The below is simply a place to keep notes of discussions I pick up specifically on the relations between science, policy, & covid-19 (not a record of the science of covid-19). No conclusions drawn – too early to do so & too great a volume of noise to think through clearly at this juncture. We have zero insight on the exact nature of government decision-making – and might well not know until 30 years’ hence (30 year role on release of documents). We are living through it – it is impossible to be objective & it is impossible to know what is going on inside government. I am not generally going to comment on the political picture, but the scientific response to it, in keeping with my long-standing approach on this website.
General picture
The key point for me at this time (obviously none of what follows is original thought) is that our science & technology was under-prepared for the crisis, even though the crisis was predictable. (One can make similar comment about other pending dangers such as climate change.)
It is obvious the public did not get the science & technology they expected & deserved. Instead, they mostly relied on age-old measures such as lock-down to stop the virus spreading. As we have seen, many thousands of people still died & continue to die.
From a science & technology perspective, the major global issue seems to be the historical absence of R&D on specific treatments for, or vaccines against, coronaviruses (& other potential pandemic threats). The virologist Vincent Racaniello has made this point particularly well (see: here). One must add that we appear to have no strong base of scientific knowledge on the biology of these viruses, despite the previous SARS crisis.
One can lay the blame on research funding agencies, governments, the pharmaceutical industry, money markets, banks, investors, etc.; indeed this is part of a bigger picture of the way science has evolved over the last 40 years (discussed elsewhere on this website). At no stage did biotech & pharma investment communities notice the many foresight activities that presaged a global pandemic, indeed one that might have conceivably involved corona-viruses (after SARS). At no stage did they adjust their investment portfolios accordingly. Neither, of course, did government officials.
In *some* but perhaps not all places, we might add the lack of framework for provision of reliable advisory services during a pandemic. It is said covid-19 is a new phenomenon, and therefore science is struggling with it. But viruses are not new, nor are infectious diseases, nor indeed dangerous coronaviruses (i.e., SARS). Nor are crises, for that matter, i.e., decision-making situations where the evidence is incomplete, equivocal, & fast moving. Nor is social media particularly new, nor disinformation (in so far as they did not suddenly appear when covid-19 began).
That science failed to develop a framework to deal with such situations, e.g., an agreed burden of proof in regard to evidence, speaks to a lack of preparation. Indeed, as the crisis goes on, a general lack of fine-grained appreciation for which areas are genuinely new and challenging, & which areas are not new and therefore can be met with more tried-and-tested scientific approaches & evidence, spells ill for our response in general. Hopefully, as panic among officials subsides, greater sense will prevail – assuming that panic does subside.
We must therefore be conscious of the fact that should an effective vaccine or treatment not be forthcoming (based on science & technology hurriedly cobbled together over the last few months) – nor the virus for some reason modify its behavior and become less dangerous – science, as well as other aspects of the states that wield it, might come into question. Herein will lie a new stage in the response to the pandemic in which solutions other than ones emanating from science could well be favored.
The UK’s initial response
Turning to the UK, it might have been more politically astute, and probably more effective, for the crisis to have been treated as a public health emergency from the outset, and delegated to public health agencies. It is a long established principle that public health is a very particular specialist area; this is why we maintain a cadre of public health experts at all times ready for emergencies, such as the WHO.
Regrettably, covid-19 became almost immediately *not* a public health problem, but a science advisory problem. Possibly this was because budget cuts meant that the public health capacity was no longer there. Politically-appointed and sometimes inexpert scientific advisers, not to mention academic committees & private consultants, none of whom were even public employees, therefore appeared to lead the response (with public health officials cast as subordinates).
There was little credible challenge provided at that time for the way decisions were being taken, presumably due to Britain’s traditional modes of class deference & elite decision-making. Ironically, therefore, it was the Chinese press that provided the greatest insight (Chinese comment on the UK response probably drove the departure of Chinese students from the UK at that time). Citing, for example, Ning Yi, a former colleague of Patrick Vallance (a former executive at the pharmaceutical firm, GSK – more recently appointed UK Chief Scientific Advisor):
In the opinion of Ning Yi, Patrick Vallance’s old colleague who worked with him, “Patrick used to be in GSK – he was a very good manager but not very sensitive about data. He is not an expert in infectious disease”. Therefore Ning Yi is disappointed about the UK strategy which is not realistic in his view. “Maybe Patrick’s team have done accurate modeling before, but in this case, it seems it would be very difficult to achieve”. – Sun Aimin, Financial Magazine, 14 March 2020.
