Transcript of Module 2 Public Hearing on 12 October 2023
(10.00 am)
Lady Hallett: Mr Keating.
Mr Keating: My Lady, my Lady. May I call Dr Stuart Wainwright, please.
Dr Stuart Wainwright
DR STUART WAINWRIGHT (affirmed).
Questions From Counsel to the Inquiry
Mr Keating: Thank you, and do sit down. Could you give your full name, please.
Dr Stuart Wainwright: I’m Stuart Wainwright.
Counsel Inquiry: And it’s Dr Stuart Wainwright, isn’t that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: And you’re somebody who has got a long history in the civil service. Am I right that you are a civil servant rather than a scientist?
Dr Stuart Wainwright: That’s right. I was a civil –
Lady Hallett: You can’t be both?
Dr Stuart Wainwright: So I was a civil servant for 20 years, recruited originally as a science fast streamer.
Mr Keating: Can I invite you to keep your voice up, and both of us will try to keep our voice up so that the stenographer can hear us. Secondly, pace. There is a stenographer who is recording what we are saying, so between us if we could avoid speaking over each other and pacing it accordingly. I may ask you to pause from time to time really just to allow everyone to digest your evidence and to allow the stenographer to capture your evidence. Is that okay?
Dr Stuart Wainwright: Of course.
Counsel Inquiry: You provided two witness statements to the Inquiry, which we’re very grateful for. The first witness statement is dated 23 August, we see that in the top right of the screen, and if we go to page 30 of that document, we see that you’ve signed that statement. That’s signed 23 August and it’s the statement of truth, and that’s correct; is that the position?
Dr Stuart Wainwright: It is correct.
Counsel Inquiry: In relation to the second witness statement, that’s dated 31 August, so the following week, and we see it’s 23 pages and at the last page, page 23, you again sign the statement of truth.
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Thank you.
Turning briefly to your professional background and really an overview of your evidence today, Dr Wainwright, and perhaps if we could have your first statement open at page 3, at paragraph 0.2. You’re here really as director of GO-Science, which we’ll explain in a moment, but in relation to your background, your doctorate, is it right that we see at paragraph 0.3 that you have a PhD in microbiology?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: And a degree in genetics from the University of Sheffield?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: And you’re also a policies fellow of the University of Cambridge’s Centre for Science and Policy. As you say, that is scientific background.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Then you joined the civil service, and you were civil service for a number of years, and you set those out in your statement at paragraph 0.4, a number of different departments.
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: But perhaps of relevance is that you were in the Cabinet Office?
Dr Stuart Wainwright: Yes. I mean, I was a civil servant for 20 years in a range of different organisations, and I guess the two main things that I did in my career was roles relating to the use of science and to resilience.
Counsel Inquiry: In terms of resilience, whilst in the Cabinet Office, you were on the Civil Contingencies Secretariat, CCS?
Dr Stuart Wainwright: That’s right, I was there twice, originally as a more junior member of staff in around 2010 to 2012, and then just before joining GO-Science for four years.
Counsel Inquiry: So that would have been 2017 to – or 2016 to –
Dr Stuart Wainwright: 2015 to 2019, I think.
Counsel Inquiry: Thank you.
You were involved in a number of significant emergencies during that time?
Dr Stuart Wainwright: That’s correct. Quite a large number. Salisbury poisonings, collapse of Carillion and Monarch, so quite a range of incidents, yes.
Counsel Inquiry: 2017, a pretty intense year, with a number of terrorist attacks and the Grenfell Tower fire?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Then you moved into preparing for Brexit?
Dr Stuart Wainwright: That’s right. The last year and a half in Cabinet Office, my role changed to understand what a no-deal Brexit might mean and to try to get the country as prepared as it could be.
Counsel Inquiry: Against that background of science, academia, civil service, you joined GO-Science in December 2019?
Dr Stuart Wainwright: That’s right, the middle of December 2019.
Counsel Inquiry: Probably hoping for a little bit more of a quieter life?
Dr Stuart Wainwright: I – it was supposed to be a more strategic role, but of course then events took off and the great majority of my time was on Covid for the first 18 months.
Counsel Inquiry: In terms of your evidence today, the purpose of you attending is, as you were the director of GO-Science, we want you to help to explain to the public and those who are here the scientific structures which SAGE was involved in. So we want you to help us with the systems, number one, and then after that part two will be exploring some of the comments and criticisms which were made about SAGE, its structures, its composition, and to give you the opportunity to comment upon those and consider lessons learnt.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: So in relation to part one, there is a sea of acronyms involving SAGE, which we should, but perhaps won’t, know all of them.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: So our collective task is trying to make that a little bit more –
Dr Stuart Wainwright: Sure.
Counsel Inquiry: – digestible and accessible today.
So let’s turn to GO-Science. Director of GO-Science from December 2019 until June 2023?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: What is GO-Science?
Dr Stuart Wainwright: So GO-Science is a relatively small part of government, technically it’s just a directorate of what’s now the Department for Science, Innovation and Technology, then it was Business, Energy and Industrial Strategy, but it’s kind of semi-independent from that department.
To be able to understand what GO-Science is, you need to understand science and government more generally.
Science is needed in almost every area of policy and operations, and every government department or almost every government department has their own chief scientists and teams of scientists and agencies. Some of those are very large, huge capabilities, such as MoD or DEFRA, and some departments have much smaller capabilities, and it’s their job, the chief scientists in those departments, to ensure that science is provided to input to policy and operations in those departments and made good use of.
GO-Science sits at the heart of government, really to do two things and support the Government Chief Scientist. At the time of the pandemic that was Patrick Vallance, it’s now Angela McLean. And the two things that we do to support the GCSA, one is to produce science advice to the heart of government, that’s Number 10, Cabinet Office and Treasury, on whatever they need it on. It was Covid in this case but it might be net zero or artificial intelligence, whatever the big issue is of the day. And the second big mission is to support all of government in doing science better. So that meant we recruited chief scientists for departments, we ran the science and engineering profession across government, things like that.
Counsel Inquiry: We can actually go to paragraph 1.1 of your statement and you touch upon the Government Chief Scientific Adviser, the GCSA the acronym –
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: That sets out there what his role is, which you’ve just told us about, really, it’s to provide scientific advice to the Prime Minister and members of Cabinet, advising the government on aspects of science or policy and ensuring and improving the quality and use of scientific advice and advice in government. The GCSA [the Government Chief Scientific Adviser] … reports to the Cabinet Secretary.”
Is that correct?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: GO-Science’s role, and your role, is really to – largely to enable him or her to complete that task?
Dr Stuart Wainwright: That’s exactly right. So our role is to support the Government Chief Scientist and my role was to help sure that that happened and the organisation was well run.
Counsel Inquiry: Yes. If we turn over a page to page 6, at paragraph 1.3, you talk about the two major missions of GO-Science:
“… firstly: science advice mechanisms that are efficient, effective, speak truth to power and are embedded permanently in government systems; and secondly, achieving visible impact through both proactive and demand led science advice that is relevant, excellent and delivered fit for purpose.”
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: “Speak truth to power”, that’s something which you’ve included in your statement as one of the major missions. What do you mean by that?
Dr Stuart Wainwright: So, I mean, the role of a civil servant generally is to provide objective and impartial advice, and that’s absolutely right. For scientists, that becomes even more so. In any area of policy or operations, government is going to want to have an honest, accurate, objective view of the science that it’s needing to contend with. So that’s about providing truth, and uncertainty as well, to those who need to make decisions.
Counsel Inquiry: You say truth and uncertainty. What do you mean by – is science certain? That’s probably a very deep question, but you mentioned the word “uncertainty”.
Dr Stuart Wainwright: So science and indeed other forms of evidence is rarely totally certain. I mean, you know, we know the world is round now, okay, but rarely in these situations is science totally certain. There’s things that we know, there’s things that we know with some level of confidence, things that we might think we know with little confidence, and there’s things that we just don’t know. And, you know, part of the role of scientific committees and advisers and the officials that supports them is to be able to present that coherent view of what the science says, but also the level of certainty that we have in what we’re seeing and what we don’t know.
Counsel Inquiry: Let’s move on to SAGE, a phrase which everybody is no doubt familiar with.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: What does SAGE stand for?
Dr Stuart Wainwright: So that stands for the Science Advisory Group (to government) [in] Emergencies.
Counsel Inquiry: We see at paragraph 2.3 overleaf that you describe this as:
“… an ad hoc independent advisory group that is convened to provide scientific advice to support decision-making in COBR in the event of a national emergency … activated by the Cabinet Office or as a ‘pre-SAGE’ on a precautionary basis by the GCSA.”
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Is that a fair summary?
Dr Stuart Wainwright: It is.
Counsel Inquiry: It’s perhaps obvious in the name, it’s advisory?
Dr Stuart Wainwright: That’s exactly right. So it’s an advisory committee to COBR. There’s a document, which I know you have, which lays out what SAGE is and how it works. That’s the – it’s a Cabinet Office publication, and that makes clear that SAGE is an advisory committee to the COBR committee. But of course COBR can set up a whole range of different advisory committees on all sorts of things.
Counsel Inquiry: Yes, so in terms of composition of the SAGE group, you say it’s not a permanent body?
Dr Stuart Wainwright: No.
Counsel Inquiry: It has no standing membership. How would the membership be selected for a certain emergency, and by whom?
Dr Stuart Wainwright: So just as COBR’s a very flexible mechanism, so is SAGE. You need the expertise in the room for the situation at hand. So, for example, SAGE was activated in the eruptions of the Icelandic volcanos in the early 2010s, so that was a totally different set of people participating in the SAGE meetings than for the pandemic.
So how those people are selected, there’s usually a starter standing roster for each major risk area of the sort of experts we might turn to, and those get regularly reviewed, but at the start of an event, we’d liaise with the Government Chief Scientist and any other major relevant chief scientist, the Chief Medical Officer in this case, to add to that list, and that would be the starter list. But as situations evolve you might need more scientific advice.
I would say usually round that table is a combination of roughly two sorts of people: scientists from within government and its technical agencies, so in this case PHE, and external academics. Usually a mix of those. Sometimes you have industry scientists for other risks as well.
Counsel Inquiry: Thank you. Could I invite you just to slow down a little bit more?
Dr Stuart Wainwright: My apologies.
Counsel Inquiry: Not at all, not at all.
In terms of SAGE itself, in its current structure, it’s been mobilised nine times since 2009; is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: And different structures before 2009 had been activated for the BSE, mad cow disease, and other incidents such as swine flu in 2009?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Okay.
SAGE, as you say, doesn’t advise, it doesn’t make decisions or set policy; is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Is that an important distinction?
Dr Stuart Wainwright: Very much so. I mean, it’s – I mean, in any situation, but particularly some kind of national crisis, there’s very tough decisions that have to be made, and we live in a democracy so it’s right that our policy decision-makers make those choices reflective of how society feels. To do that they need to take account of a wide range of evidence. Some of that is science, so this is just about providing science advice. But then the decisions are made by ministers.
Counsel Inquiry: One input into central government decision-making?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: In relation to “consensus advice”, that’s a term you use, and that’s at paragraph 2.1, you mention that:
“It brings together a range of experts and delivers consensus advice in the form of minutes.”
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: So the vehicle for the advice, in writing, are the minutes, that’s quite important; correct?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: And “consensus advice”, what does that mean?
Dr Stuart Wainwright: So in a rapidly evolving situation, you bring together a range of scientists from different disciplines, and they’ll bring to bear what they know, what they don’t know, what we’re relatively certain about, what we’re uncertain about, and the SAGE meetings allow them to bring together that – all the evidence and the science that they do understand and also what they don’t, and the minutes have to try to capture that consensus view that emerges, that the chair in the meetings will usually try to sum up after each agenda item what they think they’ve heard and what the consensus is, and if people disagree with that at the time, then they can – we’ll talk about it more, and then he’ll try to replay what the consensus is.
The minutes are the formal representation of that consensus that emerged from the meetings, so they should say what the science says, certainty levels, but also what we don’t know as well.
Counsel Inquiry: Is there any downside to this process of having just consensus advice formulated within the minutes?
Dr Stuart Wainwright: I don’t think so. So as well as the minutes, of course, the GCSA and, in this case, the CMO will also have been giving advice orally to ministers on the back of that advice, very much using the written advice as the anchor. I mean, the written advice, it has to be done at pace and speed. I mean, if I compare this to a very different world, so the world of climate change, where you have the international panel on climate change, which also works through consensus statements, but it can take months and years to produce that consensus. In this situation, we don’t have months and years, we have hours. So they are written at speed.
Counsel Inquiry: So consensus at speed?
Dr Stuart Wainwright: You’ve got it.
Counsel Inquiry: But is there a downside, in a sense, that contrarian views are significant but minority views might be excluded from what’s reduced to writing?
Dr Stuart Wainwright: Potentially. I mean, it’s not so much views. The – within a SAGE meeting, you’ll have different perspectives on the evidence, and in early stages people will have different evidence and data to hand, because it’s so fast-moving. You might get different views on how to interpret that. If that’s the case, we try to reflect that difference of interpretation in the minutes as best we can. I mean, it’s possible we may not always have got that entirely right. Although we never – very rarely would we send round the minutes for active comment. After they had been issued to attendees and to Cabinet Office as well, occasionally some of the participants might come back and say, “Actually I think you need to tweak this part”, and we would.
Counsel Inquiry: You mentioned that GO-Science is at the heart of government, but also is that – in terms of the source of government scientific advice, is SAGE the only source of government scientific advice in an emergency?
Dr Stuart Wainwright: No, not at all. And as I explained earlier, every government department or most government departments have their own chief scientist, teams of scientists. Some of them have huge scientific agencies.
Counsel Inquiry: Yes.
Dr Stuart Wainwright: The Met Office or Environment Agency or, in this case, Public Health England, and very often in emergencies, SAGE isn’t needed. So if I take the example of floods, you’ve got two highly technical agencies in the mix, the Environment Agency and the Met Office. Most floods happen, they need an awful lot of science, but there’s no role for SAGE usually, unless something unusual has happened. So the only time SAGE, in my recollection, has been activated for a flood is twice. One was when the Somerset levels refused to drain, so that was unusual, and the second was when the Toddbrook Dam was at risk, and again that was unusual, but mostly the government can rely on its good scientific technical agencies for that particular risk.
Counsel Inquiry: So SAGE is not automatic?
Dr Stuart Wainwright: No.
Counsel Inquiry: It’s something to be activated.
So let’s turn to SAGE during the pandemic, a number of meetings, we know. And you’ve set this out at paragraph 2.6, that SAGE was internally mobilised on 3 January?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: And the first SAGE meeting was on 22 January 2020; is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: We see also at paragraph 2.5, going back, that SAGE met 105 times from January 2020 to February 2022, and that’s the longest continual period for which it had been convened since its inception?
Dr Stuart Wainwright: Yes, by a very long way.
Counsel Inquiry: In terms of the volume of work, and it’s tucked away in that paragraph there, over 1,200 papers were produced or considered by SAGE by April 2022, so a huge amount of work was done?
Dr Stuart Wainwright: That is correct, yeah.
Counsel Inquiry: It’s fair to say this was an unprecedented time for GO-Science, and the team, which you led, supporting SAGE; is that correct?
Dr Stuart Wainwright: That is correct. And we were a very small organisation going into this, 60 people in total. SAGE team was five people, as I recall. By the end of April we had I think around 80 people just working on SAGE, 24/7.
I think it’s – I’d just like to say here that, I mean, what really formed SAGE was two sets of people: huge numbers of academics, I think almost 200 in total, who gave their time for free, and then officials from within GO-Science, across government, and many of the government science agencies, who joined us, again to give up their time. And I want to say a huge thank you to both groups of people, and in particular the independent scientists, who gave their time for free.
Counsel Inquiry: In relation to what you say, that the SAGE group, in terms of secretariat, there was a massive scaling up in relation to that?
Dr Stuart Wainwright: It was, we had to grow very quickly in just a month or two.
Counsel Inquiry: Drawing upon other colleagues in other departments in the civil service?
Dr Stuart Wainwright: So really four routes. We switched off most of what GO-Science did elsewhere and steered most of our staff towards it. There was a cross-government mechanism for getting staff from elsewhere in place that we got some people from, but it quickly ran out. We brought in a lot of mid-career academics, including some who worked with some of the SAGE participants, and then the biggest cohort was we put out a call to – there was also science fast streamers, but the biggest cohort was from science government agencies, so Met Office, Dstl, and particularly the Environment Agency, who gave us an awful lot of people. So they just came to our help and I can’t think them enough.
Counsel Inquiry: In terms of the composition, we see at paragraph 2.6 that the GCSA, the chief scientific officer, and the CMO, the Chief Medical Officer, assembled a group of experts from key disciplines –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – particularly medicine, public health, epidemiology, virology and behavioural science; is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: What role did the Chief Medical Officer have in SAGE? Was he originally meant to be involved in SAGE? Was that something in the original parameters, or was he brought in?
Dr Stuart Wainwright: No, he was always involved, right from the start, and the working assumption is that for a health emergency the CMO is the co-chair. I mean, in effect, Patrick Vallance acted primarily as the chair in most of the meetings. Chris would be a very sort of active – Chris Whitty, sorry – participant in support of him. There were occasions when Chris Whitty would take on the sort of full chairing role as well.
Counsel Inquiry: In terms of the members, you mentioned, you’ve touched upon that there were SAGE members, experts in the field –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – both within government, other departments, and also outside government, and that the latter group were doing this pro bono, this was a public service for free?
Dr Stuart Wainwright: That’s exactly right. As things went on for a long time, for some of them, I think it was in the autumn of 2020, we paid their universities to be able to backfill their roles, because they didn’t have time to do their teaching duties, so we paid for their teaching duties to be covered by others, some of them.
