
There is a school of thought that says now is not the time to criticise the government and its scientific advisers about the way they have handled the Covid-19 pandemic. Wait until all the facts are known and the crisis has subsided, goes this thinking, and then we can analyse the performance of those involved. It's safe to say that Richard Horton, the editor of the influential medical journal the Lancet, is not part of this school.
An outspoken critic of what he sees as the medical science establishment's acquiescence to government, he has written a book that he calls a "reckoning" for the "missed opportunities and appalling misjudgments" here and abroad that have led to "the avoidable deaths of tens of thousands of citizens".
The Covid-19 Catastrophe: What's Gone Wrong and How to Stop It Happening Again is a short polemical book, building on a series of excoriating columns Horton has written in the Lancet over the past few months. He lambasts the management of the virus as "the greatest science policy failure for a generation", attacks the Scientific Advisory Group for Emergencies (Sage) for becoming "the public relations wing of a government that had failed its people", calls out the medical Royal Colleges, the Academy of Medical Sciences, the British Medical Association (BMA) and Public Health England (PHE) for not reinforcing the World Health Organization's public health emergency warning back in February, and damns the UK's response as "slow, complacent and flat-footed", revealing a "glaringly unprepared" government and a "broken system of obsequious politico-scientific complicity".
On the page, Horton can sound strident, even arrogant, but that's not his manner in person at all, at least not in our long Zoom conversation. He's charming, open, self-critical and full of easy laughter. I suggest that, as bad as things look at the moment, surely people like the chief medical officer, Chris Whitty, and the chief scientific officer, Patrick Vallance, have been doing their best.
"Individually, they're great people," he says. "I'm not criticising individuals, but the system was a catastrophic failure." As editor of the Lancet, he's particularly aggrieved that the series of five academic papers the journal published in late January first describing the novel coronavirus in disturbing detail went unheeded.
"In several of the papers they talked about the importance of personal protective equipment," he reminds me. "And the importance of testing, the importance of avoiding mass gatherings, the importance of considering school closure, the importance of lockdowns. All of the things that have happened in the last three months here, they're all in those five papers."
He still can't understand why the government's scientific advisers didn't consult their counterparts in China. The world of medicine is a small one, he says, and everyone knows the people responsible for coordinating the Chinese government's response. "These are people they could have literally sent an email to, or picked the phone up to, and said, 'Hey, we read your paper in the Lancet, can it really be as bad as that? What is going on in Wuhan?' And if they'd done that they would have found out that this was indeed as bad as described."
He doesn't know if such conversations took place, but he can't see why, if they did, the response was so sluggish that the UK is second in the world, trailing only the much larger nation of the US, in the league of Covid-19 deaths. What he does know, from the published reports of Sage meetings, is that scientists were "trying to be as sensitive to economic issues as they were to health issues". That, he says, "is a dangerous place to be" because it compromises the ability of the advisory group to protect health.
While the arena of public health is no stranger to heated disputes, it's common for the antagonists to maintain a diplomatic front in public. Horton, who appeared on Question Time back in March and declared the government's delay in locking down a "national scandal", has never been shy about speaking out, but even by his own forthright standards, he seems to have abandoned all instincts for restraint.
