Why Britain Failed Its Coronavirus Test
Boris Johnson has faced his share of blame for the countrys death count. But the British system was failing long before the coronavirus struck. F aced with the coronavirus pandemic, Britains leaders asked their people to do three things, captured in one pithy slogan: Stay home. Protect the NHS. Save lives. On the first of those edicts, Britons largely followed through. Main streets, town centers, and public spaces were mostly abandoned, and the government pulled together a far-reaching job-protection program, ensuring that those who feared losing their jobs felt safe enough to not go to work. The second request was more unusual. During the pandemic, Britain was the only major country in the world to make protecting its National Health Service a central goal. Signs and placards went up outside peoples homes, declaring their appreciation. The words Thank You NHS can now be seen on sidewalks and soccer jerseys, in childrens bedrooms and even, until recently, the windows of 10 Downing Street. In part, this worked. The NHS adapted to the crisis at extraordinary speed, creating the emergency capacity required to deal with the surge of patients. When Prime Minister Boris Johnson was released from the hospital after contracting COVID-19, he said that Britain was winning its battle against the disease because the public had formed a human shield around this countrys greatest national asset, the NHS. On the third count, however, the country did not succeed, certainly compared with almost any other developed nation. Britain did not save as many lives as others. It had the money, the tools, and the wherewithal to respond as well as any, yet more of its people died than anywhere else in Europe. Britain has not been alone in its failure to prevent mass casualtiesalmost every country on the Continent suffered appalling lossesbut one cannot avoid the grim reality spelled out in the numbers: If almost all countries failed, then Britain failed more than most. The raw figures are grim. Britain has the worst overall COVID-19 death toll in Europe, with more than 46,000 dead according to official figures, while also suffering the Continents second-worst excess death tally per capita, more than double that in France and eight times higher than Germanys. It did not protect its oldest and most vulnerable, who died in nursing homes in appalling numbers. It allowed the disease to spread throughout the country rather than isolating it in one area. It failed to close its borders in good time, abandoned contact tracing too early, set targets that were missed, designed government programs that didnt work, and somehow contrived to let the three most senior figures overseeing its pandemic response, including the prime minister, catch the very virus they were fighting. Now it faces the worst recession of any developed country, according to the Organization for Economic Cooperation and Development , and is once again taking a gamble by easing its lockdown at a relatively early stage . Read: The meaning of Boris Johnsons illness Much of the focus has been on Johnson: an apparent manifestation of all that has gone wrong in Britain, a caricature of imperial nostalgia, Trumpian populism, and a general lack of seriousness. Yet this was not simply an issue of inept political leadership, inept or otherwise: Johnson stuck closely to a strategy designed and endorsed by the governments experts, leaders in their fields and respected internationally. Even if the prime minister did make serious mistakes, the countrys issues run far deeper. The British government as a whole made poorer decisions, based on poorer advice, founded on poorer evidence, supplied by poorer testing, with the inevitable consequence that it achieved poorer results than almost any of its peers. It failed in its preparation, its diagnosis, and its treatment. As prime minister, Johnson must accept that Britains failures are his as well. Still, the difficult truth is that the countrys failures clearly go beyond Johnson. They were collective, multilayered, and deadly. The most difficult question about all this is also the simplest: Why? To try to answer that question, I spoke with leading politicians, including a former prime minister and five former cabinet ministers; three experts who either sit on the governments scientific advisory committee for responding to pandemics, SAGE, or have briefed it during the crisis; half a dozen influential officials working in Downing Street and the NHS; and specialists associated with the governments response, including professors of epidemiology, mathematics, history, and psychology. I also interviewed diplomats and officials from Britain and other European governments to understand what assessments were being made outside the country. Those in sensitive positions mostly asked for anonymity to be able to speak frankly. What emerges is a picture of a country whose systemic weaknesses were exposed with appalling brutality, a country that believed it was stronger than it was, and that paid the price for failures that have built up for years. At