the policy impact, broadly correct, was it not?
Professor Neil Ferguson: I mean, it was an approach which ended up being adopted in terms of suppression. I mean, the issue – I mean, as you’re aware, there are multiple iterations of –
Lead Inquiry: Yes.
Professor Neil Ferguson: – of that. The first iteration, on 1 March, was, I mean – and I said to him at the time we would include containment options, which are much more similar to what turned into Report 9. I felt there were certain – so, I mean, Steven believed passionately from very early on that the country should lock down. He took a different view of that kind of interface between science and policy, and I accepted that.
So my – I had some particular technical concerns with the final report produced which you’re referring to, just in terms of the – some of the assumptions around, I mean, looking at how mitigation might fail but not looking at, for instance, how suppression might fail.
Lead Inquiry: Putting aside the technical changes and the editing, in broad terms, you saw the reports as intruding impermissibly into policy areas, did you not?
Professor Neil Ferguson: I had concerns at the way that they were written at the time would be seen – particularly if we put them out as an Imperial College report, and I said he was free – I mean, absolutely, obviously, free to do what he wanted with it, but if we put them out as an Imperial College report it would be seen as almost advocating on policy solution.
Lead Inquiry: But you had been advocating on policy in the press, to Ben Warner, to the CMO, CSA?
Professor Neil Ferguson: I mean, what I had been doing is warning – issuing warnings about was the government aware of what their policy was actually going to result in, I think.
Lead Inquiry: Did you debate publicly and with government officials the policy implications of the mathematical and epidemiological advice that you were providing?
Professor Neil Ferguson: Sorry, what do you mean by publicly?
Lead Inquiry: Did you talk about the policy consequences of your modelling in the press or in emails?
Professor Neil Ferguson: No. Not in that sense publicly.
Lead Inquiry: Did you communicate to Ben Warner in Downing Street –
Professor Neil Ferguson: Indeed.
Lead Inquiry: – your concerns about the measures, whether it should be suppression, mitigation, and what should be done?
Professor Neil Ferguson: Well, my – you’ve just covered them, emails to Ben Warner, which wasn’t … I did not view those emails as being advocating for a change of policy, more as saying: are you aware of what the current policy will cause and, you know, clearly, is the Prime Minister aware of that? It was a warning about the consequences.
Lead Inquiry: On 12 March – could we have INQ000149061 – you engaged in email communication with Professor Edmunds and Professor Farrar.
Professor Neil Ferguson: Yep.
Lead Inquiry: The email from you is at the bottom half of the page, Friday, the 13th:
“I think the message got across.”
What message was that? Was that the message at the SAGE meeting on that day?
Professor Neil Ferguson: Yeah.
Lead Inquiry: “I still think part of the issue is Chris hoping it won’t be as bad as we say.”
You expressed that view to your colleagues, Messrs Farrar and Edmunds. Did you say to the CMO himself, “I’m concerned that you appear to have a degree of optimism bias that it won’t be as bad as we all think it will be”?
Professor Neil Ferguson: Not in so many words. What I tried to do was reinforce the support for the estimates we were coming up with. I mean, I think Chris was naturally more, let’s say, conservative at accepting – and they were uncertain estimates.
Lead Inquiry: The email is obviously a conversation between yourself and Jeremy Farrar and John Edmunds. To what extent did you express these views openly in SAGE yourself on 13 March?
Professor Neil Ferguson: So on 13 March what I refer to in the second sentence there is the fact that I actually, I mean, my … I explicitly asked the question of Stephen Powis in the meeting of whether the, you know, what was the NHS surge capacity, which, in some sense, was outside the remit of SAGE, it’s an operational consideration, but by doing so – and then asked him, you know, could the NHS in any way cope with the current plan, you know, policy plans, and he said he would get back to me and did on the exact surge capacity but basically said no, there is no way the NHS would be able to cope.
Lead Inquiry: On 15 March, INQ000048089, page 2, you email Sir Chris and Sir Patrick.
Professor Neil Ferguson: I think it hasn’t updated for me. Ah, okay.
Lead Inquiry: If we could go back, thank you, if you would just go back one page, please, we can see in the middle of the page, email 15 March, 2020, 3.37 am, to Sir Patrick and Sir Chris:
“… I need to sleep now.”
Then, further down the page, figures, your thinking in relation to the impact upon NHS healthcare facilities and demand.
Then over the page, essentially, at the top of the page, you talk about what policy will need to be implemented in order to be able to avoid, as you saw it, and the figures supported you, the terrible consequences on the NHS of your figures of death and hospitalisation:
“The minimum policy will require: closing schools & universities, home isolation of cases, and large-scale intensive social distancing – reducing all contacts outside the home and work by 75% …”
Was that a mitigation policy or a suppression policy, Professor?
Professor Neil Ferguson: I mean, the difference between green and red in the previous table is the difference between mitigation and suppression.
Lead Inquiry: Does this email therefore stand as the point at which you yourself are converted to the merits of a suppression policy as opposed to a mitigation policy?
Professor Neil Ferguson: I think that’s a very different and difficult judgement. I didn’t – I’m on record as saying that I didn’t view any easy decisions here. I think it’s the point at which it was clearly apparent that exceeding NHS capacity was a government red line they did not want to cross, and I was therefore saying these are the policies which need to be implemented.
Lead Inquiry: Around this time, you were engaged in drafting Report 9?
Professor Neil Ferguson: Yes.
Lead Inquiry: Which is the report of which we’ve heard earlier today from Professor Steven Riley. Could we have, please, INQ000270159.
There is a summary on page 1 which, in essence, is this right, states that the result of epidemiological modelling is that, whilst there are two fundamental strategies, mitigation and suppression, the optimal mitigation policy is that policy which you’ve identified in the email of a relatively stringent degree of measure but falling short of a lockdown?
Professor Neil Ferguson: Not quite. So the optimal mitigation policy could achieve maybe a two-thirds reduction in peak healthcare demand and the halving of deaths, which was the “mitigation”. The suppression policy then went further and that’s, you know, where you can avoid exceeding healthcare limits.
