91.Having examined different aspects of the science advisory process earlier in this Report, this Chapter considers the main issues around the nature of the scientific advice drawn upon by the Government in the early stages of its management of the coronavirus pandemic. One key aspect of this has been the breadth of expertise represented at SAGE meetings and in other scientific advisory groups. This is in part why we called for the disclosure of information on scientific advisers throughout the early stages of pandemic.
92.When the Government Chief Scientific Adviser and the Chief Medical Officer for England wrote to us in early April to give an overview of the expertise feeding into SAGE, they explained that a range of areas of expertise were represented on SAGE: “molecular evolution, epidemiology, clinical science and practice, modelling emerging infectious diseases, behavioural science, statistics, virology and microbiology”. However, several witnesses have suggested that there was a heavy emphasis on epidemiology and modelling in the science advice relayed to central Government. For example, Professor Johan Giesecke, Former State Epidemiologist for Sweden and Professor Emeritus at Karolinska Institute, suggested that “epidemiologists and modellers had too great a power” in both the UK and Sweden in the early phase of the pandemic.”
93.We further note public comments made by Professor Mark Woolhouse, one of the key epidemiologists advising SPI-M and the Scottish Government covid-19 Advisory Group, that he thought “scientific advice [was] driven far too much by epidemiology”. Speaking to us in June, Professor Woolhouse provided further clarification that:
In the early stages of the epidemic, before we had large amounts of [public health] data, [advice] was largely on the basis of modelling, and that is all right and proper and as it should be, but we are looking literally at only one side of the equation when we do that.
He suggested that the “other side” of the equation included “the harms done by lockdown” including impacts on “mental health and social wellbeing, the education of our children and our economy.” Nevertheless, Professor Neil Ferguson—another eminent scientific adviser involved in modelling the pandemic—suggested to us in the same meeting that SAGE’s approach had “evolved over time quite a lot” and was “a lot more diverse”. He stated further that “modelling has an important role to play, but clearly it is just one of many scientific inputs.”
94.Aside from the disciplines discussed above, we have received a notable amount of written evidence regarding a perceived lack of representation across other relevant Science, Technology, Engineering, Maths and Medicine (STEMM) fields of study. For example, some of the viewpoints expressed to us include that:
a)public health science had been “underutilised”;
b)there were “concerns around the representation of immunology expertise”;
c)there was “room to enhance” the use of engineering expertise and advice;
d)early in the pandemic there was a “lack of involvement of established corona-virologists who might have been able to grasp more quickly the potentially complex symptomology, immuno-pathology and epidemiology of the virus”; and
e)the “government itself could have done better in listening to and responding to, needs and alternative views outside of ‘Golden Triangle’ Universities”.
In March, Dr Richard Horton expressed his concern to us that there was an apparent lack of public health and clinical input into SAGE. However, Sir Patrick Vallance robustly rejected the suggestion that SAGE did not have sufficient clinical representation:
both the Government chief scientific adviser—me—and of course the CMO are medics. We also have the NHS medical director on SAGE itself. We have a number of clinicians around the table, including some from Public Health England, so quite a proportion of SAGE is clinical, but—it is an important “but”—there is a clinical subgroup within SAGE and they are all clinicians. They do a lot of the work on modelling the clinical aspects.
95.Further, evidence submitted by the Nuffield Council on Bioethics and the Institute of Development Studies discussed the importance of social science perspectives in informing decision making, with the latter stating that SAGE had “minimal social science representation and is largely confined to narrow behavioural science perspectives” which compared “unfavourably” with other European countries. The Institute also suggested that more expert input was required from the fields of “anthropology, geography, sociology, economics, history and related fields.”
96.However, speaking to our Committee and the Health and Social Care Committee in November, the Secretary of State for Health and Social Care suggested that criticisms that the diversity of SAGE expertise was too narrow were “not an accurate description”:
we absolutely listen to a broad range of advice. The formal way in which the SAGE advice is brought to Ministers is, quite properly, through the CSA and the CMO. We listen very carefully to them. I also listen to all sorts of voices and scientific arguments.
The Secretary of State further commented that he did “not think that having engineers and operational skills and capabilities on SAGE would be right at all”, indicating that advice on engineering requirements was delivered “quite separately”.
97.We note that SAGE guidance indicated that “to ensure the full range of issues are considered advice needs to stem from a range of disciplines, including the scientific, technical, economic and legal”. The provision of expert economics advice to Government throughout the pandemic is one issue that we have sought to understand, particularly given the wide ranging impact the coronavirus has had on the public as a whole and at the individual level. Professor Chris Whitty told us that SAGE was not giving economics advice to Government and did not have a “specific economic group”. He also suggested that SAGE was “not constituted” to give economics advice and would require a “different membership” in order to do so, cautioning that this could expand SAGE’s operation into “such a large group that it is almost impossible to do what it is currently doing.” However, Professor Whitty acknowledged that SAGE had one participant from Her Majesty’s Treasury (HMT)—later identified as the Director of Economics at HMT—who had fed in “important insights” due to her “different disciplinary and intellectual background”. Speaking to whether the SAGE mechanism should be replicated for economics advice, Professor Whitty stated there was an “entirely legitimate question” but conceded that he did not believe he was “the right person to answer that”.
