Monday, 11 January 2021

Truth and untruth about the origins of COVID-19

On Friday 8th January a near 100–page report – with links to 100 written submissions- was released by the Science & Technology Committee of the House of Commons on the science advice given to ministers on the Coronacrisis. Inexplicably, it went virtually unreported by the media. It did not open promisingly, by misreporting when the viral outbreak actually happened. In its second paragraph, the committee said the following: 2.The emergence of a novel coronavirus, previously unseen in humans, was first reported in the city of Wuhan in China on 31 December 2019.4 The first case of the novel disease outside of China was reported on 13 January in Thailand.5 On 22 January 2020, the World Health Organisation (WHO) issued a statement saying there was some evidence of human-to-human transmission.6 On 30 January 2020, the WHO declared the outbreak a ‘Public Health Emergency of International Concern’.7 On 31 January 2020, the first two cases of covid-19 were confirmed in the UK (in England).8 The first death from covid-19in the UK (in England) was announced on 5 March.9 On 11 March, the WHO “made the assessment that covid-19 can be characterized as a pandemic”.10 4 World Health Organisation, Listings of WHO’s response to COVID-19, accessed 4 December 2020 5 World Health Organisation, WHO statement on novel coronavirus in Thailand, 13 January 2020 6 World Health Organisation, Mission summary: WHO Field Visit to Wuhan, China, 22 January 2020 7 World Health Organisation, Listings of WHO’s response to COVID-19, accessed 4 December 2020 8 GOV.UK, CMO confirms cases of coronavirus in England, 31 January 2020 9 GOV.UK, CMO for England announces first death of patient with COVID-19, 5 March 2020 10 World Health Organisation, Listings of WHO’s response to COVID-19, accessed 4 December 2020 The reliability of these dates is questionable, as the article below suggests: a hint at why they are inaccurate is to look at the sources used by the committee report drafter (s), which are either WHO or the UK Government, neither of which may be deemed to be reliable on coronavirus facts. I regard the newspaper as more reliable than these two official sources, as the reported incidences maybe cross referenced with contemporaneous accounts, all of which pre-date the 31 December 2019 date WHO cite as the earliest report of a COVID-19 case. [On page of the report, it states: “Further, Professor Chris Whitty, Chief Medical Officer (CMO) for England, informed us that he first discussed the news of the emerging outbreak with one of the deputy Chief Medical Officers on 2 January (2020)57(] Coronavirus could have been rampant in Wuhan THREE MONTHS before Beijing claims, reveals leaked hospital files • Patients with new, mysterious form of pneumonia were treated in eight hospitals • Records show that 40 patients were treated with this previously unseen illness • Hospital records show outbreak could have begun early as September 25 2019 By Abul Taher Security Correspondent The Mail on Sunday 22:09, 9 January 2021 | Coronavirus could have been rampant in Wuhan at least three months before the Chinese government has acknowledged, according to leaked hospital files. Medical records from the city reveal patients with a new, mysterious form of pneumonia were being treated at eight hospitals between late September and the beginning of December 2019. The records show that 40 patients were treated with this previously unseen illness, which bore symptoms resembling those of Covid-19. Of those, at least eight died in hospital, the files reveal. If, as some experts believe, these were early coronavirus cases, it would contradict the official Chinese government account of when the disease started. Beijing maintains that a ‘cluster of pneumonia cases of unknown cause’ first appeared on December 31, 2019, in Wuhan. The Chinese government officially declared the disease as a new coronavirus outbreak to the World Health Organisation on January 9 last year. But the hospital records show the outbreak could have begun as early as September 25, 2019. Had the Chinese authorities responded quickly, say critics, the global pandemic that has killed 1.9 million people so far may have been prevented. The records were obtained by the Epoch Times, an American-based Chinese newspaper linked to the persecuted Falun Gong religious sect in China. They show that the first patient to be treated for the new unexplained pneumonia at the Wuhan Puren Riverside Hospital was called Xiao Xgui, one of ten people cared for there until the start of December 2019. Another general hospital, Wuhan Yaxin, treated ten patients with a similar pneumonia, mostly in October 2019. The Wuhan Sixth Hospital, one of the main medical facilities in the city, recorded five deaths from the new pneumonia, with three dying in November and early December that year. One patient, Xu Xgan, became ill on October 1 (2019) and died on November 3, according to records. He was first treated at the Wuhan Central Hospital, where he was given an anti-infection treatment, before being brought to the Sixth. The Wuhan Hospital of Traditional Chinese Medicine, in Hankou District, also reported three deaths of patients from a similar unexplained pneumonia in October and November 2019. The city’s Eighth Hospital also recorded cases in the same period. Last night, The Epoch Times, which is a controversial paper fiercely critical of the Chinese regime, could not be contacted. But experts who have studied the files said they appear to be authentic. Gilles Demaneuf, a French data scientist who works with a group investigating the origins of Covid-19, said that ‘the Epoch Times findings are credible’. But he added: ‘Suspected cases [of Covid-19] do not mean confirmed cases, and should not be construed as such.’ The respected South China Morning Post, based in Hong Kong, also published a similar investigation last year, saying it had obtained medical records that showed patients were falling ill with the virus in November 2019. It said nine cases – four men and five women aged between 39 and 79 – fell ill with a disease similar to Covid-19 in and around Wuhan. This Report is structured as follows: In Chapter two, we consider how scientific advisory and key decision-making structures evolved in the early stages of the pandemic, through evidence we gathered from Chief Medical and Scientific Advisers, as well as the Secretary of State for Health and Social Care. Chapter three explores the initial awareness of the novel coronavirus in the UK Government as well as the activation and operation of SAGE itself. While it is apparent to us that science advisory mechanisms responded quickly, there is an open question regarding the longer-term operation of SAGE and the impacts on the independent experts who participate—and their research staff and technicians—as well as the Government officials who support SAGE. The transparency and communication of science advice is discussed in Chapter four. While it is regrettable that there were initial delays in the publication of SAGE evidence, minutes and the disclosure of expert advisers, we are pleased that a regular drumbeat of public information was eventually established. Nevertheless, we have concerns that the lessons from this experience have not been consistently applied, and call for the Government to publish the advice it has received on indirect effects of covid-19 (including impacts on mental health and social wellbeing, education and the economy) and work to improve transparency around the operation of the Joint Biosecurity Centre. In Chapter five, we discuss the breadth of expertise drawn upon by the Government through SAGE. We conclude that there was a particular reliance on epidemiological modelling expertise at the beginning of SAGE’s operation—reflecting the paucity of real world data early in the pandemic—and identify an apparent gap in the provision of independent advice on non-medical impacts. We also consider the issue of poor data flows, which have hampered the work of SAGE and other experts in understanding the pandemic. Our final Chapter presents a number of instances that exemplify how effectively science advice was used, in different policy areas, over the course of the pandemic. In Chapter six we consider the following examples in which science advice has been a key component: testing capacity; social distancing measures, such as face coverings; and the development of potential vaccines and therapeutics. * Transcripts of our oral evidence sessions can be viewed here: ** Written evidence received as part of our inquiry can be viewed here: *** Health and Social Care Committee and Science and Technology Committee, Parliamentary Committees join forces: Inquiry launched to scrutinise Government response to the COVID-19 pandemic, 8 October 2020 **** Correspondence from Chair to the Prime Minister regarding lessons learned so far from the covid-19 pandemic, 18 May 2020 Key findings Our overall conclusions are that: 1. During the first part of the pandemic, the Government was serious about taking and following advice from scientists of international repute, through a structure that was designed and used during previous emergencies. 2. The length of the pandemic to date has placed extraordinary demands on the scientific advisers to Government. The Government Chief Scientific Adviser, the Chief Medical Officers, their teams, ministers and officials in Departments, the devolved administrations, the NHS, public health teams in Public Health England and local authorities, and each of the participants in SAGE and its sub-groups have worked 5 The UK response to covid-19: use of scientific advice intensively and continuously since the beginning of the pandemic. The structures for science advice in emergencies have been based around shorter term emergencies and the Government should consider the resilience of the arrangements for when they are needed to ensure in the longer term. 3. Initially, there was a lack of transparency about who were the scientists who served on the Government’s advisory body, SAGE, and what evidence and scientific papers their advice drew on. This has been improved following our earlier letter to the Government Chief Scientific Adviser, but there is still insufficient visibility as to what advice was given to the Government and over the transparency of the operation and advice of the new Joint Biosecurity Centre. 