Dr David Lowry: Sage advice or politicised science: watching the Coronavirus watchers

In an article published in the Sunday Times last weekend, its political editor Tim Shipman - currently the Society of Editors’ political journalist of the year, no less- made an astonishing revelation in the following passage:

Dominic Cummings, the prime minister’s senior aide, became convinced that Britain would be better able to resist a lethal second wave of the disease next winter if Whitty’s prediction that 60% to 80% of the population became infected was right and the UK developed “herd immunity”.

At a private engagement at the end of February, Cummings outlined the government’s strategy. Those present say it was “herd immunity, protect the economy and if that means some pensioners die, too bad”.

At the Sage meeting on March 12, a moment now dubbed the “Domoscene conversion”, Cummings changed his mind. In this “penny-drop moment”, he realised he had helped set a course for catastrophe. Until this point, the rise in British infections had been below the European average. Now they were above it and on course to emulate Italy, where the picture was bleak. A minister said: “Seeing what was happening in Italy was the galvanising force across government.”

(Coronavirus: ten days that shook Britain — and changed the nation for ever How Boris Johnson changed his priorities: save lives first, and then salvage the economy; https://www.thetimes.co.uk/edition/news/coronavirus-ten-days-that-shook-britain-and-changed-the-nation-for-ever-spz6sc9vb)

This has haunting echoes of the role played by Tony Blair’s head of strategy and communications, Alastair Campbell in the build-up to the invasion of Iraq, when his role elided from policy prozelitiser to policy author.

Campbell always denies this, but in the now infamous Iraq Dossier of September 2002, ( a document created to persuade wavering MPS they must bac a war strategy( we know from the publication of the dozens of emails between Campbell and John Scarlett, then chairman of the Joint Intelligence Committee, Campbell very persistently and deliberately wordsmithed raw intelligence in a political strategy for his boss, Tony Blair, the then Labour Prime Minister

Here is an extract from the Hutton Inquiry into the death of Dr David Kelly, a government scientist and an international inspector in Iraq during the period (2001-03),who died in mysterious circumstances days after giving evidence to two Parliamentary committees, on ein secret, in July 2003

MR ALASTAIR CAMPBELL (called) Examined by MR SUMPTION

MR SUMPTION: Mr Campbell, you have been through the story of your role in the preparation of the dossier in your

evidence at phase 1 and there are only certain points which I want to ask you about again. On 9th September 2002

you wrote a memorandum to Mr Scarlett describing certain aspects of the procedure for preparing the dossier, in

which you said that you would be making comments with the assistance of an informal group of officials. You then,

on 17th September, made a number of comments to Mr Scarlett in writing, some of which came from the Prime

Minister and some of which were your own. Can I ask you: on whose instructions were you assuming the role of

making comments on drafts of the dossier?

A. In the first instance on the instructions of the Prime Minister and also because John Scarlett had asked me to

offer him presentational advice on the draft that he submitted in the second week of September.

Q. Can you tell us why it was you as the Government's director of strategy and communications who came to be

performing this function?

A. I think what the Prime Minister expected of me in this particular communications exercise, if you like, was to

perform my role, which I traditionally would perform, on something which crosses Departments, which is the role of

coordination. The second point is that this was a document that was to be presented to Parliament and to the

public, not just at home but also overseas. It was a major communications exercise. The other point I would make is

that the Joint Intelligence Committee, for very obvious reasons, do not have the expertise or the personnel to do that

kind of job.

…. I would say that I was making presentational points in accordance with the job that the Prime Minister and Mr

Scarlett had asked me to do.

SUMPION then asked: This is the first page of your memorandum to Mr Scarlett of 17th September

which I mentioned a moment ago. Would you like to go through the points that you have listed here on the second

page, 67, and explain, briefly, what point you were making in relation to each one?

A. Well, on point 1, when I say "in light of the last 24 hours..." that refers to the fact that Saddam Hussein had

announced that he was intending to allow the UN inspectors back in. Now, the Prime Minister and the Government's

view was that this was almost certainly another ploy. When I talk about making "more of the point about current

concealment plans", I am simply making the point, given that we knew he had an infrastructure for concealing his

WMD programme, that that should be brought out more in the dossier. And I then say "it would be stronger if we

said that despite sanctions and the policy of containment, he has made real progress", ie real progress in the

development of his programmes. My understanding is that John Scarlett agreed with that point; and I think one

sentence was added to the text.