Counsel Inquiry: The workload, without labouring this too much, in relation to those SAGE members, they were working all day, evenings, weekends; is that fair?
Dr Stuart Wainwright: It was incredibly hard for everybody. I mean, the pandemic had an absolutely huge effect on everyone, and I just want to acknowledge the grief of the families who are here today, and all of the awful sort of impacts that happened to the people that you know. It affected all of us in absolutely terrible ways, and I greatly respect your bravery in bringing this all to light.
For our people working on this, yes, the academics and the officials, it was very long hours, very long days, for months on end.
Counsel Inquiry: If I could move on to paragraph 2.13, on page 12, you mention that as the pandemic response grew, an official from each department was invited to attend SAGE, and there was:
“… other departmental officials … Cabinet Office, DHSC, HM Treasury … and No 10 attended as observers to allow them to hear the discussion directly, to feed in any required policy perspectives and to ask questions.”
You mention that they did not contribute to scientific advice, that this is normal practice.
I just want to hone in on the part of that passage where you say that they would feed in any required policy perspectives. What do you mean by that?
Dr Stuart Wainwright: So, this is good practice for science advisory committees generally. Government operates a huge range of policy advisory committees, SAGE is just one for emergencies. Officials like this I think need to attend for two reasons. One, in case they need to provide that context as to what the policy challenges are, what are the issues that they think the government is contending with and struggling with, and that can help with what sorts of science advice might need to be provided. But if we take – SAGE commissions itself foremost in two ways, it gets commissioned in two ways. The first is that it will get asked things by the policy customers, Cabinet Office and, in this case, Department of Health, but it also self-tasks: what it considers to be the scientific challenges and questions it tasks itself. But for these sorts of officials, it’s good for them to be there to frame what they think the policy challenges are, that helps the committee, but also it’s good for them to hear the discussion, you know. So then when they are back trying to weave together, as should happen in the best of times, different forms of advice, they have a better understanding of what the scientists are actually saying.
Counsel Inquiry: Thank you.
Lady Hallett: So I think it’s both reactive and proactive? I think I’ve heard other witnesses suggest it was only reactive to questions it’s posed.
Dr Stuart Wainwright: It was mainly reactive, but at the start you might ask, for example, if there was, you know, a particular item on – I don’t know, say, in the autumn, you know, on sort of, you know, should we have another lockdown or NPIs or whatever, they might be asked at the start of the agenda item: Could you give us a sense, Cabinet Office representative, of what’s the policy challenges at the moment. That would sometimes happen.
Mr Keating: I’m going to revisit this topic in part two, when we discuss strategic direction and whether there was sufficient strategic direction.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Let’s move on to structure, and in terms of structure there was SAGE and there was a number of subgroups, and perhaps we can bring up a brief organogram which might assist in relation to that. That’s INQ – we have it just there, thank you very much.
You mentioned in your evidence, in your statements, that some pre-existing specialist groups of experts were called upon, and that includes, I’m going to use the acronym first, SPI-M. We see that tucked away there, I hope. Is SPI-M on the list? Right in front of me.
Dr Stuart Wainwright: They are.
Counsel Inquiry: So Scientific Pandemic Insight Group on Modelling? So there was a pre-existing group in relation to that; is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: And that was activated. What was the role, briefly, of SPI-M, just to assist a member of the public to understand what SPI-M did?
Dr Stuart Wainwright: So SPI-M is a committee that stands all the time that the Department of Health run, and it advises them on – it provides modelling of potential diseases. When some kind of disease, significant disease outbreak is coming, the SPI-M-O, which I think stands for operations –
Counsel Inquiry: Correct.
Dr Stuart Wainwright: – gets activated by the Department of Health and provides sort of rapid modelling for the Department of Health and PHE.
Counsel Inquiry: This became a subgroup of SAGE in January 2020?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Am I correct in understanding the chairs were Professor Edmunds and Professor Angela McLean?
Dr Stuart Wainwright: Yes, so originally it was just – no, it wasn’t Professor Edmunds, it was Graham Medley, the chair.
Counsel Inquiry: Yes.
Dr Stuart Wainwright: Angela got made co-chair I think sometime in March.
Counsel Inquiry: Next acronym, which was a pre-existing subgroup, NERVTAG?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: We see that in front of us. So NERVTAG means New and Emerging Respiratory Virus Threats Advisory Group. Perhaps we can see why it’s called NERVTAG?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: Again, what was the role of NERVTAG?
Dr Stuart Wainwright: So, again, another existing group that meets anyway, I think it’s actually a statutory group, and run by the Department of Health and PHE, now UK Health Security Agency, and this provides not just modelling advice but they have virologists and geneticists and various kinds to advise on a wide range of emerging respiratory viruses.
Counsel Inquiry: Am I right in understanding that Professor Horby was the chair?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Yes. There was a number of other subgroups which were set up by SAGE. You’ll be pleased to know I’m not going to ask you about every single one of those. I’m going to touch upon some of those, please.
Let’s, as a general point, why were other subgroups set up?
Dr Stuart Wainwright: First of all I’d say that not all of these groups here were set up by SAGE, so some of them were set up elsewhere, but – and they were doing their own jobs, but SAGE would draw on their expertise and what they were doing.
So CO-CIN, at the bottom left, the PHE Serology Working Group, were set up independently but we made use of them anyway.
But subgroups, as the pandemic grew, and the needs of government to understand what was happening, and as more data and science emerged – I mean, remember in January we knew next to nothing, but as, gradually, more data, more science emerged, you could make more sense of things.
Counsel Inquiry: Would it help if I went through a few examples?
Dr Stuart Wainwright: Please.
Counsel Inquiry: It might help. So we’ve got general – you’ve made a distinction that some were set up elsewhere but would feed in?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: And then some were set up as a result of the needs of government, and let’s go to three examples –
Dr Stuart Wainwright: Please.
Counsel Inquiry: – which we’ll hear evidence about this week and next week.
Dr Stuart Wainwright: Excellent.
Counsel Inquiry: SPI-B, which is on that list as well, B being the significant word, behaviours, the Scientific Pandemic Insights Group on Behaviours?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: What was the role of SPI-B?
Dr Stuart Wainwright: So SPI-B had been activated, I understand, in the – during swine flu, and had been run by the Department of Health, but we took this on here and it really is to bring together a wide range of social scientists to provide that social science and behavioural advice to government, so an understanding of how different groups might react, and hopefully to aid communication.
So particularly as advice got steered towards non-pharmaceutical interventions as well as public health, and epidemiology being important, you need to understand how people are going to react as well.
Counsel Inquiry: So to summarise the evidence in your statement and to assist you, we don’t need to turn to it, but you mention in your second statement, at paragraph 1.9, that:
“… behavioural and social science was recognised as an important component of the overall scientific understanding and advice during the pandemic response.”
And we will hear from –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – the cochairs, Professors Rubin and Yardley shortly, and you said that SAGE discussions included behavioural science advice throughout the period when SAGE was active, and in fact Professor Rubin attended the first SAGE meeting in January 2020 –
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: – and subsequent meetings.
SPI-B, the subgroup, the SAGE subgroup, was set up formally on 4 February 2020 to provide independent expert advice?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: In relation to behavioural advice provided to government, to your knowledge, was SPI-B the only source of that type of scientific advice?
Dr Stuart Wainwright: No, I don’t think it was. There’s a lot of social scientists within different departments in government, PHE, Department of Health, Cabinet Office, all had social scientists, and in particular Cabinet Office also had the Behavioural Insights Team, who also were providing advice, but those organisations would come and input to SPI-B, but I imagine many of them were providing advice themselves.
Counsel Inquiry: The Behavioural Insights Team was led by Professor David Halpern; is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: We’ll be hearing from him later on in this module.
The next group is the Ethnicity Subgroup, and in fact we’ve already heard from the chair of that group.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Professor Khunti gave evidence yesterday. That was set up on 22 August 2020; is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Perhaps we can bring up your second statement at paragraph 2.40, please, dealing with the question of those from ethnic groups and the impact of Covid on them.
So if you look at paragraph 2.40 on page 18, please, you mention that:
“The understanding of the impact of [Covid] on at risk and vulnerable groups developed through the pandemic, and was considered frequently by SAGE.”
And you add:
“Some groups were at increased risk of infection …”
You talk about:
“… employment-related exposure; others were at increased risk of poor outcomes (hospitalisation and death) or Long Covid once infected …”
And you talk about the “mix” of reasons why that was.
You also mention at 2.42 that CO-CIN – and that was one of the subgroups you mentioned that fed in to SAGE – and this is data – that was established in February 2020, and that catalogued data from laboratory-confirmed cases of Covid admitted to UK hospitals. And that data indicated increased mortality in black ethnic groups compared to white ethnic groups in April 2020.
Is that right?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: You probably are aware from the wider material that there was a Public Health England report published in June 2020 about the impact of Covid on BME groups?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: And there was an updated report in August 2020 regarding the disparities in risk and outcomes in Covid-19.
So drawing that background together, we’ve got the data in February 2020, we’ve got the PHE report in June 2020, update in August 2020.
What do you say to the suggestion that the Ethnicity Subgroup should have been set up before August 2020?
Dr Stuart Wainwright: I don’t think I’d agree with that. A consideration of BME and, indeed, impacts on any underrepresented group is incredibly important. And Patrick Vallance’s statement for Module 2 lays out very clearly sort of over several pages sort of when SAGE looks at issues to do with different groups, right back to early February.
I mean, what this shows to me is that the NHS, PHE were considering these issues and trying to build them into their work. It was only as we got into later in the summer that there was enough information for SAGE to form a subgroup to look at this. There might be value in considering setting up these kinds of things earlier. I guess the challenge is: would a greater focus from SAGE or another group earlier have led to greater interrogation of the data? Maybe so, but data was light.
So I think that is something to reflect on, and within the system across science advice, whether it’s DH or PHE or SAGE, maybe there should have been some earlier consideration there. But SAGE wasn’t really asked to get involved with this until that time.
Counsel Inquiry: So just unpacking that, there was a lot in there, so SAGE wasn’t asked to look at the impacts –
Dr Stuart Wainwright: No.
Counsel Inquiry: – on ethnic groups before August 2020, number one, and in reflecting upon it you think that perhaps there would have been benefit if there was earlier focus on it?
Dr Stuart Wainwright: So SAGE did provide advice earlier on this issue, you know, and Patrick’s statement lays this out and there’s quite clearly an example of April there. I don’t know the extent to which PHE and CO-CIN or others were – how much they were investigating ethnicity before this, but I think there probably is a lesson around: across that consideration of public health and science and statistical information, was the right focus brought early enough? I think is a reasonable question.
Counsel Inquiry: And the last point, just to unpack on those series of answers, is data. You mentioned that maybe there wasn’t sufficient data, in your view, which allowed the focus that you think perhaps should have been placed?
Dr Stuart Wainwright: Data generally was a real challenge, particularly for the first year, I would say, of the pandemic. I mean, as, you know, has been, I think, well documented in Module 1, you know, there were not the surveillance systems in place going into this, so the ability to gather data in the first place was highly limited early on. And then the ability to share data across the NHS and PHE and then with academics was also very limited, and that extended to any data relating to ethnicity, and everything else.
So data sharing, or data gathering and then sharing were real challenges that hampered the ability of scientists to research and understand.
Counsel Inquiry: Just dealing with that last point about data sharing, it’s been commented in other publications that SAGE in particular had difficulties with receiving data from intergovernment departments –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – right up until May or June 2020. Was that the position?
Dr Stuart Wainwright: Yes, that’s correct, and I think Ian Diamond spoke very well about the challenges in that, and some of the potential solutions, earlier this week.
Counsel Inquiry: Final group, subgroup, I would like your assistance upon, because we’re going to hear from a member who was on that group, is Environmental Modelling Group, the EMG, which included in itself a subgroup, so a subgroup of the subgroup, the transmission working group.
Dr Stuart Wainwright: Yes.
Counsel Inquiry: So we’ve got the EMG, the Environmental Modelling Group, was established in April 2020, and that was to provide science advice and modes of transmission?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: And the EMG transmission subgroup was established in January 2021, and you mention in your statement, we don’t need to turn to it, that that was to examine further the evidence around transmission in real world settings –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – including where transmission was happening. What does that mean?
Dr Stuart Wainwright: So as – by that point the data and the evidence that we had, we had more data around how the virus was moving in real world settings like, for example, workplaces or public transport or hairdressers, whatever. All these things matter quite a lot, because it’s where people tend to meet. So by this stage quite a lot more science and evidence was emerging, so a subgroup was set up to make more sense of that emerging science and data and to be able to help inform more advice.
Counsel Inquiry: So January 2021 we were in the third lockdown?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: January 2021.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Was the work of the EMG transmission subgroup there to inform the relaxation of the lockdown and the pathway out of lockdown 3?
Dr Stuart Wainwright: I’ve struggled to recall, if I’m honest, on that. I don’t think we’d have framed it in that way. I think it would have been more: look, there’s more science and data, there’s obviously a range of NPIs under way in the country, so let’s make sense of the science and data that’s emerged and try to provide policymakers with a clearer sense of what it says.
Counsel Inquiry: We went through a number of the subgroups, we in fact touched upon Long Covid when we were talking about the impact on certain groups?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: But we will see there wasn’t a subgroup for Long Covid. Was one set up in relation to Long Covid?
Dr Stuart Wainwright: Not to my knowledge, no. I mean, I’d presume that that was set up within the Department of Health, and PHE have focused on that. I hone in a little bit on the name, Science Advisory Group for Emergencies, it’s supposed to be a short-term mechanism, but I would have expected Long Covid to be covered through the Department of Health and PHE.
Counsel Inquiry: But from your perspective, as chief executive of GO-Science for SAGE, which was operational for the longest it’s ever been –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – there wasn’t a Long Covid subgroup set up during that two-year period?
Dr Stuart Wainwright: No.
Counsel Inquiry: Was GO-Science asked to consider the risk and advise the risk and impact on those who had Long Covid during your time there?
Dr Stuart Wainwright: I don’t recall. We would need to go back and check the records.
Counsel Inquiry: Okay.
I’m going to move on now to another topic in part A, which is advice. You’ve touched upon this already, about how scientific advice was sought – “commissioned” is your word for it; correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: And that would normally come from – it’s at paragraph 2.19 of your first statement – the Cabinet Office –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – via COBR?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Is that correct? That was the primary commissioner. And in due course that evolved, did it not, with – it perhaps came from the Covid Taskforce in the autumn of 2020?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: In terms of how advice was provided to ministers, is it right that it was two-fold. First of all, the minutes, which we have already dealt with, significance?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: And secondly, advice from the Government Chief Scientific Adviser and the Chief Medical Officer?
Dr Stuart Wainwright: Yes. When they were presenting orally to ministers.
Counsel Inquiry: Yes.
Dr Stuart Wainwright: Yep.
Counsel Inquiry: So it’s that combination of oral advice combined with the underlying written material which is set out in the minutes?
Dr Stuart Wainwright: That’s exactly right.
Counsel Inquiry: We talked about confidence in terms of minutes. It’s right, isn’t it, that degrees of confidence in advice such as high, medium and low were introduced and included in minutes? Was it the case that there wasn’t at the outset that that –
Dr Stuart Wainwright: Erm.
Counsel Inquiry: – degree of confidence was included but it was – by SAGE 4, 4 February, it was added?
Dr Stuart Wainwright: That’s correct. I think earlier we might have tried to reflect it just generally in the drafting of the minutes, but we moved to that more formal grading at that point.
Counsel Inquiry: So advice would include that level of confidence –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – high, medium and low as we touched upon.
Publication of advice and analysis. Perhaps we could turn to your statement in relation to this at paragraph 2.32, page 15.
I can summarise that as we’re waiting to bring it up. In previous emergencies SAGE minutes normally were not published at the time of the crisis –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – but they would follow on once the crisis or emergency had concluded; is that correct?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: That was normal. It wasn’t exclusively the position but that was normally the way forward?
Dr Stuart Wainwright: That’s correct, yeah.
Counsel Inquiry: In relation to the pandemic, you’ve mentioned at paragraph 2.33 that a batch of SAGE papers was published on 20 March on GOV.UK, and then on 30 March, so there was initial papers were published on 20 and 30 March?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Then in due course you mention at 2.35 that all the meeting minutes were published by 29 May 2020?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: The topic of transparency and providing those minutes has been subject to a lot of public debate –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – and there’s been questions as to whether it was right, two months after the first lockdown, for those minutes, and the participants, to be published. So a couple of questions against that backdrop.
Dr Stuart Wainwright: Sure.
Counsel Inquiry: First of all, who decided that the minutes and participants should have been, would be published?
Dr Stuart Wainwright: So that will have been Cabinet Office and Number 10 who decided. The recommendation from the Government Chief Scientist and ourselves was to publish.
Counsel Inquiry: Was there any initial resistance from government as to publishing the advice?
Dr Stuart Wainwright: I’m not sure I’d regard it as resistance. It was right to publish, and I think it was right to publish for two reasons.
Firstly, this was an event that was affecting everybody, and so it’s right in a situation like that, in my view, to be transparent about the decisions on which decisions are being made.
The second reason, which is more to do with science, is that scientists – it’s a great quality – like to challenge and engage in debate, and they can more readily engage in that if you publish the SAGE minutes and the associated papers.
I think there were three problems with publishing, though, we were worried about, all of which came to pass, all of which relate to: if you only publish the SAGE minutes and not anything else within government.
So the first is that we were concerned that it would lead to greater abuse of the scientists who were supporting us. And it did. So we had to put in place a lot of mechanisms to support them. The second challenge, in our mind, which I think also came to pass, is that it would lead to an unbalanced understanding, and debate, in Parliament and the media. They were only seeing one form of advice – they were not seeing economics or operational or policy advice, they were only seeing one form of advice. And I think that did have a negative impact.