4. Although the Government was advised by many experts of distinction, and generally followed the advice that was given, the outcome during the first wave of the pandemic is not regarded as having been one of the best in the world.2 2 Sir Patrick Vallance told us in July it was “clear that the outcome in the UK has not been good” and that there was a “band of countries that have done less well” (Q1043). Further, Professor Neil Ferguson suggested to us in June that the UK’s position, in terms of per-capita deaths from covid-19, would not “necessarily change in a European setting” (Q942). While the experience of no country is perfectly comparable with others, it will be important to understand the reasons for this in order to learn lessons for the future. In this Report, there are questions of how quickly scientific analysis could be translated into Government decisions; whether full advantage had been taken of learning from the experience of other countries; and the extent to which scientific advice took as a given operational constraints, such as testing capacity, or sought to change them. 5. Measures taken to contain the pandemic had wider and indirect effects, such as on people’s livelihoods, educational progress and mental and emotional wellbeing. The assessment of these wider impacts was—and remains—much less transparent than the epidemiological analysis; the people conducting the analysis and giving advice are less visible than epidemiological modelling advisers; and its role in decision making opaque. 6. The public has benefitted from seeing and hearing directly from scientists advising the Government, and overall trust in science has remained high despite the inevitability that scientific advice has often been associated with restrictions on people’s activities and sometimes the focus of contention. As the Office for Statistics Regulation advised, in order to maintain high levels of confidence, data and statistics should be presented in ways that align with high standards of clarity and rigour—especially when they are used to support measures of great public impact. 7. A fully effective response to the pandemic has been hampered by a lack of data. For a fast-spreading, invisible, but deadly infection, data is the means of understanding and acting upon the course of the virus in the population. The early shortage of testing capacity—restricting testing only to those so ill that they were admitted to hospital—had the consequence of limiting knowledge of the whereabouts of covid-19. The ONS Infection Survey did not begin until May, and the fragmentation of data across public organisations has impeded the agility and precision of the response.The UK response to covid-19: use of scientific advice6 8. The increase in testing capacity that took place from April was driven principally by a target set by the Secretary of State for Health and Social Care rather than following a scientifically-based plan of what capacity was needed. While testing capacity has increased dramatically, it is still unclear what exact assessment has been made of the testing targets required in the management of the pandemic. In each instance, the approach we have taken is to draw on the evidence that has been presented to the Committee, orally and in writing, and to draw out lessons by way of recommendations to the Government—which is required to respond formally to the Report. Where recommendations reflect findings that things could have been done better we make them, in keeping with the scientific approach, not to apportion blame but— recalling the acute uncertainty and urgency with which decisions have had to be made—but to provide a means continually to improve our collective response to this, and future emergencies. Summary The coronavirus pandemic has marked the most significant test of the way that the UK Government takes and acts on scientific advice in living memory. The scientific community—in academia, in the public sector and in industry—has risen to that challenge in extraordinary and, in many cases, unprecedented ways. This Committee, on behalf of the House of Commons, is deeply grateful for the tireless, expert and unstinting work of everyone who has sought to understand the threat of covid-19 from its earliest appearance, and who have brought their experience, ingenuity and judgement to bear on mitigating its impacts and seeking treatments and vaccines against it. The high reputation of UK science is founded on openness and relentless self-challenge—looking always to test current theories and practices against new evidence and explanations, without sentiment and with a relish for discovery. The Science and Technology Committee in its continuing inquiry has sought to apply that same spirit. Through asking questions of expert witnesses and scrutinising written evidence our aim has been to do two things: •Distil from a necessarily complex and evolving response to a previouslyunknown virus lessons that can usefully be learned—positive and negative—that can be put into practice to help decisions yet to be taken, both in theremaining course of the pandemic and beyond; and •Capture contemporary evidence from what the people taking decisions, thoseadvising them and those working on the response to the pandemic thoughtat the time, so that future inquiries need not be only through the lens ofhindsight. In May, the Committee wrote to the Prime Minister and the Secretary of State for Health and Social Care with some recommendations drawn from the experience of the first few months of the pandemic.1 This Report considers, specifically, the ways in which the Government has obtained and made use of scientific advice during the pandemic to date. During the weeks ahead, both as the Science and Technology Committee and in our joint “lessons learned” inquiry with the Health and Social Care Committee, we will set out further evidence and findings on areas including the test and trace system, the development of vaccines and the preparedness for this emergency. In particular, the remarkable achievement of developing and being in a position to deploy multiple vaccines against a deadly and virulent virus that was completely unknown a little over a year ago ranks as one of the most outstanding scientific accomplishments of recent years—we will consider the lessons to be learned from the scientific, public policy and administrative contributions to this success in a subsequent Report. 1 Correspondence from Chair to the Prime Minister regarding lessons learned so far from the covid-19 pandemic, 18 May 2020 From Rt Hon Greg Clark MP, Chair Page 1 of 19 Rt Hon Boris Johnson MP Prime Minister (By e-mail) 18 May 2020 Dear Prime Minister, COVID-19 pandemic: some lessons learned so far I am writing to you on behalf of the House of Commons Science and Technology Committee. We are delighted to see you back after your recovery from Coronavirus and send our warm congratulations to you and Carrie on the birth of your son. My Committee has been taking evidence relating to the COVID-19 pandemic as part of our inquiry, UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks.1 It is important for us to ask questions during the pandemic both: 1 i (i) to ensure that contemporary evidence is captured on decisions and assessments so that not all evidence relies on recollections and hindsight; and ii (ii) so that any lessons learned which are relevant to the ongoing management of the pandemic can be uncovered and applied. With the second purpose in mind, we wanted to share with you, your Ministers and advisers some findings that we have identified through our first six public evidence sessions that have implications for the ongoing response to the pandemic. It is important to say from the outset that any live response to this new and deadly virus—which was unknown to most of the world at the beginning of this year, and which has spread explosively to almost every country on Earth, and whose medical and scientific characteristics are being revealed and analysed day-by-day—to entail decisions, made in good faith and with the best information then available—which turn out to be wrong as well as right. Judgements, necessarily made within a fog of uncertainty, will be revealed by subsequent experience some to have been correct, and some incorrect. Scientific hypotheses that were advanced on good grounds when tested by the Page 2 of 19 emerging evidence will be found in some cases to gain in force, and in others to need to be revised or retired. We seek to be purposeful: in the true spirit of science to confront theory and early practice with the evidence that experience makes available, and so to be able to learn and apply the lessons at the earliest possible opportunity. A policy and practice that is open to learning from experience and making necessary adjustments is more deserving of public confidence than one which is impervious to criticism or resistant to alteration. On this basis, we offer ten findings and recommendations so far. i (i) SCIENTIFIC ADVICE TO GOVERNMENT Finding 1: The Government has sought to obtain and act on good scientific advice The United Kingdom benefits from one of the strongest bases of scientific expertise in the world—in terms of both individuals and institutions. The conception and structure of the Scientific Advisory Group for Emergencies (SAGE) and its sub-groups is designed to capitalise on this strength—drawing on a range of specialists whose expertise is most relevant to the nature of the emergency in question. It is clear from all of our evidence sessions that SAGE and its subsidiary groups have been extensively consulted and highly influential in Government decisions throughout the pandemic. The leading scientists in SAGE, the Government Chief Scientific Adviser (GCSA), Sir Patrick Vallance, and the Chief Medical Officer for England (CMO), Professor Chris Whitty, are substantial figures with independent reputations. SAGE has met frequently throughout the crisis and, according to its website, met 26 times from late January to mid-April.2 2 Several witnesses who have participated in SAGE meetings described how the Group has made a serious attempt to distil the range of scientific views into advice to Government. Page 3 of 19 Professor Neil Ferguson, for example, told us: The Government have, I believe, been informed by the scientific evidence and have balanced that against other considerations—economic, health and all the things one might expect them to do.3 3 Q9 (all question numbers in footnotes refer to oral evidence taken before the Committee―transcripts are published on the Committee website: 4 Q247 5 Q80 6 Q841 Professor Chris Whitty explained the different groups feeding into SAGE: You have to remember that underneath the SAGE structure sit multiple other professional scientific advisory groups, and underneath that is a whole body of fantastic academic work.4 Witnesses told the Committee that the distinction between distilling up-to-date scientific knowledge—including areas of differing opinion—relevant to policy decisions and directing those decisions was well understood by those who have participated in SAGE meetings. Sir Patrick