Lead Inquiry: Page 2, you say:
“The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available …”
Did you consider the possibility that a sophisticated scaled-up test, trace and isolation measure could provide a degree of succour and support before vaccines were invented?
Professor Neil Ferguson: I mean, that is what was being referred to, or something equivalently effective at reducing transmission, in that sentence.
Lead Inquiry: Well, Professor, you make the point that whatever package it is has to be “maintained until a vaccine becomes available (potentially 18 months or more)”.
Professor Neil Ferguson: And that’s true whether you’re using contact tracing or you’re using – irrespective of the type of non-pharmaceutical intervention one is using. No immunity is building up in – or limited immunity is building up in the population if suppression is working and so the only way of exiting from that policy is when a vaccine is available to generate immunity through that route.
Lead Inquiry: Professor, in this document you were advocating an intensive intervention package by way of reducing contact in the workplace and at home, ensuring a degree of isolation that breaks transmission chains, and you say that package will need to be maintained until a vaccine becomes available.
You’re not there referring to testing. Testing is not a package, is it, which is concerned with –
Professor Neil Ferguson: Maybe I’ll read:
“The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available …”
Lead Inquiry: All right. Why didn’t you say, “The best way of being able to return to life, something approaching normality, after this package is – intervention package is introduced, is to develop, at speed, a rapid test, trace and isolate system”?
Professor Neil Ferguson: I mean, I think – well, we did a lot of work in the following weeks on – on that. It wasn’t, at that time, our top priority. We had a limited amount of time to look at it and I did not want to be making statements which I couldn’t back up.
Lead Inquiry: All right. Page –
Professor Neil Ferguson: I don’t disagree with the concept of having an effective test and trace system and I’m on record at looking – both stating that and looking at it in detail.
Lead Inquiry: Could we have page 16, please.
The middle of the page has the paragraph that we looked at earlier:
“In the [United Kingdom], this conclusion has only been reached in the last few days, with the refinement of estimates of likely ICU demand due to COVID-19 based on experience in Italy and the [United Kingdom] … and with the NHS providing increasing certainty around the limits of hospital surge capacity.”
Was it not the position that you had in fact for a matter of weeks known what the IFR number was likely to be, the hospitalisation number was going to be, you had informal information about NHS capacity, and obviously Professor Riley had produced his own report?
Professor Neil Ferguson: I mean, so I understand what you’re saying, the IFR didn’t change, the hospital estimates did change, they roughly doubled based on what was happening in Italy in terms of intensive care unit demand. Qualitatively, you’re completely right, it didn’t change the conclusion, but in quantitative detail it did change it significantly.
We didn’t have, I should say, we had informal – well, informal feedback from the NHS that it was highly unlikely surge capacity would be available to meet the likely demand, but we weren’t given official figures, let’s say, for what that capacity was going to be until 15 March, or 14 March.
Lead Inquiry: In the event, Professor, the government, as we all know, imposed a lockdown. You make the point in your statement that all interventions have a trade-off between potential impact and cost, and also effectiveness and practicality. A more practical intervention may achieve a higher impact than a more onerous intervention that is poorly adhered to.
Professor Neil Ferguson: Yep.
Lead Inquiry: In your view, if the goal was to prevent the collapse of the NHS, was that lockdown necessary?
Professor Neil Ferguson: This is not a question we can definitively answer. Without doubt the measures announced on 16 March had some effect on transmission, and potentially accelerated by spontaneous behaviour change, but we didn’t have the time to wait and collect the data which would allow us to say, “Yes, they’re sufficient”, or, “No, they’re not”.
Lead Inquiry: But you gave evidence, I can’t go into for legal reasons the evidence you gave, but you have spoken about what the impact might have been if the intervention had been introduced a week earlier.
Professor Neil Ferguson: So I was very careful when I made that statement to the House of Commons select committee, which is –
Lead Inquiry: All right, I’m going to stop you there. For legal reasons we can never debate in a court of law anything that is said or done in Parliament. So I cannot ask you questions about –
Professor Neil Ferguson: Okay.
Lead Inquiry: – the merits –
Professor Neil Ferguson: I will refer instead to the paper we later published on that.
Lead Inquiry: Thank you.
Professor Neil Ferguson: But I said the same at the time, which is moving all interventions back a week. So returning to your point of could things have acted – moved faster in February and March for whatever reason, more clarity on the data, more clarity on NHS capacity, had we moved the 16 March back to the 11th, the 23rd back to the 16th, that was the scenario we were looking at.
Lead Inquiry: My question to you was: if the goal was to prevent the collapse of the NHS, was that lockdown necessary? From everything you’ve said, it must surely follow that it was, because –
Professor Neil Ferguson: I mean –
Lead Inquiry: – you were saying you’ve got to do it otherwise –
Professor Neil Ferguson: So I thought you were distinguishing between what was announced on 16 March and what was announced on 23 March.
Lead Inquiry: No, the 23rd.
Professor Neil Ferguson: Okay. So I think – you know, well, I think both were warranted, but I cannot definitively say whether what was announced on the 16th, maybe in combination with what was defined – announced on the 18th, would have been sufficient in its own right, we just don’t have the data to answer that question.
Lead Inquiry: So what you’re saying is we will never know the exact nature of the number of deaths that would have been saved if a lockdown had been a week earlier; equally we’ll never know whether or not the measures short of a lockdown which were put in place around the 16th, or the 13th in fact, whether they would have worked?
Professor Neil Ferguson: I’m specifically referring to the measures announced by the Prime Minister on the 16th, which was mostly an urging of people to work from home and to reduce social contact. They weren’t mandatory measures but they did have an appreciable effect on population contact rates and behaviour. And I know there’s a certain sector of society who are exercised about the difference between mandatory and voluntary measures, and my response was we will never know in the UK context whether the measures announced on the 16th, and then later with school closure, which is mandatory on the 18th, would have been sufficient on their own. What we can say is that the mandatory lockdown was more effective at reducing contact rates, it had an even higher effectiveness.
