Prior to the onset of the COVID-19 pandemic, Britain was ranked as a global leader in health security by the comprehensive John Hopkins Global Health Security Index.
https://www.ghsindex.org/wp-content/uploads/2019/10/2019-Global-Health-Security-Index.pdf
The 2019 tabulation placed Britain second in the world in overall score on a variety of measures of pandemic response capacity [Canada ranked 5th ]. For early detection and reporting for epidemics of potential international concern, the UK ranked 6th in the world [Canada scored even higher as 4th in the world, possibly because of the historic contributions of our GPHIN system]. In another category, on rapid response and mitigation of the spread of an epidemic, UK grabbed the top score globally—Canada fell back to 17th on this metric.
In retrospect, the ranking looks cruel in the face of the devastation caused by COVID-19 and a variety of failures in policy and governance suffered by both the UK and Canada.
If Britain and Canada were both ranked globally as high achievers in health security prior to COVID, what separates these two counties in 2023 are pathways to learning lessons from the experience of the pandemic in its aftermath. Here the gap between Britain and Canada is stark and puzzling.
We can see this divergence in four domains: Parliamentary studies; national security strategy revisions; biosecurity strategy updates, and public inquiries. In each of these areas Britain has dug into the necessary business of learning and applying lessons from COVID-19. Canada, to date, has no matching effort whatsoever.
Let’s begin with Parliament. The standing committee on Health (HESA) in the Canadian House of Commons has been engaged in a long-running study of the “Emergency Situation Facing Canadians in light of the COVID-19 pandemic.” The study dates from 2020; the most recent meeting addressing this issue was held back in October 2022. Nothing for 2023, up to the Parliamentary recess in June. The committee has held 35 meetings, heard from 46 witnesses and received 160 briefs. It has produced no report. Thanks HESA.
https://www.ourcommons.ca/Committees/en/HESA/StudyActivity?studyActivityId=11498432
What the committee has managed to do is defenestrate a private member’s bill proposed by Liberal MP, Nathaniel Erskine-Smith, squarely focused on learning lessons from COVID. Opposition members on the committee objected to the idea of creating an external advisory council that would be responsible for overseeing the production of a new pandemic strategy based on lessons from COVID. The argument was that an advisory council would undermine the (very hypothetical) prospect of a full public inquiry.
https://www.ourcommons.ca/DocumentViewer/en/44-1/HESA/meeting-62/evidence
Despite an election campaign promise advanced by the Conservative Party in 2021 (led at the time by Erin O’Toole) to launch a full public inquiry into the response to the pandemic, somehow I cannot quite see the current Conservative leader, Pierre Poilievre, as being too keen. Any such public inquiry would expose his stance in support of the Freedom Convoy protests and in opposition to public health measures, and no doubt create rifts within his own caucus, as well as cast a doubtful light on his leadership qualities in a national emergency.
Partisan politics over COVID are no less in play in the British Parliament (and they had Boris Johnson as PM to contend with, let us not forget). But somehow a higher sense of national interest manages to break through. The contrast is great between an ineffectual Health committee in the Canadian House of Commons and a joint committee report produced by the British Parliament in 2021. Its study, entitled “Coronavirus: Lessons learned to date,” was a product of the combined work of two “select” committees (the equivalent of our standing committees) and was issued in October 2021, a year after its work commenced.
https://committees.parliament.uk/publications/7496/documents/78687/default/
It did not mince words in describing COVID-19 as “the biggest crisis our country has faced in generations and the greatest peacetime challenge in a century.” (Executive summary, p. 5)
The Parliamentary report was driven by a haunting realization that Britain suffered proportionally more COVID deaths in 2020 than many other countries and a fundamental question as to why that was. (Executive summary, p. 5)
The Committee found several key indicators of failure. They included the lack of any effort to understand and follow emerging international best practice in dealing with the novel coronavirus outbreak, especially from states in the near region to the outbreak in Wuhan, China. The report called in future for a “substantial and systematic method of learning from international best practice during an emergency.” (p. 30). It noted over-reliance on a pandemic response plan focused on an influenza outbreak and an underestimation of the impact of novel, especially, zoonotic, diseases. (p. 17) Strikingly, the joint committee report unearthed what it described as a cultural attitude of “fatalism” about dealing with the pandemic impact on Britain, driven partly by lack of any available vaccine at the outset and by (misplaced) doubts about the willingness of British society to put up with lockdowns and other public health measures. (p. 33)
The Committee report concludes that “decisions on lockdown [delayed until March 23, 2020) and social distancing,” by the Boris Johnson government, “during the early weeks of the pandemic—and the advice that led to them—rank as one of the most important public health failures the United Kingdom has ever experienced.” (p. 32) That’s plain speaking, O’ Canada.
