This week, Philip Ball wrote a piece in the New Statesman headlined: “Muted and deferential, the UK’s scientists have failed the pandemic test”. I regard Ball as a thoughtful and knowledgeable science writer, and I usually agree with him, but this piece made me uneasy. I expressed disagreement on Twitter and Ball asked for my reasons, so here is a brief response.
I should start by saying that, while I try to keep myself informed about the science of coronavirus, I have no background in infectious diseases, epidemiology or public health. I follow a lot of genuine experts on Twitter, and what has been striking is the lack of agreement between them on many policy issues. Initially there was uncertainty about the nature of the disease – it seems WHO held out for a long time against the view that the virus was airborne, a view that I think is now pretty universally accepted. This led to early mis-steps with a focus on handwashing and surface-cleaning rather than masks and indoor air quality. On other matters, such as vaccination of children, disagreements still remain. And when we move to consider potential non-pharmaceutical public health measures, there is a wide range of views – do lock-downs do more harm than good? Should we restrict foreign travel? How should a test-and-trace system be organised? Although people who know what they are talking about sometimes take strong and passionate positions on these issues, there is variation from country to country in how they are addressed, and my impression is the outcomes do not always support what we might have expected.
I’m not saying it doesn't matter what we do – on the contrary, I think it matters enormously, as the health of the world depends on getting it right. But it’s much harder to know what is right when the experts themselves are uncertain. So scientists will lay out scenarios A, B and C, and estimate a range of possible outcomes for each one, rather than agreeing that A is the only valid course of action. I suspect everyone would be happier if it was very clear what we had to do – even if it was painful – but instead both scientists and politicians have to weigh up pros and cons, knowing that they won’t be forgiven for a wrong decision. On top of everything else there is time pressure: if we wait for further research, it may be too late.
The decisions that governments have to make are complex and high-stakes, and the fact that we have a Prime Minister and front bench who were selected solely because of their commitment to Brexit does not inspire confidence that they will select the right policies. But should scientific advisors be doing more, as Philip Ball suggests, to challenge government?
It seems to me there are four different scenarios, each of which requires a different response.
1. Bad science/fake news
I agree that if a government minister were to state openly something that was scientific misinformation, then it is the job of senior advisors to challenge them publicly. I was among the first to criticise Deborah Birx early in 2020 when she said of Trump “He’s been so attentive to the scientific literature and the details and the data…. I think his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues.” See also here. There were also times when I thought Anthony Fauci should have just stood up and said ‘No, No, No!’ rather than sit in the same room while Trump spouted dangerous nonsense. However, bad though the situation in the UK is, I don’t think we have had anything like that situation. Certainly there are politicians and others who have tried to discredit scientific advisors as “scare-mongering”, including some who see a pandemic as a nice opportunity for a bit of disaster capitalism. But I haven’t seen government ministers making scientific claims about coronavirus that are so wildly wrong that no serious scientist could support them.
2. Policies that prove misjudged in hindsight
Most people would agree that in the early days of the pandemic, the wrong policies were adopted, with an emphasis on handwashing and cleaning surfaces, and a severe lockdown imposed too late. Jeremy Farrar, who was on SAGE at the time, described these events in his book with Ajana Ahuja, Spike, and it is clear that he, and other SAGE members, regret that they did not consider more options, or argue for more rapid action. To that extent, the criticism may be valid, but my impression is that the advisors had significant input into the policies, which at the time they thought was the least bad course of action. There were other scientists who spoke out strongly in criticism of lock-downs, but it’s not clear that this helped the situation. I agree, it would be helpful for everyone who was involved in those decisions to reflect now about what they got wrong, but it would have been hard to do so at the time - not because they were "muted and deferential" but because they had significant input into the policies.
3. Ongoing policies
We became accustomed during the past two years of seeing government advisers alongside the PM or another government minister at press briefings when a policy is announced. Ball says they should “openly criticise bad policy” – this would be fine if everyone could agree what good and bad policy were. The policy we get will typically be the least bad option, formed by trying to integrate scientific and political considerations. Nobody will be entirely happy with it – the question is not whether it has flaws, but whether there are better options that everyone could agree on. Once it is decided, it is the job of the scientific advisers to ensure it is clearly communicated and explained.
For instance, Ball says Chris Whitty was being timid in December 2021 when he suggested that we “prioritise the social interactions that really matter” at a press briefing when Johnson said “we’re not cancelling people’s parties”. This seems to me to be an unfair charge: the policy is at this point agreed. Is Whitty supposed to stand up at the podium and say “I think we should cancel parties.”? I heard the December briefing and thought Whitty’s contribution provided useful clarification, in emphasising the importance of not dropping one’s guard, and restricting contact to a small circle.
