Creeping crisis: the UK government’s response to COVID-19 (and the role of experts)

These are my presentation notes on the UK government’s initial response to COVID-19, as part of the ‘The Role of Experts’ panel at the Creeping Crisis conference. I draw on articles and blog posts stored in my COVID-19 page. You can find more on the idea of a COVID-19 creeping crisis in Hiding in Plain Sight: Conceptualizing the Creeping Crisis:

‘In December 2019, a new Coronavirus emerged in China. As little was known about the immediate consequences of the virus, the world paid scant attention. That hardly changed when China announced that the outbreak of the virus was dangerous and subsequently locked down its entire population, bringing its juggernaut economy to a sudden halt. When the first cases emerged in one European country, other countries did not take any measures. When the World Health Organization branded Europe as the new hot spot of the pandemic, the United States did not react. When the first deaths were registered on the U.S. West Coast, the New York City mayor admonished his citizens to stick with their routines (keep going to restaurants!). The COVID‐19 crisis crept up on countries, cities, and hospitals. It arrived in full view, yet still surprised politicians, hospital administrators, pundits, business owners, and citizens’

(Boin et al, 2020: 2).

‘A creeping crisis is a threat to widely shared societal values or life‐sustaining systems that evolves over time and space, is foreshadowed by precursor events, subject to varying degrees of political and/or societal attention, and impartially or insufficiently addressed by authorities’

(Boin et al, 2020: 7).

Our conference’s aim is to answer two broad questions, adapted as follows:

1. What are the main lessons to learn from the initial UK government response?
2. What are the main research challenges for our community?

Q1 Lessons from initial research: analysing policy failures

From The UK government’s COVID‑19 policy: assessing evidence‑informed policy analysis in real time and What have we learned so far from the government’s COVID-19 policy?

By late March 2020, COVID-19 prompted almost-unprecedented policy change, towards state intervention, at a speed and magnitude that seemed unimaginable before 2020. Yet, many have criticised the UK government’s response as slow and insufficient, contributing to the UK’s internationally high number of excess deaths.

Initial criticisms include that ministers did not:

• Take COVID-19 seriously enough in relation to existing evidence, when its devastating effect was apparent in China in January and Italy from February
• Act as quickly as other countries to test for infection to limit its spread
• Introduce swift-enough measures to close schools, businesses, and major social events.
• Secure enough personal protective equipment (PPE), testing capacity, and an effective test-trace-and-isolate system.
• Respond to the right epidemic (assuming that COVID-19 could be treated like influenza)
• Pursue an elimination strategy to minimise its spread until a vaccine could be developed.
• Use the right models and data to estimate the R (rate of transmission) and ‘doubling time’ of cases (which suggested locking down earlier).

Q1 Lessons from Parliament: failure and success

A new report by the House of Commons Health and Social Care and Science and Technology Committees describes Covid-19 as ‘the biggest crisis our country has faced in generations’, which disrupted our lives to an extent few predicted’. Its ‘lessons learned to date’ are similarly negative, although there are some positive lessons on vaccine development and roll-out (the following points appear in the Executive Summary).

Negative lessons

To explain why ‘in 2020 the UK did significantly worse in terms of covid deaths than many countries’:

• Poor pandemic preparedness. UK planning was based on influenza, not more relevant experiences such as SARS.
• Insufficient initial action, to pursue ‘non-pharmaceutical interventions’. The initial UK policy response was based on fatalism. It assumed that infection spread was inevitable and that people would not tolerate lockdown or ‘social distancing’ measures. It should have intervened more quickly when it emerged that there was no feasible alternative to lockdown. Its subsequent actions show that the UK public supported and followed lockdown measures.
• Groupthink and an inability to learn from best practice. The rejection of lessons from ‘East and South East Asian countries’ by policymakers and their scientific advisers reflects a wider problem of groupthink:

‘The fact that the UK approach reflected a consensus between official scientific advisers and the Government indicates a degree of groupthink that was present at the time which meant we were not as open to approaches being taken elsewhere as we should have been’.