Lead Inquiry: How clear are you in that conclusion? Plainly there are degrees of likelihood. If we had only had those measures, the ones imposed on the 16th, how clear is it?
Professor Neil Ferguson: It isn’t, and we didn’t have time to wait for it to be clear.
Lead Inquiry: Has there been any subsequent analysis done, any counterfactual work done afterwards which shows whether or not it was ever possible at all that those measures would have sufficed on their own or are we in the territory of, well, they might well have worked but we’ll never know?
Professor Neil Ferguson: Well, I mean, the policies we actually modelled in Report 9 were considerably less stringent than the lockdown of 23 March, but the reason for that is that the more – you can have a range of different measures which will achieve suppression, but the rate – the speed of doing so differs depending on how stringent the measures are, and if you are concerned about healthcare capacity being overwhelmed in the very short term, you need to implement considerably more stringent measures than if you act potentially earlier and can then later refine measures.
Lead Inquiry: Does your conclusion, your view, depend at all upon Professor Woolhouse’s point, which you have already addressed separately, that there was a failure to take proper account of spontaneous changes in behaviour?
Professor Neil Ferguson: I mean, it’s difficult. What we can do is observe. We had that one week to observe spontaneous changes in behaviour, because most – nearly all the measures announced on 16 March were recommendations, and there was a significant reduction in mobility, in how other measures have – we weren’t, at that point, measuring contact rates but in proxy measures of contact rates. Whether it would have been sufficient though we don’t have enough data to say.
Lead Inquiry: Now, very briefly, some of the high points and low points of the chronology thereafter.
In relation to the May 2020 alert system, and the government’s approach to the relaxation from the then Covid restrictions, have you said in your statement that the strategy failed to learn perhaps the most important lesson from March 2020, namely that acting early saves lives and costs no more economically than acting late?
Professor Neil Ferguson: Mm-hm.
Lead Inquiry: That is of particular application, is it not, to the debate about whether there should have been a circuit breaker in September/October or an earlier lockdown earlier than the date in November on which it was actually imposed?
Did you produce models and documents in September on behalf of ICL but also before SAGE making plain that at various stages various levels of quite stringent NPIs would be needed to slow or reverse the exponential growth in the virus as you saw it to be?
Professor Neil Ferguson: Yes, I did. And I’d like to place it into context, that first of all the efforts between April and September to, in some sense, reduce transmission through other means, through test and trace, through making environments Covid-safe, did have a marked effect. So we were not facing quite the same situation in September/October that we were facing in March 2020. We were facing a growth rate, a reproduction number of more like 1.4, 1.5 rather than one of nearly 3. But it – as all the modelling we had done all the way back in April of exit strategies and lockdown had indicated, it just wasn’t sufficient. So in that context of exponentially growing levels of infection, hospitalisation in September/October, yes, we undertook a lot – well, we undertook, first of all, for SPI-M, along with other groups, modelling of likely scenarios going into the winter and the potential impacts of control policies, anticipating, indeed, even before Alpha was announced, the likely necessity of a third lockdown in January 2021. And – but I also contributed, with Matt Keeling and with John Edmunds, to a table of potential non-pharmaceutical interventions which could be considered by the government if they wanted to escalate from what the current policy was.
Lead Inquiry: As had been foreseen in February/March, because it is part of a viral epidemic, there was a second wave?
Professor Neil Ferguson: I mean, a catastrophic second wave.
Lead Inquiry: Even though there had been Covid-safe measures to some degree put in place and even though there was longer warning of the breaking of that wave, the number of deaths in fact exceeded those in the first wave?
Professor Neil Ferguson: I mean, by two-fold, yes.
Lead Inquiry: And do you say in your statement, therefore, that the policy of acting incrementally and as late as possible, in the end – to prevent NHS capacity again from being exceeded – had a significant impact upon the number of deaths?
Professor Neil Ferguson: Yes.
Lead Inquiry: The local tier system in October 2020 you criticise. You make the point that SAGE and SPI-M-O were not consulted about the introduction of the local tier system, and you describe it as being flawed in its implementation. Was it in essence a form of epidemiological levelling up?
Professor Neil Ferguson: Mm.
Lead Inquiry: Everywhere would find itself inevitably in the highest tier?
Professor Neil Ferguson: Eventually, yes. It was sort of delaying the inevitable, and of course that has a public health, a human consequence in terms of hospitalisations and deaths.
Lead Inquiry: You state in your statement that you fully agreed with the decision to introduce the second lockdown, that is the lockdown in November 2020. There was an issue, was there not, around about 31 October, when slides developed in this ensemble process that you’ve described, prepared by Imperial, Warwick, London School of Hygiene and Tropical Medicine and Public Health England, Cambridge, were leaked, were they slides which were draft documents prepared some time before the leak?
Professor Neil Ferguson: My concern with it is they weren’t any sort of prediction, they were a commission to develop in some sense reasonably bad scenarios for the winter, before the tier system had even been introduced, and they had been superseded by, you know, more recent and calibrated projections of what the epidemic was going to be. So it felt like deliberately pessimistic figures were being produced, and I felt that, you know, that wasn’t the – I mean, the more recent figures were also – I think could have made the point equally well.
Lead Inquiry: The position was that, together with the other research groups, you had prepared documents for a specific purpose, in fact to identify a particular reasonable worst-case scenario, a very pessimistic scenario, and you have had done so some weeks before –
Professor Neil Ferguson: Well, not very pessimistic, somewhat pessimistic.
Lead Inquiry: Somewhat pessimistic. But in the event those slides came to be used –
Professor Neil Ferguson: Almost as if they were predictions, yes.
Lead Inquiry: All right. And there was a considerable press and public turmoil concerning –
Professor Neil Ferguson: Yes.
Lead Inquiry: – the production of those documents.
