like sars which looked unlikely at this stage, but if it was, for the sake of argument, the point is to make sure that any spill—over cases can be rapidly contained so it never establishes itself in the uk. you are not saying this will turn into a pandemic, but what we don't want to say is have any backwash from this. we had importation from sars and ebola, we picked them up and treated them, and that is the first thing to say, and if it is going to be a pandemic, you can never stop it, and there is an illusion you can stop it, but you can't. you can delay it and that is where a lot of the debate around border and other measures then took us but what we wanted people to realise, when you are in pandemic territory, the idea of stopping it is an illusion. you can delay it, potentially, maybe. when you referred to the minority being _ when you referred to the minority being prevent, you mean that the virus _ being prevent, you mean that the virus could — being prevent, you mean that the virus could not be stopped if it is a pandemic, if it is a sustainable human—to—human transmission and geographically spread out of china, it cannot _ geographically spread out of china, it cannot be stopped, but we can delay— it cannot be stopped, but we can delay the — it cannot be stopped, but we can delay the upswing if you like. i say that exnlicitly _ delay the upswing if you like. i say that explicitly in _ delay the upswing if you like. i say that explicitly in the _ delay the upswing if you like. i 3: that explicitly in the next sentence.— that explicitly in the next sentence. ., _, , that explicitly in the next sentence. ., , ., sentence. you were recognising at this relatively _ sentence. you were recognising at this relatively early _ sentence. you were recognising at this relatively early stage, - sentence. you were recognising at this relatively early stage, when . sentence. you were recognising at this relatively early stage, when iti this relatively early stage, when it leaves _ this relatively early stage, when it leaves china, we are in trouble? if leaves china, we are in trouble? if it... leaves china, we are in trouble? it... spill—over leaves china, we are in trouble? if it... spill—over cases from china in themselves. it. .. spill-over cases from china in themselves-_ it... spill-over cases from china in themselves. ,, , ., ., ., ., themselves. sustained human-to-human transmission _ themselves. sustained human-to-human transmission. there _ themselves. sustained human-to-human transmission. there is _ themselves. sustained human-to-human transmission. there is an _ themselves. sustained human-to-human transmission. there is an extreme - transmission. there is an extreme hi . h transmission. there is an extreme high likelihood _ transmission. there is an extreme high likelihood that _ transmission. there is an extreme high likelihood that you _ transmission. there is an extreme high likelihood that you are - transmission. there is an extreme high likelihood that you are in - high likelihood that you are in trouble, yes. nothing is certain but an extremely high likelihood. the si . ns were an extremely high likelihood. the signs were that it was sustained human—to—human transmission and by this date _ human—to—human transmission and by this date there were cases outside china, _ this date there were cases outside china, like — this date there were cases outside china, like japan, south korea. by this date— china, like japan, south korea. by this date or— china, like japan, south korea. by this date or shortly thereafter, there — this date or shortly thereafter, there was— this date or shortly thereafter, there was a probability it would come _ there was a probability it would come at — there was a probability it would come at some point. i�*m there was a probability it would come at some point.— there was a probability it would come at some point. i'm going to “ust oint come at some point. i'm going to just point out _ come at some point. i'm going to just point out that _ come at some point. i'm going to just point out that the _ come at some point. i'm going to just point out that the who, - come at some point. i'm going to just point out that the who, it i come at some point. i'm going to. just point out that the who, it had as of this point still not called even a public health emergency of international concern which is well short of a pandemic, and the pandemic was not declared until the 11th of march, i think. international views, as with many things, you look back and say, how can they be so blind and how could they not see this? at the time there was quite widespread international debate amongst serious experts. yes, some experts said it is definitely going to happen, and others said very doubtful, and there were points between. it is important that we don't look back and say, because you can say this is what would have happened. the international evidence on this at the time is relatively clear. it was uncertain at this stage. but it was heading further and further to becoming bad and in my view, if it gets bad, this will be a pandemic.— my view, if it gets bad, this will be a pandemic. your position was predicated _ be a pandemic. your position was predicated on _ be a pandemic. your position was predicated on the _ be a pandemic. your position was predicated on the who _ be a pandemic. your position was predicated on the who and - be a pandemic. your position was predicated on the who and you i be a pandemic. your position was l predicated on the who and you had your own _ predicated on the who and you had your own views and own expertise and the expertise of sage. yes, your own views and own expertise and the expertise of sage.