The third reason is that it reduced the amount of time that policy and decision-makers had to make decisions. Now, they managed that, but at times that felt – I imagine that felt challenging for them.
So it was the right thing to publish, and that was the right thing, but there were challenges, as I’ve just outlined, and I think all of those problems came to pass, and hopefully that’s some lessons that can be learned for the future.
Counsel Inquiry: So it was transparency but at a cost?
Dr Stuart Wainwright: Yes, but it was the right thing to do, but there should have been more transparency on other forms of advice.
Counsel Inquiry: One of the issues is to ensure there is a safe space for scientific debate and advice to take place?
Dr Stuart Wainwright: Yeah. And, I mean, I’m very sorry to all of our SAGE participants who received abuse. It affected a lot of them, to a very large extent. And some of them you’ll be interviewing and I hope they’re honest about that. I worry that this situation may have put off other academics from coming forward to help government in future.
So GO-Science put in place a great use of arrangements around comms support, wellbeing support, counselling, security advice and support, which felt like we should never have really have had to do them, but we had to provide that. I think in future events that might be something that the whole of government might want to think about, how it can provide that more fully for these amazing experts who are giving their time for free.
Counsel Inquiry: In terms of advice, one tangential point I just want your assistance upon is this: we have members who are in the subgroup, we have members in the SAGE group, and we know that the vanguard of that is the Chief Scientific Adviser and chief medical adviser giving that advice to politicians. What do you say to the complaints by those on the subgroup, or even on SAGE, that they never really knew how their advice was considered or flowed into decision-making?
Dr Stuart Wainwright: I understand their concerns, and I think it – we could have been better, at times, at – sorry, we and Cabinet Office could have been better at times at communicating things back to them. That did get better in the autumn of 2020, once Cabinet Office had a stronger analytical unit, who really helped engaging the experts on that.
But I think those concerns from a lot of our experts were heightened because the SAGE advice was very public and that was clear what was going on, but nothing else was. So although the SAGE advice was public, the other forms of advice, the basis on which decisions were taken, was not. So as an expert on a SAGE committee you’re left in a situation where your advice is public, but then a different decision is made, not apparently in line with that, and they’re left understanding - thinking, “Well, why?” They were not able to see that because nothing else was published.
Mr Keating: Thank you.
Lady Hallett: Can I just go back to the point about the dreadful abuse of people who, as you say, gave their time, and a great deal of time, free to try to serve the public.
Is one possible answer revealing the nature of the speciality of the scientific advisers without naming them, or does that not meet the test of openness?
Dr Stuart Wainwright: That could be one way to go. That could be a way to go. I was surprised – maybe they think differently individually, but when we did ask the SAGE participants “Are you happy to be named?” they all said yes –
Lady Hallett: They didn’t know what was going to come.
Dr Stuart Wainwright: Yeah, maybe so. I also think you’d have different views on that. I mean, people are different, you know, and some people have got thicker skins than others. I mean, that could be a good way to go. I think that might be right.
Mr Keating: I mentioned that the Chief Scientific Adviser and the Chief Medical Officer were at the vanguard of advice at central government, especially that oral advice, and it’s right, isn’t it, they attended numerous key meetings?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: You’ve summarised these in your statement, and perhaps I could do that here.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: The Cabinet, they would attend Cabinet meetings –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – on occasion, by invitation; COBR meetings; and the various ministerial implementation groups, the MIGs, which we’ll hear about in due course –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – which was one of the structures for decision-making which was implemented –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – in April/May 2020, and they were succeeded by something called Covid-O and Covid-S, Covid-O for operations and Covid-S, strategy, they were the new structures which were brought in, and again they attended those –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – and provided advice. Then there was regular updates or meetings, bilateral meetings with the Prime Minister on occasion, or at Prime Ministerial dashboard meetings which took place on certain mornings –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – in Downing Street, and also at quad meetings, which would be the meetings involving the Prime Minister, Chancellor, Health Secretary and the Chancellor of the Duchy of Lancaster?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: So in terms of that vanguard, they would attend multiple key decision-making meetings and provide that advice?
Dr Stuart Wainwright: Yeah. That’s correct.
Counsel Inquiry: In terms of other areas of work which were undertaken, and a huge amount of work was undertaken, but you mention sometimes that there was other entities which – or organisations which SAGE would call upon, and an example perhaps of this is the Academy of Medical Sciences, AMS, and they were commissioned to prepare a report, “Preparing for a challenging winter 2020/21”?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: And that was published in July 2020, and they did the same for the next winter?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: What was the rationale upon commissioning the academy to do that work and to publish that report?
Dr Stuart Wainwright: So we made – we have – GO-Science always has a good relationship with all the scientific academies, and particularly the four main ones, the Academy of Medical Sciences, the Royal Society, the Royal Academy of Engineering and the British Academy, and they, like the rest of the scientific community, were keen to help with the national effort.
In this case, of AMS, it was felt, look, with the networks they’ve got of the best medical scientists in the UK, SAGE is still embroiled in the – sort of very much the day-to-day advice that’s needed, we asked AMS to look a bit longer term and work with its members to produce an independent report on this. Which they did, and then, you’re right, in a subsequent year.
So this was that a great example of the wider academic community working to produce a slightly longer looking report than SAGE would have been able to at that point.
Counsel Inquiry: It wasn’t the longest period to be horizon scanning for –
Dr Stuart Wainwright: No.
Counsel Inquiry: – but it was really there to try to assist, was it, decision-makers in terms of considering the issues?
Dr Stuart Wainwright: That’s correct.
Counsel Inquiry: Were these reports, to your knowledge, highlighted to governments and key decision-makers?
Dr Stuart Wainwright: Yes. So I recall that for a range of these from the large academies when they came out we would communicate them within government, say: look, go look at this report that’s been produced.
For some of them we may have offered teachings on them and arranged for the academies to speak to policymakers. I can’t recall if that one happened with this one or not, but generally we tried to make sure that they were known, but to what extent they were picked up, I can’t say.
Counsel Inquiry: You can’t say whether there was traction or capacity in relation to considering those reports?
Dr Stuart Wainwright: I think others would have to answer that.
Counsel Inquiry: A discrete subtopic is the relationship between GO-Science and SAGE with the devolved administrations, which you touch upon in your statements. You mention this at paragraph 6.1 of your first statement, on page 28, that the devolved administration representatives were regular attendees of SAGE and that they received all SAGE minutes and papers at the same time –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – as Whitehall departments.
Pausing there for a moment, was there a little bit of an issue that they didn’t get the first few minutes of SAGE?
Dr Stuart Wainwright: A little, perhaps. So representatives from all of the DAs were invited I think from 11 February, and that was usually a range of participants in the DAs, so that was SAGE 6. Before then there’s a – all of them will have received the minutes – might have been a slight problem with Northern Ireland. So the minutes go in sort of two directions, they would go to Cabinet Office and then to COBR. All of the DAs were on COBR and would have received them at that point. They also went across the chief scientists network as well, so Scottish and Welsh CSAs would have received them right from the start. Northern Ireland did not have a singular CSA at that point, so they would have not received them through that route initially. However, from February 11th they would have done. Northern Ireland do now have a CSA, I should say on that.
Counsel Inquiry: Just pausing there, and I’m very grateful. So in terms of the co-ordination –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – and distribution information, two mechanisms. Number one, the minutes?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: And number two that they were attendees at the SAGE meetings?
Dr Stuart Wainwright: Exactly. And I think that’s important.
I take a step back. Usually in a crisis situation the DAs get involved at COBR and they receive all the information, and they can make sense of it and do what they want. And that happened here.
SAGE is not a body to represent all parts of the country, it’s there to get the experts together who need to be there to advise on particular matters. As it became clear the scale of the pandemic, but also that the devolved governments might be making different decisions on the back of it, it was right to have the chief scientists and the chief medical officers from all the nations there, because they might need to, in their own governments, talk about the SAGE advice in depth. So it was right to involve them from that early stage.
Counsel Inquiry: And it’s implicit in your answer, but each of the devolved administrations had their own chief scientific adviser?
Dr Stuart Wainwright: Northern Ireland did not at that point.
Counsel Inquiry: They had a departmental chief scientific adviser?
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: But for the other nations, they had their own independent advice?
Dr Stuart Wainwright: Exactly.
Counsel Inquiry: And there was co-ordination, was there not, between the CSAs, asterisk not Northern Ireland?
Dr Stuart Wainwright: Well, Northern Ireland, quite quickly their health CSA filled that space, you know –
Counsel Inquiry: Yes?
Dr Stuart Wainwright: – from early February, and co-ordination with the CSAs happened in two ways from within GO-Science, and probably more ways elsewhere. So there’s the CSA network, which meets every Wednesday all of the time. It’s a great group for bringing together all the chief scientists from the UK Government and the devolved administrations to support each other and to learn together. But in relation to Covid, as it really took off as well, we established a mechanism called the Science Co-ordination Group in May of 2020, which wasn’t to discuss science, but it brought together the chairs of all the subcommittees, PHE, the CSAs from the devolved administrations, key chief scientists from government, to co-ordinate who was doing what and what was going to what committee.
Counsel Inquiry: Thank you.
Dr Stuart Wainwright: Separately – I mean others will answer this – I know the comms met regularly. To what extent PHE engaged with their counterparts, I do not know.
Counsel Inquiry: Okay. I’m going to pause there for a moment.
In 60 minutes we’ve dealt with the first part, explaining –
Dr Stuart Wainwright: Apologies.
Counsel Inquiry: It’s not apology at all.
Hopefully we’ve met our first challenge, to try to explain how the science structures worked in terms of GO-Science, SAGE, the subgroups, how advice was commissioned, and then moving on to the attendance of those key advisers and key decision-makers and how the devolved administrations fitted in. So I’m very grateful in relation to that.
In the remaining time I want to turn to part two, which is some of the work that has been done and the analysis which has been done in relation to the issues which you faced over those two plus years in your role during – as chief executive.
Could we turn to the Institute for Government report, “Science advice in a crisis”, which is dated December 2020. That’s INQ000063070.
Whilst we’re waiting for that to be brought up, you’re familiar with this report?
Dr Stuart Wainwright: Yes, I am.
Counsel Inquiry: And you’ve had the opportunity to refresh your memory –
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: And it’s no doubt something which, whilst in your role, you considered with care, one assumes?
Dr Stuart Wainwright: Of course.
Counsel Inquiry: If we could turn, please, to page 5 of that report, and the fourth paragraph is probably worth – by way as a preface, it says:
“No system would have been flawless in responding to such an emergency. It is easy to criticise decisions with the benefit of hindsight, while decision makers (and those advising them) had to respond very fast.”
That’s a feature you make – a comment you make in your statement –
Dr Stuart Wainwright: That’s right.
Counsel Inquiry: – that we have to consider the context of decision-making:
“Nevertheless, our research has identified some clear problems: while there are improvements those providing scientific advice should reflect on, the biggest concerns are the way the government used this advice and the way it communicated it.”
I’m going to ask you questions really regarding the sort of GO-Science/SAGE aspect, under are a few topics, if I may, just to help you.
The first topic is strategy, and if we have that page open and pan out, please, second last – in fact the last paragraph, this is:
“Decision making at the centre of government was too often chaotic and ministers failed to clearly communicate their priorities to science advisers. This was most acute in the initial months but a lack of clarity about objectives persisted through the release of the first lockdown to recent decisions over the second lockdown and regional tiers.”
Pausing there, so in terms of strategy, do you have any comment to make in relation to that? Did you find, as the chief executive, that there was issues regarding the failure to clearly communicate priorities to scientific advisers?
Dr Stuart Wainwright: Yes, I’d agree with much of the tenor of this paragraph from the Institute for Government. I think it changed over time. I think initial – I’m not quite sure where to start.
Lady Hallett: At the beginning.
Dr Stuart Wainwright: It’s a very good place to start.
So, I think this went through quite different phrases. I mean, I think in the early couple of months there was actually some good examples of trying to bring together departments, the NHS, experts, to try to understand what was going on, and to try to formulate advice. But things were evolving so quickly that you have to manage the evidential, the policy, the political quite closely to be able to navigate that and adapt your objectives as you go. So there were some good attempts to do that, and initially there were people, I would say, who were in Cabinet Office in the first few months who understood how to interact with science fairly well. But it was an extraordinary situation and whether the formulation of national objectives was clear enough, I’m not sure that it was.
I think then there was a phase from after there was the change in governance to the MIGs when I think the formulation of science commissioning from the centre got quite chaotic for quite some time.
Mr Keating: This is about May 2020?
Dr Stuart Wainwright: April/May 2020. Gradually got better through the summer and then got a lot better, I think, when a much stronger analysis unit was created in the C-19 secretariat in the autumn, and again that was rebuilding Cabinet Office’s capacity to engage in science evidence and analysis and statistics, and then the questions got better.
I – one of the documents you sent me last night to look at was parts of Neil Ferguson’s statement. I agree with much of the analysis in that, not quite all but much of it, and within that he said that the setting of objectives was often very short term, when there was setting of objectives, and I agree with that. I think it had to be initially. You know, in a very fast-moving event sometimes you do need to just look at the here and now to an extent. But that setting of longer-term objectives, I agree, was absent for quite some time. However, I recall, I can’t remember if it was March or April, that there were attempts to set a longer-term strategy. I remember Mark Sedwill commissioning the now permanent secretary of FCDO, Philip Barton, to lead work to look at a long-term strategy. That looked good to me but it seemed to disappear.
Counsel Inquiry: Thank you.
I would like to turn to page 18 to perhaps give an illustration of the issue that was being experienced, so page 18 of that report, please, and the second last paragraph:
“SAGE members told us that in the autumn they were still unclear about the government’s thinking, despite the new Covid cabinet committees having been created in June with the aim of clarifying decision making. One interviewee described the conversation between ministers and SAGE as circular: ‘Ministers said: “What should we do?” and scientists said: “Well, what do you want to achieve?”’ Some back and forth is necessary to refine questions, but scientists said minsters’ objectives remained unclear throughout the crisis.”
What do you say in relation to that? Is that a valid observation?
Dr Stuart Wainwright: I think it is for that point in time. I say, I think it was a little better earlier, you know, prior to mid-March, and it was better later. I think you need much more discussion across policy officials, operators of key services and experts at these times to help determine what it is you were aiming for, and I’m not sure there was enough people in Cabinet Office with scientific skills at this point who understood how to try to frame the questions.
Counsel Inquiry: I’m going to move on to framing the questions in a moment, but this is a wider point, really, isn’t it, in terms of strategic direction?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Let’s move on to commissioning, then, which is the next point, which really flows on from your answer. If we would turn back, please, to page 5, and that paragraph we had looked at at the outset, the bottom paragraph. It says this:
“At times the process of commissioning advice – COBR asking questions for SAGE to answer – did not work well, with advisers’ ability to provide useful answers hampered by poorly formulated questions (though [your point] this improved as the crisis went on).”
Is that correct, that there was, especially at the outset, poorly formulated questions in terms of seeking advice?
Dr Stuart Wainwright: I think that’s right. I actually think it wasn’t so bad very early on, although it – I think the scale of what people had to contend with meant that it was hard to formulate the question.
So early on, as you discovered in Module 1, you know, there weren’t sufficient plans for things like non-pharmaceutical interventions in place, and I agree with the analysis of many people in Module 1 that PHE did not go in with sufficient capacity into this.
In that context, to shift from a position where I think no one ever believed sort of a lockdown could happen in a society like ours to it happening, you had to overcome a lot of public health and policy and political beliefs and dogma. That was hard, and I think needed to involve scientists, policy officials, politicians engaging closely.
But the commissioning of advice did get quite chaotic and poorly formulated from March through into the summer and then got better again in the autumn.
Counsel Inquiry: If we could turn to page 19 of this report, independent report, and you touched upon speed as one of the issues, and at page 19, the penultimate paragraph:
“The government was also slow to seek advice from SAGE on issues where it was evident some time in advance that difficult policy decisions would have to be made.”
It gives an example about return of students to universities and how SAGE was not commissioned to look at this until it was almost too late.
“Members told us that, since they were not asked for advice on some key issues, they started to set some of their own research questions based on what they thought would be useful to policymakers.”
So two questions flow from that. Firstly, was that right, in your view, that the government was on occasion slow to seek advice from SAGE on issues?
Dr Stuart Wainwright: I think it’s a bit more nuanced than that. I think by this point – we talked about the lack of capacity of PHE and others going into this situation, and SAGE had to grow into something that it was never meant to be, to fill some of the gaps that were just not there going into the pandemic. We didn’t have a lot of standing public health capacity on the scale that we needed it going into the pandemic, so a mixture of academic volunteers and a small number of officials filled that gap. I mean, this is the kind of example when you might want a SAGE view, but you might just want – in a better situation, you might want to draw on your public health experts within your public health agency. So maybe they were slow to seek scientific advice but whether SAGE advice was needed I think is a question.
Counsel Inquiry: Let’s examine that for a moment. SAGE grew into something it wasn’t ever meant to be. Was it the case that there was a vacuum which SAGE had to fill because other departments were unable or perceived to be unable to fill that?
Dr Stuart Wainwright: I think I mostly agree with that. I suppose the feeling for us through late February and into March was a feeling of other parts of government either not being there or not being allowed to be there, in some cases, and – but science, technical advice, public health advice was needed and we had to grow our structures to be able to provide that. That wasn’t out of design, certainly not by desire, but I think it was out of necessity.
Counsel Inquiry: You’ve hinted at it, but was PHE one of those organisations which you would have thought would have been asked to do some of the work which SAGE undertook?
Dr Stuart Wainwright: That’s correct.
