The Challenge of Controlling COVID-19. Lewis, Jane
was SAGE (the Government’s Scientific Advisory Group for Emergencies), which changes its membership depending on the nature of the emergency. In the event of a pandemic, SAGE was intended to act in collaboration with the Chief Medical Officer (CMO), Professor Chris Whitty, a civil servant and thus statutorily independent, politically impartial and located in PHE, and the Chief Scientific Officer (CSO), Sir Patrick Vallance, who is head of profession for the scientists working in the NHS. Both the CMO and the CSO are members and chairs of SAGE. Advice to Government was filtered through the CSO and the CMO.
SAGE considered a range of options and played a major role in shaping the Government’s response, but it did not make policy recommendations. Its ‘consensus statements’ did not present a single view, but rather put forward assessments as to the nature, degree and range of uncertainty. The CMO explained to the House of Commons’ Science and Technology Committee that he aimed to put forward the Group’s ‘central view’ and to convey the range of uncertainty to Government (Clark, 18 May 2020). But the way in which policy decisions emerged tended to be opaque. Indeed, on 22 May, Sir Paul Nurse, Director of the Francis Crick Institute (a biomedical research institute, established through a partnership between a UK Government funding agency, two charities and three universities) saw fit to ask who was formulating strategy, what was the relationship between SAGE, PHE and politicians, and who was bringing evidence and action together? (Nurse, 22 May 2020, BBC Radio 4 Today interview). He repeated his concern about secrecy in respect of decision-making in an interview with The Guardian (Sample, 2 August 2020), when he was quoted as saying that ‘it sometimes seems like a “black box made up of scientists, civil servants and politicians are coming up with the decisions”’.
Both ministers and scientists have rehearsed the well-worn dictum that scientists advise and ministers decide, but the precise way in which decisions on action and possibly strategy (this tended to be particularly opaque) were arrived at has not been clear and may have made the passing of blame onto scientists (and civil servants) easier, not least because scientists often stood alongside politicians at the regular Downing Street Briefings on COVID-19. However, standing side by side at briefings does not necessarily indicate a shared understanding. Furthermore, the membership of SAGE and its sub-groups, the papers submitted to it and the minutes of its meetings remained secret until 29 May,3 by which time the role it was playing had become the subject of media speculation, with some scientists objecting to the redactions in the official record of their proceedings.
What is clear from the publication of the membership of SAGE is that the Group was dominated by epidemiologists doing mathematical modelling to determine the course of the disease. Field epidemiologists, public health practitioners and social care experts were notable by their absence. But, while the mathematical modellers on SAGE were aware early on of the risks to elderly people in care homes, they did not know how care homes worked, for example in terms of their reliance on agency staff who were likely to work in several different homes and might thus pass on infection. Lord O’Donnell, Cabinet Secretary between 2005 and 2011, also suggested that given the effects of the pandemic on the economy, more social scientists should also have been members of SAGE and its sub-groups (O’Donnell, 2020; see also Cairney, 2020), although the views of economists reach the Treasury and the Chancellor and then the Cabinet. Nevertheless, it may be that bringing together scientists and economists in a single forum would have helped to clarify the balance of risks.
SAGE seems to have agreed on 4 February and again on 11 February that the Government should plan by using ‘influenza pandemic assumptions’, which could be modified as the data on the pattern of the disease became more certain. This is significant because the influenza outbreak in 2009 had been successfully handled (Hine, 2010), and planning had taken place for a further influenza pandemic. Indeed, the Government’s Coronavirus Action Plan (DHSC, 3 March 2020) echoed parts of the Influenza Pandemic Preparedness Strategy of 2011 (DH, 2011).4 The Coronavirus Action Plan reiterated that the UK ‘is well prepared for disease outbreaks … Our plans have been regularly tested and updated…’ (DHSC, 3 March 2020, para 3.2), which was true in that exercises had been carried out, notably the three day Exercise Cygnus in 2016.5 However, the recommendations following this Exercise, particularly regarding the supply of beds, ventilators and masks, were not followed under the conditions of austerity that prevailed after 2010.
In addition, the Government’s strategy for dealing with COVID-19 outlined by the Plan was also modelled closely on dealing with the expected influenza pandemic. Like the 2011 influenza strategy, the Coronavirus Action Plan described four phases: containment, involving detection of cases and follow-up of contacts; delay, involving measures to slow the spread of the virus, ‘pushing it away from the winter season’; research; and mitigation by providing the best care for the sick and supporting hospitals and communities (DHSC, 3 March 2020, para 3.9). This Plan did stress the importance of tracing and isolating contacts, but stated that there would be ‘less emphasis’ on measures such as intensive contact tracing in the mitigation phase, because ‘as the disease becomes established these measures may lose their effectiveness…’ (ibid., para 4.48). This echoed the Influenza Strategy, which also confined the importance of ‘test and trace’ to the first phase of the pandemic. Readers were also assured that stockpiles of ‘the most important medicines and protective equipment for healthcare staff … are being monitored daily’ (ibid., para 4.14), which was later shown not to have been the case.
SAGE also commented on issues that were central to the control of COVID-19 at an early stage. There are examples of advice that seem to back up what the Government chose to do or not to do and also enable us to see how uncertainty played into the decision not to act, for example regarding two of the issues outlined above – the decisions not to stop big sporting events and not to impose quarantine regulations. In respect of the first, the Scientific Pandemic Influenza Group on Modelling, Operational sub-Group (SPI-M-O) concluded on 11 February that the direct impact of stopping large public gatherings on the spread of the virus at the population level would be low, but that social interaction in bars and restaurants might ‘slightly accelerate’ the spread. Of course, attendance at large-scale sporting events was often also accompanied by visits to bars. This ‘consensus view on public gatherings’ was passed on to SAGE (Meeting 12, Minutes 3 March 2020), which added that it would be difficult to stop interaction in bars and restaurants. In the event, Government chose not to cancel large events and nor did it place any limitations on bars and restaurants. It is possible that the necessarily equivocal nature of much of the advice offered by SAGE lulled ministers into a lack of urgency. Or there may have been a lack of capacity on the part of Government to ask the further questions that would have been necessary prior to making difficult policy decisions. Yet again, the Government may have been straightforwardly reluctant to interfere with the everyday lives of citizens.
On quarantine, SAGE considered this early on, before the Prime Minister became actively involved in plans for controlling the virus. On 3 February, SAGE estimated (as it admitted on the basis of ‘limited data’) that if the UK reduced imported infections by 50 per cent this would ‘maybe delay the onset of any epidemic in the UK by about 5 days’. Infections would have to be reduced by 95 per cent to buy a month of time and ‘only a month of additional preparation time for the NHS would be meaningful’. But buying that amount of time would require ‘draconian and coordinated measures, because direct flights from China are not the only route for infected individuals to enter the UK’ (Meeting 3, Minutes 3 February 2020). On 23 March, SAGE minutes recorded the conclusion that closing the UK borders ‘would have a negligible effect on spread’ of the virus, because by then the number of cases arriving was insignificant compared to the domestic infection rate (Meeting 18, Minutes 23 March 2020). However, in response to a Home Office request for advice on what to do about border restrictions at the end of April (Home Office, 2020), SAGE stated firmly that determining ‘a tolerable level of risk from imported cases … is a policy question’, thus excluding it from consideration (Meeting 29, Minutes 28 April 2020).
SAGE’s advice was only as good as the quality of its data, and as Professor Neil Ferguson admitted later, this was poor in the early part of the pandemic: in particular, it was not known how far COVID-19 was ‘seeded’ from many of the people arriving from Italy and Spain (Ferguson, 10 June