Finally, in relation to SAGE, which I said I would come back to, drawing together, and you address SAGE in multiple places in your statement, would it be fair to say that you have expressed a number of views about particular aspects of the way in which SAGE operated?
Professor Neil Ferguson: Mm-hm.
Lead Inquiry: Firstly, in relation to its make-up, that is to say its membership, do you have anything to say in relation to whether or not it was dominated by epidemiologists, modellers and behavioural scientists or whether it had a sufficient number of pandemic management experts, public health experts and experts outside your particular field?
Professor Neil Ferguson: So I think it evolved over time. So in the very earliest stages of the pandemic it was a small group. I should say, there were typically always two members of – senior members of Public Health England present to represent public health, so it wasn’t that it was not present, but in terms of independent expertise there were a number of gaps. Many discussions around, you know, why wasn’t economics, more social science represented. And I would have – I mean, I think that would have been to the good.
Lead Inquiry: You have, secondly, addressed this issue of the commission basis upon which SAGE was approached. Would you agree that a byproduct of that basis, that system by which the government approached SAGE and said “Could you please address the following specific issues”, that SAGE did not feel able to raise issues of its own accord or proactively make recommendations to the extent it might otherwise have preferred?
Professor Neil Ferguson: Yes. I mean, I do.
I mean, I frame that in a broader context, that I think SAGE became almost the normative source of public health advice, certainly for the early months of the pandemic, and I don’t think it was ever properly constituted to act in that role.
I mean, I think – my own view is that most countries, not all, but most countries which handled the pandemic better had empowered public health agencies informed by independent scientific advice, but that is the appropriate body which should be informing government policy on something on the magnitude of a pandemic, not a professor from Imperial.
Lead Inquiry: Thirdly, you’ve described how there was a process of reaching consensus. Is it possible that that process of reaching consensus, which reached its fruition in the documents which were produced, may have perpetuated a status quo, it may have led to inaction, because the government, when reading those documents, would have been unaware of the range of views which were actually expressed?
Professor Neil Ferguson: I think that was a risk, and I would certainly recommend that full – I mean, more comprehensive minutes are produced in future, along with a – then probably accompanied by a summary, but minutes could give – true minutes give a much better sense of debate and discussion.
Lead Inquiry: You have described, Professor, how there were occasions when you did not – and these are my words, not yours – speak out when you might have done so, because there was a lack of understanding as to what the government’s aims were, what its objectives were, what it wanted.
Professor Neil Ferguson: I think that was true throughout 2020. 2021, it was much clearer.
Lead Inquiry: There’s next then the issue of “following the science”. Did you feel that the mantra of “following the science” blurred the boundaries between scientific advice and policy decision-making, and also perhaps lead to an unwanted pressure upon SAGE itself?
Professor Neil Ferguson: Yes, because there is no such thing as really “following the science”. I mean, policy is there to achieve – I mean, science informs policy in the sense of saying what is possible, what the likely impacts of both the virus and policies will be, but it doesn’t predetermine a single best strategy, that’s obviously determined by what, you know, what policy objectives you’re trying to achieve.
Lead Inquiry: The evidence shows multiple communications between yourself and the Chief Medical Officer and the Government Chief Scientific Adviser outwith the framework of SAGE. Does that indicate that the funnel by which SAGE’s views were communicated to government through the CMO and the CSA personally were not working as effectively as they might?
Professor Neil Ferguson: I think it more indicates the fact that it’s – in many cases it was difficult to have a free-flowing discussion of technical points within SAGE meetings, in my experience. That was partly rectified, you know, from about April onwards by Patrick Vallance having informal, small-group meetings to talk things through, but most of those email exchanges are around, I mean, you know, Chris or Patrick bouncing ideas, wanting clarification.
I think, thinking more – I think there are better ways of having structures which allow for that in a more formal way than emails, if that was your question.
Lead Inquiry: If you had been satisfied that your views were properly reflected in SAGE, and communicated to the government through the CMO and the CSA –
Professor Neil Ferguson: Yes –
Lead Inquiry: – you would not have, yourself, written directly to a Downing Street adviser, would you?
Professor Neil Ferguson: That is certainly true, yes.
Lead Inquiry: Then finally, what was your view on the diversity of SAGE? Would you agree, Professor, that, as one of the leading lights of one of the most powerful research groups, SAGE may have become too clubbable, too dominated by major teaching and research institutions?
Professor Neil Ferguson: Certainly there was a type. I mean, I think both gender diversity and minority ethnic group diversity could be better reflected in future crises.
As for – I mean, to be honest, I’m sure both Chris Whitty and Patrick Vallance would say this, that you do want the leading experts in their respective fields to be represented on a committee like that, so there is always a preponderance of people from certain institutions.
Lead Inquiry: Lastly, Professor, it is of course well known that you resigned from SAGE on 6 May 2020 for personal reasons. Do you accept, putting aside some of the public reaction, fundamentally damage was done to public trust in government structures because you were seen, wrongly as it happened, to be part of the government and therefore there was a damaging effect on compliance and –
Professor Neil Ferguson: I mean, yes, I breached lockdown rules and I apologised for that and I apologise again, and I think that and later incidents certainly didn’t help with public trust. And I think being – yes, I wasn’t a government servant, I wasn’t a government employee, but I still recognise the consequence of those actions.
Mr Keith: Thank you, Professor.
My Lady, there are a number of Rule 10 questions.
Lady Hallett: I am afraid it’s not quite over yet, Professor, I’m afraid.
Ms Morris, I think you have some questions.
Questions From Ms Morris KC
Ms Morris: Thank you, my Lady.
Professor Ferguson, I ask questions on behalf of the Covid Bereaved Families for Justice. I’m going to ask you on a single topic about restrictions on mass gatherings, which is important as members of the groups that I represent had families who attended those mass gatherings and contracted Covid-19 as a result.
Now, my Lady’s already asked you a question about mass gatherings, and Mr Keith has taken you to the substance of your advice, and that developed by SAGE, and you have been asked directly why the precautionary principle was not applied in the same way that it was to schools. So my remaining question is about the process of the advice around mass gatherings.
