Big Interview: Professor Chris Whitty

In the Eye of the Storm

Professor Chris Whitty reflects on his role leading the response to the biggest health crisis for a century. He speaks to GP Frontline...

England’s Chief Medical Officer, Professor Chris Whitty, has just rushed back to his office at the Department of Health and Social Care from unplanned, urgent meetings in Whitehall, down the road.

It’s the day the Joint Committee on Vaccination and Immunisation has said the evidence isn’t clear on Covid-19 vaccinations for 12–15 year olds and has deferred to the four Chief Medical Officers of the UK for a view to inform what will be ultimately be a political decision by Government.

He’s clearly an incredibly busy man – as he has been throughout as the clinical lead, and face, of the Covid-19 pandemic – but he’s making time for a rare sit-down interview with GP Frontline. The key message he wants to get across: “a massive thanks to general practitioners and the wider primary care team for what they’ve done during the pandemic and will have to continue to do over what will be a very difficult winter.”

Prof Whitty sees taking a view on ‘difficult issues’ as a key part of the role. However, he is also clear that his role is to advise – and the Government’s role to make decisions.

“My job is to be a doctor,” he explains, “it is right that people should ask me, and people like me, questions you would ask a doctor – and I may take advice from others, including GPs, before answering. Some decisions are highly technical, and it would be rare for a political leader to go against my advice on these, because it’s a medical question; but questions about what to do in terms of societal impact and economic interventions are for political leaders to take the call.”

His first Government role was in 2009 when he joined the Department for International Development as Chief Scientific Adviser, a role he took on at the DHSC in 2016 – with responsibilities including leading the National Institute for Health Research – until becoming CMO in 2019, succeeding Prof Dame Sally Davies. He's a Consultant Physician at UCLH, Professor of Public Health at the London School of Hygiene and Tropical Medicine and Gresham Professor of Physic.

An epidemiologist by specialty, he understands the importance of medical generalism with one of his priorities on becoming CMO to promote a greater focus on generalism in medicine in order to care for the increasing numbers of people living with multiple, chronic conditions:

“Medicine has been extraordinarily effective through medical science in dealing with individual diseases, and much less strong in dealing with people who’ve got multiple morbidities…I’d like to see a celebration of generalism that allows specialists to continue specialising, but maintaining the generalist skills that allow them to see, for example, an eight-year-old with six or seven conditions and that those interact, not just medically but in how that patient lives their life.

“It’s what most GPs deal with all the time and it’s something I think the rest of the medical profession could learn a lot from,” he says.

His priorities were obviously thrown into disarray in early 2020 with the onset of the Covid-19 pandemic. It made him one of the most recognisable faces in the country, taking part in regular press conferences alongside the Prime Minister, Cabinet Ministers and other scientific advisers. “It was the bit of the role I was least looking forward to,” he admits, “I had no idea that it would be as extensive as it is, but you’ve got to accept it if you take a role like this and then there’s an emergency. It’s the job of a doctor to communicate risk, and values, in an honest way.” In terms of how he’s dealt with the unprecedented scrutiny he modestly says; “not to get too obsessed with either the good or the bad. The best bit of advice I was given early in my career was never to worry about criticism from people you wouldn’t take advice from, and I’ve stuck to that.”

As an epidemiologist with a clinical interest in infectious disease and experience of previous pandemics, Prof Whitty says he was ‘relatively familiar’ with the necessary areas of science to lead the pandemic response but insists there was no such thing as a ‘perfect’ person for the role. “We’re all shades of imperfect on this,” he says, “it was a new infection, there was a huge amount we didn’t know. You have the things you know, and a bunch of stuff you don’t, and you have to go with your best judgement. It’s the problem of dealing with uncertainty – something every GP has to deal with every day in their professional life.”

Casting his mind back to when he first heard about Covid-19, he says: “A lot of epidemics happen…very few of them turn into a pandemic. Back in early January last year our view was that things could go one of several ways. It could be something that’s locally contained, as MERS was in South Korea; it could be something that had regional impact with some spillover, such as we saw with SARS; or it could be something that went globally. That last option was less likely than the others on day one.

“But as time went by, the more benign possibilities came off the table. A global pandemic was always a possibility but it became clearer and clearer this is what would happen. The nearest template we had – a very inexact one – was the 1918 flu pandemic. What that told us is that when these things start running, the impact on society as well as directly on health, is very significant.”

