We can now publish reports from seven secret pandemic exercises conducted by the British Government between 2015 and 2018, including Exercise Alice – the secret coronavirus exercise which could have helped us prepare for COVID-19, but which politicians and healthcare leaders failed to act on.
Reading through these reports, it’s very clear that the Department of Health, NHS England and Public Health England were aware of the risks to British lives posed by a major pandemic. They repeatedly modelled Ebola, Lassa, Influenza, and other highly infectious diseases. Each one of these pandemic exercises gave rise to multiple “lessons identified”.
Exercise Alice specifically provided guidance on preparedness for a Coronavirus pandemic. However, in the event of COVID-19, our infrastructure (for instance, care home provision and NHS protective equipment) was found wanting, and this contributed to large-scale loss of life. For some reason, the reports had not translated into pandemic preparedness.
Multiple pandemic exercises failed to deliver preparedness – Why?
We’ve been working for several months to win disclosure of these secret pandemic reports, and certain themes repeat themselves. Firstly, the participants in the exercises successfully identified many of the key challenges in a pandemic response.
For example, Exercise Pica looked specifically at primary care and GP services during an Influenza Pandemic about a year before COVID-19 happened, and it recommended remote consultations – this pandemic strategy features prominently in newspapers today, three years after that report was published.
However, the reports state lessons without providing detail, and the general impression is that they’re papering over cracks in our pandemic preparedness. For most of the reports, lessons are rarely associated with objectives which are specific, achievable and time-limited.
For instance, the Ebola Report says, “A review of capacity and capability of the surge centres is required, especially around the management of paediatrics” – however, there is no indication of how children’s services failed during the Ebola Exercise, or what will be done to address that failure.
It’s possible that PHE was simply following the lead of a Government which was committed to a 10-year programme of ideological reductions in public expenditure and transfer of social and health care provision to private providers – What was the point in publishing specific proposals if the Government lacked commitment to their implementation?
What happened to the new NHS protocols planned for 2020?
By contrast, Exercise Broad Sheet provides more detail about systemic failures in the UK’s ability to detect and pre-empt ‘High Consequence Infectious Diseases’, and does propose an entire raft of new protocols to be rolled out in 2020. However, it raises other questions.
I worked as an NHS doctor throughout the pandemic, and I haven’t come across these new protocols. Did these protocols get rolled out in 2020 or were we overtaken by the events of COVID-19? Have we addressed these systemic failures, or have we taken our eye off the ball? Do we remain systemically vulnerable to novel viruses which could cause pandemics in the future?
Exercise Alice raises serious questions for political and healthcare leaders
Exercise Alice is bigger than Cygnus.
The Department of Health argued that Exercise Cygnus was not relevant for COVID-19 because it modelled an Influenza pandemic, not a Coronavirus. Disgracefully, Government ministers made this argument while covering up Exercise Alice – a Coronavirus exercise which predicted the importance of isolating patients, contact tracing, PPE provision, trained personnel and adequate NHS beds.
The fact that COVID-19 is a novel type of Coronavirus is irrelevant – every pandemic is different, but the lessons of Exercise Alice were generally applicable to coronaviruses including COVID-19, they were agreed by general consensus, and both political leaders and NHS England executives failed to implement that consensus.
In direct opposition to the recommendations of Exercise Alice, they failed to maintain contact tracing capacity and isolate patients, they failed to provide adequate PPE, and they cut NHS beds.
Going forwards, it’s important to emphasise that future pandemics remain at the top of the UK’s national risk register, and we will continue our legal campaign to establish a new paradigm of transparency and accountability for pandemic preparedness.
Interesting that perhaps the most important document here, Exercise Alice, is the only one which is not “searchable”.
The 2016 Operation Cygnus Pandemic Preparedness Review was based on a scenario assuming an influenza pandemic. Is not influenza not a virus and spread airborne ?
Thanks K. Yes you’re right. It’s hoped that a bad influenza pandemic might be easier/quicker to develop a vaccine against than other viruses, and more treatable with antivirals. Some people thought that a Coronavirus was less likely to spread asymptomatically than Influenza… COVID-19 has shown we need to expand our thinking.
In his testimony to the Parliamentary Committee former Health Secretary Matt Hancock did not acknowledge Exercise Alice at all. Neither did the previous Health Secretary, Jeremy Hunt, who was in office when Exercise Alice took place in 2016. In relation to the initial response to COVID, Hancock said:
“The preparation and the plans that were in place were for a flu pandemic”. So, there had been a planning exercise (Alice) in 2016 but the recommendations from that report were ignored in terms of pandemic planning prior to the onset of COVID19.
Hancock went on to claim that COVID 19 was “a completely novel virus”, different to previous coronaviruses, mainly because it had the characteristic of asymptomatic transmission. The obvious implication being made by Hancock was that while flu virus planning helped in some respects, nothing could have helped plan for COVID19 (such as learning from the South Korean response based on their experience of SARS/MERS or the recommendations from Exercise Alice) because of the issue of asymptomatic transmission.
However, in Hancock’s later testimony he said that in its response to COVID19 the UK government did not accept the probability of asymptomatic transmission until early April 2020. Therefore, until early April the UK government was not responding to COVID19 as if asymptomatic transmission was present. This suggests that had Exercise Alice not been ignored, during the initial stages of the pandemic (February to April) the UK would have been benefitting from the preparations that Exercise Alice had recommended should be put in place and from the procedures that would have been enacted in response to a typical SARS/MERS pandemic. The probability is that rolling out these procedures would have saved many lives regardless of whether or not asymptomatic transmission was present in COVID19.
Exercise Norther Light seems to be a dead link.
Thanks for doing this!
Thanks for your kind words. The link works for me – can you try again?