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Mark Walport on the UK’s use of science advice during COVID-19

Mark Walport on the UK’s use of science advice during COVID-19

Science for Policy podcast episode

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About this episode

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15 October 2020


Show notes

Should scientists be free to speak out if they don’t like how politicians use science? Who is to blame if government policy doesn’t follow advice? Why were some countries hit harder than others by COVID in the spring, and did the quality of science advice have anything to do with it? When do scientists speak as scientists, and when are they simply ordinary citizens?

Sir Mark Walport discusses these questions with Toby Wardman of SAPEA. We also discuss the job of a chief scientific advisor, who's really in control of coronavirus (hint: it's not us), and why UK emergency response committees have such awesome names.


The transcript below was generated automatically and may contain inaccuracies.

Toby: Hello there, this is Toby from SAPEA with a little background and housekeeping before I launch into this episode. So as a rule, I try to make sure that the conversations which we record for this podcast are relatively timeless in subject. So guests talk about issues and themes and perspectives on science advice rather than what's happening right now day by day. That means in turn that we can usually stick to a regular schedule of publishing an episode reliably every two weeks. And so behind the scenes at any given moment, I have a few recorded episodes in the can as it were, waiting to be published in the next free slot on the schedule. But occasionally, as luck would have it, a conversation we've recorded or scheduled turns out to be very directly relevant to what's going on in the news. And that's what happened today with this episode. So it's now the 13th of October 2020. And earlier today, I spoke to Sir Matt Walport, who's a member of the SAGE Advisory Committee in the UK, about how SAGE works and how it's interacted with politicians in recent years. Now Mark and I had this recording date in our diaries for a while. But by sheer coincidence, Britain and indeed Brussels and other places in Europe woke up this morning to a fair amount of media kerfuffle about the extent to which the British government has been following or taking notice of or indeed ignoring the advice of the SAGE committee during COVID-19. So as you're about to hear, these are exactly the topics that Mark and I were able to discuss. As I mentioned, he is a member of SAGE as well as the previous UK Chief Scientific Advisor, so exactly the right person to talk to. So the result is that I'm kicking this episode out the door at a higher speed than normal on a Wednesday morning, ignoring the usual two weekly publishing schedule because the content and the context together justify it. So I mentioned this for two reasons. Firstly, if you set your watch by our regular as clockwork Monday morning episode schedule, as I'm sure practically all of you do, then I'm sorry to disrupt your sense of well-being and rhythm by throwing something at you on a random day of the week. I expect normal service will resume next Monday as will our normally carefully balanced roster of guests taking into account gender and geographical origin. I'm very aware that throwing in a long conversation between two British men in the middle of the week disrupts that somewhat. The second reason I mention it is that this conversation has been very lightly edited because of time and for about the first five minutes of the episode, the audio quality at Mark's end is ropey to say the least. After the first five minutes or so it does clear up and I think it's much more listenable after that. So thanks for your patience there. So I hope you enjoy the episode. And if you're new to this episode and you're not already a subscriber to the Science for Policy podcast, do take a minute to admire the stellar lineup we have of other guests past and future and ask yourself how on earth you've let this pass you by until now.

Toby: Hello, welcome to the Science for Policy podcast. My name is Toby and today I'm joined by the former Chief Scientific Advisor to the UK government, Sir Mark Walport. Sir Mark is a medic by training, having formally led the Medical Division of Imperial College London and he's a fellow of the Academy of Medical Sciences, the Royal Society and Academia Europaea. He also served until this year as Chief Executive of UK Research and Innovation and before that as Director of the Wellcome Trust, one of the world's largest non-government funders of scientific research. He now sits on the UK government's Scientific Advisory Group for Emergencies or SAGE. It's an important science advice committee in the UK. So Mark, welcome to the podcast.

Mark: Hello.

