Nphet lacked diversity but historical verdict is likely to be favourable

Caution often criticised, understandably at times but was justified in autumn 2020

In autumn 2020 chief medical officer Dr Tony Holohan clashed with the Government over the planned reopening of society. Photograph: Nick Bradshaw

Modern Irish society has never experienced anything as invasive and, arguably, as divisive as the National Public Health Emergency Team (Nphet), so there is unlikely ever to be a consensus on its legacy.

While the initial response of a jaded public today may be to bid good riddance to the officials who controlled so much of their life for two years, the longer-term verdict of history is likely to be more favourable.

Nphet should ultimately be judged on its performance; on how Ireland managed during the pandemic, relative to other, similar countries. By that yardstick it has done reasonably well.

Hospital Report

True, there are countries that managed to minimise mortality more successfully, but Ireland is neither as remote as <a class="search" href='javascript:window.parent.actionEventData({$contentId:"7.1213540", $action:"view", $target:"work"})' polopoly:contentid="7.1213540" polopoly:searchtag="tag_location">New Zealand</a> nor as centrally controlled as <a class="search" href='javascript:window.parent.actionEventData({$contentId:"7.1213540", $action:"view", $target:"work"})' polopoly:contentid="7.1213540" polopoly:searchtag="tag_location">China</a>

Ireland has had fewer Covid-19 deaths, less excess death during the pandemic and fewer hospitalisations relative to population than most of our neighbours.

READ MORE

For instance, Ireland has so far recorded 1,262 Covid-19 deaths per million of population, according to Our World in Data, the lowest figure in Europe apart from the Netherlands. We also have the second-lowest hospitalisations relative to population.

This is largely due to us having one of the highest rates of Covid-19 vaccination, and that in turn was the product of the trust the broad mass of the population placed in our pandemic leadership, ie Nphet.

If we have had more cases over recent months, that mattered less because virtually everyone in the adult population was benefitting from the protective effect of vaccines.

Dr Ronan Glynn, deputy chief medical officer and Professor Philip Nolan, chair of the Nphet Irish Epidemiological Modelling Advisory Group. Photograph: Colin Keegan/Collins Dublin

True, there are countries that managed to minimise mortality more successfully, but Ireland is neither as remote as New Zealand nor as centrally controlled as China. You only have to look north on the island to see how much worse things could have been.

Deep fissures

In the early days of the pandemic, Nphet was the hastily-applied sticking plaster that covered over the deep fissures exposed by the pandemic and the bewilderment of the political class.

With only an interim administration in place in Government Buildings, following the February 2020 general election, Nphet was effectively running the country. "I think that was by default because of a power vacuum. In the beginning, when they were an interim government, it suited them to hide behind Nphet," one of its members, Dr Mary Favier, told Richard Chambers in his book, A State of Emergency.

The politicians grew more assertive and impatient in 2021, but successive new variants came along to frustrate plans for winding up the emergency operation

And while a Government was appointed in June 2020, Nphet stayed calling the shots, and the politicians stayed hiding, for much of that year.

It was an unhealthy situation not of the officials’ own making. Over time, the shortcomings of this ad hoc body became evident: the preponderance of civil servants and lack of frontline clinicians in Nphet’s ranks; a lack of transparency; clumsy decision-making and reporting processes; a warped relationship with its political masters, and an exclusively public health-oriented approach that seemed to pay insufficient heed to the wider impacts of the pandemic.

As a result, Ireland suffered successive long lockdowns, each one less effective than the previous. Public opinion had fractured badly; one fringe advocated against any restrictions, while another group called for a “zero-Covid” approach entailing even stiffer lockdown. Nphet was left to plead for a middle way and to promise salvation with the arrival of the newly developed vaccines.

Professor Philip Nolan. Photograph: Colin Keegan/Collins Dublin

Its caution has often been criticised, sometimes with good reason, but was justified in autumn 2020 when chief medical officer Dr Tony Holohan clashed with the Government over the planned reopening of society. With the spread of a new, more virulent strain of the virus, the politicians' desire for a "meaningful Christmas" that year was to have catastrophic results as thousands died.

Spats

Once the vaccines were developed and distributed as last year progressed, the officials relaxed. But even as a solution to Covid-19 was being found, they found themselves embroiled in a series of damaging and ultimately unnecessary spats on antigen testing, ventilation and the nitty-gritty of regulations.

Pandemic fatigue may have contributed to the officials sweating the small stuff on these issues. Or perhaps it was being given a pulpit so often that led to gaffes, such as when antigen tests were equated with “snake oil”.

The politicians grew more assertive and impatient in 2021, but successive new variants came along to frustrate plans for winding up the emergency operation. U-turns on antigen tests and other issues were duly performed, sometimes with gritted teeth, after Nphet’s membership was expanded to include a wider breadth of opinion.

Even as the arguments raged, though, no one ever had cause to doubt the zeal and commitment of Dr Holohan and his team. In other countries, those imposing the restrictions were sometimes caught infringing them, but not in Ireland.

With more than 30 members, Nphet is too big and unwieldy. And yet it lacked diversity, especially at the start, though it was able to call on scientific expertise through numerous subgroups.

Some have suggested the national emergency management team, currently dealing with Storm Eunice, should be the vehicle for tackling future public-health crises. Maybe, but it is hard to see how this approach would make the process more transparent or inclusive.

We probably will need another crisis-type body again, possibly even for another wave in the pandemic, but one thing is clear: we will not see the likes of this Nphet again.