Lady Hallett: Is that a convenient moment, Mr Keating?
Mr Keating: Very convenient, thank you.
Lady Hallett: You’re all right if we take a break? You’ve got time this morning?
The Witness: Of course.
Lady Hallett: Very well, I shall return at 11.30. Thank you.
(11.13 am)
(A short break)
(11.30 am)
Lady Hallett: Mr Keating.
Mr Keating: My Lady, thank you.
Lady Hallett: Sorry, there was just one matter I wanted to raise, Dr Wainwright. You said earlier that the representatives of the devolved administrations attended SAGE and COBR. Was that throughout, was it that they were invited to attend but –
Dr Stuart Wainwright: So for SAGE, from SAGE 6 in – February 11th, they were always invited to attend. Whether they did or not, the minutes will show that.
COBR, I mean, people from Cabinet Office would have to confirm that. My understanding was that they were always invited but it’s possible I may have that wrong.
Lady Hallett: We’ll check that. Thank you very much. Sorry, Mr Keating.
Mr Keating: Not at all, my Lady.
Dr Wainwright, we’re coming to the end, on this part two of your evidence. There’s three more topics I’d like your assistance on before giving you an opportunity at the end to reflect upon what went well, in your view, and what could be learned by way of lessons.
So in terms of the next topic, which flows from what we discussed before the break, you mentioned SAGE grew into something that was not meant to be. Let’s look at the IFG report, please, at page 6. Page 6. It will be the third paragraph.
In terms of issues which were thrown up, it says:
“… SAGE was not designed to take on such a prolonged role.”
At this stage, December 2020, it had only met 70 times.
Drawing on what you said just before the break, was that a fundamental difficulty, that SAGE was scaling up to do something it was never meant to do over a prolonged period of time?
Dr Stuart Wainwright: Yes, but at necessity I think we had to do it at this point. But I think, you know, a lesson to learn from this is to try to make sure your public health agency has – and the Department of Health, has sufficient capacity and capability to perform all the roles that might happen in other nations.
Counsel Inquiry: Pausing there for a moment, because you have mentioned the word “capacity” of PHE, Public Health England, at that time, and SAGE had to scale up to fill this lack of capacity?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Why was it not the case, from your understanding, that PHE did not scale up to meet this challenge?
Dr Stuart Wainwright: So I think for a couple of reasons. I think you’ve got an issue about capacity, capability and trust, and I think GO-Science, the system it was able to put in place was able to deliver on those. I think we were able to deliver the capability, three sorts of capability. We were able to draw on the real international experts, through our academic experts, so the people who really knew their stuff. Secondly, we had sufficient people within GO-Science who understood science and policy. That’s the capability that we had. But we had to grow it. Thirdly, we had people who understood how to operate in a crisis. And we needed that. So we had the capability, particularly that academic capability.
Trust, I mean, others will have to comment on this, but we had the trust of Number 10 and Cabinet Office, I think because we provided that capability.
Counsel Inquiry: From your dealings, bearing in mind you had to scale up SAGE, were you aware of concerns regarding the lack of capability or confidence in PHE to deal with this crisis?
Dr Stuart Wainwright: Yes, I think I was aware of the lack of sort of capacity and capability in PHE. Even from previous roles I’d seen – they have some wonderful people in PHE but they always seem very thin on what was available. The issue of trust others will have to comment on that but my perception in February and March is that gradually the centre began to trust what GO-Science and SAGE were doing, and possibly not other parts, but I don’t know the reasons for that.
Counsel Inquiry: No.
The next topic is composition and challenge, and if we could turn over to page 7, please, the top of page 7, and again it’s one of these features we have touched upon already.
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: And it’s not something which is, perhaps, surprising to you in terms of a – as a criticism, but it says this:
“The GCSA and CMO should reflect, however, on the criticism that there could have been more challenge built into the scientific advice process. While they clearly thought hard about how to do this, scientists inside and outside government argued that SAGE has still been dominated by too narrow a group of medical scientists and modellers at the expense of others such as external public health experts.”
And, as I say, this was a criticism made in the past about previous SAGE. And public health experts again is something which is touched upon a number of times as an area where there seemed to be a lack of expertise. What do you say in relation to that criticism?
Dr Stuart Wainwright: I think this is actually quite complicated. I don’t – there is a challenge here, but I don’t – I don’t think the solution is quite as simple as what’s being suggested here.
So, first of all, do I think SAGE had challenge within it? Absolutely. I mean, the way that it worked, the individual academic groups would be challenging themselves and each other, they’d bring things to subgroups and challenge each other there, and bring it to SAGE and challenge each other more. And we drew on more and more experts – you know, almost 200 for SAGE alone over time. But I think, as we’ve said already, that as SAGE was so prominent and maybe leaned on more than it should have been, it meant that some of the areas where you might have had – drawn on more experts on public health, within PHE structures – we’ve given SAGE more of an ability to challenge those, which might be a better system – I think that is something to reflect on.
So I think a lot of challenge happened within SAGE in the system, but I think given so much focus on using SAGE, I think you reduced its role to sort of challenge other parts of the system where other forms of advice might have been brought to bear much more.
Counsel Inquiry: I would like to turn to page 33, which draws out the fact that this is a complicated area, to use your terminology. Perhaps starting at the top of page 33, and we touched upon the subgroups earlier on this morning in the first part of your evidence, it says there that the subcommittees played an “important role in giving SAGE depth and analytical capacity”, and that:
“… there is a strong case in such a broad-based crisis for using them to ensure a wide range of disciplines are contributing to advice.”
So a positive –
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: – comment there, and perhaps something to consider when we’re looking at diversity and composition?
Dr Stuart Wainwright: Absolutely.
Counsel Inquiry: If we pull out, then, into the wider page for a moment, it says this, in the middle of the second paragraph, that your organisation, the Government Office for Science, “launched wider initiatives to incorporate a range of expertise and challenge”.
So this is something which was identified you did prior to December 2020?
Dr Stuart Wainwright: Yeah.
Counsel Inquiry: Very briefly, what did you do to draw upon a greater range of expertise and create challenge?
Dr Stuart Wainwright: Yeah, so this is something that I think we improved on as we went. In the early days of the pandemic, this is before people were using Teams and Zoom, and so we were constrained a bit by – had to get the right experts in a room or on a phone line. It seems odd to be saying that now, but that was a slight constraining factor. So we worked with CMO and PHE to try to get the right experts there, and there were a lot of public health experts there. The switch to more electronic ways of working, although it was a challenge to do it initially, helped us draw in many more people. I mean, you still have to keep the meetings practical and only draw together the experts that you need, but it allowed us to go to many other parts of the country and other institutions to draw on people.
We in GO-Science we did a process of regular reviews of how we were doing, the first one was kicked off in March 2020, and we did those regularly to have a process of continuous learning, and that’s now been built in Government Office for Science into an active programme called the SAGE Development Programme, to keep it live, to keep us always getting better. One of the issues that was drawn out in that learning early on was a need to draw on academics from a greater range of institutions, and also to build in more diversity in terms of their backgrounds as well.
So that was gradually improved and was built into our thinking from there. But again, I try to think about sort of what the Inquiry might conclude. Do I think the early stages had enough experts? I don’t think more experts would have made a difference, if I’m honest.
Counsel Inquiry: I’m going to move on to another topic. The final topic is communication. In fact if we go to page 16 and 17 of this report.
It’s a phrase which we’re all very familiar with, about “following the science” and the opinion of the authors that ministers and systems – that they were “following the science” was inaccurate and damaging. And that may be questions for politicians and not to you as a civil servant, but I want to draw out some of the issues in relation to this, and whether these are matters that you raised as a problem with government during your time as chief executive.
So in relation to that phrase, it says in the second paragraph or third paragraph:
“The phrase blurred the line between the scientific advice and policy decisions.”
Do you agree, first of all, with that proposition, that the phrase blurred the line between the scientific advice and decision-making?
Dr Stuart Wainwright: I do.
Counsel Inquiry: And the next paragraph, in the same theme:
“The difference between being led by the science and being informed by the science may seem subtle, but it is important.”
And again that this is something which is not new and had been raised before in previous inquiries.
Dr Stuart Wainwright: I agree. In a situation like this, there’s no easy decisions, and it’s right that – ministers – we live in a democracy and ministers are the elected representatives of our people, and in a situation like this, it’s right that they have to balance up different factors and forms of advice, science, public health, economic, operational, policy, and it’s the understanding of all of those that should inform their decision, not one form of evidence.
Counsel Inquiry: So I want to ask you a question in relation to this, which is the impact of that phrase on your members, your SAGE members, and if there’s anything done to it.
If we turn over to address it, turn overleaf, please, page 17, first paragraph, it says there that it “undermined the protective space in which scientists advising the government could operate”.
Was that something, as an impact, that was raised to you by members, about the difficulties the phraseology by ministers was causing them?
Dr Stuart Wainwright: Yes, I mean, as I said earlier, in this period it felt SAGE was being lent on probably to a greater extent than it should have been, but also as we gradually published our minutes and nothing else was published, again it created this impression, I think, that that’s all that there was. And I think that did have a negative effect on the protective space in which our scientists could operate.
Counsel Inquiry: Flowing from the negative effect which you’ve mentioned, final point on this is the next paragraph, and your comment, if you can, in relation to this:
“Many scientists including members of the SAGE went as far as to say that they felt they were being set up as scapegoats, with politicians hiding behind a cloak of science.”
In relation to that, was that a concern which was expressed to you, perhaps informally, by members of SAGE?
Dr Stuart Wainwright: I don’t – I don’t recall.
Counsel Inquiry: Have you raised with government the concern, when you were chief executive of GO-Science, about the usage of the term “following the science”?
Dr Stuart Wainwright: Yes, I recall doing so.
Counsel Inquiry: What was the response?
Dr Stuart Wainwright: Our counterparts in Cabinet Office understood, and gradually, I can’t remember how long it took, but gradually that term did stop being used.
Counsel Inquiry: Finally, we’ve spent some time in the second part talking about the issues which SAGE grappled with during that unprecedented time, and some of the criticisms made of the structure, and you’ve had the chance to comment upon them. But it perhaps is fitting to conclude to give you the opportunity to recognise what SAGE did well.
What, in your view, were perhaps the three big areas that SAGE did well during this time period?
Dr Stuart Wainwright: I think three things. One, we delivered what we were asked to deliver, despite huge pressure, and that was due to the willingness of our volunteer experts and the officials drawn from across government to work night and day to be able to do so. So that sense of doing what was needed for the nation was one thing we got right.
I think underpinning that, our flexibility was a strength, to be able to draw on hundreds of academics and to operate reflexively.
I think the third thing we did well is what I’ve just mentioned: we took an active approach to learning and changing as we went, from March 2020, and that continues on to this day. But that sense of self-evaluation how we could improve was a strength as well.
Mr Keating: Thank you, Dr Wainwright, those are all the questions I have.
My Lady, do you have any questions?
Lady Hallett: No, I have no further questions.
Thank you so much, Dr Wainwright. I do hope the vast majority of the people you have just mentioned with whom you worked understand that the tiny minority of people who think it’s right to resort to personal abuse, well, they’re not supported, the vast majority of us are really appreciative of all the work that you and your colleagues did.
Thank you very much.
The Witness: Thank you.
(The witness withdrew)
Mr Keating: Thank you, my Lady. I’m just going to pass over to Mr O’Connor.
(Pause)
Mr O’Connor: My Lady, our next witness is Professor Graham Medley. Can he be sworn, please.
Professor Graham Medley
PROFESSOR GRAHAM MEDLEY (affirmed).
Questions From Counsel to the Inquiry
Mr O’Connor: Thank you, Professor, do take a seat.
Can you give us your full name, please?
Professor Graham Medley: Yes, Graham Francis Hassell Medley.
Counsel Inquiry: Professor Medley, you have, at our request, prepared a statement for the Inquiry. We have it up on screen. It weighs in at 123 pages, and I think on the last of those pages – yes, don’t worry, we don’t need to call it up, but you have signed the statement under the statement of truth indicating that you believe the facts stated in the statement to be true; is that right?
Professor Graham Medley: That’s correct, yes.
Counsel Inquiry: That signature was dated 4 September 2023; yes?
Professor Graham Medley: Yep.
Counsel Inquiry: Thank you.
Professor, your witness statement gives us some detail of your career to date. You are currently, and you have been since 2015, professor of infectious disease modelling at the London School of Hygiene and Tropical Medicine?
Professor Graham Medley: Correct, yeah.
Counsel Inquiry: That institution in London is one of the main centres of epidemiological research in this country?
Professor Graham Medley: Yes.
Counsel Inquiry: And we’ll be hearing also from one of your colleagues, Professor Edmunds, who is also there.
Before moving to, do we call it LSHTM or do we say London School of –
Professor Graham Medley: The “London School”, with apologies to the London School of Economics.
Counsel Inquiry: That abbreviation may end up saving us hours of time in the next couple of weeks, Professor.
So before moving to the London School, we see that you were based, first of all, at Imperial College London for ten years, from 1983 onwards.
Professor Graham Medley: Yep.
Counsel Inquiry: Then you spent some time at the University of Warwick before moving to the London School?
Professor Graham Medley: Yes, correct.
Counsel Inquiry: I think what we will discover is that, in fact, those other two institutions, Imperial College and also Warwick University, are two of the other leading epidemiological centres in this country?
Professor Graham Medley: Yes.
Counsel Inquiry: Also relevantly, Professor, you were co-chair of the committee SPI-M – which we’ve heard something about from Dr Wainwright, and of course we will be hearing much more from you about – from October 2017 until, first of all, the start of the pandemic, then, as we’ll hear, SPI-M was, as it were, replaced by SPI-M-O during the pandemic –
Professor Graham Medley: Yep.
Counsel Inquiry: – and you chaired that committee during that time. Then in February last year, when SPI-M-O stood down, you returned to being co-chair of SPI-M?
Professor Graham Medley: Yes.
Counsel Inquiry: You have, though, resigned from that position in June of this year?
Professor Graham Medley: That’s right, correct, yeah. And I was co-chair of SPI-M-O as well.
Counsel Inquiry: Yes.
Professor Graham Medley: So the co-chair is important.
Counsel Inquiry: Yes, and I’m going to come back to it, but thank you, thank you.
Just before we get into the detail, though, Professor, just help us, give us an idea of just how much of your time you spent on these matters during the pandemic. You’ve already told us that you were chair of SPI-M-O for that two years or so; we’ll hear you were also someone who attended SAGE meetings; you were also, I think we’ll hear, a member of the Welsh Technical Advisory Group. That must have taken up a lot of your time?
Professor Graham Medley: Yeah, so SPI-M, the pre-pandemic, is about six meetings a year, although we didn’t actually meet, I don’t think, in 2019 because of Brexit preparations, and then from January 2020 my involvement ramped up so that from mid-February 2020 until March 2022 I was essentially full-time working with the members of the committee and chairing the meetings, and working with the secretariat.
Counsel Inquiry: So really very little or no time left for your research or teaching commitments –
Professor Graham Medley: No.
Counsel Inquiry: – that you would otherwise have had?
Professor Graham Medley: No. The institution was extremely kind and my colleagues at the London School were extremely good at filling in for me, but no, I effectively gave up independent research for that period.
Counsel Inquiry: And I think, from having read your statement, it’s fair to say not just a full-time, as in Monday to Friday, 9 to 5, but rather more than that?
Professor Graham Medley: Yes, it was –
Counsel Inquiry: As –
Professor Graham Medley: Yes, I mean, I was – I still had commitments that I had previously, so I was filling in those, but – but anyway, the demands of what I was trying to do. And I took on other things. I’m involved, for example, in the Academy of Medical Sciences’ reports, and that was partly to kind of help things be joined up and to function to – for Wales, as you’ve mentioned. I mean, those were things that technically I suppose I didn’t have to do but actually I felt were important to be doing.
Counsel Inquiry: Professor, thank you. Let’s take then, shortly, a step back, I just want to ask you a few questions about SPI-M before the pandemic.
Let’s look, if we can, at page 9 of your statement, paragraph 3.1, that’s where you set out the dates that we’ve already discussed, you refer there to having been co-chair of SPI-M from October 2017.
Could I ask you what you might think is a surprising question: what does the I in SPI-M stand for?
Professor Graham Medley: It did stand for influenza, so the committee was originally I think set up in sort of 2005 and – or 2009 to cope – to deal with pandemic influenza. It has since changed to infections, pandemic infections, and one of the – I noticed three – two things when I took over as chair in 2017, one was that we really shouldn’t be just thinking about infections and so it was agreed – sorry, influenza, and it was agreed we would switch to infections more broadly, and we were in the process of going through what we had in terms of preparedness document and modelling capacity, so in 2018, 2019, but obviously we didn’t – because of the delays in 2019, we didn’t get through that process.
And the other thing I noticed was to do with devolved administrations, which we might come back to it, but that was noted before the pandemic.
Counsel Inquiry: I see. So just to be clear, I won’t call it up, because you’ve explained it all very well, but we were looking at an organogram with Dr Wainwright’s evidence and SPI-M on that organogram had a yet different meaning of I, for insights, but that’s wrong, isn’t it? It was influenza, and, as you’ve explained, it’s now infections?
Professor Graham Medley: Yes. Well, I’m not sure. That definition was created earlier. I’m pretty sure it was pandemic influenza, but I might … I might be wrong. I only ever called it SPI-M.
Counsel Inquiry: Well, it’s quite important, isn’t it, Professor, to know what the committee is called?
Professor Graham Medley: The committee was focused on influenza and that’s why I challenged it when I became chair, and the then Deputy CMO, Professor Jonathan Van-Tam, agreed with me, and so it was changed to infections at that point.
Counsel Inquiry: Perhaps we can just call the organogram up.