Toby: I often find myself on this podcast indebted to people who are kind enough to take time out of their busy schedules to talk to me. But I think in your case, I'm particularly lucky because not only do you have a full schedule anyway, given your role in the UK science advice community right now, but we're recording this on a day, on the 30th of October, on a day when the recent history of science advice in the UK is all over the headlines, not just in Britain, but also over here in Brussels. So I can only imagine that you are in high demand today and I want to thank you for honouring our previous agreement to record this conversation.

Mark: My pleasure.

Toby: So let's start with the easy stuff, or at least the high level stuff. You were the UK government's Chief Scientific Advisor from 2013 to 2017. Could you describe very broadly what that role involves and also how it fits into the UK's scientific advice infrastructure?

Mark: Yes, of course. The job description in a way is very simple. It's to advise on all aspects of science, engineering, technology and social science in relation to all aspects of government policy. So it's not a narrowly drawn job. And so it basically needs to focus on what is it the government cares about. And government broadly, it doesn't matter what government, should care about the health, well-being, security and resilience of the population and obviously the economy, because the health, well-being, security and resilience of all of us as citizens depends on a good economy. And that sort of drives an agenda. And broadly, given the importance of infrastructure for human health and well-being, the built, the physical, the data, the natural infrastructure have all been very important to scientific advisors. But then turning to the present, an important role for science advice is science in emergencies. And I think that not only in the UK, but around the world, citizens have become aware of science advice in a way that they never ever had been before. And for better or worse, science is extremely common now in public discourse across Europe, but more broadly. Other aspects of the agenda are obviously science in relation to the economy, how one can do the best analysis for policy. And being the government chief scientific advisor also carries with it a leadership role for science across government. So it's a big job. Like any job in or close to government, it is determined by events. And it's absolutely clear that the job that Patrick Vallance and Chris Whitty are doing has been dominated for very good reasons by coronavirus. Now in terms of the machinery, one of the advantages of the UK science advice system is that it is hardwired into government, particularly in emergencies. It's linked through an advisory committee, which has a rather nice acronym that comes out of SAGE, which stands for Scientific Advice Group in Emergencies. And SAGE is responsible for providing advice to the government chief scientists, so Patrick Vallance and the chief medical officer for England, the chief medical advisor for the government, Chris Whitty. And it's they that actually transmit the advice that comes from SAGE directly to politicians. And I think an important aspect of being a government chief scientific advisor is it's not as it were that the chief scientist can possibly know about all of the topics I've just outlined in a very sketchy way. The job of the chief scientist is to corral the evidence, find the right advisors, and distill the advice, including the uncertainties, into a form that can be communicated clearly to policymakers.

Toby: Great, thank you. It sounds like SAGE itself is essentially a standing committee, but does its makeup change frequently or is it fairly steady?

Mark: It's a standing committee only in the sense that it has -- I suppose the other thing I should have said is that the government chief scientific advisor is backed up by a network of departmental scientific advisors. And so if you like, that's the fixed element of SAGE, but it's then entirely bespoke to the emergency. And so the emergency that I faced shortly after starting, which the emergency I had to tackle were nothing like the challenges that my successor is tackling, were around flooding. And so the experts on coronavirus would not have been appropriate to provide advice on flooding in the southwest of the UK, and vice versa.

Toby: Okay, that makes sense. So you have the permanent position of chief science advisor, and you have individual government departmental science advisors, and then you have the SAGE, the committee which deals with urgent issues and the makeup their changes, depending on what's being dealt with. Do you think those formal structures are the main or only source of science advice for policymakers or are there other routes too, I mean formal or informal?

Toby: Well policymakers draw significantly on their chief scientific advisors for individual government departments. And there are also a number of government science organisations, for example the Met Office, where they would draw on advice. So I mean there are some hardwired government funded sources of research information that they will draw on. And they will look at reports written by external bodies, so for example the Academy of Medical Sciences produced a report on what might happen in the winter. And indeed one of the things that the government chief scientist can do, either through SAGE or directly, is commission other sources of advice as well. And they can bring in ad hoc science advisors, so I remember when I was advising the government on floods. We brought in from the University of Reading a hydrologist who worked in the government office of science for a period of time during the floods.