the start of 2020, Britain had been through 10 years of austerity following the 2008 financial crashanother great international crisis that hit the country harder than almost anywhere else. The NHS was stretched and fragmented, its lines of authority and responsibility tangled by years of regulatory tinkering. Outside London, the countrys economy was unproductive and poor, and its elderly-care system an unreformed national disgrace. The civil service, which believed itself to be the best in the world, had become a shadow of its former self, almost entirely shorn of the ability to act operationally or think strategically, its center hollowed out, weak, and ineffective. The country itself seemed divided and angry, unable to agree on a unifying national story. But step back and an even bleaker image is revealed. In the past two decades, the list of British calamities, policy misjudgments, and forecasting failures has been eye-watering: the disaster of Iraq, the botched Libyan intervention in 2011, the near miss of Scottish independence in 2014, the woeful handling of Britains divorce from the European Union from 2016 onward. As one senior British government adviser put it to me, Weve had our arse handed to us recently. When the pandemic hit, then, Britain was not the strong, successful, resilient country it imagined, but a poorly governed and fragile one. The truth is, Britain was sick before it caught the coronavirus. Like America, the country failed to live up to its reputation as a pillar of pandemic readiness. But unlike America, Britains political leadership stuck closely to the script experts had drawn up for itand the country still struggled. In remarks echoed, though perhaps not as colorfully, by politicians, officials, and diplomats, one figure close to Johnson told me of his experience at the heart of the government machine these past few months: Its a fucking disgrace. B ritains pandemic story is not all bad. The NHS is almost universally seen as having risen to the challenge; the University of Oxford is leading the race to develop the first coronavirus vaccine for international distribution, backed with timely and significant government cash; new hospitals were built and treatments discovered with extraordinary speed; the welfare system did not collapse, despite the enormous pressure it suddenly faced; and a national economic safety net was rolled out quickly. It is also too early to say precisely why, epidemiologically, Britain suffered more deaths than other comparable countries, such as France, Germany, Italy, or Spain. Some government officials and experts I spoke withincluding a senior adviser to the leader of one of the best-performing countries in Europesaid that Britain may have just been unlucky in the number of holidaymakers it had returning from the wrong places at the wrong times. Britain is also more densely populated than almost any other country in Europe, with its preeminent city and busiest airport. Like a Silk Road port at the time of the plague, London is a 21st-century global hub unlike anywhere else in the region. It is no coincidence that the British capital and New York have been among the two worst-affected cities in the world. Today, the scale of infection in Britain has been brought into line with that of the rest of Europe. The primary concern now being raised in London is the prospect of a second spike in Europe rather than Britainwhich may or may not prove hubristic in time. Either way, one cannot definitively judge the overall success or failure of a countrys response for months, or even years, to come. The final verdict will be influenced by when a vaccine is foundif at allas well as each countrys ability to bounce back socially and economically. Already, according to conversations I had with officials inside 10 Downing Street, the government believes that the economic recovery will soon be more important to the publics perception of British competence than the death count. Yet no one I spoke with, Johnson friend or foe, claimed that Britains response to date could reasonably be described as anything other than disappointingtoo many people have died for it to be anything else. One influential U.K. government official told me that although individual mistakes always happen in a fast-moving crisis, and had clearly taken place in Britains response to COVID-19, it was impossible to escape the conclusion that Britain was simply not ready. As Ian Boyd, a professor and member of SAGE, put it: The reality is, there has been a major systemic failure. The majority of those I spoke witheven those close to Johnson and the governments effort to contain the pandemicagreed that, in hindsight, the prime minister and his most senior health and scientific advisers made serious missteps. Most also agreed that on top of poor decisions was poor management as parts of the system became overwhelmed and, as one senior U.K. official involved in the governments pandemic response said, simply collapsed. The civil service appeared unprepared for the scale of the task: One official close to Johnson told me that the Cabinet