The report lauded British crash efforts to produce a vaccine (Astra-Zeneca) but also called for more social science studies of societal attitudes towards public health emergencies, in place of superficial, paternalistic assumptions.
The committee report also found a problem with a “groupthink” mentality about policy responses, which contained little room for challenge. The committee report cites stunning testimony from the then Chief Medical Officer for England, who stated that, “quite simply, we were in groupthink. Our infectious disease experts really did not believe that SARS [referencing the coronavirus outbreak in 2003), or another SARS, would get from Asia to us. It is a form of British exceptionalism.” (p. 19)
Did similar attitudes grip Canadian decision makers—did we suffer from failures of international outlook, fatalism, groupthink? While the British study seems to fit the Canadian scene, we can’t be sure without our own lesson-learned effort. It just seems clear we won’t get one from our Parliament. We will chase instead that ‘other’ public inquiry, into Chinese election interference.
Let’s move on to national security strategy. The purpose of a national security strategy is to operate as a road map for the policy and operations of a government in the face of national security threats and to act as an important tool of public education and accountability. Canada doesn’t have one (the only such strategy ever produced dates back to 2004—you can find it digitally shelved on the Library and Archives Canada website). Britain has managed to produce two in the midst of the COVID-19 emergency. Not bad.
The first review, published in March 2021, a year into the COVID response, was highly ambitious, as it’s title suggested:” Global Britain in a Competitive Age: The Integrated Review of Security, Defence, Development and Foreign Policy.’ Health security, or biosecurity, was not in the title, but was built into the review as a key component.
Much of the Integrated review was forward looking, promising future action to better position a post BREXIT UK. When it came to health threats, the review argued that:
“We must learn the lessons of COVID-19, bolstering our domestic and international action to address global health risks.”
The Integrated review called for a new biosecurity strategy (more on that below), and efforts to build on early governance changes introduced in 2020, including the creation of new organizations such as the Joint Biosecurity Centre and the National Institute for Health Protection. It emphasized the importance of stronger domestic preparedness and improvements to the global health system. On the domestic front, the Review argued that improvements were needed to better identify emerging health threats, to conduct scenario analysis and contingency planning, and to ensure supply chain readiness and the maintenance of emergency stockpiles. (p. 94) It would be hard to argue against the relevance of every one of these goals when ported to a Canadian context.
To strengthen global health security, the review made an aspirational pitch for a “Global One Health intelligence Hub,” to provide countries with a “single source of intelligence on human, animal and environmental risks,” with a contributing centre in the UK. (p. 94)
Following up on this aspiration, the WHO has since created a “WHO Hub for Pandemic and Epidemic Intelligence,” with the strong support of the German Government. Any substantive Canadian contribution to this Hub remains unclear.
https://pandemichub.who.int
The British government followed the 2021 national security Integrated Review with a “refresh” in March 2023. The new document was now entitled, “Integrated Review Refresh 2023: Responding to a more contested and volatile world.”
While the refresh was clearly prompted by the international destabilisation that followed the Russian invasion of Ukraine in February 2022, it called broader attention to a rapidly worsening geopolitical environment and highlighted four major disruptive trends:
Shifts in the distribution of global power
Heightened state competition
Rapid technological change
Worsening transnational challenges
Taking stock of these threat vectors, one pillar of the refresh strategy was to create better societal resilience to threats, including “improving our economic, health and energy security.” The refresh strategy left most of the heavy lifting on improving health security to a forthcoming updated biological security strategy, framing it as an “overarching strategic framework for mitigating biological risks—whether arising naturally or through accidental or deliberate release.” (p. 47)
That the UK government could create not one but two substantive strategic documents on national security policy during COVID was an impressive achievement and signalled the seriousness with which security threats and their evolution were understood. Score Britain = 2; Canada = 0
Forget an integrated review, Canada cannot even manage to generate a promised defense review update, which now may be shelved, on the evidence of recent Ministerial changes and the appointment of a caretaker DND Minister in the shape of Bill Blair. Such a review might have looked at DND capabilities for medical intelligence [MEDINT], which were no better placed in 2020 to provide accurate risk assessments on COVID-19 than was PHAC.