Toby: Yeah. I guess I'm interested in the maybe quite geeky question of whether these various sources of advice always come together at the level of SAGE or the chief science advisor and are then communicated to the policymakers that way. Or whether you get the sense that politicians also draw on their own informal sources of advice.

Mark: Well I mean inevitably politicians talk to lots of people and the government chief scientist doesn't know necessarily who they're talking to. But I mean it is a very clear role of the government chief scientific advisor and indeed departmental scientist to act as that coordination point. And the hardwired bit is that the government chief scientist and the chief medical officer in the case of a medical emergency both sit on COBRA. And that is the ultimate integrating point for advice into the government machinery.

Toby: So just for the benefit of international listeners give us a word or two about COBRA.

Mark: So COBRA is the government's emergency response mechanism. It's supported by the Civil Contingency Secretariat and it's chaired in an emergency typically by the prime minister or another senior cabinet minister. And COBRA is nothing to do with anything herpetological. It's not a snake, it's the Cabinet Office Briefing Rooms.

Toby: Thanks. So before we move on to talk about science advice recently, in COVID-19 of course in particular, you mentioned one strength of the UK system, namely that it's hardwired into the machinery of government. What do you think of some other strengths and if you like weaknesses of the way the UK system is set up?

Mark: The fundamental strength is that it is there and therefore people don't have to scrabble around and think 'how do I get advice?'. And because it's bespoke, in other words it's not actually a standing committee, it's variable and it can therefore be assembled very very rapidly to deal with different sorts of emergencies. But I think the most important thing which you learn very rapidly if you become an advisor to government is that evidence is one of the strands that policymakers look at when they're deciding what policy to implement, but it is only one of three. And policymakers when they're deciding on policies look through three lenses and the first of these is what do I know about X or Y and that's the lens of evidence. And of course an equally important part of that is what is not known about X or Y. An important part of the job of a chief scientist is to advise on the uncertainties and of course with a new infection like coronavirus the uncertainties outnumbered the certainties at the beginning by a very large fraction. The second thing that policymakers think about is: people are always coming up with bright ideas for policies but the question is are they deliverable or not? Because a great idea that simply isn't deliverable for whatever reason, either logistic or acceptability or expense, is not likely to succeed. And then the third lens that they look through is the lens of their political values, their social values, their personal values. And because there are often choices -- you know, given a piece of evidence you can decide to do something or you can decide to do something else or nothing. And those are choices that are ultimately not scientific choices, although the science may be very important in it. And so policymaking ultimately is an integral of the three and with almost any situation there are trade-offs to be made. And so I'll give an example away from coronavirus for a moment, and that is climate change. The evidence that there is anthropogenic contribution to climate change is absolutely overwhelming, it is undoubted. But of course the policy implications are much more variable because politicians could simply decide, well okay, that may be the case but we're not going to do anything about it, we don't care about future generations. Or they could decide to do absolutely everything at great economic cost or they could decide to do something in between. And I think it's sometimes very unfortunate that, rather than make explicit the fact that they're making policy choices, they sometimes, and I think this happens much less with climate change, start arguing about the science. And I think it's a much better position to say okay we understand the science, these are the trade-offs we're making. With climate change there are the different elements of climate change which is the need for sustainability, so that's the low-carbon future. But it's equally important with power that we have security of supply because in advanced societies if the electricity goes off you're in big trouble very quickly. And thirdly there's the question of affordability. And so policymakers when they're thinking about climate change policies are always thinking about not only the sustainability but the affordability economic issues and the security of supply issues as well. So in almost every policy arena there are these trade-offs and in the case of coronavirus the trade-offs are very very complicated because they're between the direct effects of a very unpleasant virus on human health but then the indirect effects which are also health-related. In other words, if a health system becomes overwhelmed, access to other health conditions, people who are frightened of turning up in hospitals because they're frightened of catching infection and therefore they die of their stroke or some other illness outside hospital, and the long-term health consequences of loss of jobs, loss of education and just sheer damage to the economy. And those are the trade-offs.