Vallance, for example, told us that he thought: the Government have listened to the advice of SAGE very carefully and followed it. Clearly, there are decisions that need to be made by politicians on how they want to implement that advice, and those areas are, rightly, political decisions and not scientific ones.5 Further when we asked Sir Patrick in March if there had been any “significant disagreement between the Government and their scientific advisers on anything material”, he was unambiguous in his response, simply replying “no”.6 Professor Chris Whitty told us how SAGE sought to distil the scientific evidence and its associated uncertainties—which may lead to a difference of opinion among those who have participated in SAGE meetings—in a helpful way for the Government to aid decision making: It is not very useful to Ministers or other decision makers to say, “There are 16 opinions. Here are all 16. Make up your mind.” Part of the process is to say in a unified way, “Here is the central view”, and then, if there are either dissenting views or a range of uncertainty quantitatively around that, to convey it in a way that is comprehensible to the people who are listening so that they understand the certainty with which the advice is Page 4 of 19 being proffered. If they do not, it is clearly going to lead to bad decision making.7 7 Q249 8 Q78 The Government Chief Scientific Adviser (GCSA) similarly explained: I think what SAGE has to do is to try to take complex science and bring it to a position where we say, “This is the consensus view of where we are now, but we are clear about the function and purposes of argument.” What I think is not helpful is to say, “Here are several different views,” and ask somebody who is less knowledgeable to bring these together and come to a single view. In SAGE, we try to come up with a consensus view, but we are always clear and open about how we arrive at that.8 While there is, and must continue to be, a clear distinction between the role of scientists as advisers, and Ministers as decision-takers, it is clear that the Government has been serious in taking scientific advice, and that British scientists on SAGE have sought to give that advice in a way designed to help decision making. Recommendation 1: The Government should continue to draw on extensive scientific advice through the further stages of the pandemic. Finding 2: The transparency around scientific advice has not always been as clear as it should have been. The strength of British science and the prominent role that scientific advice has played during the pandemic can be an important source of public confidence. The regular appearances of the GCSA and CMO at Downing Street press conferences have been a public demonstration that scientific advice has been influential in Government decisions. Yet there have been a number of concerns over the transparency of the scientific advice given and its relationship to Government decisions. First, transparency over the membership of SAGE and the groups feeding into it was not initially addressed. There are a number of reasons why transparency over who attends SAGE is beneficial. It is likely to a be a source of strength to demonstrate the breadth and depth of scientific advice that is being drawn on by Ministers and officials; and it also allows scrutiny of whether SAGE contains the appropriate range of disciplines necessary to give rounded advice. Page 5 of 19 Following evidence sessions held by the Committee, Sir Patrick Vallance made a commitment to publish the membership of SAGE. The Committee is grateful for that response to its concerns and strongly welcomes the decision. All but two of the names of people who have attended SAGE were published on 4 May. However, the published list conflates those who are part of a core membership that has guided policy throughout the pandemic while others—as Professor Sir David Spiegelhalter told us—had been present for a single meeting. A second concern is over the timely publication of the scientific papers on which SAGE has drawn for its advice. A website was established within (“Scientific advice supporting the government response to COVID-19”) containing relevant papers.9 A commitment was given to the Committee in a letter of 4 April from Sir Patrick Vallance “to regularly publish evidence documents and studies on which have formed the basis of SAGE’s discussions and advice”.10 9 10 11 12 Q259 However, after March no further papers were uploaded to the website until—after the Committee raised the matter with the CMO at our hearing on 24 April—a further set of papers was eventually published on 5 May. While it is welcome that some papers used to inform SAGE meetings have been published on this website, to date the majority of papers (92 out of 120) have not been published according to the full list of meeting papers published on, meaning much of the evidence informing SAGE is still not in the public domain.11 The CMO explained in evidence on 24 April that in certain emergencies, questions of protecting intelligence and national security arise: The last time there was a SAGE thing was the Novichok poisonings in Salisbury; at that point I was interim chief Government scientific adviser and I chaired it. There was absolutely no way we were going to put those documents into the public domain, nor will we. I have also been involved previously in SAGE meetings where some of the information was at a classified level and some was not. There will be a mixture.12 Page 6 of 19 That is completely understood and accepted by the Committee. However the CMO acknowledged that the current circumstances are different: SAGE on this occasion is dealing with something that is a straight science-to-policy question […] wherever possible, we absolutely should be putting out the data and trying to give the underlying workings.13 13 Q259 14 Q9 Our third observation concerns the transparency of SAGE’s advice itself. The Government has drawn attention to basing its decisions on scientific advice, while accepting that policy decisions are made by Ministers rather than scientific advisers. Individuals who have participated in SAGE meetings during the current pandemic have confirmed that. For example, Professor Neil Ferguson said: “To be clear, SAGE does not recommend policy”.14 It is clearly important that this distinction is respected. However, there is no transparency over what the advice of SAGE is—whether in the form of its actual advice to Ministers, minutes of its meetings, or even a summary, suitable for publication, of its advice. Without visibility of the scientific advice it will be difficult to corroborate the Government’s assertion that it always follows the scientific advice. In particular, there will be a margin of ambiguity about what was the scientific advice and what was a matter of policy. To avoid the risk of elision between the scientific advice and policy decisions, it would be good practice to ensure these are always distinguishable. Recommendation 2: To increase transparency in the provision of scientific advice the Government should: i (i) update regularly the now public list of members of SAGE and state how many meetings the named people attended; ii (ii) disclose the disciplines of SAGE participants who are not publicly named; iii (iii) publish promptly the papers on which SAGE draws for its advice after each relevant meeting; and iv (iv) publish now and regularly a summary of the scientific advice which has informed Government decisions. i (ii) CO-ORDINATION IN SCIENTIFIC ADVICE BETWEEN THE UK NATIONS Finding 3: The provision of scientific advice has been well co-ordinated between all four nations of the United Kingdom. Page 7 of 19 The Chief Medical Officers for the four nations of the United Kingdom all told us of the strong co-operation and regular liaison between the public health organisations of the UK. Dr Gregor Smith, interim Chief Medical Officer for Scotland, for example, told us that there has “been regular discussions between the four UK CMOs”, with them speaking to: one another at a minimum three times a week, but we take various opportunities to ensure that we link with one another through senior clinician groups or through more ad hoc meetings because things have arisen that we need to speak about with more urgency.15 15 Q231 16 Q236 17 Q232 18 Q252 19 See for example Qq252–253. Further, Dr Smith explained the joint approach that the four nations had been taking: “In any of the discussions across the four nations between the CMOs, there has been a remarkable sense of agreement on the approaches we need to take from the scientific base”.16 The CMO for England made similar points to the Committee: The interaction among the CMOs has been excellent throughout, and we often communicate several times a day if things are urgent. We also all interact with our own chief scientific advisers to Government. I operate incredibly closely with Sir Patrick Vallance and talk to him or communicate with him at least once a day, often more frequently, as things go along.17 Dr Smith told the Committee that although there could be circumstances in which the appropriate measures for managing COVID-19 could be different in some parts of the UK, there was value to consistent messaging for ensuring public understanding and compliance.18 Two potential future reasons for divergent measures advanced were that: i i. there could be in future different local stages of development in the epidemic; and ii ii. different operational capabilities of the NHS and public health authorities in different parts of the United Kingdom.19 Professor Whitty explained that the recent peak in infections was an “artificial” peak brought about through social distancing measures, and that because Page 8 of 19 those measures were introduced across the UK at “almost exactly the same time” the peak was “occurring at broadly the same time around the country”. Consequently, Professor Whitty advised that “the argument for strong regional variation in what we do is not terribly convincing”.20 All four Chief Medical Officers of the UK indicated their support for this position.21 20 Q280 21 Q281 22 As of 9am 11 March 2020, a total of 27,476 people had been tested, up from 26,261 (as of 9am on 10 March). See and 23 Q85 24 Q257 25 Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) Recommendation 3: All four UK Chief Medical Officers should continue to work closely together on their responses to COVID-19. i (iii) TESTING, TRACING AND ISOLATION Finding 4: Testing capacity has been inadequate for most of the pandemic so far. Capacity was not increased early enough or boldly enough. Capacity drove strategy, rather than strategy driving capacity. One of the most significant problems of the handling of the pandemic to date in the United Kingdom has