First Report - The UK response to covid-19: use of scientific advice

The coronavirus pandemic marks the most significant test of the UK’s emergency advisory and decision-making structures in living memory. As such, it is important that lessons are drawn throughout and applied so that the Government and future Governments may be better placed to respond to future crises. This has been the purpose of our inquiry—to capture those early lessons in the course of the pandemic. The machinery of science advice and decision-making has evolved throughout the Government’s management of the covid-19 pandemic, however there is an open question regarding the long-term sustainable and efficient provision of science advice to Government. Further, it remains unclear—in the long term—what role the Scientific Advisory Group for Emergencies (SAGE) will play, and—as alluded to by the Government Chief Scientific Adviser—how organisations such as the Joint Biosecurity Centre will provide a solution to the provision of science advice to Government in the coronavirus pandemic and beyond. We are concerned that at the present time the operation of the Joint Biosecurity Centre and the advice that it gives is not fully transparent. The Government, whatever organisational structures it decides upon, should commit to publishing the scientific advice it receives unless there are matters of national security (see paragraphs 59 to 64). The Government should outline in response to this Report how it intends for science advice on the novel coronavirus to operate in the longer-term management of the pandemic and what roles will be played by new bodies including the National Institute for Health Protection and the Joint Biosecurity Centre, alongside SAGE.

The Cabinet Office and Government Office for Science should update SAGE guidance to set out the role that SAGE will play in advising the Government’s long-term management of emergency scenarios. (Paragraph 34) Activation and operation of SAGE

We are satisfied that the SAGE mechanism responded to the advent of the novel coronavirus in a timely manner and that the most up-to-date scientific research and understanding was readily available to inform the Government from the outset. Nevertheless, we note that submissions presented to us raised concerns that during the early weeks of the pandemic, policy decisions in response to scientific evidence were taken more slowly than was needed, given the rapidity of the spread of the virus.

It is disappointing that the details of SAGE’s preliminary meetings were not made public for over two months, leading to unnecessary concern and confusion over what advice the Government had been receiving. Indeed, were it not for our early enquiries, this confusion may have continued until the details of SAGE’s initial meetings were published at the end of May. We note that SAGE has yet to publish any papers that might have been considered in its first two meetings. The Government The UK response to covid-19: use of scientific advice 75 Office for Science should confirm, as soon as possible, whether any papers were considered at the first two SAGE meetings and, if so, it should place them in the public domain.

We believe the initial response in setting up SAGE was timely. We have heard from some sectors of the science community that the community was not consulted appropriately. The Government should set out in response to this Report how in future emergencies it will engage formally and informally with the community.

SAGE has been activated for the longest continual period since its inception, which brings to question how sustainably the group can maintain its current level of high activity. We acknowledge senior scientists’ comments of frequent working round the clock, and we pay tribute to their continued service to the public throughout this emergency. It is also important to be clear that it is not just the participants of SAGE, and its sub-groups, who are managing this workload—it is shared by the colleagues, junior researchers and technicians who support them, too, as well as Government officials, among others. The Cabinet Office and the Government Office for Science should commit to update SAGE guidance to consider what support might be required for independent advisers in long-term emergency scenarios, within six months of SAGE being deactivated. The Government should identify a way to formally recognise and celebrate all those who have contributed to the UK scientific response to the pandemic. (Paragraph 51) Transparency and communication

Whilst we welcome the eventual disclosure of SAGE participants, the fact that the delay was attributed to advice from the Centre for the Protection of National Infrastructure (CPNI) gives us cause for concern. As suggested by Professor Chris Whitty, the advice relates to emergencies relevant to national security rather than public health crises. We therefore conclude that it was not necessary for CPNI advice to have resulted in a delay in the public disclosure of SAGE participants of over three months. Within three months of this Report, the Cabinet Office should update SAGE guidance to stipulate the timeframes in which SAGE should receive advice from the Centre for the Protection of National Infrastructure, and other relevant bodies, regarding the public disclosure of expert SAGE participants.

Regarding the disclosure of Government officials observing SAGE meetings, we agree with the redaction of information to protect the personal data of individuals including junior officials at the time of the emergency. In the interests of transparency, and to have a full picture of who is formulating policy advice to Government during the course of the pandemic, it is important that the identities of senior officials and political advisers attending SAGE meetings are made public. We also note that the minutes of previous SAGEs activated for other emergencies were eventually published with full disclosure of all participants and observers. In response to this Report, the Government should commit to the full disclosure of the following information on SAGE attendees and observers throughout the pandemic: (1) Civil servants at Senior Civil Service grade; 76 The UK response to covid-19: use of scientific advice (2) political and special advisers; and (3) the representative Government departments and job title of junior officials, in lieu of their names. Further, the Government should commit to the full disclosure of all individuals who attended SAGE meetings—and their affiliations—within three months of the current SAGE being stood down, or by the end of 2021, whichever is the earlier.

