Lord O’Donnell challenges lockdown decision-making and reversion to unilateralism
On purely medical grounds, lockdowns are effective in suppressing COVID-19. But Gus O’Donnell, the UK’s former Cabinet secretary, tells Matt Ross that national decision-makers should take a wider view of their effects – and work together to coordinate global action
“The international architecture has been found wanting,” says Gus O’Donnell. “With the global financial crisis, we had some international cooperation – and it worked. This time, it hasn’t been as collaborative.”
Lord O’Donnell, the UK’s Cabinet secretary and head of the civil service 2005-11, was at the heart of global efforts to tackle the fall-out of the credit crunch in 2009 – when UK PM Gordon Brown, hosting the G20 summit, rallied nations to invest in coordinated action to prop up the world’s economy. But during the COVID-19 pandemic, O’Donnell worries, nations are going their own way.
“We have America cutting funding to the [World Health Organisation]: the international body that’s at the heart of this,” O’Donnell tells Global Government Forum. “We have countries hanging onto their PPE [Personal Protective Equipment]. And we’ve seen very different responses: the German, the American, the New Zealand models are all radically different. And you wonder: if all the authorities and scientists have been sharing information, how have we ended up in different places?”
As the world struggles to address this new global threat, O’Donnell argues, there are “huge lessons to learn” from the financial crisis. “The obvious one is that we need strong international institutions that can share information and come to collective agreement – particularly about things which ignore borders, like viruses and climate change.”
Failing the test
In the face of such a novel and virulent virus, no country could expect to have all the answers. And O’Donnell raises questions over the UK’s approach to suppressing the pandemic, which is built around a lockdown. Before the lockdown can be eased, the government says, five tests must be met: there must be sufficient NHS capacity; a sustained fall in death rates; “manageable” infection rates; enough tests and PPE to meet demand; and confidence that loosening restrictions won’t risk a second peak. But these five tests, says O’Donnell, “focus on the visible and immediate: the number of deaths, the number of cases.” And that single-minded focus on clinical outcomes, he worries, leaves many of the harms caused by lockdown “underweighted” in the government’s decision-making.
“Every month, the economic consequences get worse: businesses go bust, and they won’t come back; people become unemployed, and that has a lasting impact,” he says. “Then there’s domestic violence, mental health issues, people missing out on education, and big impacts on inequality: the people losing their jobs are mostly on low incomes.”
All these costs, O’Donnell points out, are entirely discounted in the government’s five tests. And he points out that the lockdown represents a break with established policy on health spending. The National Institute for Clinical Excellence (NICE), the UK body tasked with assessing the value for money of medical treatments, doesn’t normally approve treatments that cost more than around £30,000 to give patients an additional year of good health (one ‘Quality Adjusted Life Year’, or QALY). Yet the enormous economic and financial costs of the lockdown and the UK’s economic stimulus package, says LSE economist Paul Frijtas, are likely to tot up to well over £30,000 per QALY: “Politicians have shown that they value life much more than they’ve put into the QALY system,” comments O’Donnell.
A wider view
O’Donnell emphasises that he’s not arguing against the lockdown: his point is simply that the metrics used in making key decisions should capture the wider economic, health and social costs and benefits of the lockdown, as well as the clinical impacts. The former civil service chief has been involved in a project by the LSE’s Centre for Economic Performance to assess the lockdown’s overall impact on ‘wellbeing’, he explains, “illustrating a framework” that could provide a more broad-based assessment of its pros and cons.
The government’s view of its policy options, O’Donnell believes, would also be improved by bringing a wider range of experts into its advisory group. “Changing people’s behaviour is at the core of this,” he comments, noting that the lockdown is “essentially a pretty voluntary exercise. We have lots of epidemiologists around that table when they’re making decisions, but I’d like to see more behavioural scientists, more social scientists.” And here, ministers may be alert to the problem: shortly after GGF spoke to O’Donnell, the government put out a request for more experts to join its advisory group SAGE – asking for specialists including behavioural psychologists and public health advisers.
Asked how he rates the civil service’s work to address COVID-19, O’Donnell replies that “the Treasury’s response in getting out the furlough programme was truly amazing.” But he acknowledges the challenges around issues such as offering support for small businesses, providing loans and helping the charity sector: “We’re asking the civil service to do things that are very, very hard,” he comments.
