Liverpool public health expert presents at Covid-19 Inquiry
The University of Liverpool’s Professor Iain Buchan presented critical lessons from the Liverpool Covid-19 testing pilot at a public hearing of Module 7 of the UK Covid-19 Inquiry.
His evidence offered insight into how future pandemics can be managed more effectively.
Module 7, focusing on Test, Trace and Isolate, is examining the UK’s approach to testing, contact tracing and self-isolation from January 2020 to 28 June 2022. Professor Buchan’s evidence drew on real-world learning from the Liverpool pilot—the UK’s first city-wide asymptomatic mass testing programme launched in November 2020.
Professor Buchan outlined seven key lessons for effective pandemic response, emphasising the need for clear testing goals, with rapid tests better suited than PCRs. He highlighted the importance of equity, timely data, public health expertise, and AI tools in supporting effective decision-making. He also stressed the need to align preparedness with innovation and economic strategy and recommended regular simulation exercises across all leadership levels to ensure readiness for future health crises and ongoing NHS pressures.
Professor Iain Buchan, Associate Pro Vice-Chancellor for Innovation at the University of Liverpool led the scientific evaluation of the Liverpool pilot. He said: “Testing in a pandemic is partnership of trust between public health authorities and the public. That trust needs a clear, shared understanding of different testing purposes – for example, a medical test to see if a patient’s illness is due to a virus is different to a public health test for a person to see if they are infected with the virus and might pass it on. A medical test that takes days and remains positive after you are no longer infectious is not useful as a community-driven test.”
He added: “Public health experts with close links to local communities are well placed to help different researchers, for example biologists, data scientists, psychologists and social scientists have a joined-up conversation in designing, evaluating and optimising pandemic testing programmes. It is vital to provide these teams with the right data at the right times to provide key insights for policymakers.”
Professor Buchan saluted the people of Liverpool for their “grit and grace” in enabling globally important insights into how lateral flow devices could be used well in the Covid-19 pandemic. The Liverpool Covid-19 Testing Pilot launched 6th November 2020 as a partnership between the people of Liverpool, local public health teams, the University of Liverpool, the NHS and the British Army.
Seven key lessons for pandemic preparedness
Professor Buchan outlined the following recommendations for future pandemics to be managed more effectively through smarter testing, fairer support systems, and better integration of data and technology:
1. Clarify the Purpose of Testing
Different goals require different testing tools. PCR tests, while highly sensitive, need a laboratory and can take days to give a result, whereas lateral flow self-tests give answers in minutes. This is time an infected person may be spreading the virus while waiting for a PCR result. If the goal is to enable communities to quickly self-isolate when they are infectious but might not have symptoms, then lateral flow tests are useful. They are also useful for getting people back to work from isolation or quarantine when they are no longer infectious. Professor Buchan explains more about different testing purposes in this film.
2. Address Poverty and Health Inequality
Residents in deprived communities were more likely to test positive but less likely to access testing or isolate. Financial insecurity and inadequate support were major barriers. Pandemic responses must embed equity from the outset.
3. Use Public Health Expertise to Bridge Disciplines
Public health professionals offer crucial context that connects behaviour, data, and modelling. Insights into how care workers live and work or how family behaviours might change after testing are essential for accurate planning and response.
4. Deliver Timely Data to Decision-Makers
The Liverpool team lacked access to England-wide hospital admission data until nine months after the start of the pilot. This delayed the important insight that community testing reduced hospital admissions with severed Covid-19 by at least a quarter. Pre-agreed data-sharing systems are essential and should be established before the next health crisis—not during it.
5. Harness AI to Guide Testing and Isolation
AI tools could provide public-facing advice on how to test, interpret results, isolate, and trace contacts. Such technologies can be piloted now to manage seasonal NHS pressures and build scalable pandemic tools.
6. Align Pandemic Readiness with Innovation and Economic Strategy
The UK has strong sources of data for training and testing AI and optimising the uses of tests for infections. Innovation in these areas can help the NHS, especially when it faces winter pressures. Local economies in the most pressured areas also need the growth that these innovations could lead to. Here you can read how the Northern Health Science Alliance outline how a ‘national grid’ of this kind of innovation could work. The UK has the collaborative public infrastructure to lead globally in this space.
7. Rehearse at All Levels of Public Leadership and Society
Simulations and practical exercises should be conducted regularly—from the top of Government to local town halls—to ensure readiness across systems. These rehearsals can also help tackle ongoing challenges like winter NHS pressures.