Acknowledging stark differences, it is something Prof Whitty saw working on the HIV/AIDS pandemic, which he describes as a ‘formative experience’ in how he’s thought about medicine since. “In the UK it was a problem largely confined to particular populations, but in southern Africa where I was working around 30% of people my own age had HIV and there were no drugs available, and so they were going to die. It was really catastrophic. It was a very different pandemic to Covid, but you saw the extraordinary impact it had on society.”

Now, his outlook is optimistic although he is very clear the pandemic ‘has a long way to run’ and that it’s ‘going to be bumpy’. He explains: “Science has already ridden to the rescue to a point. We already have some pretty good first generation vaccines. We’ll get more and that will spread our levels of protection. We’ve already got some drugs for treatment that are better than they were. There’s no doubt mortality is lower. We will get anti-virals, the first ones are beginning to come out now and I’m sure they’ll be improved on. Looking forward five years, my expectation is we’ll have quite a wide suite of medical countermeasures. It doesn’t make the problem go away, but it does de-risk it very substantially.”

All of this comes with a strong caveat that ‘there may well be variants that escape the vaccines to some degree.’ And he is clear that the forthcoming winter is going to be tough for the NHS, both in general practice and secondary care. “We’ll undoubtedly have Covid. We may have a significant surge, although it’s hard to be certain at this point, and the probability is we’ll have other respiratory viruses, such as flu and RSV in children, which we had much less of last year.”

Prof Whitty is under no illusions that the pandemic and its aftermath will likely dominate his tenure as CMO in England – and society – for the foreseeable future but he’s acutely aware that Covid-19 is far from the only public health issue of concern. In July he published his annual report on health in coastal towns, areas that with exceptions have significantly worse health overall due to deprivation or high numbers of elderly citizens or both. “It’s finding the areas where health needs are greatest yet where the system isn’t fully working right and trying to work out how to improve healthcare in those areas.” It’s an area Prof Whitty sees GPs as having a ‘really important public health role’ given their place at the heart of communities, but he recognises that they need to be better supported to do this given that the ratio of GPs to need is not even across the country.

His respect for general practice is evident and he states that in another life he may very well become a GP, but ‘there are only so many lives you can lead’. And whilst he didn’t become a general practitioner in the formal sense of going through GP training in the UK, he says he has ‘always seen [himself] as a generalist’.

“I only stopped practising general medicine when I took this job. I’ve worked as a general physician throughout all my previous government jobs and when I worked in Africa or Asia, I dealt with problems that in the UK a GP would deal with, because we’re fortunate enough to have a specialist primary care system. Most countries across the world don’t. So, I’ve done many of the things a GP would recognise as traditional general practice. I think it’s an amazing job; an extraordinary career.”

He describes the role of GPs and their teams throughout the pandemic as ‘magnificent’, particularly in terms of rapidly adapting to new ways of working in difficult circumstances, its role in research – for example the PRINCIPLE study involving the RCGP’s Research and Surveillance Centre – and the leadership of the vaccination programme.

It is this latter achievement that Prof Whitty sees as setting the UK apart from many other countries, and an area where he thinks the UK’s global responsibility lies in terms of bringing the pandemic under control. “Just providing a vaccine isn’t enough,” he explains, “GPs will appreciate this point more than people more widely, but you also need a system to deliver it. Many lower income countries have good systems for providing childhood vaccinations, but a system to deliver adult vaccines in the way GPs [here] do every year doesn’t exist in many low income countries. We have to support the delivery, not just the vaccine.”

Whilst ‘extraordinarily positive’ about general practice’s response to the pandemic, he is aware of the criticism GPs and their teams continue to face from some sections of the media and patient groups around access to face to face appointments. “Consultation at a distance has been necessary and right but hasn’t worked well for everybody in terms of doctor-patient interactions. The pendulum clearly got accelerated and swung far further than it would have done without the pandemic. When it swings back, it’s not going to go all the way, but where it should settle I don’t know. My view is the right people to make that decision are GPs, listening to their patients, getting the balance right.”

He sees the next big role for GPs in the pandemic response, aside from continued leadership of the vaccine programme, as prescribing anti-virals at a community level, although he is clear this is not necessarily ‘around the corner’.

Prof Whitty addressed the RCGP Annual Primary Care Conference this month where he was interviewed by College Chair Prof Martin Marshall. His key message was that he thinks the work of GPs and their teams during the pandemic has been ‘quite remarkable’ and that ‘when people look back on it…that will be history’s view.’•