Toby: Yeah, it's interesting what you said about when politicians are choosing to say 'we are following the science' or conversely 'we've listened to the science but we've weighed it against other factors'.

Mark: Well I think following the science is a somewhat misleading term. I think the real issue is that they are listening to the scientific evidence. That's the important thing.

Toby: Right.

Mark: And it's been interesting to watch that during the evolution of the pandemic in the UK. And I think really, what I really mean is, it's been interesting to see how it's been perceived. Because I think early on the phrase 'being led by the science' was used by the Prime Minister and frequently by the government. The government was always keen to say it was following the science or being led by the science when it was explaining quite restrictive measures early on like the national lockdown and so on. But now six months later we seem to have moved quite far away from that. Today we read in the media that SAGE made a set of recommendations in September mostly about stricter measures to control the virus and it turned out the government didn't implement those at the time. So do you agree there's been an evolution in how the role of science has been presented?

Mark: I think there's an evolution in the presentation of it all. But from day one the challenge for policymakers has been that in principle we know how to stop an epidemic. You have to stop transmission of the virus. This is a virus that jumps from one person to another and therefore the way you stop it is by isolating the population as much as you possibly can. But of course if you do that then you've also got to maintain essential services. So it's extremely difficult to have a total lockdown because people need to get their food supplies, the power needs to run, the internet needs to work, people do need to be able to get care. And so there are a number of essential jobs that have to be carried on. And then there is the balance of harms which is that education was initially shut down. It became a bit easier as the pandemic progressed because it becomes clear at any rate that younger children seem to be less susceptible and probably less important in transmission than is the case with other infections such as flu. And that of course reflects another important thing that we didn't know at the beginning how this infection was transmitted. In other words was it simply droplets, was it surface transmission, was it aerosols. We didn't know the balance between these. We didn't know what fraction of the cases were asymptomatic because of course that's very important. And one important distinction between coronavirus and SARS is that SARS seemed to be maximally transmissible when people were at their sickest, which meant that medical professionals, carers, were quite susceptible to the infection because they saw people when they were very sick. It's true in Ebola too that people are most infectious when they're very, very ill indeed and indeed just after they've died. But of course that's not the case with this coronavirus which seems to transmit very early and quite often asymptomatically. Those are all things that were learnt. And so I think it has been a continual learning curve throughout the world. But I think policymakers from the very beginning have had to balance the challenge to the economy and to people's health, employment, with the need to get social distancing.

Toby: Yeah, okay, I mean I agree with that. No argument here. What I was kind of getting at though was, OK, we agree that politicians essentially have the right to take science advice as advice not as instruction. That means to act on it or not and to weigh it against other factors when they take decisions. And that's quite right. We live in a democracy and that's how things should be at the end of the day. But we could take it in the abstract if you prefer. Do you think there's a responsibility on politicians to make it clear when they've done that, how they've done the weighing up? Because if you don't do that, don't you risk essentially science advisors becoming fall guys if things go wrong?

Mark: Well, but I mean that is our parliamentary system. And of course it's parliament that holds government to account. And so that is absolutely right. And of course there has been debate in the UK with parliament who would like to know more and understand more of the reasons. But I mean in the UK democratic system government is held to account by parliament and it's actually parliament that passes legislation or not. And so there is an accountability mechanism and it's done through democratic means.

Toby: So let me make an analogy here and then ask if you think the analogy holds in the case of science advice. So there's a basic convention in countries that have cabinet-style governments, including the UK, that disagreements among members of government are played out behind closed doors in the process of making decisions. And then when the decision has been made inside the room, all members of the cabinet take collective responsibility in public for whatever was decided, even if they privately disagree with it. So there's the idea that the privilege of being in the room where it happens, so being part of the cabinet discussions, comes with the responsibility of signing up then in public to the outcome of those discussions. I wonder whether you think that scientific advisors should or do sign up to a similar principle. So the price of being allowed to speak truth to power inside the room is that you have to kind of endorse the decision outside the room.

