Yesterday the Health Secretary Matt Hancock announced that Public Health England, established in 2013, would be replaced by a new body: the National Institute for Health Protection (NIHP). Whereas PHE was instructed to plan for pandemics and promote healthy living campaigns, the NIHP will have the sole purpose to protect people from external health threats, namely pandemics and the use of biological weapons.
Whilst scant on details as yet, Hancock said the new body would work more closely with local authorities and public health teams, wanting to model the new institute on Germany’s Robert Koch Institute. Which has the sole purpose to plan for pandemics.
However, the reasons behind Germany’s successful response to Covid-19 do not lie only in the work of this body but are because of its pre-existing health infrastructure.
Something that allowed Germany to react sufficiently to the pandemic was its strong underlying funding within its healthcare system, down to a mixture of statutory and private insurance contributions. Before the pandemic, Germany had more intensive care beds than other comparable European countries: 34 per 100,000 people, compared to 9.7 in Spain and 8.6 in Italy. It also avoided spending cuts following the financial crash, with spending rising steadily every year for 15 years. This meant that local authorities had the capacity to successfully respond to the virus. In the same week the UK abandoned contact tracing because of a lack of capacity, Germany was carrying out 160,000 tests a week, thanks to a pre-existing network of 150 university and private local labs across the country.
If Hancock wishes to use the NIHP to place greater emphasis on the response of local authorities to a pandemic, then the funding integral to such success needs to be delivered too. Across Germany there is relative conformity between its 16 states over health funding. Comparatively, in America we see states battle it out for deliveries of additional equipment, PPE and ventilators, with some significantly worse prepared than others. With the UK already experiencing regional inequality comparably worse than many European countries, a more localised health response will only work if increased funding ensures the material ability to respond is in place.
Secondly, owing to its federalised political framework, local authorities hold greater power and with that have greater accountability, when it comes to matters of health. This allowed for a quicker and locally focussed response to the threat of the disease – the very idea the UK wishes to follow with local lockdowns. For instance, Heinsberg closed public spaces as early as 26th February and Berlin closed bars in March 14th. . All of these measures preceding the federal announcement of restrictions on March 22nd.
Increased accountability between the managers of local health and the public is integral to the success of this system. For instance many hospitals in towns are controlled by elected mayors.
It is not as simple as Hancock wishing to create a new institute that will instantly help Britain’s pandemic response. The success of Germany shows pre-existing material support was integral to its response, but also how its political framework laid the foundations for successful decisions taken on local levels. If the UK wishes for a strategy of local lockdowns over the winter then the decision to implement these needs to be devolved to local authorities, not decided in Gold Command meetings every Thursday in Whitehall. With this, there would then need to be greater accountability between local health officials and the public. This would act as a check on funding decreases whilst also encouraging authorities to act more quickly to concerns. After all throughout this pandemic the UK Government has been behind public opinion on lockdown, the wearing of masks, and the severity of restrictions that should be implemented.
Yet there is a false dichotomy over pandemic responses between centralised and federalised health care systems. One of the significant reasons that Germany’s federal system worked and the USA’s didn’t was because of strong leadership from Berlin by Angela Merkel that encouraged greater unity in the response of states. The RKI set the national guidelines, and Merkel frequently encouraged all states to follow them together. At times though difficulties arose over the quality of data, with states slow to share information with the federal government – something the UK mostly avoided because of its centralised NHS structure. Also, America shows the risks of having a body with the sole purpose of preparing for pandemics. The CDC frequently gets its funding cut, after all memories wear thin and politicians believe pandemics are not that likely at all. To avoid this British Scientist Jeremy Farrar stressed the need for the new health institute to focus on other topics, like PHE did, to ensure its relevance.
The RKI was instrumental in Germany’s response. But underlying its success was a successful level of health funding, alongside political power for local authorities that allowed them to respond with speed. The Government needs to walk the balance between centralised and federalised systems carefully. National leadership is paramount to a successful response, as well as unified data sharing. But for quick and nimble local lockdowns then federalised structures work best. But for this the political system needs to play catch up: with greater powers awarded to UK councils, and greater accountability in the long-run between their health teams and the public. That will act as a successful check on the operation of health policy.