Officethe department that coordinates with all others for the prime ministerwent through multiple organizational restructures during the pandemic, signaling its lack of readiness. The senior U.K. official recounted how, in some meetings, staffers had to tally total COVID-19 case counts on their smartphones based on figures scribbled on whiteboards hastily dragged into Downing Street, because the country lacked a well-connected data system. Its obvious that the British state was not prepared for the pandemic, this official told me. But, even worse, many parts of the state thought they were prepared, which is significantly more dangerous. When the crisis came, too much of Britains core infrastructure simply failed, according to senior officials and experts involved in the pandemic response. Expert advisory committees proved too slow and ponderous, with not enough dissenting voices; crisis-response cells could not cope and had to be bypassed; the Cabinet Office buckled under the strain; the NHS had no adequate way of sharing data; authorities could not meet the sudden need for mass testing; the Foreign Office could not get people home fast enough ; the Department of Health could not design a contact-tracing app that worked; the government overall could not sufficiently procure key pandemic equipment; and Downing Street generally gave the impression of lurching from one crisis to another. People will look back and say, Could we have done it earlier? and with the power of retrospectroscope, which is an infinitely powerful instrument, the answer to that is, probably, Mark Walport, who like Boyd sits on SAGE, told me. But Walport said this was not the fundamental issue of the crisis. Many of the challenges that weve had are not, as it were, about policy advice or the science advice; they are questions about resilience. Dominic Cummings, the prime ministers most influential adviser, has used the analogy of the human immune system to explain what he believes is wrong with the British state, which he says has become too static. The immune system, Cummings argues, has no plan or central control; it is adaptable, and therefore stronger. He is only half right. The human immune system actually has two parts. There is, as Cummings correctly identifies, the adaptive part. But there is also an innate part, preprogrammed as the first line of defense against infectious disease. Humans need both. The same is true of a state and its government, said those I spoke withmany of whom were sympathetic to Cummingss diagnosis. Without a functioning structure, the responsive antibodies of the government and its agencies cannot learn on the job. When the pandemic hit, both parts of Britains immune system were found wanting. B y the time Johnson chaired his first emergency coronavirus meeting, on March 2, Britain had officially recorded 39 cases . The Chinese city of Wuhan, the epicenter of the virus, had been subject to a brutal lockdown, while other places had experienced epidemics of their own. Northern Italy was about to become the first European disaster zone. Yet in London, officials insisted there was no need to panic. Britain, it seemed, had time to ready itself, lagging a few weeks behind Italy, and was well prepared to weather the storm: The country was ranked second in the world for its preparedness against biological threats, behind only the United States, and had spent years preparing for a pandemic. It had the institutional structures in place to advise the prime minister, the health system to handle an outbreak, and the expertise to arrive at the right decisions. The true extent of Britains outbreak at that point, we now know, was likely much worse than the official figures, with cases brought back to the country from multiple parts of the worldseeds planted in the fertile soil of a heavily populated, globally connected economy. On March 3, journalistsincluding mewere called into Downing Street for a briefing setting out Britains strategy. Government advisers made clear that although they had not given up hope that the virus could be contained internationally, Britain could not do so alone. The countrys experts told us then that any steps taken to slow the spread of the disease domestically needed to be timed intelligently, to ensure that they covered the peak of the crisis. If a lockdown were ordered too early, it would suppress the disease and save lives in the short term, but only delay the inevitable outbreak, and potentially make it worse by pushing it into the winter, a time when flu-related illnesses also peak, or to a point when public willingness to endure such severe social-isolation measures had run its course. This remains a concern. The governments job, as its leaders saw it, was to ensure that the most vulnerable members of society were protected and that the spread slowed to ensure that hospitals could cope. This was not the response among Asian countries, which experienced outbreaks before Britain but nevertheless sought to permanently defeat the virus. South Korea, for example, instituted widespread testing, alongside a contact-tracing