Mark: There are two categories in respect of this. So there's the job of a government scientific advisor who is employed and therefore is a civil servant. And civil servants have to abide by the civil service code, which is that their job is that they are completely free to give their advice and express their opinions to politicians. But actually there is a responsibility that goes with the role to not then dissent from that publicly. It's a different position for members of SAGE who are not subject to any form of cabinet responsibility at all. And the policy with respect to SAGE members talking to the media has always been that SAGE members are perfectly at will to talk to the media. What they're not at will to do is, as it were, to give confidential accounts of the discussions that are going on in SAGE. In other words, they can give their own opinions but they shouldn't abuse the fact that they've had these conversations in SAGE.

Toby: Yeah, that makes sense. So that's about disagreement between scientists and politicians. But there's also the matter of disagreement among scientists. This is something that's, of course, not just happened in the UK. It's happened in other places too. In Belgium, where I live, a few weeks ago the rules were temporarily relaxed and some prominent epidemiologists, not state scientists but others who've been very much in the public eye, some of whom I think did have science advisory positions of various kinds, they publicly contested certain decisions. And then some of them went on a widely reported media strike where they refused to give any interviews or comment on the situation for a few days. So it was a pretty clear way of expressing disapproval of the way the science had been translated into policy or not. So that's one example. I know there was in the UK the so-called independent SAGE where some high profile scientists who weren't part of the formal advice mechanism set up essentially a rival committee giving different advice, which got quite some media attention earlier in the year. What do you think of developments like these?

Mark: Well, of course, it is the nature of the scientific process that it is an argumentative process and that people arrive at truth. And whilst there's uncertainty, there's often a great deal of disagreement. But I think that there has been some confusion. So there is what the scientific evidence is, and that's where it's important that the scientific community works collectively to do the research and understand, identify what are the key questions and the uncertainties. Now one of the really unique features I would have said of this pandemic, every pandemic is unique in a way, is that it's conducted in an era where science can be published online very, very quickly. And an enormous amount of science, it's all been made open, which actually is very good. And the journals have, I think, done extremely well in making peer reviewed papers available. But the archives, the preprint archives, have been extremely active. And not everything that ends up in a preprint archive is good science that will survive the peer review process. And so a lot of, frankly, not terribly good scientific research has materialised. And I think one's got to sort of divide this into three really. If you like, the scientific community achieving a consensus on what the high quality evidence shows. And some of the questions are quite difficult to answer actually. And within that, there has been some not very good science. For example, suggestions that there has been much more, much higher levels of herd immunity than the evidence supports, where the work has just frankly been wrong. There's also been suggestions that the virus might have mutated to become less virulent. And again, there's no evidence to support that. So there, that's about the scientific community working to the highest standards the values of science. And making sure that research is robust, statistically sound, carefully analysed, doesn't overclaim and reproducible. There's then I think a sort of slightly second type of issue which has arisen with science, which is that when scientists have actually commented on the quality of the delivery of government policy, looking back is always very, very much easier than looking forward. And I think one thing that is already apparent at this stage is that the countries that have done relatively well so far in coronavirus are those that have been, had their fingers very badly burnt in the past. And I think that governments are always better at managing the last emergency than the next one. So I remember when we were dealing with floods, we were also thinking about drought, because that's also an issue potentially for many countries around the world. And in the UK, we're susceptible to both drought and floods, but floods have been dominant in recent years. And it's always difficult to get people to focus on the next emergency. They always focused on the last one. And so if you look at the countries that have done reasonably well so far, and I use the word so far deliberately, Vietnam had avian influenza. Korea had a nasty outbreak of the MERS coronavirus. China again had SARS. And so the countries that have done well have, if you'd like, been burnt once and put in place the public health mechanisms to respond quickly. Germany, of course, had the outbreak of E. coli hemolytic uremic syndrome in 2011. And again, that required very good epidemiology and public health. And I think that the issue here is that it's one thing to have a national risk register -- in fact the UK has a national risk register which has pandemic infection at the top. So you might say, well, why wasn't it completely prepared? Well the answer is you can never be completely prepared in that you can't test for an infection you don't know about. But I think the question is that countries will look at is whether, you know, how many of them really paid the insurance policy necessary for managing a pandemic, which is the public health insurance policy.