been the lack of capacity to test people to determine whether they have COVID-19. Very low numbers of people were being tested well into March, with the number of tests actually falling at a critical time to 1,215 on 10 March.22 The Committee has found a consensus embracing a broad range of experts from within the UK and overseas—including among the Government’s scientific advisers—that testing capacity has been too low. Sir Patrick Vallance told the Committee on 25 March that he wished the UK had “more tests available today”, and that “it would be great to have got ahead of this more than we have been able to”.23 Professor Chris Whitty stated on 24 April that SAGE had consistently said that “one of the things we need is a greater capacity to test [for COVID-19] across the whole of the UK.24 As far back as February, the WHO-China Joint Report said that countries should “immediately expand surveillance to detect COVID-19 transmission chains by […] adding testing for the COVID-19 virus to existing surveillance systems”.25 Page 9 of 19 The Committee heard from witnesses from the Republic of Korea, Hong Kong and Germany who all emphasised the foundational nature of establishing mass testing capacity from an early stage. It was therefore identifiable from the beginning of the pandemic that testing capacity would be crucial. The evidence from Professor Sharon Peacock of Public Health England (PHE) to the Committee on 25 March was that PHE had chosen to follow a different approach to countries like the Republic of Korea which had engaged in mass testing from an early stage. Professor Peacock undertook to share “in the next few days” with the Committee the evidence and analysis on which the decision to reject the South Korean approach was taken.26 26 Qq121–124 27 Letter from PHE on 7 May 28 Letter from PHE on 1 May 29 30 31 Correspondence between Rt Hon Greg Clark to Professor Sharon Peacock, Kathy Hall and Professor John Newton 32 Q119 Despite several requests by letter, email and telephone since the 25 March, PHE has not produced to the Committee the basis for the pivotal decision to choose an initially centralised, smaller scale approach to testing over other leading international approaches. In a letter of 1 May (for which the Chief Executive of PHE has subsequently apologised27) PHE sought to discharge their obligation to share the evidence on which their decision was based at the time by pointing to a completely different study only now being carried out by the Royal Society on how testing is carried out by other countries.28 The Committee, through the Chair, questioned the Secretary of State in the Chamber of the House of Commons on 26 February29 and 11 March30 on what steps were being taken to expand capacity, and in correspondence of 30 March and 14 April.31 Answers reiterated that a gradually expanding, centralised approach was being taken, within PHE laboratories. In evidence to the Committee, Sir Paul Nurse, Director of the Crick Institute, said that he had offered his laboratories and staff to the testing effort but he did “not think that [he] got a reply” until weeks later, once the Crick Institute had publicly announced its provision of testing for healthcare workers.32 The decision to pursue an approach of initially concentrating testing in a limited number of laboratories and to expand them gradually, rather than an approach Page 10 of 19 of surging capacity through a large number of available public sector, research institute, university and private sector labs is one of the most consequential made during this crisis. From it followed the decision on 12 March to cease testing in the community and retreat to testing principally within hospitals. Amongst other consequences, it meant that residents in care homes—even those displaying COVID-19 symptoms—and care home workers could not be tested at a time when the spread of the virus was at its most rampant. The failure of PHE to publish the evidence on which its testing policy was based is unacceptable for a decision that may have had such significant consequences. The absence of disclosure may indicate that—notwithstanding the oral evidence given to the Committee—no rigorous assessment was in fact made by PHE of other countries’ approach to testing. That would be of profound concern since the necessity to consider the approaches taken by others with experience of pandemics is obvious. It is vital that the formal assessment made at the time is published without further delay, or, if it does not exist, PHE is open about this and explains why. Several witnesses who have participated in SAGE meetings told us that the capacity to test was an operational matter under the control of PHE, rather than one that they could determine. For example, Professor Neil Ferguson told us that testing had “always been discussed significantly” at SAGE, but that “the reason it was not included in initial modelling was about the projections by PHE of how quickly this country could ramp up testing capacity”.33 33 Q20 34 Q257 35 Qq138–139 On 2 April the Secretary of State for Health and Social Care, Matt Hancock MP, announced a target of 100,000 tests a day to be carried out by the end of that month. However, Professor Whitty made clear to the Committee that “SAGE did not give that specific target”.34 Even public officials emphasised that the 100,000 target was the Secretary of State’s choice, with Professor John Newton explaining: I think specifically, no, it is not a SAGE target; it is the Secretary of State’s target. I think he has taken advice from the programme and from colleagues […] I am afraid you would have to ask the Secretary of State himself exactly where he got his advice from.35 While there was some public debate at the time about whether the target was met by 30 April, it is clear that it drove a major expansion of testing to a level, in Page 11 of 19 capacity at least, comparable with what Germany had enjoyed for several weeks. For such an important determinant of a wide range of policy responses, it is surprising that a target designed to galvanise a tenfold increase in testing capacity appears not to be on the advice of PHE, NHS England or SAGE but was more of a personal initiative by the Secretary of State. Had the public bodies responsible in this space themselves taken the initiative at the beginning of February, or even the beginning of March, rather than waiting until the Secretary of State imposed a target on 2 April, knowledge of the spread of the pandemic and decisions about the response to it may have made more options available to decision makers at earlier stages. Recommendation 4: The Government should publish the assessment of other countries’ testing models on which the decision to follow a centralised, sequential approach was based. Finding 5: It is not clear that the lessons of the delays to testing have been learned. Although multiple witnesses told the Committee that it would have been desirable had much greater testing capacity been available from an earlier stage in the pandemic, no one gave an account that the lessons had been understood and would be applied to other decisions during the future course of the pandemic which were relevant. Apart from the clinical purpose of identifying for isolation and medical attention of those infected with COVID-19, the retreat to testing only hospital patients for the virus drastically curtailed the ability to gather data that could have identified the spread of the virus among different groups and with different symptomatic severity. The Office for National Statistics is now conducting a very important sampling exercise in which data on the prevalence of COVID-19 in the UK population will be gathered and reported twice-weekly. It is of great importance in providing data on the spread of diseases, its impact on the different demographic groups and geographies, the incidence of asymptomatic transmission and even the Reproduction or ‘R’ number which the Government has made key to easing some social distancing restrictions. In evidence to the Committee, the National Statistician, Sir Ian Diamond, gave an impressive account of the speed in which his team had been able to organise and implement a significant testing programme. Page 12 of 19 Sir Ian said: The fact that we came into it on a Thursday and, with the University of Oxford, put together the design and protocol […] and put it to medical ethics the following Monday and data ethics on Tuesday, with letters out to potential participants on the Wednesday, seems to me to be one of the most rapid surveys I have ever in my life seen go into the field.36 36 Q389 37 Centre for Economics and Business Research, ‘Estimates of daily economic impact of the UK’s lockdown by sector’, published 6 April 2020 However, Sir Ian also told the Committee that the request to put together such a testing programme was made only on 17 April. It is not clear why such a study could not have been instigated by the Government at a much earlier stage. Indeed, had this study been in operation even a month earlier, many of the decisions that will be made on social distancing during the days and weeks ahead may have been made earlier, based on much more detailed data. With early estimates of the impact on the economy of the lockdown running at over £17 billion a week,37 there seems to be insufficient recognition that an avoidable delay in being able to take decisions because of the lack of data has an impact that is vastly greater the cost of the data collection exercise. In particular, the intended use by the Government of current estimates of the Reproduction number (‘R’) depends, as well as on modelling assumptions that should be open to be examined, on the depth and breadth of the data available to estimate it. Being able to operate at scale at, or in advance of, the point of need is a key lesson from the testing experience and will have a particular relevance to vaccination, which we discuss in finding 9 below. Recommendation 5: The Government should learn and apply the lessons from the slowness of the provision of testing capacity and take every opportunity to build capacity in advance of need to surge capacity explosively rather than follow a more gradual “ramping up” approach. Finding 6: Strategies to deal with carriers of COVID-19 who were asymptomatic have not been clear. One of the consequences of the small capacity for testing has been that the test has until recently been largely reserved for people suffering from suspected symptoms of COVID-19. Yet evidence presented to the Committee has raised the prospect that a high proportion of people with COVID-19—and therefore capable of transmitting it to others—are free of all symptoms. Page 13 of 19 Professor Xihong Lin of Harvard University said In our paper, we analysed that about 60% to 