Jonathan Ashworth speech to the Institute for Public Policy Research (IPPR)

A year ago Boris Johnson told us: “Our country remains extremely well prepared, as it has been since the outbreak began in Wuhan several months ago”.

But the truth is COVID-19 has revealed our government as unprepared, complacent and inept with devastating consequence.

Over 120,000 have died.

Our NHS staff are exhausted and face a pay cut.

Kids have lost months of education.

Families are worn out, anxious and face tax rises.

We’re suffering a deep economic hit, with the young, women and the poor affected the most.

It didn’t have to be like this.

A healthier, more equal society would have weathered the storms better.
We should have planned better, acted more quickly and responded more comprehensively.

This isn’t about the benefit of hindsight - while the specifics of any single pandemic are unknowable, the fact of them is known – as are the steps countries need to take to prepare.

In a famous TED lecture in 2015 Bill Gates observed: “If anything kills over 10 million people in the next few decades, it's most likely to be a highly infectious virus rather than a war. Not missiles, but microbes.”

For years the Eco Health Alliance warned that specific bat-origin coronaviruses are at high risk of being the next pandemic.

In 2018 the WHO said coronaviruses, “pose major public health risks.”

In our global and populous world, we are – as experts like Anthony Fauci, the US chief medical advisor or Peter Piot from London School of Hygiene warn - in an era of pandemics.

Future outbreaks of new infectious diseases are likely. Viruses even more deadly or contagious than COVID-19 could emerge.

Future resilience against pandemics and health security isn’t a choice.

It’s a necessity.

But despite a pandemic threat being flagged on the Cabinet Office’s Risk Register for years, the UK was – and crucially remains – unprepared.

Years of cuts to public services and austerity left our health and care services lacking the capacity needed when disaster struck.

Public health funding has been slashed since 2010, health inequalities have widened.

COVID hit a population with millions of people in poor health, in poor housing and with job and income insecurity.

While our world-leading scientific community have led in COVID treatment trials, vaccine development and genomic sequencing, we must now rebuild our public health capability to match our scientific one.

In March 2020, no independent public health expert sat on SAGE.

Instead of preventing infection in the first place, the UK based its strategy on avoiding overload on the NHS.

Lack of testing and tracing meant we were way behind the exponential growth curve, locking down weeks too late to avoid a severe first wave.

So we had a failure of decision making at the top of government.

But we lacked capacity too.

The NHS entered the crisis, short of 100,000 staff including 40,000 nurses, we had fewer acute beds than 10 years ago.

Our PPE stock pile had dwindled.

Operations were cancelled and treatments delayed to prevent our NHS from collapsing.

But a strategy based on the fundamentals of public health and prevention would have meant we didn’t have to choose between COVID care and cancer care.

Our lack of preparedness was most evident in public health.

Protecting the public means putting public health at the centre of policy – all policy.

But years of public health cuts left local services reduced and overstretched.

And yet once in an epidemic, it is local public health professionals who are trained in the techniques of disease containment and who should be leading the response.

They should have been resourced from the start to do case finding and the retrospective and forward contact tracing that hunts down and breaks onwards chains of infection, as happened successfully in South Korea, Taiwan and Vietnam.

Instead the Government spent billions on private sector alternatives who are less effective than experts rooted in communities on the ground.

And scandalously those who are sick or need to isolate still aren’t given adequate financial recompense to do so – a fundamental failing of Test and Trace highlighted by its head Dido Harding only a few weeks ago.

We are a rich country with millions of our citizens walking a tightrope of ‘just about getting by’.

COVID knocked them off that tightrope – it hit incomes, it spread easily in public facing workspaces, crowded factories and overcrowded housing.

It caused severe disease.

Particularly in those with pre-existing chronic illness.

Michael Marmot’s work has shown, how ten years of austerity with poor housing, food insecurity, lack of green space, insecure income has given us deteriorating population health, increasing health inequality and falling life expectancy.

That’s meant in this crisis our poorest communities paid for years of austerity and public health spending cuts with their lives and livelihoods.

If it is unforgiveable that so many were left so exposed, how much more unforgiveable is it now to refuse to invest heavily in public health for the future?

Investing in public health and narrowing health inequity is a guiding mission of mine.

It is the lodestar that guides me.

Population health and wellbeing must be at the centre of all policies in government.

We can’t precisely predict which disease will take off next or when but we do know that it will come.

In the last hundred years we’ve experienced flu pandemics, the emergence and spread of HIV/AIDS, Ebola, SARS, MERS, Nipah virus and Zika virus.

