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Key Pandemic Lessons Identified in Exercise in 2018

There has been much media coverage today of “Exercise Iris”, an exercise delivered to Scottish Health Boards in March 2018 by the Scottish Government’s Health Protection Division.  The exercise scenario was based on an outbreak of Middle East Respiratory Syndrome (MERS) in Scotland, and media reporting has focused on why the exercise recommendations were not shared and acted upon more widely.  Understandably, people are asking if we might be in a better situation now if the lessons identified two years ago had prompted action across the UK.

Really there are two separate issues here: sharing observations and recommendations from exercises; and turning these recommendations into actions.  We will explore the latter issue first.

The failure to convert “lessons identified” into “lessons learned” is a well established theme in both the practitioner and academic literature on crisis management.  Time and time again recommendations are made following an exercise, or indeed an actual incident, but they are never followed through.  Looking at the post-exercise report from Exercise Iris, there are two obvious reasons why this may have been the case here: many of the recommendations are rather vague; and, at least in the public version of the report, no deadlines are given for completion.  The situation is further complicated because the actions fall on many different organisations (individual Health Boards, the Scottish Government etc) and it is not clear who was responsible overall for seeing that actions were completed.  It is thus not altogether surprising that resources were not immediately made available to address the identified issues.

The information sharing issue is less straightforward.  The Scottish Government has stated that the findings were shared with attendees, which implies that they were not shared with anybody else at the time.  It is reported that the findings were subsequently shared with the UK Government’s New and Emerging Respiratory Virus Threats Advisory Group in June 2019.  One has to be mindful of hindsight bias here: now that we are in a pandemic it seems obvious that these particular findings should have been shared widely; but if everybody shares the findings of every single exercise with everybody else then there would simply be information overload and none of the reports would ever get read.  Perhaps the real questions is why, when we became aware that we were facing a pandemic, were the recommendations still not widely disseminated.  Maybe all we need is a searchable database of post-exercise reports from across the health services, emergency services, central and local government upon which we can draw when we need to.

In summary then, there should clearly be better mechanisms for sharing findings from exercises throughout the UK (and beyond) but, even where information is shared, it is far from certain that it will be acted upon.