The Covid-19 pandemic was a predictable event, even if the timing and exact nature of the event could not be foreseen. The World Health Organisation (WHO) had identified novel coronaviruses specifically as a threat.
This raises important and wide-ranging questions for the UK Government about the identification, assessment, management of, and preparedness for, risk. While the UK’s National Risk Register (NRR) acknowledges the risk of new and emerging infectious diseases occurring, it does not explicitly identify the potential threat of coronaviruses. The Science and Technology Committee should consider recommending whether the NRR should categorise more specifically emerging infectious diseases.
There has been a clear lack of testing infrastructure in the UK to deal with this pandemic, with testing having been limited due to the shortage of testing capacity. This has had adverse consequences for the ability to track and trace the spread of the virus. The decision was taken on 12th March to cease testing in the community and focus on testing principally within hospitals due to testing capacity constraints. This was a crucial decision-making moment and raises significant questions around the UK Government’s strategy for mitigating the spread of the virus and the timing of the decision to implement lockdown measures.
The response to the pandemic demonstrates the importance of taking steps to build-up the UK’s national resilience. Any assumption that testing capacity which is not formally retained can be scaled-up during emergencies needs to be challenged robustly on the basis of the current experience. It is crucial, therefore, that the increase in UK testing capacity that has been developed over the course of the pandemic is maintained, not least given the scientific expectation that cases will increase in the winter, and that we will need to be prepared to live with the virus for the foreseeable future.
The availability of data is crucial to gaining a fuller understanding of the nature and spread of the virus and, in turn, to informing and supporting the decision making process. However, data collection and management appears to have been a particular weakness. National pandemic management needs strong central control supported by robust, well-designed data collection flowing into real-time analysis. Having such a system in place, including continuous background surveillance to allow much earlier disease detection, should be a post Covid-19 national priority.
While governments have claimed that they are “following the science” or being “led by the evidence”, the role of the scientific community is to develop and present the evidence for different options; it is the role of government to determine policy. Governments will undoubtedly have to take account of other social, ethical, legal, economic and political considerations, in addition to science. While government should make clear when it is departing from the scientific advice received, it is important to recognise that there will not always be a clear scientific consensus, especially when addressing the novel and fluid situation in which we find ourselves.
The Scientific Advisory Group for Emergencies (SAGE) and its subgroups should contain those with direct experience of how the pandemic has unfolded on the ground, which would include those directly involved in public health, clinical and care service provision. As well as directing advice towards questions posed by government, SAGE and its subgroups should be able to raise issues and questions contemporaneously. This will help ensure that government has access to the best available scientific understanding as well as minimising the risk that important matters are not addressed by the scientific advice.
SAGE and related advisory committees rely extensively on the goodwill of expert participants. The Science and Technology Committee should invite those who have served on Covid-19-related scientific advisory groups to provide feedback on their direct experiences. Not only is this important in instances where experts may be asked to serve again, it also relates to accessing new expertise and widening the pool of participants. It also brings into focus the resilience of the present arrangements given the extended period over which external scientists have been called upon to give advice.
While it seems clear that the provision of scientific advice has generally been well coordinated across all four nations of the UK, there are questions relating to how governments within the UK tap into, coordinate and makes best use of the wide body of expertise that exists both within and outwith government departments and formal structures, both on an on-going basis and in crisis situations.
Previous epidemics have demonstrated that human social behaviour is a key determinant of how any disease outbreak spreads and how spread can be contained. The independent Scientific Pandemic Influenza Group on Behaviours (SPI-B) provides independent, expert behavioural science advice to SAGE. A key issue relating to the timing of introducing stricter social distancing measures in the UK seemed to be based on a view expressed by the Secretary of State for Health and Social Care and the UK Chief Medical Officer that such measures should not be introduced too soon as this could result in behavioural fatigue, with this being presented as though it were based on behavioural science advice. Members of SPI-B have stated that this advice did not emanate from the Group. It will therefore be important to ascertain the source of this advice and the evidence underpinning it since it was critical to the timing of introducing the UK’s ‘lockdown’ measures.
While the impressively rapid development of initiatives on vaccine development is to be applauded, it is important to be clear that the development of a vaccine that can fully protect against the virus is low. It is more likely that any vaccine would help reduce and manage the spread and severity of the virus. It will be important to ensure that there is responsible and realistic public messaging in relation to the UK’s ability to develop a safe and effective vaccine, and what this means in terms of our need to live with the virus for the foreseeable future.