(http://image.guardian.co.uk/sys-files/Politics/documents/2003/09/23/Sept22PM2.pdf)

There is much more along the same lines. What Campbell argued was merely more professional presentation, others said was “sexing up”, which is how Dr David Kelly saw it in his devastating discussion with a then BBC defence correspondent

The generic point is while the commonly repeated mantra is ‘advisers advise, and ministers decide’, in the cases of Campbell and Cummings respectively, they both took a much more strategic role in pressing policy: they were de facto decision-makers.

COBRA, SAGE and Secrecy

Astonishingly, the composition of the very group of scientific advisors behind the Prime Minister’s and CoBRA decisions is secret. Professor Devi Sridhar, the chair of global health at the University of Edinburgh- an internationally respected expert - wrote revealingly in an article in the Guardian today

“It is still not clear who exactly is advising the government, who sits on the Scientific Advisory Group for Emergencies (SAGE), and what factors the prime minister and his colleagues are taking into account in his decision-making.”

(“Britain had a head start on Covid-19, but our leaders squandered it” Guardian, 24 March 2020; www.theguardian.com/commentisfree/2020/mar/23/britain-covid-19-head-start-squandered)

It is astonishing that even someone of Professor Sridhar’s elevated global status in the field, does not know who is sitting on SAGE or its sub committees. Why is this information not public? SAGE does publish time-lagged minutes of its deliberations, including an attendees/participation list. For instance on its web site, it is possible to read the minutes of the three meetings of SAGE convened to deal with Ebola. (8 December 2014: meeting summary)

One of the attendees was Chris Whitty, then the Chief Scientific Advisor for the Department for International Development (DFID)

But why cannot the contemporaneous details of SAGE meetings be published shortly after they have taken place?

The SAGE web site states: “The membership of SAGE depends on the nature of the emergency but it typically includes leading experts from within government and leading specialists from the fields of academia and industry. The group typically is chaired by the Government Chief Scientific Adviser or a departmental Chief Scientific Adviser”.

Annex – SAGE background

UK Scientific Advisory Group in Emergencies

Practice provided by

Gavin Lofthouse
gavin.lofthouse@cabinet-office.x.gsi.gov.uk
004420 7276 5060

If you are a public official, please sign in here to see the contact details of the innovator.

Type of organisation: Civil Contingencies Secretariat

Country: United Kingdom

Level of government: Central government

Type of practice: Process

Type of hazard or threat:

Risk management theme: Crisis management & preparedness

The UK Scientific Advisory Group in Emergencies (SAGE) is an independent support group that provides science-based expertise for the management of complex and unprecedented crises for the UK cabinet. SAGE convenes in situations that require cross government co-ordination, notably when the Cabinet Office, in consultation with the Prime Minister, decides to activate the Cabinet Office Briefing Room (COBR). The SAGE provides scientific and technical advice on the development of a crisis, and on potential scenarios and their impacts. Under the authority of the Government Chief Scientific Advisor, SAGE includes experts from all sectors and disciplines to analyze data, to assess existing research, or to commission new research. To inform UK cross-government decision-making during the emergency response and the recovery phases, the SAGE submits policy option papers which outline scientific and technical solutions, their pros and cons and response scenario papers. At all stages, SAGE representatives attend the COBR to explain scientific issues.

Why the good practice was developed

As in many OECD countries, crises affecting the UK have become more complex as a result of increased interconnectedness of our modern societies, the emergence of new threats, and the evolution of several risk factors. SAGE has been set up to meet the needs of Cabinet Office strategic crisis managers when confronted with complex crises. The understanding of this complex risk landscape requires thinking across sectors, identifying potential cascading impacts and evaluating uncertainties. Having access to the best available advice in a timely fashion is key to effective crisis management decision-making. To ensure a full range of issues are considered, advice needs to stem from a range of disciplines, including scientific, technical, economic and legal. Thus, it is crucial to set up a specific group which can quickly mobilise and peer-review multidisciplinary scientific expertise during crises.