98.However, speaking to us in November, Sir Patrick Vallance stated his viewpoint that economic analysis was “not something that takes place in SAGE, nor should it take place in SAGE”. He also pointed out that such analysis was taken elsewhere:
It is very clear that SAGE exists to provide the science advice. The Treasury and the Cabinet Office bring in the other parts of the equation, particularly on the economy. I do not think it is right to think that SAGE would be the place that you integrate all of this and come out with a single number.
We further note the evidence received in Chapter four, concerning the public communication of the economic advice given to Government (paragraphs 75–77).
99.Further, Philip Duffy, the Chief Scientific Adviser at HM Treasury, told us in May his view that the Treasury had “significant influence” on the questions put to SAGE for consideration, and described how HMT was kept up to date on economic impacts:
within the Treasury we have established broad governance to draw together our best understanding of the economic and market data but also of what is happening with the epidemic. I chair a sub-board of that committee, which looks at the impact on businesses and companies. The third area that has been an absolute priority for the Treasury is to lay its hands as quickly as possible on as much realtime data […] we have a very broad realtime dataset that can support the Chancellor and Prime Minister in the decisions they have had to take over the last few months.
Mr Duffy also told us he was “nervous” about the suggestion of creating “some form of economic SAGE or a social policy SAGE, or some kind of allied group that would look at the broader issues” as ministerial decisions had been made with “a combination of the best science that we can find and our best analysis of the social, economic and political consequences of those choices”. He also expressed that he was “sceptical of the notion that a few extra economists would somehow accelerate answers or give us a sense of rigour around some of those choices.”
100.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.
101.The disclosure of the minutes of SAGE meetings, beginning in May, has enabled us to analyse how the number of experts who attended SAGE meetings has evolved throughout the pandemic. Our analysis has focused on minutes published by SAGE, covering meetings in the period of 22 January—29 October, spanning the initial spread of the coronavirus in the UK, the first nationwide lockdown and the period leading up to the second nationwide lockdown in England. In general, SAGE meetings have increased in size throughout the pandemic, with the first thirteen meetings comprising under 20 participants before steadily growing throughout the first nationwide lockdown to often include in excess of 30 individuals (Figure 2).
Source: GOV.UK. Notes: Individuals whose names have been redacted from SAGE minutes (as of 14 December 2020) are omitted from this analysis.
102.According to a 2019 Royal Society report, there is “considerable strength in UK data science in academic, industrial, charitable and government sectors”. Emphasising the importance of data in managing the coronavirus, Sir Patrick Vallance told us that:
One lesson that is very important to learn from this pandemic, and for emergencies in general, is that data flows and data systems are incredibly important. You need the information in order to be able to make the decisions. Therefore, for any emergency situation those data systems need to be in place up front to be able to give the information to make the analysis and make the decisions.
Sir Patrick indicated that this was not limited to testing data but also encompassed “basic information flows around patients in hospital, rates of admission and rates of movement”. However, he suggested that a principal issue in managing the pandemic was that “at the beginning there were definitely times when we would have liked data that was difficult to get”. While he stated that “data flows are getting much better now”, he pointed out that the NHS “does not have centralised data flows on everything you need”.
103.Sir Patrick later wrote to us reinforce his view that in the “first weeks of the UK’s epidemic, it was difficult for SAGE to accurately assess the state and trajectory of the outbreak at that time due to the lack of data” pointing to specific issues including:
a)that it took until mid-February for the “relevant data sharing agreements [to be] signed by modelling groups”, with the first detailed PHE “line list data” being provided to modellers on 6 March;
b)that initially “not all SPI-M modelling groups were able to access” data from NHS England and that early data “lacked granular detail, such as how many patients were new covid-19 admissions, versus potential re-admissions”; and
c)that “comprehensive data on covid-19 in care homes were not available to the Government”.
104.A SAGE meeting on 15 March demonstrated the impact of poor data management in the understanding of the disease at the most critical time for the UK:
Owing to a 5–7 day lag in data provision for modelling, SAGE now believes there are more cases in the UK than SAGE previously expected at this point, and we may therefore be further ahead on the epidemic curve.