• Limited capacity to test, trace and isolate. The government gave up too early on community testing before eventually ramping up capacity. Then, the establishment of its NHS Test and Trace was chaotic, largely because it established a new centralised system rather than relying on more-established local capacity. Test and trace policy did not deliver on its aim to develop an alternative to prevent further lockdowns. The test and trace system is now good, but is not accompanied by an effective compensation model to allow people to isolate.
• Insufficient National Health Service (NHS) capacity. The government acted quickly and well to boost emergency hospital capacity, but without ensuring the maintenance of equally important core services (e.g. cancer treatment).
• Failure to protect social care. Policymakers and scientific advisers were too late to recognise the impact of discharging people from hospitals to social care ‘without adequate testing or rigorous isolation’ (again, without learning from international practice).
• Excessive ministerial optimism underpinned the rejection of science advice. Ministers paid insufficient attention to scientific advice on the need for further lockdowns to address surges of infection in Autumn 2020.
• Lack of attention to inequitable outcomes. ‘Black, Asian and Minority Ethnic communities’ faced  disproportionately (a) high rates of death and illness, (b) low access to PPE, and (c) low access to safe housing and working conditions. ‘People with learning disabilities and autistic people’ faced (a) higher mortality risk (exacerbated by inappropriate ‘do not resuscitate’ orders), (b) lower access to essential care services, and (c) diminished contact with family members and carers.

Positive lessons

• The vaccine rollout was a success. The UK vaccine programme was ‘one of the most effective in Europe and, for a country of our size one of the most effective in the world’. It resulted from major and early investment in research and development, an effective regulatory response, and a Vaccines Taskforce led with authority.
• Its research on COVID-19 treatment is world-leading.

Q2. Research challenges for a research and practice community

There are many different research challenges based on what researchers want to do, including:

Using research to change the minds of policymakers: COVID-19 crisis strategy

One specific criticism is that UK ministers and their advisers defined the COVID-19 policy problem incorrectly. They sought a shift of approach from (a) managing a chronic and seasonal problem, to (b) pursuing an elimination strategy until a vaccine was available, but expressed continual frustration about their lack of impact on government policy and official advice (a complaint captured partly by the idea of ‘groupthink’).

Summary of UKG definition of the policy problem (from here)

1. The UK Government’s COVID-19 Policy: What Does “Guided by the Science” Mean in Practice?

2. COVID-19: effective policymaking depends on trust in experts, politicians, and the public

These articles help to explain this relative lack of ‘impact’ by most potential-expert-advisers:

First, to all intents and purposes, policymakers need to find ways to ignore almost all information. One way is to rely on a small number of trusted experts. Guided by the science means by our scientific advisers.

Second, a classic categorisation of interest group strategy and status helps to categorise the role and status of expert advisers.

• An insider strategy follows the ‘rules of the game’, including: accept a government’s definition of the problem (or right to define it), be pragmatic, present modest demands, and don’t criticise the outcomes in public.
• Non-governmental advisers may learn – and largely follow – similar rules.
• Some advisers are also civil servants, expected to follow additional – formal and informal – rules associated with their conduct in government.
• One example of a formal rule isto defend a distinction between (a) officials giving evidence and advice and (b) ministers making policy.
• Informal rules may describe how to conduct yourself in discussion (in ways that contrast with the idea of maverick scientists speaking truth to power at all costs)

Third, governments assign status to groups based on their resources, policy positions, and willingness to pursue an insider strategy.

• Core insiders (senior government science advisers) are consulted regularly in relation to the general problem. They know and follow the rules, and can navigate complex policy processes.
• Specialist insiders (such as members of the Scientific Advisory Group for Emergencies, SAGE) provide advice on specific issues. They appear sensitive to informal rules when speaking in public, and may have some navigation skills.
• Peripheral insiders are consulted cosmetically, and few have enough experience of engagement to learn and follow the rules.
• Outsiders may be of no use to government and/or reject the rules of the game. Many prefer the rules or principles that they associate with their profession, including transparency, visibility, responsibility, integrity, independence, and accountability.

Take-home message. This dynamic suggests that a vague criticism of groupthink, or push for the reform of advisory systems, will not address the routine assignment of core insider status to very few people. Ministers will identify good reasons to trust very few advisers, and have virtually no incentive to listen to external critics.

‘some experts remain core insiders if they advise on policies that they do not necessarily support, while outsiders have the freedom to criticize the policy they were unable to influence’

Using research to change the minds of policymakers: COVID-19 and inequalities

A more general criticism is that governments (such as the UK) do not back up their ‘Health in All Policies’ rhetoric with substantive action. HiAP focuses on the ‘social determinants’ of health and health inequalities:

‘significant and persistent disparities in health outcomes caused by structural inequities in social and economic factors, including employment opportunities, the law and the justice systems, education, housing, neighborhood environments, and transportation. These elements are otherwise known as the social determinants of heath. The opportunity or lack of opportunity to be healthy is too often associated with a person’s socioeconomic status, race, ethnicity, gender, religion, sexual identity, or disability’

(Bliss et al., 2016: S88).