It’s INQ000303289, page 1, please.
So if we look there, do you see the top and bottom row?
Professor Graham Medley: Yes.
Counsel Inquiry: Do you think, then, Professor, this actually might represent a misunderstanding within GO-Science as to what the I stands for?
Professor Graham Medley: It clearly represents a misunderstanding between myself –
Counsel Inquiry: Well, it could just be a mistake, because the I, for example, in SPI-B certainly stands for insights?
Professor Graham Medley: Yes.
Counsel Inquiry: But with your experience of working on this committee, I’m asking you whether you think that it may be that other people on the committee and who support the committee might actually think that the I stands for something different?
Professor Graham Medley: My understanding is that everybody on the committee was focused on influenza, and that is why I challenged it when I became chair, because I said that the next pandemic may well not be influenza.
Counsel Inquiry: All right. Let’s leave it there. Thank you, we can take that down.
So you’ve explained then that when you took over in 2017 it was an influenza committee, if I can use that shorthand, but that before the pandemic you were already trying to make that shift to broaden the scope of the committee so that it looked more broadly at infection –
Professor Graham Medley: Yep.
Counsel Inquiry: – rather than simply at influenza, and I think you said a moment ago that something in the nature of six meetings a year would have been –
Professor Graham Medley: Yes.
Counsel Inquiry: – the norm?
Professor Graham Medley: Yes.
Counsel Inquiry: Although you also said that in fact the year before the pandemic it hadn’t met at all?
Professor Graham Medley: I think it met once at the beginning of 2019. We – the role of that committee was really to address policy questions that were raised to us, and we relied upon people coming from the centre of government with particular questions, and if they were not available, then in most – a lot of the rest of the work could be done by email and so there was no point in us gathering if policy wasn’t there to ask us questions and interrogate us.
Counsel Inquiry: Does that explain what might otherwise have been a bit – it explains your remark that perhaps the reason you didn’t meet in 2019 was because of Brexit?
Professor Graham Medley: We were told that was why.
Counsel Inquiry: There’s no obvious connection between the risk of a pandemic and Brexit, but is your explanation that the officials in government were so busy concentrating on Brexit they didn’t have time to ask you –
Professor Graham Medley: Yes.
Counsel Inquiry: – about pandemics?
Professor Graham Medley: Yes.
Counsel Inquiry: But I think you’re telling us that the fact you didn’t meet didn’t mean that, as a committee, you weren’t doing any work; is that fair?
Professor Graham Medley: Yes, I think so. We had – we have – the main output from the government was the preparedness document, and this is a short summary of what modelling tells us about the start of epidemics, and it’s designed – was written originally to fill the gap, that kind of knowledge gap between the start of the epidemic and before we have sufficient data within the UK to be able to make more focused – produce more focused evidence, and it’s there to, as I say, fill that gap, to explain to policymakers what we understand generically about controlling the start of epidemics. And we had just refreshed that document and we were going through to refresh it, and I can’t – I can’t remember at the moment what else was on our agenda, but I think we were being asked about the – the Department of Health had conducted an analysis of pre-buying vaccines, influenza vaccines, and investing that, and we were being asked to discuss that work.
Counsel Inquiry: Right. So that was the sort of background activity –
Professor Graham Medley: Yep.
Counsel Inquiry: – in the year or so before the pandemic?
Professor Graham Medley: Yes.
Counsel Inquiry: Just for completeness, you mentioned the Department of Health, that was the body, the department, to which SPI-M reported?
Professor Graham Medley: Yes.
Counsel Inquiry: Although, as we have seen from the organogram, it’s accurate in this respect, once the committee became SPI-M-O, it reported to SAGE?
Professor Graham Medley: Correct. We had a secretariat associated with SPI-M, and we retained that same secretariat as SPI-M-O, so the people we were working with day to day didn’t change, but the position in the organogram changed.
Counsel Inquiry: Let me ask you about the switch from SPI-M to SPI-M-O. We can look briefly, if we may, at page 23 of your statement, paragraph 3.43. You explain here, Professor, that SPI-M, so the old committee, was emailed in late January, 21 January, about what you describe as the novel coronavirus.
Professor Graham Medley: Mm-hm.
Counsel Inquiry: You spoke to the secretariat, and in fact there was then a meeting of SPI-M on 27 January to discuss preparedness and so on, and it appears to have been shortly after that that the change was made from SPI-M to SPI-M-O, because you then mention the first meeting of SPI-M-O on 3 February, so a week or so later.
On the paper, it’s simply a change of name from one committee to another. What about the membership of the committee, did it remain the same as between the old and the new?
Professor Graham Medley: No, it didn’t. I advised – I mean, it’s not my committee, it is run by the secretariat, but I gave a lot of thought and we had a lot of discussion about the membership, and so the – I think all the members of SPI-M became members of SPI-M-O, but we also involved a much wider range of people as well. And my principal – well, I had several concerns, but at that point my main concern was that we had sufficient expertise to be able to answer any – all the questions that we were – we might be asked, but I also gave thought to the composition of the committee in terms of the people, their relationships to each other, and the relationships to me.
I had no thought at that point that this would go on for two years, meeting every week, and I did have qualms at the beginning that I had involved too many people, but in fact that turned out to be very good, because in the end SPI-M-O was essentially co-created by the members and the secretariat, and we needed to have that community to be able to carry through, as I say, meeting weekly for two years.
Counsel Inquiry: Yes. Just give us an idea, Professor, we don’t need exact numbers, but the move from two committees, roughly how many academic members of the first committee and then how many – how much larger was SMI-M-O?
Professor Graham Medley: That’s a good question. Off the top of my head I’m going to say three times bigger, but I would need to count them.
Counsel Inquiry: A substantial increase.
Professor Graham Medley: Yes. And the workload meant that not every member could attend every meeting, so having that, if you like, redundancy in the numbers, so meant that there was always a – always a quorate in the meeting.
Counsel Inquiry: Just before we get much further, I want to take you to a part of your witness statement where you crystallise what the function of this organisation was. So if we can look at page 86, please, and it’s the paragraph at the bottom of that page, 8.27, you say:
“The role of SPI-M-O [so the new committee created in early February 2020] is to generate scientific evidence based on transmission dynamic modelling of the epidemic. The key questions for SPI-M-O are what drives the tram (epidemiological parameters, core groups …) and what determines disease given infection.”
And you refer to the models as being “intended to inform policy”, so “guided by what policy options are being considered at the time”.
And you go on to say:
“The age-dependent risk of severe outcomes [that’s of the infection Covid] … were well established by the end of February.”
So we’ll come back, I don’t want to unpack all of that now, Professor, because in a sense that’s what we’ll do for the rest of the morning, but it was a modelling committee, and those key aspects of the disease, what drives it and what determines the disease, given infection, those were at the heart of the modelling exercise?
Professor Graham Medley: Yes, I mean, the – just to caveat that, we are not clinicians, we’re not medics, and we’re not immunologists, although all of those disciplines are pulled into modelling at one point or another, so we are not looking at the process of disease, but we are looking, at a population level, at the consequences of widespread infection.
Counsel Inquiry: Moving on to a couple of more just practical points about the committee, you mentioned that you were co-chair of SPI-M-O, as you had been of SPI-M, and more precisely you were the academic co-chair, and we know from your statement that there was also a policy co-chair. Certainly as from March of 2020 the co-chair, the policy co-chair, was Angela McLean?
Professor Graham Medley: Yes, correct.
Counsel Inquiry: Who was then the chief scientific adviser in the Ministry of Defence?
Professor Graham Medley: Yes.
Counsel Inquiry: Tell us in a few sentences what the significance of there being two chairs and their different functions and responsibilities.
Professor Graham Medley: So, in order to kind of make a lot of sense of the rest of my evidence, I just need to kind of point out that government – what happens in government is very different to what happens outside. The code of conduct, the employment of civil servants, the conditions under which they’re employed, is very different from outside, and particularly from academia, which is where I’m coming from. And so crossing that fence, the things that we were allowed to be – to know and the things that we were allowed to say, in some senses, but not – it’s more about what we could know and what we couldn’t know – is not simple.
And so it was decided, I think as I became chair, the co-chair situation was developed. So there was somebody inside government, and their task is to talk to people in government about the modelling, to bring the appropriate questions to us, and to take the answers back. And then I’m the academic co-chair and my role is to try and get – or to get the members to provide the evidence in answer to the questions.
But because I am not a member of government, I can’t go into government and talk to civil servants openly, you know, about what they might be thinking or what they’re worried about.
Counsel Inquiry: Yes, and I think you explain in your statement that you felt that Angela McLean did a very effective job of fulfilling that function –
Professor Graham Medley: Yes.
Counsel Inquiry: – of the policy chair that you just described?
Professor Graham Medley: It was an essential – well, essentially it was an extremely important step change in the way that SPI-M-O worked in March 2020.
Counsel Inquiry: Moving on, we’ll see from some of the documents we look at that the routine during the pandemic was for there to be three SPI-M-O meetings a week, two subcommittee meetings, and then, if you like, a plenary meeting which considered what had happened at the two earlier subcommittee meetings; is that right?
Professor Graham Medley: That was the normal pattern, but there were many other ad hoc meetings as issues arose, and of course the meetings between members, you know, to discuss particular technical issues.
Counsel Inquiry: Yes, but what we may see is that the subcommittees then fed into, and other discussions, the main meeting?
Professor Graham Medley: Yes.
Counsel Inquiry: Then that main meeting produced material, which we’ll have a look at in due course, which then went to SAGE?
Professor Graham Medley: Correct, yeah.
Counsel Inquiry: We’ve heard from Dr Wainwright that that pyramid, if you like, of advice being generated by SAGE and its subcommittees, at the top were Chris Whitty and Patrick Vallance?
Professor Graham Medley: Yes.
Counsel Inquiry: Did they ever attend SPI-M-O meetings?
Professor Graham Medley: They didn’t in person, except very occasionally, but the meetings, especially when they went online, so at the end of March, there would be typically sort of somewhere between 20 and 40 members of SAGE, there would be sort of the order of ten members of the SPI-M-O – sorry, members of SPI-M-O, and then about ten members. SPI-M-O secretariat, and then a whole host of other people, sort of numbering more than the other attendants combined, of people from across government listening in. And so I’m pretty sure that there will have been people from SAGE secretariats and the CMO’s office also listening in to that meeting, but they came only very – I can only remember twice where Patrick Vallance came to SPI-M-O.
Counsel Inquiry: And you’ve described, I was going to mention it, but from the end of March, so the first lockdown, your meetings were all done remotely?
Professor Graham Medley: Yes.
Counsel Inquiry: And the output, again we’ll come back to it, but the output from these, the larger SPI-M-O meetings, would it be fair to say that, first of all, there was something called a consensus statement, and we’ll have a look at one or two of them in due course, which was the work, or the outcome of the meeting which was going to SAGE, and you might also send papers, academic papers, that had been prepared by members of SPI-M-O and discussed as well?
Professor Graham Medley: Yeah, they were technical papers rather than – I mean, they were written by academics but they hadn’t been through the peer review process.
Counsel Inquiry: No, that’s an important qualification. Because of the speed with which these matters with being dealt with, they were being turned around very quickly, but they look like short academic-style papers?
Professor Graham Medley: Yes, they often were the beginning of bigger amounts of work.
Counsel Inquiry: One other practical aspect of SPI-M-O, and for this can I ask that we go to page 35 of your statement, and paragraph 3.84, it’s the question of tasking, Professor.
I think you were watching Dr Wainwright’s evidence, is that right, and so he was of course talking about SAGE, not SPI-M-O, but he explained that, yes, SAGE received questions from policymakers that they were asked to consider, but there was also at least a degree of self-tasking going on on SAGE, so proactivity as well as reactivity.
What you describe in this paragraph is a bit different. What you seem to be suggesting is really you were purely reactive. You say that although you had some influence with the secretariat, the agenda was set by policymakers and decision-makers and you weren’t able to determine the scope of the agenda.
So are we right to see a bit of a difference between what you say about SPI-M-O and what Dr Wainwright said about SAGE?
Professor Graham Medley: Well, it might just be a matter of language and degree, but I felt that we were – myself especially, but members were able to raise issues, and one that was raised a lot was the relationship between – with economic analysis, and so we were – felt quite happy to be able to tell the secretariat, SAGE and SPI-M-O secretariat, that this ought to be considered. But in the end it’s not our meeting, we are independent academics who are coming along to a meeting organised and held by government in order to get our input into the questions that they wish to address.
Now, if we spot a gap and say, “No, you’re asking the wrong question, and this is a whole area that you need to look at”, then they have the decision about whether to take that advice or not.
Counsel Inquiry: But you could be proactive at least in the sense of expressing a concern that there was a gap?
Professor Graham Medley: Oh, yes, and do it in the strongest, most vigorous possible terms. And because, of course, we’re outside government, we could take – you know, take that to the public, as it were. So we did have quite a lot of power, soft power, if you like –
Counsel Inquiry: Yes.
Professor Graham Medley: – in terms of determining the agenda. But in the end they weren’t our meetings.
Counsel Inquiry: Understood. I’m going come to come back to one or two of those points in due course but let me just ask you one or two more quite practical questions.
The first is: we’ve seen that pyramid before, it’s right, isn’t it, that SPI-M-O itself had a number of subject-based subcommittees, not just the two that met before the plenary session, but various that were little committees that were focusing on particular issues?
Professor Graham Medley: Mm-hm.
Counsel Inquiry: You’ve listed them in your statement, I’m not going to go through them. But can you help us with whether there was something called a behavioural and social interventions subgroup of SPI-M-O?
Professor Graham Medley: I think very early on there was, but that got moved, got I think turned into a child – a school-specific –
Counsel Inquiry: Right.
Professor Graham Medley: I think it was called BSI at that point, but yes, as you’ve described it, but then it changed its name.
So the acronyms for what we now call NPIs changed a lot in that period. Whether that subgroup started, I think, and I think Professor Julia Gog was the –
Counsel Inquiry: Yes.
Professor Graham Medley: – leading that at one point, but I don’t remember it meeting beyond the end of March 2020.
Counsel Inquiry: Right, so early on.
On a similar theme, Professor, you’ve mentioned your involvement in the Welsh Technical Advisory Group. I’ll ask you about that in a moment, but before I do, much more generally, as far as SPI-M-O was concerned, did you think it was important that the devolved nations themselves were represented through membership on SPI-M-O?
Professor Graham Medley: Yes. So the devolved administrations or devolved nations question is something which worried me a lot over the two years. As I said in 2017, when I took over as chair, one of the questions – the other question I looked – that concerned me was: who were we talking to in the event of a pandemic? And clearly because health is a devolved responsibility, it meant that the different nations could make different decisions and go in different directions, and there’s a danger, in epidemiological terms, if that happens that nations start gaming against each other. In other words, the best thing for Scotland to do depends on what England does, and the best thing for England to do depends on what Scotland does. So – and that almost never produces an optimum outcome. It’s much better if you have both administrations agreeing a common goal and co-operating closely.
So I raised that then with the secretariat and I don’t know who they spoke to but the message came back that, no, that would not be a problem, that the United Kingdom in the event of a pandemic would respond as one unit of administration. I didn’t take it any further, it’s not – my role is to raise problems not solve them. But clearly as the epidemic – well, let me start at the beginning, as it were.
The epidemics, when it first started, as you have heard and you may well ask me in the future, the data flowing for analysis and modelling was really very poor, and it wasn’t until late in April 2020 that we actually had data from across all four nations.
So there was clearly not a seamless navigation of the four nations issue, and nations data definitions changed differently during the epidemic, which caused us some analytical headaches. But clearly, as policy started to diverge, it became, I think, you know, important that not only did we have a central group of SPI-M-O, I needed to – or it needed to be done to make sure that there was modelling capacity within each of the nations to help support their decisions, and so we co-opted a member from the University of Swansea, who essentially formed the – Mike Gravenor, who formed the kind of modelling unit for Wales, but with input from other SPI-M-O members, so I think Matt Keeling worked quite close, and John Edmunds worked quite closely with Mike Gravenor, and Wales invited me to their TAG meetings and I went to ensure that there was some coherence in terms of capacity and capability and understanding of the modelling.
Scotland had a much bigger internal capacity, so I really wasn’t involved that much at all with Scotland. They came to our meetings in SPI-M-O, and some of the submeetings that you’ve talked about the devolved administrations brought their own analysis to those. The nation I didn’t really have much involvement with at all is Northern Ireland. I think right at the beginning or early in the epidemic it had been suggested that I have a call with the Chief Medical Officer for Northern Ireland, but that I don’t think ever transpired. So, yeah, I’m – unfortunately, and I don’t – I’m not very proud of that, it didn’t happen.
Counsel Inquiry: Your discussions didn’t happen?
Professor Graham Medley: The discussions didn’t happen, and I don’t – I didn’t have sight of what Northern Ireland were doing in terms of modelling.
Counsel Inquiry: So you’ve, I think, explained that both in Wales and Scotland there was, as it were –
Professor Graham Medley: Yes.
Counsel Inquiry: – a freestanding, albeit linked, modelling capacity that was being developed?
Professor Graham Medley: Yes.
Counsel Inquiry: Is the position that you can’t really help us with what, if anything, similar took place in Northern Ireland?
Professor Graham Medley: I don’t – I don’t know what took place in Northern Ireland.
Counsel Inquiry: Yes, thank you, Professor, that’s very helpful.
I want to move on to a slightly different topic, albeit one that’s at the heart of your committee, which is about modelling. And I do so with some trepidation, given the complex detail on models which is to be found not only in your statement but in the statements of your colleagues which have been prepared for this Inquiry.
I want, if I may, to at least start with some very basic principles, and it may be that we can build our understanding with some of your colleagues who are giving evidence next week.
