Public awareness in the Scientific Advisory Group for Emergencies (SAGE), or more specifically the scientists said to be guiding the Government’s COVID-19 decisions, is leading to increased scrutiny and calls for transparency.
Thinking back to January 2020, in the days we as UK residents were living our 'normal' everyday lives, going to pubs, travelling abroad or even being within 2m of strangers and friends and/or family outside our household, very few people would have heard of Chris Whitty and Patrick Vallance who have now become 'household names' and even faces, with Professor Whitty, England's Chief Medical Officer, appearing in TV advert breaks (shown in video below) from the Government urging us to 'Stay Home, Protect the NHS, Save Lives' and both regularly taking key roles in the BBC's daily press briefing on COVID-19. In these briefings, the political figures, often situated at the middle podium, have frequently justified the decisions that have been made saying that they have been guided by 'the science'.
Professor Chris Whitty, England’s Chief Medical Officer, appearing in Government advert urging the public to stay at home
Many people will now know that there is a group of scientific advisors, with some knowing that they are called the Scientific Advisory Group for Emergencies (SAGE). As defined by Government Office for Science, SAGE are 'responsible for ensuring that timely and coordinated scientific advice is made available to decision makers to support UK cross-government decisions in the Cabinet Office Briefing Room (COBR)'.
SAGE has provided evidence for events since 2009 (and scientific evidence was also used in events preceding this such as the foot and mouth crisis). Events listed on SAGE’s website are: swine flu, volcanic ash emergency, Japan nuclear incident, winter flooding, Ebola outbreak, Nepal earthquake, Zika outbreak (precautionary), Toddbrook reservoir and of course, now COVID-19.
The increase in media coverage and therefore public awareness of scientific advice and SAGE is undoubtedly because COVID-19 is an event affecting all UK resident’s lives (and of course lives throughout the world). Consequently, the situation previously described in January 2020 seems like a distant past time. This was spoken about by Sir Ian Boyd (former Chief Scientific Adviser at the Department for Environment, Food and Rural Affairs) in an interview with ITV News: "This is more than just an interesting thing going on, absolutely everybody in the country is affected by it….And therefore there’s a lot more interest in scrutiny in the underlying process."
With this growing emphasis on SAGE in the media, we thought it would be useful to reflect on some of the questions Dr Emily So (Co-Investigator on Expertise Under Pressure project) had after being called upon as an expert herself in the 2015 Nepal Earthquake, which were posed in our previous blog summarising our Disaster Response | Knowledge Domains and Information Flows workshop in February this year.
What is the process of turning this information into decisions and action?
The job of SAGE is to pool together scientific expertise to answer questions which are posed by COBR. It is at COBR that the scientific evidence is considered, as well as other advice including evidence from the 'economic, security, administrative and political spheres'. An analysis of the minutes of previous SAGE events shows that the number of meetings, time frame and number of people involved varies from event to event. These figures are summarised in the first table below. For the Nepal earthquake, there was only one meeting, whilst for Swine Flu, a previous pandemic, there were 22 meetings spanning from May 2009 – November 2010. The number of people attending the meetings also varied and those involved differed depending on the expertise that was required at the time. On May 4th, a 'list of participants of SAGE and related sub-groups' for COVID-19 was released (a breakdown of the number of participants in each group is provided in the second table).
A letter (dated 4 April 2020) from Sir Patrick Vallance, indicated that the frequency and timing of meetings was driven by current events and that "from 1 January to 31 March 2020 SAGE meetings were held on: • January: 28 • February: 3, 4, 6, 11, 13, 18, 20, 25, 27 • March: 3, 5, 10, 13, 16, 18, 23, 26, 29, 31. In addition, a precautionary SAGE meeting was held on 22 January 2020 to discuss scientific questions that were raised by COVID-19.". During April, reports suggest SAGE met twice a week.
Data source: Scientific Advisory Group for Emergencies (SAGE)
A critique within the media is whether there is enough breadth in the expertise for the COVID-19 response with some feeling there is an over reliance on modelling the pandemic and a lack of public health experts. Another Guardian article suggests the Government have sent out requests to universities to expand the pool following this criticism. Putting that aside, as can be seen by the number of attendees and members of each group, many voices are put forward. However, these voices are not always in agreement and SAGE meetings can include 'heated and prolonged' discussions.
