A one-day UK government tabletop exercise simulating a large-scale MERS-CoV outbreak reaching England from the Middle East — the “hidden sister” of Exercise Cygnus, classified for five years and only released after Freedom of Information battles during COVID-19. The first UK exercise to test a coronavirus scenario.
Open Classified Files Back to HubExercise Alice tested England’s response to a MERS-CoV outbreak — a coronavirus scenario that proved tragically prescient four years later when SARS-CoV-2 emerged.
Exercise Alice specifically modelled a coronavirus (MERS-CoV) outbreak in England — not influenza. It was the first UK government exercise to test response to a coronavirus threat. The findings warned about prolonged incubation periods, surface contamination, and the need for higher PPE levels than flu — all directly relevant to SARS-CoV-2.
The report was classified under Section 36 of the Freedom of Information Act — “prejudice to effective conduct of public affairs.” Officials argued disclosure could “heighten public concern” and “undermine confidence.” Only released in October 2021 after Dr Qureshi’s legal campaign and Information Commissioner’s Office intervention.
The exercise identified that “level and use of PPE was central to the exercise dialogue and considered of crucial importance for frontline staff.” The recommendation to review and expand PPE stockpiles was never fully implemented. By March 2020, the UK faced catastrophic PPE shortages that cost healthcare worker lives.
Alice recommended developing a “live database of contacts” and community sampling plans. Four years later, the UK had to build Test & Trace from scratch during COVID-19 at a cost of £37 billion — making it one of the most expensive programs in UK history and widely criticized for inefficiency.
The scenario modeled 60 UK Muslim travelers returning from Umrah pilgrimage in Saudi Arabia, carrying MERS-CoV. Three cases present at hospitals 10 days later. Pre-symptomatic attendance at mosque gatherings amplified community spread to 50 cases and 650 contacts — overwhelming NHS capacity in London and Birmingham.
Exercise Alice (Feb 2016, coronavirus) and Exercise Cygnus (Oct 2016, influenza) were conducted just 8 months apart. Together they painted a complete picture of UK pandemic unpreparedness for any pathogen. Both reports were classified. Both sets of recommendations were largely unimplemented when COVID-19 arrived.
A one-day tabletop exercise with two inject-led sessions, clinical advisory group meetings, and plenary feedback — simulating a MERS-CoV outbreak reaching UK soil.
60 UK Muslim travelers return from Umrah pilgrimage in Jeddah and Medina, Saudi Arabia. All appear asymptomatic upon arrival. No screening is conducted. They disperse to communities in London and Birmingham.
Three individuals present at separate hospitals with flu-like symptoms during peak influenza season. Travel history prompts MERS-CoV suspicion. Laboratory confirms two cases within 48 hours. Routine admissions occurred without initial isolation — potential nosocomial exposure.
Two infected individuals attended a large gathering at Balham Mosque before becoming symptomatic. Secondary transmission explodes across South London. Contact tracing overwhelms available staff. NHS surge capacity tested. PPE supplies critically low. Media reporting triggers public anxiety.
Participants identify 12 specific actions and 4 overarching themes: clearer governance structures, better integration of primary care, enhanced PPE stockpiles, and quarantine vs. self-isolation analysis. Chief Medical Officer commissions the report. Actions assigned to PHE for implementation — then filed away.
Led by Public Health England’s Emergency Response Department with cross-government participation and devolved administration representation.
The exercise produced detailed recommendations — most of which went unimplemented before COVID-19 arrived four years later.
Recommended reviewing and expanding PPE reserves to address potential surge demand. The exercise found PPE was “of crucial importance” but supplies were inadequate. UK PPE stockpiles were allowed to expire without renewal before 2020.
Recommended building a “live database of contacts” with community sampling capability. No such system existed when COVID-19 arrived. The UK’s improvised Test & Trace cost £37 billion and was widely criticized for inefficiency.
