The Scientific Advisory Group for Emergencies and the chief medical officer confirm what was clear to us – that the UK abandoned the test, isolate and contact-trace approach to Covid-19 so early because Public Health England (PHE) was unable to deliver what the World Health Organization and other countries recognised was necessary.
Prompt and efficient testing requires a national network of microbiology/virology laboratories to be mobilised and coordinated rapidly. From 1939 to 2003, this was provided by the Public Health Laboratory Service (PHLS). After its abolition in 2003, only the central laboratories and regional centres were retained in the Health Protection Agency (HPA), and even fewer when it became PHE. Microbiology became a small part of PHE, with greater emphasis on epidemiological modelling in a shrinking funding envelope.
As inspector of microbiology and infection control at the Department of Health (2003-10), one of us (Brian Duerden) had a remit to ensure NHS laboratories contributed to public health needs, which became increasingly difficult. As clinical academics and former NHS, PHLS, HPA and PHE consultants, we observed the “modernisation” of pathology services, with microbiology/virology laboratories centralised in main hospitals or on non-hospital sites. Some remain managed by NHS trusts but others are run by private companies, and trusts only funded the testing they required for their patients and those of local GPs – public health did not feature.
The failure of this approach has been cruelly exposed. Covid-19 would challenge any system, but PHE has proved unfit for purpose, unable to lead capability and deploy testing rapidly to non-PHE laboratories. Subsequent reform should ensure maintenance of an NHS and academic laboratory capability for public health, to face the present challenge and be ready for the next one.
Prof Brian I Duerden Chepstow, Monmouthshire, Dr Geoffrey L Ridgway Ringwood, Hampshire, Dr Roderic E Warren Bicton, Shropshire, Prof Peter M Hawkey Professor of clinical and public health bacteriology, University of Birmingham
