SAGE is the Scientific Advisory Group for Emergencies. The text up there comes from the UK Government description. SAGE is the main venue to coordinate science advice to the UK government on COVID-19, including from NERVTAG (the New and Emerging Respiratory Virus Threats Advisory Group, reporting to PHE), and the SPI-M (Scientific Pandemic Influenza Group on Modelling) sub-groups on modelling (SPI-M) and behavioural public policy (SPI-B) which supply meeting papers to SAGE.
I have summarized SAGE’s minutes (41 meetings, from 22 January to 11 June) and meeting/ background papers (125 papers, estimated range 1-51 pages, median 4, not-peer-reviewed, often produced a day after a request) in a ridiculously long table. This thing is huge (40 pages and 20000 words). It is the sequoia table. It is the humongous fungus. Even Joey Chestnut could not eat this table in one go. To make your SAGE meal more palatable, here is a series of blog posts that situate these minutes and papers in their wider context. This initial post is unusually long, so I’ve put in a photo to break it up a bit.
Did the UK government ‘follow the science’?
I use the overarching question Did the UK Government ‘follow the science’? initially for the clickbait. I reckon that, like a previous favourite (people have ‘had enough of experts’), ‘following the science’ is a phrase used by commentators more frequently than the original users of the phrase. It is easy to google and find some valuable commentaries with that hook (Devlin & Boseley, Siddique, Ahuja, Stevens, Flinders, Walker, Lancet Infectious Diseases, FT; see also Vallance) but also find ministers using a wider range of messages with more subtle verbs and metaphors:
- ‘We will take the right steps at the right time, guided by the science’ (Prime Minister Boris Johnson, 3.20)
- ‘We will be guided by the science’ (Health Secretary Matt Hancock, 2.20)
- ‘At all stages, we have been guided by the science, and we will do the right thing at the right time’ (Johnson, 3.20)
- ‘The plan is driven by the science and guided by the expert recommendations of the 4 UK Chief Medical Officers and the Scientific Advisory Group for Emergencies’ (Hancock, 3.20)
- ‘The plan does not set out what the government will do, it sets out the steps we could take at the right time along the basis of the scientific advice’ (Johnson, 3.20).
Still, clearly they are saying ‘the science’ as a rhetorical device, and it raises many questions or objections, including:
- There is no such thing as ‘the science’.
Rather, there are many studies described as scientific (generally with reference to a narrow range of accepted methods), and many people described as scientists (with reference to their qualifications and expertise). The same can be said for the rhetorical phrase ‘the evidence’ and the political slogan ‘evidence based policymaking’ (which often comes with its notionally opposite political slogan ‘policy based evidence’). In both cases, a reference to ‘the science’ or ‘the evidence’ often signals one or both of:
- a particular, restrictive, way to describe evidence that lives up to a professional quality standard created by some disciplines (e.g. based on a hierarchy of evidence, in which the systematic review of randomized control trials is often at the top)
- an attempt by policymakers to project their own governing competence, relative certainty, control, and authority, with reference to another source of authority
2. Ministers often mean ‘following our scientists’
When Johnson (12.3.20) describes being ‘guided by the science’, he is accompanied by Professor Patrick Vallance (Government Chief Scientific Adviser) and Professor Chris Whitty (the UK government’s Chief Medical Adviser). Hancock (3.3.20) describes being ‘guided by the expert recommendations of the 4 UK Chief Medical Officers and the Scientific Advisory Group for Emergencies’ (Hancock, 3.3.20).
In other words, following ‘the science’ means ‘following the advice of our scientific advisors’, via mechanisms such as SAGE.
As the SAGE minutes and meeting papers show, government scientists and SAGE participants necessarily tell a partial story about the relevant evidence from a particular perspective (note: this is not a criticism of SAGE; it is a truism). Other interpreters of evidence, and sources of advice, are available.
Therefore, the phrase ‘guided by the science’ is, in practice, a way to:
- narrow the search for information (and pay selective attention to it)
- close down, or set the terms of, debate
- associate policy with particular advisors or advisory bodies, often to give ministerial choices more authority, and often as ‘an insurance policy’ to take the heat off ministers.
- What exactly is ‘the science’ guiding?
Let’s make a simple distinction between two types of science-guided action. Scientists provide evidence and advice on:
- the scale and urgency of a potential policy problem, such as describing and estimating the incidence and transmission of coronavirus
- the likely impact of a range of policy interventions, such as contact tracing, self-isolation, and regulations to oblige social distancing
In both cases, let’s also distinguish between science advice to reduce uncertainty and ambiguity:
- Uncertainty describes a lack of knowledge or a worrying lack of confidence in one’s knowledge.
- Ambiguity describes the ability to entertain more than one interpretation of a policy problem.
Put both together to produce a wide range of possibilities for policy ‘guided by the science’, from (a) simply providing facts to help reduce uncertainty on the incidence of coronavirus (minimal), to (b) providing information and advice on how to define and try to solve the policy problem (maximal).