I’d like you to look, please, at an email, INQ000047898, please. Thank you.
Just looking at the first paragraph and the attendees in highlight, first, if we may. This is an email dated 27 February 2020. It’s an email from Professor Sir Jonathan Van-Tam to, amongst others, Oliver Dowden – it discusses a meeting between himself and Oliver Dowden, the then Secretary of State for Digital, Culture, Media and Sport, and it includes a summary of the meeting. It’s a minute being circulated after with accompanying comments, you will see on page 2, from yourself.
Can you see there “Comments from modellers”, and your name is the second in bold there.
Have you seen this email before, Professor?
Professor Neil Ferguson: I believe I have, yes.
Ms Morris KC: Thank you.
The meeting itself between Professor Sir Jonathan Van-Tam and Mr Dowden and others was about mass gatherings, and the summary of your views on page 2, we don’t need to look at the substance of it, but do you agree there with the summary that’s provided in the email?
(Pause)
Professor Neil Ferguson: Yes, it’s a reasonable summary.
Ms Morris KC: Thank you.
Going back to page 1, if we may, and just to the beginning of that email, and just highlighting that first paragraph, please, this is the beginning of it:
“Do let me know if you are happy for me to send to DCMS, also please note that I have included the comments from academics/modellers but not sure how happy they will be that their assumption heavy views will be shared but have caveated that their opinions are not based on data.”
My first question is: did you know that this view was being shared?
Professor Neil Ferguson: No.
Ms Morris KC: No. Have you later become aware that it was shared?
Professor Neil Ferguson: Yes.
Ms Morris KC: Roughly when, can you assist?
Professor Neil Ferguson: I mean, I think as part of this public inquiry.
Ms Morris KC: Okay, thank you, that’s helpful.
Do you agree that your view was assumption-heavy, as the caveat indicates?
Professor Neil Ferguson: Given that – at the time, yes.
Ms Morris KC: Thank you. Back to page 2, please, if we may, just before the summary of the modellers, it says in red:
“… please note that there is no data to support the following.”
Do you agree with that caveat?
Professor Neil Ferguson: No data directly for Covid. There was data for other diseases which have similar transmission patterns but not for Covid.
Ms Morris KC: Understood. In providing the view that is represented in this email, had you conferred with colleagues in South East Asia on the issue before providing this view in whatever context?
Professor Neil Ferguson: I mean, certainly we had – I discussed with colleagues, not specifically because of this email or the request but the issue of restricting gatherings had been discussed in – with colleagues around the world.
Ms Morris KC: Thank you.
Professor Neil Ferguson: I should maybe add that we have published analyses of the effect of restricting gatherings of different sizes. I mean, over the course of the pandemic, drawing on experience across multiple countries, and I’m happy to share those if it’s helpful.
Ms Morris KC: Thank you, no, it’s just simply the information that you were pulling together for this summary.
So my point really is that there was a SAGE meeting as well on that date, this is 27 February. We can go to the minutes if you like, but I think you can take it from me that there was a SAGE meeting –
Professor Neil Ferguson: Yes.
Ms Morris KC: – on that day, and both yourself and Professor Sir Jonathan were there. How comfortable are you with your individual views on a topic such as mass gatherings being shared via email as opposed to being shared within the consensus statement of the SAGE minutes?
Professor Neil Ferguson: My preference in all of these, it would have been better for a summary opinion from SAGE or SPI-M, probably including SPI-B, to be written. My understanding, and it is a long time ago, was that Jonathan Van-Tam wanted an urgent and quick opinion rather than having the time to go through the formal process. But I would agree a more considered and consensus view would be preferable, clearly.
Ms Morris KC: Particularly when the two things happen on the same day, is that fair?
Professor Neil Ferguson: Yes, yeah.
Ms Morris KC: The email is on the same day as the SAGE meeting?
Professor Neil Ferguson: I should say it wasn’t unusual, that timescale of getting advice.
Ms Morris: I see. That’s helpful. Thank you, Professor.
Thank you, my Lady.
Lady Hallett: Thank you, Ms Morris.
Ms Gowman.
Questions From Ms Gowman
Ms Gowman: Thank you, my Lady.
Professor, I ask questions on behalf of Covid Bereaved Families for Justice Cymru. First, at paragraph 164 of your statement, you opine that border controls had little impact on the final mortality and healthcare burden. When you made that statement, were you aware of the First Minister for Wales’ requests of the Prime Minister for enforceable restrictions to control the border between England and Wales?
Professor Neil Ferguson: I wasn’t, no.
Ms Gowman: For context, therefore, please can we display exhibit INQ000083851.
These are the COBR meeting minutes from 12 October 2020, and if we turn to page 7 of that document, and specifically turn to paragraph 11, we see an example of the First Minister highlighting his belief that cross-border travel between areas of England with high infection levels and Wales left people situated within low areas of infection in Wales susceptible to increased risk.
Professor Neil Ferguson: So maybe I’ll – so I thought in your original question was in relation to kind of international travel. Okay, it’s a slightly different context, yes.
Ms Gowman: We can see from that document that, despite the concern identified by the First Minister, and said at paragraph 12 to be understood by the Prime Minister, that no regulations were imposed despite that identified risk. Can you see that?
Professor Neil Ferguson: Yes.
Ms Gowman: To your knowledge, Professor, has there been any statistical analysis of the likely impact on mortality and healthcare burden in Wales of not implementing border controls between England and Wales specifically?
Professor Neil Ferguson: Specifically, no. I think there has been some consideration and analysis not by my own – maybe even by my own group, but certainly by other groups, of the extent to which – this is when Covid was endemic in the UK, as it is today, of how the extent to which infections get moved from area to area, so there is some analysis of that. I’m not completely familiar with it all.
Ms Gowman: So when you said within your statement that there was no evidence to suggest that – there was evidence to suggest that border controls would have little impact on the final mortality and healthcare burden, that was not specifically to Wales, and is it fair to say that you can’t comment on the position in respect of Wales?