Objectives

· To provide decision-making advice on the scientific concepts key to understanding the emergency

· To give advice on how the emergency might develop, outline its potential implications and evaluate related uncertainties

Scientific Advisory Group for Emergencies (SAGE)

Effective emergency management relies upon ministers having access to the best available advice in a timely fashion

https://www.gov.uk/government/publications/scientific-advisory-group-for-emergencies-sage

Published 16 October 2012

From: Cabinet Office

This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Documents

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/80087/thumbnail_sage-guidance.pdf.png

Scientific Advisory Group for Emergencies (SAGE)

PDF, 537KB, 68 pages

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/80087/sage-guidance.pdf

Details

Effective emergency management and informed decision-making relies upon Ministers having access to the best available advice in a timely fashion. To ensure the full range of issues are considered advice needs to stem from a range of disciplines, including the scientific, technical, economic and legal. This guidance focuses on the coordination of scientific and technical advice to inform strategic UK cross-government decision making during the emergency response and recovery phases.

Both “Responding to emergencies, the UK central government approach response, and concept of operations” (CONOPS) and the Emergency Response and Recovery (ERR) guidance provide an emergency management framework for the UK. This UK framework includes structures for coordinating scientific and technical advice during emergency response and recovery. At the UK level the Scientific Advisory Group for Emergencies (SAGE) is responsible for coordinating and peer reviewing, as far as possible, scientific and technical advice to inform decision-making. At the local level Scientific and Technical Advisory Cells (STACs) provide advice to local Strategic Coordinating Groups (SCGs) and/or Recovery Coordinating Groups (RCGs) which respond to the local consequences and manage local recovery efforts.

Published 16 October 2012

A strategic framework for the Scientific Advisory Group for Emergencies (SAGE)

Contents

Acronyms ..................................................................................................................... 1

Introduction .................................................................................................................. 2

Aims and objectives ..................................................................................................... 3

Intended audience ....................................................................................................... 4

Using this guidance ...................................................................................................... 5

Development of this guidance ...................................................................................... 8

Part One: Scientific and technical advice during emergencies ................................... 9

Local level .................................................................................................................... 9

The Lead Government Department Concept ............................................................... 9

Departmental / Devolved Administration only (or Level 1) emergencies ...................... 9

UK Cross-government (or Level 2 and 3) emergencies ............................................. 10

Overseas emergency with UK impacts ...................................................................... 10

Part Two: The Role and Governance of SAGE .......................................................... 12

SAGE aims and objectives ........................................................................................ 12

Governance of SAGE ................................................................................................ 13

Assurance .................................................................................................................. 16

Flexible structure ........................................................................................................ 17

Part Three: SAGE activation and de-activation .......................................................... 18

Activating SAGE ........................................................................................................ 18

Defining SAGE membership ...................................................................................... 18

Defining the governance structure of SAGE .............................................................. 21

Handover arrangements from pre-existing groups to SAGE ...................................... 21

Deactivating of SAGE ................................................................................................ 22

Part Four: Organising SAGE ...................................................................................... 23

Ensuring transparency and protecting sensitive information ...................................... 23

Contributing to situational awareness ........................................................................ 24

Ensuring that policy decision are informed by scientific and technical advice ............ 25

Ensuring communications are informed by scientific and technical advice ................ 26

Drawing on other types of advice ............................................................................... 27

Funding SAGE activities ............................................................................................ 29

Flexible approach ....................................................................................................... 30

Part Five: Interactions between SAGE and STACs .................................................. 31

Circumstances where SAGE and STACs might operate in parallel ........................... 31

Timescales for SAGE and STAC activation ............................................................... 32

Principles for SAGE / STAC interaction ..................................................................... 32

Assurance .................................................................................................................. 33

Defining SAGE, STAC interactions ............................................................................ 33

Default interaction model ........................................................................................... 34

Pragmatic arrangement for overcoming interaction issues ........................................ 35

Multiple STAC interaction .......................................................................................... 38

Part Six: The Interaction between SAGE and Devolved Administration advice groups ................................................................................................................................... 39

The interaction between Devolved Administration advice groups and SAGE (if active) ................................................................................................................................... 39

Requesting assistance and dealing with these requests ............................................ 40

Scientific coordination arrangements in Scotland ...................................................... 40

Scientific coordination arrangements in Wales .......................................................... 41

Scientific coordination arrangements in Northern Ireland .......................................... 42

Part seven: Dealing with requests for assistance and concerns ................................ 44

Reasons for requests for assistance and concerns ................................................... 44

Principles for dealing with requests and concerns ..................................................... 44

Principles for asking for assistance or raising concerns ............................................. 44