For many years the UK has been substituting diminishing core state expertise in a range of areas with science advisory services outsourced to academics based at UK universities. This is not to say it is not useful to talk to a wide of range of people when gathering evidence, but one should not restrict it to only UK academics, and one should not outsource key policy decisions to them. In my view (see rest of website), the ability to analyse & weigh evidence needs to be retained by the state among its own expert employees; they are public servants and therefore in principle bound by law to serve the public interest and accountable for their decisions. A state with no experts is not up to much. This is evidently particularly the case for public health.
The outsourcing of science advisory services, common in the UK, became visible to the public around the middle of March 2020 (initially it was very hard to grasp its scope as there was a good deal of obfuscation by government about it). Academics from UK universities were soon seen to be leading the response, while also giving differing opinions on TV & social media.
Public communications
The virus is invisible & therefore the exact choice of words used in public communication might well be critical to the public’s understanding of it and what they must do to stop it.
In the UK, government used the term ‘lock-down’ – in Singapore the term ‘circuit-breaker’ was used instead – perhaps more descriptive of the true nature of the intervention. The UK had a single-minded propaganda drive on ‘protecting the NHS’ & ‘clapping for the NHS’, rather than one more broadly focused on safeguarding one’s own health, and the health of one’s family, neighbors and the community at large (c.f. Singapore). Perhaps the UK’s NHS-focused communications were not sustainable once the immediate risk to hospital capacity had passed, even though the virus had not gone away & public health messages logically had to continue. Overall, creating a sense that there was a period of emergency, after which the virus went away by itself, was perhaps unwise.
Evidently reasons for these varied communications decisions are not yet known, i.e., to what extent evidence on past public health communications was marshaled to support decisions. One notable feature: learning concerning public health communication from HIV/AIDS, the only pandemic the UK had experienced in living memory, fell seemingly by the wayside (see here). Another established concept that was perhaps not prominent: ‘health: everybody’s business’ (long-standing official stock phrase).
Warlike metaphors (battle, fight, etc.) sometimes used with covid-19, or references to a winter wave & seasonality *might* have created a sense that the virus was an external threat, when in fact it was not as such ‘external’ (viruses have no external existence outside cells), but depended for its propagation on everyone’s behavior (i.e., it was everybody’s business). Unlike Father Xmas, the virus would not check the calendar for when it should arrive; rather, its transmission characteristics would hinge on human behavior, and so on. Mere uninformed speculation on my part; I am simply asking: was this kind of thing considered & appropriate scientific evidence marshaled?
Science advisory services in Public Health England
I put a freedom of information (FOI) request to Public Health England (PHE) asking for details of any PHE team(s), group(s) or cell(s) etc. that are gathering and/or appraising scientific evidence on covid-19. I asked: (1) topics under assessment by these groups; (2) the size of the group(s) (headcount); (3) date when group(s) constituted; (4) the academic & professional qualifications of those in the groups (including subjects of any university degrees held); & (5) methods used to obtain & assess evidence, i.e., literature review (name databases), telephone call or videoconference, exchange of email, meeting, etc. I also asked PHE to give the names of all public health agencies and scientific organizations overseas that they had been in contact with (email exchange/telephone call/meeting, etc.) since December 2019, where PHE officials had sought advice or information on covid-19 & its control (including an approximate frequency of contact in each case).
This is the response I received dated 10 Nov 2020:
PHE is responsible for providing guidance and advice to government and front-line services for all aspects of public health. It is a designated Category 1 responder organisation under the Civil Contingency Act and this specifically includes the COVID-19 response, providing clinical expertise and wider public health advice and guidance across national and local government, the NHS and third sector. Further information requested will be made available as part of PHE’s standard process when a full report will be made available at the end of the incident. Therefore, this information is exempt under Section 22 – Information intended for future publication, exemption. We have considered whether it would be in the public interest for us to provide you with the information ahead of publication, despite the exemption being applicable…the public interest favours non-disclosure of the specified information.
Accordingly, at this juncture we cannot make any comment about the means used to obtain science advisory services within PHE during the pandemic. It is, however, regrettable that they have chosen not to disclose this information given secrecy is not typically the friend of public health. In an evolving crisis of unknown duration such as the pandemic, it can hardly be wise to wait until the end to draw conclusions, as indicated in their response.
Science advisory services in relation to schools
I put a freedom of information (FOI) request to the Department for Education (DfE) asking if DfE had any team or group that was gathering and/or appraising scientific evidence on school opening & covid-19 in regard to health & other risks to pupils & teachers, and community transmission. Additionally, I asked (1) the size of the group (headcount); (2) when it was constituted; & (3) the academic & professional qualifications of those in the group (including subjects of any university degrees held).
