Government does not listen to scientific advice enough outside of emergencies, Sir Chris Whitty has warned.
Speaking at the Covid-19 Inquiry on Thursday, England's chief medical officer said paying more attention to scientific advice would help government to be more prepared for emergencies when they occur.
“Within government, there's sometimes a lack of understanding of science between emergencies,” Whitty said.
“In an emergency, everybody is clamouring for science advice. I've seen this in every emergency I've ever seen. They are desperate to get the scientists in the room.
“Between emergencies, you have to kind of elbow your way in. What I think they need to do is think about the range of issues between emergencies which may, in due course, lead us into problems.”
Whitty, who became the government's chief medical adviser since 2019, just before the Covid-19 pandemic started, said the major flaw in the system is the lack of a Scientific Advisory Group for Emergencies in these in-between periods.
“What you have is large numbers of expert committees doing a perfectly good job on their own, but what you don't have is an overall structure,” Whitty said.
SAGE is convened as needed and brings experts from government, academia and industry together to provide scientific and technical advice to support government decision makers during emergencies.
More permanently, departments have scientific advisory committees and councils which deal with specific issues, such as NERVTAG, an expert Department of Health and Social Care committee which advises the chief medical officer on new and emerging respiratory viruses.
Whitty said the current system is very good at responding to emergencies, with SAGE allowing for “much faster decision-making and much more focused and more radical thinking" during the pandemic “than occurred between emergencies".
“I don't really think, despite what a few people have said, that there was any weakness in the radicalism or change in opinion of SAGE once the emergency was under way,” he added.
The existing system is also good at detecting early signs of events that could realistically occur, he said.
Whitty said this system has a “big weakness”: it makes it difficult to be "radical" in anticipating emergencies, one of the key concerns raised in the inquiry so far.
“I think central to a lot of the debate that [the inquiry has] had over the last several weeks... has been the point that we should have had a more imaginative approach to how we would respond to a major pandemic, whether it was influenza, something like influenza, or indeed something else,” Whitty said.
“But this would require quite radical changes in the way people think. I don't think the current committee system, which is excellent, is designed to inject radicalism of that size into the situation.”
Whitty said this means “the only situation in which [scientific advisory committees] would end up in a radical place… is if they were challenged, usually by political leaders, who said, "This is a very big problem, I want you to think really widely about this”.”
Whitty used Covid-19 lockdowns as an example of how it is “much easier” to be radical “when you've got the whole system operating together”.
He said introducing lockdown rules was a "very radical thing to do".
“I would have thought it would be very surprising – without this being requested by a senior politician, or similar – that a scientific committee would venture, in between emergencies, into that kind of extraordinarily major social intervention, with huge economic and social ramifications."
Asked if his point was that “between emergencies, because there is an absence of common aim, a common imperative to address all aspects of the instant emergency, there is a risk that all the various committees will fail to address sufficiently or think deeply enough about the possible ramifications or the consequences or the steps that have to be taken in relation to a prospective future emergency”, Whitty responded: “That is exactly right.”
"You don’t turn around after 20 years and say 'what a waste of money that was, we haven’t had a war'" – Vallance calls for mindset change on mitigation spending
Appearing at the inquiry later in the day, former government chief scientific adviser Sir Patrick Vallance called for a change in mindset about spending public money on pandemic preparedness, arguing it should not be seen as a waste if scenarios you prepare for do not happen.
Drawing a comparison with defence spending, he said: “You need an army in a country and you don't turn round after 20 years and say, "What a waste of money that was, we haven't had a war". I think it's the same thing [for pandemics].
Vallance, who was the government's chief scientific adviser during the height of the Covid-19 pandemic, said the Vaccine Task Force was a good example of worthwhile spending.
“When we set up the vaccines taskforce, it was very, very possible – even likely – that it would fail. At the end of it, of course, it was a great success and the National Audit Office wrote a report saying what a great success it was,” he said.
“If it had failed, the National Audit Office, I suspect, would have written a report saying what an outrageous waste of public money the whole thing was – and yet both things were totally possible.
“So there is an inherent reluctance to spend money in things which then might fail and look like a disastrous misuse of public money. So I think we need to be much more explicit about why spending public money is important for certain things, even if that then turns out not to be what's needed or used.”
Making a similar point, Whitty called for a change in how officials present risk mitigation options to ministers.
“I think what we need to do is put to political leaders, who absolutely have to make this decision: what is the level of risk that you think we should be insuring for?
“And this should be explicit. I think we've not necessarily always done that, and said to our political leaders... 'this much additional risk mitigation, held in some form or another, will reduce the risk of a future pandemic or other emergency, but it will cost this much and do you, essentially, wish to take that insurance?'”
Whitty said this would mean politicians having to make tough choices between “having an insurance against future events and, for example, investing in immediate emergencies, pressures in the NHS during winter and so on”.
One of the key areas where the UK could invest more in preparedness is the “ability to scale up in the predictable areas”, such as diagnostic skills and PPE, Whitty said.
This inability to scale up “was the weakness that was demonstrated during the early phase in Covid”, he added.
Agreeing, Vallance said the ability to scale up was “really, really important” and properly investing in the the industrial base of areas such as diagnostics, where the UK was much less prepared to scale up compared to Germany, for example, would be key.
Both agreed that being prepared should mean not having a plan for every eventuality, but having generic capabilities to face a range of possible outcomes.