Chapter 9: Scientific and technical advice

Introduction

¶9.1. Throughout the Covid-19 pandemic, decision-makers were fortunate to have at their disposal the expertise and advice of scientists and other experts, many of whom were world leaders in their fields. These scientists and advisers worked extremely long hours and under extraordinary pressure – more often than not unpaid – to provide advice to ministers on how to respond to the virus. They have been criticised by some who disagree with the advice they tendered. That is understandable and perfectly acceptable. Opinions will obviously differ. However, it is not acceptable to launch personal attacks, abuse and threats. The scientists and experts who offered their services to the UK government and devolved administrations during the pandemic deserve the unreserved thanks of the whole of the UK for doing their very best to protect the public in a crisis.

¶9.2. This chapter examines the effectiveness of the advice mechanisms in place across the UK during the pandemic. It considers how advice was generated and communicated to ministers, whether it was subject to adequate scrutiny and challenge, and the extent to which it was properly understood and utilised during the response.

Scientific advice

¶9.3. There were a number of key scientific advisory personnel and groups that played a central part in the response to the pandemic.

Key individuals

Chief Scientific Advisers

¶9.4. The Government Chief Scientific Adviser is a permanent secretary-level post that reports directly to the UK government's Cabinet Secretary and is a UK-wide role.¹¹ INQ000238826_0213 para 659 The office holder is responsible for:

" providing scientific advice to the Prime Minister and members of the Cabinet, advising the government on aspects of science for policy and improving the quality and use of scientific evidence and advice in government".²² INQ000148407_0007 para 14

¶9.5. The Government Chief Scientific Adviser is supported by the Government Office for Science (also known as GO-Science), an office of the Department for Science, Innovation and Technology.³³ INQ000148407_0007 para 14 From April 2018 to March 2023, the Government Chief Scientific Adviser was Professor Sir Patrick Vallance (later Lord Vallance of Balham), a clinical academic with a background in medicine and pharmacology.⁴⁴ INQ000147810_0002 para 2; INQ000238826_0009 para 13 Professor Vallance explained that his role was "primarily about providing science advice to policy makers, rather than advising on science policy itself".⁵⁵ INQ000147810_0003 para 6

¶9.6. The majority of UK government departments also employ a departmental Chief Scientific Adviser who provides scientific advice within the department and across government.⁶⁶ INQ000147810_0004 para 10 The departmental Chief Scientific Advisers were involved in various aspects of the Covid-19 response, including holding roles on the Scientific Advisory Group for Emergencies (SAGE) and its sub-groups and providing support to both the Government Chief Scientific Adviser and the Chief Medical Officer for England (discussed below). The Chief Scientific Adviser at the Department of Health and Social Care is also the head of the National Institute for Health and Care Research.

¶9.7. The devolved administrations adopted different structures for their scientific advisers.⁷⁷ INQ000409589_0003 para 5; INQ000356177_0068 para 260

¶9.8. The Chief Scientific Adviser for Scotland is responsible for sourcing and providing advice in response to requests from the Scottish Government.⁸⁸ INQ000274012_0003 para 7 It is a part-time role, with the holder typically seconded from academia. The post was held by Professor Sheila Rowan from June 2016 to June 2021, followed by Professor Julie Fitzpatrick.⁹⁹ INQ000352847_0002 para 7; INQ000274012_0001 para 1

¶9.9. In addition, the Chief Scientist (Health) for the Scottish Government reported to the Chief Medical Officer for Scotland, who was Dr Catherine Calderwood from April 2015 to April 2020. Professor David Crossman held the position of Chief Scientist (Health) for the Scottish Government from November 2017 to April 2022. However, he played no role in the pandemic response until March 2020, when he was invited to develop a testing strategy in Scotland and was appointed Vice Chair of the Scottish Government Covid-19 Advisory Group.¹⁰¹⁰ INQ000273976_0009 para 39 Professor Crossman observed:

" During the pandemic it was not entirely clear how the Scottish Government wanted to use its Chief Scientific Adviser and CSH [Chief Scientist (Health)]. Certainly, there were times where I was uncertain where I fitted into the structures which provided advice to Scottish Government."¹¹¹¹ INQ000185342_0004 para 13

¶Professor Crossman's limited early involvement in the pandemic response and his evidence that he did not know if he "would have had much traction" had he attempted to be more vocal in raising his concerns demonstrated a lack of engagement by Dr Calderwood with a senior scientific adviser to the Scottish Government at the beginning of the pandemic.¹²¹² INQ000273976_0024 paras 39-41, 133

¶9.10. Professor Peter Halligan was the Chief Scientific Adviser for Wales from March 2018 to February 2022.¹³¹³ INQ000361396_0001 para 2 However, it was Dr Rob Orford, Chief Scientific Adviser (Health) from January 2017, who led the Welsh Government's scientific efforts during the pandemic.¹⁴¹⁴ INQ000190665_0006 para 18; INQ000347980_0008-0009 para 23; INQ000356177_0004 para 13; INQ000361396_0004-0005 paras 15-16 Dr Andrew Goodall (Director General of Health and Social Services in the Welsh Government and Chief Executive of NHS Wales from June 2014 to November 2021, Permanent Secretary to the Welsh Government from September 2021) emphasised the need to formally recognise the Chief Scientific Adviser (Health) for Wales in the UK's preparedness and response systems.¹⁵¹⁵ INQ000396878_0028 para 102 This lack of clarity in the roles and responsibilities of the Chief Scientific Adviser for Wales and the Chief Scientific Adviser (Health) for Wales likely contributed to the UK government's assumption that Professor Halligan should represent Wales at SAGE.¹⁶¹⁶ INQ000300039_0001; INQ000356177_0068 para 260

¶9.11. In Northern Ireland, there was no cross-government chief scientific adviser. Instead, there were two departmental Chief Scientific Advisers. One of these was Professor Ian Young, Chief Scientific Adviser to the Department of Health (Northern Ireland) from November 2015.¹⁷¹⁷ INQ000409589_0002 para 3 Prior to the pandemic, this was a part-time role. During the Covid-19 response it became equivalent to a full-time role, albeit that Professor Young continued to do clinical work and also "some academic work at times".¹⁸¹⁸ Ian Young 7 May 2024 124/14-19 He confirmed that his "remit in relation to the pandemic was not recorded or specified in writing at the outset but evolved during the pandemic".¹⁹¹⁹ INQ000409589_0004-0005 para 11

¶9.12. This lack of clarity in roles did not exist in the UK government. The devolved administrations should consider providing greater clarity as to the specific roles and responsibilities of their Chief Scientific Advisers and Chief Scientific Advisers for Health within pandemic planning to avoid similar confusion at the outset of any future emergency.

Chief Medical Officers

¶9.13. The Chief Medical Officer for England is the UK government's principal medical adviser. They provide public health and clinical advice to ministers in the Department of Health and Social Care, the Prime Minister, other ministers and senior officials across government in England.²⁰²⁰ INQ000248853_0005, 0008 paras 2.2, 4.1-4.2 Since October 2019, the post has been held by Professor Sir Christopher Whitty, an epidemiologist and physician specialising in infectious diseases.²¹²¹ Professor Whitty was also Chief Scientific Adviser for the Department of Health and Social Care and Chief Executive Officer of the National Institute for Health and Care Research from January 2016 to August 2021. INQ000248853_0005 para 2.1; 'Chief Medical Officer and Expert Adviser: Professor Chris Whitty', GOV.UK (https://www.gov.uk/government/people/christopher-whitty#biography; INQ000591916)

¶9.14. During the pandemic, Professor Whitty was supported by three Deputy Chief Medical Officers for England.²²²² INQ000269203_0005 para 1.6; INQ000251906_0001 para 3; INQ000248853_0009 para 4.4 Professor Whitty told the Inquiry that he and the Deputy Chief Medical Officers had "considerable mutual trust in one another's judgement".²³²³ INQ000251645_0012 para 2.16 He also "spoke several times each day" with Professor Vallance, whom he described as "exceptionally level headed and collegiate".²⁴²⁴ INQ000273955_0004 para 13; INQ000251645_0013 para 2.18 Professor Vallance stated that he felt "extremely fortunate" to work with Professor Whitty, with whom he felt "able to discuss everything".²⁵²⁵ INQ000273955_0004 para 13 Both said that they were aligned in their advice on the vast majority of occasions and that they were able to explain the reasons for any disagreements to decision-makers.²⁶²⁶ INQ000273955_0006 para 20; INQ000251645_0027 paras 2.66-2.67 Boris Johnson MP, Prime Minister from July 2019 to September 2022, remarked that Professors Vallance and Whitty:

" did an excellent job of presenting the science in a way that was most useful to political decision-makers".²⁷²⁷ INQ000255836_0022 para 95

¶9.15. Under the devolution settlements, health is a devolved responsibility.²⁸²⁸ INQ000251645_0030 para 2.78 Each devolved administration therefore has its own Chief Medical Officer.

¶9.16. During a public health emergency in Scotland, the Chief Medical Officer for Scotland's role is akin to those of both the Chief Medical Officer for England and the Government Chief Scientific Adviser. They are the most senior adviser to the Scottish Government on health matters and the main translator of scientific information and debate for decision-makers.²⁹²⁹ INQ000273978_0019-0020 para 81 Dr Calderwood resigned in April 2020 and was succeeded on an interim basis by Professor (later Sir) Gregor Smith, who had been Deputy Chief Medical Officer for Scotland from April 2015.³⁰³⁰ INQ000273978_0005 para 24 Professor Smith was confirmed in the post permanently in December 2020.

¶9.17. Dr (later Sir) Frank Atherton was Chief Medical Officer for Wales from August 2016.³¹³¹ INQ000391115_0002 para 4 Although he was a Welsh Government staff member, he told the Inquiry that he operated with a high degree of independence and was able to offer guidance without being constrained by government policy or direction.³²³² Frank Atherton 4 March 2024 3/5-5/4; INQ000391115_0002-0003 para 6 He told the Inquiry that his advice to the Welsh Cabinet was based on a range of sources, including SAGE outputs and information from the Joint Biosecurity Centre, the Welsh Government's Knowledge and Analytical Services, the Chief Economic Adviser in Wales and the Technical Advisory Group/Technical Advisory Cell.³³³³ INQ000391115_0022, 0032 paras 87, 128 From March 2020, he regularly attended Welsh Cabinet meetings to give oral updates and advice, in addition to providing written advisory notes, which began to be published from May 2020 and were incorporated into Cabinet papers.³⁴³⁴ INQ000391115_0032-0033 paras 127, 130 He emphasised the trust and collaboration he had with his colleagues, especially Dr Orford.³⁵³⁵ INQ000391115_0032 para 128

¶9.18. Professor Sir Michael McBride has been the Chief Medical Officer for Northern Ireland since September 2006. During the pandemic, he was an official within the Department of Health (Northern Ireland) and, as a member of the department's senior management team and departmental board, was part of its management structure.³⁶³⁶ Michael McBride 10 May 2024 5/19-24 Prior to the pandemic, he had concurrently held the offices of Permanent Secretary to the Department of Health (Northern Ireland) and Chief Medical Officer for Northern Ireland.³⁷³⁷ Michael McBride 10 May 2024 3/8-14

¶9.19. Professor McBride told the Inquiry that he had responsibility for the provision of medical advice and also policy responsibility:

" for all aspects of public health, so that would have included health protection, health improvement. I also had policy responsibility for quality and safety and policy, so as that pertained to, for instance, serious adverse incidences, investigation processes and policy, complaints policy. I also had policy responsibility for research within health and social care … I also had a number of other roles within that, including sponsorship responsibilities on behalf of the department which I exercised in relation to the Public Health Agency."³⁸³⁸ Michael McBride 10 May 2024 7/19-8/12

¶During the pandemic, Professor McBride's role also extended to the operational aspects of the response.³⁹³⁹ INQ000137326 He accepted that he was not functionally independent of the Department of Health (Northern Ireland). He told the Inquiry that he was "conscious it almost seems like I'm trying to wear two hats, you know, both at the same time".⁴⁰⁴⁰ Michael McBride 10 May 2024 5/13-25, 6/24-25 While he accepted that he was "not independent in terms of policy responsibility", he emphasised that he was independent in his "professional advisory role".⁴¹⁴¹ Michael McBride 10 May 2024 4/24-5/10

¶9.20. In the context of the pandemic, it is difficult to see how Professor McBride's roles in a smaller devolved administration could be decoupled from each other in practice or how he could provide advice to the Northern Ireland Executive Committee on the response to the pandemic without that advice being informed by the position and interests of the Department of Health (Northern Ireland).

¶9.21. It is also noteworthy that, in the specific context of power-sharing in Northern Ireland, the Department of Health (Northern Ireland), like all Executive departments, operates with a high degree of operational independence. As described throughout this Report, the response to the pandemic was driven by the Department of Health (Northern Ireland) rather than representing a true cross-government effort. The Department of Health (Northern Ireland), including Professor McBride, was at times protective of its centrality to the response and regarded the Northern Ireland

¶Executive Committee as an obstacle to that response.⁴²⁴² INQ000309178; INQ000023229; INQ000438904; see also comments by Michelle O'Neill MLA (deputy First Minister of Northern Ireland from January 2020 to February 2022) recorded in a note of the meeting of 30 March 2020; INQ000065748_0022-0023; INQ000259487; INQ000438173_0006 para 21; INQ000065721_0008; INQ000411509_0022-0023 paras 102-104; Jenny Pyper 2 May 2024 195/13-196/24, 199/18-200/2; INQ000412903_0058 para 175; INQ000308444_0003Show full note It was also perceived as being "in a very powerful position" throughout the pandemic.⁴³⁴³ INQ000408058_0030-0031 para 74

¶9.22. It would have been preferable for the Northern Ireland Executive Committee to have had access to its own source of medical advice which was independent of any government department. This might have helped to produce an earlier cross-government understanding of how the pandemic was likely to develop, adequate planning across government and a more effective cross-government response.

¶9.23. Reforming the office of Chief Medical Officer for Northern Ireland so that it is independent of the Department of Health (Northern Ireland) (and of any other Executive department) would enable the Chief Medical Officer for Northern Ireland to provide advice without the risk of being perceived as representing the interests of a single department or minister. It would also ensure that scientific advice is immediately and directly available to the wider Executive Committee.

Recommendation 1: Chief Medical Officer for Northern Ireland

¶The Department of Health (Northern Ireland) should reconstitute the role of the Chief Medical Officer for Northern Ireland as an independent advisory role. The Chief Medical Officer for Northern Ireland should not have managerial responsibilities within the Department of Health (Northern Ireland).

