Following the science

Evidence-based decision making should absolutely be a cornerstone of government, especially in a pandemic for which science is of paramount importance to our response.  However, we must recognise both the potential and the limits of science. In an emergency, data for decisions may be uncertain, incomplete, or even missing. Nevertheless, rapid decisions have to be made.  Science advice is only one aspect of this.  Ministers also need to consider economics, ways of implementation, and broad consequences to society, and they need to be able to take the public with them. 

At the frontiers of science, there is always uncertainty, and to pretend otherwise would be foolish. What science does is to try to gather evidence to reduce the uncertainty, but this happens only gradually as data are gathered and hypotheses tested and discarded until some idea of the truth emerges. But even those “truths” can fall by the wayside in the face of new and contradictory evidence. The entire process is based on honesty, openness and transparency, in which the evidence is published for all to see and argue about.  It is no coincidence that scientists are highly trusted. 

The current pandemic – dealing with an emergency

In the case of the Covid-19 pandemic, we have learned a lot amazingly fast. This is a new virus about which we knew nothing just a few short months ago. In record time, SARS-Cov2, the specific coronavirus that caused COVID-19, was identified and sequenced, paving the way for a sensitive test for infections. We can now identify who has been infected as well as begin to understand the biology of the virus, its infectivity and routes for development for vaccines and therapeutics. This stunningly rapid progress is the result of investment over many decades and the commitment of an army of scientists across the globe. 

But for many other aspects of the virus, it will take time to establish the facts. How many people have been infected? Will we become immune once infected, and if so, for how long? Why are different groups of people affected in different ways? A lot of this reflects the uncertainty inherent at the frontiers of all science.

It is always right to take an evidence-based approach whenever possible, but given the uncertainties and the realities in this fast-moving pandemic scenario, there will inevitably be mistakes. We will not really know for certain what they were until we analyse all the data in hindsight. Given such uncertainties, ministers need to make the best decisions they can now, but also be prepared to change tack later, in light of new evidence. Being able to do that requires an openness and honesty with the public. The public will feel misled if ministers use “the science” as a prop to create a false sense of security and certainty only to change tack later. It will lead to an erosion of public trust precisely at a time when long-term trust is needed to allow the hard choices ahead. Ultimately, as has been pointed out, advisers advise, ministers decide. In these decisions, science advice is often only one of the things they need to consider. Considering science advice is not the same as simply “following the science.” 

Moreover, there is often no such thing as following “the” science. Reasonable scientists can disagree on important points, but the government still has to make decisions. Take the example of face masks.  The gold standard of scientific evidence is the Randomised Control Trial (RCT) – where different groups of similar people are treated differently and the end result is measured.  There is hardly any useful RCT evidence on whether face masks are effective in reducing the spread of this or the influenza virus. 

However, many practices that we now consider essential for good hygiene, such as washing hands to reduce viral transmissions, or the wearing of masks by surgeons, were not based on RCT evidence. Rather they were based on our understanding of how infections spread. In the case of COVID-19, we know that you can be infectious even when you do not have any symptoms. We know that coughing, sneezing, and even talking or breathing release droplets from the mouth that are a key means by which the virus spreads.  We also know that cloth-based face masks reduce the spread of those droplets. 

So given the stakes, even in the absence of RCT evidence, it was this understanding of modes of transmission and the need for precautionary common sense that convinced over 50 governments to make the use of face masks mandatory in situations where physical distancing is not possible or predictable such as busy public transport, shopping and other potentially crowded public or workspaces. Our government too has now recommended the use of face coverings in such situations.

Learning from the past and planning for the future

Moreover, science advice should not be heeded only during emergencies. For many years, a pandemic has been the biggest risk on the UK Government’s National Risk Register.  The Government even tested its own pandemic reactions (operation Cygnus 2016). So, it is not surprising that many have been incredulous at the lack of planning and preparation for what was clearly the most important known risk.

Interestingly, those countries that had first-hand experience of SARS and MERS were also the best prepared for COVID-19. We have tended to be much less prepared because our economic system usually rewards efficiency - which often comes without building in spare capacity. Most of the time, this is good for the economy. Putting large resources into pandemic preparation and stockpiles, is perceived as being at the expense of more nurses, GPs, and hospital capacity, and yet in the long run can help to avoid huge human and economic costs.  Not spending on resilience to predictable crises is a false economy.

The current Covid-19 pandemic has had terrible effects and we cannot yet foresee how it will end. It is completely predictable that an even worse virus will emerge someday. Equally predictable and even more cognitively challenging, are the slow motion ongoing mega-crises of climate change and biodiversity loss, which unmitigated, will be catastrophic for the future of humanity.

It would be extremely short-sighted for the government to tackle this crisis, then go back to business as usual. So instead of prioritising immediate economic efficiency and agility above all others, we must seriously look at how to develop resilience towards known major risks by analysing what mistakes were made this time and finding ways to compensate. Given the shocks to the economy from the 2008 financial crisis and the current pandemic, we can see that it is not a choice between having an efficient flourishing economy and spending on resilience. Rather, we must see that building in resilience is necessary for stable growth and long-term prosperity.

Preparing much better for things we know are going to happen would be one way to respect the sacrifice, loss, heroism, and hard work of so many in the current crisis.