COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

This post is part 8 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The table is too big to reproduce here, so you have the following options:

Table 2 in PDF

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Or, if you prefer not to read the posts individually:

The whole thing in PDF

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The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

COVID-19 policy in the UK: SAGE Theme 3. Communicating to the public

This post is part 7 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings

SAGE’s emphasis on uncertainty and limited knowledge extended to the evidence on how to influence behaviour via communication:

‘there is limited evidence on the best phrasing of messages, the barriers and stressors that people will encounter when trying to follow guidance, the attitudes of the public to the interventions, or the best strategies to promote adherence in the long-term’ (SPI-B Meeting paper 3.3.20: 2)

Early on, SAGE minutes described continuously the potential problems of communicating risk and encouraging behavioural change through communication (in other words, based on low expectations for the types of quarantine measures associated with China and South Korea).

• It sought ‘behavioural science input on public communication’ and ‘agreed on the importance of behavioural science informing policy – and on the importance of public trust in HMG’s approach’ (28.1.20: 2).
• It worried about how the public might interpret ‘case fatality rate’, given the different ways to describe and interpret frequencies and risks (4.2.20: 3).
• It stated that ‘Epidemiological terms need to be made clearer in the planning documents to avoid ambiguity’ (11.2.20: 3).
• Its extensive discussion of behavioural science (13.2.20: 2-3) includes: there will be public scepticism and inaction until first deaths are confirmed; the main aim is to motivate people by relating behavioural change to their lives; messaging should stress ‘personal responsibility and responsibility to others’ and be clear on which measures are effective’, and ‘National messaging should be clear and definitive: if such messaging is presented as both precautionary and sufficient, it will reduce the likelihood of the public adopting further unnecessary or contradictory behaviours’ (13.2.20: 2-3)
• Banning large public events could signal the need to change behaviour more generally, but evidence for its likely impact is unavailable (SPI-M-O, 11.2.20: 1).

Generally speaking, the assumption underpinning communication is that behavioural change will come largely from communication (encouragement and exhortation) rather than imposition. Hence, for example, the SPI-B (25.2.20: 2) recommendation on limiting the ‘risk of public disorder’:

• ‘Provide clear and transparent reasons for different strategies: The public need to understand the purpose of the Government’s policy, why the UK approach differs to other countries and how resources are being allocated. SPI-B agreed that government should prioritise messaging that explains clearly why certain actions are being taken, ahead of messaging designed solely for reassuring the public.
• This should also set clear expectations on how the response will develop, g. ensuring the public understands what they can expect as the outbreak evolves and what will happen when large numbers of people present at hospitals. The use of early messaging will help, as a) individuals are likely to be more receptive to messages before an issue becomes controversial and b) it will promote a sense the Government is following a plan.
• Promote a sense of collectivism: All messaging should reinforce a sense of community, that “we are all in this together.” This will avoid increasing tensions between different groups (including between responding agencies and the public); promote social norms around behaviours; and lead to self-policing within communities around important behaviours’.

The underpinning assumption is that the government should treat people as ‘rational actors’: explain risk and how to reduce it, support existing measures by the public to socially distance, be transparent, explain if UK is doing things differently to other countries, and recognise that these measures are easier for some more than others (13.3.20: 3).

In that context, SPI-B Meeting paper 22.3.20 describes how to enable social distancing with reference to the ‘behaviour change wheel’ (Michie et al, 2011): ‘There are nine broad ways of achieving behaviour change: Education, Persuasion, Incentivisation, Coercion, Enablement, Training, Restriction, Environmental restructuring, and Modelling’ and many could reinforce each other (22.3.20: 1). The paper comments on current policy in relation to 5 elements:

1. Education – clarify guidance (generally, and for shielding), e.g. through interactive website, tailored to many audiences
2. Persuasion – increase perceived threat among ‘those who are complacent, using hard-hitting emotional messaging’ while providing clarity and positive messaging (tailored to your audience’s motivation) on what action to take (22.3.20: 1-2).
3. Incentivisation – emphasise social approval as a reward for behaviour change
4. Coercion – ‘Consideration should be given to enacting legislation, with community involvement, to compel key social distancing measures’ (combined with encouraging ‘social disapproval but with a strong caveat around unwanted negative consequences’ (22.3.20: 2)
5. Enablement – make sure that people have alternative access to social contact, food, and other resources for people feeling the unequal impact of lockdown (particularly for vulnerable people shielding, aided by community support).

Apparently, section 3 of SPI-B’s meeting paper (1.4.20b: 2) had been redacted because it was critical of a UK Government ‘Framework; with 4 new proposals for greater compliance: ‘17) increasing the financial penalties imposed; 18) introducing self-validation for movements; 19) reducing exercise and/or shopping; 20) reducing non-home working’. On 17, it suggests that the evidence base for (e.g.) fining someone exercising more than 1km from their home could contribute to lower support for policy overall. On 17-19, it suggests that most people are already complying, so there is no evidence to support more targeted measures. It is more positive about 20, since it could reduce non-home working (especially if financially supported). Generally, it suggests that ministers should ‘also consider the role of rewards and facilitations in improving adherence’ and use organisational changes, such as staggered work hours and new use of space, rather than simply focusing on individuals.

Communication after the lockdown

SAGE suggests that communication problems are more complicated during the release of lockdown measures (in other words, without the ability to present the relatively-low-ambiguity message ‘stay at home’). Examples (mostly from SPI-B and its contributors) include:

• Address potential confusion, causing false concern or reassurance, regarding antigen and antibody tests (meeting papers 1.4.20c: 3; 13.4.20b: 1-4; 22.4.20b: 1-5; 29.4.20a: 1-4)
• When notifying people about the need to self-isolate, address the trade-offs between symptom versus positive test based notifications (meeting paper 29.4.20a: 1-4; 5.5.20: 1-8)
• If you are worried about public ‘disorder’, focus on clear, effective, tailored communication, using local influencers, appealing to sympathetic groups (like NHS staff), and co-producing messages between the police and public (in other words, police via consent, and do not exacerbate grievances) (meeting papers 19.4.20: 1-4; 21.4.20: 1-3; 4.5.20: 1-11)
• Be wary of lockdowns specific to very small areas, which undermine the ‘all in it together’ message (REDACTED and Clifford Stott, no date: 1). If you must to it, clarify precisely who is affected and what they should do, support the people most vulnerable and impacted (e.g. financially), and redesign physical spaces (meeting paper SPI-B 22.4.20a)
• When reopening schools (fully or partly), communication is key to the inevitably complex and unpredictable behavioural consequences (so, for example, work with parents, teachers, and other stakeholders to co-produce clear guidance) (29.4.20d: 1-10)
• On the introduction of Alert Levels, as part of the Joint Biosecurity Centre work on local outbreaks (described in meeting paper 20.5.20a: 1-9): build public trust and understanding regarding JBC alert levels, and relate them very clearly to expected behaviour (SAGE 28.5.20). Each Alert Level should relate clearly to a required response in that area, and ‘public communications on Alert Levels needs many trusted messengers giving the same advice, many times’ (meeting paper 27.5.20b: 3).
• On transmission between social networks, ‘Communicate two key principles: 1. People whose work involves large numbers of contacts with different people should avoid close, prolonged, indoor contact with anyone as far as possible … 2. People with different workplace networks should avoid meeting or sharing the same spaces’ (meeting paper 27.5.20b: 1).
• On outbreaks in ‘forgotten institutional settings’ (including Prisons, Homeless Hostels, Migrant dormitories, and Long stay mental health): address the unusually low levels of trust in (or awareness of) government messaging among so-called ‘hard to reach groups’ (meeting paper 28.5.20a: 1).

See also:

SPI-M (Meeting paper 17.3.20b: 4) list of how to describe probabilities. This is more important than it looks, since there is a potentially major gap between the public and advisory group understanding of words like ‘probably’ (compare with the CIA’s Words of Estimative Probability).

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

COVID-19 policy in the UK: SAGE meetings from January-June 2020

This post is part 4 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings

SAGE began a series of extraordinary meetings from 22nd January 2020. The first was described as ‘precautionary’ (22.1.20: 1) and includes updates from NERVTAG which met from 13^th January. Its minutes state that ‘SAGE is unable to say at this stage whether it might be required to reconvene’ (22.1.20: 2). The second meeting notes that SAGE will meet regularly (e.g. 2-3 times per week in February) and coordinate all relevant science advice to inform domestic policy, including from NERVTAG and SPI-M (Scientific Pandemic Influenza Group on Modelling) which became a ‘formal sub-group of SAGE for the duration of this outbreak’ (SPI-M-O) (28.1.20: 1). It also convened an additional Scientific Pandemic Influenza subgroup (SPI-B) in February. I summarise these developments by month, but you can see that, by March, it is worth summarising each meeting. The main theme is uncertainty.

