Secret government science group has shocking lack of expertise | Anthony Constello | Opinion


TThe success of any scientific advisory group certainly depends on a culture of openness, independence and diversity of opinion. Unfortunately, this culture of openness has been conspicuous by its absence from the government’s Scientific Advisory Panel on Emergencies. It is only thanks to the persistence of Guardian journalists that we can now identify 23 participants in Sage. Among them, 13 are paid government employees, working as ministerial, health or public service advisers. As such, the presence of their bosses, Patrick Vallance and Chris Whitty, to say nothing of the Prime Minister’s senior advisor, Dominic Cummings, could well influence their ability to speak freely.

Beyond that, what do the members of this committee really tell us? We learned from the list of participants in a crucial Sage meeting on March 23, leaked to the Guardian, that the group includes seven clinical academics, three microbiologists, seven modellers, two behavioral specialists with a history of disasters and terrorism , a geneticist, a public servant and two political advisers, one of whom is the most powerful lieutenant prime minister in recent memory.

The composition of Sage reflects a strangely biased and extremely medical view of science. Indeed, there are many other perspectives that could bring value to a team in a pandemic crisis. Has Sage consulted public health epidemiologists on the front line of the response to the coronavirus in China or Hong Kong, such as Professor Gabriel Leung? Has the group obtained input from infectious experts from the World Health Organization, such as epidemiologist Mike Ryan, who leads the containment team for Covid-19 around the world?

The group does not include a molecular virologist who could explain the detailed pathogenic differences between Covid-19 and influenza, not an intensive care expert or a leader in nursing, and no immunologist to examine whether this virus produces long-lasting immunity and protective. There are no social scientists who could work on community engagement, nor a logistician, who would have expertise in planning the delivery of supplies and resources during a pandemic. A balanced scientific advisory group would include at least experts working on the front lines of the pandemic, such as those in public health, primary care and intensive care.

With regard to other measures of diversity, Sage’s gender balance is predictable, with 16 men to 7 women and one person belonging to an ethnic minority. Given that coronavirus has been shown to disproportionately affect people from black communities and ethnic minorities, the comparative lack of Black and ethnic minority experts seems a troubling omission.

In the absence of meeting minutes, we may never know if, despite these shortcomings, a culture of openness exists within Sage. The lack of a written record also makes two of the group’s most important decisions particularly difficult to understand. At its first meeting on January 28, Sage did not ask its mathematical modellers to model a community testing program. Community testing and contact tracking would not have been included as a possible strategy in the original modeling because there weren’t enough tests available. The United Kingdom was among the first countries to develop a Covid-19 test in mid-January, approved by the WHO, and has an exceptional national research infrastructure. Yet our national capacity to respond to a pandemic challenge seems to have been overlooked. The basic principles of public health and the WHO daily mantra – finding the virus, testing, tracing and isolating, promoting social distancing and doing everything at high speed – seem to have been effectively ignored.

All that was discussed by Sage in February led to an alternative strategy, implemented by Boris Johnson, Vallance and Whitty in early March: moving from confining the virus to delaying its spread, allowing it to move around in the population so that we end up acquiring “collective immunity” at a delayed speed.

So, at a time when the UK has had fewer than 10 deaths from Covid-19 and less than 500 confirmed cases of coronavirus, the government, informed by Sage, has decided to end all community testing and research. The public health community was puzzled. It’s hard to think of other severe viral epidemics managed this way, apart from the flu, which differs significantly from the coronvirus.

Six weeks later, WHO’s preferred approach – testing, tracing and isolating the virus – is apparently back on the agenda. Matt Hancock has promised that the UK will deliver 100,000 tests a day by the end of this week, with the military, Deloitte, Serco and Boots setting up test centers across the country. Health workers and their families can register for tests immediately. All hospitalized patients will be tested. However, the government is bypassing local authorities’ public health teams and general practitioners who are at the forefront of routine screening and testing in the NHS and local communities. His strategy still seems to be to flatten the curve, rather than finding all cases of coronavirus.

Without testing, tracing those who have come into contact with infected people and isolating these clusters, the virus will reappear. Future closings will be necessary and economic recovery will be extremely difficult. In a month, we could be heading for 60,000 or more deaths. It is impossible to say whether things would have happened differently if Sage had included people from public health and primary care. But if its composition and the details of its decisions had been revealed earlier, the wider scientific community would have had the opportunity to offer constructive criticism, perhaps in time to save thousands of lives.

Anthony Costello is Professor of Global Health and Sustainable Development at University College London and former Director of Maternal and Child Health at WHO


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