80% of daily new cases were asymptomatic. This was very interesting. A New England Journal of Medicine article was published earlier this week. In that study, they tested pregnant women in New York City. Among 215 pregnant women who tested positive, 85% were asymptomatic. Yesterday in the news there was a report on Boston homeless shelters: among a couple of hundred people who were tested, all those who tested positive were asymptomatic.38 38 Q229 39 Q283 40 Q173 The possibility of significant levels of asymptomatic transmission have a profound consequence for the management of the pandemic. If people have no means of knowing they are infected, then they risk transmitting the infection to large numbers of people if they are not rigorously socially distanced. This is a particular concern for NHS workers and care workers who may be asymptomatically infected and transmitting the disease to vulnerable people with whom they are in close contact. A significant degree of asymptomatic infection may require regular testing in particular settings—like hospitals and care homes—of all workers who come into contact with vulnerable groups, whether or not they display symptoms themselves. Recommendation 6: The Government should explicitly set out its approach to managing the risk of asymptomatic transmission of the disease. Finding 7: In combination with other measures, contact tracing can help to reduce the spread of disease. The UK’s limited capacity for contact tracing was an important factor in the decision to stop full contact tracing on 12 March. Rigorous contact tracing has been used in several countries that have reported low death rates from COVID-19, such as the Republic of Korea, Singapore and Hong Kong. Professor Chris Whitty told the Committee that contact tracing was a “very powerful tool of public health”, but that it was “unbelievably labour intensive” if done manually.39 Although Professor John Newton gave the Committee his opinion that contact tracing would have been stopped once there was widespread transmission in the UK regardless of capacity,40 many of our expert witnesses acknowledged that limited testing and tracing capacity was a Page 14 of 19 factor in the decision to stop contact tracing. For example, Professor Neil Ferguson said on 25 March: If we have to transit from the suppression strategy and the lockdown strategy to something this country can maintain long term, undoubtedly much more widespread testing, contact tracing and other methods will have to be deployed. If we are talking about back in January/February/ early March, it was very clear from messages from Public Health England that we would have nowhere near enough testing capacity to adopt that strategy.41 41 Q20 42 Q417 43 Qq416 and 418 44 Q335 45 Q336 46 Q339 With respect to easing lockdown restrictions, Professor Jonathan Edmunds, of the London School of Hygiene and Tropical Medicine, explained that contact tracing would “play a role” in managing the epidemic, but would require some social distancing measures to remain in place.42 He made clear that the point at which effective contact tracing would become feasible was an “operational decision” and would depend on the capacity for tracing and isolation in relation to the numbers of cases.43 We also heard that multiple approaches may be required towards managing the manual burden of contact tracing, including the use of new technologies. Professor Christophe Fraser told us that the use of digital contact tracing applications would be necessary to manage the spread of COVID-19 as manual efforts would be “unlikely to be quick enough” to inform those who might be infected.44 Nevertheless it is clear from the experiences of other countries, such as Singapore,45 that we cannot rely on the use of a contact tracing application to fulfil our needs. Indeed, Matthew Gould, the Chief Executive Officer of NHSX—which is developing the app—indicated to us that achieving the levels of uptake required for this approach to be optimal would be “tough”.46 Therefore it is critical that the capacity for contact tracing is advanced for future stages of managing the epidemic. Recommendation 7: The Government must urgently build up contact tracing capacity in order to facilitate further easing of social distancing measures as soon as possible, while minimising the risk of a second peak in infections. Finding 8: The role of isolation in combination with testing and tracing has been important in countries which have, so far, tackled the pandemic effectively. Page 15 of 19 The Committee has taken substantial evidence on how other countries have managed the pandemic, including leading experts from around the world. The consistent message from all of these witnesses was that not only is testing and contact tracing foundational to effective management but so is an extensive programme of isolating and managing infected persons. Professor Gabriel Leung of Hong Kong University emphasised the importance of quarantine and isolation in testing, tracking and tracing the virus in Hong Kong: every single infected individual who is confirmed by testing goes into a hospital bed. In fact, up until very recently, almost all of them would go into a negative pressure single room. All their close contacts who are identified by contact tracing are then quarantined in an isolated facility that is separately and specially prepared for such a purpose. There is no home quarantining for close contacts of confirmed cases.47 47 Q112 48 Q110 49 Q114 50 Q210 Dr Erica Lee of the Korea Centers for Disease Control and Prevention confirmed that the Republic of Korea had been using “isolation and quarantine measures”.48 Dr Lee also explained how Korea changed its approach to respond to rising cases so that there were categories of quarantine: If they have severe symptoms and they need the treatment, we transport them to either the negative pressure rooms or the tertiary hospitals designated by the Government. If the symptoms are mild, we have designated living and treatment facilities, so they can stay there in isolation and if they become severe, we transport them to the hospitals right away. If they have light symptoms or they are asymptomatic cases, we sometimes recommended that they stay home in isolation.49 Professor Xihong Lin of the Harvard T.H. Chan School of Public Health emphasised the important role of quarantine and isolation: social distancing, testing and contact tracing greatly help in reducing the transmission but they are not enough, based on analysis of the Wuhan data and other countries. Smart isolation and quarantine, such as the centralised quarantine and isolation used in Wuhan, is needed to bend the curve in a timely fashion.50 Without developed, extensive and operational testing and tracing capacities targeted isolation of infected individuals is difficult to achieve. However, when Page 16 of 19 testing and tracing has reached a dependable level and cases have fallen to a low enough level, other countries have found that dedicated facilities to isolate and treat infected people has been important in keeping cases very low. These include designated hospitals and non-clinical facilities such as requisitioned hotel accommodation. While intrusive, and incurring cost, providing dedicated facilities may be worthwhile when set against the more hidden but vastly greater cost of maintaining tighter restrictions on the rest of the population for longer if infected individuals are less rigorously isolated from society. Recommendation 8: The Government should set out the role of isolation and quarantine as part of its test, track and trace strategy, ensuring that it draws on the experiences of other countries. (iv) DEVELOPMENT OF VACCINES Finding 9: The development and deployment of vaccines could be critical to halting the COVID-19 pandemic. It is encouraging news that the first human trials of potential vaccines are now underway in the UK. The Secretary of State for Health and Social Care announced on 21 April that human trials of a potential vaccine for COVID-19 would start on 23 April.51 This is testament to the UK’s expertise in this area and the hard work of the researchers involved and those supporting them. Professor Sarah Gilbert, who is part of the Oxford team developing a vaccine, has said that she is “very optimistic” of a successful vaccine, which is a particularly encouraging assessment.52 51 52 See for example: We took evidence from Professor Andrew Pollard, of the University of Oxford, and Dr Melanie Saville, Director of Vaccine Research and Development at the Coalition for Epidemic Preparedness Innovations (CEPI), both of whom made clear the need to start the manufacture of potential vaccines before their effectiveness is proven in order for any successful vaccine to be available at scale as soon as possible. Dr Saville stressed the importance of investing in manufacturing capacity at an early stage and explained the work that CEPI was undertaking in this regard: to reach a 12 to 18-month timeframe many activities need to be done in parallel and at risk. With manufacturing, you do not usually scale up your process until you have clinical data. One of the approaches that CEPI is Page 17 of 19 taking in terms of funding is to accelerate the scale-up of manufacturing so that it is done even at pre-clinical phases.53 53 Q50 54 Q53 55 ‘COVID-19 Daily Deaths’, NHS England 56 Q284 Professor Pollard explained that if investment at risk in manufacture of a COVID-19 vaccine did not take place until all trials were completed then the UK would be “years and years away” from having a vaccine that could be ready for mass use.54 Clearly no vaccine may be used (other than in trials) before its effectiveness and safety is assured. However, to wait until all trials are completed in order to build up the capacity to manufacture and distribute vaccines could lose valuable time. Therefore, even at the risk of redundancy, it is imperative to ensure that the UK has built up sufficient manufacturing and distribution capacity to roll-out a vaccine as soon as its effectiveness is proven. Recommendation 9: The Government should build capacity for vaccine manufacture and deployment now in advance of need and so that their mass use can start as soon as their safety is proven. I (V) RECORDING ETHNICITY Finding 10: There are significant unexplained differences in the death rates in the UK of Black, Asian and minority ethnic groups compared to the population as a whole. NHS England publishes a breakdown of COVID-19 deaths by ethnicity,55 which is dependent upon such information being recorded in emergency department, in-patient or out-patient datasets, and is unavailable for almost 10% of such cases. Further, it does not cover those who die outside of an NHS setting, for example in care homes. Professor