4. Cases where policies are not followed
Ball also notes cases where rules or guidance were not followed: Dominic Cummings’ trip to Barnard Castle, MPs not wearing masks, or drinks at no. 10. He feels scientific advisors are “appeasing” government when they refuse to comment on such matters. I disagree. Their role is to help ensure that policies are based on the best scientific evidence. Where there is failure to adhere to policies, it’s the job of the police, politicians and the media to hold people to account.
Government advisers and Independent SAGE
Concerns about lack of transparency around SAGE led to the formation of Independent SAGE. I regard this as a very useful development, that serves much of the function that Ball sees as missing in regular SAGE. They provide a wealth of information about different aspects of pandemic management, and can express their views robustly, and suggest alternatives to current policies. Perhaps one way forward would be to formalise the need for a body separate from scientific advisors that is quite independent from government. But we do still need a group of scientists who work directly with government to provide scientific input into rapid decisions about what is needed now.
I should make clear that I totally agree with Ball’s criticisms of the government – my sense is that most of his piece is aimed at highlighting how dishonest and incompetent they have been in responding to coronavirus. But it strikes me as unfair to extend the criticism to Whitty, Vallance and members of SAGE who have tried to steer us through the pandemic as best they can, even though that means working with this dysfunctional government. My view is that we would be in a far worse position without their input.
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I live in Canada where health is a provincial responsibility so I get to watch the antics of 13 provincial/territorial governments and their (long-suffering?) Chief Medical Officers of Health.
ReplyDeleteAs in the UK, the Chief Medical Officers of Health do not publicly disagree with their premiers. It does not seem to me to be their responsibility to do so. They are civil servants.It is not their job to spread panic and dissension in public. If the CMOHs disagree with Gov't policy they should resign. Then complain. Personally I think some should but anyway….
In my own province of Ontario we do have an outside advisory committee to the Gov't on and members there have been known to imply that the premier is a blundering idiot.
I’m pleased to see your response to my article, Dorothy. I have always found your comments on the pandemic (and much else) helpful and constructive, and I am glad to see my piece getting this discussion going. I don’t want my own response here to seem like a “You said… No, you said…” argument – in fact I welcome the chance to clarify some of the issues I raised, and I don’t think we disagree as much as you might have imagined.
ReplyDeleteYou rightly point out that much was not known in the early days of the pandemic, and that it would be unreasonable to criticise scientists for getting some things wrong in their advice. I totally agree. It’s important to acknowledge that mistakes were made, but I don’t think that at any point in my piece I was criticizing errors of scientific judgement. Well, maybe just in terms of Harries, whose statements on masks and WHO advice had no grounds and were strongly criticized by Farrar himself. I’m not sure I could see how anyone could defend the latter in particular, even at the time.
What dismays me is not that the “herd immunity” approach was so wrong, but that there does not seem to be either proper reflection about why it was adopted, or efforts to correct misstatements about that from ministers such as Patel and Hancock (and from Harries herself). It seems clear from Farrar’s book that their claims are not supported by the evidence, but I think the scientists involved in making that mistaken decision have now a responsibility to stand up and say “No, actually herd immunity was a key aspect of our original strategy.” Farrar does say essentially that in his book, and explains that Vallance probably regrets the way he advocated the herd-immunity goal initially. But this could have been said much earlier, when ministers were making misleading statements.
But my key point here is that it is not enough for the scientific advisers and advisory groups to be saying “Ah, we called that one wrong.” They surely have to ask themselves how they ended up with an initial policy that not only conflicted with much international opinion at the time, but which even at the time was patently flawed (as Farrar told me in the summer of 2020, we really knew nothing about immunity to the virus, and so could not have plausibly made it a target) and which, most of all, led in precisely the direction that a libertarian and exceptionalist government would have wanted. They must surely ask themselves if there was inadvertent collusion. They should ask if it was proper that lockdowns were not considered or modelled at an early stage, even though they were being implemented elsewhere, simply because this did not seem to be a policy option on the table – and why Sage did not push harder for them until a very late stage.
You say you have not seen ministers and senior politicians making claims that were wildly wrong. But what about the example I give of Rees Mogg on masks? If scientific advisors can’t stand up and correct that sort of thing, or criticize the politicized refusal of Tory MPs to wear masks even while they debate their reintroduction, surely something is amiss?
You say that it isn’t reasonable to expect advisors to openly criticize bad policy when there’s no consensus about what is a good policy. That’s an entirely fair point. But it’s not what I was calling for, I think. There is no serious doubt, and was not at the time, that it was a bad policy for the prime minister to be shaking hands with everyone in a hospital containing Covid patients in March 2020. It is outrageous that such idiotic behaviour put Vallance and Whitty on the spot. But that’s the job they signed up for, and they needed to be able to say “Well actually prime minister, we are strongly advising people not to do that now…”. That would have better served the interests of public health. They didn’t have to say “For God’s sake man, what were you thinking?!”
[More to follow, but I'm at my character limit now...]
