The Economist - USA (2022-01-29)

22 Britain TheEconomistJanuary29th 2022

C

ivilservantshavebeenordered

backtotheirdesksaspartofthe

government’sefforttoshowthatpost­

pandemiclifeisreturningtonormal.But

thereisa problem:lackofspace.Thecivil

serviceisatitsbiggestin 12 years.Staff

numbersattheDepartmentforHealth

andSocialCarenearlydoubledinthe

yeartoSeptember2021,with2,070extra

civilservantsbattlingthepandemic.

ThetrendisoutlinedbytheInstitute

forGovernment(ifg), a think­tank,inits

annualWhitehallMonitor.Underthe

austerityprogrammeofDavidCameron’s

government,thecivilservicewascutbya

fifth,reachinga lowof384,260full­time­

equivalentstaffinsummer2016.Those

cutshavebeennearlyfullyreversed:

headcountreached472,700lastautumn,

thehighestsincemid­2010(seechart).

Brexitwasonereason:thousandsof

staffwerehiredtonegotiatetradedeals

andrewriteregulations.Covid­19forced

a secondhiringspree,asyetmoreex­

pertswereneededtorunvaccinepro­

grammes,findandbuyequipment,and

administerfurloughpayments.

Thisshrinkfollowedbya swellhas

complicatedthegovernment’saimto

spreadcivilservantsroundthecountry,

aspartof“levellingup”.Juniorofficials

havebeenshed;seniormanagersand

policyspecialists,whotendtoclusterin

Whitehall,added.Londonnowholds18%

morecivilservantsthanin2010.

RishiSunak,thechancellor,wantsto

cutthe“non­frontline”civilserviceback

toitssizein2019.Dependingonthe

definition,thatwouldmean28,000jobs

going,saystheifg. Itistemptingtothink

it willbeeasytoswingtheaxe,nowthat

Brexitisdoneandcovid­19issubsiding.

ButBrexitlandedthestatewithtasks

thatusedtobedoneinBrussels,suchas

regulatingchemicalsandenforcingtrade

remedies.Andthepandemicrevealed

howthreadbarepartsofit hadbecome.

Ministerswanttomakeit moreresilient

beforethenextcrisis.Thatsuggestsless

a brutalchopthana lighttrim.

Thecivilservice

Stateof emergency

Howcovid-19produceda biggerWhitehall

Many more Mandarins

Britain, civil service staff

Source:InstituteforGovernment

500

450

400

350

300

2119171513112009

Full-timeequivalent,’000

20

10

0

-10

-20

-30

-40

2120181614122010

% change since 200, by region

NorthernIreland

Wales

Scotland

London

England (excl. London)

netics  work  done  at  British  institutions.

Most  of  the  techniques  upon  which  com­

mercial genome­sequencing is based were

invented  in  Britain.  Also  crucial  was  Brit­

ain’s  contribution  to  sequencing  the  hu­

man genome starting in the 1990s, as part

of  a  global  consortium.  Sanger  sequenced

and  published  nearly  a  third  of  that,  the

biggest  chunk  of  any  institution.  The  ebi

was lured to Britain at the start of the effort. 

The project was initially paid for by the

Wellcome  Trust,  a  British  charity  that  is

one of the world’s largest funders of medi­

cal research. It started a virtuous cycle. The

Sanger and ebi sequenced and distributed

more  and  more  genomes,  understanding

life’s code better as they went, and getting

better  at  sequencing.  Other  British  geno­

mics  departments  learned  from  them.  In

Silicon  Valley,  entrepreneurs  founded

companies  and  built  machines  to  meet

their  needs.  The  cost  of  sequencing  a  ge­

nome  fell  dramatically.  It  took  13  years  to

sequence  the  first  human  genome.  Today

the job can be done in a few hours. 

Until a decade ago, the government was

not  a  big  funder  of  genome­sequencing.

That changed under the influence of emi­

nent medics with well­tuned political an­

tennae, such as Sir John Bell and Dame Sal­

ly  Davies.  In  2013  Genomics  England  was

founded,  with  £100m  ($156m)  to  lead  the

job  of  repurposing  Britain’s  genomics  in­

frastructure to improve health care. Anoth­

er £250m was committed in 2015. By 2019 it

had  sequenced  the  genomes  of  100,000

nhs patients,  focusing  on  rare  diseases

and  common  cancers.  By  the  end  of  2021

UK  Biobank,  a  charity  founded  in  2006  to

catalogue physiological data from 500,000

volunteers,  had  used  the  Sanger  to  se­

quence the genomes of 200,000 of them. 

Since 2019 the nhs has offered genome

analysis  for  any  seriously  ill  child  with  a

suspected genetic disorder. In 2021 this of­

fer  was  extended  to  patients  in  their  20s.

Around the same time, the nhs also started

testing for variations to a portion of the ge­

nome that, when present, cause severe re­

actions to common chemotherapy drugs. 

In its most recent spending review the

government  funded  a  Newborn  Genomes

Programme,  which  aims  to  sequence  the

genomes of up to 200,000 babies in order

to  improve  the  early  diagnosis  and  treat­

ment of rare diseases. Our Future Health, a

project that will sequence the genomes of

5m adults selected to be statistically repre­

sentative of the entire population, aims to

help personalise health care.

The  idea  is  to  save  money  even  while

improving  treatment.  People’s  genomes

can be examined for clusters of genes that

raise or lower the risk of specific diseases—

clusters  determined  by  linking  the  health

outcomes  of  Biobank’s  participants  with

an analysis of their genomes. The patterns

revealed can be used to identify people in

the wider population whose genomes indi­

cate that they are at higher risk. These peo­

ple  can  then  be  invited  for  scans  and

check­ups before the usual age thresholds.

Those at lower risk can wait until later. 

Because  the  genome  is  the  instruction

manual  for  human  biology,  sequencing  it

offers  an  unparalleled  view  into  the  body,

its  functioning  and  what  is  likely  to  go

wrong  with  it.  And  because  it  does  not

change  over  a  lifetime,  it  need  be  se­

quenced only once. This makes it very dif­

ferent  from  other  diagnostic  tools,  says

Matt Hurles, who leads a research group at

the Sanger that studies the genetic origins

of  disease.  As  more  genomes  are  se­

quenced,  and  more  are  correlated  with

health outcomes, more will be learned.

Through a combination of serendipity,

invention  and  pluck,  Britain  has  built  the

world’s  most  advanced  genome­sequenc­

ing infrastructure. But as happens depress­

ingly  often  in  Britain,  technological  pro­

wess has failed to produce market­leading

firms.  Solexa,  a  sequencing  company

founded  in  1998  by  Cambridge  scientists,

was  acquired  by  Illumina,  an  American

company  that  makes  sequencing  ma­

chines, in 2007. Oxford Nanopore, a com­

pany  which  provides  mobile  sequencing

technology,  had  revenues  of  just  £114m  in

2020.  Fortunately,  the  Sanger’scontribu­
      tion to Britons’ health doesnotdepend on
      where its machines are made.n