I’m looking for these purposes at page 31 of your report, and it starts at paragraph 3.69.
You describe there, Professor, a very basic distinction in modelling between, on the one hand, what you describe as “statistical models”, which are “data-driven”, which have few, if any, assumptions built into them, and which generate what you call a prediction or, in longer terms, a quantitative forecast.
So that’s one thing, the statistical model.
On the other hand, you describe something called a mathematical model, which is driven to a much greater degree by assumptions, what you describe as a series of what ifs, and those models you say generate not predictions or forecasts, by which you mean the same thing, but scenarios, which is I think a term of art and means something rather different.
So far, so good?
Professor Graham Medley: Yes. No, absolutely. I mean – but virtually all the models, the ones we use, are somewhere between the two.
Counsel Inquiry: Exactly. So I wanted to say, although they’re capable of being described as alternatives, if you like, they are in fact on a spectrum, they’re at either end of a spectrum –
Professor Graham Medley: But they are a mixture of data and assumption.
Counsel Inquiry: The more you go towards a mathematical model, the more assumptions that the model builds in?
Professor Graham Medley: I’m a biologist by background, so a mathematician I’m sure – I think your next witness might well argue about some of the wordings and the definitions, but essentially once you replace, start to replace data with assumption, then you have moved towards a more mechanistic description, set of assumptions about the processes that determine transmission.
Counsel Inquiry: As you do that, what – the output from that model –
Professor Graham Medley: Yeah.
Counsel Inquiry: – becomes not a prediction but a scenario?
Professor Graham Medley: Yes, at the statistical end – I mean statistical models still have models in them, they still have mathematics in them, but they are much more data driven, and from those you can create formal statistical predictions, and we did that, on SPI-M-O, early in the epidemic. But it was quite short lived because it’s the sort of thing that can be done relatively easily, to –
Counsel Inquiry: I want to move from the general to the specific, or the practical. Because, as you say, when one looks at the SPI-M-O papers, and we’ll look at them, there are various things that are being done. Some of the – it appears, anyway – product of your meetings was what you describe in your statement as “nowcasts”, in other words estimating the position of the disease at the time of the meeting, and that I take it would be performed by a statistical exercise; yes?
Professor Graham Medley: Yes, a more statistical –
Counsel Inquiry: Yes, and then, perhaps a little bit further along the range, we will see in the papers “Medium term projections”, which appear to be a prediction or a projection of how the pandemic is likely to develop in a matter of weeks, three weeks, four weeks, those are the sorts of periods we see in the papers?
Professor Graham Medley: But that’s – yes, but that is only possible with the relatively strong assumption about transmission in the coming –
Counsel Inquiry: Yes, so that – but just to help us sort of place these things in the –
Professor Graham Medley: Yes.
Counsel Inquiry: – hierarchy, that is clearly less –
Professor Graham Medley: You are correct and I’m highlighting the fact that the big difference is a strong assumption that you have to put in for something that hasn’t happened yet.
Counsel Inquiry: But it is still something in the nature of a prediction of what, assuming that that – with that strong assumption that things are going to carry on as they are, how you are able to give a projection of how you think the pandemic is going to develop in the next few weeks?
Professor Graham Medley: Yes. Although I don’t want it to be thought of as a statistical prediction –
Counsel Inquiry: No?
Professor Graham Medley: – in the same way –
Counsel Inquiry: As the nowcast?
Professor Graham Medley: As a nowcast.
Counsel Inquiry: Then something different again which we also see in the papers is a reasonable worst-case scenario. That is something completely different, it’s not a prediction of any sort, it’s a very assumption-driven model which doesn’t try to predict the way the pandemic is likely to develop at all, it is simply one course that the pandemic might take –
Professor Graham Medley: Yes.
Counsel Inquiry: – depending on the assumptions that are used?
Professor Graham Medley: Yes, although we have to be a bit careful with the language, because whilst it’s not a formal statistical prediction, and – it’s a set of scenarios of things that might happen, but the circumstances under which they might happen are really quite rare. On the other hand, they do have elements of prediction in them, so we’re not drawing random graphs. You know, they have –
Counsel Inquiry: Yes.
Professor Graham Medley: – the salient features that we think of a particular disease within them. You know? And it’s that nuance which I think has, you know, caused lots of problems, that – on the one hand if we say, “Well, they’re not predictions”, which they’re not, then the temptation is to say, “Well, they’re valueless then”. You know?
Counsel Inquiry: One way, you make this point in your statement Professor, as I understand it anyway, is that when we are dealing with the nowcast and also the medium-term projection, what is generated is, as it were, a single projection, with all the caveats you’ve described built in: the R number today is 1.5. Or: over the next three weeks we expect or we project the pandemic will do this or that.
So there is a single product which one is looking at, albeit understanding it with the appropriate caveats.
When one has a scenario, there is no value in looking at a single scenario, the whole purpose of scenarios is to develop a number of scenarios and look at them all together. Is that one – I think that may be really what you’re saying by saying if one just looks at the reasonable worst-case scenario, it’s valueless because you need to look at it with all the other scenarios that have been created and look at them together?
Professor Graham Medley: Generally with scenarios you’re absolutely right, the more that you can look – or looking at one has less value than looking at several. The reasonable worst-case scenario, though, is a slightly different thing, it’s more of a planning tool than it is an epidemiological modelling –
Counsel Inquiry: And I think you, certainly someone refers to the fact that, for example, some risk registers require there to be a reasonable worst-case scenario –
Professor Graham Medley: That is my understanding.
Counsel Inquiry: – for planning purposes.
Professor Graham Medley: Yes.
Counsel Inquiry: And perhaps that’s where some of the confusion arises.
Just a couple of sample documents produced by SPI-M-O. I mentioned earlier, just by way of example – well, first of all, let’s look at the minutes of a meeting, if we may, and I’m going to look at two documents, they’re not from the same meeting, but I don’t think that matters for these purposes.
Can we go to INQ000233688, please. This, we see immediately, is a meeting on – it’s quite late, it’s February 21, it’s on a Wednesday, I think it’s one of these plenary meetings we’ve discussed, would that be right?
Professor Graham Medley: Mm. We call it the main meeting.
Counsel Inquiry: The main meeting, I’ll remember that.
We don’t need to look at this in any detail, although I will come back to it in due course for one point. Just casting our eyes down, we can see the topic headings: forward look, R, growth rate, incidence, medium-term projections, restrictions and so on. These were not considered every week, although I think the R rate was something you looked at very regularly, but these were the type of issues that were addressed at your meetings regularly, Professor?
Professor Graham Medley: Yes, yes, and that agenda was, as I said, decided by myself, the co-chair and the secretariat.
Counsel Inquiry: If we look at the second topic, “R/Growth rate/Incidence”, we see there is reference there to the committee having discussed the issue and a consensus view having been agreed?
Professor Graham Medley: Yes, so the main meeting was every Wednesday morning. On the Tuesday afternoon we met as a group to discuss the reproduction numbers and the consensus, and essentially came to an agreement at that – that was a very technical meeting. I mean, typically the SPI-M-O meeting was three hours, the previous day’s meeting would often be two hours. Very technical discussion about the reproduction numbers.
That was set because we got a data drop on the Monday evening, so members had, you know, 24, 12 hours to do that analysis. And then the SAGE meeting would follow – the Wednesday, on the Thursday, then we would – I would meet with the secretariat and co-chair on Thursday evening and we would discuss the issues that had come up in that SAGE to go to the next, the meeting the following week.
Counsel Inquiry: Yes, so that was the pattern of things?
Professor Graham Medley: That was, yeah, the –
Counsel Inquiry: Then, just lastly on this, if we look at the bottom we can see what’s being sent up to SAGE, the consensus statement we’ve already discussed, and then the medium-term projections and some papers –
Professor Graham Medley: Yes.
Counsel Inquiry: – of the type we mentioned.
Let’s, if we may, look at a sample consensus statement. As I say, I’m afraid it’s not the precise one that’s referred to here, but I don’t think that matters.
Thank you very much.
So this is in fact earlier in the pandemic, it’s September of the year before, Professor, but we see here the first paragraph:
“SPI-M-O’s best estimate for R in the UK is between 1.2 and 1.5 …”
That’s the type of consensus that you reached week by week –
Professor Graham Medley: Yes.
Counsel Inquiry: – about the R number?
Professor Graham Medley: So the consensus – well, it differed on – for what it was we were talking about. For this reproduction number, which we ended up doing every week – so even when SAGE didn’t meet, SPI-M-O had to meet because we were producing this official government statistic, and was – actually came from a statistical combination. So many groups contributed estimates of the reproduction numbers in the different devolved administrations and the different regions of England. They were then combined statistically and the technical meeting was really to discuss why that was wrong, and so there may well be individual reproduction numbers where it hadn’t worked or it was completely out of kilter with the rest and we’d have long discussion about it and whether it should be included or not, and so having decided what was in and what was out, then these, this consensus is essentially a statistical combination.
Counsel Inquiry: Yes.
Professor Graham Medley: Other things, where you can’t do a statistical combination, the point of the consensus was to ensure – sort of cover the variability and cover the uncertainty in the views on the committee. So we didn’t – it’s not consensus as in agreeing a single thing, it’s consensus as in agreeing what the uncertainty was.
Counsel Inquiry: Well, I wanted to ask you about consensus, Professor, and let me come on to that now. Can we just look, for these purposes, at your statement at paragraph 3.9 on page 13. Perhaps you say there something similar to what you’ve just told us, Professor, I’m starting three lines down, you said:
“SAGE and its sub-groups developed a consensus in the sense that what was written was agreed by all not to be wrong.”
Just pausing there, that sounds a rather, if you like, reductionist way of producing a piece of advice.
Professor Graham Medley: So we weren’t producing advice. I mean, perhaps I’m wrong to include SAGE in this description, but SPI-M-O was very much about creating evidence, not advice, and the documents were written by the secretariat, the SPI-M-O secretariat, and myself and the co-chair then went through them, corrected them, changed them, discussed them, and, as I say, the point was that the documents emphasised that the – uncertainty. So we didn’t come to an agreement about what the evidence was, we came to an agreement about, if you like, what the evidence wasn’t, so that the statements that were included had to be something that captured the disagreement.
Counsel Inquiry: It sounds like the R number is actually quite a good example of this, because if amongst the committee there is a disagreement about whether, for example, the R number is in one place or another, the consensus statement would, as it were, sort of find the lowest common denominator, it would capture the range of views?
Professor Graham Medley: Lowest common denominator I think is wrong. It’s not the lowest common denominator, because at the time you don’t know what is correct. So you can have everybody agreeing with one piece of evidence except for one person. It would be wrong to dismiss the wrong person – the one person. You have to try to capture everything. So the reproduction number, I think that was a particularly narrow range that you just showed, of between 1.1 – was it 1.2 and 1.5? In other circumstances we have much wider ranges.
Counsel Inquiry: If on your committee you had a few people, expert, who took the view that the R number was quite low, say below 1 –
Professor Graham Medley: Yes.
Counsel Inquiry: And you had other people who disagreed with them, and thought that the R number was above 1 –
Professor Graham Medley: Yes.
Counsel Inquiry: – from what you’re saying, that would translate into a consensus statement that we are agreed the R number is between 0.8 and 1.4?
Professor Graham Medley: So what would happen on the Tuesday afternoon is that we would have a vigorous discussion about it, and because we had multiple groups, then – and because it was a relatively technical issue, then the person who is out, if there’s one person whose estimate is very different from the rest, then they would be challenged, and say: well, why are you getting that? And often it would be because they were looking at a different data stream. You know. Or they had made a different set of assumptions. And so if there was no reason to exclude it, then we would include it, and say: yes, there is uncertainty here, we – the estimate would come out as being, saying: well, it’s likely or highly likely the reproduction number is above 1, if that was, you know, the majority, but we can’t be 100% sure.
Counsel Inquiry: What this process doesn’t seem to generate, Professor, is a statement saying something like: we had a debate about it, some people thought it was 0.8, some others, perhaps more, thought it was 1.2, these are the reasons why each group took the view they did. Because of the need to reduce what is being –
Professor Graham Medley: Yes.
Counsel Inquiry: – said into a consensus. And you know that that is an outcome that has been criticised?
Professor Graham Medley: Well, I’m not sure what the criticism –
Counsel Inquiry: Well, let me show you. If we can look perhaps at Professor Woolhouse’s statement, which is INQ000250231 at page 7, and if we can look at paragraphs 35 and 36. You can see – it’s really perhaps 36, where he’s talking about consensus, he says:
“Another weakness is that on many issues there was not complete consensus at the time and reporting what was effectively the majority view might have given an impression of groupthink. In my experience, minority views were not always communicated to officials and ministers.”
So that’s the point. If there is a minority view, why not explain that there are different views on the committee, explain the pros and cons of the different arguments, so that those who are receiving the benefit of your expertise can understand and, if necessary, take up with those involved what the difference of view is, rather than reducing it to what Professor Woolhouse suggests is a sort of bland statement which doesn’t actually capture the disagreement on the committee?
Professor Graham Medley: Yeah, so I completely respect what Mark Woolhouse is saying, but in my view I didn’t feel that at all, otherwise I would have changed it. But I think the question then of how – so we’ll take a step back for a moment. Uncertainty is, I think, the – one of the core issues in terms of how science and policy work, because as scientists, you know, we have, I think, an understanding of what we mean by uncertainty, and I think that doesn’t always map directly on to policymakers, of what they’d understand by uncertainty. And of course uncertainty within decision-making is absolutely critical. And within the pandemic, you know, uncertainty was almost, you know, the biggest issue in the decision-making.
How we communicate that uncertainty I think is a very valid – as scientific subgroups, is a very valid question, and I think I was content with this consensus approach, but of course I think the people who need to be asked are those who received it: did it work for them? The consensus, the – for example, the scale we had in terms of SAGE papers, there’s kind of a likelihood scale ranging from almost certain not to happen, through unlikely, likely – plausible, likely, highly likely, to almost certain to happen. And again I found that very useful as a sort of extended traffic light system, but it’s, you know – the system wasn’t designed for my benefit, it was designed for somebody else to read.
Counsel Inquiry: Certainly not, and you do explain in your statement, exactly as you’ve said, that you felt that this idea of uncertainty within the scientific analysis may not have been properly understood by ministers, and do you think that it may be this consensus approach may be one of the reasons why it wasn’t properly understood?
Professor Graham Medley: Again, you’ll have to ask the people to whom we were communicating. A lot of my understanding about uncertainty and consensus – you know, and how we reached – how we defined it and used it, have come on in reflection. I think during the pandemic I was quite – it appeared to me to be a very sensible way of working, to capturing that uncertainty, in a statement rather than in a series of bullet points.
Counsel Inquiry: We certainly will, in due course, ask the people who received that, your materials, Professor, but even then, with hindsight, are you able to say that you think perhaps it might have been done a better way?
Professor Graham Medley: But I think an advantage of the consensus approach that we had, which I don’t think you can – should be minimised, is that the way in which it enabled the committee to function. I think if – given that it’s a group of academics, that if we had said, “Right, everybody write down your views”, then we would have ended up with 20 bullet points, because people would have found all sorts of nuances, we would have been emphasising the differences in the actual meetings. And part of my concern with a group of academics who are always competing with each other for grant funding and publications and data, was to get a cohesion, and so having a consensus approach whereby we had to agree on something was actually extremely useful.
I – the approach – running a committee or trying to get within those – these timeframes, capturing all the possible nuances I think would have been much more difficult.
Counsel Inquiry: Yes.
Professor Graham Medley: But of course I’m saying that’s running it from my point of view, not from the people who need it.
Counsel Inquiry: It’s a useful insight, Professor, and of course one of the things which Professor Woolhouse mentions there and which you mention, I haven’t touched on so much, is the delay aspect.
Professor Graham Medley: Mm.
Counsel Inquiry: And one of the concerns about consensus that’s been expressed is that it takes time to create a consensus and therefore it delays the evidence, but I think what you’re saying is that actually trying to capture a range of different views may be even more time consuming, because all the members of the committee would want their views to be represented?
Professor Graham Medley: I think that’s correct. And the other point to remember is that we are independent academics and we are having our meeting in front of the secretariat, who then produced these documents. So – and I as co-chair have input into the SPI-M-O document, but we are doing it for their purposes rather than for ours.
Counsel Inquiry: Let me move on.
Lady Hallett: Mr O’Connor, before you do, it looks as though we’re not going to finish the professor before the break.
Mr O’Connor: We’re not, no.
Lady Hallett: Can you be back this afternoon, Professor?
The Witness: I can.
Lady Hallett: In which case I think best, probably, to break now?
Mr O’Connor: Certainly.
Lady Hallett: Very well, I’ll be back at 1.50, please.
(12.48 pm)
(The short adjournment)
(1.50 pm)
Lady Hallett: Mr O’Connor.
Mr O’Connor: Professor Medley, I want to take you to a slightly different topic from what which we were discussing before lunch, and that is a more general consideration of the balance of the make-up of SPI-M-O, and in particular the question of whether it might have included experts from wider disciplines.
Let me start, if I may, by asking you to look at two paragraphs in Professor Woolhouse’s statement, and it’s page 4 of his statement, please, and paragraphs 18 and 19. We see here that Professor Woolhouse, in the first paragraph, makes the point that SPI-M-O was exceptionally well qualified in epidemiology and so on, and he says the group was fit for purpose with regard to quantifying the direct health harms caused by Covid-19, but it didn’t have appropriate expertise to assess, using models or any other form of analysis, the harms being done to the economy, nor harms to education, mental health and societal wellbeing.
He goes on to say that this “lack of attention”, as he puts it, to the wider harms was repeatedly raised by him and others during SPI-M-O meetings. He understood that it wasn’t the committee’s role but no one, DHSC officials or Cabinet Office observers, was able to say whose role it was.