If you want to know more about CFINTCOM threat assessments on COVID-19 in the early months of the COVID-19 pandemic, you can read my analysis, “Pandemic Warnings: Taking Stock of the Canadian Military’s Flawed Early Intelligence,” (October 27, 2021)
Maybe through the internal and multi-year Defence Intelligence Enterprise renewal project, some strengthening of a “MEDINT” capacity has occurred, but without the defence review update we are unlikely to hear anything about this in public.
So, what about comparative biosecurity strategies? That’s easy, alas--there is no basis for comparison, as Canada does not have one. Britain published a biosecurity strategy in 2018, which was in place when COVID swept in, and has just produced a new version, to articulate lessons learned from the pandemic.
The UK 2018 Biosecurity Strategy can be found here:
In the British lexicon, biosecurity refers to an all-hazards approach, encompassing naturally occurring pathogens, accidental release of hazardous materials, and deliberate use (biowarfare) The 2018 strategy was clear that “significant outbreaks of disease are among the highest impact risks faced by any society.” (p. 5) This reflects findings incorporated in the UK national security risk assessment profile that identifies a major human health crisis as a top tier issue.
High impact is one thing; probability is another. While the 2018 strategy recognized the extent to which zoonotic diseases (those transmitted from animals to humans ) statistically dominated health outbreaks, especially new and emerging infectious diseases (p. 9), there was still a sense of confidence in the ability to combat infectious diseases outbreaks that comes through in the document. At one point the 2018 strategy states that “the UK has in place a comprehensive e and well-tested system for rapidly detecting and identifying disease outbreaks.” (p. 23). Globally, the WHO, possessed a “world leading surveillance and information network filtering through 5000 disease ‘signals’ a month looking for outbreaks of pandemic potential.” (p. 26)
The weak link in the global system was clearly felt to be inadequate health security capabilities in the developing world (low and middle-income countries), perhaps based on the experience of Ebola outbreaks in West Africa and MERS (Middle East Respiratory syndrome) as it impacted countries like Yemen. Tightening global health security meant an outward focus on supporting improved capacity in such countries, something for which the biological security strategy promised significant British support.
In terms of Britain’s own capacity, the 2018 biological security strategy was all about fine-tuning an existing machinery, and identifying areas of further improvement. It used a four pillars approach, organized around requirements to understand biological risks; to prevent, where possible, such risks from emerging; to detect—to “characterise and report biological risks when they do emerge as early and reliably as possible;” and finally a response pillar once a biological risk has reached the UK.
Embedded in a confident expression of capabilities and the need for incremental change only were some interesting and forward-looking plans. These included mention of the need for what the strategy called “horizon-scanning” for emerging biological threats, coupled with a monthly report, strengthening of public health international intelligence work through the Global Health Security Agenda (a multilateral body of which Canada is a member), and “exploration” of enhanced usage of big data, open-source information, and social media in disease outbreak tracking. (p. 16)
But it cannot be said that the UK’s 2018 Biological Security Strategy was marked by any urgency of action, major reform ideas, or sense of major deficiencies.
Whatever complacency may have surrounded the 2018 document was, of course, profoundly shaken by the British experience of COVID-19. As we have seen, the 2021 Integrated Review called for a revision of the Biological security strategy. Work got underway in early 2022, with a framework statement that indicated that “Learning from COVID-19, we will improve our ability to anticipate and respond to biological threats through effective surveillance, improve our national readiness across the whole risk lifecycle, and exploit opportunities presented by these risks.” The process of revising the 2019 strategy began with a public “call for evidence,” based on four broad questions addressed to experts in the field. Question three specifically addressed lessons:
“What lessons can we learn from the UK’s Biological security delivery since 2018, including but not limited to COVID-19?”
For Canada to have a biological security strategy at all would be a major step forward in preparedness to meet future pandemic threats; to open up the formulation of strategic doctrine to outside experts, based explicitly on a need to learn lessons from COVID-19, would be equally unprecedented and valuable.
The new British Biological Security Strategy was published in June 2023.
It retained the same structure of a four pillars approach contained in the 2018 document but was marked by greater innovation and more urgency around the need for change. The 2023 strategy did not pull any punches about what the future might hold:
“As devastating as COVID-19 was, there is a reasonable likelihood that another serious pandemic could occur soon, possibly within the next decade.” (p. 15)
It based this prediction on changes in the global environment which heightened biological insecurity, from forced migration, the movement of people, tourism, trade and environmental loss. The intersection of pandemic risks and climate change impacts was especially noted.