¶9.24. In June 2024, the Northern Ireland Executive established the post of Chief Scientific and Technology Adviser and a Northern Ireland Science and Technology Advisory Network. The Executive Office told the Inquiry that the latter will be chaired by the Chief Scientific and Technology Adviser and will provide a vehicle for delivering collective advice to the Northern Ireland Executive.⁴⁴⁴⁴ UK Covid Inquiry: Module 2C. Closing submission on behalf of The Executive Office, The Executive Office, 6 June 2024, pp17-18, para 57 (https://covid19.public-inquiry.uk/documents/module-2c-closing-statement-on-behalf-of-the-executive-office- dated-06-06-2024) This is a welcome recognition of the need for formal and structured scientific advice across government.

¶9.25. Close working relationships between scientific advisers are essential for an effective emergency response. They must be able to debate relevant issues freely, challenge one another and resolve any differences in opinion. The evidence heard by the Inquiry shows that the Chief Scientific Advisers, Chief Medical Officers and their deputies in all four nations of the UK worked exceptionally well together throughout the Covid-19 response. Such strong working relationships must be a feature of any future emergency.

Scientific advisory groups

The Scientific Advisory Group for Emergencies

¶9.26. SAGE brings together independent research and analysis from a range of experts across government, academia and industry.⁴⁵⁴⁵ INQ000148407_0018 para 49 It does not formulate policy or undertake a delivery role, but provides a single source of scientific and technical advice to support decision-makers across the UK in the event of a civil emergency.⁴⁶⁴⁶ INQ000148407_0017 para 45; INQ000238826_0010 para 17 As a UK-wide technical resource, SAGE provides scientific advice that is relevant to all four nations of the UK. It engages on issues of national or regional difference only where there is "a strong technical (e.g. epidemiological) rather than political or operational reason to do so".⁴⁷⁴⁷ INQ000251645_0021 para 2.45 The exact role it plays is determined by the emergency in question, but its advice is "limited to scientific matters and is a cross‑disciplinary consensus view based on available evidence at the time".⁴⁸⁴⁸ INQ000252449_0007 para 2.3

¶9.27. During the Covid-19 response, SAGE was the primary mechanism through which scientific advice was channelled into government. However, it was not designed for the breadth or duration of the role that it performed during the response.⁴⁹⁴⁹ INQ000236243_0035 para 123 Prior to the pandemic, crisis management structures (including SAGE) were typically utilised as "short-term response vehicles" for discrete and short-lived emergencies.⁵⁰⁵⁰ INQ000236243_0033 para 113 Between January 2020 and February 2022 – the longest period for which SAGE had been convened since its inception – it met on 105 occasions.⁵¹⁵¹ INQ000252449_0007 para 2.5 During that time, more than 350 scientists participated in or contributed to its work.⁵²⁵² INQ000147810_0020 para 64

¶9.28. SAGE's first precautionary meeting was convened by Professor Vallance and held on 22 January 2020.⁵³⁵³ INQ000061509 This and all subsequent meetings were chaired by Professor Vallance. As Covid-19 was a health-related emergency, Professor Whitty acted as Co-Chair for the duration of the response.⁵⁴⁵⁴ INQ000251645_0012-0013 para 2.17 The chairs rapidly assembled a group of experts from key disciplines, including medicine, epidemiology, virology and behavioural science.⁵⁵⁵⁵ INQ000252449_0007 para 2.6 They were also assisted by specialists from across government, including Public Health England and the Office for National Statistics, and by departmental Chief Scientific Advisers.⁵⁶⁵⁶ INQ000148407_0024 para 73 SAGE also expanded its structure through the establishment of sub-groups, each of which had its own disciplinary expertise, such as the environment, ethnicity or social care.⁵⁷⁵⁷ INQ000252449_0009-0011 para 2.10

¶9.29. The established system by which SAGE reported to COBR did not, however, continue beyond the first few months of the pandemic. In mid-March 2020, Ministerial Implementation Groups were set up by the UK government. Professor Vallance noted that, for a period between March and May 2020, while scientific advice was "presented directly into regular meetings in No. 10 [10 Downing Street]", it was "less clear how science advice was feeding into" the Ministerial Implementation Groups.⁵⁸⁵⁸ INQ000238826_0012 para 23 The replacement of the Ministerial Implementation Groups with the Covid-19 Strategy Committee (Covid-S), the Covid-19 Operations Committee (Covid-O) and the Covid-19 Taskforce in May 2020 "helped to simplify the structure".⁵⁹⁵⁹ INQ000238826_0012 para 23 Professor Vallance told the Inquiry:

" [I]t narrowed down to a more sensible system, and that then improved quite a lot over time in terms of them being able to ask better questions as well and frame them more appropriately."⁶⁰⁶⁰ Patrick Vallance 20 November 2023 113/2-7

¶9.30. In future emergencies, a consistent and clear structure and reporting line for SAGE should be established from the outset. As Professor Vallance noted:

" [T]here needs to be a system that swings into action immediately … a structure which will stay constant … properly populated with people who can both look at the operational needs that come out of that, so they can co-ordinate that across Whitehall, and have enough scientific understanding and data analysis understanding to be able to absorb the evidence and understand the implications."⁶¹⁶¹ Patrick Vallance 20 November 2023 113/7-15; see also INQ000238826_0012 para 23

¶9.31. Those who attended SAGE meetings did so in the capacity of either 'participant' or 'observer'. Participants were expert government advisers or external scientific advisers. They actively engaged in the debates that took place. Observers were representatives of government departments or agencies and did not contribute to meetings other than to clarify a point or ask a question. However, they were expected to disseminate information to their home organisation.⁶²⁶² INQ000252449_0012-0013 para 2.15 This distinction was necessary in order to prevent the number of participants in SAGE from becoming unwieldy, while balancing the need for others to be fully aware of the latest scientific advice.

¶Figure 39: Organogram showing SAGE and its sub-groups

¶Source: INQ000303289

¶9.32. One of these sub-groups, the Scientific Pandemic Insights Group on Behaviours (SPI-B), had its origins in the Scientific Pandemic Influenza Group on Behaviour and Communications (SPI-B&C), which was established in response to the 2009 to 2010 H1N1 influenza pandemic ('swine flu'). SPI-B provided independent, expert, social and behavioural science advice to SAGE.

¶9.33. When SPI-B was established in February 2020, the 'C' was removed on the basis that communications were considered to be operational matters for government.⁶³⁶³ James Rubin 18 October 2023 9/5-10/14; INQ000052045_0004 In this respect, there appeared to have been some misunderstanding as to the difference between the behavioural science underpinning communication strategies (which should have remained a matter for SPI-B and SAGE) and the communication itself (which was properly a matter for government). There were also departmental behavioural and communications teams within both the Cabinet Office and 10 Downing Street, including the Cabinet Office Behavioural Insights Team. This, on occasion, resulted in a fragmented approach, a lack of accountability with regard to advice (eg on 'behavioural fatigue'; see Chapter 4: Realisation and lockdown, in Volume I), under-utilisation of SPI-B and tensions between the various teams. These tensions sometimes spilled into the public domain.⁶⁴⁶⁴ INQ000273901_0050, 0072; INQ000197166; INQ000197167 In future, there should be clarity on the roles to be played by the different bodies.

¶9.34. The Inquiry notes that Dame Deirdre Hine's July 2010 review of the UK response to the swine flu pandemic raised issues concerning SPI-B&C not being used as effectively as it might have been.⁶⁵⁶⁵ The 2009 Influenza Pandemic: An Independent Review of the UK Response to the 2009 Influenza Pandemic, Dame Deirdre Hine, July 2010, pp73-74, para 4.57 (https://assets.publishing.service.gov.uk/media/5a7975f1ed915d0422068a10/ the2009influenzapandemic-review.pdf; INQ000022705) This problem appears to have arisen again. The recommendation from Dame Deirdre Hine bears repetition: relationships ought to be built between the relevant teams to ensure the effective use of SPI-B's expertise in addition to internal government resources. Similarly, the expertise of SPI-B and government behavioural science teams ought to be drawn upon in pandemic planning.

¶9.35. In addition, SAGE drew upon the expertise of two pre-existing expert committees of government departments: the Scientific Pandemic Infections Group on Modelling (SPI-M), which was redeployed as a formal sub-group of SAGE for the duration of the pandemic, and the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), which remained separate from SAGE (see below). Both bodies performed a vital role in the pandemic response and they worked together well. In non-pandemic periods, SPI-M provides expert advice on infectious disease analysis, modelling and epidemiology. In an emergency, SPI-M's Operational sub‑group (SPI-M-O) can be stood up, as happened with the Covid-19 response.⁶⁶⁶⁶ INQ000144792_0016 para 157

¶9.36. NERVTAG is an expert committee of the Department of Health and Social Care. It provides independent scientific risk advice to the Chief Medical Officer for England – and, through them, to ministers, the Department of Health and Social Care and other government departments – on the threat posed by new and emerging respiratory viruses and options for their management. Although the Department of Health and Social Care's protocol indicated that NERVTAG would stand down in an emergency, a decision was taken that it would remain operative to harness its expertise.⁶⁷⁶⁷ INQ000226562_0010, 0019-0020 paras 40, 78. For a summary of the work of NERVTAG during the pandemic, see, for example, INQ000221969 With Professor Sir Peter Horby (Professor of Emerging Infectious Diseases and Global Health at the University of Oxford) as its Chair from May 2018, NERVTAG subsequently took commissions from SAGE, the Department of Health and Social Care and Public Health England. SAGE, however, remained responsible for the coordination of scientific advice, including from NERVTAG.⁶⁸⁶⁸ INQ000226562_0010-0011 para 41

¶9.37. Effective communication and collaboration between the advisory groups (whether permanent or ad hoc) are crucial elements in developing interdisciplinary evidence. There were some good examples of collaboration – for instance, in the relationship between NERVTAG and SPI-M-O.⁶⁹⁶⁹ INQ000260643_0009-0010 para 3.4 However, many groups were convened only during emergencies or created during the pandemic. Consequently, relationships had to be built without pre-existing foundations of interdisciplinary knowledge. For example, Professor Graham Medley (Professor of Infectious Disease Modelling at the London School of Hygiene & Tropical Medicine and Co-Chair of SPI-M-O from January 2020 to February 2022) described links between SPI-B and SPI-M-O as "non-existent initially".⁷⁰⁷⁰ INQ000260643_0009-0010 para 3.4 Collaboration relied upon individuals within SAGE, NERVTAG and the various sub-groups and committees.

¶9.38. The Inquiry was concerned to learn that this issue resurfaced in the 2022 mpox (previously known as monkeypox) outbreak, during which "the modellers, the clinicians and the behavioural experts were somewhat siloed".⁷¹⁷¹ INQ000217363_0012 para 44 This is indicative of a systemic issue. To address this, the chairs of these groups should jointly consider and keep under review mechanisms to promote effective collaboration, including creating cross-membership between sub-groups and the sharing of relevant materials.

¶9.39. The SAGE mechanism, however, did work well. Under intense and sustained pressure, it provided high-quality scientific advice throughout the Covid-19 pandemic. Nevertheless, while fundamental change is not required, the unprecedented duration and complexity of the Covid-19 pandemic exposed several weaknesses within SAGE's structure. As discussed further below, these related to the recruitment and selection of its participants, attendance at meetings, the process for commissioning advice, the preparation and communication of advice, and resourcing and pastoral support.

¶The devolved administrations' attendance at SAGE meetings

¶9.40. The devolved administrations were often represented at SAGE by their Chief Scientific Advisers, Chief Medical Officers or a senior official – some of whom attended as participants and others as observers, depending on their role.⁷²⁷² INQ000148407_0024 para 75; see, for example, INQ000061509_0002; INQ000346264_0006-0007 para 19

¶9.41. Dr Jim McMenamin, Head of Infections Service and Strategic Incident Director for Covid-19 at Public Health Scotland, attended SAGE from its first meeting on 22 January 2020.⁷³⁷³ INQ000274125_0006-0007 Table 2 Although Professor Halligan was invited on behalf of Wales, he did not attend, as health was not part of his remit.⁷⁴⁷⁴ INQ000361396_0004-0005 paras 15-16 Dr Orford contacted the Government Office for Science Secretariat and asked to be provided with the "read-out from the SAGE meeting" and for clarity on the attendance of the devolved administrations.⁷⁵⁷⁵ INQ000300039_0003 On 5 February 2020, he queried why the invitation to SAGE was extended to Professor Halligan only. He considered this to be inadequate from a health standpoint and it was something he had previously queried with Professor Halligan in August 2019.⁷⁶⁷⁶ INQ000300039_0001; INQ000298960 It is unfortunate that this had not been clearly resolved by the onset of the pandemic. Professor Halligan's office should have been more proactive in respect of the first meetings of SAGE. Either a representative from his office should have attended those meetings, or he should have sought permission to send Dr Orford (or a representative) from the outset. On 11 February 2020, Dr Orford attended SAGE as an observer. This was the first time a representative of the Welsh

¶Government attended a SAGE meeting on Covid-19. From 5 March 2020, Dr Orford was formally recognised as a participant.⁷⁷⁷⁷ INQ000356177_0004 paras 14-16

¶9.42. The Northern Ireland Executive was not invited to be represented at the first meeting of SAGE. Professor McBride said he attended a number of SAGE meetings as an observer from 7 February 2020 onwards and the Department of Health (Northern Ireland) confirmed that a "trainee medical adviser" observed some of them.⁷⁸⁷⁸ Michael McBride 10 May 2024 28/3-29/16 However, neither the content of the SAGE meetings nor any underlying papers were synthesised for ministers in Northern Ireland. It was not until 27 April 2020, when Professor Young established the Strategic Intelligence Group (see below), that the capacity to produce regular Northern Ireland-specific analyses existed.⁷⁹⁷⁹ Ian Young 7 May 2024 132/11-133/20; INQ000409589_0016-0017 para 47 Professor Young was on leave due to illness from 12 February to 23 March 2020.⁸⁰⁸⁰ INQ000409589_0004-0005 para 11 Upon his return, he joined SAGE as a full participant and attended meetings from 29 March.⁸¹⁸¹ INQ000409589_0012-0013 para 34 According to Professor Young, he was keen to emphasise at SAGE that Northern Ireland, "by virtue of geographical separation from [Great Britain,] was a separate epidemiological unit (as part of the island of Ireland)".⁸²⁸² INQ000409589_0014 para 40

¶9.43. Professor Vallance confirmed that the devolved administrations were invited to every SAGE meeting from 11 February 2020.⁸³⁸³ INQ000238826_0214 para 663 The meetings were also not the only mechanism by which the devolved administrations engaged with SAGE's advice. For example, from 24 January 2020 onwards, Professor Whitty met with his counterparts "on a frequent and regular basis".⁸⁴⁸⁴ INQ000251645_0029-0030 paras 2.75-2.77; Christopher Whitty 21 November 2023 39/22-24 In addition, the devolved administrations were routinely represented at COBR, which was a key channel for sharing scientific advice.