Thank you.
Now, I think that you broadly agree with those comments, first of all in the sense that clearly those wider disciplines weren’t on your committee, and secondly you were told that it wasn’t your job to consider those wider harms?
Professor Graham Medley: Yes, not just broadly, I completely agree, and it was raised many times and particularly in regard to the strategy that the Government wished to pursue across the whole epidemic, which was an area in which modelling was underused, I think.
Counsel Inquiry: Yes. Can I just take you to one passage in your statement, please, and that’s paragraph 34 – sorry, page 34, and we see at the end of paragraph 3.80 you say:
“It is explicitly states in [minutes in] SAGE … [in] September 2020 … that the economic harms of interventions were being addressed outside of the SAGE structures.”
Then further down, if we can look at the next paragraph, you say something rather similar to Professor Woolhouse, about four or five lines up from the bottom:
“I was assured that the quantitative exploration of the impact of measures on the economy, education, mental health and societal well-being was being done.”
Professor Woolhouse said he never found out who was supposed to be doing that modelling or exploration. Did you ever receive an answer to that?
Professor Graham Medley: No, I didn’t. We raised it – as I say, we raised as a gap, or us not doing it, and our concern about who was doing it, several times. It’s included in some of our consensus statements. I notice that the one we produced in February regarding school closures, we state in that that school closures causes harms, but we are no experts in that area.
And … yeah.
Counsel Inquiry: Let’s just look at one more paragraph on this in your statement, and we need to go forward, please, to page 119 and paragraph 12.27. You are responding there to a question about the development of epidemiology economic models, so this is the broader type of modelling.
You say they do exist, they’re used to evaluate cost efficiency of things like vaccines and new medicines. And dropping down a couple of lines, you mention the fact that the impact of the epidemic was exacerbated by disparities in, for example, housing, access to healthcare and occupation, and that the epidemic increased those disparities. You then say this:
“This is a major gap in modelling and should be addressed.”
How, by whom?
Professor Graham Medley: So it’s a major gap in infectious disease modelling, not just in this epidemic but generally. We – at the moment decisions are made on the basis of averages, so – and I’m not aware that we were asked during the epidemic, but indeed have never been asked to model the outcomes within different groups. So if something is deemed to be cost-effective on average, you know, if it prevents – let’s say it prevents a thousand – there is a very simple example. Suppose you have two interventions and one saves a thousand lives, the other saves 500, then clearly the thousand is better, but if those thousand are all from one particular group, and the 500 are a much better cross-section of society, then maybe the thousand isn’t better. That’s not a question we can answer directly, that’s, you know, then a policy interpretation of the models, but we were never asked those questions, and as a consequence we’ve never developed the models. Now, the policy side, of course, can say that: we don’t ask those questions because you haven’t got the models.
So we need to address that, and I think it’s a subject-specific issue that we need to go to the research councils to make sure for the next pandemic we have those models available.
It’s not straightforward, but it’s perfectly possible to do, if the data are available, and we know what type of policy questions we might be asked.
Counsel Inquiry: Was this gap something that was discussed on SPI-M –
Professor Graham Medley: Yes.
Counsel Inquiry: – before 2020?
Professor Graham Medley: Yes, and I had actually published about it previously. I had a piece of work which was trying to address this.
We as modellers know of this gap, and we have been trying to address it, but we hadn’t solved it by the time the epidemic started.
Counsel Inquiry: Is it closer to being solved now?
Professor Graham Medley: A good question. I’m – not that I am aware of, no, but it might be.
Counsel Inquiry: It sounds as though it’s not being treated as an urgent –
Professor Graham Medley: Well, I know people have written grant applications, but they have to be funded. It’s not something that we can just do, it’s something that we as a community can try to address.
Counsel Inquiry: Going back to the point you referred to, you certainly say in your statement, and it makes sense, that it’s something that should be addressed between pandemics rather than during one?
Professor Graham Medley: Absolutely. And many of the issues that I raise in my statement are of that nature.
Counsel Inquiry: Thank you.
I want to move on to another related topic. It’s a theme of your statement, Professor, and in fact it’s something that Dr Wainwright gave us some evidence about at the beginning of the day, that, at least at various stages during the pandemic, you, as a committee, lacked sufficient understanding of government policy to be able to give them as much help as you would otherwise have been able to do.
Can you expand on that for us?
Professor Graham Medley: Yes. So I think there are two – two answers to that., the first of which is really a between-epidemic problem, and that is governments have – well, what the policy needs to do is to give some indication of what it regards as a better outcome. And by an outcome I mean over the whole epidemic. So from beginning to end.
So some idea in 2020 – we didn’t have vaccines and there was no guarantee that they would have arrived, in which case the epidemic might have lasted three, four, five years, we might still be in the epidemic now without the vaccines, but what would the decision-makers think of as being success over that period of time. Because that then provides the framework, the strategy for understanding what government is trying to achieve. It’s not up to us to determine what that is, because they’re value-based judgements as to whether the United Kingdom did badly or well, and personal perspectives in terms of whether the country did badly or well, and we have elected representatives to make those very difficult decisions for us.
Counsel Inquiry: Sorry, can I just add a thought, which is that it was apparent that the government had some policies. I mean, for example, we knew they wanted to save the NHS. Was that too broad a policy objective for you to work with?
Professor Graham Medley: Yes. And that was – only became – that was only stated early in the epidemic, but the pre-pandemic strategy was to have the epidemic in one wave, which has – the only advantage it has is that it’s over more quickly. Yeah? So that was the strategy. There were no other strategies.
That changed, then, as soon as the epidemic – or very quickly into the epidemic, and the strategies were much more short term, and modelling has a particular problem with a lack of discussion and sort of a lack of understanding what the policies might be, because we cannot make a policy-neutral model. So in the types of model that you talked about at the beginning, particularly for the scenario models but also for the medium-term projections, if we don’t know what government might do when or why they might do it, then we have to second-guess, we have to make it up. We can’t put nothing into the model.
So ideally what happens is that you have a discussion with the policymakers to come – to ensure that there’s shared understanding of what evidence is going to be most useful for them to make their decisions.
Counsel Inquiry: What I wanted to understand, and I think you’re helping us in this regard, is: is it a question of detail? Is it a question of temporal scope, long-term policies? Or perhaps it’s both.
Professor Graham Medley: I think it’s a combination of both. And the best way that I can describe it, I think, is the comparison in the epidemic. So up until January 2021 we didn’t really know what – what the government would have thought of as being a good 2020, you know, or – sorry, “good” is the wrong word, less worse. Epidemics are bad things, bad things happen in them. But what would the government have regarded as being a less worse outcome?
After January, from January 2021 afterwards, the Cabinet Office started to send people to the SPI-M-O meetings and we started to have much more of a dialogue. Now, this fence between within and outside of government still exists, but it’s possible to talk and signal over the fence, and we clearly understood, although we might not have been directly told, that the government would have regarded a success in the next six months by not having a major surge of infection. In which case we can say: well, do it slowly, take your – you know, don’t rush to open up immediately, remove restrictions slowly, and remove them in an ordered way so that the data analysis and the modelling can inform you what the impact of the previous decision was. And that was the roadmap: the data, not dates process.
Counsel Inquiry: I was about to say, that’s data not dates?
Professor Graham Medley: Yes.
Counsel Inquiry: And we can see that that was a process where there was no doubt a dialogue between the government and you which –
Professor Graham Medley: Yes.
Counsel Inquiry: – informed when the various steps –
Professor Graham Medley: And critically was that time period. So we had raised very early, and it’s in one of our consensus statements, that we – it’s not just us as modellers but data analysis needs a period of several weeks between making a change, a decision, and seeing it reflected in the data.
So there are several instances of measures being introduced by the government too late, so that you couldn’t evaluate them properly before the next decision had to be made.
So I think one of our – I think one of SPI-M-O’s sort of contributions to that roadmap was to say: spread out the decisions and tell us when you’re going to make it, because then when we do the modelling we can include that date in the modelling as the date at which things might change.
And I think the evidence that we produced for that period was much improved in terms of its relevance to the decision-making, and supported the decisions much more. And it wasn’t – much of a relief to me – it wasn’t then put front and centre to explain why the decisions were being made.
The amount of work done in that period was absolutely huge in terms of the members of SPI-M-O and their teams. You know, not just the people coming to the meetings but the teams of people behind them. But it was not presented as being: this is why we have to make this decision. And it was a much more ordered, rational period of time in which hopefully the decisions were better.
Counsel Inquiry: Last thought on this subject, Professor, we’re obviously at least partly thinking about recommendations for the future and how the next pandemic might be handled. The period that you’re referring to as being a much better period was, of course, a year into the Covid pandemic. How realistic is it, do you think, that were there to be another pandemic, or when there is another pandemic, the initial period, which will be one of inevitably great uncertainty, whether it would be possible for the government to provide the modellers and the scientists with that type of sort of calm, thought-through strategic information at the very start of a pandemic as opposed to well into it?
Professor Graham Medley: Well, the time to do it is now. I was disappointed that as soon – you know, when we reached February 2022 the policymakers who we had been interacting with were disbanded and – you know, almost immediately. I would very much like to have gone with them, with that group, gone back to February 2020 and re-gone through that process.
I mean, critical in that was Dame Angela McLean, the policy co-chair, who I suspect had brokered that interaction. Because it’s a risk for government officials to come and talk to people, so – even though it wasn’t direct talking – to come and meet with people outside government and discuss policy options. And so – but that is absolutely critical, and I’ve mentioned in the report we had sort of – Dame Angela McLean also managed to get two people into Cabinet Office, so people from SPI-M-O who worked in Cabinet Office, just to keep the – that dialogue flowing. When I say dialogue, I don’t necessarily – I mean information rather than words. So that we are able, as modellers, to understand what government wants to try and achieve, so that we can support their decisions to achieve that. Or, of course, we can tell them: no, that’s impossible.
Counsel Inquiry: Yes.
Professor Graham Medley: Yeah.
Counsel Inquiry: We heard that you had resigned the chairmanship of SPI-M earlier this year?
Professor Graham Medley: Yep.
Counsel Inquiry: Are you in fact still a member of the committee at all?
Professor Graham Medley: No, I’m not.
Counsel Inquiry: Regardless, the type of work that you’re describing, the sort of between pandemic preparation work, is that something that SPI-M ought to be involved with?
Professor Graham Medley: We ought to be, but, you know, much to my disappointment it’s not happening, or it wasn’t when I was there. And, you know, we – actually, the first piece of work that we came back to on SPI-M was that piece of work that we hadn’t finished before, which is this pre-purchase of vaccines. So the Department of Health is asking whether it should invest a large amount of money to buy vaccines for influenza for the next pandemic.
Well, the answer to that question very much depends on what government would do. Because if the government was prepared to stop the epidemic with a lockdown at the next time, then it changes, you know, the amount of investment now that’s worthy of putting in. But we don’t have any idea of what that is, and that policy landscape is still developing. So UKHSA, Department of Health, how SPI-M feeds into it is all still there, but it needs to have – or we’re not quite clear what those relationships are, but it needs to have input from the centre of government, because if it gets bad enough that you need Cabinet Office policymaking, then Cabinet Office should be involved now to discuss what that’s going to look like.
Counsel Inquiry: Thank you, Professor.
I want to change focus again and in fact take us back to the beginning of the Covid pandemic, early 2020. We’ve heard your evidence about SPI-M, the I standing for influenza but transporting itself across to infection at that time. But, as you’ve said, a committee that, historically at any rate, had very much focused on influenza planning.
Professor Graham Medley: Yeah.
Counsel Inquiry: Let’s look, if we may, at another passage from Professor Woolhouse’s statement.
It’s on page 44, paragraphs 243 and 244, I think. Yes, thank you.
So 243, yes, he says:
“An important question in those early stages was whether a Covid-19 epidemic would be more influenza like or more SARS-like. The UK response initially assumed … an influenza-like event. This was not unreasonable but, in my view, it took looking to recognise that Covid-19 had many similarities to SARS: we knew from early January that [it] was closely related to SARS. Compared with influenza, Covid-19 had a higher R number and had little impact on children while being highly dangerous to the elderly, frail and infirm.”
Do you agree with that so far?
Professor Graham Medley: Well, I’m not sure what he means by “early stages”. I mean, the timeframe is – generically I agree that pre-pandemic preparedness was influenza, and I have – if you look at the cover of the SPI-M modelling summary, it spells out influenza as the I. So – and SARS – so this was transmissible SARS, but I think I first used “transmissible SARS” as a phrase in February, so I think we realised quite quickly that this was not influenza. That is important in public health considerations, but in terms of the modelling was not critical, I don’t think.
Counsel Inquiry: You’ve already stated in the course of your evidence today, and as I think we know, that in early 2020 there really was only one policy that the Government had, it’s the delay, contain, mitigate. You’ve also referred to the idea of just letting the epidemic take its course. And you say quite straightforwardly in your statement that that turned out to be outdated.
Two questions –
Professor Graham Medley: Sorry, it would have been outdated for influenza as well, because influenza still would have had the same kind of health impact.
Counsel Inquiry: Let’s just focus on Covid, if we may. The two high level questions that arise, Professor, is firstly, and that’s really the point raised by Professor Woolhouse, whether the UK pivoted away from its pre-existing influenza-based plans too slowly in early 2020, and the related question is whether SPI-M-O or SAGE should have done more to alert policymakers that there was a problem with the influenza plan, or was it that the policymakers themselves weren’t tasking SPI-M-O and SAGE appropriately?
Let’s take them in stages. Do you think that the pivot from the earlier contain, delay, mitigate strategy towards suppression happened too late?
Professor Graham Medley: So that question of – which is why I pointed out that the – that plan would have been inadequate or, sorry, wouldn’t have … given the preferences that the government subsequently showed, that they didn’t want to have the epidemic in one wave, that would have been true for influenza as well. So the realisation that there would be a large number of hospitalisations and deaths, would mean that they were going to stop the epidemic, would have to have occurred with influenza. Yeah?
Counsel Inquiry: I don’t want to get into a debate with you about a pandemic that didn’t happen, Professor, but vaccines might have played a part in influenza –
Professor Graham Medley: But the virus that was causing the epidemic wasn’t the issue. The issue was that in the plan these large numbers of – you know, hundreds of thousands of deaths were just going to happen. It was going to be a natural event that the country would get through.
Counsel Inquiry: All right.
Professor Graham Medley: Yeah?
Counsel Inquiry: Yes.
Professor Graham Medley: The question of suppression, of stopping the epidemic, yeah, is – was clearly made, but that wasn’t because it was coronavirus, presumably the government would have made that same decision had it been pandemic influenza.
Counsel Inquiry: So I think what you’re saying is that the reason why there was a delay in changing, in pivoting from one strategy to the other was really the fact that policymakers themselves had previously signed up to the earlier policy, and it was only when they decided on a change of course that a new policy was adopted?
Professor Graham Medley: Yes. And that policy, I’m not sure where it originates from, but, you know, clearly the world and society has changed a lot in the intervening period. And the ability to stop it. You know, I mean, I don’t think ten years ago it would have been possible to have the kind of lockdowns that we had.
Counsel Inquiry: Can we look at another passage of your statement, please, Professor, it’s page 18, and I want to look at paragraphs 3.27 and following. Picking it up at the end of paragraph 3.27, please, you say, last sentence:
“My view is that the reality of the epidemic, via the SAGE process, was not given sufficient weight initially.
“3.28. There was a sense that [the] government strategy was being created ‘on the hoof’ during February and March …”
Just pausing there, are you here referring to some similar points to those we were just discussing? What do you mean by policy being created “on the hoof”, Professor?
Professor Graham Medley: I mean the lack of a plan. It wasn’t clear what the plan was going to be. If they were not – government were not going to follow the pre-pandemic plan, and clearly at that point, I don’t think – it depends when I was writing this, but I never got a sense that not having a single wave was something that the government was thinking about. I had a conversation on 4 March which convinced me, you know, very quickly that even if that was the government plan they would change their mind. And so it was really, at that period of time, was a sense of, from my point of view, the lack of strategy, of the lack of decision-making under uncertainty, the things that might happen in the future and what we would do at that point.
Counsel Inquiry: I suppose not lack of strategy, because I think what you’re telling us is there was the strategy, there was the single wave strategy?
Professor Graham Medley: I realise the inconsistency in what I’m saying, yes.
Counsel Inquiry: But were you expecting them to change course but that call didn’t come or –
Professor Graham Medley: I thought they would, and that was partly, of course, from the international perspective, in the sense that we had already seen, you know, the first country, China, close the economy rather than face the epidemic. And even from that perspective you thought, well, that might well be the response.
Counsel Inquiry: So, and this is what you mention at the bottom of the page we’re looking at, you talk about China’s response being to “close their economy rather than face the epidemic and its consequences”. You say you thought it was “likely that generalised NPI would be a widely used intervention in the pandemic”, and that what happened in Italy confirmed your view.
So looking at – focusing in on Professor Medley and SPI-M-O in, let’s say, February 2020, it sounds almost as though you were waiting for the government to ask you about lockdowns or to issue you with some tasking saying, “We don’t think we can bear to take this wave, what else can we do?” But that call didn’t come. Is that what you’re saying?
Professor Graham Medley: Yeah, we were doing things, we were looking at the impact, and we were particularly asked about schools. You know, much to some people’s frustration, because – some members’ frustration, because, as Professor Woolhouse has already pointed out, that relatively early, in February, having realised that this was more SARS than influenza, then care homes would be more of a problem than schools. So – nonetheless the government was asking us about the impact of closing schools, and, you know, that is the only NPI, really, for which we had prior information. We were not being asked about alternatives to the strategy.