This is the response I received on 4 Sep 2020:
We have been able to answer parts 1 and 2 of the FOI. In response to part 3 of your request, I can confirm the Department does not hold this information and therefore cannot provide the information that you have requested. We have interpreted the ask as referring to people engaged with the scientific evidence around school opening and its link to coronavirus and transmission and not wider analysis of issues as a result of that (e.g. attendance data, learning loss etc.).
The Chief Scientific Adviser for DfE was invited to attend SAGE from 4 February. From this date, a small secretariat, comprising of between 3 and 5 people at any one time, was formed to support the Chief Scientific Adviser and Deputy Chief Scientific Adviser in their engagements with SAGE and its sub-groups. The secretariat is responsible for co-ordinating commissions to the scientists, providing a link between scientific groups and policy officials at DfE, and disseminating relevant evidence to policy officials and DfE ministers. On the gathering and appraising of evidence in relation to Covid-19 and education, the department has relied on the input of scientists including members of the Task and Finish Group for Children, SPI-M and other SAGE sub-groups and PHE.
In so much as the above answers my questions, or provides a complete picture, it would seem the DfE scientific advisory services are significantly under-powered. Indeed, besides all the outsourced advisory services (SPI-M, SAGE, Task & Finish Group, etc. – the naming of these groups is quite odd, isn’t it?), one could say it is surprising that at core there is only a small team of 3-5 officials dealing with this matter (& of unknown qualifications). To complete the picture, we would also need to understand the PHE capacity mentioned above and how it interacted with the decision-making process (I lack these data).
It is worth noting the Children’s Commissioner raised concerns about the scientific advisory capacity within DfE. The Chief Scientific Advisor of the Department for Education is to my knowledge Osama Rahman, an economist (‘having spent 10 years as a lecturer and senior lecturer in economics at various UK universities’; see here). It is therefore hard to see how he would have scientific expertise or judgement germane to the topics in hand, such as the impact of school opening on viral transmission; transmission blocking measures required in schools, etc.
Consequently it could well be the case there is little significant capacity to gather and appraise evidence (e.g., scanning the relevant scientific literature, contacting and speaking with relevant scientists around the world, appraising inputs & briefing ministers, let alone informing the real decision-makers, i.e., schools, parents, the public, etc.).
My guesstimate is that one would need a minimum of 10 people constantly assessing the scientific picture across a range of topics; I would expect them to be seconded full-time, at the post-doc type level, from relevant academic fields. It would need that capacity just to keep on top of the emerging evidence – evidence moves on this topic. This is a matter of importance in terms of control of the pandemic; yet, oddly, based on the limited information I have to hand, seems to be an after-thought.
Role of scientific advisory services; accountability mechanisms (if any)
There was a distinct void where scientific advisory services could have played a role, such as in helping parents home school their children, people trapped at home exercise & eat well, reducing risks of domestic abuse, and so forth. Obviously the private sector jumped in to supply some of these services. Generally the approach of the official scientific advisors might even have undermined the confidence & morale of the public. For example, parents were told their children were becoming mentally ill at home. One cannot really call these claims scientific even though they came from the mouths of scientists.
Turning to another field where scientific advisory would have been crucial: burden of proof. We must admit that instead of a consistent, transparent approach, different burdens of proof were randomly applied to different interventions. Take hand-washing, as opposed to wearing face masks. The scientific evidence for the former as a specific against covid-19 transmission was lacking, while that in favor of the latter was relatively strong. We therefore do not know why a decision was taken to promote hand-washing while singing the happy birthday song (common advice in many Western countries at that time); conversely mask use was actively discouraged by senior officials.
Indeed, in the UK, scientists even spread spurious claims that masks were dangerous, that they could cause suffocation, or even increase virus spread. It was charlatanism. Evidently scientific evidence was not the key factor; perhaps decisions were instead based on long-standing official assumptions about hygiene, odd skepticism of practices from overseas, pure guesswork, and so forth. Who can say?
One can question the salience of pandemic influenza to the current disaster; but, at least in the early stages, as a reasonable approximation, it was identified as the key model. Yet, ironically enough, senior officials mostly seemed to lack expertise on this particular topic: I could only spot two highly-credentialed respiratory virus experts (Jonathan Van Tam & Maria Zambon). Both have published extensively on pandemic influenza; Van Tam also co-authored a textbook entitled An Introduction to Pandemic Influenza. It did not appear that either of them was in charge.
The UK body previously charged (in public law) with infectious disease control, Health Protection Agency (HPA), was abolished by the Conservative-Liberal coalition administration in 2012. Its replacement, Public Health England (PHE), had no such statutory basis. I would guess PHE funding was also cut; possibly from a relatively low base. At least at the start of the pandemic, it would therefore have been a good decision to strengthen & support PHE; and indeed, put PHE on a legal basis in which it reported to the public, not ministers (& was legally accountable for its advice & decisions). Not done.