Toby: All right. So in terms of preparedness, I'm sure you know that INGSA, the International Network of Government Science Advisers, is running a kind of COVID-19 science advice observatory. And one of the observations they've made is that many countries around the world had some degree of pandemic planning in place on paper. And yet when this pandemic hit, they didn't actually make much use of it. Do you think this is true of the UK?

Mark: I think that, you know, one of the big issues was obviously testing very early on. And there's no question that getting testing and tracing and isolation working properly has been a challenge. And it's been a challenge of logistic delivery. And it goes back to my comment about the sort of three elements of policymaking, which is that it's one thing to make a policy, the difficult bit is often delivering it. And so I think that a lot of the challenges nationally and internationally have been logistic. And testing has not been, you know, has been very difficult. And I think everyone will acknowledge that. Ventilators were in short supply, but actually ventilators were tracked down fairly quickly. The so-called Nightingale hospitals were created at very short notice. But the logistic response to an extraordinary global scale emergency like coronavirus is actually a very, very difficult one. And very easy for scientists to criticise the logistic responses. But frankly, many of them have no expertise in logistics. And if they were put in charge, wouldn't know what to do. And so I think that the, you know, the real challenge is the scientists are there to provide the advice. They are citizens like any other when it comes to assessing the quality of the policy response where they, you know, some have some expertise, but many don't have.

Toby: So you mentioned a few moments ago, one factor that you see as correlating with a good public health outcome during the pandemic, which is whether a country's had a recent, recent-ish experience with something similar, like a similar infectious disease outbreak. Yeah. Since this is a science advice podcast, I'm also kind of bound to ask, do you see any correlation between a country's science advice culture or maturity or sophistication of science advice infrastructure and good health outcomes? In other words, do you think that countries with stronger science advice mechanisms have done better in the pandemic?

Mark: No, I don't think that's the case. I mean, I think that there are a whole set of separate questions about health systems. And I think that actually one of the things that really does come out is that health systems by and large are misnamed. They're disease systems. And so we have the National Health Service, but it's actually really the National Disease Service. And if you like, the financial imperative for paying for disease is extremely clear. There are very good economic models. The market responds. The economic models for paying for health are much less well developed. And indeed, many of the things that you need to have good public health are not actually in the control of the health system. There are things like education, housing, transport, jobs. And those are really important. And of course, one of the other really important things that's come out as a feature of COVID-19 is that it has exposed extraordinarily starkly the social determinants of disease, because this is not a disease that strikes people equally. And it's clear that there are vulnerable populations, particularly aged populations and aging men more than women. It's associated with obesity, with cardiovascular disease, with hypertension. And people from ethnic minorities have suffered much more. And a lot of this maps with the social determinants of chronic disease. And so the social determinants of chronic disease, such as obesity and diabetes, are very similar to the social determinants that determine the outcome, in this case, of an infectious disease.

Toby: Right. So the observation is that it correlates more with social factors than with science advice.

Mark: Well, it's all tied up together because, of course, science advice has been extremely important in uncovering the social determinants of disease. Yeah, fair point. Yeah. And so it was the work of Michael Marmot, particularly in the UK, that really laid open the extraordinary strength of the social determinants of disease. So I think this is more about health systems, how much people have paid for them, public health systems. The science advice is a part of the story, but it's not the whole part.

