Frustrations simmer as Nphet and Government muddle through

Initial reaction to pandemic was near-consensus but this soon wore thin

Chief medical officer Tony Holohan: A senior official suggests there is a “central problem” with the power located in Nphet, namely that “focusing purely on the disease leads to a certain view”.

Chief medical officer Tony Holohan: A senior official suggests there is a “central problem” with the power located in Nphet, namely that “focusing purely on the disease leads to a certain view”.

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In his inimitable style, former Downing Street adviser Dominic Cummings this week described the UK’s department of health as a “smoking ruin” during the early days of the Covid pandemic. Centralised procurement was an “expensive disaster zone” he said.

He also claimed the vaccine rollout succeeded partly because it was not run by the department of health.

While Cummings’s melodramatic cadences make the UK’s experience seem exceptional, in many ways that is how democracies in general have confronted the pandemic. Uncomfortable combinations of politicians, technocrats and officials have jostled for primacy, trying to figure out a path through the devastation wrought by Covid.

How has this developed in Ireland?

“It is possible that we are facing events unprecedented in modern times,” then-taoiseach Leo Varadkar told a press briefing on March 9th, 2020. He had just come from the first meeting of the Cabinet subcommittee on Covid-19, wryly remembered by one participant as like something out of a bygone era. In a “completely packed” Sycamore Room in Government Buildings, Ministers, officials and advisers heard a stark presentation from chief medical officer Dr Tony Holohan. Italy had just gone into a full lockdown.

‘Very tight-knit’

The initial reaction to Covid-19 was characterised by near consensus, sources say. “In the beginning it was very much [Minister for Health Simon] Harris, Leo [Varadkar] and Tony Holohan, and that was all very tight-knit.” Paschal Donohoe, then minister for both finance and public expenditure, and a select group of senior officials, also drew up the early response. Martin Fraser, secretary general at the Department of the Taoiseach was, and remains, a key actor, as were his counterparts in finance, Derek Moran, and public expenditure, Robert Watt – now in the same role at the Department of Health. Also involved was Jim Breslin, then-head of the Department of Health.

Alongside this, the National Public Health Emergency Team (Nphet), and particularly Dr Holohan, rose to prominence, and power. The political system was in a holding pattern; Varadkar’s caretaker government held the reins after an inconclusive election. It was, a Nphet member recalls, an atmosphere “amplified by fear, the catastrophe in Bergamo, the political interregnum and the personalities of the people involved”.

As the pandemic has worn on, consensus has worn thin: most visibly last October, when the chief medical officer’s push for a Level-5 lockdown was dramatically rejected by the Government, encapsulated by Varadkar’s TV interview with Claire Byrne. Sources on both sides argue that relations currently, and generally, are “a lot warmer than many media reports suggest”, but nonetheless, frustrations have continued.

Disease focus

A senior official says there is a “central problem” with the power located in Nphet, namely that “focusing purely on the disease leads to a certain view”. Other criticisms from politicians, advisers and officials are well-rehearsed: that the team is unwieldy, full of civil servants, has been slow to act on issues like masking and antigen testing, and ultimately retains too much agenda-setting power. Some on the political side also argue the chief medical officer is too central. “Locating all the institutional power of Nphet in one individual means they carry too much power and too much responsibility.”

Privately, many Nphet members don’t dispute the unusual extent of its powers. One remarks on the sheer unlikeliness of how policy developed: “We had a meeting at midnight, and the next day the Government says everyone must stay in their house.”

It is, the member continues, “an ad hoc technocratic structure inserted into the decision-making process of government in a not necessarily well-thought-through way”, but ultimately, “the advice is good and [the Government] needs the advice”. While there have been moves to reform or restructure Nphet, they have all fallen away due to concerns over optics, or the competing priorities of the pandemic.

Force and visability

There have been attempts to redress the power balance, with varying degrees of success. The Senior Officials Group, led by Fraser, was designed to blend Nphet advice with wider perspectives before they were sent to the Cabinet Covid subcommittee. However, it has had limited success, often overtaken by events, as well as the force and high visibility of Nphet recommendations.

For the time being, after what is commonly acknowledged to have been a “disaster” at Christmas, after which cases spiked, there is once again little difference between the stances of Nphet, Government and officialdom. There is a broad consensus that unlocking will be incremental, conservative and reliant on vaccination. Whether that survives the next few weeks, as case numbers stall and patience with restrictions wears thin, remains to be seen. Meanwhile, old frustrations still bubble under the surface.

“We can’t continue with Nphet structures; once we get to a different place with the disease we’ll have to do it differently [than] all these endless meetings and press conferences”, remarked one exasperated official.

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