COVID-19 has brought a lot of new people to the attention of the public. Unlike politicians, these “chief” advisers who are mainly scientists and medics, are normally only active behind the scenes. How do they operate and how can single individuals work across the wide range of technical knowledge needed in the complex circumstances associated with COVID-19? The answer is that they are at the pinnacle of a system of science and medical advice involving perhaps hundreds of technical specialists. Something called SAGE is at the centre of this system.
SAGE, the Science Advisory Group for Emergencies, is a formal part of the UK government’s emergency response structure. It’s a subcommittee of COBR, which stands for Cabinet Office Briefing Rooms (popularly referred to as COBRA).
The government recently released details of the SAGE discussions about its advice to government on how to respond to COVID-19. This has set off a series of articles about the government response, some supportive and some critical.
There has been particular criticism about decisions being taken behind closed doors. In my time as a chief scientific adviser in government, I experienced many SAGEs and chaired a few of them. Here, I explain what happens behind those doors and why they need to remain closed – at least initially.
Behind closed doors
When an emergency happens in the UK, the Civil Contingencies Secretariat (CCS), which sits in the Cabinet Office, the central government department responsible for the organisation of government, calls and organises COBR. The response time for this can be as little as 30 minutes.
The CCS prepares a briefing for COBR, known as a CRIP, the Common Recognised Information Picture. This is the basis upon which all discussions and decision are made. It ensures that everybody involved is working off the same information.
SAGE is established at the request of COBR and it is normally chaired by the government’s chief scientific adviser – at present, this is Patrick Vallance. However, SAGE may be chaired on some occasions by other departmental chief scientific advisers or the chief medical officer. The advice from SAGE contributes to the briefing and the chair of SAGE attends COBR.
When SAGE is called, it is the job of the Government Office for Science to bring together the necessary range of expertise to formulate advice to COBR. When time is short, this expertise normally comes from scientists in government departments, especially their own chief scientists. But when time permits, SAGE pulls in expertise from around the country including, in the case of something like COVID-19, epidemiologists, clinicians, virologists, behavioural scientists, systems scientists and engineers.
The job of SAGE is to respond to questions from COBR. These can be quite specific or very broad. For COVID-19, the complexity of the response is such that SAGE has to rely on other established groups to help it with formulating its advice. For example, it uses the New and Emerging Respiratory Virus Threats Advisory Group, Scientific Pandemic Influenza Group on Modelling in the Department for Health and Social Care, and the independent Scientific Pandemic Influenza Group on Behaviours. These groups, which have deep specialists in various important aspects of disease control as their members, many of whom come from universities, have been thinking about pandemics for many years. Some of them run computer models of how the disease might spread.
SAGE has the job of integrating the information from these disparate sources and of augmenting advice where necessary if it recognises any gaps. This is a pyramidal system that takes an immense amount of technical information and boils it down to the essentials needed to inform both the strategic and tactical thinking going on at COBR.
It is at COBR that the scientific advice is pitted against other forms of advice from the economic, security, political, administrative and diplomatic spheres. This is not, as some have suggested, a closed system. Individual dissenting voices need to be listened to but not necessarily heeded. They challenge groupthink, but they are not part of the consensus process.
SAGE is an important feature of most emergencies in some form, especially during the early response phase. It sets out the scientific evidence and often defines the most appropriate options. However, a very important role is for it to set out the uncertainties – what we don’t know as much as what we do know – because this helps to define risks.
Adaptation and flexibility
All emergencies are messy. If it sometimes seems that the government is changing its mind then that is because it is responding to the evidence as it emerges. Adaptation and flexibility are part of any successful strategy and not, as some people seem to think, lack of ability. People like Vallance and Chris Whitty, the chief medical officer, need to be supported, not hobbled.
SAGE only exists to support COBR, so when emergencies move from response to recovery it tends to stand down. But often the job of science is not finished at this point so other “task-and-finish” advisory groups are established at departmental level. For example, following the poisoning of Sergei Skripal and his daughter Yulia Skripal with a novichok nerve agent in Salisbury, Wiltshire, I chaired the Decontamination Science Advisory Group, which had the job of advising when different contaminated locations in Salisbury were safe to be returned to public use.
At present, the SAGE process has never been worked so hard. Those involved right now will be struggling to find time to sleep, let alone have a protracted public dialogue over social media, as suggested in a Nature editorial. Some level of understanding of what is going on inside government on the part of the responsible media is important. If there are sometimes differences between the UK’s approach to managing the COVID-19 epidemic and other countries, these will almost certainly be deeply rooted in consensus advice coming from a large number of technical experts across the country. Very few other countries have this kind of system in place.