Lessons from the costly failings of UK test and trace

Prime Minister Boris Johnson promised that the UK’s test and trace scheme would be “world-beating”. The only area in which it has beaten the world seems to be cost: a budgeted £22bn for 2020-21, and £15bn more for the coming year. A parliamentary report witheringly concluded last week that despite the “unimaginable resources” lavished on the project, it appeared to have made little “measurable difference” to the pandemic’s progress. When it comes to learning lessons, especially on how to prepare for future pandemics, test and trace will hold many on how not to do things.

NHS Test and Trace did notch up some achievements that, in isolation, appear eye-catching. Between its launch last May and January this year, daily UK testing capacity for Covid-19 mushroomed from 100,000 to about 800,000; the UK now has one of the world’s highest per capita testing rates. The scheme contacted 2.5m people who tested positive, and 4.5m of their contacts. But it failed, twice, to deliver on what was supposed to justify its vast price tag: avoiding further lockdowns.

Financial Times analysis found close to 90 per cent of funding to date was funnelled into testing, rather than contact tracing, reflecting in part the high cost of “gold standard” PCR tests, labs and machines. But less than two-thirds of lab capacity built up was actually being used in November and December, even as new infections soared. The scheme has latterly poured billions into rapid lateral flow tests, despite concerns over their accuracy.

Some of the failings reflected ill-advised decisions by the scheme. One was to build a new, centralised system from the ground up. Unlike the vaccinations effort, test and trace largely failed to use NHS and local authority networks whose community knowledge could have formed the core of a more effective, decentralised operation. Many countries adopted a more localised approach. Building from scratch meant extensive use of costly consultants, which MPs noted, the scheme was struggling to “wean itself off”.

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Yet the scheme was desperately struggling to catch up from the outset. Test and trace systems are most effective when deployed early, so they can clamp down on the spread when infections remain few. In the most successful examples — such as Taiwan and South Korea, which had experience of the Sars epidemic — border controls were imposed and contact-tracing introduced rapidly. The UK scheme was launched only in May, two months into lockdown, with infections just past their first peak. Though lockdown had slowed community transmission, scaling up and relying on test and trace to avert a second wave was always going to be an immense challenge — and the scheme made a poor fist of it.

To be successful, moreover, such schemes rely not just on comprehensive tracing of new infections and their contacts, but on all those people then isolating. Inadequate financial support for much of last year for those isolating meant many lower-paid and self-employed workers did not isolate even if contacted, or avoided being tested.

None of this excuses the costly misfiring of NHS Test and Trace. A full accounting cannot overlook mistakes by the government and health authorities even before the scheme began: failures to ensure sufficient testing capacity early in the pandemic, to control borders quickly, and even before that to ensure the country was prepared to cope with such a pandemic. A key part of ensuring it is ready for the next will be deciding what to preserve, what to mothball, and what to scrap, from the test and trace system that has now so expensively been put in place.

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