 The future of public health policymaking after COVID-19 explores how HiAP advocates seek (largely in vain) to use policy theory insights to challenge the lack of policy progress, such as via framing and coalition building strategies, and seeking ‘windows of opportunity’ to act. One challenge for this kind of work is that policy theories are designed largely to explain policymaking constraints, not to help overcome them:

‘relatively abstract policy theories will rarely provide concrete advice of how to act and what to do in all given contexts. There are too many variables in play to make this happen. The complexity of policy processes, its continuously changing nature, and its diversity across contexts, prevent precise prediction for policy actors seeking influence or policy change’

(Weible and Cairney, 2018: 186)

Q2. Research challenges for policy scholars

The most relevant challenge is to juggle three different statements on policy learning:

1. We should encourage certain kinds of research-informed ‘policy learning’.

The House of Commons report (discussed in Q1) is a good example of exhortation to learn from – and perhaps adopt – ‘international best practice’. It is part of a collection of continuous and energetic calls for the UK Government to learn from the policies of more successful countries such as South Korea. Indeed, Dominic Cummings (former Special Adviser to Prime Minister Boris Johnson) declared that: ‘Essentially if we just cut and pasted what they were doing in Singapore or Taiwan or whatever, and just said that’s our policy everything would have been better’ (Oral evidence to the House of Commons Science and Technology Committee, 26.5.21).

• Few accounts describe how to do it.

Very few accounts provide enough (a) clarity to describe convincingly what and how to learn, or (b) awareness of political and policymaking reality, to present plausible claims.

This lack of clarity is apparent in published academic articles that claim – misleadingly – to facilitate policy learning or transfer: Intra-crisis learning and prospective policy transfer in the COVID-19 pandemic.

• Learning (and ‘policy transfer’) is a political act. We need to understand why governments will not learn from most other governments.

This work-in-progress presents three questions to guide policy learning, followed by a simple distinction between (a) what policy analysts or designers may seek (an agency-focused approach), and (b) what we would expect to actually happen in complex policymaking environments (a context-focused approach).

1. What is the evidence for one government’s success, and from where does it come?   

• Policy analysis: seek multiple independent sources of evidence.
• Policy process: (a) political actors compete to define good evidence and its implications; (b) governance choices (on the extent to which policy is centralised) influence evidence choices.

2. What story do exporters/ importers of policy tell about the problem they seek to solve?

• Policy analysis: improve comparability by establishing how each government defines the policy problem, establishes the feasibility of solutions, and measures success.
• Policy process: it is often not possible to determine a policymaker’s motivation, especially when many venues or levels of government contribute to policy.

3. Do they have comparable political and policymaking systems?

• Policy analysis: identify the comparable features of each political system (e.g. federal/ unitary).
• Policy process: identify the comparable features of policymaking systems (e.g. actors, institutions, networks, ideas, socioeconomic context).

A quick application of these questions to UK learning from South Korea helps to demonstrate the low likelihood of it happening:

1. What is the evidence for one government’s success, and from where does it come? UK ministers and scientific advisers expressed scepticism about the long-term success ofcountries – like China and South Korea – who introduced very strong lockdown protocols. Advisers predicted that these countries would minimise a first wave of infection but then open up to cause a much larger second wave. As such, the evidence of success was highly contested.
2. What story do exporters/ importers of policy tell about the problem they seek to solve? The UK government’s definition of the policy problem (described above) is not conducive to learning from countries like South Korea. It portrayed Korean-style restrictions as politically infeasible (before the UK lockdown).
3. Do they have comparable political and policymaking systems? Their political system differences are relatively straightforward to identify since, for example, the UK is a liberal democracy with a less established tradition of state intervention in the ways now taken for granted in 2020. It would be difficult to know where to begin to compare their policymaking systems (containing multiple authoritative venues, each with their own institutions, networks, and ideas).

The more general take-home message is to ‘beware the insufficient analysis of the connection between functional requirements and policymaking dynamics. Too often, researchers highlight what they need from governments to secure policy change, while policy theories identify the low likelihood that governments can meet that need’.