¶9.44. It is surprising that representatives from each of the devolved administrations were not invited to attend SAGE from the outset of the pandemic. The processes by which the devolved administrations subsequently secured appropriate representation and gained access to SAGE lacked clarity, which resulted in disparities in access to information that might have informed their decision-making. As Professor Vallance commented, there is:

" a good case to be made for representatives of Devolved Administrations being invited to SAGE discussions that concern their countries from the first meeting".⁸⁵⁸⁵ INQ000238826_0214 para 664

¶9.45. SAGE is not intended to be a geographically representative body.⁸⁶⁸⁶ INQ000274125_0002 para 6 It brings together the scientific experts who are best qualified for a specific emergency, regardless of their location. Ensuring that the devolved administrations have access to SAGE must not overwhelm its membership. The Inquiry recommends, therefore, that a small number of representatives from each of the devolved administrations should be invited to attend meetings of SAGE and its sub-groups from the outset of any future emergency. The devolved administrations should be consulted about who is best placed to attend, but SAGE should determine their status as participant or observer.

Recommendation 2: Attendance of the devolved administrations at SAGE meetings

¶The Government Office for Science (GO-Science) should invite the governments of Scotland, Wales and Northern Ireland to nominate a small number of representatives to attend meetings of the Scientific Advisory Group for Emergencies (SAGE) from the outset of any future emergency. The status of those representatives as either 'participant' or 'observer' should depend upon their expertise and should be a matter for SAGE to determine.

Scientific advisory groups for the devolved nations

¶9.46. The Inquiry heard that the devolved administrations depended heavily on the scale and breadth of SAGE's expertise throughout the pandemic, but most particularly in the early months. As the pandemic progressed, the devolved administrations utilised or set up their own advisory scientific committees. These fed information into SAGE while applying its advice to their own local circumstances.

¶The Scottish Government Covid-19 Advisory Group

¶9.47. Although SAGE was a useful source of evidence and scientific consensus from which Dr Calderwood could develop advice for the Scottish Government, Nicola Sturgeon MSP (First Minister of Scotland from November 2014 to March 2023) had two concerns about the operation of SAGE in the initial weeks of the pandemic. The first was that SAGE's advice was insufficiently tailored to Scottish circumstances. The second was that there was no opportunity for Ms Sturgeon or other Scottish Government ministers to ask questions of SAGE participants directly to better understand the advice.⁸⁷⁸⁷ INQ000339033_0033-0034 para 88; INQ000273978_0009 para 41 For these reasons, she considered it appropriate to establish a Scottish advisory body to interpret and supplement the advice available to the Scottish Government from SAGE. She asked Dr Calderwood to establish such a group, which became the Scottish Government Covid-19 Advisory Group.⁸⁸⁸⁸ INQ000339033_0033-0034 para 88

¶9.48. Professor Andrew Morris, Professor of Medicine at the University of Edinburgh, chaired the Scottish Government Covid-19 Advisory Group. Its members were invited to serve by Dr Calderwood, and later by Professor Smith, and they were chosen on the basis of scientific or technical expertise. The group's membership included public health experts, clinicians, and academics spanning the disciplines of epidemiology, virology, public health, behavioural science, global health, medicine and statistical modelling.⁸⁹⁸⁹ INQ000339033_0034 paras 89-90; INQ000273978_0016 paras 65-66

¶9.49. The Scottish Government Covid-19 Advisory Group met regularly for the first few months and senior decision-makers within the Scottish Government expressed satisfaction with its work. Ms Sturgeon commented:

" [It] was a reliable and effective source of advice, and it worked well – both in terms of the advice it provided directly and through its sub-groups, either on its own initiative or commissioned, and in its reciprocity with SAGE, which enabled advice from the latter to be interpreted for the Scottish context."⁹⁰⁹⁰ INQ000339033_0036 para 95

¶A principle of reciprocity was agreed between SAGE and the Scottish Government Covid-19 Advisory Group to ensure that the two groups were given access to each other's papers.⁹¹⁹¹ INQ000215468_0007 para 20

¶9.50. Although the Scottish Government Covid-19 Advisory Group's role was akin to that of SAGE, it had fewer resources and a less established presence in government.⁹²⁹² INQ000274154_0054 para 155 Competing priorities meant that Professor Smith attended just 8 of the 40 meetings in 2020 and others would regularly deputise on his behalf.⁹³⁹³ INQ000147306 His lack of attendance in person became an issue of concern for members, with the minutes of the meeting on 20 April 2020 recording that Professor Morris "will send Gregor [Professor Smith] an email about the group".⁹⁴⁹⁴ INQ000217536_0003 Professor Morris accepted that "you could conclude" that:

" in order to engage with that expertise properly or appropriately, it would have been necessary for the CMO [Chief Medical Officer] to have attended the meetings and listened to the views and expert opinions of that wide variety of experts".⁹⁵⁹⁵ Andrew Morris 23 January 2024 212/7-12

¶9.51. The Scottish Government also received advice from other organisations, such as Public Health Scotland, the four Chief Medical Officers, Scottish territorial health boards, Scottish local authorities, primary care services, the Scottish business community and the independent care sector.⁹⁶⁹⁶ INQ000346264_0025 para 100 This meant that the group often struggled to secure direct access to senior decision-makers. Professor Morris reflected:

" Ideally, the rapid assembly of the C19AG [Scottish Government Covid-19 Advisory Group] would have been part of mature and pre-existing advisory structures, with deep integration across the four nations."⁹⁷⁹⁷ INQ000346264_0044-0045 para 195

¶The Technical Advisory Cell and the Technical Advisory Group (Wales)

¶9.52. The Technical Advisory Cell and the Technical Advisory Group were central to the Welsh Government's response to the pandemic, providing crucial scientific advice and expertise to inform key public health decisions. The Technical Advisory Cell, established on 27 February 2020, provided a secretariat, coordination and leadership function for the Technical Advisory Group.⁹⁸⁹⁸ INQ000356177_0001-0002 paras 4-5; INQ000068498; INQ000068504 By the end of March 2020, the Technical Advisory Group was operational as a distinct body, separate from the Technical Advisory Cell and comprised experts from various fields.⁹⁹⁹⁹ INQ000356177_0005, 0011 paras 21, 40 The group's role was to:

" collate, create and mobilise knowledge related to the pandemic, including Welsh specific information, to support decision making within the Welsh Government by Welsh Ministers".¹⁰⁰¹⁰⁰ INQ000356177_0003-0004 para 12

¶9.53. Technical Advisory Group meetings were scheduled to review SAGE's outputs and interpret them in a Welsh context.¹⁰¹¹⁰¹ INQ000356177_0021 para 75; Rob Orford 4 March 2024 91/6-18. From March 2020 to May 2022, the group held 149 meetings (INQ000356177_0017 para 57). Dr Orford was appointed Chair to both the cell and the group, due to the health-related nature of the Covid-19 emergency.¹⁰²¹⁰² INQ000356177_0004 para 13. At the beginning of March 2020, Felicity Bennée joined as Co-Chair (INQ000356177_0012 para 45).

¶9.54. By October 2020, the Technical Advisory Group had established nine sub-groups. All sub-group chairs were members of the main group and, where relevant, a member from each sub-group also participated in the equivalent SAGE sub-group.¹⁰³¹⁰³ INQ000312569_0006-0008 paras 8-9. The sub-groups were the All-Wales National Modelling Forum, Policy Modelling, Research, Socio-Economic Harms, International Intelligence, Virology and Testing, Children and Schools, Risk Communication and Behavioural Insights, and Environmental Science (INQ000356177_0013-0017 paras 53-56, Table 1). Subject matter experts from Public Health Wales were also members of the Technical Advisory Group and its sub-groups.¹⁰⁴¹⁰⁴ INQ000235212_0034 para 110

¶9.55. Mark Drakeford MS, First Minister of Wales from December 2018 to March 2024, believed that the work of the Technical Advisory Cell and the Technical Advisory Group was extremely valuable.¹⁰⁵¹⁰⁵ Mark Drakeford 13 March 2024 28/14-29/2. The Technical Advisory Cell has now become a permanent division within the Health, Social Care and Early Years Group in Wales. In Chapter 2: The emergence of Covid-19, in Volume I, the Inquiry concludes that the Welsh Government was slow to respond to Covid-19 in January and February 2020. Dr Orford suggested that having a Technical Advisory Cell (or similar structure) in place earlier could have led to a different reaction from January 2020 onwards.¹⁰⁶¹⁰⁶ INQ000390618_0058 para 177

¶The Strategic Intelligence Group (Northern Ireland)

¶9.56. On 27 April 2020, Professor Young established the Strategic Intelligence Group in Northern Ireland.¹⁰⁷¹⁰⁷ INQ000409589_0016-0017 para 47; INQ000183441 Prior to that point, there had been no advisory group to consider SAGE papers and output in the Northern Ireland context and specifically for a ministerial audience. Professor Young explained that advice from the Strategic Intelligence Group aligned closely with advice emanating from SAGE, but took account of the circumstances in Northern Ireland, including its cultural and geographical features, the spread of the virus and the response to it throughout the island of Ireland.¹⁰⁸¹⁰⁸ INQ000409589_0017 para 48 The delay in establishing such a body is symptomatic of a problem described throughout this Report: the lack of a coherent, cross-government response in Northern Ireland to the emerging pandemic. Rather, the response was driven by the Department of Health (Northern Ireland) and individuals within it. As a result, Professors Young and McBride had a great deal of control over the flow of information and advice to ministers across government in Northern Ireland. One particularly unfortunate consequence was that the establishment of Northern Ireland-specific scientific advice had to await the return of Professor Young from a period of absence.

¶9.57. Professor McBride observed that, "in all small jurisdictions, one of the problems is that you have too many single critical points of failure potentially". He identified this as a possible point of learning for the future.¹⁰⁹¹⁰⁹ Michael McBride 10 May 2024 30/15-19 The problem of having so few people in critical positions extends further than potential points of failure – there were very few, if any, individuals capable of providing informed challenge. In this context, Professor Young highlighted the importance of the work of the Strategic Intelligence Group. He considered that it would be desirable to stand up a similar body at an earlier stage during any future pandemic or health emergency to serve a similar function.¹¹⁰¹¹⁰ INQ000409589_0017-0018 para 50 The Inquiry agrees on the need for nation-specific scientific advisory bodies in each of the devolved administrations to advise their respective governments. These structures should be ready to be activated at the outset of any future pandemic.

The role of public health bodies in providing advice

England

¶9.58. Public Health England was established in April 2013 as an executive agency of the Department of Health (known from January 2018 as the Department of Health and Social Care). Public Health England provided the infrastructure for health protection in England, including the investigation and management of local and nationwide outbreaks of infectious disease.¹¹¹¹¹¹ INQ000273878_0006-0007 paras 19, 20 It was effectively abolished by the UK government

following the commencement of the pandemic and replaced by the UK Health Security Agency in October 2021.¹¹²¹¹² The UK Health Security Agency brought together the staff and capabilities of NHS Test and Trace and the health protection, clinical and scientific elements of Public Health England (INQ000251906_0007 para 27). Some parts of Public Health England's remit, such as those relating to preventing ill health and reducing health disparities, were transferred to the Department of Health and Social Care. The UK Health Security Agency was established to provide the UK's "permanent standing capacity to prepare for, prevent and respond to infectious diseases and other threats to health".¹¹³¹¹³ INQ000251906_0007 paras 27-28. As noted in the Inquiry's Module 1 Report: "Its creation to fulfil this purpose demonstrated that there was no such effective permanent standing capacity prior to the pandemic." Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024 (https://covid19.public-inquiry.uk/documents/module-1-full-report).

¶9.59. During the Covid-19 response, Public Health England delivered clinical and public health advice to the Chief Medical Officer for England and to government departments.¹¹⁴¹¹⁴ INQ000090337_0002 It also provided operational support to the Department of Health and Social Care and to the NHS and translated SAGE's advice into evidence-based guidance for clinical audiences and the public. In addition, Public Health England undertook a range of specific scientific, research and evaluation tasks, including early testing and contact tracing.

¶9.60. Significant resource constraints affected Public Health England's ability to fulfil both its advisory and its operational functions.¹¹⁵¹¹⁵ INQ000249526_0080-0081 para 247 As was common across the four nations, there was, for example, no standing capacity for a scaled-up test and trace system.¹¹⁶¹¹⁶ INQ000273878_0020 para 54 The resource constraints on Public Health England are illustrated by its £287 million budget for 2019/20, compared with the £37 billion allocated to NHS Test and Trace.¹¹⁷¹¹⁷ INQ000273878_0030-0031, 0033 paras 88, 96

¶9.61. Professor Vallance observed:

" The decisions taken over a number of years to reduce the science budget of PHE [Public Health England] must have had an effect on its ability to perform at scale during the pandemic. The outsourcing of research to universities left PHE with restricted internal science and operational capability … it is important to view public health science funding as a resource that is required for the future, much in the same way as the army is required to be ready for action even when there is no war."¹¹⁸¹¹⁸ INQ000238826_0227 para 710

Scotland

¶9.62. Health Protection Scotland was part of NHS National Services Scotland. It was responsible for implementing operational decisions made by the Scottish Government, developing guidance arising out of government policies throughout the pandemic and producing detailed statistics and analysis of data in respect of the health service. On 1 April 2020, functions of Health Protection Scotland were transferred to a new body, Public Health Scotland.¹¹⁹¹¹⁹ This Report uses the correct name for the body according to the relevant time period. For references that span both before and after 1 April 2020, the Report uses the current name.

¶9.63. The main avenue for clinical and scientific advice to flow from Public Health Scotland to the Scottish Government was via the Chief Medical Officer for Scotland, either in direct correspondence or communication between advisers and the Chief Medical Officer, or through the National Incident Management Team.¹²⁰¹²⁰ INQ000360968_0006 para 2.6

¶9.64. The National Incident Management Team met for the first time on 13 January 2020 in response to emerging knowledge about the virus. It was a cross-system approach that incorporated health boards, local authorities and the Scottish Government. It met regularly to consider the developing data and evidence in order to allow information and advice to be fed to the Scottish Government.