A frustration that is becoming increasingly apparent in the media is questions over what is the science the politicians are referring to and how decisions are influenced by other considerations. In the Centre for Science and Policy’s (CSaP’s) podcast on 'Science, Policy and Pandemics' (episode 2), David Spiegelhalter says that we need to be clear the decisions are made by politicians taking into account the scientific advice. Another of many examples is when asked about his thoughts on the exit strategy during a BBC interview with Victoria Derbyshire (20/04/2020), former Prime Minister Tony Blair highlighted how the easing of the lock down will be based on scientific and medical advice but that in the end it is a political judgement.
The reason this overlap between science and politics is causing frustration is that SAGE is only one strand of information feeding into COBR. In an interview with Times Higher Education, Professor James Wilsdon, a professor in research policy at the University of Sheffield is quoted saying "It is problematic if political choices are being made and then the science advice system has to front them up. There needs to be a clearer sense of where science advice ends and political judgement begins − and at times that has been quite blurred".
Concerns about this blurring of boundaries between the scientific and political spheres were exacerbated further following The Guardian article revealing that Dominic Cummings and Ben Warner, both political figures, had attended SAGE meetings. In defense of this, a Downing Street advisor said that they were not members of SAGE and would only contribute if there were issues about Whitehall raised. However, their involvement has led to a flurry of reports questioning the independence of SAGE from politics, one example being Bloomberg alleging that Cummings was more than a bystander.
Chris Tyler, Associate Professor in Science Policy and Knowledge Infrastructure, UCL, discusses this further saying that it may be acceptable to let Cummings witness the debate as there are huge areas of uncertainty which need to be understood. However, if as the Guardian article suggests he is able to ask questions, this may risk politicising the scientific evidence before it goes up to COBR.
Whether or not Cummings did have a role in the SAGE meetings, the coverage of this in the media has clearly led to even more scrutiny of SAGE and pressure for transparency of where the boundary between the science and politics lies in the process of making decisions.
What happens to the gathered advice after it has been given or the event has taken place?
SAGE has been accused of keeping their advice behind closed doors, with the New York Times describing the operations as being within a 'virtual black box'. I have briefly touched on the growing calls for transparency due to the increased public awareness and media interest in SAGE as well as the ongoing rhetoric by the politicians that decisions are following the science. Consequently, headlines such as ‘Case for transparency over SAGE has never been clearer’ have been circulated in the last few weeks.
As the pandemic has progressed the reasons for the calls for transparency have varied. In the initial stages, members of the public wanted to know why the UK was not in lock down when other European countries were and what the science, which was continuously being referred to, actually was. This led to the release of the scientific evidence on 16 March. This release, although criticised as being too late by some, was welcomed by several members of the scientific community as it was thought to be vital for building trust with the public.
However, the calls for transparency continued. The requests then became about understanding what the lock down exit strategy will be and who the experts actually are. In response to a request for these names by Rt Hon Greg Clark MP, Sir Patrick Vallance stated: "The decision to not disclose SAGE membership for the time being is based upon advice from the Centre for the Protection of National Infrastructure and is in line with the standard procedure for COBR meetings, to which SAGE gives advice. This contributes towards safeguarding individual members personal security and protects them from lobbying and other forms of unwanted influence which may hinder their ability to give impartial advice. Of course, we do not stop individuals from revealing that they have attended SAGE." (4 April 2020)
Since that response, the revelation that political figures had sat in on SAGE meetings increased the pressure from the media to identify the experts. Reports, including one from the New Scientist (27 April), indicated that Patrick Vallance had said the list of names would be released after the experts had been given the option to opt-out of being identified. This list was released on 4 May, followed by an additional release of evidence on the 5 May.
Some calls for transparency are going even further with requests to release the minutes of SAGE meetings to understand why decisions were actually made. Sir David King, a former Chief Scientific Advisor, has also formed an 'Independent SAGE' with the first meeting (4th May) taking place via livestream on Youtube, this group was called 'a rival panel of experts' in the media.
Transparency is not a new concept and it is commonly referred to in the disaster management literature. Even in reference to SAGE, previous reports (pre COVID-19) have called for a more transparent process. Transparency is sought to develop trust with the public, as well as allowing the net of expertise to be cast further by giving other scientists and wider research community the opportunity to scrutinise the evidence before decisions are made, with the reason being that external scrutiny can help to avoid groupthink and identify blindspots. A counter argument here being that the decisions are being made in a time constrained environment and is there time to hear all these voices? Furthermore, there are concerns about how to ensure that those voices are from those with the relevant expertise: "The world wants to know what the science is behind the decisions, but there is great danger of misinformation when media interest is amplifying the voices of scientists, but not necessarily those most qualified to comment." (Gog, J. 2020).