It is regrettable that full transparency was not achieved in time for the JBC’s inauguration on 1 June. We welcome the disclosure of the expert advisory boards supporting the JBC. Nevertheless, the Department of Health and Social Care (DHSC) has yet to commit to publish the outputs, including meeting papers and minutes, of all the JBC’s established boards. It would appear that the Government has not learned fully from the public concern resulting from the initial delays in publishing SAGE information. The Department of Health and Social Care should commit, within a month of this Report, to publish the relevant outputs—including terms of reference, meeting papers and meeting minutes—of the steering and advisory boards supporting the JBC. DHSC should also set out how regularly these boards will meet and when relevant papers can be expected to be in the public domain—preferably within a fortnight of each meeting.

Given the frequent reporting of the views of SAGE advisers in the media— particularly where these have diverged from decisions taken by the Government— and the continued public interest in the evidence base underlying decisions made, we are satisfied for the most part that the demarcation between adviser and decision- maker has remained intact. If we are to fully understand the extent to which the Government has been guided by scientific and medical expertise, then we must see the science advice that is reflected in the papers and meeting minutes published by SAGE. This advice must also be taken in the context of other advice and evidence submitted to Government—only then will the full justification for the Government’s actions be understood. The Government should publish the science advice given by the Government Chief Scientific Adviser and Chief Medical Officer for England to COBR and the Prime Minister to date, and commit to the disclosure of future SAGE advice within two months of it being given, or the policy being decided, whichever is the later.

Transparency in the evidence behind Government decisions enables higher quality decision-making through scrutiny, and better understanding of the reasons for those decisions. While calls for the publication of SAGE evidence from this Committee and many others were eventually heeded, it is regrettable that a significant amount of time passed before a regular publication rhythm was established. However, we acknowledge that in emergencies, where evidence is subject to great uncertainty, careful thought must be given to the way information is communicated and presented, given the context at the time. During those crucial early weeks of the pandemic—in which important decisions were made by the Government—public understanding and scrutiny was hampered by a lack of transparency. For example, when details of the 16 March Imperial College report were made public, it was not known what other evidence was being considered by SAGE and the Government. It is regrettable that a repeat of this scenario occurred on 31 October, ahead of the The UK response to covid-19: use of scientific advice 77 second national lockdown in England, where there was a delay in publishing the data behind the modelling used by SAGE. Presenting a graph to the public including a scenario of 4,000 deaths per day—based on out-of-date information and without a clearly marked source—risked, as indicated by the Office for Statistics Regulation, causing public confusion and undermining confidence in the statistics, and in our view, causing public alarm beyond what was justified. We agree with the assessment of the Office for Statistics Regulation and urge the Government and its advisers to ensure that analysis selected for public presentation meets high standards of rigour and relevance.

It has been made clear to us that policy decisions throughout the coronavirus pandemic have not been based solely on medical and epidemiological science, but rather have been developed with a wide range of inputs that include scientific research and opinion. Nevertheless, as indicated by the Government Chief Scientific Adviser, while the scientific analysis informing the Government’s interventions has enjoyed a great level of public exposure, the analysis and advice outside of SAGE (including economic and social considerations) have been “less visible”. It is disappointing that the Treasury had “not done a specific prediction or forecast of the restrictions” implemented, or those not pursued, but rather provided an “ongoing analysis” of economic factors, despite SAGE indicating that social and economic impacts should factor into such decisions. It is understandable that that these analyses are subject to significant uncertainty, however by analogy the epidemiological modelling published by SAGE, too, is uncertain and should not to be interpreted as a strict predictor of what will happen. The Government should, as a matter of urgency, publish the advice it has received on the potential indirect covid-19 impacts (e.g. economic, social and other health impacts) of the interventions it has undertaken, alongside the evidence base for that advice and should continue to commission such research.

The public has shown a strong appetite for more information. The Government should attempt to quantify the four forms of health impacts identified by Professor Whitty. Further, it should consider whether it is possible to provide an analysis of—either consistently or on a sample basis—those who died with covid-19 as distinct from those who died from covid-19.