¶9.65. Representatives of Public Health Scotland attended Scottish Government Resilience Room meetings and the Four Harms Group. Prior to such meetings, Public Health Scotland provided statistical information and analysis by way of the regularly updated Situation Reports (SitReps). These reports formed a key aspect of the analysis and assessment of the progress of the pandemic.¹²¹¹²¹ INQ000360968_0008 para 2.13; INQ000339576_0006-0007 para 1.2.8

¶9.66. Unlike in England, there was often a lack of direct contact between ministers in Scotland and Wales on the one hand and Public Health Scotland and Public Health Wales on the other. As Professor Nick Phin (Director of Public Health Science at Public Health Scotland from January 2021) said, in Scotland this created at least a risk that advice being provided to the Chief Medical Officer for Scotland at the National Incident Management Team meetings was subject to a filter, with:

" people … interpreting what they heard and … trying to then re-interpret that in the context of what they were being asked".¹²²¹²² Nick Phin 19 January 2024 177/14-24

¶9.67. Public Health Scotland was a key component in implementing policy, but had limited involvement during the policy formulation stage. This gave rise to a risk that Scottish Government policy could not be properly implemented. There were also delays built into the system, which led to inefficiency. Once a policy had been devised, it fell to Public Health Scotland to provide the relevant guidance, but that guidance then had to be approved by ministers. In some instances, this might have led to the guidance being out of date even before it had commenced.¹²³¹²³ INQ000339576_0011 para 1.4.7; INQ000355769_0022-0023 para 13.2.5; Nick Phin 19 January 2024 209/16-210/1

Wales

¶9.68. Public Health Wales is an NHS trust dedicated to improving health, reducing health inequalities and protecting public wellbeing in Wales. It provided a wide range of advice to the Welsh Government. As Dr Tracey Cooper (Chief Executive of Public Health Wales from June 2014) put it: "[T]he advice was about everything."¹²⁴¹²⁴ Tracey Cooper 5 March 2024 148/20 This

included lockdowns and other interventions. Public Health Wales also played a key role in developing several Welsh Government plans and strategies.¹²⁵¹²⁵ INQ000235212_0008_0016-0017, 0058-0065, 0097 paras 32, 50-51, 189-218, 307; INQ000056350_0003-0004 Dr Cooper noted that its role was initially unclear and often extended beyond its mandate.¹²⁶¹²⁶ Tracey Cooper 5 March 2024 119/1-22

¶9.69. Public Health Wales eventually played a crucial advisory role during the pandemic, but it was not adequately consulted by the Welsh Government in January and February 2020. Mr Drakeford told the Inquiry:

" I cannot rule out the possibility that, had the Public Health Wales view been more directly communicated to ministers, that that would have made a difference to the actions that we took, but the system that we had … is that the Public Health Wales does not speak directly to ministers by routine, they speak to Welsh ministers via the Chief Medical Officer."¹²⁷¹²⁷ Mark Drakeford 13 March 2024 57/14-25

¶9.70. Requests for advice to Public Health Wales from the Welsh Government began to increase significantly from mid-February 2020 and surged from early March 2020. Clarity about its role improved only after the Public Health Protection Response Plan was produced on 4 May 2020.¹²⁸¹²⁸ Tracey Cooper 5 March 2024 119/7-16; Public Health Protection Response Plan, Public Health Wales, 4 May 2020 (https://phw.nhs.wales/news/covid-19-public-health-wales-health-protection-response-plan-published) The role of Public Health Wales in the pandemic should have been more clearly defined from the outset, rather than months after the pandemic started.

¶9.71. Public Health Wales does not hold a comprehensive record of all of the advice provided during this crucial time. From 12 October 2020, the Welsh Government adopted a more systematic approach to requesting advice from Public Health Wales and formal advice notes were produced.¹²⁹¹²⁹ Tracey Cooper 5 March 2024 124/24-127/16 This underscores the importance of adopting formal commissioning processes that ensure all advice is recorded.

Northern Ireland

¶9.72. The Public Health Agency was established under the Health and Social Care (Reform) Act (Northern Ireland) 2009.¹³⁰¹³⁰ Health and Social Care (Reform) Act (Northern Ireland) 2009, section 12(1) (https://www.legislation.gov.uk/nia/2009/1/section/12) Its functions can be summarised under three broad headings: improving health and social wellbeing and reducing health inequalities; health protection; and service development in Northern Ireland.

¶9.73. At the time of the pandemic, Professor McBride – on behalf of the Department of Health (Northern Ireland) – was the senior departmental sponsor for the Public Health Agency.¹³¹¹³¹ INQ000421704_0021-0022 para 49 Dr Joanne McClean (Director of Public Health at the Public Health Agency from September 2022) explained that sponsorship entailed the provision of direction and ensuring that the Public Health Agency performed in accordance with its statutory duties and the wishes of the Minister of Health.¹³²¹³² Joanne McClean 2 May 2024 97/6-11

¶9.74. The Public Health Agency did not have the same sort of advisory function as its counterparts in Wales and Scotland. It provided information – for example, relating to contact tracing, testing capacity, surveillance and care homes – to the Department of Health (Northern Ireland), which then determined what ought to be communicated to the Northern Ireland Executive Committee through the Minister of Health.¹³³¹³³ INQ000437430_0061 paras 199, 202 The Public Health Agency did not produce its own guidance, as it did not have the capacity or expertise to do so, nor did it have access to sufficiently up-to-date information. It relied upon advice and guidance produced by Public Health England and, where necessary, adapted it for use in Northern Ireland.¹³⁴¹³⁴ INQ000437430_0025-0026 para 65

¶9.75. Prior to the pandemic, questions had been raised as to whether the Public Health Agency could discharge its statutory functions. In 2017, the Department of Health (Northern Ireland) aired concerns about the depletion of the Public Health Agency's staffing and experience. In 2018, this concern was raised again. At a mid-year accountability meeting on 12 December 2018, Professor McBride noted that it was vital to ensure that resources were in place to effectively deal with any potential threat or event.¹³⁵¹³⁵ INQ000421704_0021-0022 para 49 After 2018, the situation deteriorated still further as a result of the Public Health Agency losing critical staff and experience.¹³⁶¹³⁶ Joanne McClean 2 May 2024 99/2-6

¶9.76. The Public Health Agency is an example of an important public body in Northern Ireland whose capacity had been steadily eroded in the years leading up to the pandemic. Professor McBride's concern that it had insufficient resources available to meet a significant event was well founded. At the outset of the pandemic, it had a number of staff vacancies and had made interim appointments in key roles.¹³⁷¹³⁷ INQ000421704_0361 para 831 In an email to Professor McBride on 3 February 2020, a senior medical officer within the Department of Health (Northern Ireland) noted that the Health and Social Care Board (which at that point commissioned health services in Northern Ireland) and the Public Health Agency had less capacity and less resilience than in 2009 (during the swine flu pandemic).¹³⁸¹³⁸ INQ000425506_0001

¶9.77. It is also clear that, in the early stages of the pandemic, the Department of Health (Northern Ireland) changed its working relationship with the Public Health Agency.¹³⁹¹³⁹ INQ000001196_0020, 0026 paras 9.4, 12.3 Amid concerns about the ability of the Public Health Agency to provide reliable information about the numbers of daily deaths, the Department of Health (Northern Ireland) transferred a number of functions of the Public Health Agency to itself in April 2020.¹⁴⁰¹⁴⁰ INQ000001196_0018-0019 paras 9.1-9.2 Richard Pengelly, Permanent Secretary to the Department of Health (Northern Ireland) from July 2014 to April 2022, described this as the department stepping into a:

" much more command and control-type approach as opposed to the normal relationship between sponsor department and arm's length body where there's quite a remove between the two organisations".¹⁴¹¹⁴¹ Richard Pengelly 7 May 2024 85/16-19

¶9.78. A rapid review of the Public Health Agency's functions in relation to the pandemic was commissioned by it in June 2020 and reported in July 2020.¹⁴²¹⁴² INQ000001196 The main finding was that there was not "a sufficient resource in the agency to do all of the things which need to be done at this time".¹⁴³¹⁴³ INQ000001196_0026 para 12.5 The review noted that this had negatively impacted upon the general ability of the Chief Executive and Director of Public Health to keep both the Public Health Agency's board and the Department of Health (Northern Ireland) informed about the Public Health Agency's work. It suggested that this might offer a partial explanation for the "tension" that at times existed between the Public Health Agency and the Department of Health (Northern Ireland).¹⁴⁴¹⁴⁴ INQ000001196_0026-0027 para 12.6

¶9.79. It is concerning that, at the onset of the Covid-19 pandemic, the Public Health Agency had less capacity and resilience than it had had a decade previously. It is regrettable that this, in turn, directly impacted upon its ability to perform its functions and on its relationship with the Department of Health (Northern Ireland).

¶9.80. The scientific resource provided by the public health bodies in all four nations is an essential element of the response to a pandemic. Accordingly, the capacity of each of these bodies should be strengthened so that they are able properly to fulfil their role in the event of a future emergency.

Recruitment and selection of participants

¶9.81. All members of and participants in the UK's scientific advisory groups are to be highly commended for their exemplary service in the course of the pandemic. The Inquiry nevertheless identified two areas in which the recruitment of participants for scientific advisory groups could be improved for the future: open and transparent recruitment processes and also greater diversity of participants.

¶9.82. SAGE is not a permanent body and has no standing participants.¹⁴⁵¹⁴⁵ INQ000252449_0007 para 2.3 The participants of SAGE and its sub-groups are recruited on an ad hoc basis according to the requirements of the specific emergency. Each meeting brings together "scientists relevant to the questions that are thought most important at that point in time".¹⁴⁶¹⁴⁶ INQ000251645_0014-0015 para 2.25 The flexibility afforded by this approach is an advantage of the SAGE system. During the

Covid-19 pandemic, it meant that the composition of SAGE could be adapted when necessary and tailored to evolving policy needs. As Dr Stuart Wainwright, Director of the Government Office for Science from December 2019 to June 2023, suggested: "You need the expertise in the room for the situation at hand."¹⁴⁷¹⁴⁷ Stuart Wainwright 12 October 2023 10/17-18

¶9.83. The rapid identification of scientific experts is crucial during a public health emergency. It is equally important that those experts are drawn from a diverse range of disciplines, backgrounds and experience. The incorporation of multiple voices, including those with dissenting views, helps to build sufficient challenge into the advisory process and to guard against 'groupthink'.¹⁴⁸¹⁴⁸ As set out in the Inquiry's Module 1 Report, 'groupthink' refers to the phenomenon by which people in a group tend to think about the same things in the same way. Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024 (https://covid19.public-inquiry.uk/documents/module-1-full-report).

¶9.84. However, when SAGE was activated in January 2020, there was no "systematic process" in place to ensure that the participant experts were adequately diverse. Professor Vallance told the Inquiry:

" The first three SAGE meetings were attended by a number of experts chosen because of their expertise in the fields most directly relevant to the questions SAGE had to address, as well as some officials from DHSC [the Department of Health and Social Care], PHE and some CSAs [Chief Scientific Advisers]."¹⁴⁹¹⁴⁹ INQ000147810_0018 para 57.4; INQ000238826_0213-0214 para 661

In a medical crisis, the Chief Medical Officer will also usually "suggest medical and public health experts".¹⁵⁰¹⁵⁰ INQ000147810_0013 para 41 The initial list of invitees was determined by Professors Vallance and Whitty, in consultation with the SAGE Secretariat, and included:

" people who had experience of epidemic modelling and other sciences in the context of previous emergencies such as Ebola".¹⁵¹¹⁵¹ INQ000251645_0014 para 2.24; INQ000238826_0216-0217 para 673

¶9.85. Professor Vallance acknowledged that there was a tendency to appoint scientific experts who were "known" and that this posed a "risk to diversity".¹⁵²¹⁵² INQ000238826_0218 para 678 A number of witnesses expressed concerns about this issue.¹⁵³¹⁵³ INQ000281260_0036, 0039 paras 148, 150, 154, 156; INQ000250232_0041 para 7.1 For example, Dr Leon Danon (Associate Professor in Infectious Disease Modelling and Data Analytics at the University of Bristol and participant in SPI-M-O from February 2020) noted that SPI-M-O was dominated by a group of epidemiological modellers from Imperial College London and the London School of Hygiene & Tropical Medicine. He considered that this:

" led to advice being less robust than it could have been if a broader group of experts was empowered to provide analysis and advice from the outset".¹⁵⁴¹⁵⁴ INQ000056416_0015

¶9.86. Professor Lucy Yardley, Professor of Health Psychology at the University of Bristol and the University of Southampton and Co-Chair of SPI-B from April 2020, noted that the lack of diversity was exacerbated by a shortage of resources. She told the Inquiry:

" There was no time or resource available in the early stages of the pandemic to undertake a systematic search for a wide, representative group or to engage in formal processes for selecting and inviting members … only people with the capacity to free up substantial time for SPI-B from their day jobs and home commitments could make a significant input."¹⁵⁵¹⁵⁵ INQ000236376_0007 para 4.3

¶9.87. Similarly, membership of the Scottish Government Covid-19 Advisory Group was drawn via existing networks and relationships. The group included epidemiologists, behavioural scientists, virologists and public health experts. However, there was no direct representation of at-risk or vulnerable groups or any direct expertise in respect of health economics or ethics.¹⁵⁶¹⁵⁶ INQ000375323_0006 para 15 Experts in these areas would likely have added extra evidence and context to the matters under discussion.

¶9.88. Some members of the Technical Advisory Group in Wales felt that it also lacked diversity.¹⁵⁷¹⁵⁷ Robert Hoyle 29 February 2024 186/21-188/6; Ann John 1 March 2024 116/25-117/25; INQ000366137_0018 para 66 Dr Orford agreed that improving group composition was crucial and should be addressed before a future pandemic.¹⁵⁸¹⁵⁸ Rob Orford 4 March 2024 95/7-96/21 Some sub-group members also commented that a lack of diverse representation contributed to insufficient challenge in discussions at times.¹⁵⁹¹⁵⁹ INQ000347980_0011 para 30; INQ000280125_0007 para 28; INQ000399290_0010-0011 para 35

¶9.89. Members of the Strategic Intelligence Group in Northern Ireland were selected and approached by Professor Young after discussion with Professor McBride.¹⁶⁰¹⁶⁰ INQ000409589_0016-0017 para 47 Professor Young explained that the membership was selected to provide a range of scientific expertise and representation from key sectors in Northern Ireland.¹⁶¹¹⁶¹ INQ000409589_0017 para 49 Members were also invited to suggest additional members, but, beyond this, there was no selection process to consider wider participation.

