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Sage minutes reveal ‘lack of urgency, need for transparency’

Image: Number 10 [CC BY-NC-ND 2.0], via Flickr

Scientists criticise some conclusions reached during meetings, which were used to inform key policy decisions

Scientists have cautiously welcomed the publication of minutes from the first 34 Covid-19 meetings of the government’s Scientific Advisory Group for Emergencies, following weeks of criticisms over the group’s secrecy.

The minutes, released on 29 May, provide an insight into issues the government has been repeatedly criticised over including its focus on planning for flu; the alleged plans for herd immunity; the apparent lack of capacity for testing for Covid-19; and the decision to drop community testing in mid-March.

Sage co-chairs chief scientific adviser, Patrick Vallance (pictured left), and chief medical officer Chris Whitty (pictured right), both noted the importance of openness as they published the minutes four months after the meetings started.

Devi Sridhar, a professor and chair of global public health at the University of Edinburgh, told Research Professional News the minutes were “incredibly useful to understand the basis of the scientific advice that the government was receiving given that we heard the term ‘following the science’ repeated for several key decisions”.

“We have a chance to actually read through and understand the basis for which decisions are made or at least the basis for which government claims the decisions are made,” she said.

John Ashton, a British doctor, academic and former public health chief, welcomed the publication of the minutes, but said: “I just don’t understand what the argument was for not releasing them as those meetings took place.”

By releasing the minutes immediately after the meetings took place, “we would have had more buy-in into the policy-forming process and there would have been better trust with government and its advisers”, he told Research Professional News.

“Right at the beginning [of the epidemic] I said the process needs to be open and transparent and it’s been anything but.”

Sridhar is critical of a number of conclusions reached during the meetings, including the assumption early on in the pandemic that the virus could not be preventing from spreading. Sage also concluded that neither travel restrictions nor banning mass gatherings would be effective in limiting transmission.

“What was clear was that from the start in February the group did not see the virus as being containable—I don’t think they thought any country could control it,” Sridhar said.

“So they immediately switched into the 2011 Pandemic Flu Plan, which assumes that it flows through [the population] and you try to protect the vulnerable and mitigate against the worst.”

She also takes issue with the conclusion in the eighth Sage meeting that contact tracing would “no longer be useful” when there is sustained transmission in the UK, with Public Health England having the capacity to track just five cases a week.

“It didn’t fit with other countries which had really scaled up,” she said, noting that even war-torn areas in Africa can 25,000 contacts for Ebola.

Sridhar was also shocked by the apparent lack of urgency reflected in the minutes, especially when it came to decisions around the use of facemasks.

“With facemasks there seemed to be so many meetings and debates on the evidence,” she said. “But to me these felt like academic debates that would be appropriate in normal times being used in a crisis situation where delaying a decision is [effectively] making a decision not to respond.”

David King, former chief scientific adviser and chair of the rival, unofficial, Independent Sage, believes Sage scientists missed the opportunity to act on vital evidence from China at the beginning of the pandemic and wasted time on calculations of their own.

“They were acting as if they couldn’t give advice ‘until they had calculated everything’. When I was chief scientific adviser, we didn’t ever have all the information to do perfect calculations—we had to operate with advice immediately for the simple reason that, if you let an epidemic run, you know it’s going to get worse and worse day-by-day.

“In the case of this epidemic, we knew very early on that the number of people going down with the disease was increasing two-fold every three to four days.”

Sridhar believes the group would have benefitted from more academics with an immunology and public health background and is critical about what she sees as the over-reliance on modellers.

“Modelling is useful, but you can’t over-rely on it because they are doing their best guesses. But, given the uncertainty, in some way it’s better to go the tried-and-trusted route of public health and core epidemiology.”

A version of this article also appeared in Research Fortnight