Following the science: what should that mean?

 

It has been a mantra repeated every day at the UK Government’s Covid-19 press briefing that they are following, or are guided by the science.

What does this mean or what should it mean?

Winston Churchill famously said that scientists should be on tap, but not on top. 

This meant, of course, that politicians should be the ones on top. 

Scientists can present the known facts, and even reasonable assessments of those aspects of a problem that are understood in principle or to some level, but for which there remain a range of uncertainties (due to incomplete data or immature science). As Donald Rumsfeld said, there are known knowns, unknown knowns and unknown unknowns. Science navigates these three domains.

Yet, it is the values and biases, from whatever colour of leadership is in charge, that will ultimately drive a political judgment, even while it may be cognisant of the evidence. The science will constrain the range of options available to an administration that respects the science, but this may be quite a wide range of options. 

For example, in the face of man-made global warming, a Government can opt for a high level of renewables, or for nuclear power, or for a radical de-growth circular economy; or something else. The science is agnostic to these political choices.

The buck really does stop with the politicians in charge to make those judgments; they are “on top”, after all.

So the repeated mantra that they are “following the science” is rather anti-Churchillian in its messaging.

If instead, Ministers said, “we have considered the scientific advice from the Chief Scientific Adviser, based on discussions of a broad range of scientific evidence and opinion represented on SAGE (Scientific Advisory Group for Emergencies), and supporting evidence, and have decided that the actions required at this stage are as follows …”, then that would be correct and honest. 

And even if they could not repeat such a wordy qualification at every press conference it would be like a proverbial Health Warning – available on Government websites – like on a cigarette packet, useful for anyone who feels brave enough to start smoking the daily propaganda on how brilliant the UK is in its response to Covid-19 (which, despite a lot of attacks on it, has not been as bad as some make out, and the Chief Scientific Adviser (CSA) and Chief Medical Officer (CMO) have rightly gained a lot of credibility during the crisis).

The uncomfortable truth is that ‘following the science’ is about proaction not reaction; about listening to a foretold risk years in advance and taking timely and substantive actions – through policies, legislation, projects, etc. – to mitigate against or build resilience in the face of known risks.

Pandemics of either a flu variety or novel virus kind have been at the top of the UK’s national risk assessment for a decade. Both SARS and MERS were warnings that South Korea took seriously to increase their preparedness. The UK was also warned by its scientists to be prepared. The UK Government under different PMs has failed to take the steps required.

Listening to the science in the midst of a pandemic is good, but doing so well in advance of one, and taking appropriate action is a whole lot better. Prevention is better than cure, is a well known and telling adage.

Of course, the naysayers will come out in force. If one responds to dodgy code prior to 2000 and nothing bad happens, they will say that the Y2K bug was a sham, an example of alarmism “gone mad”; they will not acknowledge the work done to prevent the worst outcomes. Similarly, if we mothball capacity for a pandemic, then once again, expect the charge of alarmism and “why so many empty beds?”.

Our economy is very efficient when things are going well – just-in-time manufacture, highly tuned supply chains, minimal redundancy, etc. – but not so great when shocks come, and we discover that the UK cannot make PPE (personal protective equipment) for our health and care workers and we rely on cheap off-shored manufacturing, and have failed to create sufficient stocks (as advised by scientists to do so).

Following the science is not something you do on a Monday. You do it all week, and then you act on it; and you do this for risks that are possibly years or decades in the future. You also have to be honest about the value-based choices you make in arriving at decisions and not to hide being the science.

Scientists don’t argue about the knowns: the second law of thermodynamics, or that an R value greater than 1 means exponential growth in the spread of a virus. But scientists will argue a great deal about the boundary between the known and unknown, or the barely known; it’s in their nature. Science is not monolithic. SAGE represents many sciences, not ‘the’ science.

For Covid-19 or any virus, “herd immunity” is only really relevant to the situation where a vaccine is developed and applied to the great majority of the population (typically greater than 85%), with a designed-in strong immunity response. Whereas immunity resulting from having been naturally infected is a far less certain outcome (particularly for Coronaviruses, where there is typically a weak immune response).

So, relying on uncontrolled infection as a basis for herd immunity would be naive at best. It is true that it was discussed by SAGE as a potential outcome, but not as the core strategy (as Laurence Freedman discussed here); the goal was always to flatten the curve, even if there was great debate about the best way to achieve this.

One of the problems with the failure to be open about that debate and the weighing of factors is that it leaves room for speculation as to motives, and social media has been awash with talk of a callous Government more interested in saving the economy than in saving lives. I am no fan of this Government or its PM, but I feel this episode demonstrates the lack of trust it has with the general public, a trust that Boris Johnson failed to earn, and is now paying the price in the lack of trust in his Government’s pronouncements.

Yet I do have confidence in the CSA and CMO. They are doing a really tough job, keeping the scientific advice ‘on tap’. They cannot be held responsible for the often cack-handed communications from Ministers, and failure to be straight about PPE supplies and the like.

Some people have criticised the make up of SAGE – for example, because it has too many modellers and no immunologists and no virologists. I don’t understand the lack of immunologists.

Virologists are clearly key for the medium-long term response, but a vaccine is probably over a year away before it could be deployed. So, at the moment, containment of the spread ‘is’ the Emergency, and social distancing, hand-washing, isolation, hospitals, testing, etc. are the tools at hand, and it might be defendable that they are not currently the focus of the discussion.

Groups at Oxford University and Imperial College are being funded to help develop vaccines and to run clinical trials. Virology is not being ignored and it is rather odd to suggest otherwise.  But again, transparency should be the order of the day – transparency on who is invited onto SAGE, when and why, and transparency on the evidence they receive or consider. But having a camera in there broadcasting live discussions may inhibit frank debate, so is probably not a great idea, but the Minutes do need to be published, so other experts can scrutinise the thought processes of the group.