— the expertise of sage. yes, but in this area, the expertise of sage. yes, but in this area. the _ the expertise of sage. yes, but in this area, the uk _ the expertise of sage. yes, but in this area, the uk and _ the expertise of sage. yes, but in this area, the uk and who, - the expertise of sage. yes, but in this area, the uk and who, and i the expertise of sage. yes, but in i this area, the uk and who, and the who is a reasonable anchor point and if you diverged from who, which was appropriate at some points, you have to have a good reason. it is a reasonable point of international comparison. it is the international norm. ., ., ., . ., . norm. you gave advice and received advice from — norm. you gave advice and received advice from sage _ norm. you gave advice and received advice from sage and _ norm. you gave advice and received advice from sage and you _ norm. you gave advice and received advice from sage and you relayed i advice from sage and you relayed advice _ advice from sage and you relayed advice without any express regard being _ advice without any express regard being made to the technical position of the _ being made to the technical position of the who and whether a pandemic had been _ of the who and whether a pandemic had been declared, correct? the advice i had been declared, correct? tie: advice i consider is had been declared, correct? tt9: advice i consider is sensible had been declared, correct? tt9 advice i consider is sensible at the time and i would have been wrong at this point to have said to number ten, the game is over, this is going to be a pandemic. that would have been an incorrect technical advice to them, so this gives two scenarios, one of which is a pandemic and one that isn't. concurrently, you knew there was sustained — concurrently, you knew there was sustained human—to—human transmission or at least the signs were _ transmission or at least the signs were pointing in that direction, and you knew— were pointing in that direction, and you knew because you have described to us how _ you knew because you have described to us how you were aware that the uk was poorly— to us how you were aware that the uk was poorly placed to be able to respond — was poorly placed to be able to respond in terms of the public health— respond in terms of the public health capability, in terms of the absence — health capability, in terms of the absence of plans, in terms of the absence — absence of plans, in terms of the absence of— absence of plans, in terms of the absence of controlled measures to stop the _ absence of controlled measures to stop the virus physically reaching these _ stop the virus physically reaching these shores. so was it not therefore _ these shores. so was it not therefore the case that this was the point _ therefore the case that this was the point at _ therefore the case that this was the point at which you appreciated we were _ point at which you appreciated we were in— point at which you appreciated we were in a — point at which you appreciated we were in a terrible bind? it was coming— were in a terrible bind? it was coming and it was very little practically that appeared to be possible to be able to deal with it other— possible to be able to deal with it other than delay? i possible to be able to deal with it other than delay?— other than delay? i think it was cominu , other than delay? i think it was coming. that — other than delay? i think it was coming, that implies _ other than delay? i think it was coming, that implies certainty, i coming, that implies certainty, which is not what i'm saying. we should have been at this point. it is pretty rare that someone in my job, notjust me, my predecessors, writes this kind of e—mail to number ten, this is not the kind of thing you do on a monthly basis or a yearly basis. it is a rare event to say we are very concerned. we have activated the sage mechanism and we are writing to number ten as we will talk about, lots of briefings with senior people in the official and official system happened in short order after this so i fully agree that this is a point we are starting to move and escalate this is a major issue across government, notjust within the technical agencies which we previously discussed. ianthem within the technical agencies which we previously discussed.— we previously discussed. when we resume we previously discussed. when we presume that _ we previously discussed. when we presume that you _ we previously discussed. when we presume that you wrote _ we previously discussed. when we presume that you wrote to - we previously discussed. when we presume that you wrote to the - we previously discussed. when we i presume that you wrote to the health department at numberten presume that you wrote to the health department at number ten because by this stage. _ department at number ten because by this stage, the formal process by which _ this stage, the formal process by which you — this stage, the formal process by which you gave advice to ministers and the _ which you gave advice to ministers and the prime minister of course, had not _ and the prime minister of course, had not yet — and the prime minister of course, had not yet been set up because sage itself was _ had not yet been set up because sage itself was not yet operating in this way _ itself was not yet operating in this wa . , itself was not yet operating in this way-- there — itself was not yet operating in this way-- there is _ itself was not yet operating in this way.