regime to keep the disease at bay until a vaccine could be found. Many others in the region adopted masks en masse. Travel restrictions were put in place. Lockdowns, large and small, were implemented. Read: The U.K.s coronavirus herd immunity debacle Like much of the Western world, Britain had prepared for an influenza pandemic, whereas places that were hit earlyHong Kong, South Korea, Singapore, Taiwanhad readied themselves for the type of respiratory illness that COVID-19 proved to be. There was a bit too much exceptionalism about how brilliant British science was at the start of this outbreak, which ended up with a blind spot about what was happening in Korea, Taiwan, Singapore, where we just werent looking closely enough, and they turned out to be the best in the world at tackling the coronavirus, a former British cabinet minister told me. The focus on influenza pandemics and the lack of a tracing system were compounded by a shortfall in testing capacity. According to a report on the governments handling of the pandemic by Lawrence Freedman, a war-studies professor emeritus at Kings College London, Britains original plan was overwhelmed by the speed of the pandemic, which it did not fully understand until it was too latean account supported by the experts I spoke with. If there had been more testing capacity, not only would the government have stood a better chance at tracing those with the disease, but it would have been better informed about the spread of the virus in general, and may therefore have ordered the lockdown earlier. Even doing so by a small amount of time would have made a difference. Neil Ferguson, one of the countrys leading epidemiologists, told lawmakers in June that Britains death toll could have been halved had the lockdown, which began March 23, been imposed a week earlier (though this was not SAGEs advice at the time). Still, this narrow focus on when recommendations were given, and whether it was the best advice, runs the risk of appearing to absolve Johnson of blameif the system is at fault, then no one person could have salvaged it. And his insistence that he was following experts advice masks the inherently political choices all leaders must make in times of crisis. Other leaders, supported by other systems, arrived at better decisions more quickly than Britain. On March 10, restrictions began to be imposed in Berlin, a decision that Freedman concludes was a significant factor in Germanys overall success. Leaders in France and Italy enacted more stringent restrictions in their cities and countries, and suffered fewer deaths. One of the central criticisms of Johnsons leadershipexpressed to me in multiple conversationsis not a refusal to accept the truth (the charge of many international observers, including Barack Obamas deputy national security adviser Ben Rhodes, lumping him in with populists such as Donald Trump or Jair Bolsonaro) but a failure to challenge his experts strategy. It was the prime ministers duty to question the scientific advice, to demand more. This is not a critique made solely in hindsight: On March 12, Rory Stewart, a former Conservative lawmaker who took on Johnson for the party leadership last year, set out the reasons Johnson needed to follow Merkels lead. The key thing to understand in any emergency response is that you need to make a judgment, he said then. Stewart said Johnson needed to take responsibility and argued it was deeply, deeply unfair to claim that Britain followed the experts plan, not his own. To a large extent, Johnsons hope and trust in his advisers was understandable: A Downing Street official asked me to imagine the outrage if the prime minister had been accused of overruling scientific and medical advisers early in the crisis. Still, Johnsons strategy throughout was one that his hero Winston Churchill raged against during the First World War, when he concluded that generals had been given too much power by politicians. In the Second World War, Churchill, by then prime minister and defense secretary, argued that at the summit, true politics and strategy are one. Johnson did not take this approach, succumbingas his detractors would have itto fatalistic management rather than bold leadership, empowering the generals rather than taking responsibility himself. (Of course, Johnsons hospitalization in April also had an impact, something even his detractors, among them Tony Blair, told me cannot be discounted when trying to measure the governments performance.) Had Johnson not challenged his advisers because he was told what he wanted to hearthat locking down the economy was not necessary? Was Johnson, part libertarian, part optimist, simply too instinctively skeptical of draconian limits on individual freedom to impose them? It was a mixture of poor advice and fatalism on behalf of the experts, one former colleague of Johnsons told me, and complacency and boosterism on behalf of the PM. Read: The coronavirus is more than just a health crisis What it all adds up to, then, is a sobering reality: Institutional weaknesses of state capacity and advice were not corrected by