¶9.90. Professor Whitty cautioned against the inclusion of "every possible representative group", on the basis that this would have "inevitably led to less opportunity for those present to challenge and debate the science". The Inquiry recognises the danger. The importance of access to a range of perspectives must be weighed against the need to provide advice within a short timeframe and to avoid the membership of advisory groups becoming, as Professor Whitty put it, "impossibly large".¹⁶²¹⁶² INQ000251645_0015 paras 2.27-2.28 However, this does not negate the need for a balance to be struck among those present in terms of their scientific disciplines, backgrounds and experiences. The inclusion of experts from a more diverse range of backgrounds might have helped to challenge orthodox scientific thinking and brought wider experience of public health conditions on the ground. The Inquiry notes the positive steps being taken to improve diversity and in response to the Module 1 Report in this respect.¹⁶³¹⁶³ UK Government Response to the Covid-19 Inquiry Module 1 Report, Cabinet Office, 16 January 2025, p35 (https://assets.publishing.service.gov.uk/media/67879a232cca34bdaf58a239/UK_Government_Response_to_the_Covid-19_Inquiry_ Module_1_Report.pdf; INQ000625630); INQ000148407_0023 para 70

¶9.91. To prepare for a future crisis, a process of open and transparent recruitment should take place to identify a list of experts willing to participate in advisory groups when their expertise is required and to act as chairs of potential sub-groups. This would help to break down barriers and improve diversity in terms of the range of participants' disciplines and the institutions from which they are drawn. It would also help to build a broader pool of expertise that can be used to regularly refresh or rotate participation during a prolonged emergency. Mechanisms – for example, annual meetings – could also be put in place to build professional networks in order to enable efficient collaboration and understanding of disciplines in future crises.

Recommendation 3: Register of experts

¶The Government Office for Science (GO-Science) should develop and maintain a register of experts across the four nations of the UK who would be willing to participate in scientific advisory groups, covering a broad range of potential civil emergencies. The register should be regularly refreshed through open calls for applications.

Attendance of officials

¶9.92. As the response to the pandemic escalated, officials from across the UK government (including the Cabinet Office, Department of Health and Social Care, the Treasury and 10 Downing Street) began to attend SAGE meetings as observers.¹⁶⁴¹⁶⁴ For example, Dr Ben Warner, Special Adviser to the Prime Minister from December 2019 to May 2021, attended SAGE as an observer on numerous occasions, starting on 20 February 2020. Dominic Cummings, Adviser to the Prime Minister from July 2019 to November 2020, attended four meetings in March and April 2020. Observers, including those from the Treasury, were invited to attend by Professor Vallance in his capacity as Chair (INQ000238826_0043, 0220 paras 126, 686; see also 'The lockdown files: Rishi Sunak on what we weren't told', Fraser Nelson, The Spectator, 27 August 2022 (https://www.spectator.co.uk/article/the-lockdown- files-rishi-sunak-on-what-we-werent-told; INQ000280042)).Show full note This enabled them to listen to the discussions, feed in required policy perspectives, ask questions and report the information gathered to their home organisation.¹⁶⁵¹⁶⁵ INQ000252449_0012 para 2.13

¶9.93. Likewise, Welsh Government policy leads joined the sub-groups of the Technical Advisory Group aligned with their areas.¹⁶⁶¹⁶⁶ INQ000068507 Dr Orford and Robin Howe, Chair of the Testing sub-group, noted the value of officials attending to hear debates and grasp the strength of the evidence.¹⁶⁷¹⁶⁷ INQ000356177_0016 para 54; INQ000353795_0004 para 15

¶9.94. The Scottish Government had representatives from within its health and social care directorates in attendance at Scottish Government Covid-19 Advisory Group meetings. Representatives included the co-directors and Deputy Director of Covid Health Response, the Chief Statistician and the Deputy Director of the Testing and Contact Tracing Policy Division. Some of its standing members also held advisory positions within the Scottish Government, including the Chief Social Policy Adviser.¹⁶⁸¹⁶⁸ INQ000147306

¶9.95. In Northern Ireland, some officials from within the Department of Health (Northern Ireland) attended meetings of the Strategic Intelligence Group. These included the Chair of the Contact Tracing Service Steering Group and the Senior Statistician in the Department of Health (Northern Ireland).¹⁶⁹¹⁶⁹ INQ000347393; INQ000347404; INQ000347371; INQ000347364

¶9.96. The attendance, as observers, of relevant officials at meetings of scientific advisory groups enables the salient features of the debate to be relayed to absent decision-makers. However, this should not be used as a substitute for the formal output contained in the official minutes, papers and briefings. Decision-makers should always refer to such formal output documents for an authoritative statement of scientific advice.

Commissioning process

¶9.97. The processes of commissioning advice from the scientific advisory groups across the UK differed by nation and evolved as the pandemic progressed. In the initial months of the pandemic, SAGE and its sub-groups received commissions for advice primarily from the Civil Contingencies Secretariat (which provided the secretariat for COBR). From May 2020 onwards, the responsibility for commissioning advice moved to the Covid-19 Taskforce in the Cabinet Office.¹⁷⁰¹⁷⁰ INQ000252449_0014 para 2.23. The Covid-19 Taskforce led the cross-government response to Covid-19 until March 2022.

¶9.98. Sub-groups could also self-generate their work.¹⁷¹¹⁷¹ INQ000238826_0014 para 31 For instance, much of the research undertaken by SPI-M-O was not commissioned. Its participants often conducted their own analyses, which they brought to the committee for discussion.¹⁷²¹⁷² INQ000273553_0023 para 6.11

¶9.99. The commissioning of scientific advice during the Covid-19 response was not always focused and achievable. Some commissions were too narrow, while others were too broad. For example, Professor Vallance said that the UK government often asked questions that were "too granular for the evidence that was available". SPI-M-O therefore became "overwhelmed by requests to model different and very specific scenarios and policy options".¹⁷³¹⁷³ INQ000238826_0014 para 30 Professor Horby said that direct commissions for NERVTAG from Public Health England were, at times, "too broadly specified".¹⁷⁴¹⁷⁴ INQ000226562_0020 para 80 Professor James Rubin (Professor of Psychology and Emerging Health Risks at King's College London and Chair of SPI-B from February 2020 to June 2021) told the Inquiry that early commissions to SPI-B were occasionally "unclear or vague".¹⁷⁵¹⁷⁵ INQ000250232_0058 para 13.1 Professor Yardley noted that some questions from decision-makers were poorly formulated.¹⁷⁶¹⁷⁶ INQ000236376_0010-0011 para 5.3 It was often necessary to clarify or modify those questions, which meant that the provision of advice was delayed.

¶9.100. This confusion was compounded by the tendency of government departments to directly approach SAGE sub-groups for advice rather than routing their requests in the appropriate manner.¹⁷⁷¹⁷⁷ See, for example, INQ000250232_0058 para 13.1; INQ000226562_0020 para 79; INQ000236261_0016 para 5.30 The use of direct commissions subjected participants to intense and unmanageable workloads. Professor Catherine Noakes, Professor of Environmental Engineering at the University of Leeds and Chair of the Environmental Modelling Group, a sub-group of SAGE, recalled that these commissions often came from the Cabinet Office with "almost impossible timescales".¹⁷⁸¹⁷⁸ INQ000236261_0016 para 5.30 The Inquiry agrees with Professor Whitty's reflection:

" [A]n early central clearinghouse for policy requests to SAGE and its subgroups with senior scientists and policymakers triaging the requests would have improved prioritisation."¹⁷⁹¹⁷⁹ INQ000251645_0018 para 2.37

¶9.101. The Scottish Government typically requested the Scottish Government Covid-19 Advisory Group to provide scientific advice through a commission process that was developed over time.¹⁸⁰¹⁸⁰ INQ000346264_0027-0028 para 112 Professor Morris estimated that around 80% of the group's advice was commissioned by the Scottish Government.¹⁸¹¹⁸¹ Andrew Morris 23 January 2024 221/9-11 However, the group could also provide advice to the Scottish Government on its own initiative:

" where a particular topic was seen as a priority at that stage in the pandemic and the [Scottish Government Covid-19 Advisory Group] judged it important to provide further information on this".¹⁸²¹⁸² INQ000346264_0027-0028 para 112

¶The Scottish Government Covid-19 Advisory Group provided advice without commission on eight occasions, on topics ranging from testing to risk communication.¹⁸³¹⁸³ Andrew Morris 23 January 2024 221/1-11 Professor Morris noted:

" This was a strength of an independent group as it had the flexibility to do more than just answer the questions that were posed."¹⁸⁴¹⁸⁴ INQ000346264_0027-0028 para 112

¶9.102. In Wales, advice was initially provided by the Technical Advisory Group as needed on an ad hoc basis, without a formal commissioning structure.¹⁸⁵¹⁸⁵ Rob Orford 4 March 2024 101/7-13 Members of its sub-groups found the initial lack of a formal process for commissions challenging due to the pressures of demand and the very short deadlines set.¹⁸⁶¹⁸⁶ INQ000313383_0004-0005

¶9.103. In Northern Ireland, there was no cross-government chief scientific adviser or cross-government advisory body. Scientific advice was provided to the Northern Ireland Executive Committee exclusively by the Department of Health (Northern Ireland) through the Minister of Health or by the attendance of the Chief Medical Officer for Northern Ireland and the Chief Scientific Adviser to the Department of Health (Northern Ireland) at Executive Committee meetings. Accordingly, the Executive Committee could not – and did not seek to – directly commission scientific advice from the Strategic Intelligence Group. The recently established post of Chief Scientific and Technology Adviser will provide a vehicle for delivering collective advice to the Northern Ireland Executive in future.

¶9.104. The commissioning of scientific advice improved, however, as the pandemic progressed and governance structures evolved. In the summer of 2020, the Government Office for Science and the Covid-19 Taskforce worked together to establish a revised commissioning process. This aimed to ensure that requests for scientific advice were "triaged and tracked properly".¹⁸⁷¹⁸⁷ INQ000252449_0014 para 2.24 From December 2020 onwards, SAGE and SPI-M-O meetings were attended by the leader of the Covid-19 Taskforce, which facilitated a "better understanding of what could be conceivable policy".¹⁸⁸¹⁸⁸ INQ000273553_0021-0022 para 6.6.2

¶9.105. In Wales, as a result of continuing pressure on the limited resources of the Technical Advisory Group, a formal process for commissioning advice was introduced in March 2021 and, from April 2021, a steering group provided senior oversight.¹⁸⁹¹⁸⁹ INQ000068514; INQ000274156_0032 para 97 Each subgroup of the Technical Advisory Group continued to proactively review new evidence relevant to its area of focus.¹⁹⁰¹⁹⁰ INQ000356177_0033 para 129

¶9.106. Scientific advisory groups are likely to work most effectively where the context of the tasks set for them is understood and the advice that is sought forms part of a clearly defined, strategic plan. However, the Inquiry heard that participants in UK advisory groups did not always understand the UK government's aims.¹⁹¹¹⁹¹ See, for example, INQ000250232_0066 para 15.4; INQ000273553_0100 para 15.4 There was a lack of clearly stated policy objectives and 'red lines'. This hampered the groups' ability to provide useful and targeted advice and led to conservatism with regard to the interventions that were modelled. For example, Professor John Edmunds, Professor of Infectious Disease Modelling at the London School of Hygiene & Tropical Medicine and a participant in SPI-M, stated that SPI-M-O was:

" slow to model the implication of lockdown policies in detail … It was not clear to me that such radical measures were politically acceptable and so we did not spend as much time on them in early March as we should have."¹⁹²¹⁹² INQ000273553_0021-0022 para 6.6.2

¶9.107. A similar issue arose in Wales in respect of the Welsh Government's aims. Dr Robert Hoyle, Head of Science at the Welsh Government Office for Science from May 2019 and a member of the Technical Advisory Cell and Technical Advisory Group, told the Inquiry:

" [I] asked the question on my first meeting about what the strategy was, and essentially it was to reduce harm or harms, and I was never convinced that it was any clearer than that."¹⁹³¹⁹³ Robert Hoyle 29 February 2024 178/7-17

¶9.108. The work of the advisory groups will be considerably assisted if, from the outset of any future pandemic:

clear commissioning channels are established and followed;
commissions are refined, prioritised and screened to ensure clarity as to what advice is being sought and to identify any requests outside a group's remit;
there is clear tracking of requests and responses to prevent duplication and reduce administrative delays; and
scientific advisory groups are provided with a better understanding of the governments' strategies and objectives so that the purpose and context of the commissioned advice can be better appreciated and advice made more pertinent.

Consensus approach

¶9.109. The emergency nature of a SAGE activation means that its advice must be produced and communicated to decision-makers at speed. The official written output of SAGE during the Covid-19 response was its minutes. These were prepared by the SAGE Secretariat in the Government Office for Science, signed off by the co-chairs and disseminated across government after each meeting. The minutes took the form of a consensus statement reflecting the discussion in SAGE meetings.¹⁹⁴¹⁹⁴ INQ000252450_0004 para 0.8 The consensus approach was devised in response to a recommendation made by Dame Deirdre Hine in July 2010 that the UK government and devolved administrations should be "presented with a unified, rounded statement of scientific advice".¹⁹⁵¹⁹⁵ The 2009 Influenza Pandemic: An Independent Review of the UK Response to the 2009 Influenza Pandemic, Dame Deirdre Hine, July 2010, p8, para 16, recommendation 10 (https://assets.publishing.service.gov.uk/media/5a7975f1ed915d0422068a10/ the2009influenzapandemic-review.pdf; INQ000022705)

¶9.110. Professor Dame Angela McLean, Chief Scientific Adviser to the Ministry of Defence from 2019 to 2023 and Government Chief Scientific Adviser from April 2023, explained that a consensus position is "not the same as reaching a compromise view".¹⁹⁶¹⁹⁶ INQ000309529_0013 para 43 As Professor Whitty put it, SAGE provides a "single integrated view of the science provided by multiple disciplines". This does not mean "it can or should provide a consensus, except when consensus reflects the reality of scientific opinion". It attempts to provide:

" a central view of scientific understanding at that point in time, and where necessary indicates the spread of opinion or uncertainty around that central view".¹⁹⁷¹⁹⁷ INQ000251645_0014 para 2.21

¶9.111. A consensus view inevitably carries more weight than an individual opinion, but it also takes more time to generate, which necessarily delays the provision of advice to decision-makers. In an emergency situation, a balance must be struck between the robustness of advice and the need to produce it rapidly. Professor Medley estimated that the delay created by the consensus process was "at most two calendar days".¹⁹⁸¹⁹⁸ INQ000260643_0013 para 3.9 This delay was not excessive and was worthwhile because it led to a unified view formulated by multiple specialist disciplines.

