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

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3Activation and operation of SAGE

Timeliness of coordinating SAGE and science advice

35.The purpose of mechanisms such as SAGE and COBR is to ensure that the delivery of scientific advice to decision-making is in step with the rapid nature of how an emergency unfolds. While the timing of advice and decisions on specific interventions will be discussed in later Chapters, this Chapter considers the broad timing of scientific advice from the outset of the pandemic.

Initial awareness of the outbreak in China

36.In our initial public hearing in March, Dr Richard Horton, editor of the Lancet, expressed his concern that the Government had not responded rapidly to the emerging threat in China:

what strikes me is the mismatch between the urgent warning that was coming from the frontline in China in January and the, honestly, somewhat pedestrian evaluation of the likely severity of the outbreak in [SAGE] evidence.54

Dr Horton suggested that three Lancet academic papers detailing the outbreak in China—published on 24, 30 and 31 January—did not appear to have been considered by SAGE.55

37.However, at the same meeting Sir Patrick Vallance indicated that advisers in central Government were aware of the issue in January:

very early on there were two things that could happen […] Either China could contain this completely and it would go away—that was one possibility—or they would not contain it and it would spread and become a pandemic […] Early in January, it was not clear which of those would be the case.56

Further, Professor Chris Whitty, Chief Medical Officer (CMO) for England, informed us that he first discussed the news of the emerging outbreak with one of the deputy Chief Medical Officers on 2 January.57 Sir Patrick also told us in March that by the time the WHO had officially declared the crisis as a pandemic situation on 11 March, the UK Government was already “planning that it would go across the world”.58

38.This is supported by the first “precautionary” SAGE meeting being held on 22 January 2020,59 less than one month after China reported the first cluster of coronavirus cases and eight days before the World Health Organisation declared the outbreak a Public Health Emergency of International Concern (PHEIC).60 Nevertheless, details of this first SAGE meeting were not made public for some time, with the minutes alone being published on 29 May.

Setting up SAGE

39.Written evidence submitted by a collective of University researchers who interviewed “senior scientists” advising the Government and its agencies—indicated the view that “the UK’s early warning systems for emerging infectious disease, situated in PHE, served their purpose well.” However, they also suggested that it took a few weeks to get SAGE set up fully. One interviewee told the researchers that processes around SAGE were “extremely confused to begin with” amidst advisers joining the group “at a rate of knots”.61

40.Similarly, written evidence submitted by the Royal Society explained that the systems needed to coordinate science advice “were not initially in place” and therefore the pandemic “initially overwhelmed the UK Government’s abilities to access and deploy the UK’s operational science capabilities at sufficient scale and speed”. On the Government’s outreach to the wider scientific community—including with the National Academies—the Royal Society suggested there was an “unplanned reactive effort”.62 The Physiological Society also suggested that opportunities to engage with the Government were “piecemeal”.63

Timeliness of advice and decision-making

41.The Secretary of State for Health and Social Care, Matt Hancock MP, told us in July that “various SAGE conclusions, especially on lockdown measures or the non-pharmaceutical interventions, were followed in a timely manner, in some cases on the same day.”64 Sir Patrick Vallance nevertheless impressed upon us in July that “the ultimate decisions are a mixture of policy and timing”, which were outside of SAGE’s control and that timing of decisions was “a policy question”.65

42.Written evidence from the University of Liverpool and the University of Oxford suggested that while “scientific advice to Government was timely […] decisions based on it were often delayed, particularly during the earlier part of the crisis (January–April)”. Based on interviews with scientists advising the Government, they suggested that “six weeks of opportunity was wasted” and pointed to one interviewee’s comments of:

a couple of heated moments [in mid-March] where [scientific advisers] were saying “you are not moving fast enough”. The Government’s most senior expert advisors, we were told, responded that policy decisions were a process, that the politicians needed to be led through it.66

43.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.

44.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 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.

45.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.

Scientific advice

46.We have heard from numerous participants of SAGE—and its sub-groups—that the science advisory machinery has operated by conveying a central view, whilst reflecting the scientific uncertainty that is associated with covid-19 being an entirely new threat. For example, Professor Neil Ferguson set out his view on the role of external advisers in giving science advice:

The aim of SAGE is to give the co-chairs sight of the best scientific evidence and the uncertainty around specific topics. We are not trying to reduce uncertainty; we are trying to convey to [Sir Patrick Vallance] and [Professor Chris Whitty] what is known about the science and what the uncertainties are, so that they can make a judgment about how they communicate that to Ministers.67

Similarly, Sir Patrick Vallance, the Government Chief Scientific Adviser, stressed to us that with “a number of experts and scientists around a table, you are not going to have a discussion in which everyone agrees with everyone else”, pointing out that the group challenged views by discussing alternatives and possible outcomes “at every stage of the process”.68

47.In terms of relaying scientific advice to decision-makers, Professor Chris Whitty indicated that SAGE worked to ensure that the nuance between statistical confidence and uncertainty was communicated:

One of the things you are trying to convey is both the central projection—this is where on average we think things will go—and the uncertainty around that […] you ideally also provide confidence intervals.69

48.Professor Whitty also gave us an insight into why SAGE sought to distil the scientific evidence—and its associated uncertainties and differences in expert opinion—to provide a central view that maximises its usefulness for Government decision-making:

It is not very useful to Ministers or other decision makers to say, “There are 16 opinions. Here are all 16. Make up your mind.” Part of the process is to say in a unified way, “Here is the central view”, and then, if there are either dissenting views or a range of uncertainty quantitatively around that, to convey it in a way that is comprehensible to the people who are listening so that they understand the certainty with which the advice is being proffered. If they do not, it is clearly going to lead to bad decision making.70

Sir Patrick echoed this viewpoint:

What I think is not helpful is to say, “Here are several different views,” and ask somebody who is less knowledgeable to bring these together and come to a single view. In SAGE, we try to come up with a consensus view, but we are always clear and open about how we arrive at that.71

Sustainability of SAGE participation

49.Reflecting on inviting experts to attend SAGE meetings, Sir Patrick Vallance told us in July that in general “when people are asked if they would help in a Government emergency, the answer is yes. They turn up and work extremely hard at it.”72 However, he pointed to the upcoming issue of “how we keep that sustainable for them as the new academic term starts”. We also note later comments made by Sir Patrick to the Joint Committee on the National Security Strategy that SAGE was “not part of the government operational machinery and certainly cannot run for very long periods”.73 Professor Robert MacKay, Director of Mathematical Interdisciplinary Research at the University of Warwick, highlighted that academic expert advisers had “many other obligations” including teaching and administration and as a result colleagues working in epidemiology had been “working round the clock.”74 He suggested that mitigating this could involve “a number of fellows to be on research contracts with an agreement to be on call in a relevant crisis”.

50.Professor Neil Ferguson, who has participated in SAGE and is a member of SPI–M (the modelling group that feeds into SAGE), also provided an example of the pressure and urgency facing academic advisers in emergency situations:

Groups contributing to SPI-M will all independently go away and try to answer those questions and come back often two days or three days later, after working all night, with our best estimate of the answer.75

51.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.