Professor Neil Ferguson: I think that would be fair. I was thinking of the international borders.
Ms Gowman: Thank you, Professor.
The second topic relates to paragraph 141 of your statement, and the working group meeting convened on 1 March 2020, to analyse key clinical variables for reasonable worst case planning for the NHS, which you’ve already touched upon in your evidence.
It’s right, isn’t it, that there were no academics or NHS clinical leaders from Wales on that working group?
Professor Neil Ferguson: Sorry, remind me of the date again? It’s quite hard to –
Ms Gowman: 1 March. And if it assists, this is –
Professor Neil Ferguson: You’re correct. To my knowledge there were no representatives from Wales in that meeting.
Ms Gowman: With this in mind, what steps, if any, were taken by the working group, or indeed SAGE, who had commissioned the working group, to engage academics and NHS clinical leaders in Wales to seek to agree a co-ordinated approach on these very important issues that were discussed at the meeting?
Professor Neil Ferguson: I wouldn’t be able to answer for the Chief Medical – I mean, if anything happened it would be via the Chief Medical Officer’s office.
Ms Gowman: Similarly, what steps, to your knowledge, were taken after the meeting to promptly share the important outcomes of that meeting with academics, NHS clinical leaders and decision-makers in Wales?
Professor Neil Ferguson: Again, I mean, the sharing would have been through the four, you know, devolved administrations and CMOs – four nations CMO group, to my knowledge.
Ms Gowman: But from your perspective you didn’t raise the alarm with your counterparts, for example, in Wales?
Professor Neil Ferguson: No, I mean, all SAGE business at that time was official sensitive.
Ms Gowman: In a similar vein, at paragraph 27 of your statement you state that the MRC Centre for Global Infectious Disease Analysis staff were seconded to the UK government departments. What steps, if any, were taken to share the expertise of MRC GIDA with the Welsh Government?
Professor Neil Ferguson: So no … the Welsh – I mean, the Welsh Government and all devolved administrations were represented on SPI-M, and I was party to a number – I would have to go back – a number of conversations which involved them, some of which touched specifically on Wales. We did generate estimates every week of Welsh healthcare demand, the trajectory of the epidemic in Wales and Scotland and in Northern Ireland, not just in England. We just had a limited capacity and we’re based in London, so – and we were working flat out, we couldn’t do any more than we were doing.
Ms Gowman: Thank you, Professor.
My Lady, those are my questions, thank you.
Lady Hallett: Thank you very much, Ms Gowman.
Is it Mr Menon?
Questions From Mr Menon KC
Mr Menon: Good afternoon, Professor Ferguson, I ask a few questions on behalf of some children’s rights organisations.
Firstly, could we have your first Module 2 witness statement on the screen, please, the reference is INQ000249526, and in particular page 123, paragraph 406.
Do you have that?
Professor Neil Ferguson: Yep.
Mr Menon KC: You say, Professor, in that paragraph, that SAGE was never explicitly asked to evaluate what policies would lead to minimum use of economically and socially disruptive non-pharmaceutical interventions, and that perhaps a more appropriate use of SAGE would have been to review a range of strategic policy options drawn up by the government and to provide scientific challenges to their suitability in meeting the stated policy goals.
My question is this: if the government had asked SAGE to conduct such reviews of a range of strategic policy options, could SAGE have potentially done so?
Professor Neil Ferguson: Yes. There’s always a limit in terms of bandwidth and capacity but, I mean, I believe in broad terms, and particularly as the pandemic went on and capacity ramped up, yes, we could have done.
Mr Menon KC: Specifically, to give an example, could SAGE have evaluated the social and psychological impacts of non-pharmaceutical interventions on children specifically and provided the government with advice as to their suitability?
Professor Neil Ferguson: So, I mean, this is going outside my area of expertise but I believe SPI-B, the behavioural science group of – or subgroup of SAGE, could have done that, and there were a number – in fact there were quite a number of working groups around, let’s say, the broad both public health and educational effect of non-pharmaceutical interventions on children which I partly participated in, which involved the Department of Education and members of SPI-B and clinicians. But undoubtedly it could be – it wasn’t done in the way which I was suggesting there as a kind of commission to look at different policy options, it was more evaluating the, you know, role of children in transmission.
Mr Menon KC: Thank you.
Secondly, page 69 of the same statement, paragraph 219(a), this is a subparagraph on children and modelling, and you observed that the role of children in transmitting Covid was a topic of much activity and discussion in SAGE during 2020.
Was there any discussion or acknowledgement in SAGE as to the differential impacts of non-pharmaceutical interventions on children as compared to adults?
Professor Neil Ferguson: I think in the initial stages of the pandemic, limited, just because of due to time, I think. The – to be fair, I think I remember Chris Whitty raising it as an issue all the way back in February 2020, but it wasn’t considered in the formal way. I think SAGE became more focused on both inequity of impacts of the pandemic and of interventions as 2020 progressed, but again SAGE was responding mostly to, you know, commissions for scientific advice rather than proactively coming up with a work plan.
Mr Menon KC: Understood. So no modelling done as such; is that right?
Professor Neil Ferguson: So … I’m not sure there are models which can – I mean, so the mathematical models we use to model an epidemic, I mean, model outcomes on health typically. I mean, we have now coupled those models to economic models to model the impacts on the economy. As for modelling impacts on mental health, we haven’t attempted to do that as yet, and in some sense it – impacts on education I think would be, I mean, difficult to model and maybe not impossible, but not something we were ever asked to do.
Mr Menon KC: Thank you.
Thirdly, I assume you were aware at the time that there were social distancing exemptions for children in Scotland but not for children in England from about July 2020 onwards.
Are you aware of any modelling that was done as to the impact of such a relaxation of the rules?
Professor Neil Ferguson: Actually, I mean, when I nodded, I mean, I thought you were going to say something else. I don’t think I was aware – you’ll have to elaborate about what the relaxation was in Scotland for me to comment.