¶9.112. Some SAGE minutes recorded uncertainty by setting out a "level of certainty rating" using grading expressed in terms of confidence.¹⁹⁹¹⁹⁹ INQ000251645_0020 para 2.42; see, for example, INQ000061573_0002-0003 paras 9-10 This provided decision-makers with clarity as to the level of certainty expressed in the scientific advice. However, this approach was adopted only occasionally rather than routinely. Professor Whitty reflected:

" We should have from the beginning had the discipline more thoroughly of saying high confidence and low confidence. I think that was a sensible way to do it."²⁰⁰²⁰⁰ Christopher Whitty 21 November 2023 61/4-7

¶9.113. The consensus approach, while providing decision-makers with a concise synopsis of the evidence on which SAGE's advice was based, meant that the minutes failed to capture the full extent of the discussion that had taken place. Minority or dissenting opinions, which could have been significant, were excluded from the minutes. Professor Mark Woolhouse, Professor of Infectious Disease Epidemiology at the University of Edinburgh and a participant in SPI-M-O, expressed the following concern:

" SAGE and its subgroups put too much emphasis on consensus and too little on minority views. The most likely outcome – intended or otherwise – of only expressing a single view is that it presents policy makers with an overly limited set of options and so will channel policy decisions along a particular route."²⁰¹²⁰¹ INQ000250231_0050 para 281

¶9.114. Those who relied on the written minutes could be led to believe that the advice represented the common view of all expert participants. Indeed, in Professor Woolhouse's experience:

" [R]eporting what was effectively the majority view might have given an impression of groupthink … minority views were not always communicated to officials and ministers."²⁰²²⁰² INQ000250231_0007 para 36

¶9.115. While Professor Whitty acknowledged that this was a "potential weakness" of the consensus process, he noted that the minutes were not the sole medium by which SAGE's advice was communicated. There were two additional mechanisms by which decision-makers "could get the spread of opinion".²⁰³²⁰³ Christopher Whitty 21 November 2023 65/7, 62/15-16 Firstly, Professors Whitty and Vallance regularly delivered verbal briefings to the Prime Minister and others, during which they "tried to communicate the range of opinion around the central SAGE conclusion".²⁰⁴²⁰⁴ INQ000251645_0020 para 2.42 However, this assisted only those who were present at such briefings or who had access to any read-out (to the extent that they had an understanding of what was being summarised). Secondly, officials from government departments were routinely invited to attend SAGE meetings as observers, and they did attend. They were therefore privy to the full debate that took place and in a position to challenge the accuracy of the consensus statement set out in the minutes if they wished to do so.²⁰⁵²⁰⁵ Christopher Whitty 21 November 2023 63/2-17 It is not clear, however, whether such officials generally felt able to do so.

¶9.116. The Chief Medical Officer for Scotland also formulated advice on the "centre ground" where there was most confidence and agreement. It was considered unhelpful to present a wide range of different – often conflicting – medical or scientific views to ministers.²⁰⁶²⁰⁶ INQ000215470_0010-0011 para 40; INQ000274154_0055 para 158 The advice of the Scottish Government Covid-19 Advisory Group was provided in writing to the Scottish Government, along with a number of 'deep dives'. Written advice was ordinarily provided on a consensus basis. Where there was no consensus, this was stated.²⁰⁷²⁰⁷ INQ000215468_0004 para 13 In Wales, the Technical Advisory Cell and the Technical Advisory Group sought to create an environment where different opinions could be voiced, but they also sought to provide consensus of opinion to "ensure there was an agreed position on papers".²⁰⁸²⁰⁸ INQ000390618_0011-0012 para 31 If consensus could not be reached, this would be included in their advice. Similarly, when briefing ministers in Northern Ireland, Professor McBride sought to include a range of consensus estimates for the potential course of the pandemic, including potential case numbers and the range of potential impact on hospital admissions.²⁰⁹²⁰⁹ INQ000226184_0034 para 101 Although, according to Professor Young, "core decision makers (including Ministers, at times) looked for certainty in terms of scientific advice", the limitations of knowledge and evidence were also made clear.²¹⁰²¹⁰ INQ000409589_0041 para 114; INQ000226184_0036 para 107; INQ000436641_0057 para 220

¶9.117. On balance, the consensus mechanism was effective during the Covid-19 response. It considerably strengthened and broadened the scientific advice that was produced, while avoiding a situation in which ministers were faced with the competing and complex opinions of various experts. As Professor Sir Jonathan Van-Tam, Deputy Chief Medical Officer for England from October 2017 to March 2022, pointed out:

" If the CMO and the GCSA [Government Chief Scientific Adviser] were to give non-scientists (such as the Prime Minister) a range of different opinions, I think it is inevitable that they would simply ask them which one they ought to listen to; the result being that the Prime Minister would be making decisions on the basis of one person's view rather than a broad range that have been discussed and tested before being assimilated into an agreed central opinion."²¹¹²¹¹ INQ000269203_0013-0014 para 4.3

¶9.118. The delays caused by the consensus process would have been significantly longer if every variant of opinion had been recorded. This would not have been realistic in a fast-moving crisis. However, in future emergencies, minutes setting out consensus views should indicate the level of confidence within the group. They should also highlight more clearly any uncertainties and explain the drivers of those uncertainties. In addition, it would be useful for the advisory body to provide a menu of options available for use by decision-makers in any response. The provision of these potential options and advice on the options should not be confused with policy-making, which remains a matter for decision-makers.

Other sources of challenge

¶9.119. Decision-makers were not solely reliant on the scientific advisory bodies or individual advisers. They were also able to access and call upon other sources of external expertise to help challenge advice received or to ensure a greater diversity of opinion. Much comment and expertise existed in the public domain, with Independent SAGE (see below) being one of the most visible commentators.

¶9.120. Decision-makers were also proactive in seeking an alternative view.²¹²²¹² INQ000255836_0128-0131 paras 457-465 For example, as considered in Chapter 6: The second wave, in Volume I, Mr Johnson held a 'challenge' meeting on 20 September 2020 with "dissenting scientists" and Dr Anders Tegnell, Swedish state epidemiologist.²¹³²¹³ INQ000238826_0013-0015 paras 27, 32; INQ000255836_0129-0130 paras 460-462 One of the participants, Professor Carl Heneghan, Professor of Evidence-Based Medicine at the University of Oxford, had also been invited to attend roundtables organised by the Cabinet Office as early as April 2020. Professor Heneghan continued to have discussions with Mr Johnson and his advisers in 10 Downing Street and in the Cabinet Office until 1 November 2020.²¹⁴²¹⁴ INQ000280651_0003-0005 paras 6-25

Feedback on advice

¶9.121. The information flow from SAGE to the UK government was one-way. All contact with decision-makers occurred through the Chief Medical Officer for England and the Government Chief Scientific Adviser. According to Professor Edmunds, both were "scrupulous about not reporting back discussions held within central government to SAGE".²¹⁵²¹⁵ INQ000273553_0020-0021 para 6.6 This helped to protect the integrity of the scientific advisory process by ensuring that it remained free from external influence. However, it also meant that participants did not receive clear responses on how their advice had been utilised and communicated to decision-makers. Professor Rubin remarked that the advice of SAGE or SPI-B "often appeared to disappear into a black hole".²¹⁶²¹⁶ INQ000250232_0065 para 15.1 His Co-Chair, Professor Yardley, said that it was "almost entirely a matter of guesswork as to what decisions had been affected by SAGE advice, in what ways and why, or why not".²¹⁷²¹⁷ INQ000236376_0011 para 5.4

¶9.122. Professor Vallance acknowledged that he and Professor Whitty:

" could have been better at feeding back to the sub-groups how their work had been used by SAGE and how it had been communicated to policy-makers".²¹⁸²¹⁸ INQ000238826_0216 para 671

¶9.123. Several participants in the Scottish Government Covid-19 Advisory Group told the Inquiry of a lack of feedback from the Scottish Government and the impact that this had on their understanding of the effectiveness of the advice provided. They did not know, for example, how the information was presented to ministers (except for in the context of 'deep dives'). Had Professor Smith been able to attend more meetings, this could have considerably assisted members in understanding the way in which their advice was being received. Similarly, Professor Jason Leitch (National Clinical Director and Co-Director of the Directorate for Healthcare Quality and Improvement in the Scottish Government from January 2015) was not a member of the Scottish Government Covid-19 Advisory Group, although he did attend some of its meetings as an observer.²¹⁹²¹⁹ INQ000346395_0018 para 61 Given Professor Leitch's prominent role in communicating to the public the advice on which Scottish Government decision-making was based, it seems unusual that he was not a member of the group. If he had been, it would have assisted communication between him and members of the Scottish Government Covid-19 Advisory Group.

¶9.124. In Wales, Dr Chris Williams (Consultant Epidemiologist at Public Health Wales and a member of the Technical Advisory Group) said that the main indication that work on a particular question had been completed was "a cessation of further queries or requests" on the matter. He said:

" Feedback loops, particularly on the use of data or responses, would have helped but in most cases did not occur."²²⁰²²⁰ INQ000251938_0009 para 38

¶9.125. The absence of structured feedback loops was understandably demotivating for participants in scientific advisory groups. It made it difficult for them to see the impact of their advice and to learn whether and how it could be improved. Furthermore, the isolation of advisers from decision-makers meant that ministers did not generally directly challenge or interrogate scientific advice, other than through established conduits, typically Chief Scientific Advisers and Chief Medical Officers.

¶9.126. In Northern Ireland, the Chief Medical Officer for Northern Ireland and the Chief Scientific Adviser to the Department of Health (Northern Ireland) were the conduits for the information generated by SAGE and by the Strategic Intelligence Group. It appears that the Northern Ireland Executive Committee had limited visibility of the work of the Strategic Intelligence Group.²²¹²²¹ INQ000418976_0045-0047 paras 145, 149; INQ000436641_0057 para 219 According to Arlene Foster, Baroness Foster of Aghadrumsee (First Minister of Northern Ireland from January 2016 to January 2017 and from January 2020 to June 2021), neither the Strategic Intelligence Group's composition nor its work was transparent. She understood that it reported to Professor McBride, who funnelled the information to the Executive Committee.²²²²²² INQ000418976_0045 para 145 Minutes of the Strategic Intelligence Group's meetings were not provided to the Executive Committee. Michelle O'Neill MLA, deputy First Minister of Northern Ireland from January 2020 to February 2022, told the Inquiry she remained:

" unsure, even now, of the extent to which the CMO and CSA were providing briefings to the Executive Committee based on their interpretation of the information coming from SAGE or whether they were providing advice based upon the views of their UK counterparts".²²³²²³ INQ000438428_0007 para 19

¶9.127. Baroness Foster suggested that there might have been:

" a reticence within DoH [Department of Health (Northern Ireland)] to give Ministers access to the raw material, i.e. before it had been synthesised by the DoH and/or the CMO and CSA".²²⁴²²⁴ INQ000418976_0046-0047 para 149

¶However, she reflected that:

" the elected representatives tasked with the decision-making should be entitled to greater transparency in terms of access to minutes, and an understanding of the basis for dissenting views".²²⁵²²⁵ INQ000418976_0046-0047 para 149

¶9.128. Politicians ought to be willing to examine the material that underpins consensus scientific advice and to consider the nuance of scientific debate. However, there is no evidence that politicians in Northern Ireland asked to be provided with the SAGE or Strategic Intelligence Group papers or proactively sought them out.

¶9.129. The UK government and devolved administrations should institute a process by which feedback from lead officials can be given to the scientific advisory groups.²²⁶²²⁶ The Inquiry notes that the UK government, in its response to the Inquiry's Module 1 Report, proposed that its scientific advisory groups will be allowed "the freedom to advise by setting the agendas, and building in two-way feedback between experts and lead officials". UK Government Response to the Covid-19 Inquiry Module 1 Report, Cabinet Office, 16 January 2025, p34 (https://assets.publishing.service.gov.uk/media/67879a232cca34bdaf58a239/UK_Government_Response_to_the_Covid-19_Inquiry_ Module_1_Report.pdf; INQ000625630); INQ000148407Show full note This would help them to understand how their advice is used and enable them to reflect upon whether any improvements can be made.

Ministers' understanding of scientific advice

¶9.130. The decisions made during the pandemic naturally had grave and far-reaching consequences. Accordingly, it was critical that ministers fully understood the advice they received. However, the Inquiry heard that ministers and non-expert civil servants often found it difficult to comprehend and interrogate scientific information. Helen MacNamara, Deputy Cabinet Secretary from January 2019 to February 2021, explained that many ministers lacked confidence in their ability to understand technical material.²²⁷²²⁷ INQ000273841_0022 para 38; Helen MacNamara 1 November 2023 30/22-32/14 Professor Vallance said that it was "often necessary to explain scientific concepts on many occasions".²²⁸²²⁸ INQ000238826_0207 para 642 He recalled that Mr Johnson in particular:

" did struggle with some of the concepts … I do not think that there was necessarily a unique inability to grasp some of these concepts with the Prime Minister at the time, but it was hard work sometimes to try to make sure that he had understood what a particular graph or piece of data was saying."²²⁹²²⁹ Patrick Vallance 20 November 2023 62/16-63/3

¶9.131. Professor Vallance's contemporaneous 'evening notes' included the following observations:²³⁰²³⁰ Professor Vallance recorded his personal views in his 'evening notes' on an almost daily basis during the pandemic response. These were private notes kept by him during a period of "enormous stress" in which he reflected on the day's events as a "day-by-day release valve" (INQ000238826_0157-0159 paras 471-480).

