As the Covid inquiry kicks off oral hearings today, we will once again debate what exactly happened in 2020 and 2021, and who is ultimately responsible for the decisions made. The government has already started to close in on scientists and point the finger at them for the poor response in the early stages of the pandemic. The prime minister, Rishi Sunak, has said it was a mistake to “empower scientists” and the BMJ pointed to the former health secretary Matt Hancock making “science the fall guy” in the blame game over what went wrong.
But it’s vital that the inquiry separates out what were scientific questions, that independent advisers and academics could provide data and input on, and what were leadership decisions. Policy measures such as closing gyms or schools or play parks, or the introduction of mandatory face coverings, were conveyed as “scientific” decisions, but they weren’t. Scientists could present the probable risks and benefits of certain policy options, but the final decision didn’t lie with them.
For example, when considering whether to close gyms, a scientific question would be: “What is the risk of transmission within a gym setting? How many would become severely ill and need hospitalisation, and how many would die?” That type of analysis, as well as guidance on measures to reduce transmission in that setting, could be given, along with an assessment of how certain we were about the knowledge. This is what Covid-19 advisory group members were tasked with.
For scientists, the challenge was filling in the puzzle pieces about Sars-CoV-2, from how transmissible it was, and risks of transmission in various settings, to the hospitalisation rate and burden on healthcare services. And, of course, modelling possible future scenarios. Certainly, we can evaluate how well they performed these tasks, and whether their data and predictions were reasonable given the situation.
In terms of the response itself, public health scientists, including myself, had our own ideas for what the best approach would be (including learning from other countries that had had earlier waves of Covid-19) and these were presented to ministers in the form of briefings and papers – just as with any other area of policy, from defence to the economy. The pandemic brought a new immediacy to scientific advice, but it didn’t fundamentally change the job of elected politicians, which was to balance these multiple streams of advice, and decide what the next stage of the response would be.
Another political decision was over whether face masks should be mandatory for children in primary schools. Again public health scientists can answer, “What’s the risk of transmission within a primary school classroom?” and “How effective are face coverings if used appropriately at reducing transmission?” But this was balanced against the advice from child psychologists who provided evidence on the impact of face coverings on emotional and speech development, especially for young children with special needs, and with input from headteachers on the practical challenges of implementing mandates.
Ministers then had to decide whether to introduce these, and if the benefits outweighed the costs.
What’s particularly surprising is when government ministers such as Sunak, when he was chancellor, chose not to take any scientific advice at all in policy decisions, such as in the launch of “Eat Out to Help Out”. In this scheme, the public were encouraged and actively subsidised to spend money in one of the riskiest settings for transmission: indoor hospitality. They were led to believe it was safe, even though scientists could clearly predict this would lead to onwards transmission and would probably undo the progress made in bringing case incidence down going into autumn.
If scientific advice had been considered more thoroughly, then other approaches with similar economic benefits might have been used, such as expanded outdoor dining, takeaways and deliveries, and local vouchers and support schemes.
The Covid inquiry starting point should be that government has a responsibility to ensure that its citizens are “safe enough” from risks that it can manage. We expect the water from our taps to be clean and not give us cholera, the food in shops not to poison us, and our roads to have speed limits and traffic rules to prevent accidents. This came to the forefront in the Covid-19 response: governments were expected to protect their populations and parse the question of “how safe is safe enough”.
There was no perfect path through the pandemic as various countries struggled with waves of hospitalisations and high death tolls. Government ministers had to make rapid decisions, and countries that did better in terms of health and economic measures (such as Denmark, Norway, Japan, South Korea and New Zealand) seriously considered the trade-offs, and made judgments with strong and competent leadership. There was no way that life could continue as it did before Sars-CoV-2 – some action had to be taken.
Scientists did their best to rapidly collect data about a new pathogen, analyse it and provide factual advice to governments on the risks that Covid-19 posed to human health, healthcare services and economic stability. They also could suggest various public health solutions to the challenge, but what leaders decided to do with that advice in terms of policy was 100% political.
Scientific advice can provide data on the risks and benefits of closing schools or gyms or of “doing nothing”, but no scientist ever had the executive power to make policy decisions. This was the responsibility of elected officials. And knowing my academic colleagues, none of us would have wanted that power either.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