Called for evidence and cost-benefit analysis of quarantine versus self-isolation options. MERS-CoV’s longer incubation period and surface persistence required strategies beyond influenza playbooks — exactly the challenge COVID-19 presented.
Recommended clearer command arrangements and escalation triggers. Without predefined protocols, responses devolved into “siloed operations” with fragmented decision-making — a pattern repeated during COVID-19’s early weeks.
Recommended systematic screening of travelers from affected regions, including temperature checks and quarantine protocols. The UK’s lack of port health screening in early 2020 allowed SARS-CoV-2 to enter unchecked from Italy, Iran, and beyond.
Called for developing MERS-CoV serology assays with scalability plans and enhancing laboratory surge capacity. The UK’s testing capacity bottleneck in March 2020 directly echoed this unaddressed recommendation.
Exercise Alice was one of eleven pandemic simulations staged between 2015–2019, all classified, only revealed through FOI campaigns during COVID-19.
| Exercise | Date | Pathogen | Status |
|---|---|---|---|
| Exercise Alice | Feb 2016 | MERS-CoV (Coronavirus) | Classified until Oct 2021 |
| Exercise Cygnet | 2016 | Pandemic Influenza | Classified |
| Exercise Cygnus | Oct 2016 | H2N2 Influenza | Released Oct 2020 |
| Exercise Northern Light | May 2016 | Ebola | Classified |
| Exercise Typhon | Feb 2017 | Lassa Fever | Classified |
| Exercise Broad Street | Jan 2018 | Lassa Fever | Classified |
| Exercise Pica | 2018 | Pandemic Influenza | Classified |
| Exercise Cerberus | Feb 2018 | Avian Influenza | Classified |
| + 3 more Ebola exercises | 2015–2019 | Ebola | Classified |
The UK government conducted at least eleven pandemic preparedness exercises between 2015–2019. Every single one was classified. When COVID-19 arrived, the public, Parliament, and even local health authorities were unaware of their findings. Dr Moosa Qureshi’s FOI campaign revealed that PHE initially refused to release even the names of the exercises, citing national security. Secrecy doesn’t protect preparedness — it prevents accountability.
Exercise Alice became a focal point in debates about government transparency and accountability during COVID-19.
NHS consultant Dr Moosa Qureshi submitted FOI requests to PHE in 2021. PHE initially refused, citing Section 36 (prejudice to public affairs). After multiple extensions, internal reviews, and threats of ICO complaint, the report was finally released on October 7, 2021 — alongside six other classified exercise documents.
The Exercise Alice report was submitted as core evidence to the UK COVID-19 Inquiry Module 1. Witnesses from the BMA argued that unaddressed weaknesses reflected systemic deprioritization of pandemic risks over fiscal constraints. No senior officials were held responsible for the implementation lapses.
Virologist Dr David Matthews (University of Bristol) described the exercise as “completely relevant” to COVID-19 preparedness. Prof Peter Openshaw (Imperial College London) expressed surprise at the absence of these findings from advisory committees like NERVTAG, underscoring missed opportunities for enhanced preparedness.
1. Public Health England, “Report: Exercise Alice — Middle East Respiratory Syndrome Coronavirus (MERS-CoV),” 15 Feb 2016. Released via FOI Oct 2021.
2. Booth, Robert, “Secret planning exercise in 2016 modelled impact of Mers outbreak in UK,” The Guardian, 10 June 2021.
3. UK COVID-19 Inquiry, Module 1: Resilience and Preparedness. covid19.public-inquiry.uk
4. Leigh Day Solicitors, “Eleven pandemic simulation exercises were staged between 2015–19,” Press release, 10 June 2021.
5. BMJ, “What parliament omitted from its ‘lessons learnt’ on coronavirus,” 27 Oct 2021.
6. BMA, “The public health response by UK governments to COVID-19,” Report 4, 28 July 2022.
7. Grokipedia, “Exercise Alice,” encyclopedia entry, 2024.
8. Wikipedia, “Pandemic predictions and preparations prior to the COVID-19 pandemic,” 2024.