Toby: OK. So I want to put one more slightly provocative question to you. On this podcast a few weeks back, which, of course, is then well before the second wave of coronavirus, that's what we're now seeing, Peter Gluckman, the chair of INGSA, and also, as it happens, the chief science advisor to New Zealand at the same time as you were doing that job in the UK, he commented that the UK science advice system is often seen as one of the best in the world, if not the best. But then based on looking at what's happened to disease patterns in Britain, he said the system has not done a good job. Now he did nuance that by pointing out that he's not saying it's the fault of the science advisors. He wasn't able to say if it was science advice or the advisors or whether the advice was ignored. But then he went on to make what I thought was the interesting point, which is what I want to ask you about, even if you don't accept the premise about the UK, which is that he said even if the scientists were giving the best possible advice at the best possible time, if it was not being taken up by policymakers, that in itself indicates that there's something missing either in the skill set of the scientists or the process itself. So I mean, I'm interested to hear your thoughts both on that question, and I suppose on the premise that something has gone wrong somewhere, if you think it has.

Mark: Well, it won't surprise you that I radically disagree with Peter on this, although I, you know, I worked reasonably closely with him when I was the chief scientist. And actually, it's there is a quite important point, which comes when you compare New Zealand with the UK. And that is that we are talking about this entirely as though humans are in control of what happens with Coronavirus. But there are all sorts of other circumstances that determine how Coronavirus distributed and why some countries may be more vulnerable than others. And so New Zealand, which is extremely isolated, is not in any sense a global hub, was able to control it because actually, it has a relatively small dispersed population, and is able to control its borders much more than other countries. Now, if you look at the cities around the world that fared badly, Brussels, London, New York, European and US cities, what have they in common? Global hubs. And so those parts of the world, which are global hubs tended to be hit early and hard. Look at the geography of how it spread in Europe. So did Lombardy do anything wrong? Of course not. It was the place it started, it was unlucky at the end of the day. So Italy then went on to have a rather localized pandemic. What happened in the UK is that at the end of February, over a half term holiday, holiday makers who'd been away on holidays across Europe returned from France, from Spain and from Italy. And we know from studying the genetics of the virus that came in, that there were about 1300 separate, essentially asymptomatic introductions of the coronavirus into the UK across the country. And so it started as a very widespread epidemic. Now, all of these things aren't in the control of scientists, science advisors, or indeed anyone else really. And I think that the sort of the human tendency, what to want to ascribe cause and blame to almost everything has got to be tempered by an understanding that we're dealing with the forces of nature. And at the end of the day, the forces of nature always trump humans, be it an earthquake, a tsunami, or a tsunami of infection in the form of pandemic. And so I don't think you would say this is some failure of science advice. At the end of the day, this is a horrible infection that turns out to be very, very transmissible. It's much worse than flu, or at least any flu we've had recently. And I don't think that, you know, so the UK has got a hardwired, very good system of science advice. And so I, as I said, I don't really agree with Peter, and nor do I think that, you know, it comes back to the job of scientists is to understand that politicians have to deal with very, very different balancing acts. And there's an extraordinary difficult balancing act with Coronavirus between the health of citizens directly affected by the Coronavirus and the health of citizens indirectly affected by Coronavirus. And that's a really difficult balancing act.

Toby: Yeah, I think those points are well taken. And I think Peter's point, if I can try to represent it, has two different elements. So one's about the performance of Britain, which you've dealt with very thoroughly just now. But the other is the more free-floating suggestion that if we have a situation, any hypothetical situation where science advice is not taken, and then with hindsight, with hindsight, it turns out that it would have been good to take it. That maybe indicates a possible issue, which might need addressing in terms of the process, or as he said, maybe a skills gap with the people involved. But I take it you're not convinced by that suggestion either?

Mark: Well, but I mean, I think that's to that is to misunderstand the political process, which is that politics is about values, as well as about evidence. And you know, if you want to make people to do things, then you have to understand behavioral science as well. And so if this is not all natural sciences, it's the complexity of humans. Not everything is sort of Hegelian, rational thought.

Toby: So I'm pleased that you brought up the role of social and behavioral sciences, because this is a feature of the UK science advice scene, which, I mean, it may not be unique, but it's certainly something that's been noticed by observers from elsewhere, the influence of these behavioral and social science principles in decisions about the policy response to COVID-19, for instance, there's the famous so-called nudge units in the UK government, in other words, trying to take into account not just cold, hard, epidemiological facts, but also issues like how people are likely to respond to certain measures when and for how long they will remain effective and so on. Is this a long standing feature of UK science? And has it been influential during the corona crisis too?