January 2020

The first meeting highlights immense uncertainty. Its description of WN-CoV (Wuhan Coronavirus), and statements such as ‘There is evidence of person-to-person transmission. It is unknown whether transmission is sustainable’, sum up the profound lack of information on what is to come (22.1.20: 1-2). It notes high uncertainty on how to identify cases, rates of infection, infectiousness in the absence of symptoms, and which previous experience (such as MERS) offers the most useful guidance. Only 6 days later, it estimates an R between 2-3, doubling rate of 3-4 days, incubation period of around 5 days, 14-day window of infectivity, varied symptoms such as coughing and fever, and a respiratory transmission route (different from SARS and MERS) (28.1.20: 1). These estimates are fairly constant from then, albeit qualified with reference to uncertainty (e.g. about asymptomatic transmission), some key outliers (e.g. the duration of illness in one case was 41 days – 4.2.20: 1), and some new estimates (e.g. of a 6-day ‘serial interval’, or ‘time between successive cases in a chain of transmission’, 11.2.20: 1). By now, it is preparing a response: modelling a ‘reasonable worst case scenario’ (RWC) based on the assumption of an R of 2.5 and no known treatment or vaccine, considering how to slow the spread, and considering how behavioural insights can be used to encourage self-isolation.

February 2020

SAGE began to focus on what measures might delay or reduce the impact of the epidemic. It described travel restrictions from China as low value, since a 95% reduction would have to be draconian to achieve and only secure a one month delay, which might be better achieved with other measures (3.2.20: 1-2). It, and supporting papers, suggested that the evidence was so limited that they could draw ‘no meaningful conclusions … as to whether it is possible to achieve a delay of a month’ by using one or a combination of these measures: international travel restrictions, domestic travel restrictions, quarantine people coming from infected areas, close schools, close FE/ HE, cancel large public events, contact tracing, voluntary home isolation, facemasks, hand washing. Further, some could undermine each other (e.g. school closures impact on older people or people in self-isolation) and have major societal or opportunity costs (SPI-M-O, 3.2.20b: 1-4). For example, the ‘SPI-M-O: Consensus view on public gatherings’ (11.2.20: 1) notes the aim to reduce duration and closeness of (particularly indoor) contact. Large outdoor gatherings are not worse than small, and stopping large events could prompt people to go to pubs (worse).

Throughout February, the minutes emphasize high uncertainty:

• if there will be an epidemic outside of China (4.2.20: 2)
• if it spreads through ‘air conditioning systems’ (4.2.20: 3)
• the spread from, and impact on, children and therefore the impact of closing schools (4.2.20: 3; discussed in a separate paper by SPI-M-O, 10.2.20c: 1-2)
• ‘SAGE heard that NERVTAG advises that there is limited to no evidence of the benefits of the general public wearing facemasks as a preventative measure’ (while ‘symptomatic people should be encouraged to wear a surgical face mask, providing that it can be tolerated’ (4.2.20: 3)

At the same time, its meeting papers emphasized a delay in accurate figures during an initial outbreak: ‘Preliminary forecasts and accurate estimates of epidemiological parameters will likely be available in the order of weeks and not days following widespread outbreaks in the UK’ (SPI-M-O, 3.2.20a: 3).

This problem proved to be crucial to the timing of government intervention. A key learning point will be the disconnect between the following statement and the subsequent realisation (3-4 weeks later) that the lockdown measures from mid-to-late March came too late to prevent an unanticipated number of excess deaths:

‘SAGE advises that surveillance measures, which commenced this week, will provide

actionable data to inform HMG efforts to contain and mitigate spread of Covid-19’ … PHE’s surveillance approach provides sufficient sensitivity to detect an outbreak in its early stages. This should provide evidence of an epidemic around 9- 11 weeks before its peak … increasing surveillance coverage beyond the current approach would not significantly improve our understanding of incidence’ (25.2.20: 1)

It also seems clear from the minutes and papers that SAGE highlighted a reasonable worst case scenario on 26.2.20. It was as worrying as the Imperial College COVID-19 Response Team report dated 16.3.20 that allegedly changed the UK Government’s mind on the 16^th March. Meeting paper 26.2.20a described the assumption of an 80% infection attack rate and 50% clinical attack rate (i.e. 50% of the UK population would experience symptoms), which underpins the assumption of 3.6 million requiring hospital care of at least 8 days (11% of symptomatic), and 541,200 requiring ventilation (1.65% of symptomatic) for 16 days. While it lists excess deaths as unknown, its 1% infection mortality rate suggests 524,800 deaths. This RWC replaces a previous projection (in Meeting paper 10.2.20a: 1-3, based on pandemic flu assumptions) of 820,000 excess deaths (27.2.20: 1).

As such, the more important difference could come from SAGE’s discussion of ‘non-pharmaceutical interventions (NPIs)’ if it recommends ‘mitigation’ while the Imperial team recommends ‘suppression’. However, the language to describe each approach is too unclear to tell (see Theme 1. The language of intervention; also note that NPIs were often described from March as ‘behavioural and social interventions’ following an SPI-B recommendation, Meeting paper 3.2.20: 1, but the language of NPI seems to have stuck).

March 2020

In March, SAGE focused initially (Meetings 12-14) on preparing for the peak of infection on the assumption that it had time to transition towards a series of isolation and social distancing measures that would be sustainable (and therefore unlikely to contribute to a second peak if lifted too soon). Early meetings and meeting papers express caution about the limited evidence for intervention and the potential for their unintended consequences. This approach began to change somewhat from mid-March (Meeting 15), and accelerate from Meetings 16-18, when it became clear that incidence and virus transmission were much larger than expected, before a new phase began from Meeting 19 (after the UK lockdown was announced on the 23^rd).

Meeting 12 (3.3.18) describes preparations to gather and consolidate information on the epidemic and the likely relative effect of each intervention, while its meeting papers emphasise:

• ‘It is highly likely that there is sustained transmission of COVID-19 in the UK at present’, and a peak of infection ‘might be expected approximately 3-5 months after the establishment of widespread sustained transmission’ (SPI-M Meeting paper 2.3.20: 1)
• the need the prepare the public while giving ‘clear and transparent reasons for different strategies’ and reducing ambiguity whenever giving guidance (SPI-B Meeting paper 3.2.20: 1-2)
• The need to combine different measures (e.g. school closure, self-isolation, household isolation, isolating over-65s) at the right time; ‘implementing a subset of measures would be ideal. Whilst this would have a more moderate impact it would be much less likely to result in a second wave’ (Meeting paper 4.3.20a: 3).

Meeting 13 (5.3.20) describes staying in the ‘containment’ phase (which, I think, means isolating people with positive tests at home or in hospital) , and introducing: a 12-week period of individual and household isolation measures in 1-2 weeks, on the assumption of 50% compliance; and a longer period of shielding over-65s 2 weeks later. It describes ‘no evidence to suggest that banning very large gatherings would reduce transmission’, while closing bars and restaurants ‘would have an effect, but would be very difficult to implement’, and ‘school closures would have smaller effects on the epidemic curve than other options’ (5.3.20: 1). Its SPI-B Meeting paper (4.3.20b) expresses caution about limited evidence and reliance on expert opinion, while identifying:

• potential displacement problems (e.g. school closures prompt people to congregate elsewhere, or be looked after by vulnerable older people, while parents to lose the chance to work)
• the visibility of groups not complying
• the unequal impact on poorer and single parent families of school closure and loss of school meals, lost income, lower internet access, and isolation
• how to reduce discontent about only isolating at-risk groups (the view that ‘explaining that members of the community are building some immunity will make this acceptable’ is not unanimous) (4.3.20b: 2).

Meeting 14 (10.3.20) states that the UK may have 5-10000 cases and ‘10-14 weeks from the epidemic peak if no mitigations are introduced’ (10.3.20: 2). It restates the focus on isolation first, followed by additional measures in April, and emphasizes the need to transition to measures that are acceptable and sustainable for the long term:

‘SAGE agreed that a balance needs to be struck between interventions that theoretically have significant impacts and interventions which the public can feasibly and safely adopt in sufficient numbers over long periods’ …’the public will face considerable challenges in seeking to comply with these measures, (e.g. poorer households, those relying on grandparents for childcare)’ (10.3.20: 2)

Meeting 15 (13.3.20: 1) describes an update to its data, suggesting ‘more cases in the UK than SAGE previously expected at this point, and we may therefore be further ahead on the epidemic curve, but the UK remains on broadly the same epidemic trajectory and time to peak’. It states that ‘household isolation and social distancing of the elderly and vulnerable should be implemented soon, provided they can be done well and equitably’, noting that there are ‘no strong scientific grounds’ to accelerate key measures but ‘there will be some minor gains from going early and potentially useful reinforcement of the importance of taking personal action if symptomatic’ (13.3.20: 1) and ‘more intensive actions’ will be required to maintain NHS capacity (13.3.20: 2).