political judgment, and political weaknesses were not corrected by institutional strength. The system was hardwired for a crisis that did not come, and could not adapt quickly enough to the one that did. O ver time, Britains NHS has come to represent the country itself, its sense of identity and what it stands for. Set up in 1948, it became known as the first universal health-care system of any major country in the world (although in reality New Zealand got there first). Its creation, three years after victory in the Second World War, was a high-water mark in the countrys power and prestigea time when it was a global leader, an exception. Of course, neither Britain nor its health-care system is exceptional anymore, at least in this regard. Every developed country in the world, apart from the United States, has a universal health-care system, many of which produce better results than the NHS. Yet from its beginnings, the NHS has occupied a unique hold on British life. It is routinely among the most trusted institutions in the country. Its key tenetthat all Britons will have access to health care, free at the point of servicesymbolizes an aspirational egalitarianism that, even as inequality has risen since the Margaret Thatcher era, remains at the core of British identity. It is impossible to entirely disentangle modern Britain from the NHS, or vice versa. The country, so often lumped together with the U.S. as economically Anglo-Saxon, has a slice of socialism at the heart of its national life, largely left alone by governments of all persuasions. More recently, the NHS has been at the center of every election for at least a generation, a main character in the fight over Brexit, and finally, the linchpin in Britains battle to contain the pandemic. In asking the country to rally to the NHSs defense, Johnson was triggering its sense of self, its sense of pride and national unityits sense of exceptionalism. Before the coronavirus, the NHS was already under considerable financial pressure. Waiting times for appointments were rising, and the country had one of the lowest levels of spare intensive-care capacity in Europe. In 2017, Simon Stevens, the NHSs chief executive, compared the situation to the time of the health services founding decades prior: an economy in disarray, the end of empire, a nation negotiating its place in the world. Britain had come full circle, he seemed to be saying. A rebirth was needed. Instead, the country entered a rolling political crisis over Brexit, ending in Johnsons elevation to the premiership and election victory in December 2019. Then came the pandemic. When Italys hospitals quickly became overwhelmed in early March, there were serious concerns that the NHS would meet a similar fate. Extraordinary measures would be required to make space for the coming crisis. The question now troubling experts is: at what cost? In early April, the first of Englands seven new Nightingale hospitalsnamed after Florence Nightingale, the pioneering Victorian nursewas opened in a conference center in East London, ready for the expected surge in patients. The hospital was built in nine days with space for 4,000 beds and opened by Prince Charles to much acclaim, restoring the belief that the country could still act with speed. Medical students were pushed into service, retired NHS staff were called back in, and an army of volunteers was recruited to help hospitals function. Existing hospitals were hastily redesigned, nonessential operations were canceled, and the public was urged to avoid overburdening the system where possible. By early May, such was the success in creating additional capacity that the government announced that the Nightingale hospitals would be wound down and put in hibernation after barely being used. Read: A Brits advice for the U.S. health-care system Yet this apparent victoryof sparing the NHS the fate that met Italys hospitalsmay have been pyrrhic. According to Freedmans report, the effort to increase capacity potentially deterred people who needed urgent treatment but did not want to burden the health system. Others who required treatment might have been denied it because the focus had quickly shifted to COVID-19. The consequences may be serious and long term, but the most immediately tragic effect was that creating space in hospitals appears to have been prioritized over shielding Britains elderly, many of whom were moved to care homes, part of what Britain calls the social-care sector, where the disease then spread. Some 25,000 patients were discharged into these care homes between March 17 and April 16, many without a requirement that they secure a negative coronavirus test beforehand. In effect, Britain was rigorously building capacity to help the NHS cope, but releasing potentially infected elderly, and vulnerable, patients in the process. By late June, more than 19,000 people had died in care homes from COVID-19. Separate excess-death data suggest that the figure may be considerably higher. According to a report by the International Long-Term Care Policy Network, a London-based research body, Britain has