If so, note that being guided by science does not signal more or less policy change. Ministers can use scientific uncertainty to defend limited action, or use evidence selectively to propose rapid change. In either case, it can argue – sincerely – that it is guided by science. Therefore, analyzing critically the phraseology of ministers is only a useful first step. Next, we need to identify the extent to which scientific advisors and advisory bodies, such as SAGE, guided ministers.
The role of SAGE: advice on evidence versus advice on strategy and values
In that context, the next post examines the role of SAGE.
It shows that, although science advice to government is necessarily political, the coronavirus has heightened attention to science and advice, and you can see the (subtle and not subtle) ways in SAGE members and its secretariat are dealing with its unusually high level of politicization. SAGE has responded by clarifying its role, and trying to set boundaries between:
- Advice versus strategy
- Advice versus value judgements
These aims are understandable, but difficult to do in theory (the fact/value distinction is impossible) and practice (plus, policymakers may not go along with the distinction anyway). I argue that it also had some unintended consequences, which should prompt some further reflection on facts-versus-values science advice during crises.
The ways in which UK ministers followed SAGE advice
With these caveats in mind, my reading of this material is that UK government policy was largely consistent with SAGE evidence and advice in the following ways:
- Defining the policy problem
This post (and a post on oral evidence to the Health and Social Care Committee) identifies the consistency of the overall narrative underpinning SAGE advice and UK government policy. It can be summed up as follows (although the post provides a more expansive discussion):
- coronavirus represents a long term problem with no immediate solution (such as a vaccine) and minimal prospect of extinction/ eradication
- use policy measures – on isolation and social distancing – to flatten the first peak of infection and avoid overwhelming health service capacity
- don’t impose or relax measures too quickly (which will cause a second peak of infection)
- reflect on the balance between (a) the positive impact of lockdown (on the incidence and rate of transmission), (b) the negative impact of lockdown (on freedom, physical and mental health, and the immediate economic consequences).
While SAGE minutes suggest a general reluctance to comment too much on the point 4, government discussions were underpinned by 1-3. For me, this context is the most important. It provides a lens through which to understand all of SAGE advice: how it shapes, and is shaped by, UK government policy.
- The timing and substance of interventions before lockdown, maintenance of lockdown for several months, and gradual release of lockdown measures
This post presents a long chronological story of SAGE minutes and papers, divided by month (and, in March, by each meeting). Note the unusually high levels of uncertainty from the beginning. The lack of solid evidence, available to SAGE at each stage, can only be appreciated fully if you read the minutes from 1 to 41. Or, you know, take my word for it.
In January, SAGE discusses uncertainty about human-to-human transmission and associates coronavirus strongly with Wuhan in China (albeit while developing initially-good estimates of R, doubling rate, incubation period, window of infectivity, and symptoms). In February, it had more data on transmission but described high uncertainty on what measures might delay or reduce the impact of the epidemic. In March, it focused on preparing for the peak of infection on the assumption that it had time to transition gradually towards a series of isolation and social distancing measures. This approach began to change from mid-March when it became clear that the number of people infected, and the rate of transmission, was much larger and faster than expected.
In other words, the Prime Minister’s declarations – of emergency on 16.3.20 and of lockdown on 23.3.20 – did not lag behind SAGE advice (and it would not be outrageous to argue that it went ahead of it).
It is more difficult to describe the consistency between UK government policy & SAGE advice in relation to the relaxation of lockdown measures.
SAGE’s minutes and meeting papers describe very low certainty about what will happen after the release of lockdown. Their models do not hide this unusually high level of uncertainty, and they use models (built on assumptions) to generate scenarios rather than estimate what will happen. In this sense, ‘following the science’ could relate to (a) a level of buy-in for this kind of approach, and (b) making choices when scientific groups cannot offer much (if any) advice on what to do or what will happen. The example of reopening schools is a key example, since SPI-M and SPI-B focused intensely on the issue, but their conclusions could not underpin a specific UK government choice.
There are two ways to interpret what happened next.
First, there will always be a mild gap between hesitant SAGE advice and ministerial action. SAGE advice tends to be based on the amount and quality of evidence to support a change, which meant it was hesitant to recommend (a) a full lockdown and (b) a release from lockdown. Just as UK government policy seemed to go ahead of the evidence to enter lockdown on the 23rd March, so too does it seem to go ahead of the cautious approach to relaxing it.
Second, UK ministers are currently going too far ahead of the evidence. SPI-M papers state repeatedly that the too-quick release of measures will cause the R to go above 1 (in some papers, it describes reaching 1.7; in some graphs it models up to 3).