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On the 16^th March, the UK Prime Minister Boris Johnson describes an ‘emergency’ (one week before declaring a ‘national emergency’ and UK-wide lockdown)

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Meeting 16 (16.3.20) describes the possibility that there are 5-10000 new cases in the UK (there is great uncertainty on the estimate’), doubling every 5-6 days. Therefore, to stay within NHS capacity, ‘the advice from SAGE has changed regarding the speed of implementation of additional interventions. SAGE advises that there is clear evidence to support additional social distancing measures be introduced as soon as possible’ (16.3.20: 1). SPI-M Meeting paper (16.3.20: 1) describes:

‘a combination of case isolation, household isolation and social distancing of vulnerable groups is very unlikely to prevent critical care facilities being overwhelmed … it is unclear whether or not the addition of general social distancing measures to case isolation, household isolation and social distancing of vulnerable groups would curtail the epidemic by reducing the reproduction number to less than 1 … the addition of both general social distancing and school closures to case isolation, household isolation and social distancing of vulnerable groups would be likely to control the epidemic when kept in place for a long period. SPI-M-O agreed that this strategy should be followed as soon as practical’

Meeting 17 (18.3.20) marks a major acceleration of plans, and a de-emphasis of the low-certainty/ beware-the-unintended-consequences approach of previous meetings (on the assumption that it was now 2-4 weeks behind Italy). It recommends school closures as soon as possible (and it, and SPIM Meeting paper 17.3.20b, now downplays the likely displacement effect). It focuses particularly on London, as the place with the largest initial numbers:

‘Measures with the strongest support, in terms of effect, were closure of a) schools, b) places of leisure (restaurants, bars, entertainment and indoor public spaces) and c) indoor workplaces. … Transport measures such as restricting public transport, taxis and private hire facilities would have minimal impact on reducing transmission’ (18.3.20: 2)

Meeting 18 (23.3.20) states that the R is higher than expected (2.6-2.8), requiring ‘high rates of compliance for social distancing’ to get it below 1 and stay under NHS capacity (23.3.20: 1). There is an urgent need for more community testing/ surveillance (and to address the global shortage of test supplies). In the meantime, it needs a ‘clear rationale for prioritising testing for patients and health workers’ (the latter ‘should take priority’) (23.3.20: 3) Closing UK borders ‘would have a negligible effect on spread’ (23.3.20: 2).

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The lockdown. On the 23^rd March 2020, the UK Prime Minister Boris Johnson declared: ‘From this evening I must give the British people a very simple instruction – you must stay at home’. He announced measures to help limit the impact of coronavirus, including police powers to support public health, such as to disperse gatherings of more than two people (unless they live together), close events and shops, and limit outdoor exercise to once per day (at a distance of two metres from others).

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Meeting 19 (26.3.20) follows the lockdown. SAGE describes its priorities if the R goes below 1 and NHS capacity remains under 100%: ‘monitoring, maintenance and release’ (based on higher testing); public messaging on mass testing and varying interventions; understanding nosocomial transmission and immunology; clinical trials (avoiding hasty decisions’ on new drug treatment in absence of good data) and ‘how to minimise potential harms from the interventions, including those arising from postponement of normal services, mental ill health and reduced ability to exercise. It needs to consider in particular health impacts on poorer people’ (26.3.20: 1-2). The optimistic scenario is 10,000 deaths from the first wave (SPIM-O Meeting paper 25.3.20: 4).

Meeting 20 Confirms RWC and optimistic scenarios (Meeting paper 25.3.20), but it needs a ‘clearer narrative, clarifying areas subject to uncertainty and sensitivities’ and to clarify that scenarios (with different assumptions on, for example, the R, which should be explained more) are not predictions (29.3.20).

Meeting 21 seeks to establish SAGE ‘scientific priorities’ (e.g. long term health impacts of COVID-19, including socioeconomic impact on health (including mental health), community testing, international work (‘comorbidities such as malaria and malnutrition) (31.3.20: 1-2). NHS to set up an interdisciplinary group (including science and engineering) to ‘understand and tackle nosocomial transmission’ in the context of its growth and urgent need to define/ track it (31.3.20: 1-2). SAGE to focus on testing requirements, not operational issues. It notes the need to identify a single source of information on deaths.

April 2020

The meetings in April highlight four recurring themes.

First, it stresses that it will not know the impact of lockdown measures for some time, that it is too soon to understand the impact of releasing them, and there is high risk of failure: ‘There is a danger that lifting measures too early could cause a second wave of exponential epidemic growth – requiring measures to be re-imposed’ (2.4.20: 1; see also 14.4.20: 1-2). This problem remains even if a reliable testing and contact tracing system is in place, and if there are environmental improvements to reduce transmission (by keeping people apart).

Second, it notes signals from multiple sources (including CO-CIN and the RCGP) on the higher risk of major illness and death among black people, the ongoing investigation of higher risk to ‘BAME’ health workers (16.4.20), and further (high priority) work on ‘ethnicity, deprivation, and mortality’ (21.4.20: 1) (see also: Race, ethnicity, and the social determinants of health).

Third, it highlights the need for a ‘national testing strategy’ to cover NHS patients, staff, an epidemiological survey, and the community (2.4.20). The need for far more testing is a feature of almost every meeting (see also The need to ramp up testing).

Fourth, SAGE describes the need for more short and long-term research, identifying nosocomial infection as a short term priority, and long term priorities in areas such as the long term health impacts of COVID-19 (including socioeconomic impacts on physical and mental health), community testing, and international work (31.3.20: 1-2).

Finally, it reflects shifting advice on the precautionary use of face masks. Previously, advisory bodies emphasized limited evidence of a clear benefit to the wearer, and worried that public mask use would reduce the supply to healthcare professionals and generate a false sense of security (compare with this Greenhalgh et al article on the precautionary principle, the subsequent debate, and work by the Royal Society). Even by April: ‘NERVTAG concluded that the increased use of masks would have minimal effect’ on general population infection (7.4.20: 1), while the WHO described limited evidence that facemasks are beneficial for community use (9.4.20). Still, general face mask use but could have small positive effect, particularly in ‘enclosed environments with poor ventilation, and around vulnerable people’ (14.4.20: 2) and ‘on balance, there is enough evidence to support recommendation of community use of cloth face masks, for short periods in enclosed spaces where social distancing is not possible’ (partly because people can be infectious with no symptoms), as long as people know that it is no substitute for social distancing and handwashing (21.4.20)

May 2020

In May, SAGE continues to discuss high uncertainty on relaxing lockdown measures, the details of testing systems, and the need for research.

Generally, it advises that relaxations should not happen before there is more understanding of transmission in hospitals and care homes, and ‘until effective outbreak surveillance and test and trace systems are up and running’ (14.5.20). It advises specifically ‘against reopening personal care services, as they typically rely on highly connected workers who may accelerate transmission’ (5.5.20: 3) and warns against the too-quick introduction of social bubbles. Relaxation runs the risk of diminishing public adherence to social distancing, and to overwhelm any contact tracing system put in place:

‘SAGE participants reaffirmed their recent advice that numbers of Covid-19 cases remain high (around 10,000 cases per day with wide confidence intervals); that R is 0.7-0.9 and could be very close to 1 in places across the UK; and that there is very little room for manoeuvre especially before a test, trace and isolate system is up and running effectively. It is not yet possible to assess the effect of the first set of changes which were made on easing restrictions to lockdown’ (28.5.20: 3).

It recommends extensive testing in hospitals and care homes (12.5.20: 3) and ‘remains of the view that a monitoring and test, trace & isolate system needs to be put in place’ (12.5.20: 1)

June 2020

In June, SAGE identifies the importance of clusters of infection (super-spreading events) and the importance of a contact tracing system that focuses on clusters (rather than simply individuals) (11.6.20: 3). It reaffirms the value of a 2-metre distance rule. It also notes that the research on immunology remains unclear, which makes immunity passports a bad idea (4.6.20).