Options for providing assistance in situations where COBR is active ........................ 45

Options for proving assistance in situations where COBR is not active ..................... 45

Providing support and assistance outside of the COBR mechanism ......................... 45

Annex A: Underpinning definitions ............................................................................ 46

Annex B: Overarching principles ................................................................................ 49

Annex C: Consultation approach ............................................................................... 55

Annex F: ECOSA and its handover procedures ......................................................... 59

Annex G: Guidance on producing a funding issues paper ........................................ 64

Figures

1 The COBR Mechanism 11

2 SAGE Governance structures 14

3 Managing information flows between the intelligence cell and SAGE 28

4 Default SAGE, STAC interaction model 34

5 Lead STAC concept 35

6 Pooling scientific resources between SCGs 37

7 Pooling and marshalling scientific resources between SCGs 37

Tables

1 The role of scientific and technical advice in emergency management

Introduction

1. Effective emergency management and informed decision-making relies upon Ministers having access to the best available advice in a timely fashion. To ensure the full range of issues are considered advice needs to stem from a range of disciplines, including the scientific, technical, economic and legal. This guidance focuses on the coordination of scientific and technical advice to inform strategic UK cross-government decision making during the emergency response and recovery phases.

2. Both “Responding to emergencies, the UK central government approach response, and concept of operations” (CONOPS)1 and the Emergency Response and Recovery (ERR)2 guidance provide an emergency management framework for the UK3. This UK framework includes structures for coordinating scientific and technical advice during emergency response and recovery. At the UK level the Scientific Advisory Group for Emergencies (SAGE) is responsible for coordinating and peer reviewing, as far as possible, scientific and technical advice to inform decision-making. At the local level Scientific and Technical Advisory Cells (STACs) provide advice to local Strategic Coordinating Groups (SCGs) and/or Recovery Coordinating Groups (RCGs) which respond to the local consequences and manage local recovery efforts.

1 http://interim.cabinetoffice.gov.uk/media/349120/conops-2010.pdf?bcsi_scan_F8D0BFE83951C3DA=0&bcsi_scan_filename=conops-2010.pdf

2 http://www.cabinetoffice.gov.uk/media/353478/err-guidance-050410.pdf

3. Since the development of the SAGE and STAC concepts both have been activated in real emergencies and tested via exercises. SAGE was activated during the 2009 H1N1 influenza pandemic, during the 2010 volcanic ash disruptions and the Fukushima nuclear incident in 2011. STACs have been activated for a number of events, including the 2008 Cumbrian flooding. These activations and exercises have highlighted both good practice and lessons for the future. In addition a number of lessons on the coordination and use of scientific and technical advice have been identified in tier one (UK cross-government) emergency exercises. This guidance

3 CONOPs is targeted at government departments whilst ERR is targeted at local emergency planners and responders. The Devolved Administrations each have their own emergency management arrangements which are covered in both CONOPs and ERR.

4 CONOPS: http://interim.cabinetoffice.gov.uk/media/349120/conops-2010.pdf?bcsi_scan_F8D0BFE83951C3DA=0&bcsi_scan_filename=conops-2010.pdf

and ERR: http://www.cabinetoffice.gov.uk/media/353478/err-guidance-050410.pdf

draws on this experience and is designed to enhance the overarching UK framework for emergency management and should be read in conjunction with CONOPs and/or ERR, local STAC guidance and guidance on crisis management arrangements in the Devolved Administrations (DA)4.

Aims and objectives

4. Specifically, this guidance aims to:

· clarify what is meant by evidence based decision making and scientific and technical advice;

· clarify when the provision of coordinated scientific and technical advice may be appropriate;

· set out how scientific and technical advice will be coordinated and provided from the outset of emergencies to recovery;

· further clarify activation, organisation, funding and deactivation arrangements for SAGE;

· identify the potential anticipated outputs and products from SAGE;

· clarify the handover and transition arrangements between SAGE and other scientific advisory groups during activation and deactivation;

· clarify the principles of interaction between SAGE and STACs and other scientific and technical advice arrangements, including those used in the Devolved Administrations (DAs), as appropriate;

· reflect on lessons identified and highlight good practice; and

· be both flexible and scalable so it can be applied to all emergencies (as defined by the Civil Contingencies Act 2004)5.