It is abundantly clear from the newspaper headlines that there has been growing critiques of SAGE being ‘secret’ and the decisions happening behind closed doors. Consequently there have been calls for this evidence to be in the public sphere to allow for scrutiny but also build trust with the public. This pressure from the media and public appears to have led to the release of evidence and experts' names, with the Government Office for Science recognising “In fast moving situations, transparency should be at the heart of what the government does”.
What if the experts are wrong?
It is far too soon to know what was the right or wrong action to take and perhaps we will never know as there are so many parameters to consider, but when looking at this question there are a few things that I want to discuss: uncertainty, consensus and blame, which are not mutually exclusive from one another.
After her own involvement in the Nepal earthquake’s SAGE meeting, Dr So posed this question 'What if the experts are wrong?' as she knows that there is uncertainty in the models that make casualty loss predictions for earthquakes. Obviously there is lots of uncertainty in this pandemic, be it the spread of infection, death rates or impact of interventions. To avoid being ‘wrong’ this uncertainty needs to be communicated to both the decision makers and the wider public.
I have already referred to the heated discussions within SAGE. There have been reports, including one from Buzzfeed that there was no consensus as to when the lock down and social distancing should be implemented. With some scientists arguing that it needed to be introduced immediately to halt the spread of the virus and “pleaded with the government to change tack or face dire consequences”, whilst others felt that introducing social distancing measures at that point in time would be unsustainable and lead to a second wave of infection. Within this same article Vallance is reported to have said "If you think SAGE is a cosy consensus of agreeing, you’re very wrong indeed". What is key here is that these areas of agreement and disagreement are passed up to COBR (as well as the uncertainty) in the evidence being presented.
The most concerning aspect related to whether or not experts are right or wrong is the 'blame game' as accusations have come out that Boris Johnson's team are using the scientists as 'human shields'. We are now seeing experts expressing concern with the politicians language which can be misinterpreted by the public that decisions have been made by the scientists. In his interview with ITV, Sir Ian Boyd states that he always told ministers it’s dangerous to say 'I will follow the science' as "essentially what they are doing is shifting the decision making role from them to the scientific advisors. And it would be better if they said 'will be strongly advised by the science' or something like that". Another issue with this phrase is that it doesn’t always acknowledge that "in reality the science of this crisis had been riddled with doubt, uncertainty, and debate" (Professor Robert Dingwall, a member of the New and Emerging Respiratory Virus Threats Advisory Group).
Many feel that a judicial review is inevitable following COVID-19. To avoid a blame game of who was right or wrong, it is important in the coverage of SAGE and the evidence presented to acknowledge the uncertainty and that there is not always consensus. A previous post by EuP Research Associate Federico Brandmayr speaks more about these issues of responsibility by considering what COVID-19 could learn from the L’Aquila earthquake.
It seems obvious that an increase in public awareness of scientific advice has led to increased scrutiny and calls for transparency of SAGE. By reflecting on the questions posed in our previous workshop, it has inevitably led to even more questions in relation to the use of scientific expertise in emergency response situations and I will now conclude by highlighting three of these:
- Decisions go beyond science. It needs to be clear where the boundary between the scientific, economic and political spheres lies rather than repeatedly saying that decisions are following the science. Where is this line drawn? Is there even a line?
- SAGE is receiving critique for being secretive which has led to numerous calls for transparency for both the scientific evidence and names of experts. This is considered important by many to develop and maintain trust with the public and also allow for the scrutiny of evidence by a 'larger net of experts'. Delay in the release of names was due to concerns the experts may be put under undue influence. Perhaps a question for 'next time' is 'How do we create an appropriate environment to allow for the open interrogation of evidence?'.
- To avoid experts 'being wrong', the communication of uncertainty is vital, as well as recognising that there might not actually be a right or wrong answer based on the evidence that experts have available at the time. In such an uncertain, time-pressured environment, disagreement is inevitable. These areas of consensus and disagreement need to be passed up to COBR to consider and also be communicated to the public for a truly transparent process. Has uncertainty been clearly communicated in the UK’s and worldwide response to COVID-19? If not, what should have been done differently?
Throughout the next few months, the EuP team will continue to reflect upon questions which COVID-19 has raised for our project through our series of blog posts with the overarching aim being to develop our understanding of the role of experts in bringing about social change.
Text by Hannah Baker, originally published 5/05/2020 on the Centre for Humanities and Social Change website. Information correct at the time of original posting.
The views, thoughts and opinions expressed on the CRASSH blog belong solely to the authors and do not necessarily represent the views of CRASSH or the University of Cambridge.