Prime ministers do not aspire to infallibility or immortality, but a display of mental or physical frailty at a point of national crisis is something any Downing Street spin doctor would dearly wish to avoid, and if possible suppress. The impression of the ship of state adrift, and the helmsman heading below deck, pleading illness, hardly inspires confidence, however much personal sympathy in this case is felt towards Boris Johnson. With questions being asked about the government’s lockdown exit strategy and Labour revitalised by a new leader seeking to make a mark, No 10 needs to be at its most coherent and decisive. It is also a concern if Johnson as adjudicator is absent just as Whitehall jostling starts between those putting either the interests of the nation’s health or its economy first. But the infectiousness of this virus made it practically impossible for Johnson to hide from others in No 10, and the public, that he had contracted it. Once the decision was made for Johnson to go to hospital, No 10 went public within two hours. Little other option was available. Rumours had been circulating for days that his recovery was not under way, highlighted by the return of the health secretary, Matt Hancock.
One person closely involved said: “The difficulty is that the crisis is so all-enveloping, the PM could not stop working. No one likes to think they are dispensable. The first step was to get him to admit to himself how ill he was becoming. What was subsequently admitted to the nation was a second order issue”. Even now No 10 is reluctant to go into detail on the prime minister’s health, stressing in its statement that the hospital admission was simply a precautionary step to undertake tests, rather than an acknowledgement that he had deteriorated. He would continue to be briefed at his hospital bed and was very much in charge.
By contrast, Donald Trump in opening his Sunday press conference provided a dramatic, possibly melodramatic, medical bulletin on Johnson’s health, offering the US’s prayers to help Johnson in “his personal fight with the virus”. Trump has a relationship with the truth that could be described as sometimes adjacent, but he did not give the impression that Johnson was going to hospital for routine tests. If No 10 is being economical about a more serious illness, it would not be the first time the public has been misled by a serving prime minister about his health. The UK may be at war with an invisible virus, but British prime ministers at times of conflict have always been reluctant to admit they have been incapacitated. David Lloyd George in 1918 suffered a bout of influenza so severe his valet said it was touch and go whether he would survive. Medical bulletins at the time made no suggestion he was in any danger. Andrew Bonar Law resigned in 1923 only on receiving a diagnosis of terminal throat cancer, and Henry Campbell-Bannerman, prime minister from 1905 to 1908, died days after his resignation in 10 Downing Street. During Winston Churchill’s two wartime illnesses, the full extent of them was never revealed. In February 1943, after the then 69-year-old contracted pneumonia, his personal physician Charles Wilson drafted a bulletin, but Churchill immediately demanded to see it. He dismissed it as “alarmist” and liable to cause confusion and despondency and was, in any case, untrue. Churchill, therefore, dictated his own bulletin, but Wilson said it was inaccurate and misleading and he could not possibly sign it. Elaborate textual negotiations led to a compromise, and subsequent bulletins always referred to his improving condition. A further bout of pneumonia in August 1944 was not publicised at all, and according to his wife, Clementine, only the smallest circle was informed. Similarly, the cocktail of drugs being taken by Anthony Eden during the Suez crisis was known only to a few, and even now the impact on his judgment is a matter of dispute. But these were more discreet times, and the ruling class could form a small circle of trust. That in turn made it easier to put out bland medical bulletins that disguised more than they revealed. The White House has been equally skilled at suppressing the truth about its president’s health. Franklin D Roosevelt famously had polio, Dwight D Eisenhower had both a heart attack and a stroke while in office. John F Kennedy suffered Addison’s disease, hypothyroidism and severe back pain, none of which was publicly disclosed during his lifetime. Grover Cleveland in 1893 even had a secret operation to remove a cancerous growth that took place on a boat, dressed up as a fishing trip on a lake. The fear that power, credibility and respect will seep away if ill health is revealed remains. Not just the electorate will lose faith, but your cabinet colleagues may sniff a succession. Tony Blair was reluctant to reveal his heart issues for fear allies of the the then chancellor, Gordon Brown, might take advantage. Hillary Clinton was hammered when she contracted pneumonia, and wobbled in front of the TV cameras when walking to a car. In 2016 news of her illness received 13 times more coverage than revelations about fraud in Trump’s charitable foundation. Bernie Sanders has frantically denied his heart attack makes him the weaker of the three septuagenarians seeking the presidency. But outright suppression of the truth in modern politics has its downsides. Figures such as Peter Mandelson, Gordon Brown’s chief communicator after the financial crash, have warned the prerequisite for national unity at a time of genuine crisis is a government that levels with the British public about the difficulties the Whitehall machine is facing. There will come a point when, if Johnson’s condition is serious, the medical and spin doctors will have to tell the public as much.