The lifting of most remaining public health restrictions next week will mark the end of the current emergency phase of the Covid-19 pandemic. The powerful advisory body that shaped the official response for the past two years, the National Public Health Emergency Team (Nphet), is to be wound down, its functions absorbed by existing Government structures.
Elsewhere, public health advisers to governments worked quietly behind the scenes; in Ireland, Nphet members became household names. Their prominence was partly the result of timing – when the pandemic struck, an interim government was in office, leaving a power vacuum – and partly by design. To their credit, both the interim government, led by Fine Gael, and its successor, headed by a Fianna Fáil Taoiseach, made it a point of principle that policy would be led by science and the best available public health advice.
Nphet’s dominance proved controversial. Government could always disregard its advice, but the political price to be paid for going it alone and then getting it wrong meant Nphet had more power in reality than it had in theory. When ministers broke with Nphet in late 2020 by easing restrictions for “a meaningful Christmas”, Covid cases spiked and thousands died.
The basic measure of Nphet’s success will be the public health outcomes. Ireland had fewer deaths, fewer excess deaths and fewer hospital admissions that most of its neighbours. Nphet members showed integrity and commitment under trying conditions. Irish people need not look far to see how much worse the pandemic could be in a country where public health decisions were routinely taken for political reasons.
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Notwithstanding that success, Nphet’s gaps and blindspots also provide useful lessons. It was slow to embrace transparency, and for much of the pandemic it had too few frontline clinicians among its members. Its remit was exclusively public health, so factoring in the social and economic costs of lockdowns fell to Government at the final step in the process; a better system would have weighed all these considerations at an earlier stage. Given the world’s rapidly-evolving understanding of Covid-19, Nphet could sound overly dogmatic. It was slow to embrace face masks and outright dismissive of antigen testing – an issue on which Government eventually overruled it. It struggled to adjust its message in light of emerging evidence that Covid was an airborne disease as opposed to one spread by droplets.
The Government has created an expert group to identify lessons from the pandemic for the health service, but a broader inquiry into the official handling of the emergency is essential. Its purpose would not be to identify heroes and villains but to rigorously analyse all dimensions of the response and to draw lessons for the future. Setting up that inquiry should be a priority.