Mr Menon KC: Well, I mean, there were a number of relaxations.
I mean, for example, in July 2020 the need for children under the age of 12 to distance physically from each other was removed, not in England.
In September 2020, children under the age of 12 were exempt from the rule of six when it was reintroduced in Scotland.
I mean, those are just two examples, but there are others.
Professor Neil Ferguson: So I am not aware of certainly SPI-M being asked to look at exempting children from social distancing restrictions in England. I’m not aware really of SAGE discussions of that. So I think the – Patrick Vallance and Chris Whitty will be able to give you a definitive view, but I don’t think it was significantly considered at SAGE.
Mr Menon KC: Finally, page 54, at paragraph 174 of the same statement, please. In this paragraph, Professor, you mention a meeting in February 2020 when school closures was discussed by SAGE as a possible non-pharmaceutical intervention.
Thinking back, I appreciate it’s a long time ago, but was this discussion of school closures before SAGE ever considered, for example, other non-pharmaceutical interventions such as closing pubs and non-essential shops, requiring adults to work from home? Can you help?
Professor Neil Ferguson: Yes. I mean, so case isolation and, you know, quarantine had been discussed earlier, but this was the first community measure which was discussed. The reason being is it was already one of the most commonly – I mean, you’ll be aware that countries in East Asia were already responding to the pandemic and nearly all of them shut schools, and so we were looking at what’s going on in Singapore, Hong Kong and other countries. And there is a – I appreciate the social and emotional and mental health cost and educational cost of closing schools, but there is a rationale to it in many cases, because children have very high close contact rates and connect households together. So if you’re wanting to break chains of transmission, it is an obvious measure to start, and was adopted by nearly all countries in the first few months of the pandemic to varying degrees. A more nuanced understanding of the role of children in Covid transmission then developed.
Mr Menon KC: Subsequently?
Professor Neil Ferguson: Yeah.
Mr Menon: Thank you.
Lady Hallett: Thank you very much, Mr Menon.
Mr Dayle.
Questions From Mr Dayle
Mr Dayle: Thank you, my Lady.
Professor Ferguson, I ask questions on behalf of FEHMO, the Federation of Ethnic Minority Healthcare Organisations. I have five short topics.
Firstly, in the period leading up to the pandemic and in the early stages, did the data sources and modelling you’ve referred to include ethnicity?
Professor Neil Ferguson: Do you mean prior to 2020?
Mr Dayle: Perhaps more specifically in the period of January 2020 up to March/April 2020.
Professor Neil Ferguson: So none – at that time, period none of the data we were provided with on surveillance – well, that’s not completely true. A small portion of the data we were provided on surveillance had ethnicity. It was incomplete in many cases, and therefore of difficult – difficult to use, but most data sources did not provide any information on ethnicity. Neither, therefore, was ethnicity considered in the analysis we were doing at the time.
That situation changed quite substantially over the following, I would say, three to four months, such that we were more able to – it wasn’t a primary focus, but we were more able to look at ethnicity in detailed epidemiological analysis of the impact of a pandemic on different groups.
Mr Dayle: Okay.
In light of that evidence, can I ask you to reflect on that state of affairs: do you agree that ethnicity should have been a part of the mix of data sources that were under study, and included in the work in modelling that was pursued?
Professor Neil Ferguson: Yes, and I should say gender as well, because there were differences by sex in outcomes as well.
Mr Dayle: Okay, thank you.
Secondly, in your first witness statement – and you perhaps don’t have to refer to it – you note that you were not aware of any mechanistic models representing variation by ethnicity and/or deprivation. Presumably you’re referring to economic deprivation. And you cited two possible reasons: one, complexity of modelling required to do so and, secondly, data gaps.
So my questions are: appreciating that you have indicated that this is an area of current research for you at ICCRT, can you share any insight at this time as to whether it would have been possible to carry out such modelling during the Covid pandemic?
Professor Neil Ferguson: I think it wouldn’t have been possible in the first few months, if it had been made – I mean, we just didn’t have time and we didn’t have the data sources. If it had been a priority, then certainly by the end of 2020 it would have been possible if it had been a priority.
I think it isn’t a trivial undertaking because it increases, for the reasons I explain in my statement, the computational complexity of models quite dramatically. But let me put it this way, it is something we’re actively working on and in future epidemics – I hope I don’t see another pandemic – but I would very much hope that it is one of the factors included.
I would also say, I think, as well as differential impacts by minority ethnic group, there were also very significant differential impacts by, as you say, level of economic deprivation which – we would like to be able to capture both, because both pointed to the fact that the poorest in society had the least ability to comply with measures, to work from home, were most exposed to the virus in health settings, in service jobs, and I think that should be better reflected in analysis and modelling going forward.
Mr Dayle: Thank you.
Putting aside issues of modelling complexity and data gaps, are there any other factors that would have precluded ethnicity being considered in the work leading up to the early stages of the pandemic?
Professor Neil Ferguson: I mean, I can’t see of any reasons it wouldn’t be considered beyond those two, but those are kind of quite major hurdles.
Mr Dayle: Thirdly, at paragraph 3.42 of your first statement, you state that the potential for unequal impacts was appreciated by SAGE from February 2020 onwards, and that you believe this was discussed frequently at SPI-B, that you’ve referred to. You refer specifically to care homes, low income households and low income population groups as being discussed in March 2020.
Then you go on in paragraph 3.44 to state that differences in impact between ethnic groups “began to be recognised from early April, once sufficient data accumulated”.
What specific data are you referring to there?
Professor Neil Ferguson: So I’m talking about individual level both case data, hospitalisation data and mortality data. So that data was – only really became available after the initial decision to lock down. I mean, you heard the discussion of the poor data streams. But once we – by late March, early April, we were getting regular detailed lists of cases, hospitalisation – well, hospitalisations were later; cases and deaths, my – some colleagues within the Imperial group were working closely with clinical colleagues in northwest London on detailed health data, so we were able to then look at ethnicity as a risk factor for both exposure and hospitalisation and death.
