Who is responsible for the UK’s testing strategy?

The virologist and director of the London School of Hygiene and Tropical Medicine, Peter Piot, gives a good interview in this podcast about his experience of catching COVID-19. He first began feeling unwell in mid-March but couldn’t get a test. For reasons unknown to all of us the government was rationing testing at the early stage of the pandemic and on the 10th March the UK performed only 1,215 tests. Indeed, one of the findings of The Science and Technology Committee into the UK response to the pandemic so far was the UK’s decision not to urgently build testing capacity early on as “one of the most consequential made during this crisis”. In the end Peter Piot went to a private clinic for a PCR test at a cost of £300 and tested positive. This begs the question if testing capacity was available at private clinics then why weren’t we using it?

The Science and Technology Committee investigation has asked for evidence from Public Health England to explain their decision not to expand testing capacity but at the time the report was written none had been provided. I’m not sure if it has since become available but in their letter of lessons learned so far they appear to blame Public Health England, NHS England (not sure where Scotland fits in here), and SAGE while simultaneously giving credit to the Secretary of State for massively increasing testing at the end of April.

For such an important determinant of a wide range of policy responses, it is surprising that a target designed to galvanise a tenfold increase in testing capacity appears not to be on the advice of PHE, NHS England or SAGE but was more of a personal initiative by the Secretary of State. Had the public bodies responsible in this space themselves taken the initiative at the beginning of February, or even the beginning of March, rather than waiting until the Secretary of State imposed a target on 2 April, knowledge of the spread of the pandemic and decisions about the response to it may have made more options available to decision makers at earlier stages.

Is this a fair analysis? Who should take responsibility here for failure to test early on? Even if it is the fault of PHE, SAGE, or the NHS I feel the government should accept responsibility here because that’s what a good leader does. If you lead a team and someone on your team messes up as a leader it’s your responsibility to take the fallout and rectify the situation.

Back to Peter Piot’s podcast. He says the only real exit strategy is a vaccine. “When you look at the future of this epidemic there are three options theoretically. One is that the virus dramatically mutates and suddenly is no longer that virulent or transmissible. Secondly, it would be that nearly everybody is infected. We don’t want to take this approach because it would mean millions and millions of deaths. Thirdly a vaccine. We don’t know if a vaccine is possible. Having worked on HIV since 1984 trying to develop a vaccine and tens of billions of pounds have been invested in it and we still don’t have one. The good news is there are lots of initiatives, over 100, there should be maybe ten serious candidates and we should know by the end of the year whether it’s possible or not.”

If a vaccine never becomes available or takes decades and decades to develop then in the absence of a less virulent mutation we will have no choice but option B where we all eventually get the virus and the population as a whole develops immunity. In this situation, countries with similar demographics will end up with similar death rates after a few years.  I truly hope that doesn’t happen and that we get a vaccine by Christmas but we should be realistic and not assume that because our lockdowns are easing the epidemic is over.