The above remark on HPA & PHE takes us into a specialist world of public health agencies, public health in local government, etc. which I am not in a position to comment upon being completely ignorant of the topic (see: here & here). But it seems generally the case that glitches in the handling of the 2009-2010 swine flu crisis by the UK government were not addressed; indeed, perhaps, there was even an official refusal to confront these lessons after the fact and learn from them. This seems like the kind of selective amnesia that anyone dealing with science & research policy in Britain will immediately recognize.
Regrettably we see signs that lessons have not been learned again as we enter the next phase of the covid-19 crisis (including fixing the noted lack of ability to learn lessons). All things being equal, it could have been a better option to outsource advisory services to the WHO. The failure, not just in the UK (& for obvious reasons due to Brexit), but also across Europe, to recognize the continental scale of the crisis, and the need for a continental level response, is marked. National level responses continue to dominate. One can identify problems in European governance, such as the relative weakness of the European CDC, but the virus does not wait for those to be rectified. Freedom of movement has always been on the virus’ agenda. Team Europe has therefore done badly; the UK is one of the worst of a bad lot. Panic among officials might excuse the first round of errors, but surely not the second.
All seems to hinge on the hope the virus, as a natural phenomenon, changes its behavior into a less dangerous form. In this sense, the virus will determine the final verdict on our responses. But another alternative would be that the public are sufficiently callous not to mind another round of mass death.
It must be admitted there has been little or no general outrage about the deaths in the spring; besides which, historical cases show people are capable of astonishing levels of callousness (see: here). From the perspective of the moral state of our society & government accountability, in particular concern for senior citizens, I find that one of the most depressing phenomena of the crisis.
Bail-outs
Another major area we will need to grapple with as analysts is the response across the entirety of science to the crisis. In spite of a certain amount of rhetoric about meaningful change on the back of the crisis, e.g., decarbonization, the primary goal of financial bail-outs by taxpayers has been to maintain the economic & social status quo. This has in many countries entailed giving taxpayer funds to a range of politically well-connected firms such as major airlines and banks, but without the competitive tendering or other forms of screening or strategic planning we might hope would have occurred.
As in the 2008 financial crisis bail-outs, we are therefore experiencing a very particular kind of industrial strategy (without it being named as such). The opportunity to restructure the ownership of pharmaceutical R&D, provision of healthcare services, and so forth, if it has been taken at all, has tended towards greater privatization – as opposed to a more public-service oriented ethos.
In the USA, there was no move to institute universal healthcare; while in the UK efforts to privatize healthcare were accelerated. While admitting to a complicated picture, calls for global cooperation on vaccines were it seems often ignored. There has thus far been little discernible effort by governments to re-tool the pharmaceutical industry to deal with future pandemics, and so on (see: here). All of these trends would tend to suggest that our leaders are not yet learning the humanitarian lessons of the crisis – concerning in terms of how we deal with its next stages, or subsequent crises.
The above is undoubtedly an area to watch; things might change & it is too early to tell how the crisis will impact the focus of investments in science & research across the board.
Note on reading
Just a list of various things I have read that seem relevant (no particular order).
Health Management & Policy Governance Lab (University of Michigan)
How has science shaped COVID-19 policy? (University of Colorado Boulder)
Science Advice & COVID-19: What are we learning? (INGSA)
Berridge, 2020, History Does Have Something to Say, in: History Workshop
Berridge, 1996, AIDS in the UK: The Making of Policy, 1981-1994
Covid-19 editorial content in the British Medical Journal & The Lancet
Oshinsky, 2005, Polio: An American Story
Blakely, 2006, Mass Mediated Disease: A Case Study Analysis of Three Flu Pandemics and Public Health Policy
Griffiths & Hunter, 2007, New Perspectives in Public Health
Graupner, 2020, Will coronavirus pandemic change Big Pharma’s long-term focus? Deutsche Welle
Dew, 2012, The Cult and Science of Public Health: a Sociological Investigation
Deloitte, undated, COVID-19 response for Pharma companies Respond. Recover. Thrive.
Epstein, 1996, Impure Science: AIDS, Activism, and the Politics of Knowledge
Ranger & Slack, 1995, Epidemics and Ideas: Essays on the Historical Perception of Pestilence
Roger Pielke Jr, Covid-19 Resources for Research and Teaching
Van Tam & Sellwood, 2010, Introduction to Pandemic Influenza
Schietke, et al., 2014, Influenza Pandemic in Germany 2020: Scenarios and Action Options
Science Think Tank 