Mr Dayle: Do you –
Lady Hallett: I think you’ve had your time, I’m afraid, Mr Dayle.
Mr Dayle: Very well.
Lady Hallett: I’m also not clear where these questions are on the ones I approved.
Mr Dayle: My understanding is that they are just a slight rephrase of the ones –
Lady Hallett: You have one more minute, Mr Dayle.
Mr Dayle: Very well. I am most obliged.
Do you recall any data indicating a trend towards potential disparate impacts between ethnic groups coming towards April of 2020?
Professor Neil Ferguson: Yes, I mean, we published some early analyses. Also it didn’t come as any surprise to me. I mean, pandemics build on the pre-existing health inequity, and there is already health inequity between ethnic – inequity between different ethnic groups in the United Kingdom.
Mr Dayle: And had a better data capture system been in place from the onset, does it follow that the disparate impact on some ethnic groups would have been identified sooner?
Professor Neil Ferguson: Perhaps. I can’t be definitive about that, because it also partly depends on how much data has been accumulated.
Mr Dayle: The penultimate topic: you state at paragraph 3.44 of your first witness statement that, despite the ICCRT publishing analysis on 29 April that identified two times higher risk of death for black patients, you believe that SAGE didn’t review or discuss the data on ethnic inequalities until late May, with the first comment not being issued until 4 June; the Ethnicity Subgroup of SAGE was not formed until September.
So two questions: can you share any insights as to why there was such delay in responsive action?
Professor Neil Ferguson: As I think I’ve referred to earlier, SAGE was being bombarded with requests for evidence from government and it was government which largely determined the topics, certainly at that point in time, that SAGE was prioritising.
Mr Dayle: And finally, in your second witness statement at paragraph 22, you explain you have been asked to comment on specific questions regarding considerations of vulnerable groups in modelling. You do not appear to have been instructed specifically to address ethnicity as a vulnerability. However, you were asked to address “whether the public health response was sufficiently targeted at those who were most vulnerable”. In your answer you refer to the elderly and those required to shield, but not specifically to ethnicity.
And my question is: do you consider that more could and should have been done to target minority ethnic communities as vulnerable groups for interventions?
Professor Neil Ferguson: I mean, I think the – the data is complex. A lot of the vulnerability of minority ethnic groups is associated with either occupational exposure or the higher prevalence of comorbid conditions, and so it counts – those conditions, diabetes for instance, were – meant that individuals with those conditions, regardless of ethnicity, were prioritised as vulnerable groups.
So I can’t give a simple answer, but just being of a specific ethnicity, independent of either occupational exposure or comorbidities, I’m not – to my knowledge, I’m not aware of intrinsic differences by ethnicity in Covid vulnerability.
Mr Dayle: Thank you, Professor.
Thank you, my Lady.
Lady Hallett: Mr Dayle, I apologise. We were both right. You were right that you did have permission to ask the questions, I missed a sheet, but I think I was right on the timing. Maybe we have been a bit mean with the timing. So thank you very much for your questions. I’m sorry for interrupting so –
Mr Dayle: Very well, my Lady.
Mr Keith: My Lady, no one is more sorry than myself, other than perhaps Professor Ferguson, at the fact that I have to lengthen the process, or ask for your permission to do so.
We were provided with some six or seven pages of separate topics which we gave assurances to the CPs that CTI would sweep up in the course of a lengthy examination.
We have been prodded by Mr Metzer, quite properly, on behalf of the Long Covid groups that there was an area consisting of four short questions which I did not put to Professor Ferguson.
Lady Hallett: Very well, Mr Keith.
Apologies to our stenographer.
Mr Keith: Indeed.
Lady Hallett: And apologies to Professor –
The Witness: It’s fine.
Lady Hallett: – Ferguson.
Further Questions From Lead Counsel to the Inquiry
Mr Keith: Professor Ferguson, were you aware of the fact of long-term sequelae being likely to be produced, to occur, from previous coronaviruses like SARS and MERS?
Professor Neil Ferguson: I mean, I was aware of – I mean, a lot of viral infections can have long-term sequelae, but the magnitude of those sequelae and the severity associated with the original strain, particularly of SARS-CoV-2, I was – I did not anticipate.
Lead Inquiry: Can you explain why in your modelling you did not model for long-term sequelae?
Professor Neil Ferguson: I mean, in the early months it was – we had almost no data to do so. It took quite a long time thereafter. In terms of modelling long-term sequelae, in some sense it’s a risk associated with each infection, and so the outputs of the existing models can be used to estimate the burden without the models necessarily being dramatically changed.
Lead Inquiry: Would you agree that if you model for death or acute infections in relation to a viral pandemic without modelling for long-term sequelae, a misleading impression may be given?
Professor Neil Ferguson: You are certainly not capturing all the morbidity caused by a pandemic. I would argue that the things we did capture gave a fairly grim picture of the risk Covid paid – posed, rather. We just had no detailed – it took months for detailed data on long – to be collected.
Lead Inquiry: Would you agree that in future, modelling of infectious diseases should include potential long-term sequelae from the outset?
Professor Neil Ferguson: I think long-term sequelae have been – I don’t think this is an issue about modelling, I think long-term sequelae of viral infections have been an understudied area more generally, partly because they are hard to resolve. Covid provided a one-off, in some sense, horrible experiment which highlighted how important they were and is there – has therefore heightened their importance as a research topic.
Mr Keith: Thank you.
Lady Hallett: Thank you very much indeed, Professor Ferguson, that is it.
I note in your statement that you say:
“In all my experience of working on the pandemic I didn’t encounter a government official, fellow scientist or clinical colleague who was not working flat out.”
I think we’ve seen the proof of that in the timing of some of the emails. So thank you very much for all the work that you did during the pandemic, and your colleagues.
(The witness withdrew)
Lady Hallett: 10 o’clock tomorrow, please.
(5.00 pm)
(The hearing adjourned until 10 am on Wednesday, 18 October 2023)