Funding, flights & freedoms
Some of the biggest problems currently facing the government, he suggests, are a consequence of a decade of tightly-constrained health service budgets. When he was in the civil service, he says, the Cabinet Office’s Civil Contingencies Secretariat had well-rehearsed pandemic response plans and stockpiles of PPE. Over the last decade, though, demand for health services has risen faster than spending: “If you’re running the health service ‘hot’, requiring them to operate with scarce resources, there’s a bit of rationing goes on: there’s a temptation not to have unused spare capacity,” he says. “But in fact you need to work out how your service will cope with peak load, not average load.”
Other challenges may result from specific policy decisions around the corona response: O’Donnell is “really puzzled” as to why the government has allowed incoming flight passengers to enter the country without any attempt to check their temperatures or require people to self-isolate. Other countries – including Australia and Singapore – hold arriving travellers in hotels for 14 days, and British ministers are now floating the idea of introducing similar measures. “I’m even more puzzled now that they’re thinking of bringing them in,” he comments. “There were flights arriving from Italy and New York when the virus was rife there, and it would have made sense to do it then.”
Such rules may stick in the throat of Boris Johnson’s Tory government, which instinctively dislikes heavy-handed controls on people’s behaviour. But as ministers consider the tools that may permit people to escape from lockdown – such as location-tracking apps to identify potentially-infected citizens – they should, O’Donnell believes, balance individual freedom against collective risk. Measures should be built on “consent, and a very clear expectation that this is what you do,” he says – but he points out that in some areas of public health, “there are rules: [in the USA] you have to have certain vaccinations to put your child in school, for example. Because this isn’t just a matter for yourself: you’re potentially causing harm to others. So the state has a legitimate role.”
Postpone, plan and partner
As the UK focuses on tackling the pandemic, O’Donnell believes, it should request an extension to the Brexit ‘transition period’ – postponing the December deadline to agree a trade deal. “It’s extremely likely that any deal we do now would miss out on some issues which are a win for both the EU and the UK, because officials and politicians have quite rightly been focusing on the virus,” he says. “I really hope we can leave ideology to one side, and avoid making a mistake that all sides would regret by rushing this.”
When O’Donnell joined other former officials to call for an extension last week, some commentators warned that their intervention could make life harder for serving officials by stoking suspicions of an ‘establishment’ pro-EU view. “But this isn’t about being pro-EU; it’s about the UK’s national interest. We’re just talking about getting the best possible deal, and why wouldn’t you want that?” responds O’Donnell. “Former officials are put into the House of Lords, where people speak their views and vote on legislation. What’s the point of that if you then say that former officials can’t speak?”
Looking further ahead, O’Donnell returns to the need for concerted, international action to identify and address future threats. Around the world, national leaders are currently learning about the huge potential costs of not averting and preparing for such risks. But the lesson to take away, he argues, is not simply that we should protect ourselves against future pandemics; it is the need for strong global collaboration to address all the dangers we face in common.
“We’re always fighting the last war. Now we’ve had a pandemic, we’ll organise ourselves for that – but what about all the other things on the risk register? What about cyber security, climate change?” he concludes. “We should be spending a lot more on prevention. And we need to look at the international architecture, and say: is it fit for 21st century problems?”
About Matt Ross
Matt is Global Government Forum's Contributing Editor, providing direction and support on topics, products and audience interests across GGF’s editorial, events and research operations. He has been a journalist and editor since 1995, beginning in motoring and travel journalism – and combining the two in a 30-month, 30-country 4x4 expedition funded by magazine photo-journalism. Between 2002 and 2008 he was Features Editor of Haymarket news magazine Regeneration & Renewal, covering urban regeneration, economic growth and community development; and from 2008 to 2014 he was the Editor of UK magazine and website Civil Service World, then Editorial Director for Public Sector – both at political publishing house Dods. He has also worked as Director of Communications at think tank the Institute for Government.
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While as I ever I agree with most of what Gus says, I have to take some issue with his views on assessing the impact of the lockdown. There are two key issues he doesn’t account for.
1) Most of the economic impact can be put down to the virus, not the lockdown. People were beginning to withdraw economically anyway, and would have done even without the lockdown. And if we come out before most people feel comfortable, the economy won’t just spring back to normal.
2) The QALY approach is designed for a stable system, with limited variation, in particular where interventions are individual and independent. It is entirely inappropriate for such a novel, unstable, high-risk situation. Has he really calculated the full volume of QALYs vs the worst case projections?
Low-probability high-risk issues like pandemics just can’t be considered with normal economic tools.