4 May 2020: "Late afternoon meeting with PM [Prime Minister] on schools. My God this is complicated … PM is clearly bamboozled."²³¹²³¹ INQ000273901_0042
14 May 2020: "PM still confused on different types of test (he holds it in his head for a session and then it goes)."²³²²³² INQ000273901_0053

11 June 2020: "Watching PM get his head round stats is awful. He finds relative and absolute risk almost impossible to understand."²³³²³³ INQ000273901_0093
22 July 2020: "PM struggled with the whole concept of doubling times … just couldn't get it."²³⁴²³⁴ INQ000273901_0124

¶9.132. Mr Johnson was not alone in struggling to understand complex scientific concepts. A clear example of the difficulties ministers and others (including some commentators) encountered can be seen in epidemiological modelling, which is an "essential tool for policy makers".²³⁵²³⁵ INQ000273553_0094 para 14.3

Overview of epidemiological modelling

¶9.133. Epidemiological modelling played a central role in the formulation of scientific advice and was used to investigate a variety of important factors. These included how quickly the virus might be spreading, the proportion of the population that could become infected and the number of people who might be hospitalised or die.²³⁶²³⁶ INQ000236423_0003 This helped to inform public health strategy by demonstrating the likely effectiveness of different measures, such as school closures or nationwide lockdowns.

¶9.134. SPI-M-O was responsible for the majority of epidemiological modelling provided to the UK government. Its participants were specialists in the analysis of infectious disease transmission dynamics.²³⁷²³⁷ INQ000260643_0025 para 3.47 The work of world-leading modelling teams from multiple institutions, including Imperial College London, the London School of Hygiene & Tropical Medicine, the University of Warwick and the University of Exeter, was compared, challenged and discussed at SPI-M-O meetings, before being fed into SAGE and the UK government.

¶9.135. The devolved administrations did not have access to nation-specific models at the outset of the pandemic. The Welsh Government was heavily reliant on SPI-M-O's models, adjusting UK estimates to about 5% to create rough impact approximations based on pandemic influenza worst-case scenarios.²³⁸²³⁸ Michael Gravenor 1 March 2024 134/14-25; INQ000356177_0007-0008 paras 27-30 Many witnesses agreed that this approach was not ideal.²³⁹²³⁹ INQ000251938_0021 para 92; INQ000183861_0005; INQ000366137_0039-0040 para 133 In June 2020, funding was provided for Swansea University (working with others) to create models specific to Wales.²⁴⁰²⁴⁰ INQ000356177_0026-0027 paras 100-102 Dr Orford believed that Welsh-specific models were "invaluable" and wished they had been available sooner.²⁴¹²⁴¹ INQ000356177_0010 para 36; INQ000390618_0023 paras 64-65

¶9.136. In Scotland, modelling was conducted by the Covid-19 Modelling and Analysis Hub (which later became known as the Covid-19 Analysis Division). This was headed by Dr Audrey MacDougall, Deputy Director from March 2020 to November 2021, and

¶Roger Halliday, Chief Statistician for Scotland from 2011 to April 2022. They initially developed modelling of the pandemic by using a UK-wide model developed by

¶Imperial College London, scaled to Scotland. Mr Halliday noted: "This was good enough to support decisions on initial lockdown and on managing NHS Scotland capacity."²⁴²²⁴² INQ000274011_0008 para 21(a) However, it was not until May 2020, when his team had developed a model that ran exclusively on Scottish data, that the modelling advice to Scottish ministers became a "strong offering".²⁴³²⁴³ INQ000274011_0009 para 21(f)

¶9.137. Professor Young could not explain why Northern Ireland did not have capacity in pandemic modelling that could be immediately instituted at the outset of the pandemic, as he did not have any role in relation to pandemic planning.²⁴⁴²⁴⁴ INQ000409589_0018 para 52 Mr Pengelly suggested that Northern Ireland did not have modelling capacity because it "hadn't been needed prior to the pandemic".²⁴⁵²⁴⁵ Richard Pengelly 7 May 2024 65/4-13

¶9.138. At the end of March 2020, Professor Young established a Northern Ireland Modelling Group.²⁴⁶²⁴⁶ INQ000137356 Its membership included individuals from Queen's University Belfast and Ulster University, the Public Health Agency and the Strategic Investment Board. The value of the modelling that the group provided was that – while UK modelling (which included modelling of the pandemic in Northern Ireland) was helpful– it:

" generally lagged behind NI local modelling which used the most up-to-date data … to inform advice to the Minister of Health and NI Executive".²⁴⁷²⁴⁷ INQ000409589_0018 para 52

¶9.139. The devolved administrations each benefited from having access to nation-specific models. Access to such modelling will be crucial from the outset of a future pandemic.

Challenges with understanding

¶9.140. There are limits to what models can achieve, but a number of witnesses suggested that this was often difficult for decision-makers and others to appreciate fully. As Professor Edmunds noted, models are "relatively crude tools … a simplification of incredibly complex systems".²⁴⁸²⁴⁸ INQ000273553_0095-0096 para 14.5 For instance, they typically represent human behaviour as constant and modified only by interventions. In practice, behaviour changed substantially – and often unpredictably – throughout the pandemic. Professor Neil Ferguson, Mathematical Epidemiologist at Imperial College London, explained that "very few models attempt to predict such changes, largely because we don't have a good quantitative and predictive understanding of them".²⁴⁹²⁴⁹ INQ000249526_0018 para 49

¶9.141. Data limitations, particularly during the early stages of the pandemic, also meant that the estimation of key parameters such as the reproduction number (R) and the infection fatality ratio was uncertain.²⁵⁰²⁵⁰ INQ000260643_0081-0082 para 8.12(d)

¶9.142. SPI-M-O devoted considerable time and effort to ensuring that these intrinsic limitations were understood by decision-makers. Professor McLean, who was appointed as SPI-M-O's Executive Co-Chair on 27 March 2020, worked to build relationships between modellers and the UK government. She also provided technical briefings to journalists that helped to inform the accuracy of their reporting.²⁵¹²⁵¹ INQ000309529_0012 para 40 From January 2021 onwards, Professor McLean frequently attended Covid-19 Taskforce meetings to answer questions on modelling. She also arranged for two SPI-M-O participants to join the Covid-19 Taskforce as part-time secondees. In addition, SPI-M-O produced a number of 'explainer' documents to aid ministers' comprehension of epidemiological concepts.²⁵²²⁵² See, for example, INQ000310168; 'SPI-M: The general principles and assumptions on transmission of SARS-CoV-2', SAGE, 16 April 2020 (https://www.gov.uk/government/publications/spi-m-the-general-principles-and-assumptions-on-transmission-of-sars-cov-2-16- april-2020; INQ000194018); 'Introduction to epidemiological modelling, October 2021', SAGE, 29 October 2021 (https://www.gov.uk/government/publications/introduction-to-epidemiological-modelling/introduction-to-epidemiological-modelling- october-2021; INQ000236423)Show full note

¶9.143. Despite these efforts, there were deficiencies in understanding that persisted throughout the pandemic. Professor Matthew Keeling, Professor of Maths and Life Sciences at the University of Warwick and participant in SPI-M since 2009, told the Inquiry:

" [Politicians] were often asking questions that were way beyond the scope of any model, while for modellers it was often difficult to clearly communicate many of the subtleties and uncertainties to policy makers."²⁵³²⁵³ INQ000217363_0015 para 56

¶9.144. In particular, ministers failed to grasp the distinction between model-based forecasts and scenario modelling. Forecasting focuses on 'what will' questions (such as 'What will daily Covid-19 cases be in a week?'). It provides an up-to-date assessment of the current epidemiological situation and predicts what is likely to happen in the near future. In contrast, scenario modelling answers 'what if' questions (such as 'What will intensive care unit admissions be if new measures are introduced next month?'). It allows policy-makers to explore the possible consequences of various different courses of action.²⁵⁴²⁵⁴ INQ000249526_0016-0017 para 46; John Edmunds 19 October 2023 78/14-21

¶9.145. Scenarios were often wrongly treated as forecasts. Professor Whitty recalled that they "were not meant to be predictions, they were not presented as predictions, but they were often interpreted as predictions".²⁵⁵²⁵⁵ Christopher Whitty 21 November 2023 75/11-14 In the autumn of 2020, for example, a series of draft reasonable worst-case scenarios was developed. As discussed in Chapter 2: The emergence of Covid-19, in Volume I, a reasonable worst-case scenario is a prediction not of what will happen but of the worst that could realistically happen if no countermeasures were put in place.²⁵⁶²⁵⁶ For further discussion of reasonable worst-case scenarios, see Chapter 2: The emergence of Covid-19 , in Volume I. However, these scenarios were used as a part of the public justification for the UK government's decision to enter a second lockdown at the end of October 2020.²⁵⁷²⁵⁷ INQ000273553_0089-0091 para 12.14 The SPI-M-O modellers were then:

" heavily criticised in the press and by some politicians when reality did not match these 'predictions', with the resulting reputational damage that this entailed".²⁵⁸²⁵⁸ INQ000273553_0089-0091 para 12.14; 'Apocalyptic forecast of 4,000 coronavirus deaths a day could be FIVE TIMES too high and had already been proved wrong when government revealed it at weekend', Sam Blanchard and Xantha Leatham, Daily Mail, 2 November 2020 (https://www.dailymail.co.uk/news/article-8904617/UK-Governments-forecast-4-000-coronavirus-deaths-day-FIVE- TIMES-high.html; INQ000212171)

¶9.146. Professor Ferguson stated that the hostility formed part of a wider critical narrative in which modellers were accused of being "relentlessly over-pessimistic doom- mongers".²⁵⁹²⁵⁹ INQ000249526_0147 para 520

¶9.147. Similar issues arose in the devolved administrations. Concerns were raised in Scotland about the use to which models were put. The inherent uncertainty within modelling was sometimes overlooked. The Scottish Government Covid-19 Advisory Group considered this to be a specific challenge when providing advice to government and considered it incumbent upon itself to highlight those uncertainties. Professor Morris noted that highlighting such uncertainty "cut across normal advice to Government where a single best prediction is often preferred"; providing a range of opinions or potential outcomes where there is no clear outcome is a key function of the scientific advisory process.²⁶⁰²⁶⁰ INQ000346264_0040 para 176

¶9.148. In Wales, there was divided opinion as to the extent to which reliance on modelling was at an appropriate level.²⁶¹²⁶¹ INQ000347979_0022 paras 73-74; INQ000371584_0018-0019 paras 75-76; INQ000366137_0047 para 158; INQ000399290_0029 para 98 However, communicating uncertainty to decision-makers proved challenging. Dr Brendan Collins, Chair of the Technical Advisory Group modelling sub-groups from March 2020, acknowledged that expectations for modelling were sometimes too high.²⁶²²⁶² INQ000371584_0006-0007 para 27

¶9.149. Given that modelling is "one of the important technical skills in an infectious emergency", it is critical that both its strengths and its limitations are understood by those relying on its outputs in their decision-making processes.²⁶³²⁶³ INQ000251645_0043 para 4.16 This is so that they can effectively assess the meaning of such data and can communicate it accurately to the media and the public. The difficulties described above illustrate the value of promoting scientific literacy in government.

¶9.150. Educating decision-makers on the use of core scientific concepts would enhance both political and public understanding of this discipline. In advance of any future pandemic, the UK government and devolved administrations should develop a focused training module describing core scientific and modelling concepts that could be delivered to relevant decision-makers and officials (including those responsible for communications) at the outset of an emergency.

Communicating to the public

'Following the science'

¶9.151. During the pandemic, government ministers repeatedly and publicly asserted that they were 'following the science'. A variation of the phrase was used at 15 of the 30 press conferences held by the UK government between 17 March and 17 April 2020. It therefore formed a central plank of UK government communications during this period.²⁶⁴²⁶⁴ 'Prime Minister's statement on coronavirus (COVID-19): 17 March 2020', Prime Minister's Office and Boris Johnson, 17 March 2020 (https://www.gov.uk/government/speeches/pm-statement-on-coronavirus-17-march-2020; INQ000237479_0003); 'Foreign Secretary's statement on coronavirus (COVID-19): 6 April 2020', Foreign and Commonwealth Office, Prime Minister's Office and Dominic Raab, 6 April 2020 (https://www.gov.uk/government/speeches/foreign-secretarys-statement-on-coronavirus-covid-19-6- april-2020; INQ000220110_0002)Show full note The Inquiry heard widespread criticism of Mr Johnson and other UK Cabinet ministers for their use of the phrase.²⁶⁵²⁶⁵ Gus O'Donnell 10 October 2023 44/7-45/3; Helen MacNamara 1 November 2023 29/3-34/10; Patrick Vallance 20 November 2023 54/5-56/17

¶9.152. The concept of 'following the science' also featured in Northern Ireland. As Peter Weir, Lord Weir of Ballyholme (Minister for Education in Northern Ireland from May 2016 to March 2017 and from January 2020 to June 2021), explained:

" From the very early stages of the pandemic, the concept of following the science became central to the decision-making of the Executive i.e. the advice of the CMO and CSA was critical to our decision making process, and, while not dictating the decision, was often the central plank of our decision-making process, allied with the provision of information that was channelled through them such as by SAGE or the PHA [Public Health Agency]."²⁶⁶²⁶⁶ INQ000408058_0019 para 42

¶This was also recognised by Baroness Foster, who told the Inquiry that, at the outset of the pandemic, the approach of following the science became "the principal and foremost consideration".²⁶⁷²⁶⁷ INQ000418976_0044 para 141 She described it as:

" something of a comfort blanket for society in general – a way of ensuring that we were acting rationally and doing what was best, on the basis of the best available evidence".²⁶⁸²⁶⁸ INQ000418976_0044 para 141

¶9.153. Robin Swann MLA, Minister of Health for Northern Ireland from January 2020 to October 2022 and from February to May 2024, rejected the notion that the concept of the Northern Ireland Executive 'following the science' was problematic:

" I do not consider that the practise [sic] of 'following the science' risked that scientists bore too much responsibility for decisions. Scientific information was offered as advice which politicians then considered and then took a decision."²⁶⁹²⁶⁹ INQ000452486_0020 para 67

¶9.154. By contrast, 'following the science' (or analogous phrases) were less frequently used by the Welsh Government and the Scottish Government in their public health communications. Ms Sturgeon claimed that the language of 'following the science' was used by her on occasion but that she became increasingly uncomfortable with the phrase as the pandemic progressed.²⁷⁰²⁷⁰ INQ000339033_0050-0051 para 133 Professor Leitch confirmed that "[w]e often referred to 'following the science' in public communications" and defended the use of the phrase: "It was true to say that we were following the science."²⁷¹²⁷¹ INQ000329366_0004-0005 para 17