- The use of behavioural insights to inform and communicate policy
In March, you can find a lot of external debate about the appropriate role for ‘behavioural science’ and ‘behavioural public policy’ (BPP) (in other words, using insights from psychology to inform policy). Part of the initial problem related to the lack of transparency of the UK government, which prompted concerns that ministers were basing choices on limited evidence (see Hahn et al, Devlin, Mills). Oliver also describes initial confusion about the role of BPP when David Halpern became mildly famous for describing the concept of ‘herd immunity’ rather than sticking to psychology.
External concern focused primarily on the argument that the UK government (and many other governments) used the idea of ‘behavioural fatigue’ to justify delayed or gradual lockdown measures. In other words, if you do it too quickly and for too long, people will tire of it and break the rules.
Yet, this argument about fatigue is not a feature of the SAGE minutes and SPI-B papers (indeed, Oliver wonders if the phrase came from Whitty, based on his experience of people tiring of taking medication).
Rather, the papers tend to emphasise:
- There is high uncertainty about behavioural change in key scenarios, and this reference to uncertainty should inform any choice on what to do next.
- The need for effective and continuous communication with citizens, emphasizing transparency, honesty, clarity, and respect, to maintain high trust in government and promote a sense of community action (‘we are all in this together’).
John and Stoker argue that ‘much of behavioural science lends itself to’ a ‘top-down approach because its underlying thinking is that people tend to be limited in cognitive terms, and that a paternalistic expert-led government needs to save them from themselves’. Yet, my overall impression of the SPI-B (and related) work is that (a) although SPI-B is often asked to play that role, to address how to maximize adherence to interventions (such as social distancing), (b) its participants try to encourage the more deliberative or collaborative mechanisms favoured by John and Stoker (particularly when describing how to reopen schools and redesign work spaces). If so, my hunch is that they would not be as confident that UK ministers were taking their advice consistently (for example, throughout table 2, have a look at the need to provide a consistent narrative on two different propositions: we are all in this together, but the impact of each action/inaction will be profoundly unequal).
Expanded themes in SAGE minutes
Throughout this period, I think that one – often implicit – theme is that members of SAGE focused quite heavily on what seemed politically feasible to suggest to ministers, and for ministers to suggest to the public (while also describing technical feasibility – i.e. will it work as intended if implemented?). Generally, it seemed to anticipate policymaker concern about, and any unintended public reactions, to a shift towards more social regulation. For example:
‘Interventions should seek to contain, delay and reduce the peak incidence of cases, in that order. Consideration of what is publicly perceived to work is essential in any decisions’ (25.2.20: 1)
Put differently, it seemed to operate within the general confines of what might work in a UK-style liberal democracy characterised by relatively low social regulation. This approach is already a feature of The overall narrative underpinning SAGE advice and UK government policy, and the remaining posts highlight key themes that arise in that context.
They include how to:
- describe different types of intervention, such as contain, delay, mitigate and suppress
- deal with limitations, such as to (a) test to inform epidemiological forecasts and policy, and (b) challenge assumptions and conclusions within SAGE
- communicate risk and policy change to the public.
Delaying the inevitable
All of these shorter posts delay your reading of a ridiculously long table summarizing each meeting’s discussion and advice/ action points (Table 2, which also includes a way to chase up the referencing in the blog posts: dates alone refer to SAGE minutes; multiple meeting papers are listed as a, b, c if they have the same date stamp rather than same authors).
The full list of SAGE posts:
It is part of a wider project, in which you can also read about:
- The early minutes from NERVTAG (the New and Emerging Respiratory Virus Threats Advisory Group)
- Oral evidence to House of Commons committees, beginning with Health and Social Care
I hope to get through all of this material (and equivalent material in the devolved governments) somehow, but also to find time to live, love, eat, and watch TV, so please bear with me if you want to know what happened but don’t want to do all of the reading to find out.
If you would rather just read all of this discussion in one document:
If you would like some other analyses, compare with:
- Freedman (7.6.20) ‘Where the science went wrong. Sage minutes show that scientific caution, rather than a strategy of “herd immunity”, drove the UK’s slow response to the Covid-19 pandemic’. Concludes that ‘as the epidemic took hold the government was largely following Sage’s advice’, and that the government should have challenged key parts of that advice (to ensure an earlier lockdown).
- More or Less (1.7.20) ‘Why Did the UK Have Such a Bad Covid-19 Epidemic?’. Relates the delays in ministerial action to inaccurate scientific estimates of the doubling time of infection (discussed further in Theme 2).
- Both Freedman and More or Less focus on the mishandling of care home safety, exacerbated by transfers from hospital without proper testing.
- Snowden (28.5.20) ‘The lockdown’s founding myth. We’ve forgotten that the Imperial model didn’t even call for a full lockdown’. Challenges the argument that ministers dragged their feet while scientists were advising quick and extensive interventions (an argument he associates with Calvert et al (23.5.20) ‘22 days of dither and delay on coronavirus that cost thousands of British lives’). Rather, ministers were following SAGE advice, and the lockdown in Italy had a far bigger impact on ministers (since it changed what seemed politically feasible).