Jay Patel is a researcher at the University of Edinburgh’s Global Health Governance Programme working on covid-19 strategy.

While the intricacies of optimal pandemic strategy remain under dispute, one policy instrument has consistently been part of effective toolkits to control covid-19 infection rates: a functional test, trace and isolate system.

Although some countries rolled out “test and trace” to great effect, others invested a significant number of resources into these programs — and fell short.

Before covid-19, the Global Health Security Index ranked the United Kingdom as the second-most-prepared country to deal with a pandemic, after the United States. Yet the United Kingdom has one of the highest death rates from covid-19 worldwide.

At the center of its pandemic response was its flawed test-and-trace system. An eye-watering 22 billion pounds (more than $30 billion) was budgeted for the program between 2020 and 2021. In March, Chancellor of the Exchequer Rishi Sunak outlined a further blunt commitment of 15 billion pounds (more than $20 billion) to nourish the program in the coming year. Rather than addressing areas of weakness and applying targeted interventions to improve them, wads of cash were thrown at the system in the hope it would naturally revitalize.

As a result, more than 11 times the nation’s public health budget has been allocated for an intrinsically defective system.

Last September, the British government’s scientific advisory group reported that test and trace was having only “a marginal impact on transmission.” This week, a report evaluating its overall operational performance found “no clear evidence” of its effectiveness and it remains “unclear whether its specific contribution to reducing infection levels … has justified its costs.”

How did Britain get this so wrong?

First, testing. When the covid-19 pandemic began, Britain had 44 molecular virology laboratories. If integrated correctly, this should have put us head-and-shoulders above other countries in testing. The obvious approach in February 2020 was to rapidly repurpose existing labs for covid-19 testing and strengthen these facilities with sufficient funding and resources. Instead, they were completely ignored. New facilities were set up and managed by staff without appropriate expertise; tests were handled poorly; and turnaround times were sluggish.

Second, contact tracing. Effective tracing is vastly dependent upon trust. After all, who wants to be the person that reports their friends for a (brief) restriction of their civil liberties? Countries in the Asia-Pacific region, particularly Japan, Vietnam and South Korea, traced remarkably well. They mobilized their health-care workers and local public health teams, scattered across communities, to conduct interviews with cases in quarantine facilities. These were local people with local awareness. In Britain, we did the opposite, following a centralized approach with tracers working online and via call centers. How could we expect to tease out honest reporting from simply talking to people in call centers?

Instead, as authorities in Singapore and Taiwan were rapidly tracing contacts both prospectively and retrospectively, using local teams to quickly identify the source of infection and any linked clusters, Britain had just begun piloting their complicated mobile tracing app in the Isle of Wight in May. The app exemplified the general propensity to overcomplicate solutions that only needed to be very simple. By choosing these complex digital systems over more simple systems and grass-roots tracing, we shot ourselves in the foot, with an announcement last October that we lost nearly 16,000 cases due to technical glitches.

Thirdly, and most crucially, isolation. Even with the best testing and tracing systems, without isolating identified cases and contacts, we can’t expect any beneficial effect on infection rates. The distribution of spending toward supporting isolation is lamentable; less than 1 percent goes toward enabling and encouraging people to stay at home for 10 days. Other jurisdictions have set a better standard. New York’s “Take Care” initiative is an exemplary model of how to appropriately support people to isolate. Its comprehensive approach, prioritizing financial and tangible practical support, has led to adherence levels as high as 87 percent. In Britain, however, basic financial packages are not easily accessible, and millions are ineligible for the meager statutory sick pay. As a result, less than 1 in 5 symptomatic cases is fully adhering to self-isolation.

Through it all, the most fatal error, underpinning the entire failure, was the early decision not to strengthen existing local public health teams and primary care networks, instead prioritizing outsourced, centralized systems led by private firms. One of the reasons Britain’s vaccination program has been such a success was because it was run through the National Health Service, which was able to leverage expertise and existing systems. Test and trace should have followed the same model.

Perhaps the most discouraging aspect is that the problems that existed a year ago still exist today. Lessons from other countries were disregarded and opportunities to reorganize the system were not seized. Worse still, the current trajectory shows no sign of change.

We can only hope that we are better prepared for inevitable future outbreaks.

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