5 See www.statutelaw.gov.uk

Intended audience

This guidance is primarily designed to be used by the key customers and providers of strategic scientific and technical advice at the UK cross-government level (see below).

Providers of advice:

government advisory and regulatory agencies;

external experts (including academics, industry and international experts);

existing advisory groups (including departmental and Devolved Administration led groups, cross-government scientific advisory groups (SAGs); and

external advisory groups and networks).

Customers of advice:

The Cabinet Office Briefing Room (COBR) mechanism - which comprises of Ministers and Government Departments (COBR may seek advice on emergencies in the UK or on emergencies that have occurred overseas that have an impact on UK interests.)

Devolved Administrations;

local decision makers; and

STACs (if active).

Ebola outbreak, 2014

In 2014 SAGE was activated in response to the Ebola outbreak in West Africa.

8 December 2014: meeting summary (PDF, 98.9KB, 5 pages)
29 October 2014: meeting summary (PDF, 157KB, 5 pages)
16 October 2014: meeting summary (PDF, 102KB, 5 pages)

Scientific Advisory Group for Emergencies - Ebola Summary Minute of 3rd Meeting 8 December 2014 35 Great Smith Street, London

List of attendees

Chairs

Sally Davies CMO

Mark Walport GCSA

Attending

Paul Cosford PHE

John Edmunds LSHTM

Neil Ferguson Imperial

Peter Grove DH

Simon Hay University of Oxford

David Lalloo Liverpool School of Tropical Medicine (via telephone)

Melissa Leach Institute of Development Studies (via telephone)

Peter Piot LSHTM

Andrew Pollard University of Oxford (via telephone)

David Salisbury

John Simpson PHE

Alasdair Walker MOD

John Watson DH

Chris Whitty CSA, DFID

Officials & Secretariat

Colin Armstrong GO-Science

Phil Green Wellcome Trust

Claudia Lally GO-Science

Alex McLaughlin DH

Ruth Parry DH

Anne Philpott DFID

Marsha Quallo-Wright GO-Science

Elizabeth Surkovic GO-Science

Hannah Thomson Cabinet Office

Chloe Watson Wellcome Trust

ACTIONS

1. CMO to liaise with CDC about the design of the proposed vaccine clinical trial in Sierra Leone.

2. John Edmunds to provide SAGE with findings from serological study in DRC.

3. Modelling sub-group to agree whether to base weekly case data in the indicative future scenarios slide on sitrep or line-list data (or both) and to feed back to the SAGE chairs.

4. Modelling sub-group to ensure that the format of the indicative future scenarios slide remains consistent over the coming months and to ensure that the actual number of beds is included as well as the planned numbers.

5. DFID to draft a letter for CMO to send to WHO regarding guidance on water, sanitation and hygiene practices outlining proposed steps to answer questions on whether the virus survives in sewage.

AGENDA ITEM 1: WELCOME

GCSA welcomed participants to the third meeting of the Scientific Advisory Group for Emergencies on Ebola. He reminded participants that the purpose of the meeting was to discuss the design of vaccine clinical trials and to provide advice on the likelihood that the disease will spread to other countries.

AGENDA ITEM 2: VACCINES

Trial Design

Vaccines were currently being developed by GSK, Merck (previously NewLink), and Johnson & Johnson. Phase I trials for the Johnson & Johnson vaccine were due to begin in Oxford in mid-December.

The US National Institute for Health (NIH) was leading on the planned phase II and III trials in Liberia, a consortium led by the Norwegian Government was leading on the trials in Guinea, and the US Centers for Disease Control and Prevention (CDC), with significant logistical support from the UK, was leading on the trial in Sierra Leone.

The proposed design for the Sierra Leone clinical trial was discussed. It was suggested that it could be beneficial to add a boost arm to the trial.

SAGE provided clear advice that the most appropriate design for the study in Sierra Leone would be for all trial participants to receive the Prime dose of the vaccine, with the provision on the Boost being randomised. This was based on initial evidence suggested that two of the three vaccines (including the most advanced) would require boosting to provide the necessary protection.

Health Care Workers

CMO highlighted that discussions were underway to explore whether vaccines trials could be developed that included UK healthcare workers. A letter had been developed outlining an additional phase IIa trial be conducted with UK healthcare workers, to investigate prime boost vaccination. In addition, an Innovative Medicines Initiative proposal had outlined a phase II study that would allow UK healthcare worker participation.