It describes the result of multiple meeting papers on the unequal impact of COVID-19:

‘There is an increased risk from Covid-19 to BAME groups, which should be urgently investigated through social science research and biomedical research, and mitigated by policy makers’ … ‘SAGE also noted the importance of involving BAME groups in framing research questions, participating in research projects, sharing findings and implementing recommendations’ (4.6.20: 1-3)

See also: Race, ethnicity, and the social determinants of health

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

COVID-19 policy in the UK: The overall narrative underpinning SAGE advice and UK government policy

This post is part 3 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings (update: see the notes on Dominic Cummings’ tweets at the end)

I discuss the UK government’s definition of the COVID-19 policy problem in some other posts (1. in a now-dated post on early developments, and 2. in relation to oral evidence to the Health and Social Care committee). It includes the following elements:

• We need to use a suppression strategy to reduce infection enough to avoid overwhelming health service capacity, and shield the people most vulnerable to major illness or death caused by COVID-19, to minimize deaths during at least one peak of infection.
• We need to maintain suppression for a period of time that is difficult to predict, subject to compliance levels that are difficult to predict and monitor.
• We need to avoid panicking the public in the lead up to suppression, avoid too-draconian enforcement, and maintain wide public trust in the government.
• We need to avoid (a) excessive and (b) insufficient suppression measures, either of which could contribute to a second wave of the epidemic of the same magnitude as the first.
• We need to transition safely from suppression measures to foster economic activity, find safe ways for people to return to work and education, and reinstate the full use of NHS capacity for non-COVID-19 illness.
• In the absence of a vaccine, this strategy will likely involve social distancing and (voluntary) track-and-trace measures to isolate people with COVID-19.

This understanding in the UK, informed strongly by SAGE, also informs the ways in which SAGE (a) deals with uncertainty, and (b) describes the likely impact of each stage of action.

Manage suppression during the first peak to avoid a second peak

Most importantly, it stresses continuously the need to avoid excessive suppressive measures on the first peak that would contribute to a second peak [my emphasis added]:

• ‘Any combination of [non-pharmaceutical] measures would slow but not halt an epidemic’, 25.2.20: 1).
• ‘Mitigations can be expected to change the shape of the epidemic curve or the timing of a first or second peak, but are not likely to reduce the overall number of total infections’. Therefore, identify whose priorities matter (such as NHS England) on the assumption that, ‘The optimal shape of the epidemic curve will differ according to sectoral or organisational priorities’ (27.2.20: 2).
• ‘A combination of these measures [school closures, household isolation, social distancing] is expected to have a greater impact: implementing a subset of measures would be ideal. Whilst this would have a more moderate impact it would be much less likely to result in a second wave. In comparison combining stringent social distancing measures, school closures and quarantining cases, as a long-term policy, may have a similar impact to that seen in Hong Kong or Singapore, but this could result in a large second epidemic wave once the measures were lifted’ (Meeting paper 4.3.20a: 3).
• ‘SAGE was unanimous that measures seeking to completely suppress spread of Covid-19 will cause a second peak. SAGE advises that it is a near certainty that countries such as China, where heavy suppression is underway, will experience a second peak once measures are relaxed’ (also: ‘It was noted that Singapore had had an effective “contain phase” but that now new cases had appeared) (13.3.20: 2)
• Its visual of each possible peak of infection emphasises the risk of a second peak (Meeting paper 4.3.20: 2).

• ‘The objective is to avoid critical cases exceeding NHS intensive care and other respiratory support bed capacity’ … SAGE ‘advice on interventions should be based on what the NHS needs’ (16.3.20: 1)
• The fewer cases that happen as a result of the policies enacted, the larger subsequent waves are expected to be when policies are lifted (SPI-M-O Meeting paper 25.3.20: 1)
• ‘There is a danger that lifting measures too early could cause a second wave of exponential epidemic growth – requiring measures to be re-imposed’ (2.4.20: 1)

Avoid the unintended consequences of epidemic suppression

This understanding intersects with (c) an emphasis of the loss of benefits caused by certain interventions (such as schools closures).

• SPI-B (Meeting paper 4.3.20b: 1-4) expresses reluctance to close schools, partly to avoid the unintended consequences, including: displacement problems (e.g. school closures prompt children to be looked after by vulnerable older people, or parents to lose the chance to work); and, the unequal impact on poorer and single parent families (loss of school meals, lost income, lower internet access, exacerbating isolation and mental ill health). It then states that: ‘The importance of schools during a crisis should not be overlooked. This includes: Acting as a source of emotional support for children; Providing education (e.g. on hand hygiene) which is conveyed back to families; Provision of social service (e.g. free school meals, monitoring wellbeing); Acting as a point of leadership and communication within communities’ (4.3.20b: 4).
• ‘Long periods of social isolation may have significant risks for vulnerable people … SAGE agreed that a balance needs to be struck between interventions that theoretically have significant impacts and interventions which the public can feasibly and safely adopt in sufficient numbers over long periods. Input from behavioural scientists is essential to policy development of cocooning measures, to increase public practicability and likelihood of compliance … the public will face considerable challenges in seeking to comply with these measures, (e.g. poorer households, those relying on grandparents for childcare)’ (10.3.20: 2).
• After the lockdown (23.3.20), SAGE describes a priority regarding: ‘how to minimise potential harms from the interventions, including those arising from postponement of normal services, mental ill health and reduced ability to exercise. It needs to consider in particular health impacts on poorer people’ (26.3.20: 1-2).

Exhort and encourage, rather than impose

It also intersects with (d) a primary focus on exhortation and encouragement rather than the imposition of behavioural change (Table 1), largely based on the belief that the UK government would be unwilling or unable to enforce behavioural change in ways associated with China. In that context, the government’s willingness and ability to enforce social distancing and business closure from the 23^rd March is striking.

Examples include:

• when recommending ‘individual home isolation (symptomatic individuals to stay at home for 14 days) and whole family isolation (fellow household members of symptomatic individuals to stay at home for 14 days after last family member becomes unwell)’, it assumes a 50% compliance rate, and notes that ‘closing bars and restaurants ‘would have an effect, but would be very difficult to implement’ (5.3.20: 1).

See also: oral evidence to the Health and Social Care committee, which suggests that the UK government and SAGE’s problem definition contrasts with approaches in countries such as South Korea (described by Kim et al, and Kim).

It also contrasts with the approach described by several of the UK’s (expert) critics, including Professor Devi Sridhar (Professor of Global Public Health), who is critical of SAGE specifically, and more generally of the UK government’s rejection of an ‘elimination’ strategy:

Eradication -> getting rid of every case of COVID on the planet. Only possible in long-term w/vaccine.

Elimination -> moving towards 0 infections within national borders. Yes, imported cases will occur, but if identified quickly, can mean return to largely ‘normal’ daily life.

— Prof. Devi Sridhar (@devisridhar) June 22, 2020

We need a concerted push across the 4 nations for elimination. Here is how New Zealand did it & why it's feasible over the summer with political will, leadership & public willingness to comply. Only way to get back to 'normal' life. https://t.co/7BXf5gZJjz https://t.co/Qk7PM13XrO

— Prof. Devi Sridhar (@devisridhar) June 14, 2020

Too much short-sightedness & focus on 2 weeks ahead instead of 6-8 months ahead. Same issue back in Jan 2020.

— Prof. Devi Sridhar (@devisridhar) June 26, 2020

Table 1 sets out one way to describe the distinction between these approaches:

• The UK government is addressing a chronic problem, being cautious about policy change without supportive evidence, identifying trigger points to new approaches (based on incidence), and assuming initially that the approach is based largely on exhortation.
• One alternative is to pursue elimination aggressively, adopting a precautionary principle before there is supportive evidence of a major problem and the effectiveness of solutions, backed by measures such as contact tracing and quarantine, and assuming that the imposition of behaviour should be a continuous expectation.

One approach highlights the lack of evidence to support major policy change, and therefore gives primacy to the status quo. The other is more preventive, giving primacy to the precautionary principle until there is more clarity or certainty on the available evidence.

In that context, note (in Table 2) how frequently the SAGE minutes state that there is limited evidence to support policy change, and that an epidemic is inevitable (in other words, elimination without a vaccine is near-impossible). Both statements tend to support a UK government policy that was, until mid-March, based on reluctance to enforce a profound lockdown to impose social distancing.

As the next post describes, the chronology of Table 2 is instructive, since it demonstrates a degree of path dependence based on initial uncertainty and hesitancy. This approach was understandable at first (particularly when connected to an argument about reducing the peak of infection then avoiding a second wave), before being so heavily criticised only two months later.

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

Update 24.5.21

Dominic Cummings’ tweets 38-55 (22-24 May 2021) describe much of the initial UK Government approach (described above) as a ‘herd immunity’ strategy:

38/ Media generally abysmal on covid but even I’ve been surprised by 1 thing: how many hacks have parroted Hancock’s line that ‘herd immunity wasn’t the plan’ when 'herd immunity by Sep' was *literally the official plan in all docs/graphs/meetings* until it was ditched

— Dominic Cummings (@Dominic2306) May 22, 2021

51/ It was in week of 9/3 that we started to figure out Plan B to dodge herd immunity until vaccines. Even AFTER we shifted to PlanB, COBR documents had the ‘OPTIMAL single peak strategy’ graphs showing 260k dead cos the system was so confused in the chaos, see below pic.twitter.com/kXsgfkQdbF

— Dominic Cummings (@Dominic2306) May 23, 2021

I discuss here why I think ‘herd immunity’ has become a damagingly ambiguous term, used too loosely and misleadingly by too many people to help us understand what happened:

3. Defining the policy problem: ‘herd immunity’, long term management, and the containability of COVID-19 | Paul Cairney: Politics & Public Policy (wordpress.com)

However, clearly these tweets are crucial to our understanding of the influence of initial advice and strategies, based on the idea of acting to mitigate a first peak while avoiding a second.

COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings

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:

1. 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.

3. 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:

1. the scale and urgency of a potential policy problem, such as describing and estimating the incidence and transmission of coronavirus
2. 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:

1. 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):

1. coronavirus represents a long term problem with no immediate solution (such as a vaccine) and minimal prospect of extinction/ eradication
2. use policy measures – on isolation and social distancing – to flatten the first peak of infection and avoid overwhelming health service capacity
3. don’t impose or relax measures too quickly (which will cause a second peak of infection)
4. 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.

2. 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 23^rd 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).

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:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

Further reading

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:

The whole thing in PDF

Table 2 in PDF

The whole thing as a Word document

Table 2 as a word 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).
• Greg Clark MP (chair of the House of Commons Science and Technology Committee) Between science and policy – Scrutinising the role of SAGE in providing scientific advice to government

As part of our #Covid19 series, @draccoops and @cptyler (@UCLSTEaPP) look at UK’s science advisory system and at the lessons we should learn from the current crisis, to improve how science and #evidence inform public policy making #scipol #sciadvice https://t.co/XpZ1iXQKKF

— CfSocialScience (@CfSocialScience) June 1, 2020

Understanding Public Policy 2nd edition

All going well, it will be out in November 2019. We are now at the proofing stage.

I have included below the summaries of the chapters (and each chapter should also have its own entry (or multiple entries) in the 1000 Words and 500 Words series).

 

Taking lessons from policy theory into practice: 3 examples

Notes for ANZSOG/ ANU Crawford School/ UNSW Canberra workshop. Powerpoint here. The recording of the lecture (skip to 2m30) and Q&A is here (right click to download mp3 or dropbox link):

The context for this workshop is the idea that policy theories could be more helpful to policymakers/ practitioners if we could all communicate more effectively with each other. Academics draw general and relatively abstract conclusions from multiple cases. Practitioners draw very similar conclusions from rich descriptions of direct experience in a smaller number of cases. How can we bring together their insights and use a language that we all understand? Or, more ambitiously, how can we use policy theory-based insights to inform the early career development training that civil servants and researchers receive?

The first step is to translate policy theories into a non-technical language by trying to speak with an audience beyond our immediate peers (see for example Practical Lessons from Policy Theories).

However, translation is not enough. A second crucial step is to consider how policymakers and practitioners are likely to make sense of theoretical insights when they apply them to particular aims or responsibilities. For example:

1. Central government policymakers may accept the descriptive accuracy of policy theories emphasising limited central control, but not the recommendation that they should let go, share power, and describe their limits to the public.
2. Scientists may accept key limitations to ‘evidence based policymaking’ but reject the idea that they should respond by becoming better storytellers or more manipulative operators.
3. Researchers and practitioners struggle to resolve hard choices when combining evidence and ‘coproduction’ while ‘scaling up’ policy interventions. Evidence choice is political choice. Can we do more than merely encourage people to accept this point?

I discuss these examples below because they are closest to my heart (especially example 1). Note throughout that I am presenting one interpretation about: (1) the most promising insights, and (2) their implications for practice. Other interpretations of the literature and its implications are available. They are just a bit harder to find.

Example 1: the policy cycle endures despite its descriptive inaccuracy

The policy cycle does not describe and explain the policy process well:

• If we insist on keeping the cycle metaphor, it is more accurate to see the process as a huge set of policy cycles that connect with each other in messy and unpredictable ways.
• The cycle approach also links strongly to the idea of ‘comprehensive rationality’ in which a small group of policymakers and analysts are in full possession of the facts and full control of the policy process. They carry out their aims through a series of stages.

Policy theories provide more descriptive and explanatory usefulness. Their insights include:

• Limited choice. Policymakers inherit organisations, rules, and choices. Most ‘new’ choice is a revision of the old.
• Limited attention. Policymakers must ignore almost all of the policy problems for which they are formally responsible. They pay attention to some, and delegate most responsibility to civil servants. Bureaucrats rely on other actors for information and advice, and they build relationships on trust and information exchange.
• Limited central control. Policy may appear to be made at the ‘top’ or in the ‘centre’, but in practice policymaking responsibility is spread across many levels and types of government (many ‘centres’). ‘Street level’ actors make policy as they deliver. Policy outcomes appear to ‘emerge’ locally despite central government attempts to control their fate.
• Limited policy change. Most policy change is minor, made and influenced by actors who interpret new evidence through the lens of their beliefs. Well-established beliefs limit the opportunities of new solutions. Governments tend to rely on trial-and-error, based on previous agreements, rather than radical policy change based on a new agenda. New solutions succeed only during brief and infrequent windows of opportunity.

However, the cycle metaphor endures because:

• It provides a simple model of policymaking with stages that map onto important policymaking functions.
• It provides a way to project policymaking to the public. You know how we make policy, and that we are in charge, so you know who to hold to account.

In that context, we may want to be pragmatic about our advice:

1. One option is via complexity theory, in which scholars generally encourage policymakers to accept and describe their limits:

• Accept routine error, reduce short-term performance management, engage more in trial and error, and ‘let go’ to allow local actors the flexibility to adapt and respond to their context.
• However, would a government in the Westminster tradition really embrace this advice? No. They need to balance (a) pragmatic policymaking, and (b) an image of governing competence.

2. Another option is to try to help improve an existing approach.

• Koski and Workman build on PET to recommend ways to process information more effectively.
• Studies built on MSA tend to focus on ‘entrepreneurs’ having a technically and politically feasible solution ready for the next window of opportunity.
• Sanderson describes the skills required for ‘intelligent policymaking’.
• I sum up these approaches in ‘How Can Policy Theory Have an Impact on Policy Making?’ Teaching Public Administration, 33, 1, 22-39 

Further reading (blog posts):

The language of complexity does not mix well with the language of Westminster-style accountability

Making Sense of Policymaking: why it’s always someone else’s fault and nothing ever changes

Two stories of British politics: the Westminster model versus Complex Government

Example 2: how to deal with a lack of ‘evidence based policymaking’

I used to read many papers on tobacco policy, with the same basic message: we have the evidence of tobacco harm, and evidence of which solutions work, but there is an evidence-policy gap caused by too-powerful tobacco companies, low political will, and pathological policymaking. These accounts are not informed by theories of policymaking.

I then read Oliver et al’s paper on the lack of policy theory in health/ environmental scholarship on the ‘barriers’ to the use of evidence in policy. Very few articles rely on policy concepts, and most of the few rely on the policy cycle. This lack of policy theory is clear in their description of possible solutions – better communication, networking, timing, and more science literacy in government – which does not describe well the need to respond to policymaker psychology and a complex policymaking environment.

So, I wrote The Politics of Evidence-Based Policymaking and one zillion blog posts to help identify the ways in which policy theories could help explain the relationship between evidence and policy.

Since then, the highest demand to speak about the book has come from government/ public servant, NGO, and scientific audiences outside my discipline. The feedback is generally that: (a) the book’s description sums up their experience of engagement with the policy process, and (b) maybe it opens up discussion about how to engage more effectively.

But how exactly do we turn empirical descriptions of policymaking into practical advice?

For example, scientist/ researcher audiences want to know the answer to a question like: Why don’t policymakers listen to your evidence? and so I focus on three conversation starters:

1. they have a broader view on what counts as good evidence (see ANZSOG description)
2. they have to ignore almost all information (a nice way into bounded rationality and policymaker psychology)
3. they do not understand or control the process in which they seek to use evidence (a way into ‘the policy process’)

We can then consider many possible responses in the sequel What can you do when policymakers ignore your evidence?

Examples include:

• ‘How to do it’ advice. I compare tips for individuals (from experienced practitioners) with tips based on policy concepts. They are quite similar-looking tips – e.g. find out where the action is, learn the rules, tell good stories, engage allies, seek windows of opportunity – but I describe mine as 5 impossible tasks!
• Organisational reform. I describe work with the European Commission Joint Research Centre to identify 8 skills or functions of an organisation bringing together the supply/demand of knowledge.
• Ethical dilemmas. I use key policy theories to ask people how far they want to go to privilege evidence in policy. It’s fun to talk about these things with the type of scientist who sees any form of storytelling as manipulation.

Further reading:

Is Evidence-Based Policymaking the same as good policymaking?

A 5-step strategy to make evidence count

Political science improves our understanding of evidence-based policymaking, but does it produce better advice?