Chris Whitty, told us that there was “pretty clear evidence that there is over-representation, at least in certain areas, of people from BAME backgrounds in the number of people who get into severe difficulties” with COVID-19, but that the reason for this was not clear.56 Further, an analysis from the Institute for Fiscal Studies identified that “data published by NHS England on registered hospital deaths by ethnic group have confirmed stark inequalities between ethnic groups”. It explained that: among the black Caribbean and ‘other’ (which includes the Arab population) groups, per-capita hospital deaths are close to three times Page 18 of 19 those of the white British majority, and the ‘other black’ group has also recorded a disproportionate number of hospital deaths.57 57 58 59 Q284 60 61 Q284 62 Q286 63 Q288 Analysis published by the Office for National Statistics (ONS) on 7 May made similar findings: “After adjusting for age […], men and women from all ethnic minority groups (except females with Chinese ethnicity) are at greater risk of dying from COVID-19 compared with those of White ethnicity”.58 Professor Whitty made clear to us on 24 April that the cause for BAME over-representation in those people “who get into severe difficulties with this disease” was not known.59 The ONS analysis identified some of the reasons for the difference in outcomes, and found “that the difference between ethnic groups in COVID-19 mortality is partly a result of socio-economic disadvantage and other circumstances, but a remaining part of the difference has not yet been explained”.60 Professor Whitty explained that he had requested Public Health England and academic input to try and establish why there was this over-representation: I have asked Public Health England to look seriously at any datasets, because it is a major concern. In the National Institute for Health Research, we have put out a call for our academic colleagues also to look at it.61 It was also highlighted to us that data on the ethnicity of those dying from COVID-19 was not systematically collected. Professor Whitty argued that ethnicity and gender should be recorded “much more systematically”62 in a wide variety of data sources to facilitate monitoring and research into health impacts related to such characteristics. Dr Frank Atherton, Chief Medical Officer for Wales, similarly agreed that “more data is needed”.63 Recommendation 10: The Government should consider how ethnicity data on those dying as a result of COVID-19 could be systematically recorded. The Science and Technology Committee hopes that these initial findings and recommendations will be useful as a constructive contribution to the important Page 19 of 19 and difficult decisions you and your colleagues in Government have to make during the weeks ahead. As we continue to take evidence during the remaining course of this pandemic the Committee will, in the same spirit, write to you with further observations based on what we learn. I am copying this letter to the Secretary of State for Health and Social Care, the Chief Medical Officer for England and the Government Chief Scientific Adviser. I will be placing this letter in the public domain. With best wishes, Rt Hon Greg Clark MP Chair The UK response to covid-19: use of scientific advice House of Commons Science and Technology Committee First Report of Session 2019–21 Report, together with formal minutes relating to the report Ordered by the House of Commons to be printed 16 December 2020 HC 136 Published on 8 January 2021by authority of the House of Commons Contents Summary3 Key findings 4 1 Introduction 7 Covid-197 Our inquiry 7 Aims of this Report 8 2 Expert advice and Government decision-making structures 10 Scientific advisory structures in the pandemic 10 UK Government 10 Science advice in the devolved nations 13 Key decision-making structures in the UK Government during the pandemic 14 Cabinet Office and COBR 14 Other decision-making structures 17 3 Activation and operation of SAGE 19 Timeliness of coordinating SAGE and science advice 19 Scientific advice 21 Sustainability of SAGE participation 22 4 Transparency and communication 24 Disclosure of science advisers and SAGE participants 24 Communicating science advice to Government decision-makers 27 Transparency of evidence and advice to Government 29 Communicating science advice to the public 31 5 Nature of the scientific advice to Government 37 Initial breadth of scientific expertise 37 Multi-disciplinary advice 38 Our analysis of SAGE meetings 40 Access to data in the development of expert advice 41 6 Application of science expertise 45 Testing and contact tracing 45 SAGE discussions 45 Capacity targets 47 Testing capacity growth 49The UK response to covid-19: use of scientific advice2 Social distancing and face coverings 53 The two-metre rule 53 Face coverings 54 Vaccine and therapeutic development 55 Annex One: Letter from the Chair of the Committee to the Prime Minister, dated 18 May 2020 59 Conclusions and recommendations 74 Formal minutes 82 Witnesses 83 Published written evidence 86 List of Reports from the Committee during the current Parliament 90 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Published written evidence: 100 written submissions, all downloadable and searchable The following written evidence was received and can be viewed on the inquiry publications page of the Committee’s website. C numbers are generated by the evidence processing system and so may not be complete. 1 ABPI (The Association of the British Pharmaceutical Industry) (C190098) 2 Academy of Medical Sciences (C190102) 3 Apple (C190017) 4 BIVDA (C190082) 5 Barr, Dr G D (C190056) 6 Battye, Rose (C190040) 7 Biochemical Society (C190088) 8 Blott, Richard (C190039) and (C190049) 9 British Pharmacological Society (C190075) 10 British Society for Immunology (C190093) 11 Care England (C190021) 12 Clark, Dr Andre (C190008) 13 Centre for Genomic Pathogen Surveillance (C190090) 14 Cheng, CEO Andersen (CEO, Nomidio & Post-Quantum) (C190028) 15 Cole, Dr Jennifer (C190002) 16 Daniels, Professor James (Former DfiD Quarantine Manager, Ebola, VQF Hastings, SIERRA LEONE, WHH Dfid Funded) (C190051) 17 Davies, Nick (Research Fellow in Mathematical Modelling, London School of Hygiene and Tropical Medicine) (C190037) 18 Department of Health and Social Care (C190057) and (C190112) 19 Earlham Institute (C190024) 20 Emergent BioSolutions Inc. (C190058) 21 Evans, Ken (C190100) 22 Everbridge (C190019) 23 Faculty of Pharmaceutical Medicine (RCP UK) (C190091) 24 Fenton-O, Mark (C190009) 25 Fight for Freedom: Stand with Hong Kong (C190052) 26 Finlayson, Ashley (C190060) 27 Ferguson OBE, Professor Neil (Professor of Mathematical Biology, Imperial College London) (C190041) 28 Global Disability Innovation Hub (C190104) 29 Gonzalez-Rodriguez, Dr Jose (Associate Professor in Analytical Chemistry, University of Lincoln) (C190078) 30 Google (C190015) 31 Gough, Professor David (Director, EPPI-Centre, University College London) (C190097)87 The UK response to covid-19: use of scienti fic advice 32 Guinchard, Dr Audrey; and Dr Subhajit Basu (C190029) 33 Head, Mr Michael (Senior Research Fellow in Global Health Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton) (C190067) 34 Health Research Authority (C190096) 35 Health and Safety Executive (C190033) 36 Hebard, Peter (Covid Task Force Coordinator, IMechE Covid Task Force) (C190042) and (C190054) 37 Hilton, Mr Samuel (Research Affiliate, Centre for the Study of Existential Risk); Toby Ord (Senior Research Fellow, Future of Humanity Institute); and Haydn Belfield (Academic Project Manager, Centre for the Study of Existential Risk) (C190076) 38 Home Office (C190036) 39 Imperial College London (C190038) 40 Institute for Life Sciences, University of Southampton (C190071) 41 Institute of Development Studies (C190089) 42 Institute of Physics and Engineering in Medicine (C190087) 43 Institution of Chemical Engineers; and International Society for Pharmaceutical Engineering UK Affiliate (ISPE UK) (C190068) 44 Keeling, Professor Matt (Professor, University of Warwick) (C190032) 45 Kime, Mr David Allan (C190001) 46 Kolstoe, Dr Simon (Senior Lecturer in Evidence Based Healthcare, and independent chair PHE Regulation & Governance Group, University of Portsmouth/PHE) (C190086) 47 Lawson, Dr Aaron (Lecturer in Environmental Health, Ulster University; and Contracted Research Associate, Safefood Ireland (The Food Safety Promotion Board)) (C190006) 48 Lewis, Dr Gregory (C190107) 49 Lin, Professor Xihong (Professor of Biostatistics, Harvard T.H. Chan School of Public Health) (C190013) 50 Lord Dowding Fund for Humane Research (C190095) 51 Loughhead, Professor John (Chief Scientific Adviser & Director General, Department for Business, Energy and Industrial Strategy) (C190046) 52 MacKay, Prof Robert (C190027) 53 Maroso, Mr Gabriele (Co-Founder Associate, Onfido) (C190014) 54 McAllister, Hayden (C190069) 55 National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections; University of Oxford, Nuffield Department of Primary Care Health Sciences; and University of Liverpool, Institute of Infection and Global Health (C190084) 56 National Institute for Health and Care Excellence (C190092) 57 National Physical Laboratory (C190094) 58 Newton, Professor John (Director of Health Improvement, Public Health England; and Government’s Government adviser on increasing Covid-19 testing capacity, Public Health England) (C190034)The UK response to covid-19: use of scientific advice88 59 Northumbria Law School, University of Northumbria at Newcastle and the Centre for a Spacefaring Civilization; Northumbria Law School, University of Northumbria at Newcastle and the Centre for a Spacefaring Civilization; Northumbria Law School, University of Northumbria at Newcastle and the Centre for a Spacefaring Civilization; and Northumbria Law School, University of Northumbria at Newcastle and the Centre for a Spacefaring Civilization (C190059) 60 Nuffield Council on Bioethics (C190045) and (C190062) 61 Powis, Professor Stephen (National Medical Director, NHS England and NHS Improvement) (C190043) 62 Public Health England (C190035) 63 RJALogix (C190108) 64 Richardson, Professor Sylvia (Director, MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge) (C190113) 65 Riley, Keith (C190099) 66 Roche Products Ltd (C190085) 67 Royal Academy of Engineering (C190101) 68 Royal Society of Chemistry (C190064) 69 Royal Society of Edinburgh (C190103) 70 SC Johnson Professional (C190070) 71 Safer Medicines Trust (C190079) 72 Schofield, Dr Stan (C190012) 73 Science Policy Research Unit, University of Sussex Business School; Science Policy Research Unit, University of Sussex Business School; Science Policy Research Unit, University of Sussex Business School; Science Policy Research Unit, University of Sussex