In discussion, the following points were raised regarding the design of clinical trials:

 Studies would need to determine the best interval between a prime and boost dose. The Johnson & Johnson studies would be looking at one and two month intervals. Shorter intervals between prime and boost doses would be investigated in an additional phase I trial.

 How a step-wedge trial design could be used to investigate prime-boost vaccination. Ring vaccination was highlighted as an alternative option to this design.

 A serological study was being conducted in DRC to examine sero-positivity in recovered patients. John Edmunds agreed to provide SAGE with findings from the study.

 It was questioned whether recruitment of healthcare workers to the trial would be sufficient given that no healthcare workers had contracted Ebola for two months (previously levels were 10%).

AGENDA ITEM 3: MODELLING

Disease spread in Africa

The probability of cases spreading to other countries in West Africa and their ability to cope with an outbreak was discussed. The difficulty in modelling the spread of disease in Africa, based on scant data, was acknowledged.

Whilst the Index for Risk Management (INFORM) coping capacity indicator gave a good proxy for whether a country could deal with an outbreak it did not take into account the Ebola specific interventions that countries in West Africa had introduced since the outbreak. It was expected that these countries would have an improved ability to deal with outbreaks.

The GCSA stated that the limitations of this analysis should be stressed when presenting the findings to other groups.

Consensus statement

The latest version of the Ebola Modelling Group Consensus Statement was presented.

It was noted that there had been a general decline in the number of cases in Liberia, with substantial geographical variation. In Guinea, the number of cases was reported to have plateaued but with local variations. In Sierra Leone, the data suggested that cases were still increasing, with a slight lengthening in the doubling time.

Transmission close to death and around the time of burial was considered to be more important than previously thought. The need to focus on the transmission that occurs in the few days before death, in addition to transmission during burials, was highlighted.

Current data indicated that as the number of beds available in treatment centres had increased, the reproduction number had decreased. However, this could not necessarily be deemed causal.

The GCSA requested the modelling group to discuss whether to use the weekly case numbers from the sit-rep or the more accurate WHO line list data in the modelling slide.

False-negatives

SAGE noted that the case fatality rate for individuals reported as ‘not a case’ in the line-list data was almost identical to the case fatality rate among confirmed cases and the weekly incidence of cases in the two groups was also highly correlated (92%). SAGE agreed that this potential false-negatives issue was a cause for concern and should be investigated further.

AGENDA ITEM 4: SURVIVAL OF EBOLA VIRUS

A paper from the World Health Organization (WHO) and UNICEF on water, sanitation and hygiene was discussed. The recommendations for safe distances between latrines and water sources, particularly in relation to the transmission of other waterborne diseases were discussed. It was agreed that better information was needed regarding natural flow in urban areas, and confirmation was needed around Ebola Virus survival in sewage.

The Department for International Development (DFID) agreed to draft a letter for CMO to send to WHO, regarding the guidance on water, sanitation and hygiene practices, outlining proposed steps to answer questions on whether the virus survives in sewage.

AGENDA ITEM 5: CEILING OF CARE FOR EBOLA PATIENTS

CMO provided an update on discussions with clinical experts from the four specialist infectious disease units in the UK to discuss evidence around the benefits of offering level 3 care to Ebola sufferers in West Africa. These experts had endorsed the recommendation that rehydration treatment, such as that used in Kerrytown, was the optimal intervention and that there was little evidence about the effectiveness of higher level interventions. A letter outlining these recommendations had been published on the Lancet website.

AGENDA ITEM 6: SOCIAL SCIENCE AND ANTHROPOLOGY

Melissa Leach updated the group on the work of the Anthropology platform:

 Evidence was being gathered on practices and behaviours around burials and the days immediately before and after death.

 Liberia’s mass-cremation policy was causing concern and may be resulting in increased under-reporting, inappropriate burials and a growing black market for Ebola-negative death certificates.

 There was a concern that many Ebola survivors are being stigmatised, making it difficult for them to re-enter communities. The use of a punch card transition, with multiple recognised stages, was suggested as one possible intervention to aid the reintegration of survivors.

 Communication around safe practices should continue, even if there was a decline in the number of cases.

AGENDA ITEM 7: AOB

An exercise involving the Devolved Administrations was planned for w/c 8 December

Coronavirus (COVID-19): scientific evidence supporting the UK government response

The national and global response to the spread of COVID-19 continues to develop quickly and our collective knowledge of the virus is growing by the second.