¶9.155. The first line of criticism directed at the use of this phrase was that it gave the impression that scientific advice alone was influencing decision-making, rather than being one of many considerations, including economic, social, political and operational issues. It was the role of ministers to balance these competing factors and to come to a decision based on the totality of the evidence. The phrase 'following the science' was therefore said to be misleading, implying incorrectly that those wider factors were being ignored or that a government was only in receipt of scientific advice. Alex Thomas, expert witness on political and administrative decision-making, described the phrase as "very damaging" on the basis that it "undermined the importance of ministerial judgement, and the accountability of ministers for decisions".²⁷²²⁷² INQ000236243_0035 para 120 He also suggested that decision-makers relied on this mantra as a "shield" to hide their role in the formulation of unpalatable decisions.²⁷³²⁷³ INQ000236243_0042-0043 para 142.6 Many witnesses agreed that ministers' insistence that they were 'following the science' blurred the line between scientific advice and policy decisions.²⁷⁴²⁷⁴ INQ000309529_0022 para 73; INQ000273553_0100 para 15.3.2; Patrick Vallance 20 November 2023 57/17-20

¶9.156. Professor Whitty told the Inquiry:

" I considered the concept that the Government was 'following the science' to be a misunderstanding, and potentially a misleading one … the decisions political leaders and other core decision-makers were taking were informed by the scientific and medical evidence available at the point in time the decision was taken. They were however also rightly informed by economic, social, political, diplomatic, operational, political and other issues."²⁷⁵²⁷⁵ INQ000251645_0217 para 14.17

¶Professor McLean suggested that this misconception was exacerbated by "having science advisers alongside decision-makers at press conferences, and no representatives of the sources of other evidence".²⁷⁶²⁷⁶ INQ000309529_0022 para 74 Professor Vallance explained that, while he understood the likely intent of the phrase was to show that the UK government was listening to the evidence and the advice that scientific advisers were providing:

" Looking back, I think that 'following the science' was not a good choice of words as it elided the advice with the policy."²⁷⁷²⁷⁷ INQ000238826_0231 para 726

¶9.157. Mr Johnson told the Inquiry that, after a conversation with Professor Whitty on 28 February 2020:

" From that moment on I could see that there were limits to the mantra that we were 'following the science'. Science could guide us and help us but many of the decisions would involve such complex moral and political dilemmas that only elected politicians could take them."²⁷⁸²⁷⁸ INQ000255836_0022 para 91

¶That notwithstanding, Mr Johnson's realisation was not reflected subsequently in the UK government's communications approach.

¶9.158. In a crisis, it is essential to maintain a clear distinction between the provision of scientific advice and the formulation of policy. As Professor Vallance put it: "[S]cience advisers advise and ministers decide."²⁷⁹²⁷⁹ INQ000238826_0220 para 685 By adopting a mantra that they were 'following the science', the UK government and devolved administrations downplayed their responsibility for their own decision-making. Decision-makers should have made clear that science was not the only relevant kind of advice and that it was their responsibility, as elected politicians, to balance the full range of considerations.

¶9.159. The second line of criticism of the phrase was the suggestion that it implied there was a single, universally accepted scientific view – when, in reality, SAGE's advice reflected a range of views that had been consolidated into a consensus position. Moreover, the message failed to encapsulate the reality that scientific evidence and advice were evolutionary and not static. This led to confusion about the rationale for decision-making, particularly where policy judgements changed over time.²⁸⁰²⁸⁰ INQ000573845_0002

¶9.160. Professor Vallance told the Inquiry that references to 'following the science' failed to recognise that science is a process of testing and building knowledge and overturning hypotheses when new evidence arises. In his view, this was not understood by many people and:

" there was a bit of dependency, that this was a scientific problem and people would listen slavishly to this and wanted to sort of slightly hide behind this at times".²⁸¹²⁸¹ Patrick Vallance 20 November 2023 57/17-20

¶9.161. An inherent issue with the 'following the science' message was also that it failed to provide sufficient information for the media and the public to understand what science had been followed or why – and thus to communicate and judge the rationale for, or validity of, government decisions. This meant that the audience (including communicators such as the media) was given inadequate information on what was being done.²⁸²²⁸² INQ000573845_0002

¶9.162. On occasion, the correct balance was struck in messaging. For example, during a media briefing on 23 April 2020, Ms Sturgeon said the following:

" I am seeking today really, to start a grown up conversation with you, the public. The decisions that lie ahead of us, of all of us, are really complex. We will – as we have done all along – seek to inform those decisions with the best scientific advice possible. But the science will never be exact, so we will also require to make very careful judgments."²⁸³²⁸³ 'Coronavirus (COVID-19) update: First Minister's speech 23 April 2020', Scottish Government, 23 April 2020 (https://www.gov.scot/publications/coronavirus-covid-19-update-first-ministers-speech-23-april; INQ000292547_0003)

¶9.163. Similarly, 'following the science' was not part of the Welsh Government's strategy, although the term was sometimes used by ministers, including Mr Drakeford.²⁸⁴²⁸⁴ Toby Mason 7 March 2024 90/13-18; INQ000220482 He told the Inquiry that he tried to avoid using the phrase because the Welsh government was rather "informed by" the science before making decisions.²⁸⁵²⁸⁵ Mark Drakeford 13 March 2024 79/13-17 Welsh ministers did refer to decisions being "based on" scientific evidence.²⁸⁶²⁸⁶ INQ000090562_0002; 'First Minister of Wales' statement on coronavirus lockdown extension', Welsh Government, 16 April 2020 (https://www.gov.wales/first-minister-of-wales-statement-on-coronavirus-lockdown-extension; INQ000573850) Professor Ann John, Clinical Professor of Public Health and Psychiatry at Swansea University, believed that communications by the Welsh Government maintained a clear line between scientific advice and policy decisions:

" With particular reference to the phrase, 'following the science', I do think it blurred the boundary between scientific advice and policy decisions for the public and raised issues of accountability. This boundary was more clearly communicated in Wales."²⁸⁷²⁸⁷ INQ000286066_0039 para 7.7

¶9.164. The Inquiry agrees that the phrase 'following the science' blurred the boundary between scientific advice and policy-making. It should not have become an often used mantra to justify policy decisions. By using it in this way, the accountability of ministers for their decisions was obscured by the implication that scientists had dictated the path they should follow. This might have contributed to the disgraceful abuse directed towards scientists by some members of the public during the course of the pandemic. Although some of the devolved administrations used alternatives and, on occasion, articulated how scientific advice had been used more accurately, these still failed to convey the debate and competing opinions that are inherent in scientific disciplines. The UK government and devolved administrations should aim to provide a fuller explanation of the factors that influence their decision-making in future emergencies.

¶9.165. In future, there needs to be well-publicised clarity on the fundamental distinction between advisers and decision-makers. This would enable scientific advice to be provided in a protected space, allowing advisers to give expert and objective views, free from prejudice and in a framework that clearly maintains ministerial accountability. A phrase such as 'informed by the science' would be a better way of describing the appropriate balance between scientific advice and political decisions, although it still does not encapsulate the competing factors that need to be balanced.

Publication of advice

¶9.166. The measures taken to control the spread of Covid-19 placed unprecedented restrictions on people's lives and freedoms. Compliance with those restrictions depended on public trust in the handling of the crisis by the UK government and devolved administrations, coupled with a clear understanding of the basis on which its decisions were made.

¶9.167. Transparency builds trust. It enables external scrutiny and challenge, encourages open debate and upholds accountability. It should therefore be at the heart of any emergency response. As Professor Edmunds remarked:

" Secrecy leads to speculation which can easily lead to distrust in the process of policy formulation and mistrust in the aims and intentions of the Government."²⁸⁸²⁸⁸ INQ000273553_0098-0099 para 15.1

¶9.168. The UK government's initial response to the Covid-19 pandemic was marked by a lack of transparency. Professor Anthony Costello, Professor of Global Health and Sustainable Development at University College London, recalled: "[A] culture of openness was conspicuous by its absence … everything was, at first, shrouded in secrecy."²⁸⁹²⁸⁹ INQ000281260_0037 para 151 Ministers repeatedly assured the public that they were 'following the science', while declining to share the scientific advice that they had received. The minutes from SAGE meetings were not published, neither were its participants or the documentary evidence on which its findings were based. This impacted negatively on public understanding of the scientific advisory process and on the scientific community's ability to scrutinise the rationale for the UK government's decisions. Both factors were particularly important in light of the personal sacrifices that those decisions required.

¶9.169. Professor Vallance told the Inquiry that non-publication of SAGE minutes was due to previously "established practice", whereby they were not released until a crisis had concluded.²⁹⁰²⁹⁰ INQ000147810_0015 para 49 There were also "concerns about security and the need for confidentiality as ministers considered options".²⁹¹²⁹¹ INQ000147810_0015 para 51 The decision as to whether to publish the minutes was a matter for the Cabinet Office.²⁹²²⁹² INQ000252449_0016 para 2.33

¶9.170. The Inquiry heard that most SAGE participants would have welcomed the publication of their advice. They believed that the concerns referred to above "were outweighed by the benefits that would arise from openness".²⁹³²⁹³ INQ000273553_0098-0099 para 15.1 In the spring of 2020, Sir David King, Government Chief Scientific Adviser from October 2000 to December 2007, responded to the situation by convening Independent SAGE. This was an independent group of scientists set up to monitor and assess UK strategy and to "provide open and transparent advice about public health issues relating to the Covid pandemic".²⁹⁴²⁹⁴ INQ000281260_0057-0058 paras 223, 226 Professor Susan Michie, Director of the Centre for Behaviour Change at University College London, stated that the "initial secrecy surrounding SAGE's membership, minutes and reports" was the "main reason" for the formation of Independent SAGE.²⁹⁵²⁹⁵ INQ000252610_0023 para 4.34

¶9.171. Professor Vallance agreed that SAGE minutes and papers should have been published "from the very beginning" of the pandemic. It was Professor Vallance who instigated the process that led to their eventual publication.²⁹⁶²⁹⁶ INQ000238826_0017-0018 para 42 After approval was obtained from the Cabinet Office, the first collection of SAGE papers was published on 20 March 2020, followed by a second tranche on 30 March. On 4 May 2020, the names of individuals who participated in SAGE were released with their permission. On 29 May, the minutes of all SAGE meetings were published on the UK government website (GOV.UK). From that date onwards, SAGE minutes and papers were routinely published within two weeks of each meeting, "except where those papers were still under active policy consideration or where there was a national security risk in publication".²⁹⁷²⁹⁷ INQ000252449_0016 paras 2.33-2.35 The Inquiry notes that the Government Office for Science has introduced internal guidance to ensure that, in future emergencies, SAGE papers and minutes will be published from the outset as soon as is practically possible. This is consistent with the views expressed by Professor Vallance.²⁹⁸²⁹⁸ INQ000142161_0004 para 2; INQ000238826_0017-0018 para 42

¶9.172. The Scottish Government Covid-19 Advisory Group published short summaries of each meeting on its website from the outset. However, full minutes were not published until 2 November 2020, with the minutes from earlier meetings published retrospectively thereafter. Other than on two occasions, the group's advisory papers to the Scottish Government were not published.²⁹⁹²⁹⁹ INQ000346264_0016-0017 paras 55-59

¶9.173. In Wales, nearly all Technical Advisory Cell and Technical Advisory Group documents were published from May 2020 onwards.³⁰⁰³⁰⁰ INQ000356177_0018-0019, 0026 paras 63, 97. In total, 20 modelling updates were published and almost 80 subject-specific reports from the Technical Advisory Group were published. In the same period, more than 70 Technical Advisory Cell summary-of- advice documents and more than 20 Technical Advisory Cell and Chief Scientific Adviser for Health advice documents for review cycles were published. The Technical Advisory Cell also prepared and published more than 40 Situation Report summaries.Show full note However, Dr Orford stated that the minutes were "not perfect" due to high demand on the secretariat and a lack of specialist training.³⁰¹³⁰¹ INQ000390618_0013 para 35 He said that, with more resources, minutes could be produced and published in a similar format to those published by SAGE, which would enhance transparency in future pandemics. Publishing these documents gave the Welsh public insight into the science behind key decisions, helping to explain lockdowns and social distancing rules. However, further resources could have further assisted in this process.

¶9.174. In Northern Ireland, minutes of Strategic Intelligence Group meetings were not published, nor were they provided to the Northern Ireland Executive Committee.³⁰²³⁰² INQ000436641_0056 para 217; INQ000418976_0075-0076 para 245 As explained above, scientific advice was provided to the Northern Ireland Executive by the Department of Health (Northern Ireland). It did this via Executive Papers. The content of Executive Papers and all aspects of Executive business are regarded as confidential and, as such, Executive Papers are not routinely published.³⁰³³⁰³ INQ000409729_0023 Ultimately, this meant that, beyond the advice emanating from SAGE, scientific advice was not routinely published in Northern Ireland.

¶9.175. In Professor Whitty's opinion, the publication of scientific advice "should be the default".³⁰⁴³⁰⁴ INQ000251645_0022 para 2.48 However, he raised concerns about publishing the identity of SAGE's participants in light of the abuse that was subsequently suffered by many of them. He told the Inquiry:

" If by making names public individual scientists or their families are targeted, or the best available scientists feel unable to take the risk of advising Government, the benefits of transparency may be outweighed by the risks to personal safety (to the scientists involved and their families) and proper advice (to Government and wider society)."³⁰⁵³⁰⁵ INQ000251645_0022 para 2.50

¶9.176. The scientific advice provided by SAGE was only one of the constituent parts that fed into decision-making. Although SAGE minutes and papers were ultimately published, other advice provided to ministers (including economic advice) was not. This could have given rise to the mistaken impression that scientific advice was the sole factor informing the UK government's decisions. This was not always the case. For example, as outlined in Chapter 5: Exit from lockdown, in Volume I, although the availability of accurate economic modelling was limited, economic considerations were a significant factor in the UK government's decision-making about the easing of restrictions in England in the summer of 2020 and the reduction in social distancing guidance. However, the lack of transparency of the economic advice contributed to an impression of imbalance.

¶9.177. In future emergencies, minutes of advisory groups and supporting technical advice, including economic modelling and analysis, should be routinely published wherever possible. This would achieve greater transparency and enable greater external scrutiny and challenge, thereby engendering greater public trust in the response. It is recognised that some material might be unsuitable for publication – for instance, to protect national security, personal safety, market sensitivity or commercial confidentiality.

Recommendation 4: Publication of technical advice

¶During a whole-system civil emergency, the UK government and devolved administrations should each routinely publish technical advice on scientific, economic and social matters at the earliest opportunity, as well as the minutes of expert advisory groups – except where there are good reasons that prevent publication, such as commercial confidentiality, personal safety or national security, or because legal advice privilege applies.