[Cont. 2/3] And when government officials were first found to have violated lockdown rules – in the Cummings revelations in May 2020 – there is no serious doubt that the public needed to be told that this was not right, for the sake of compliance, trust and public health. To dismiss this as a matter of “politics” was quite wrong. To his credit, Jonathan Van-Tam seemed to recognize as much when, faced with that question at a later press briefing, he stressed that the rules applied to everyone. That was all it needed, not a diatribe about Cummings. Again, the chief scientists should never have been placed in that position – but sadly, that’s what happened, and I don’t think they responded as they should have done. So when you say that the role of scientific advisers is “to help ensure that policies are based on the best scientific evidence [and ] where there is a failure to adhere to policies, it’s the job of the police [if only!], politicians and the media to hold people to account”, I think that doesn’t quite cover it. When there are public-health implications, I think the scientists have to get involved – not necessarily to condemn, but to clarify.
ReplyDeleteThe endless revelations now about parties, not to mention the suggestions from some politicians that future restrictions should not be so tight and even that lockdowns should be made illegal, could make it virtually impossible for future governments to impose lockdowns if a more lethal new variant were to arise. Is it right that scientists should just cross their fingers that this won’t happen, or should they respond to such developments now by making it clear what the pros and cons of lockdowns and restrictions have proved to be, and robustly stand up for the need to retain that final measure? When political actions constrain future scientific advice or undermine current advice, it becomes a scientific issue.
And there have been examples of egregiously bad policy or management that called for more forceful clarifications from the scientists. The decision to send schools back for a single day at the height of the lethal second wave in the new year of 2021 was one such: a quite staggering mistake. And I don’t feel scientists should be as relaxed as they seem about the political abusing of the vaccine rollout, which has been falsely used to claim that we couldn’t have done it without Brexit.
I did not criticize Whitty for being too timid in pushing back on Johnson’s eagerness to encourage Christmas parties in December 2021. Rather, I pointed out that even Whitty’s very mild response was seized on by opponents of restrictions and used to accuse him of being “undemocratic” or some such – in other words, this was a sign of how emboldened some have become in challenging the right of scientific advisers to do anything other than slavishly back up what the politicians say. It is a warning we need to heed. I was glad that Whitty said at least this much (although I think he could have gone even further).
[Cont. 3/3] You say that we absolutely still need “a group of scientists who work directly with government to provide scientific input into rapid decisions”, i.e. Sage or something like it. I fully agree, and don’t think I implied otherwise. But I believe we need an urgent reconsideration of the way in which such a body operates. Is it proper, for example, that the scientific advisers always (or nearly so) be chaperoned by ministers when they speak to the public? That never used to happen. My sense is that Whitty and Vallance have sometimes been unsure how far they can go in pushing back on comments and decisions they think are scientifically questionable – indeed, it’s been pretty poignant seeing them try to abide by the rules that politicians have openly flouted. I think this needs to be clarified. It is quite right that advisers should be aiming to support the government as far as they can. But there is so much now that has been utterly unsupportable – not just the parties and rule-breaking, not just the fatal hesitation and delay in taking effective action (which has surely cost thousands of lives) but also, for example, the unlawful system of preference in the awarding of Covid contracts and the astonishing incompetence in management of the testing system. We are simply failing the public if the chief scientists are supposed to keep quiet in the face of such things, which seriously undermine their efforts to guide us through the pandemic.
ReplyDeleteIn short, scientific advice to policy has a moral and social-responsibility dimension, not just a technical one. This has been recognized for decades among many experts in this field. It was pointed out in 1969 by Joseph Haberer in his book Politics and the Community of Science:
“The failure of scientists has lain in their moral obtuseness, in their incapacity to define, delineate or even recognize the nature of the problem of responsibility. Characteristically, responsibility has been recognized only in its narrower sense. Scientists have been willing to be held responsible for the calibre of their scientific work; or when acting in administrative positions for their performance in terms of the formal responsibilities attached to their positions. Beyond this methodological and bureaucratic responsibility scientists have not, at least until very recently, ventured.”
This is, I think, overly harsh in applying it to “the community of science” today. But I think the danger Haberer identifies is still present. He was speaking in a context of far more profound abuses of political power in the earlier twentieth century, but we are now discovering just how dismaying in its own way was the political context in which UK scientific advisers were trying to do their job. I and others are baffled by why chief scientists and scientific institutions seem to want to normalize that, or to resist suggestions that the system might need an overhaul. It seems to me they can only gain, both in influence and in public standing, by being proactive and self-reflective in that capacity. No one else is going to (or can be trusted to) do that job for them.
In any event, many thanks for your comments – and I hope we get the chance to chat about these things some day.
The problem is our Chief and Deputy Scentific and Chief Medical officers advised *in favour* of herd immunity. That notion has derailed us throughout the pandemic. Not one has apologised for the horrific loss of life. There are continuing ramifications with unmitigated infections in children. Is anyone accountable, ever?
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