The first ever meeting of the National Public Health Emergency Team (Nphet) was 570 days ago. In the interim, the frequency with which it has met has usually mirrored the progression of the Covid-19 pandemic.
Probably more important than the frequency of meetings was the agenda-setting power they had. At important moments, the contents of the letter sent by chief medical officer Dr Tony Holohan, and the associated briefing of the Cabinet subcommittee on Covid-19, were the drumbeat of the pandemic in Ireland.
When it convenes next Wednesday, it will be almost a month since Nphet’s last meeting, and in that time case numbers have climbed significantly. Even as vaccination mitigates the worst of the virus, the hospital system and intensive care units have been seeing more admissions.
Hospital Report
The pandemic picture is deteriorating, yet nobody has seen fit to call a meeting of the body charged with providing expert advice on how to manage it. The reason underlying this is likely to be a subtle but significant change in how Ireland is managing Covid-19.
Firstly, power within Nphet has become more focused on a core group. Beyond Holohan, deputy chief medical officer Dr Ronan Glynn, Prof Philip Nolan of the Irish Epidemiological Modelling Group and Dr Cillian de Gascun of the National Virus Reference Laboratory are influential. So too is Dr Darina O’Flanagan, former head of the Health Protection Surveillance Centre (HPSC) and a special adviser to Nphet, and more recently Dr John Cuddihy, the current head of the HPSC.
Recent policy proposals that go to full Nphet meetings largely originate from this group, with the broader meetings “rubber-stamping” them, a source observes .
Shifting approach
Despite – or perhaps because of – the visible and damaging rows between Nphet and the Government that have erupted at times during the pandemic, this group liaises closely with the group of senior officials chaired by Martin Fraser, secretary to the Government. These lines of communication are bolstered by bilateral interactions between key civil servants and Nphet members.
Meanwhile, the political side is also briefed bilaterally, but there is a greater emphasis on the Cabinet Covid-19 subcommittee. This body, comprising Coalition leaders and some senior Ministers, was always important, but it has become more so in recent weeks.
Rather than legislating for every social interaction, members were told significant changes could take place once certain markers were hit
It will meet on Thursday for the second time since the last Nphet meeting. It is here that updated modelling is shared, and that policy matters such as sectoral reopenings are teased out. The patterns that defined Irish policy makers’ approach to the pandemic are shifting, and several sources believe that a new model of pandemic policymaking is gradually emerging.
“Insofar as possible, there’s an attempt to revert to pre-pandemic structures,” says one.
“We’re into a different phase,” says another. “We’re trying to exit from a regime, and that’s being done by negotiation.”
The reasons are partially procedural – meetings of 50 people over Zoom, discussing complex health policy issues, were always unwieldy. They are partly political, with genuine concerns on all sides that authority and power rest – and be seen to rest – with the Government. And, perhaps most importantly, they are partially rooted in a tentative hope that Ireland is moving to a new phase of the pandemic.
Personal judgment
At its most recent meeting, Nphet discussed how, when vaccination reaches levels of about 90 per cent of over-16s, there could be a world with less centralised testing, and less demand for masks and social distancing.
Rather than exhaustively legislating for every social interaction, members were told significant changes could take place once certain markers were hit – such as high levels of vaccination, the reproduction number for each new case being close to or below one, and there being tolerable loads on hospital and critical care capacity.
“Ireland will transition from regulation and population-wide restrictions to a focus on public health advice and personal judgment and responsibility,” the meeting was told.
This would be the most substantial shift in policy in the State since March of last year and, were it to last, it would probably mark the end of the acute phase of the pandemic.
As always, Covid-19 and its variants have the capacity to reverse progress – the current confounding impact of Delta being the most recent example. But, if progress is consolidated, a new day may be dawning.
