Offline: Independent science advice for COVID-19—at last

Abstract

“Is the government's objective to suppress infection or to manage the infection?”, asked Sir David King at the first press conference of a newly formed independent Scientific Advisory Group for Emergencies (SAGE), held last week. The UK now has two SAGEs. The officially constituted SAGE has seen its reputation collapse during the past 3 months. Partly, this loss of credibility arose out of the group's unwillingness to be transparent about its membership and its proceedings. At a moment of national emergency, SAGE's secrecy simply became unacceptable. The public had a right to know the evidence on which advice was being made to government—advice that was not only protecting lives but also destroying livelihoods. But the official SAGE luxuriated in elite insouciance. It displayed a very British characteristic: the arrogance of exceptionalism. Rarely has a publicly constituted body been so out of touch with the public mood for accountability. By striking contrast, the independent SAGE published its membership before holding its first meeting. A more gender and ethnically diverse scientific group than the official SAGE, the new committee was also broader in the range of science it drew upon. Public health was its core, but it also included experts on modelling, behavioural science, and public policy. This wider intellectual reach made its recommendations more relevant to the UK's current predicament. The first meeting was broadcast on YouTube, giving the public full access to the difficult judgments needed to steer the country out of lockdown. It also displayed the challenges faced by political decision makers who have to ensure the country is prepared should a second wave of the coronavirus disease 2019 (COVID-19) pandemic ensue. “I completely disagree with you Martin”, replied Allyson Pollock to Martin McKee at one point. He had suggested that legislation to reform the health and social care system in the aftermath of COVID-19 was unlikely in the short term. Pollock disagreed. She believed that legislation was possible if the political will was there. It was an example of the transparency many observers of the regime of science policy making had been craving. The recommendations from the independent SAGE focused on five additional areas beyond seeking clarification of the government's overall objective in managing the pandemic. First, how was the government planning to ensure financial security for the most marginalised groups in society, including black and minority ethnic populations? COVID-19 has revealed, exploited, and accentuated deep socioeconomic and racial disparities in the UK. As Zubaida Haque noted, the existing “economic safety net is not enough”. Haque is deputy director of the Runnymede Trust and an expert on race equality. The government had ignored those least able to protect themselves, she argued. Second, community public health and primary care systems needed to be urgently strengthened. Pollock directs the Newcastle University Centre for Excellence in Regulatory Science. She pointed out that community public health had been decimated during the past decade. Third, improved long-term planning was required to meet the needs of those most at risk of infection—by increasing intensive care capacity, for example. Fourth, policies were needed to control borders—at seaports, airports, and for train services to Europe. And finally, the emphasis on vaccines as a means to return life to some measure of normality should be tempered by accepting that no vaccine was going to be a perfect “magic bullet”. As Deenan Pillay, Professor of Virology at University College London, stressed, even if a vaccine was made and manufactured by the end of the year it was unlikely to be completely effective and would almost certainly not be universally taken up. King's argument for setting up a rival body to SAGE was that ensuring public trust in scientific advice given to government demanded that those giving advice should not be dependent on the government. Too many of those on the official SAGE were government employees. This first meeting of an independent SAGE set a new standard for science policy making. The openness of the process, vigour of discussion, and identification of issues so far barely discussed by politicians injected much-needed candour into public and political discussions about COVID-19. It is hard to predict the longevity of this new group. But its point was made. On the same day it held its first meeting, the government published the names of the members of the official SAGE.