Principles of science advice to government: key problems and feasible solutions

Example 3: how to encourage realistic evidence-informed policy transfer

This focus on EBPM is useful context for discussions of ‘policy learning’ and ‘policy transfer’, and it was the focus of my ANZOG talk entitled (rather ambitiously) ‘teaching evidence-based policy to fly’.

I’ve taken a personal interest in this one because I’m part of a project – called IMAJINE – in which we have to combine academic theory and practical responses. We are trying to share policy solutions across Europe rather than explain why few people share them!

For me, the context is potentially overwhelming:

• Policy learning is a political process, and expert-driven learning is one of many possibilities, alongside dialogue, bargaining, and hierarchical models.
• Indeed, researchers often do badly because they don’t learn how to deal with the politics.
• Policy transfer can be maximal or minimal, and driven voluntarily or via coercion. A policy solution, when ‘imported’, can be mimicked, translated or transformed.
• When transfer is voluntary, receptivity to new solutions is more important than their supply.
• There are very different ‘evidence-based’ models on how to ‘scale up’ policy success.

So, when we start to focus on sharing lessons, we will have three things to discover:

1. What is the evidence for success, and from where does it come? Governments often project success without backing it up.
2. What story do policymakers tell about the problem they are trying to solve, the solutions they produced, and why? Two different governments may be framing and trying to solve the same problem in very different ways.
3. Was the policy introduced in a comparable policymaking system? People tend to focus on political system comparability (e.g. is it unitary or federal?), but I think the key is in policymaking system comparability (e.g. what are the rules and dominant ideas?).

To be honest, when one of our external assessors asked me how well I thought I would do, we both smiled because the answer may be ‘not very’. In other words, the most practical lesson may be the hardest to take, although I find it comforting: the literature suggests that policymakers might ignore you for 20 years then suddenly become very (but briefly) interested in your work.

 

The slides are a bit wonky because I combined my old ppt to the Scottish Government with a new one for UNSW Paul Cairney ANU Policy practical 22 October 2018

I wanted to compare how I describe things to (1) civil servants (2) practitioners/ researcher (3) me, but who has the time/ desire to listen to 3 powerpoints in one go? If the answer is you, let me know and we’ll set up a Zoom call.

Evidence-based policymaking: political strategies for scientists living in the real world

Note: I wrote the following discussion (last year) to be a Nature Comment but it was not to be!

Nature articles on evidence-based policymaking often present what scientists would like to see: rules to minimise bias caused by the cognitive limits of policymakers, and a simple policy process in which we know how and when to present the best evidence.[1]  What if neither requirement is ever met? Scientists will despair of policymaking while their competitors engage pragmatically and more effectively.[2]

Alternatively, if scientists learned from successful interest groups, or by using insights from policy studies, they could develop three ‘take home messages’: understand and engage with policymaking in the real world; learn how and when evidence ‘wins the day’; and, decide how far you should go to maximise the use of scientific evidence. Political science helps explain this process[3], and new systematic and thematic reviews add new insights.[4] [5] [6] [7]

Understand and engage with policymaking in the real world

Scientists are drawn to the ‘policy cycle’, because it offers a simple – but misleading – model for engagement with policymaking.[3] It identifies a core group of policymakers at the ‘centre’ of government, perhaps giving the impression that scientists should identify the correct ‘stages’ in which to engage (such as ‘agenda setting’ and ‘policy formulation’) to ensure the best use of evidence at the point of authoritative choice. This is certainly the image generated most frequently by health and environmental scientists when they seek insights from policy studies.[8]

Yet, this model does not describe reality. Many policymakers, in many levels and types of government, adopt and implement many measures at different times. For simplicity, we call the result ‘policy’ but almost no modern policy theory retains the linear policy cycle concept. In fact, it is more common to describe counterintuitive processes in which, for example, by the time policymaker attention rises to a policy problem at the ‘agenda setting’ stage, it is too late to formulate a solution. Instead, ‘policy entrepreneurs’ develop technically and politically feasible solutions then wait for attention to rise and for policymakers to have the motive and opportunity to act.[9]

Experienced government science advisors recognise this inability of the policy cycle image to describe real world policymaking. For example, Sir Peter Gluckman presents an amended version of this model, in which there are many interacting cycles in a kaleidoscope of activity, defying attempts to produce simple flow charts or decision trees. He describes the ‘art and craft’ of policy engagement, using simple heuristics to deal with a complex and ‘messy’ policy system.[10]

Policy studies help us identify two such heuristics or simple strategies.

First, respond to policymaker psychology by adapting to the short cuts they use to gather enough information quickly: ‘rational’, via trusted sources of oral and written evidence, and ‘irrational’, via their beliefs, emotions, and habits. Policy theories describe many interest group or ‘advocacy coalition’ strategies, including a tendency to combine evidence with emotional appeals, romanticise their own cause and demonise their opponents, or tell simple emotional stories with a hero and moral to exploit the biases of their audience.[11]

Second, adapt to complex ‘policy environments’ including: many policymakers at many levels and types of government, each with their own rules of evidence gathering, network formation, and ways of understanding policy problems and relevant socioeconomic conditions.[2] For example, advocates of international treaties often find that the evidence-based arguments their international audience takes for granted become hotly contested at national or subnational levels (even if the national government is a signatory), while the same interest groups presenting the same evidence of a problem can be key insiders in one government department but ignored in another.[3]

Learn the conditions under which evidence ‘wins the day’ in policymaking

Consequently, the availability and supply of scientific evidence, on the nature of problems and effectiveness of solutions, is a necessary but insufficient condition for evidence-informed policy. Three others must be met: actors use scientific evidence to persuade policymakers to pay attention to, and shift their understanding of, policy problems; the policy environment becomes broadly conducive to policy change; and, actors exploit attention to a problem, the availability of a feasible solution, and the motivation of policymakers, during a ‘window of opportunity’ to adopt specific policy instruments.10

Tobacco control represents a ‘best case’ example (box 1) from which we can draw key lessons for ecological and environmental policies, giving us a sense of perspective by highlighting the long term potential for major evidence-informed policy change. However, unlike their colleagues in public health, environmental scientists have not developed a clear sense of how to produce policy instruments that are technically and politically feasible, so the delivery of comparable policy change is not inevitable.[12]

Box 1: Tobacco policy as a best case and cautionary tale of evidence-based policymaking

Tobacco policy is a key example – and useful comparator for ecological and environmental policies – since it represents a best case scenario and cautionary tale.[13] On the one hand, the scientific evidence on the links between smoking, mortality, and preventable death forms the basis for modern tobacco control policy. Leading countries – and the World Health Organisation, which oversees the Framework Convention on Tobacco Control (FCTC) – frame tobacco use as a public health ‘epidemic’ and allow their health departments to take the policy lead. Health departments foster networks with public health and medical groups at the expense of the tobacco industry, and emphasise the socioeconomic conditions – reductions in (a) smoking prevalence, (b) opposition to tobacco control, and (c) economic benefits to tobacco – most supportive of tobacco control. This framing, and conducive policymaking environment, helps give policymakers the motive and opportunity to choose policy instruments, such as bans on smoking in public places, which would otherwise seem politically infeasible.

On the other hand, even in a small handful of leading countries such as the UK, it took twenty to thirty years to go from the supply of the evidence to a proportionate government response: from the early evidence on smoking in the 1950s prompting major changes from the 1980s, to the evidence on passive smoking in the 1980s prompting public bans from the 2000s onwards. In most countries, the production of a ‘comprehensive’ set of policy measures is not yet complete, even though most signed the FCTC.

Decide how far you’ll go to maximise the use of scientific evidence in policymaking

These insights help challenge the naïve position that, if policymaking can change to become less dysfunctional[1], scientists can be ‘honest brokers’[14] and expect policymakers to use their evidence quickly, routinely, and sincerely. Even in the best case scenario, evidence-informed change takes hard work, persistence, and decades to achieve.

Since policymaking will always appear ‘irrational’ and complex’[3], scientists need to think harder about their role, then choose to engage more effectively or accept their lack of influence.

To deal with ‘irrational’ policymakers, they should combine evidence with persuasion, simple stories, and emotional appeals, and frame their evidence to make the implications consistent with policymakers’ beliefs.

To deal with complex environments, they should engage for the long term to work out how to form alliances with influencers who share their beliefs, understand in which ‘venues’ authoritative decisions are made and carried out, the rules of information processing in those venues, and the ‘currency’ used by policymakers when they describe policy problems and feasible solutions.[2] In other words, develop skills that do not come with scientific training, avoid waiting for others to share your scientific mindset or respect for scientific evidence, and plan for the likely eventuality that policymaking will never become ‘evidence based’.

This approach may be taken for granted in policy studies[15], but it raises uncomfortable dilemmas regarding how far scientists should go, to maximise the use of scientific evidence in policy, using persuasion and coalition-building.