- there is a _ itself was not yet operating in this way. yes. there is a sage meeting on the 23rd of way. 193 there is a sage meeting on the 23rd ofjanuary, a week or so later, _ the 23rd ofjanuary, a week or so later, and — the 23rd ofjanuary, a week or so later, and on page two, paragraph nine, _ later, and on page two, paragraph nine, a _ later, and on page two, paragraph nine1a clear— later, and on page two, paragraph nine, a clear reference to sustained human—to—human transmission. and then on— human—to—human transmission. and then on page — human—to—human transmission. and then on page three, paragraph 28, sage _ then on page three, paragraph 28, sage says— then on page three, paragraph 28, sage says this, for the uk, sage agrees _ sage says this, for the uk, sage agrees the — sage says this, for the uk, sage agrees the current triggers which would _ agrees the current triggers which would require a change in the approach _ would require a change in the approach of mps are appropriate. can you help _ approach of mps are appropriate. can you help as— approach of mps are appropriate. can you help as to why sage was still debating — you help as to why sage was still debating the appropriateness of the triggers— debating the appropriateness of the triggers as opposed to what change the uk _ triggers as opposed to what change the uk government was required in li-ht the uk government was required in light of— the uk government was required in light of triggers being activated which _ light of triggers being activated which of— light of triggers being activated which of course you agreed already they were? — which of course you agreed already the were? :, :, ~' which of course you agreed already the were? :, :, ~ :, which of course you agreed already they were?— they were? looking at those ones, sustained human-to-human - sustained human—to—human transmission outside china, that is a key rider to that. or a severe uk case which we did not have at that stage. the point about this, we think both of these are very close in time and that was the reason that sage was meeting, and they meet very rarely, this is not something that meets every time there is a mild concern. sage meets because we think there's the potential for a very serious all of government response and if it is just serious all of government response and if it isjust a serious all of government response and if it is just a health department response, you would expect it to be dealt with within the technical agencies of the health department. testify the technical agencies of the health department-— the technical agencies of the health de artment. ~ , ' department. why were there different trir rers department. why were there different triggers being — department. why were there different triggers being utilised _ department. why were there different triggers being utilised by _ department. why were there different triggers being utilised by sage - department. why were there different triggers being utilised by sage and i triggers being utilised by sage and building _ triggers being utilised by sage and building in a delay because the opinion— building in a delay because the opinion was the triggers have not yet been — opinion was the triggers have not yet been triggered? to the earlier triggers— yet been triggered? to the earlier triggers that you had advised were appropriate, which was family to family— appropriate, which was family to family human—to—human transmission geographical spread, or infection amongst — geographical spread, or infection amongst health care workers. it rather— amongst health care workers. it rather appears that these triggers had shifted the goalposts. they were hi-h had shifted the goalposts. they were high levels of trigger which work required —— which were required... | required —— which were required... regret using required —— which were required... i regret using the word triggers because that is an unusual framing —— unhelpfulframing, but they because that is an unusual framing —— unhelpful framing, but they work to achieve different levels of escalation. the ones i did on the 5th of january were to say this needs to be escalated quite seriously within the health system, especially public health england and the emergency response in the department of health and social care which then it was, and part of that response was to trigger the sage system, also meetings of the permanent secretary in the department of health and social care, and at this point the sage triggers are about what we should do in terms of cross government response which is a significant step up response which is a significant step up from the ones i was previously doing. they are different triggers, you are right, and the reason is they are to do different things and this is now the fact the whole of government needs to be thinking about this. the government needs to be thinking about this. :. . about this. the earlier triggers were there _ about this. the earlier triggers were there to _ about this. the earlier triggers were there to identify - about this. the earlier triggers were there to identify a - about this. the earlier triggers were there to identify a level. about this. the earlier triggers l were there to identify a level of seriousness, but these triggers reguire. — seriousness, but these triggers require. it— seriousness, but these triggers require, if trigger, a change in approach? _ require, if trigger, a change in approach?— require, if trigger, a change in approach? yes. what about the reference to — approach? 