recorded more deaths from COVID-19 as a percentage of its nursing-home population than any other country in Europe, apart from Spain. A cross-party parliamentary report was more cutting : Sending patients into care homes without testing them for COVID-19 was an appalling error and an example of the governments slow, inconsistent and at times negligent approach to social care. This tragedy is an example of Britains systemic failures of governance, according to leading health experts and former cabinet ministers I spoke with, an indictment of the countrys short-term, centralized government apparatus. Britain failed to foresee the dangers of such an extraordinary rush to create hospital capacity, a shift that was necessary only because of years of underfunding and decades of missed opportunities to bridge the divide between the NHS and retirement homes, which other countries, such as Germany, had found the political will to do. Ultimately, the scandal is a consequence of a political culture that has proved unable to confront and address long-term problems, even when they are well known. The NHS remains the pride of the country, but it is kept separate from the largely private social-care sector. In 1948, this made sense, when child mortality and diseases such as tuberculosis were the chief health concerns, and life expectancy stood at 66 for men and 70 for women ( today it is 80 and 84, respectively). When the pandemic gripped Britain, these two systems came into conflict. The NHS was protected and given priority, leaving care homes in the lurch. Britain is far from unique in seeing the disease rip through its care homes. Yet this should not distract us from the reality that, just as other political leaders made better choices than Johnson did, other health systems, such as Germanys, which is better funded and decentralized, performed better than Britains. Those I spoke with who either are in Germany or know about Germanys success told me there was an element of luck about the disparity with Britain. Germany had a greater industrial base to produce medical testing and personal protective equipment, and those who returned to Germany with the virus from abroad were often younger and healthier, meaning the initial strain on its health system was less. However, this overlooks core structural issuesresulting from political choices in each countrythat meant that Germany proved more resilient when the crisis came, whether because of the funding formula for its health system, which allows individuals more latitude to top up their coverage with private contributions, or its decentralized nature, which meant that separate regions and hospitals were better able to respond to local outbreaks and build their own testing network. Also unlike Britain, which has ducked the problem of reforming elderly care, Germany created a system in 1995 that everyone pays into, avoids catastrophic costs, and has cross-party support. The reforms, although far from perfect, have provided the foundations for a system that has been able to adapt and respond to changing circumstances, according to the British health think tank the Nuffield Trustexactly what has not happened in Britain. A second, related revelation of the crisiswhich also exposed the failure of the British stateis that underneath the apparent simplicity of the NHSs single national model lies an engine of bewildering complexity, whose lines of responsibility, control, and accountability are unintelligible to voters and even to most politicians. In a number of conversations for this piece, the NHSs byzantine nature was likened to the spiderweb of regulatory bodies tasked with monitoring Britains financial sector in the run-up to the 2008 crisis. That system was hailed as world leading but failed when called upon, and much of the regulatory burden has since been centralized. Britain, I was told, has found a way to be simultaneously overcentralized and weak at its center. The pandemic revealed the British states inability to manage the nations health: to create a funding model that does not solely promote efficiency, to rise above short-term problems and tackle the problem of old-age care, and to mend the broken system of accountability that runs through so much of British public life. Throughout the NHSs existence, British governments, both Conservative and Labour, have found the political will to tinker with it, but rarely to tackle its long-term challenges, fearful of losing votes. The NHS did not fail, but the system overall didand people died as a result. B ritains unwillingness to address systemic problems is not confined to health care. Since at least the 1970s, growing inequality between comparatively rich southeast England (including London) and the rest of the country has spurred all parties to pledge to rebalance the economy and make it less reliant on the capital. Yet large parts remain poorer than the European average. According to official EU figures , Britain has five regions with a per capita gross domestic product of less than $25,000. France, Germany, Ireland, Austria, the Netherlands, Denmark, and