As indicated by the Chief Medical Officer for England, the SAGE secretariat faced “huge pressure” in managing the monumental task of organising SAGE whilst adhering to the principles of transparent and scrutable scientific advice. We commend the efforts of officials in the Government Office for Science, the SAGE secretariat and independent advisers in their efforts to establish a regular rhythm of publicly available information, and hope that this is taken forward as a key learning for future emergencies. The Cabinet Office should work alongside the Government Office for Science to update SAGE guidance to incorporate the lessons learned for managing transparency during emergencies, taking account of: a) the potential volume of information; b) the publication and communication of non-peer-reviewed research informing SAGE; c) the potential length of time over which SAGE is activated; and 78 The UK response to covid-19: use of scientific advice d) the potential impacts on public trust.

We applaud the dedication with which the scientific community within the UK and globally have directly engaged with the public, in addition to their intensive studies of the coronavirus itself. We are also grateful to those within universities and research institutes for their efforts in supporting the clear and direct communication of the science of covid-19. These efforts have helped ensure that the trust of the British public in the strength of independent science advice has remained high during the pandemic, and we hope that these efforts are supported so that they may continue. We note, however, that a balance needs to be achieved so that Government decisions are not seen to be entirely science-led. The Government Office for Science should work with Government departments and public bodies, such as UK Research and Innovation, to identify the lessons to be learned from the Government’s communication of science—drawing also upon the experiences of researchers and their respective institutions. These lessons should be reflected within updated SAGE guidance, including a consideration of the support that SAGE participants may require for effective public communication and engagement during emergencies. (Paragraph 90) Nature of the scientific advice to Government

We believe that a gap persists in the transparency of the advice that is given to the Government, outside of the auspices of SAGE, particularly on the topic of non- medical impacts of the pandemic and related Government interventions. While this Committee is not advocating the establishment of an “economics SAGE”, we do note that SAGE’s remit covers the inclusion of numerous disciplines, including “scientific, technical, economic and legal” expertise. Further, it is entirely within the gift of SAGE to establish sub-groups to draw in other expertise as necessary. Whilst we have been assured that a Treasury official has been present at SAGE meetings, it has been stressed to us that SAGE does not issue economic advice and thus such advice must be received by Government through other avenues. The Government must, in response to this Report, set out how advice to central Government on the indirect effects (for instance impacts on mental health and social wellbeing, education and the economy) of covid-19, and the Government’s policy response to it, has been structured throughout the pandemic, and commit to the public disclosure of the individuals and institutions from which it has sought such advice and publication of relevant papers.

Given the UK’s strengths in statistical analysis and data science, it is regrettable that poor data flows, delays in data-sharing agreements and a general lack of structuring and data integration across both the health and social care sectors have throttled timely data sharing and analysis. For example, it is unacceptable that detailed public health data was only made available to modellers from March. The potential consequences of this will undoubtedly include slower and less effective decision- making. The establishment of the Joint Biosecurity Centre as an effort to centralise data flows to manage the pandemic gives some hope, although it is unfortunate that no central mechanism to coordinate data was in place at the start of the pandemic. However it will only be successful in this mission if it learns from the issues encountered in the early stages of the pandemic, such as those raised to us by SAGE, representatives of the health and social care sector and the academic and research The UK response to covid-19: use of scientific advice 79 community. In response to this Report, the Department of Health and Social Care (DHSC) should set out an action plan that describes what efforts have been made, and will be made during the pandemic, to address the poor data access issues raised by the scientific community and SAGE and its sub-groups, including a consideration of: i) agreements and incentives for data sharing; ii) integration of data flows across the health and social care sectors, including public health bodies at the national and local levels; and iii) integration of data flows across the health and social care systems of the four UK nations. DHSC should also describe what role the Joint Biosecurity Centre will be given to make best use of such data flows and outline what support it will receive to achieve this.

We are satisfied that the science advice informing the Government has drawn upon some of the best expertise that the UK—and indeed the world—has to offer. We acknowledge the initial dominance of modelling expertise on SAGE and believe this is a fair reflection of the lack of data at the beginning of the pandemic. We also note comments from the Secretary of State for Health and Social Care that SAGE expertise was broad enough and that advice from some disciplines—such as engineering—was given “quite separately”. We also appreciate that sub-groups and other advisory structures exist that may feed into Government decision-making, and that the composition of SAGE has evolved to incorporate a wider range of disciplines. (Paragraph 110) Application of science expertise

The Government was too slow to increase testing capacity to the levels required to help contain the spread of the coronavirus. We have previously suggested that strategy was driven by the capacity available, rather than strategy driving the necessary increase in capacity. It was clear early in the year that Public Health England was not set up for the mass scale necessary for coronavirus testing. This lesson had previously been learned by countries who dealt with the MERS outbreak of 2015, and it is regrettable that it is a lesson that the UK did not heed in advance of the pandemic.