Mark: Yes, I think it has been. I mean, I think it is a recognition that if you want to provide evidence, you need a very wide range of evidence. And that includes the social sciences. And so the example that I used quite often, because it was from my time as the chief scientific advisor was the value of anthropology in understanding Ebola and what was going on, which is that there were some big outbreaks of Ebola in West Africa during the severe phase of the infection. And it turned out they were related to funerals. And the anthropologists understood that the way you pay respect to a deceased person in West Africa is to touch the corpse, which is a very deeply engaged cultural behavior. And that was seemed to be responsible for the transmission of quite big outbreaks at some funerals and the higher the status of the person being buried, the more people tended to be there and touch them. And you might simply have said, okay, we'll introduce a rule overnight that you mustn't touch people at funerals. But then that was attacking a deeply embedded cultural behavior. And again, anthropologists were able to advise on to how to sensitively substitute other behaviors which were less harmful. And so that was a very clear example of the value of one discipline of the social sciences anthropology but with major behavioral implications in the context of another infection. And so there is nothing new about having social science as part of the advice mechanism. And indeed, it's extremely important.

Toby: Okay. So thank you so much for sharing your insights and experience, especially about the UK. I want to finish with a topic that's much broader, I mean, purely because I'm interested to see what you think. What do you think is the state of public trust in science and expertise right now in autumn 2020?

Mark: Well, trust is specific, not generic. The great expert on this is Baroness Onora O'Neill. And I mean, she always gives the example of journalists, which is that if you look at trust leagues, then journalists come rather low. But if you ask the question, do you trust the journalist to tell you the football scores? Well, the answer is, of course you do. And so trust is very, very context specific. And so a scientist who's talking about the Higgs boson will be completely trusted, even if they're talking rubbish and all their physicist colleagues tell them, argue about the way they present it. On the other hand, the second the scientist starts talking about something which impinges on people's value systems, then that trust becomes much more nuanced. And so scientists talking about pesticides or scientists talking about fracking or climate are rather less trusted. And so trust in science is something that is actually quite context specific. Observations during coronavirus show that actually the scientists who have been talking about the infection have had a pretty high degree of trust. But the corollary of trust is also trustworthiness. And if you want to be trusted, then you have to behave in trustworthy ways, which is I think one of the other reasons why some of the cacophony of science which has been put forward, some of it much less good, has been quite troubling within the scientific community. And just because a scientist speaks doesn't mean that the scientist is any good. And so there is a sort of self-policing responsibility of science to make sure that --

Toby: That makes me wonder, because the word you use, the cacophony of science, I think is a very good word to describe the way the scientific process is supposed to work within a community of scientists, the process of hypothesis and experiment and debate and disagreement and peer skepticism and so on. And it's what allows science as a whole to move towards understanding the truth or approximating it better. So maybe one problem is that we haven't noticed or we haven't adapted to the fact that we've suddenly been doing that process right out in the open under the media spotlight since COVID came along. And I guess to an observer outside, it looks rather striking.

Mark: Yes. And of course, I mean, there are a number of players in this game and the world of journalism and indeed the world of politics are quite keen to hear dissenting voices. But sometimes a greater value is ascribed to a small number of dissenting voices than is appropriate. And MMR was a very good example of that. So the assertion that measles, mumps and valor vaccination might be associated with the development of the vaccine was so far from the scientific mainstream, not supported by any serious research at all. And yet it went through a phase when a very small number of individuals were presented to the public as though they had an equal and opposite position to the mainstream science. And there is an element of that with some of the COVID science as well. And herd immunity is one example. I think the idea that the virus has somehow become more benign is another example of that. Yeah, I know. I mean, the truth is that people want to hear things that support their beliefs. But as the famous quote from Moynihan was, you can have your own opinions, but you can't have your own truths.

Toby: On that resounding note, thank you very much indeed for taking the time to talk to me.

Mark: Pleasure.

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