Sweden have none. If Britain were part of the United States, it would be anywhere from the third- to the eighth-poorest state, depending on the measure. Britains performance in this crisis has been so bad, it is damaging the countrys reputation, both at home and abroad. According to one senior British official, who has decades of experience and who does not serve Johnson, there was a sense of shock internationally that Britain had so obviously fallen short, a feeling echoed along the corridors of power in Westminster. Inside Downing Street, officials believe that the lessons of the pandemic apply far beyond the immediate confines of elderly care and coronavirus testing, taking in Britains long-term economic failures and general governance, as well as what they regard as its ineffective foreign policy and diplomacy. Read: The coronavirus is never going away The reaction in Downing Street is a reminder that the Johnson program is revolutionary in instinct, aspiring to do far more than tinker, and Reaganite in its desire to overturn the status quo and usher in a new political zeitgeist that is more assertive on the world stage and more dynamic at home. Whether one believes the government or its self-perception does not change its intention to be transformative. One Johnson adviser told me the government would be remembered for restructuring the British state. Read: Boris Johnson can remake Britain like few before him The trouble for the prime minister is that although the pandemic might reinforce the belief that Britains problems are deep and structural, his handling of it may serve to undermine the countrys consent for him to pursue the kind of program he says is necessary. And the scale of the task itself is enormous. We need a complete revamp of our government structure because its not fit for purpose anymore, Boyd told me. I just dont know if we really understand our weakness. In practice, does Johnson have the confidence to match his diagnosis of Britains ills, given the timidity of his approach during the pandemic? The nagging worry among even Johnsons supporters in Parliament is that although he may campaign as a Ronald Reagan, he might govern as a Silvio Berlusconi, failing to solve the structural problems he has identified. As Blair and others pointed out to me, it is not just in the big calls that Johnson, his scientific advisers, and the system have been found wanting, but in day-to-day governance as well: the ability to get children back to school, open restaurants, protect the economy, and roll out a working contact-tracing system. The prime minister indicated the kind of big-thinking optimism that he believes is necessary with a recent speech detailing his plans to bring Britain out of its pandemic slump with a Rooseveltian New Deal. Yet what did it amount to? Little more than a mishmash of existing projectsa speech and a plan that seemed to confirm Johnsons own critique about the countrys systemic failure to think big and act boldly. Britain is, of course, not alone in being beset by structural problems, failures of governance, and periodic crises. France, Italy, Spain, and the EU as a whole have obvious and lasting dilemmas that have not been addressed. And the United States is divided by racism and inequity. Britains international reputation may also dramatically shift if it discovers and shares a working vaccine while avoiding the worst of a second wave. This is not a story of pessimistic fatalism, of inevitable decline. Britain was able to partially reverse a previous slump in the 1980s, and Germany, seen as a European laggard in the 90s, is now the Wests obvious success story. One of the strengths of the Westminster parliamentary system is that it occasionally produces governmentslike Johnsonswith real power to effect change, should they try to enact it. But just because other countries screw things up does not mean Britains problems arent real and serious, and just because the country has recovered in the past does not mean it will again. It has been overtaken by many of its rivals, whether in terms of health provision or economic resilience, but does not seem to realize it. And once the pandemic passes, the problems Britain faces will remain: how to sustain institutions so that they bind the country together, not pull it apart; how to remain prosperous in the 21st centurys globalized economy; how to promote its interests and values; how to pay for the ever-increasing costs of an aging population. Read: Boris Johnson and the optimism delusion If Britain is to solve them, it needs to up its game or be left behind; to realize it is no longer world leading in as many fields as it thinks, and that its problems run far deeper than whichever crop of politicians is in charge. The really important question, Boyd said, is whether the state, in its current form, is structurally capable of delivering on the big-picture items that are coming, whether pandemics or climate change or anything else. Britain was sick before the crisis hit. If it is to survive the next one intact, it has to address its underlying health conditions.