These dilemmas are too frequently overshadowed by claims – more comforting to scientists – that politicians are to blame because they do not understand how to generate, analyse, and use the best evidence. Scientists may only become effective in politics if they apply the same critical analysis to themselves.

[1] Sutherland, W.J. & Burgman, M. Nature 526, 317–318 (2015).

[2] Cairney, P. et al. Public Administration Review 76, 3, 399-402 (2016)

[3] Cairney, P. The Politics of Evidence-Based Policy Making (Palgrave Springer, 2016).

[4] Langer, L. et al. The Science of Using Science (EPPI, 2016)

[5] Breckon, J. & Dodson, J. Using Evidence. What Works? (Alliance for Useful Evidence, 2016)

[6] Palgrave Communications series The politics of evidence-based policymaking (ed. Cairney, P.)

[7] Practical lessons from policy theories (eds. Weible, C & Cairney, P.) Policy and Politics April 2018

[8] Oliver, K. et al. Health Research Policy and Systems, 12, 34 (2016)

[9] Kingdon, J. Agendas, Alternatives and Public Policies (Harper Collins, 1984)

[10] Gluckmann, P. Understanding the challenges and opportunities at the science-policy interface

[11] Cairney, P. & Kwiatkowski, R. Palgrave Communications.

[12] Biesbroek et al. Nature Climate Change, 5, 6, 493–494 (2015)

[13] Cairney, P. & Yamazaki, M. Journal of Comparative Policy Analysis

[14] Pielke Jr, R. originated the specific term The honest broker (Cambridge University Press, 2007) but this role is described more loosely by other commentators.

[15] Cairney, P. & Oliver, K. Health Research Policy and Systems 15:35 (2017)

The role of evidence in UK policymaking after Brexit

Join us for free panel discussion on policmaking post-Brexit today at 15:30 with @CairneyPaul & @jameswilsdon et al https://t.co/D9oWn9QNpR

— Palgrave Comms (@PalCommsOA) June 22, 2017

We are launching a series of papers on evidence and policy in Palgrave Communications. Of course, we used Brexit as a hook, to tap into current attention to instability and major policy change. However, many of the issues we discuss are timeless and about surprising levels of stability and continuity in policy processes, despite periods of upheaval.

In my day, academics would build their careers on being annoying, and sometimes usefully annoying. This would involve developing counterintuitive insights, identifying gaps in analysis, and challenging a ‘common wisdom’ in political studies. Although not exactly common wisdom, the idea of ‘post truth’ politics, a reduction in respect for ‘experts’, and a belief that Brexit is a policymaking game-changer, are great candidates for some annoyingly contrary analysis.

In policy studies, many of us argue that things like elections, changes of government, and even constitutional changes are far less important than commonly portrayed. In media and social media accounts, we find hyperbole about the destabilising and changing impact of the latest events. In policy studies, we often stress stability and continuity.  My favourite old example regards the debates from the 1970s about electoral reform. While some were arguing that first-past-the-post was a disastrous electoral system since it produces swings of government, instability, and incoherent policy change, Richardson and Jordan would point out surprisingly high levels of stability and continuity.

In part, this is because the state is huge, policymakers can only pay attention to a tiny part of it, and therefore most of it is processed as a low level of government, out of the public spotlight.

These insights still have profound relevance today, for two key reasons.

1. The role of experts is more important than you think

This larger process provides far more opportunities for experts than we’d associate with ‘tip of the iceberg’ politics.

Some issues are salient. They command the interest of elected politicians, and those politicians often have firm beliefs that limit the ‘impact’ of any evidence that does not support their beliefs.

However, most issues are not salient. They command minimal interest, they are processed by other policymakers, and those policymakers are looking for information and advice from reliable experts.

Indeed, a lot of policy studies highlight the privileged status of certain experts, at the expense of most members of the public (which is a useful corrective to the story, associated with Brexit, that the public is too emotionally driven, too sceptical of experts, and too much in charge of the future of constitutional change).

So, Brexit will change the role of experts, but expect that change to relate to the venue in which they engage, and the networks of which they are a part, more than the practices of policymakers. Much policymaking is akin to an open door to government for people with useful information and a reputation for being reliable in their dealings with policymakers.

2. Provide less evidence for more impact

If the problem is that policymakers can only pay attention to a tiny proportion of their responsibilities, the solution is not to bombard them with a huge amount of evidence. Instead, assume that they seek ways to ignore almost all information while still managing to make choices. The trick may be to provide just enough information to prompt demand for more, not oversupply evidence on the assumption that you have only one chance for influence.

With Richard Kwiatkoswki, I draw on policy and psychology studies to help us understand how to supply evidence to anyone using ‘rational’ and ‘irrational’ ways to limit their attention, information processing, and thought before making decisions.

Our working assumption is that policymakers need to gather information quickly and effectively, so they develop heuristics to allow them to make what they believe to be good choices. Their solutions often seem to be driven more by their emotions than a ‘rational’ analysis of the evidence, partly because we hold them to a standard that no human can reach. If so, and if they have high confidence in their heuristics, they will dismiss our criticism as biased and naïve. Under those circumstances, restating the need for ‘evidence-based policymaking’ is futile, and naively ‘speaking truth to power’ counterproductive.

Instead, try out these strategies:

1. Develop ways to respond positively to ‘irrational’ policymaking

Instead of automatically bemoaning the irrationality of policymakers, let’s marvel at the heuristics they develop to make quick decisions despite uncertainty. Then, let’s think about how to respond pragmatically, to pursue the kinds of evidence informed policymaking that is realistic in a complex and constantly changing policymaking environment.

2. Tailor framing strategies to policymaker cognition

The usual advice is to minimise the cognitive burden of your presentation, and use strategies tailored to the ways in which people pay attention to, and remember information.

The less usual advice includes:

• If policymakers are combining cognitive and emotive processes, combine facts with emotional appeals.
• If policymakers are making quick choices based on their values and simple moral judgements, tell simple stories with a hero and a clear moral.
• If policymakers are reflecting a ‘group emotion’, based on their membership of a coalition with firmly-held beliefs, frame new evidence to be consistent with the ‘lens’ through which actors in those coalitions understand the world.

3. Identify the right time to influence individuals and processes

Understand what it means to find the right time to exploit ‘windows of opportunity’.

‘Timing’ can refer to the right time to influence an individual, which involves how open they are to, say, new arguments and evidence.

Or, timing refers to a ‘window of opportunity’ when political conditions are aligned. I discuss the latter in a separate paper on effective ‘policy entrepreneurs’.

4. Adapt to real-world organisations rather than waiting for an orderly process to appear

Politicians may appear confident of policy and with a grasp of facts and details, but are (a) often vulnerable and therefore defensive or closed to challenging information, and/ or (b) inadequate in organisational politics, or unable to change the rules of their organisations.

So, develop pragmatic strategies: form relationships in networks, coalitions, or organisations first, then supply challenging information second. To challenge without establishing trust may be counterproductive.

5. Recognise that the biases we ascribe to policymakers are present in ourselves and our own groups.

Identifying only the biases in our competitors may help mask academic/ scientific examples of group-think, and it may be counterproductive to use euphemistic terms like ‘low information’ to describe actors whose views we do not respect. This is a particular problem for scholars if they assume that most people do not live up to their own imagined standards of high-information-led action (often described as a ‘deficit model’ of engagement).

It may be more effective to recognise that: (a) people’s beliefs are honestly held, and policymakers believe that their role is to serve a cause greater than themselves.; and, (b) a fundamental aspect of evolutionary psychology is that people need to get on with each other, so showing simple respect – or going further, to ‘mirror’ that person’s non-verbal signals – can be useful even if it looks facile.

This leaves open the ethical question of how far we should go to identify our biases, accept the need to work with people whose ways of thinking we do not share, and how far we should go to secure their trust without lying about one’s beliefs.

At the very least, we do not suggest these 5 strategies as a way to manipulate people for personal gain. They are better seen as ways to use psychology to communicate well. They are also likely to be as important to policy engagement regardless of Brexit. Venues may change quickly, but the ways in which people process information and make choices may not.

 

I know my audience, but does my other audience know I know my audience?