Early warning was one key area for change. The 2023 strategy proposed the creation of a “Biothreats Radar” to watch out for emerging threats, and a fusion centre for warnings placed in a new “National Situation Centre,” a sort of disease outbreaks war room, where policy-makers (no Dr. Strangeloves please ) would have available to them a “comprehensive picture of known and nascent biological threats.” Annual threat forecasts were to be created that would marry longer term global trends to British biological security policy. These were to be published, “where possible.” (p. 26)
The strategy also leaned forward into tech futures, through a partnership with the US Defence Advanced Research Program Agency (DARPA) to pilot the development of advanced airborne sensors combined with big data analytics that could be used to sniff out early indications of infectious diseases outbreaks in major urban centres, transportation hubs or key border crossing points. (p. 44). A high-tech version of wastewater surveillance.
Future pandemic preparedness would be anchored in governance changes, to ensure dedicated government leadership on biosecurity at the Ministerial, senior officials level, and with coordination in the Cabinet Office (“Biological Security Coordination Unit, ” p. 57), through new partnerships with stakeholders “on the ground,” to be embodied in a UK Biosecurity Leadership Council, and enhanced reliance on independent scientific evidence and expertise, including through the creation of a “national biosurveillance network.” (p. 45)
Sprinkled throughout the strategy was mention of a future and unknowable “Disease X,” a clear recognition, fostered by COVID-19, that future threats might not look like past ones. Watching out for Disease X was one mission for the new Biothreats “radar” and underpinned the aspirational “100 day mission”—an ability on the part of British science and industry to mobilise and produce a responsive vaccine, if none existed, within 100 days.
There may be another “refresh” mandated for the biological security strategy in the years ahead, depending on the outcome of yet another aspect of the British effort to learn lessons from COVID-19.
Britain has committed to a major public inquiry, conducted under the UK Inquiries Act, into the response to COVID-19. Terms of reference were established in June 2022, following a process of deliberation between the Government and the appointed chair of the Inquiry, and with an added feature of public input. They are set out in two aims: one to examine the COVID-19 response across a multitude of issues; the second to “identify the lessons to be learned…to inform preparations for future pandemics across the UK.”
https://www.gov.uk/government/publications/uk-covid-19-inquiry-terms-of-reference/uk-covid-19-inquiry-terms-of-reference
The Inquiry began its work in 2023, first by studying issues of “resilience and preparedness,” and aims to conclude public hearings by the summer of 2026 with a report to follow, presumably in 2027. Included in the Inquiry is a dimension called “Every Story Matters,” which invites Britons to submit accounts of their experiences through a web portal.
Were a future Canadian government or parliament to summon the will to launch its own public inquiry, the UK precedent would stand as a model. It is also proof that it can be done.
What conclusions can we draw from this comparative look at British efforts to learn lessons from COVID-19? I can find at least seven takeaways. The first is how seriously the need was understood and acted on. A second is the extent to which efforts to learn lessons were public facing. A third is the emphasis given to the importance of early warning of disease outbreaks. A fourth is willingness to embrace governance changes. A fifth is understanding of the importance of partnerships with the private sector to draw on relevant expertise. A sixth is embrace of the need for innovation, again especially with regard to early warning capabilities and technological advances. A seventh might be learning lessons despite partisan politics, and a willingness to take the time necessary.
These are all bankable for Canada, if the political (and bureaucratic—they can be inseparable) will to act is there. That’s a big IF. For now, the Canadian record is a very sorry one. No Parliamentary report, no national security strategy, no biological security strategy, no inquiry. All these NOs add up to NO public knowledge or accountability. That’s how you ensure that publics, in an age of growing distrust of government and authority, will be resistant to government direction and leadership when the next pandemic rolls around.
Canada would have a long way to go if she were to accept the British model. Our biggest obstacle is that we have imported so much of the American culture war dimension (when in fact we aren't America and shouldn't act like we are). With respect to the origin of the disease, I am not convinced it is zoonotic, but I'm not a biologist. I think that since the Chinese state is so opaque, we may never know the truth. Canada has a much greater degree of delegation when it comes to the delivery of public services (like the provision of health care) than Britain. We don't have a National Health Service. We have the feds and the provinces constantly arguing about who is paying for what. I agree we should have an inquiry, but it will only be of value if some public agency takes ownership and ensures as a nation we are prepared. Canada should have been in a better position than most to handle the pandemic due to our experience with SARS. But we failed.