Business School; Science Policy Research Unit, University of Sussex Business School; and Science Policy Research Unit, University of Sussex Business School (C190081) 74 Shanks, Professor Thomas (C190010) 75 Simpson, Mr Karl (Director, JKS Bioscience Limited) (C190047) 76 Smith, Sam (coordinator, medConfidential) (C190016) 77 Snell, Mr Geoff (C190074) 78 Society for Applied Microbiology (C190083) 79 Taylor, Mr Christopher Marc (Chair, ISRCTN registry) (C190077) 80 techUK (C190022) 81 The Francis Crick Institute (C190072) 82 The Future Vaccine Manufacturing Research Hub (C190106) 83 The Physiological Society (C190061) 84 The Royal Society (C190110) 85 Thimbleby, Prof Harold (C190005) 86 Tissue Solutions (C190053) 87 Tyrzyk, Mr Roger (Country Manager, IDnow) (C190018) 88 UCL Institute for Healthcare Engineering (C190105)89 The UK response to covid-19: use of scienti fic advice 89 UK Collaborative on Development Research (UKCDR) (C190080) 90 UK Reproducibility Network Steering Group; UK Reproducibility Network Steering Group; UK Reproducibility Network Steering Group; UK Reproducibility Network Steering Group; UK Reproducibility Network Steering Group; and UK Reproducibility Network Steering Group (C190063) 91 UK Research and Innovation (C190073) 92 Universities Policy Engagement Network (UPEN) (C190065) 93 University College London (C190055) 94 Vaghjiani, Nikita (Public Affairs Adviser, Royal College of Physicians) (C190007) and (C190025) 95 Vallance, Sir Patrick (C190111) 96 Veneklasen, Mr. Ethan (Head of Advocacy and Communications, ID2020) (C190031) 97 Watt, Dr Andrew (C190109) 98 Wellcome Sanger Institute (C190066) 99 Wilby, Professor Alvin (C190050) 100 Yoti (C190044) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Transparency data List of participants of SAGE and related sub-groups Updated 8 January 2021 Contents 1. Scientific Advisory Group for Emergencies (SAGE) 2. Scientific Pandemic Insights Group on Behaviours (SPI-B) 3. Scientific Pandemic Influenza Group on Modelling (SPI-M) 4. PHE Serology Working Group 5. COVID-19 Clinical Information Network (CO-CIN) 6. Environmental Modelling Group 7. Children’s Task and Finish Working Group 8. Hospital Onset COVID-19 Working Group (HOCI) 9. Ethnicity Subgroup Since SAGE first met in response to COVID-19 on 22 January 2020, it has been grateful for insights from a huge range of sources. At high pace, experts from academic, public sector, industrial and commercial communities have provided the high quality research and information used to formulate advice given to government. Listed here are the names of participants who provided input as experts at one or more meetings, including public servants who acted in an expert capacity. SAGE participants are required to declare any interests relevant to the SAGE meetings they attend. Find out more about participants interests. These meetings are also regularly attended by officials from Her Majesty’s Government. These attendees have not been named. Permission to publish names was requested from all participants. Those who did not give permission have not been named. SAGE also uses advice generated by the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), which is an existing group that advises the government on the threat posed by new and emerging respiratory viruses. Find out more about NERVTAG. Scientific Advisory Group for Emergencies (SAGE) SAGE provides scientific and technical advice to support government decision makers during emergencies. Find out more about SAGE. Sir Patrick Vallance FMedSci FRS Government Chief Scientific Adviser Professor Chris Whitty CB FMedSci Chief Medical Officer and Chief Scientific Adviser, Department of Health and Social Care Professor Rebecca Allen University of Oxford Professor John Aston Chief Scientific Adviser, Home Office Professor Charles Bangham Imperial College London Professor Wendy Barclay FMedSci Imperial College London Professor Jonathan Benger UWE Bristol Fliss Bennee Welsh Government Mr Allan Bennett Public Health England Professor Phil Blythe Chief Scientific Adviser, Department for Transport Professor Chris Bonnell London School of Hygiene and Tropical Medicine Professor Sir Ian Boyd FRSE University of St Andrews Professor Peter Bruce University of Oxford Caroline Cake HDR-UK Professor Andrew Curran Chief Scientific Adviser, Health and Safety Executive Professor Paul Cosford Public Health England Dr Gavin Dabrera Public Health England Professor Sir Ian Diamond FRSE FBA National Statistician, Office for National Statistics Professor Yvonne Doyle CB Medical Director, Public Health England Professor Deborah Dunn-Walters University of Surrey Professor John Edmunds OBE FMedSci London School of Hygiene and Tropical Medicine Professor Sir Jeremy Farrar FMedSci FRS Director, Wellcome Trust Professor Michael Ferguson University of Dundee Professor Neil Ferguson OBE FMedSci Imperial College London Professor Kevin Fenton Public Health England Dr Aidan Fowler FRCS National Health Service England Professor Julia Gog University of Cambridge Professor Robin Grimes Chief Scientific Adviser, Ministry of Defence Dr Ian Hall University of Manchester Dr David Halpern Behavioural Insights Team, Cabinet Office Dido Harding NHSI Dr Jenny Harries OBE Deputy Chief Medical Officer Dr Demis Hassabis FRS Personal capacity as a data scientist Professor Andrew Hayward UCL Professor Gideon Henderson Chief Scientific Adviser, Defra Professor Peter Horby University of Oxford Professor Anne Johnson UCL Dr Indra Joshi NHSx Professor Kamlesh Khunti University of Leicester Dr Ben Killingley UCLH Professor David Lalloo Liverpool School of Tropical Medicine Professor Janet Lord University of Birmingham Professor Dame Theresa Marteau FMedSci University of Cambridge Professor Dame Angela McLean FRS Chief Scientific Adviser, Ministry of Defence Dr Jim McMenamin Health Protection Scotland Professor Graham Medley London School of Hygiene & Tropical Medicine Dr Laura Merson University of Oxford Professor Susan Michie FAcSS FMedSci University College London Professor Christine Middlemiss Chief Veterinary Officer Professor Andrew Morris FMedSci FRSE University of Edinburgh Professor Paul Moss University of Birmingham Professor Carole Mundell Chief Scientific Adviser, Foreign and Commonwealth Office Professor Cath Noakes University of Leeds Dr Rob Orford Welsh Government Professor Michael Parker University of Oxford Professor Sharon Peacock FMedSci Public Health England Professor Alan Penn Chief Scientific Adviser, Ministry of Housing, Communities and Local Government Dr Pasi Penttinen European Centre for Disease Prevention and Control Professor Guy Poppy Chief Scientific Adviser, Food Standards Agency Professor Steve Powis FRCP National Health Service England Dr Mike Prentice National Health Service England Mr Osama Rahman Chief Scientific Adviser, Department for Education Professor Venki Ramakrishnan PRS Ex Officio as Chair of DELVE, convened by the Royal Society Professor Andrew Rambaut FRSE University of Edinburgh Professor Tom Rodden Chief Scientific Adviser, Department for Digital, Culture, Media and Sport Professor Brooke Rogers OBE Kings College London Dr Cathy Roth Department for International Development David Seymour HDR-UK Professor Sheila Rowan MBE FRS FRSE Chief Scientific Adviser, Scotland Alaster Smith Department for Education Professor Iyiola Solanke University of Leeds Dr Nicola Steedman Scottish Government Dr James Rubin Kings College London Professor Calum Semple University of Liverpool Dr Mike Short CBE Chief Scientific Adviser, Department for International Trade Dr Gregor Smith Scottish Government Chief Medical Officer Professor Sir David Spiegelhalter FRS University of Cambridge Professor Jonathan Van Tam MBE Deputy Chief Medical Officer Professor Russell Viner PRCPCH University College London Professor Charlotte Watts CMG FMedSci Chief Scientific Adviser, Department for International Development Dr Rhoswyn Walker HDR-UK Professor Sir Mark Walport FRCP FMedSci FRS UK Research and Innovation Professor Mark Wilcox University of Leeds Professor Lucy Yardley FAcSS University of Bristol and University of Southampton Professor Ian Young Northern Ireland Executive Professor Maria Zambon FMedSci Public Health England Scientific Pandemic Insights Group on Behaviours (SPI-B) SPI-B provides advice aimed at anticipating and helping people adhere to interventions that are recommended by medical or epidemiological experts. Find out more about SPI-B Professor Richard Amlôt Public Health England Professor Imran Awan Birmingham City University Professor Laura Bear London School of Economics Professor Chris Bonnell London School of Hygiene and Tropical Medicine Dr Ellen Brooks-Pollock University of Bristol Professor Val Curtis London School of Hygiene and Tropical Medicine Professor Stephen David Reicher University of St Andrews Dr Laura de Moliere Her Majesty’s Government Professor John Drury University of Sussex Dr Mark Egan Behavioural Insights Team Professor Nicola Fear Kings College London Dr David Halpern Behavioural Insights Team Mr Hugo Harper Behavioural Insights Team Professor Gerard Hastings University of Stirling Professor Ann John Swansea University Dr Atiya Kamal Birmingham City University Dr Daniel Leightley Kings College London Professor Dame Theresa Marteau University of Cambridge Mr Shaun McNally Her Majesty’s Government Professor G.J. Melendez-Torres University of Exeter Professor Susan Michie University College London Dr Gavin Morgan University College London DCC Paul Netherton Devon and Cornwall Police Professor Melissa Parker LSHTM Professor Michael Parker University of Oxford Mr Richard Pemberton British Psychological Society Dr Henry Potts University College London Professor Subhash Pokhrel Brunel University Dr Lorna Riddle Her Majesty’s Government Professor Brooke Rogers Kings College London Dr James Rubin Kings College London Ms Kathryn Scott British Psychological Society Dr Louise Smith Kings College London Professor Iyiola Solanke University of Leeds Mr Hugh Stickland Office for National Statistics Professor Clifford Stott Keele University Dr Tushna Vandrevala Kingston University Professor Russell Viner University College London Dr Jo Waller Kings College London Professor Charlotte Watts Chief Scientific Adviser, Department for International Development Professor Robert West University College London Professor Lucy Yardley University of Bristol and University of Southampton 4 participants have not given permission to be named. Scientific Pandemic Influenza Group on Modelling (SPI-M) SPI-M gives expert advice to the Department of Health and Social Care and wider UK government on scientific matters relating to the UK’s response to an influenza pandemic (or other emerging human infectious disease threats). The advice is based on infectious