Published 20 March 2020

https://www.gov.uk/government/news/coronavirus-covid-19-scientific-evidence-supporting-the-uk-government-response

From:

Government Office for Science

During a response to a virus of this nature, it is imperative that the public is confident the government has based its decisions on a representative range of the most up-to-date science advice. In the case of COVID-19, the Scientific Advisory Group for Emergencies (SAGE) has been providing ministers and officials with free and frank advice throughout, based on external scientific evidence and a wide source of essential information.

In fast moving situations, transparency should be at the heart of what the government does.

We have therefore published the statements and the accompanying evidence to demonstrate how our understanding of COVID-19 has continued to evolve as new data emerges, and how SAGE’s advice has quickly adapted to new findings that reflect a changing situation.

View the scientific evidence supporting the government response to COVID-19

Government Chief Scientific Adviser Sir Patrick Vallance:

This is an incredibly fast-moving, developing situation and as part of our collective efforts to give the clearest and most reliable scientific advice, SAGE has and continues to draw upon a huge range of experts and a huge range of evidence.

The UK is home to experts who are at the forefront of their chosen fields and we are making full use of their expertise to grow our understanding of COVID-19 as we work tirelessly to tackle this disease.

The collective evidence we have published today has played a considerable role in shaping our recommendations on when, how and why the government have made the interventions it has so far.

Background to SAGE

The Scientific Advisory Group for Emergencies (SAGE) provides ministers and officials with evidence-based scientific advice in emergencies, ensuring government advisers are informed and best-placed to make critical decisions based on a range of credible scientific evidence.

The advice provided by SAGE is one of many essential sources of information that government weighs up before adopting new policies and interventions, and gives maximum assurance that the complexities and implications of any policy have been properly considered.

SAGE relies on external science advice, including advice from expert groups and their papers. In the case of COVID-19, this includes the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), Scientific Pandemic Influenza Group on Modelling (SPI-M) in the Department for Health and Social Care, and the Independent Scientific Pandemic Influenza Group on Behaviours (SPI-B).

These groups consider the scientific evidence, and provide their consensus conclusions to SAGE. Both the evidence they have considered and their consensus statements have been included in this current batch of evidence.

The growing evidence base on COVID-19

Contained within this release are the methods and findings that have informed SAGE advice on the COVID-19 outbreak to date.

Among the papers referenced here, some are pre-prints. These are academic papers that have not yet been through the peer-review process, which can take months, and have been drawn upon by SAGE to ensure that the most current evidence is being reviewed in order to provide rapid advice to policy makers.

Some of the bespoke new modelling that SAGE has drawn upon to formulate its conclusions has not yet been published here. This is to allow scientists time to publish their research through the right academic channels.

As our understanding of the virus grows, we will continue to feed into the essential scientific advice needed by the government to respond to the virus. During this time, we will update these pages with the evidence we are collecting to keep the public informed, while also continuing to provide free and frank advice to policy makers.

Scientific Advisory Group for Emergencies (SAGE): Coronavirus (COVID-19) response

https://www.gov.uk/government/groups/scientific-advisory-group-for-emergencies-sage-coronavirus-covid-19-response

The Scientific Advisory Group for Emergencies (SAGE) provides scientific and technical advice to support government decision makers during emergencies.

Contents

Role

SAGE is responsible for ensuring that timely and coordinated scientific advice is made available to decision makers to support UK cross-government decisions in the Cabinet Office Briefing Room (COBR). The advice provided by SAGE does not represent official government policy.

Expert groups

SAGE relies on external science advice and on advice from expert groups. During COVID-19 this includes the:

New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG)
Scientific Pandemic Influenza Group on Modelling (SPI-M) (Department for Health and Social Care)
Independent Scientific Pandemic Influenza Group on Behaviours (SPI-B)

These groups consider the scientific evidence and feed in their consensus conclusions to SAGE.

Scientific evidence supporting the government response to COVID-19

The national and global response to the spread of COVID-19 continues to develop quickly and our knowledge of the virus is growing. These statements and accompanying evidence demonstrate how our understanding of COVID-19 has evolved as new data has emerged.

This page will be updated on a regular basis with the latest available evidence provided to SAGE.

Introduction to the evidence