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.