disease modelling and epidemiology. Find out more about SPI-M. Dr Marc Baguelin Imperial College London Fliss Bennee Welsh Government Dr Paul Birrell Public Health England Dr Joshua Blake University of Cambridge Professor Veronica Bowman Her Majesty’s Government Professor Stephen Brett Imperial College London Dr Ellen Brooks-Pollock University of Bristol Dr Andre Charlett Public Health England Dr Leon Danon University of Exeter Dr Nick Davies London School of Hygiene & Tropical Medicine Professor Daniela DeAngelis University of Cambridge Dr Louise Dyson University of Warwick Professor John Edmunds London School of Hygiene & Tropical Medicine Dr Rosalind Eggo London School of Hygiene & Tropical Medicine Professor Neil Ferguson Imperial College London Dr Thomas Finnie Public Health England Dr Sebastian Funk London School of Hygiene & Tropical Medicine Dr Nick Gent Public Health England Professor Julia Gog University of Cambridge Professor Nicholas Grassly Imperial College London Dr Ian Hall University of Manchester Dr Edward Hill University of Warwick Dr Thomas House University of Manchester Dr Christopher Jewell Lancaster University Professor Mark Jit London School of Hygiene & Tropical Medicine Dr Thibaut Jombart London School of Hygiene & Tropical Medicine Professor Matt Keeling University of Warwick Dr Petra Klepac London School of Hygiene and Tropical Medicine Dr Adam Kucharski London School of Hygiene and Tropical Medicine Dr Jamie Lopez Bernal Public Health England Professor Dame Angela McLean Chief Scientific Adviser, Ministry of Defence Professor Graham Medley London School of Hygiene and Tropical Medicine Dr Lorenzo Pellis University of Manchester Dr Jonathan Read Lancaster University Professor Steven Riley Imperial College London Professor Chris Robertson University of Strathclyde Dr Julie Robotham Public Health England Dr James Rubin Kings College London Dr Michael Tildesley University of Warwick Dr Edwin Van Leeuwen Public Health England Professor Jonathan Van Tam MBE Deputy Chief Medical Officer Dr Marc Warner Faculty, on behalf of NHSx Professor Mark Woolhouse University of Edinburgh Professor Lucy Yardley University of Bristol and University of Southampton Dr Rohini Mathur London School of Hygiene & Tropical Medicine Dr Joe Hilton University of Warwick Professor Wendy Barclay Imperial College London Mr Bill Quilty London School of Hygiene & Tropical Medicine Dr Sam Clifford London School of Hygiene & Tropical Medicine Professor Axel Gandy Imperial College London Dr Samir Bhatt Imperial College London Dr Thomas Crellen University of Oxford Mr Hugo Lewkowicz University of Manchester Dr Carl Whitfield University of Manchester Dr Joshua Firth University of Oxford Dr Gayatri Amirthalingam Public Health England Dr Heather Whitaker Public Health England Dr Kimberley Moore Faculty, on behalf on NHSx Mr Martyn Fyles University of Manchester Dr Elizabeth Fearon London School of Hygiene & Tropical Medicine Professor Deirdre Hollingsworth University of Oxford Dr Robert Challen University of Exeter Dr Gwen Knight London School of Hygiene & Tropical Medicine Dr Helena Stage University of Manchester Dr Tim Lucas Imperial College London Dr Emma Davis University of Oxford Dr Lewis Spurgin University of East Anglia Dr Daren Austin GSK, contributing in personal capacity PHE Serology Working Group The Serology Working Group provides oversight of sero-epidemiology work for COVID-19 in England and partners with international colleagues, including the WHO, on these serological studies. The group monitors and reviews work on the establishment and running of population-based seroprevalence surveys in England. Sero-epidemiology is crucial in informing our understanding of the extent of transmission of SARS-CoV-2, and to monitor how this changes over time. Dr Gayatri Amirthalingam Public Health England Dr Marc Baguelin London School of Hygiene and Tropical Medicine Professor Wendy Barclay Imperial College London Dr Rupert Beale Francis Crick Institute Dr Tim Brooks Public Health England Dr Mary De Silva Wellcome Trust Professor Sir Jeremy Farrar Wellcome Trust Professor Paul Kellam Imperial College London and Kymab Ltd Professor Sharon Peacock Public Health England Dr Mary Ramsay Public Health England Professor Gavin Screaton University of Oxford Dr Edwin Van Leeuwen Public Health England 5 participants have not given permission to be named. COVID-19 Clinical Information Network (CO-CIN) CO-CIN collates clinical information from the usual health care records of people of all ages admitted to hospital in the UK to characterise the clinical features of patients with severe COVID-19 in the UK. Dr Kenneth Baillie University of Edinburgh Dr Annemarie Docherty University of Edinburgh Dr Chris Green University of Birmingham Professor Ewen Harrison University of Edinburgh Professor Peter Horby University of Oxford Professor Peter Openshaw Imperial College London Professor Calum Semple University of Liverpool Professor Wei Shen Lim University of Nottingham Professor Jonathan Van Tam Deputy Chief Medical Officer Environmental Modelling Group The purpose of this group is to identify and steer the role that environmental modelling, data analysis and environmental sampling can play in understanding COVID-19 transmission, with a view to understanding transmission routes, factors that influence this and the impact of environmental and behavioural interventions and mitigations at a mechanistic level. Dr Alexander Allen National Health Service Professor Phil Blythe Chief Scientific Adviser, Department for Transport Dr Andrew Curran Chief Scientific Adviser, Health and Safety Executive Mr Adrian Eggleton National Health Service Dr Shaun Fitzgerald University of Cambridge Dr Ian Hall University of Manchester Dr Ben Killingley UCLH Professor Dame Theresa Marteau University of Cambridge Professor Cath Noakes University of Leeds Professor Alan Penn Chief Scientific Adviser, Ministry of Housing Communities and Local Government Professor Harry Rutter University of Bath Professor Tim Sharpe University of Strathclyde Dr Danielle Solomon National Health Service Professor Mark Wilcox University of Leeds Also attended by representatives of the Royal Academy of Engineering. Children’s Task and Finish Working Group The group provides consolidated scientific health advice to government. Subject advice focuses on the transmission of COVID-19 in children and within schools, ensuring research questions are fed into relevant studies and UKRI/ funders for new funding. Professor Laura Bear London School of Economics Professor Chris Bonnell London School of Hygiene and Tropical Medicine Dr Ellen Brooks-Pollock University of Bristol Professor John Edmunds London School of Hygiene and Tropical Medicine Dr Rosalind Eggo London School of Hygiene and Tropical Medicine Dr Thomas Finnie Public Health England Ms Clementine Fu Her Majesty’s Government Professor Julia Gog University of Cambridge Professor Peter Horby University of Oxford Dr Thomas House University of Manchester Dr Lorna Howarth Her Majesty’s Government Dr Michael J Tildesley University of Warwick Professor G. J. Melendez University of Exeter Professor Matt Keeling University of Warwick Dr Petra Klepac London School of Hygiene and Tropical Medicine Professor Graham Medley London School of Hygiene and Tropical Medicine Dr Gavin Morgan University College London Professor Cath Noakes University of Leeds Professor Michael Parker University of Oxford Dr Lorenzo Pellis University of Manchester Mr Osama Rahman Chief Scientific Adviser, Department for Education Dr Jonathan Read Lancaster University Professor Steven Riley Imperial College London Professor Brooke Rogers Kings College London Dr Edwin Van Leeuwen Public Health England Professor Russell Viner University College London Professor John Watkins Cardiff University and Public Health Wales Professor Charlotte Watts Chief Scientific Adviser, Department for International Development Professor Lucy Yardley University of Bristol and University of Southampton 7 participants have not given permission to be named. Hospital Onset COVID-19 Working Group (HOCI) This working group focuses on hospital-onset COVID-19 infection (HOCI) and its purpose is to provide thought leadership, direction to analysis and precipitate policy change and interventions that lead to a rapid and sustained reduction in the rate of HOCI. Mr Alexander Allen Public Health Registrar Dr Meera Chand Public Health England Dr Aidan Fowler National Health Service England Professor Alison Holmes Imperial College London Dr Russell Hope Public Health England Dr Susan Hopkins Public Health England Professor Nick Lemoine National Institute for Health Research Dr Kiran Loi National Health Service England Ms Ruth May National Health Service England Professor Graham Medley London School of Hygiene and Tropical Medicine Professor Cath Noakes University of Leeds Professor Sharon Peacock Public Health England Dr James Price Imperial College London Dr Lisa Ritchie National Health Service England Dr Julie Robotham Public Health England Professor Calum Semple University of Liverpool Ms Sue Tranka National Health Service England Ms Karen Turner National Health Service England Dr Ben Warne Cambridge University Hospitals Professor Mark Wilcox University of Leeds Ethnicity Subgroup This subgroup advises on COVID-19 risks and impacts for minority ethnic groups. Professor Benjamin Barr University of Liverpool Professor Laura Bear London School of Economics Mr Iain Bell Office for National Statistics Professor Ewan Birney Deputy Director General EMBL Professor Enitan Carrol University of Liverpool Dr Rosalind Eggo London School of Hygiene & Tropical Medicine Professor Kevin Fenton Public Health England Dr Ben Goldacre University of Oxford Dr Jenny Harries Deputy Chief Medical Officer Dr Ewan Harrison Wellcome Sanger Institute & University of Cambridge Professor Julia Hippisley-Cox University of Oxford. Dr Atiya Kamal Birmingham City University Professor S Vittal Katikireddi University of Glasgow Professor Kamlesh Khunti University of Leicester Dr Rohini Mathur London School of Hygiene and Tropical Medicine Professor Melinda Mills University of Oxford Dr Tolullah Oni University of Cambridge Professor Michael Parker Ethox Centre, University of Oxford Dr Julia Pearce King’s College London. Professor Alan Penn Chief Scientific Adviser, Ministry for Housing and Local Government Professor Lucinda Platt London School of Economics and Political Science Professor Henry Potts University College London Mr Osama Rahman Chief Scientific Adviser Department for Education Dr Allison Streetly Public Health England Ms Ruth Studley Office for National Statistics Mr Nizam Uddin The Prince’s Trust Professor Ewen Harrison University of Edinburgh

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