193 what about the reference to hmg's approach, consideration of countermeasures, health— consideration of countermeasures, health campaigns, border measures? what did _ health campaigns, border measures? what did sage have in mind? you are talkin: what did sage have in mind? you are talking about — what did sage have in mind? you are talking about measures _ what did sage have in mind? you are talking about measures which - talking about measures which inevitably will require cross government agreement and considerations and i think you took the example of border measures which are an extraordinarily complex issue and we might want to come back to that. ~ : :, and we might want to come back to that. ~ ::, : ~ :, and we might want to come back to that. ~ :, , that. we will come back to borders. there is a big _ that. we will come back to borders. there is a big difference _ that. we will come back to borders. there is a big difference between i there is a big difference between things which are entirely within what is sometimes called the health family where you can sort it out with a combination of nhs, public health and academia, and those things which are going to inevitably require, notjust desire, but require, notjust desire, but require a cross government response. and what these triggers would mean is a change of whole of government, the hmg point, and this is a hmg response, the whole of government. the entire debate is taking place in the context of our country and the government responds practically to an emerging crisis. what in practice did sage _ an emerging crisis. what in practice did sage understand the government would _ did sage understand the government would do. _ did sage understand the government would do, what was it advising it would _ would do, what was it advising it would do — would do, what was it advising it would do and what did it think it would _ would do and what did it think it would do — would do and what did it think it would do in the event of these fresh triggers— would do in the event of these fresh triggers being triggered? what in practice _ triggers being triggered? what in practice does it amount to? the earliest things _ practice does it amount to? ti9 earliest things that would have to be considered, and they are not easy and we should talk about them seriously or not at all, border measures. which require a lot of thinking and implications of course for trade and diplomacy and for the economy. implications for consider. but that is because one of the earliest things is to reduce the risk of importation and you also need to alert the overall economic system that something which may well be a significant economic shock is in the vicinity, though it does not mean it will happen. there are a large number of different things which will need to be considered. is this all in the context of borders? no, the _ this all in the context of borders? no, the point is, what other things whichjust cannot be no, the point is, what other things which just cannot be done within the health system, that is really the question on this. there are some things which can be done within the health system but there are many things also which cannot be done within the health system and i have given some examples. let’s within the health system and i have given some examples.— given some examples. let's look at borders. given some examples. let's look at borders- by — given some examples. let's look at borders. by this _ given some examples. let's look at borders. by this date, _ given some examples. let's look at borders. by this date, advice - given some examples. let's look at borders. by this date, advice on - borders. by this date, advice on port _ borders. by this date, advice on port health recommendations had been inen1_ port health recommendations had been given, yourself and the cmo advised it was— given, yourself and the cmo advised it was too— given, yourself and the cmo advised it was too soon to do any additional measures— it was too soon to do any additional measures on the basis of one case in japan _ measures on the basis of one case in japan or— measures on the basis of one case in japan or thailand. measures on the basis of one case in japan orthailand. on measures on the basis of one case in japan or thailand. on the 2nd of february— japan or thailand. on the 2nd of february you engaged the advice of professor— february you engaged the advice of professor edmonds, professor ferguson, you made a request for their— ferguson, you made a request for their views — ferguson, you made a request for their views on travel advice. in relatively— their views on travel advice. in relatively early february, the fifth, — relatively early february, the fifth, there was a cobra meeting and you advised — fifth, there was a cobra meeting and you advised that practically speaking significant border measures, putting aside the issues about— measures, putting aside the issues about trade and commerce and flow of personnel, _ about trade and commerce and flow of personnel, and the political combinations, a stringent process would _ combinations, a stringent process would be — combinations, a stringent process would be unlikely to achieve much other— would be unlikely to achieve much other than— would be unlikely to achieve much other than a delay to be measured in days in— other than a delay to be measured in days in the _ other than a delay to be measured in days in the event of the emergence of the _ days in the event of the emergence of the virus — days in the event of the emergence of the virus question that was a technical— of the virus question that was a technicaljudgment and i wanted to check— technicaljudgment and i wanted to check that other people who technicaljudgment and i wanted to check that other people— check that other people who have different experience _ check that other people who have different experience in _ check that other people who have different experience in this - check that other people who have different experience in this area | different experience in this area were able to challenge if they thought that this first view was incorrect and i did not want it to be the last word. i was worried i would ask for an opinion and then be sure that others had a chance to disagree if they felt my opinion and my provisional opinion was wrong. late my provisional opinion was wrong. we can deal with the board speedily because — can deal with the board speedily because in terms of the merits of border— because in terms of the merits of border measures,