‘Know your audience’ is a key phrase for anyone trying to convey a message successfully. To ‘know your audience’ is to understand the rules they use to make sense of your message, and therefore the adjustments you have to make to produce an effective message. Simple examples include:

• The sarcasm rules. The first rule is fairly explicit. If you want to insult someone’s shirt, you (a) say ‘nice shirt, pal’, but also (b) use facial expressions or unusual speech patterns to signal that you mean the opposite of what you are saying. Otherwise, you’ve inadvertently paid someone a compliment, which is just not on. The second rule is implicit. Sarcasm is sometimes OK – as a joke or as some nice passive aggression – and a direct insult (‘that shirt is shite, pal’) as a joke is harder to pull off.
• The joke rule. If you say that you went to the doctor because a strawberry was growing out of your arse and the doctor gave you some cream for it, you’d expect your audience to know you were joking because it’s such a ridiculous scenario and there’s a pun. Still, there’s a chance that, if you say it quickly, with a straight face, your audience is not expecting a joke, and/ or your audience’s first language is not English, your audience will take you seriously, if only for a second. It’s hilarious if your audience goes along with you, and a bit awkward if your audience asks kindly about your welfare.
• Keep it simple stupid. If someone says KISS, or some modern equivalent – ‘it’s the economy, stupid’, the rule is that, generally, they are not calling you stupid (even though the insertion of the comma, in modern phrases, makes it look like they are). They are referring to the value of a simple design or explanation that as many people as possible can understand. If your audience doesn’t know the phrase, they may think you’re calling them stupid, stupid.

These rules can be analysed from various perspectives: linguistics, focusing on how and why rules of language develop; and philosophy, to help articulate how and why rules matter in sense making.

There is also a key role for psychological insights, since – for example – a lot of these rules relate to the routine ways in which people engage emotionally with the ‘signals’ or information they receive.

Think of the simple example of twitter engagement, in which people with emotional attachments to one position over another (say, pro- or anti- Brexit), respond instantly to a message (say, pro- or anti- Brexit). While some really let themselves down when they reply with their own tweet, and others don’t say a word, neither audience is immune from that emotional engagement with information. So, to ‘know your audience’ is to anticipate and adapt to the ways in which they will inevitably engage ‘rationally’ and ‘irrationally’ with your message.

I say this partly because I’ve been messing around with some simple ‘heuristics’ built on insights from psychology, including Psychology Based Policy Studies: 5 heuristics to maximise the use of evidence in policymaking .

Two audiences in the study of ‘evidence based policymaking’

I also say it because I’ve started to notice a big unintended consequence of knowing my audience: my one audience doesn’t like the message I’m giving the other. It’s a bit like gossip: maybe you only get away with it if only one audience is listening. If they are both listening, one audience seems to appreciate some new insights, while the other wonders if I’ve ever read a political science book.

The problem here is that two audiences have different rules to understand the messages that I help send. Let’s call them ‘science’ and ‘political science’ (please humour me – you’ve come this far). Then, let’s make some heroic binary distinctions in the rules each audience would use to interpret similar issues in a very different way.

I could go on with these provocative distinctions, but you get the idea. A belief taken for granted in one field will be treated as controversial in another. In one day, you can go to one workshop and hear the story of objective evidence, post-truth politics, and irrational politicians with low political will to select evidence-based policies, then go to another workshop and hear the story of subjective knowledge claims.

Or, I can give the same presentation and get two very different reactions. If these are the expectations of each audience, they will interpret and respond to my messages in very different ways.

So, imagine I use some psychology insights to appeal to the ‘science’ audience. I know that,  to keep it on side and receptive to my ideas, I should begin by being sympathetic to its aims. So, my implicit story is along the lines of, ‘if you believe in the primacy of science and seek evidence-based policy, here is what you need to do: adapt to irrational policymaking and find out where the action is in a complex policymaking system’. Then, if I’m feeling energetic and provocative, I’ll slip in some discussion about knowledge claims by saying something like, ‘politicians (and, by the way, some other scholars) don’t share your views on the hierarchy of evidence’, or inviting my audience to reflect on how far they’d go to override the beliefs of other people (such as the local communities or service users most affected by the evidence-based policies that seem most effective).

The problem with this story is that key parts are implicit and, by appearing to go along with my audience, I provoke a reaction in another audience: don’t you know that many people have valid knowledge claims? Politics is about values and power, don’t you know?

So, that’s where I am right now. I feel like I ‘know my audience’ but I am struggling to explain to my original political science audience that I need to describe its insights in a very particular way to have any traction in my other science audience. ‘Know your audience’ can only take you so far unless your other audience knows that you are engaged in knowing your audience.

If you want to know more, see:

Kathryn Oliver and I have just published an article on the relationship between evidence and policy

How far should you go to secure academic ‘impact’ in policymaking? From ‘honest brokers’ to ‘research purists’ and Machiavellian manipulators

Why doesn’t evidence win the day in policy and policymaking?

The Science of Evidence-based Policymaking: How to Be Heard

When presenting evidence to policymakers, engage with the policy process that exists, not the process you wish existed

 

 

Why the pollsters got it wrong

We have a new tradition in politics in which some people glory in the fact that the polls got it wrong. It might begin with ‘all these handsome experts with all their fancy laptops and they can’t even tell us exactly how an election will turn out’, and sometimes it ends with, ‘yet, I knew it all along’. I think that the people who say it most are the ones that are pleased with the result and want to stick it to the people who didn’t predict it: ‘if, like me, they’d looked up from their laptops and spoken to real people, they’d have seen what would happen’.

To my mind, it’s always surprising when so many polls seem to do so well. Think for a second about what ‘pollsters’ do: they know they can’t ask everyone how they will vote (and why), so they take a small sample and use it as a proxy for the real world. To make sure the sample isn’t biased by selection, they develop methods to generate respondents randomly. To try to make the most of their resources, and make sure that their knowledge is cumulative, they use what they think they know about the population to make sure that they get enough responses from a ‘representative’ sample of the population. In many cases, that knowledge comes from things like focus groups or one-to-one interviews to get richer (qualitative) information than we can achieve from asking everyone the same question, often super-quickly, in a larger survey.

This process involves all sorts of compromises and unintended consequences when we have a huge population but limited resources: we’d like to ask everyone in person, but it’s cheaper to (say) get a 4-figure response online or on the phone; and, if we need to do it quickly, our sample will be biased towards people willing to talk to us.* So, on top of a profound problem – the possibility of people not telling the truth in polls – we have a potentially less profound but more important problem: the people we need to talk to us aren’t talking to us. So, we get a misleading read because we’re asking an unrepresentative sample (although it is nothing like as unrepresentative as proxy polls from social media, the word ‘on the doorstep’, or asking your half-drunk mates how they’ll vote).

Sensible ‘pollsters’ deal with such problems by admitting that they might be a bit off: highlighting their estimated ‘margin of error’ from the size of their sample, then maybe crossing their fingers behind their backs if asked about the likelihood of more errors based on non-random sampling. So, ignore this possibility for error at your peril. Yet, people do ignore it despite the peril! Here are two reasons why.

1. Being sensible is boring.

In a really tight-looking two-horse race, the margin of error alone might suggest that either horse might win. So, a sensible interpretation of a poll might be (say), ‘either Clinton or Trump will get the most votes’. Who wants to hear or talk about that?! You can’t fill a 24-hour news cycle and keep up shite Twitter conversations by saying ‘who knows?’ and then being quiet. Nor will anyone pay much attention to a quietly sensible ‘pollster’ or academic telling them about the importance of embracing uncertainty. You’re in the studio to tell us what will happen, pal. Otherwise, get lost.

2. Recognising complexity and uncertainty is boring.

You can heroically/ stupidly break down the social scientific project into two competing ideas: (1) the world contains general and predictable patterns of behaviour that we can identify with the right tools; or (2) the world is too complex and unpredictable to produce general laws of behaviour, and maybe your best hope is to try to make sense of how other people try to make sense of it. Then, maybe (1) sounds quite exciting and comforting while (2) sounds like it is the mantra of a sandal-wearing beansprout-munching hippy academic. People seem to want a short, confidently stated, message that is easy to understand. You can stick your caveats.

Can we take life advice from this process?

These days I’m using almost every topic as a poorly-constructed segue into a discussion about the role of evidence in politics and policy. This time, the lesson is about using evidence correctly for the correct purpose. In our example, we can use polls effectively for their entertainment value. Or, campaigners can use them as the best-possible proxies during their campaigns: if their polls tell them they are lagging in one area, give it more attention; if they seem to have a big lead in another area; give it less attention. The evidence won’t be totally accurate, but it gives you enough to generate a simple campaigning strategy. Academics can also use the evidence before and after a campaign to talk about how it’s all going. Really, the only thing you don’t expect poll evidence to do is predict the result. For that, you need the Observers from Fringe.

The same goes for evidence in policymaking: people use rough and ready evidence because they need to act on what they think is going on. There will never be enough evidence to make the decision for you, or let you know exactly what will happen next. Instead, you combine good judgement with your values, sprinkle in some evidence, and off you go. It would be silly to expect a small sample of evidence – a snapshot of one part of the world – to tell you exactly what will happen in the much larger world. So, let’s not kid ourselves about the ability of science to tell us what’s what and what to do. It’s better, I think, to recognise life’s uncertainties and act accordingly. It’s better than blaming other people for not knowing what will happen next.

 

*I say ‘we’ and ‘us’ but I’ve never conducted a poll in my life. I interview elites in secret and promise them anonymity.