The reason why Dominic Cummings (or any other political role) should not be sitting on SAGE, in my view – even if they make no contribution to the discussion – is that there is a risk (a certainty, probably) that he then provides a backdoor summary of the discussions to the Prime Minister, which may conflict with that provided by the CSA. It is the CSA’s job to summarise the conclusions of the discussion and debate at SAGE and provide clear advice, that the Government can then consider and act on. The political advisers and politicians will have plenty of opportunity to add their spin after receiving the scientific advice; not during its formation or communication.

Now, it seems, everyone agrees that testing and contact tracing will be key tools in ending or reducing the lock down, but of course, that means having the systems in place to implement such a strategy. We don’t yet have these.

The British Army, I understand, don’t use the term “lessons learned”, because it is so vacuous. We have “lessons learned” after every child abuse scandal and it doesn’t seem to make much of a difference. 

A lesson truly learned is one that does not need that label – it is a change to the systems, processes, etc., that ensures a systemic response. This results in consistently different outcomes. It is not a bolt on to the system but a change in the system.

Covid-19 asks lots of questions not just about our clinical preparedness but the fairness of our systems to safeguard the most vulnerable.

Like a new pandemic, the threats from global warming have also been foretold by scientists for decades now, and UK politicians claim to be listening to the science, but they are similarly not acting in a way that suggests they are actually hearing the science.

As with Covid-19, man-made global warming has certainties and uncertainties. It is certain that the more carbon dioxide we put into the atmosphere the warmer the world will get, and the greater the chance of weather extremes of all kinds. But, for example, exactly how much of Greenland will melt by 2100 is an on-going research question.

Do the uncertainties prevent us taking proactive action?

No, they shouldn’t, and a true political leader would take the steps to both reduce the likely size of impacts (mitigations), and increase the ability of society to withstand the unavoidable impacts (adaptation), to increase resilience.

The models are never perfect but they provide a crucial tool in risk management, to be able to pose ‘what if’ type questions and explore the range of likely outcomes (I have written In Praise of Computer Models before).

Following the science (or more correctly, the sciences) should be a full-time job for any Government, and a wise one would do well to listen hard well in advance of having to respond to an emergency, to engage and consult on its plans, and to build trust with its populace.

Boris Johnson and his Government need to demonstrate that it has a plan, and seeks support for what it aims to do, both in terms of prevention and reaction. It needs to do that not just for the Covid-19 crisis, but for the array of emerging crises that result from man-made global warming.

We need to change the system, before the worst impacts are felt.

(c) Richard W. Erskine, 2020.

 

FOOTNOTE – Sir Mark Walport and John Ziman – on science policy and advice

I listened to Sir Mark Walport a few years ago in a conversation about the role of Chief Scientific Adviser (a post he has held), which was very interesting

“ON STANDING FOR SCIENCE AND WHERE SCIENCE FITS IN POLICY”, SIR MARK WALPORT, Science Soapbox,

http://www.sciencesoapbox.org/sir-mark-walport/

[This episode was recorded on July 21, 2016 in front of a live audience at Caspary Auditorium at The Rockefeller University.]

He said that any policy must look at a problem through 3 different lenses:
– Evidence lens
– Deliverability lens
– Values lens

and that science can only help with the first of these.

He made the point that trust in science is very context specific: Science can say anything about the Higgs Boson and be believed, but on an issue like embryology, values kick in and there will be much less trust.

He also makes a strong distinction between ‘pollable’ questions and non-pollable questions. I will give examples.

“does extra CO₂ in the atmosphere lead to increased global warming?” is a non-pollable questions (the unequivocal answer is: yes); whereas “should UK focus on renewables or nuclear power to decarbonise the grid?” is a pollable question (answer: Brits much prefer renewables, by a wide margin).

Scientists need a special range of skills to be able to do the advice job, above and beyond their scientific skills. John Ziman explored the differences between scientific discourse and political debate in his paper (2000) “Are debatable scienti􏰜fic questions debatable?”

Click to access Ziman.pdf

He explains how complex most scientific questions are, with rarely a simple resolution, and conducted in a way quite different to political debate (yet no less argumentative!). The two styles sit awkwardly together.

Yet public and political discourse (especially on social media, but in newsprint, and parliament too) often expects a binary answer: yes or no, right or wrong. Shades of grey are often not tolerated, and if you don’t ‘choose a side’, expect to get caught in the crossfire.

I haven’t read the belatedly released SAGE Minutes yet but I expect there will have been lots of discussions on points where Walport’s lenses (Evidence, Deliverability, Values) sit uncomfortably alongside each other.

At some point, I imagine a fly on the wall, hearing …

“we need to do test, trace and isolate as soon as possible”

“agreed, but we need to recognise the constraint that the test capacity is limited at the moment, so we’ll have to wait till we have flattened the curve enough, to reduce the testing demand, but also build up capacity; meanwhile we cannot avoid a lockdown”

“can someone answer this – how well will the public comply and how would this change the numbers?”

“we ran some sensitivity analysis, and we need very high compliance to make it work”

“…”

Leading to a messy compromise set of ‘options’ and scientists NOT the ones with the authority to choose which ones.

The scientists didn’t choose a context where Governments had failed to take on board prior recommendations over some years, to build capacity in PPE, etc. So the advice is very context dependent.

It is highly disingenuous of politicians to say they are ‘following the science’ when that is just one element in the decision making, and where a poor starting position (e.g. the lack of prior investment in pandemic responsiveness) is neither something they influenced, nor can change.

….  o o O o o ….

Updated with Diagram and Footnote on 28th June 2020