We note that while more data eventually became available through initiatives such as the Office for National Statistics (ONS) infection survey, the National Statistician, Professor Sir Ian Diamond, pointed out that the ONS “responded to the first request [they] got” from the Government on 17 April. Nevertheless, Sir Ian suggested that the response from the ONS—and partners—in initiating the work was rapid, stating that it was “one of the most rapid surveys I have ever in my life seen go into the field”.
105.The difficulties with accessing health data was also made clear to us by Professor Carol Propper, Professor of Economics and President of the Royal Economic Society:
There is scientific uncertainty and there is uncertainty within the social sciences and economics community [...] The more we can put these ideas together, the more we can get as much realtime data as possible and get health authorities to release health data, which is very difficult to do on a timely basis, the faster we can begin to analyse...It is all about having data and ideas and sharing both.
106.We also had several concerns outlined to us in written evidence, including that:
a)problems occur “at every level, from data collection, curation, storage in accessible sharable formats, incentives for sharing, and a lack of competence in well-established ways of handling and sharing data that are compliant with regulations and address privacy concerns”;
b)there has been “fragmentation of health data across various organisations such as NHS Digital, NHS England and Public Health England”, including “a lack of clarity on which organisations hold certain data and how to access data”;
c)“the devolved nature of UK health systems and their differing legislation has made the combination of datasets difficult and has hampered the ability to carry out a UK-wide analysis”; and
d)the care sector suffers from “different systems collecting different data and a poor take up by the care homes and home care sector due to a lack of trust in the central and local authorities collecting the data”.
107.Professor Sylvia Richardson, Director of the MRC Biostatistics Unit and the then President-Elect of the Royal Statistical Society, also raised concern that the statistical community had been “hampered” in early efforts to access data and analyse the pandemic due to the lack of “a central core where all these data can be put together”.
108.The creation of the Joint Biosecurity Centre sought to provide such a centralised data hub, to enable faster, more integrated analysis and decision-making, as suggested by Professor Richardson who indicated that the JBC’s creation was an “extremely positive move”.
109.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 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:
110.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.
144 dated 4 April 2020
145 Professor Johan Giesecke, Former State Epidemiologist for Sweden and Professor Emeritus at Karolinska Institute ()
146 The Guardian, , 23 April 2020
147 Professor Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh ()
148 Professor Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh ()
149 Professor Neil Ferguson, Director, MRC Centre for Global Infectious Disease Analysis, Imperial College London ()
150 Written evidence submitted by the Academy of Medical Sciences ()
151 Written evidence submitted by the British Society for Immunology ()
152 Written evidence submitted by the Royal Academy of Engineering ()
153 Written evidence submitted by the Royal Society of Edinburgh ()
154 Institute for Life Sciences, University of Southampton ()
155 Dr Richard Horton, Editor-in-Chief of The Lancet ()
156 Sir Patrick Vallance, UK Government Chief Scientific Adviser ()
157 Written evidence submitted by the Institute of Development Studies () and the Nuffield Council on Bioethics ()
158 Oral evidence taken before the Science and Technology Committee and the Health and Social Care Committee on 24 November 2020, HC 877 ()
159 UK Government, , p.5, October 2012
160 Professor Chris Whitty, Chief Medical Officer for England (). See also Philip Duffy, Director-General (Growth and Productivity) and Chief Scientific Adviser, HM Treasury ()
161 Professor Chris Whitty, Chief Medical Officer for England ()
162 Sir Patrick Vallance, UK Government Chief Scientific Adviser ()
163 Sir Patrick Vallance, UK Government Chief Scientific Adviser ()
164 Philip Duffy, Director-General (Growth and Productivity) and Chief Scientific Adviser, HM Treasury ()
165 Philip Duffy, Director-General (Growth and Productivity) and Chief Scientific Adviser, HM Treasury ()
166 We have only included named participants from SAGE meetings, based on minutes available as of 14 December 2020. Individuals whose names have been redacted are omitted from this analysis.
167 The Royal Society, , May 2019
168 Sir Patrick Vallance, UK Government Chief Scientific Adviser ()
169 Sir Patrick Vallance, UK Government Chief Scientific Adviser ()
170 Written evidence submitted by Sir Patrick Vallance ()
171 GOV.UK, , published 29 May 2020
172 Office for National Statistics,
173 Professor Sir Ian Diamond, National Statistician, Office for National Statistics ()
174 Professor Carol Propper, Professor of Economics, Imperial College Business School ()
175 Written evidence submitted by the Royal Society ()
176 Written evidence submitted by the Wellcome Sanger Institute ()
177 Written evidence submitted by the Wellcome Sanger Institute ()
178 Written evidence submitted by Care England ()
179 Professor Sylvia Richardson, Director, MRC Biostatistics Unit, University of Cambridge ()
180 Professor Sylvia Richardson, Director, MRC Biostatistics Unit, University of Cambridge ()