The majority of emerging diseases and almost all known pandemics are zoonoses, caused by microbes of animal origin that ‘spill over’,

Jumping from animal to human (and often back again).

And this is happening with increasing frequency.

From environmental degradation and biodiversity loss, deforestation, land use change to the exploitation of wildlife - these all bring humans into greater contact with wild animals creating the conditions for increased pathogen transmission between humans and animals.

Expansion of poultry and pig production in South East Asia led to repeated influenza outbreaks.

The Nipah virus, a very dangerous virus, originated in fruit bats infecting pig farms in Malaysia spreading to Singapore.

Coronaviruses originated in bats caused SARS, MERS and COVID-19, driven by expansion of human settlements and exploitation of wildlife.

The recent Intergovernmental Council on Pandemic Prevention estimate there are hundreds of thousands of viruses that could infect humans. They warn five new diseases emerge in people every year, any one of which could become the next pandemic.

Once human to human transmission is established, our highly connected world ensures increasingly rapid spread.

Climate change, with increases in temperature and increased rainfall is already causing species migration widening the potential distribution of disease.

The movement of certain species of mosquitoes for example is estimated to expose one billion new people to diseases including dengue fever, yellow fever and zika by the end of the century.

So combined with the current, unprecedented rate of biodiversity loss as humans expand across the planet, we are becoming ever more exposed to the emergence of new diseases.

Given COVID-19 has already cost the world 2.6 million lives and an estimated $28 trillion dollars – and cost the UK billions of pounds - this can be no time for complacency.

So what further action do we need to take?

The first action is implementing our core commitment to public health to build a resilient, healthier and fairer society at home and supporting others to do so abroad.

Secondly given we now understand the dangers of environmental exploitation in driving zoonotic spill overs, tackling climate change and biodiversity loss with a green recovery from the COVID crisis is more urgent than ever.

It’s key to building health security.

As the “preventing future pandemics” coalition warn today, we must invest in the global infrastructure needed for prevention.

This requires leadership at the G7, COP26 and G20, internationally forming alliances to make the world a safer place for the future.

Next, science remains a cornerstone of a successful future.

The World Health Organisation prioritises a number of pathogens for further research including coronaviruses, Ebola, Lassa, Nipah, Zika and Rift Valley Fever.

So from genomics sequencing to surveillance systems, from world-beating epidemiological mathematical models to developing life-saving vaccines and therapeutics, we need continuing investment and partnerships between industry, research institutions and government.

mRNA vaccine advances are hugely exciting, and we’re pleased to see the target to develop new vaccines in 100 days.

If successful countless lives should be saved in the future.

Peter Hotez from the National School of Medicine in the US rightly argues access to scientific innovation is inherent to the concept of universal health coverage.

We have a responsibility therefore to challenge so called vaccine nationalism and ensure fair distribution of COVID vaccines.

For me not only is that morally right but to be frank given none of us will be safe, until all are safe, it’s vital to reduce the chance of further vaccine-resistant mutations too.

Secondly we need viral discovery through international coordinated surveillance and sequencing. We need a global alert system to spot outbreaks quickly.

Our government has offered a genomic sequencing to the world to identify further COVID-19 variants, I welcome that.

But we need to support the science with international agreements on shared benefit.

In 2007, Indonesia blocked data sharing about avian flu when they were denied access to a vaccine developed using the strain they had provided to the surveillance network.

Getting clear agreements in place must be a task for the G20 and G7 later this year.

Finally, I started my remarks observing how warnings were ignored and senior politicians were slow to respond.

We can’t ever allow that to happen again.
The new National Institute for Health Protection and ministers have responsibilities for pandemic preparedness.

These plans should be independently assessed by an outside body. An OBR style process for health resilience and security.

And as Secretary of State for Health, I would report to Parliament annually on pandemics preparedness placing the public health and wellbeing at the heart of everything I do.

Outlining how we’re building a more resilient country, to reduce inequality, to invest in science and to build a greener, safer future.

Finally, governments rightly invest in defence planning and ‘war games’.

Practicing for pandemics should be no different.

Ministers should ‘germ game’ on an annual basis to prepare themselves and the country for the next pandemic or infectious outbreak.

Never again should we have Ministers ignoring the science and learning on the job.

The emergence of new diseases may seem like random bad luck and the death tolls from consequent pandemics inevitable.

But they are not just bad luck and devastating spread is not inevitable.

We can reduce the chance of new crossover diseases by tackling biodiversity loss, climate change and poverty.

We can support healthier populations.

We can respond effectively, reducing the opportunities for spread, illness and death.

These are within our control.

We were not ready for this pandemic.

But through rebuilding our society, investing in science and working internationally we can be ready for the next one.