The Government was slow to move once it realised that coronavirus testing required a rapid expansion and did not engage sufficiently with the wide array of scientific expertise available within the UK—particularly within our universities and research institutes. While we appreciate the complexities of such a feat, including the need to ensure health and safety guidelines are adhered to, it does not justify that many researchers who were willing and able to contribute went unheard. An overt initial focus on boosting capacity within established structures—namely PHE and NHS laboratories—clouded the exploration of a more decentralised avenue, such as that clearly employed by the Republic of Korea. As such, a significant and foreseeable opportunity was missed to prepare the UK for a potential pandemic situation. (Paragraph 138) 80 The UK response to covid-19: use of scientific advice

The Committee will report separately and more fully on the test, trace and isolate system and the mass testing programme in due course. But in considering the role of science advice, and its influence on Government decisions, we are concerned by the continued lack of justification provided to the Committee by Public Health England for taking an initial centralised approach, and why a more decentralised approach—drawing, for example, on the experience of the Republic of Korea—has not been followed.

The creation of NHS Test and Trace involves a budget of £22 billion for financial year 2020–21 and the justification for most of its spending being on the central part of the system, rather than through local public health teams, has not been clearly made. Concerns have also been raised about the inability of local public health teams to access timely information. This is particularly concerning given SAGE’s conclusion in September that the system, at that time, was “having a marginal impact on transmission”.

The Government should: explain clearly the justification for taking a relatively centralised approach to test, trace and isolate; set out its assessment of the impact of the system on the spread of the virus since the outset, including on health outcomes; and review the balance between the local and national components of the system, including its value for money and effectiveness. The Government should set out the rationale and justification for, as the National Audit Office put it, the “unusual organisational relationship” that NHS Test and Trace has with the Department of Health and Social Care.

Throughout the pandemic, the UK has relied on its own bespoke system of science advice and guidance on non-pharmaceutical interventions, while at the same time global-level guidance has been issued regularly by the World Health Organisation (WHO). There have also been numerous opportunities to learn from the approaches undertaken by nations around the world. The UK’s policies on areas such as testing and tracing, the two-metre rule and the use of face coverings suggest that the Government’s approach has been to carve its own path between SAGE and WHO advice. We have heard that a “precautionary” approach was taken to social distancing in the UK—based on SAGE guidance—above the World Health Organisation’s recommendation of “at least 1 metre”. However, on face coverings a precautionary approach was not employed, and SAGE’s recommendations were not taken up until two months after they were made. In general, more lessons could have been applied from the experiences of other countries, particularly those which have dealt with previous coronavirus outbreaks (e.g. SARS and MERS). The Government should commit to review—before the end of 2021—the relationship between SAGE and expert advisory structures in other countries and the World Health Organisation, to understand where knowledge sharing may be improved during future emergencies.

Given the importance of refining interventions to mitigate both impacts on public health and economic recovery, a review of social distancing measures came quite late. While the scientific approach quite rightly waits for the evidence before making a definitive recommendation, this often necessitates delay and may not produce conclusive results. The pandemic has demanded that policy be made and adapted on a faster timescale and in this instance the Government was too slow to respond. The UK response to covid-19: use of scientific advice 81 The Government should employ a more adaptive approach to non–pharmaceutical interventions such as social distancing rules and commit to a review of the approach employed in the UK as compared with countries that dealt with the SARS and MERS outbreaks (such as the Republic of Korea), setting out the reasoning for differences in policy decisions. The outcome of this review should be published by the end of 2021.

The development of vaccines and therapeutics is a policy area in which it is right that science must lead the way, so that there may be a high level of confidence that a rigorous approach has been taken towards safety and efficacy. From the beginning of the pandemic, the clear advice from experts was that significant investment and resource, at risk of failure, was required on many fronts to maximise the potential for success. The Government listened to this advice and we applaud the speed at which the Government implemented support for research and clinical trials, and took steps to secure the manufacture and procurement of potential vaccines.

We acknowledge that a large part of the success to date into the development of covid-19 vaccines and therapeutics can be credited to lessons learned from previous outbreaks and efforts made to prepare for future crises. As further promising vaccine candidates and treatments come to light, other aspects of the Government’s pandemic preparedness, such as the logistics of a mass vaccination campaign, will be tested. (Paragraph 159) 82 The UK response to covid-19: use of scientific advice