Counsel Inquiry: No. Were you, either on SPI-M-O or on SAGE, encouraging the government to think about alternative strategies?
Professor Graham Medley: Regardless of the – or under most strategies that you would think of, then putting in place NPIs and, I mean, restrictions such as – or guidance such as asking people with clinical disease to stay at home, so individual isolation, would have to be done, and my frustration at that point was that those were not being put in place early enough, because we didn’t know whether they would work.
So coming back to this point about sufficient time and data to enable – see interventions working, the doing nothing and then suddenly changing your mind, which is to some extent what happened, was perhaps where I got the – you know, some of that confusion from, that if – regardless of what the outcome you want to achieve is, putting those kind of interventions, individual isolation, in place sooner would have seemed to be more sensible.
Sorry, does that answer your question?
Counsel Inquiry: I want to stay on this subject but move on to a slightly different issue, which is the NHS, and which – as we know, the cause of the NHS, whether it would be overwhelmed or not, became a key issue.
If we look at paragraph 4.9 of your statement at page 43 –
Professor Graham Medley: Just to point out whilst that is coming up, in the pre-pandemic preparedness plan, hospitalisations are not mentioned.
Counsel Inquiry: No. Let’s just look at this paragraph, Professor. It’s the second sentence:
“Throughout February 2020 it became increasingly clear …”
And I take it you mean – well, is that clear to you, clear to SPI-M-O?
Professor Graham Medley: Yes, to SPI-M-O.
Counsel Inquiry: “… that NHS capacity in the UK would be overwhelmed.”
Professor Graham Medley: Yes.
Counsel Inquiry: And you say that SAGE asked a working group be set up to discuss the extent of the overwhelm.
Now, we may hear from those, for example, in Number 10 that this prospect of the NHS being overwhelmed wasn’t something that at the very least they adverted to until a couple of weeks later than the end of February, in mid-March.
But are we to take it from this that – not the possibility but the certainty of NHS capacity being overwhelmed was something that was clear to you and to SPI-M-O during February?
Professor Graham Medley: So the extent of the epidemic became very clear during February and so I think at that point we were, you know, the – we’d essentially established the infection fatality rates, so that’s the proportion of people who are – die following infection, at about 1%, big variation with – especially with age, but – and if 80% of the population becomes infected in a single wave, then you can calculate the numbers of people who would die.
The question, then, of hospitalisation is slightly more complicated, because of course it depends on who goes to hospital under those kind of circumstances.
So it needed a meeting with the NHS and with clinical colleagues for them to say what symptoms would justify admission into hospital, because that is a variable, it’s a clinical variable that if somebody goes to hospital then they might not be admitted, and that – those kind of clinical questions determine the extent to which the epidemic results in hospitalisations, for example.
Counsel Inquiry: Well, Professor, just looking at this statement, and maybe you want to qualify or change it, looking at the statement, what you say is it became increasingly clear that capacity would be overwhelmed, and all you were doing with the NHS was talking about the extent of the overwhelm?
Professor Graham Medley: I think that’s right. I mean, throughout – I mean, yes, I stand by the statement, throughout February. What I mean is that, in terms of being able to make a clear statement, it was absolutely clear the expected deaths. Hospitalisations are slightly, you know, more uncertain because it requires more clinical input.
Counsel Inquiry: I want to have a look – sorry, Professor.
Professor Graham Medley: I don’t think it’s recorded in the minutes, but just to make it clear, so Dominic Cummings’ iPhone X, for example, attended all of the SPI-M-O meetings, even those, I think, pre-pandemic. Whether it’s recorded in the minutes I’m not sure, but, we – as I said, there was a whole host of people phone – people phoning in from across government. So even if it might not be in the paperwork, but I’d argue about that, it was known.
Counsel Inquiry: Let’s have a look at what is in the paperwork, Professor, and I want to look at the minutes of two SAGE meetings at the end of February.
So first of all for 25 February – thank you – we see a SAGE meeting. Though this is pre-lockdown, so it looks as though it was held in person, although there may well have been people dialling in. We see that you were there.
If we can go over to the next page, please, we can see that the measures to limit spread are referred to. And if we look at paragraph 13, it says:
“Any combination of measures would slow but not halt an epidemic.”
Then this:
“NHS needs must be considered in any decisions to alter the epidemic curve.”
Is that consistent with a view that you’d reached that NHS overwhelm was at that stage inevitable?
Professor Graham Medley: I think so, yes. Remember these documents are written by civil servants for civil servants –
Counsel Inquiry: Well, just pausing there, Professor, we may hear that SAGE minutes are written for policymakers.
Professor Graham Medley: Who are civil servants.
Counsel Inquiry: Well, they are politicians, Professor.
Professor Graham Medley: Well, I always think of them as decision-makers.
Counsel Inquiry: I’m not going to quibble with you about language, Professor, but I want to press you on the rather more important point, which is whether the sentence “NHS needs must be considered in any decisions to alter the epidemic curve”, does that really mean, does that sentence signal a conclusion that it is inevitable that the NHS will be overwhelmed in the approaching epidemic?
Professor Graham Medley: It certainly indicates that the NHS is a major factor.
Counsel Inquiry: Well, that’s not the same thing, Professor, is it?
Professor Graham Medley: No. No. I mean, I don’t remember that – as I said, I went to many meetings over the epidemic, I don’t remember that particular meeting.
Counsel Inquiry: Let’s have a look at the next one, Professor. It’s a meeting in fact only two or three days later, two days later, so it’s the 11th meeting of SAGE.
It’s a different document. INQ000213175.
Professor Graham Medley: No, this is a paper I wrote.
Counsel Inquiry: I may have the wrong …
(Pause)
Counsel Inquiry: We may have to come back to this. Just bear with me one moment.
(Pause)
Counsel Inquiry: We can take that down, that’s the wrong reference. Yes, could we have INQ000106129 on the screen, please.
There may be a problem with the document. I tell you what I’m going to do, Professor, I’m going to read out – there was a SAGE meeting a couple of days later – I think there is a problem with getting the document on the screen, but I will read out the entry. In fact it’s the same entry that you refer to in your statement, but what it says is:
“UK academic modelling groups, Imperial Oxford, London School of Hygiene and NHS planners to organise a working group in the week starting …”
I think we’ve got it on screen – yes.
So if we go over to the bottom of the second page, please, thank you. Yes, this was the passage I was reading.
If we see the very bottom:
“UK academic modelling groups … and NHS planners to organise a working group in the week starting 2 March [so the next week] to analyse key clinical variables for reasonable worst-case scenario planning for the NHS, for review by SPI-M and then discussion at SAGE.”
So on the one hand, Professor, we have your statement which says that during February it became clear that the NHS would be overwhelmed, and then we have these two sets of minutes at the end of February, neither of which refer to an overwhelming of the NHS. Here what is referred to is reasonable worst-case planning. So, as we’ve already discussed, it’s a scenario, it’s not a prediction. How can we reconcile those two things, Professor?
Professor Graham Medley: So at the beginning of February it wasn’t clear at all. By the end of February SAGE was asking for quantitative details. So that meeting happened on 1 March, I think. It was asked for in SAGE, so by 1 March we had the – a good understanding of what the impact would likely be on the NHS. So that’s, you know, that’s throughout February.
Counsel Inquiry: Professor, from a lay perspective, and of course with hindsight, but if you and your colleagues had already realised during February that the NHS was going to be overwhelmed by the pandemic that was developing, why didn’t you just say so?
Professor Graham Medley: Well, we – I mean, we – the secretariat that we were talking to completely understood. The SAGE secretariat were taking the minutes. I didn’t write these documents, the documents were written by somebody else for somebody else, they’re not written for my benefit, and it’s really the writers and the readers that you need to question. I was – at the end – by the end of February it was clear, I think, that the NHS would be overwhelmed, and I don’t think that was being kept a secret.
Counsel Inquiry: So the situation you’re describing is a meeting, a SAGE meeting, where everyone round the table is discussing the fact that the NHS is going to be overwhelmed –
Professor Graham Medley: Yes.
Counsel Inquiry: – but the minutes record simply that there needs to be some reasonable worst-case planning for the NHS?
Professor Graham Medley: Yes.
Counsel Inquiry: I see, thank you.
I want to move to a related document, and that is, please, INQ000129093. I hope this one is right. Thank you.
This is – Professor, I think you’ve seen this document before, it’s a report or a note written by someone called David Halpern, who was a Number 10 civil servant, a behavioural expert who will be giving evidence to the Inquiry in two or three weeks’ time.
We can see it’s dated at the top September 2020, and he’s looking back, is he not, at the early days of the pandemic? It’s a sort of a – well, it says, it’s a lessons learned document.
If we can turn over to the second page, it’s the section which is headed “The Early misstep” that we’re interested in, and it’s in fact the next page where we – the particular point, but I’ll just introduce it, if I may.
You can see he says:
“Arguably the most fundamental misstep in the UK response was the presumption that Covid would be an unstoppable flu-like wave.”
He says, the next paragraph:
“It is important to see that this presumption was not based on ignorance, but on a century of prior knowledge and assumptions.”
Then the next paragraph, he refers to the mass expertise which he has described converging on the conclusion that once early containment had failed, a flu-like wave was inevitable.
If we can go to the next page, he carries on referring to this, as it were, received wisdom, which he perceived in any event, and he describes it as being a block to any suggestion that there might be an alternative policy of suppression.
If we can pick it up at the bottom of this page, please, so the paragraph – he says:
“If I had to choose a single issue – and moment – that embodied this failure, I’d point to the unshakeable conviction of the SPI-M modellers that suppression – the sustained holding down of Covid prevalence – was not a viable strategy. For example, Graham Medley, chair of SPI-M, was asked in SAGE in the second week of March, along with the other modellers: ‘how certain they were that major second waves would arise in China and other Asian nations?’ (ie that suppression was not a viable strategy). Medley answered immediately, and with total conviction: ‘as close as 100% as possible…yes, 100%’. His colleagues echoed the conclusion ‘yes, 100%’. They were totally convinced that as soon as the harsh lockdowns in Wuhan, South Korea and elsewhere were lifted, cases would immediately surge again.”
And he observes:
“Nothing in science, and certainly nothing in statistical modelling, is 100%. Let alone in the face of the data already emerged from the Asian experience. This was doctrine, not science.”
Professor, is it right that you believed, as it were, as a matter of doctrine, that suppression wasn’t viable in February and March 2020?
Professor Graham Medley: So epidemics have happened throughout history, and the study of them through models is a science, scientific discipline, so it’s absolutely not doctrine. And I think that we were correct that – there were surges. You know, the virus did come back in every country in the world. It was a question of how long they suppressed it for rather than whether they suppressed it. And in terms of health outcomes, clearly suppressing it until a vaccine was available and getting the vaccine into the people was critical in determining the outcome of that. But every country has had a subsequent epidemic, and to some extent, you know, the – so what is said here is correct, but it’s out of context, because I think the – if I remember this particular discussion, it was, you know: will having a lockdown solve the problem? And the answer to that is: no, it will not solve the problem, because it will continue to be a problem. And if you go back to what you were doing previously, you – it will re-occur. Which of course it did in the United Kingdom.
Counsel Inquiry: It did, but, you see, the debate we’ve been having for the last ten minutes or so is trying to understand what was happening in that time.
Professor Graham Medley: Yeah.
Counsel Inquiry: And why it was that lockdown doesn’t seem to have been considered during February or even in early March.
Professor Graham Medley: Yeah.
Counsel Inquiry: And what you were telling us was that you were, as it were, waiting for the government to ask you about it, but they didn’t. But I wonder whether actually it’s possible that you and your colleagues didn’t think it would work and so weren’t pressing for it and that was at least one of the reasons why it wasn’t on the agenda?
Professor Graham Medley: So – well, we didn’t know if it would work, but even if it worked, it doesn’t resolve the problem in terms of the longer term. You know, because unless you continue that suppression, then it will come back.
Counsel Inquiry: Of course if, as you say, you had – it was very clear to you that the NHS would be overwhelmed –
Professor Graham Medley: Yes.
Counsel Inquiry: – then that puts a rather different perspective on whether there needs to be a lockdown, doesn’t it?
Professor Graham Medley: Potentially. I mean, you’re asking me about perspectives. My role and the role of the models is not to provide those kind of decisions. Our job is to give the evidence, or was to give the evidence.
Counsel Inquiry: Yes.
Professor Graham Medley: Now, I completely understand what you’re saying, is that had it become – had we made it clear or had policymakers known what the potential for a single wave epidemic was, that they would have been asking much earlier. I don’t think that they could not have known. But I might be wrong.
Counsel Inquiry: What was, as you have said, known to be certainly going to happen to the NHS, wasn’t a question of modelling at all, by that stage, was it? It was a statistical prediction. It wasn’t a scenario, to use that binary approach we were discussing. On your analysis, you knew that was going to happen.
Professor Graham Medley: Yeah, and we had already seen the policy response to it internationally.
Counsel Inquiry: But it wasn’t flagged up in the SAGE minutes?
Professor Graham Medley: No, but then nor was it – we asked about, you know, what – tell us about lockdowns in terms of policymakers.
Counsel Inquiry: Professor, that –
Professor Graham Medley: There wasn’t that dialogue going on, as I pointed out before.
Counsel Inquiry: Thank you. I’m going to move on. I’ve got a few more slightly shorter topics to deal with, with you, and the first of them is about – is to do with nosocomial infection after the first lockdown.
If we can start, for these purposes, with paragraph 6.6 of your report, which is on page 55.
So here, Professor, you address the question of transmission within LTCFs, which we know is long-term care facilities, I think.
Professor Graham Medley: Yes.
Counsel Inquiry: We can call them care homes, nursing homes.
You refer to an email that you sent to Patrick Vallance in April 2020, do you not? Perhaps we can call that up on screen, and I think the best number to do that with is INQ000 – well, no, well, shall we try INQ000260625.
What we see here is an email exchange. Let’s look first at your email to Sir Patrick Vallance, or Patrick Vallance as he was then. So we see it’s dated 17 April of 2020, and looking at the second paragraph, you talk about two conclusions being relatively robust. The first is that the number of deaths in hospital is less than 50% of all deaths. Secondly, that deaths at home and in care homes are not plateauing.
Then looking at the next paragraph, second sentence:
“Consequently my reading of the situation is that we have widespread ongoing transmission in the health and social care systems. Hospital and community health and social care appear to be driving transmission, and potentially at an increasing rate.”
Then you make this rather striking observation:
“In effect, this is the opposite of shielding – vulnerable are being preferentially infected.”
Can you expand on the observation you were making?
Professor Graham Medley: So this is 17 April, so lockdown has been going for three weeks, and we’ve seen the hospitalisation rate and the death rates turn over, much to everybody’s relief, that government could introduce measures that would stop the epidemic. So this is a relative – this is a dataset looking at deaths. Now, I’m not sure that the data, when they were fully unwound and looked at, actually supported the conclusion, the worry that I had in this email.
Counsel Inquiry: Right.
Professor Graham Medley: But clearly we had stopped transmission – my feeling at this time was that transmission within the community had been stopped, or reduced greatly, so that this reproduction number was less than 1, so the prevalence in the community is falling. But the deaths in care homes and in the community were continuing to rise. And the care population, which it turns out we knew very little about, so the people receiving care – there are more people in residential and informal care than there are in care facilities, and others will know more about that than I do, but this rise in deaths of people at home and in care homes was concerning to me because it meant that we were effectively closing schools and locking down on one hand, and being successful, but there were epidemics in the care sector and the health sector which were continuing to rise. And that’s, of course, exactly what you don’t want to happen.
Counsel Inquiry: It’s what you don’t want to happen and it’s what we now know at around this time was happening?
Professor Graham Medley: Yes.
Counsel Inquiry: So here you are sounding the alarm to Patrick Vallance. If we can go back to –
Professor Graham Medley: Just to come back to another point, I mean, this is part of the difficulty – you know, the situation I was in as an independent – so if somebody from within government has sent me a document that he’s described as not for sharing, I’ve then shared it potentially with somebody else inside government, I mean there are all sorts of boundaries going on partly because of this problem that I was outside but …
Counsel Inquiry: Well, you obviously thought it was the right thing to do, to –
Professor Graham Medley: I did.
Counsel Inquiry: – to share your concern with –
Professor Graham Medley: I did.
Counsel Inquiry: – the Chief Scientific Adviser.
Professor Graham Medley: Clearly.
Counsel Inquiry: And I want to ask you about his response, please. So if we look at the very top of the page, it’s a short response, he says:
“Thank you for sharing [it]. I think that’s what we’ve been driving at in SAGE and I will reinforce again with the accountable departments that this is a very, very key area that they need to get on top of.”
Do you know, can you help us any further with what –
Professor Graham Medley: No, I –
Counsel Inquiry: – Patrick Vallance did about that?
Professor Graham Medley: Patrick Vallance was the most senior email I had, so I had told the person the most – the highest up the chain, we had been talking about it at SAGE and SPI-M-O, we’d discussed this possibility previously, and, you know, he presumably did something about it, but I didn’t hear any more.
Counsel Inquiry: Right. That was on 17 April. If we could go to another document, please, it’s INQ000213298.
This, when it comes up, we will see is a consensus statement from your committee, SPI-M, SPI-M-O, three days later on 20 April.
If we look at the second paragraph, the first paragraph talks about hospital transmission, and then the second paragraph says:
“This estimate does not include people who acquire infection in hospital, leave (either because they are discharged, or because they are outpatients) and are then readmitted with COVID-19. This requires urgent investigation.”
So again, the nosocomial infection. Was an urgent investigation undertaken?
Professor Graham Medley: So I contacted a scientist who I knew working in PHE, who had – was – had some expertise in nosocomial infections. I was also – I think about this time the SAGE nosocomial working group was set up, so there was urgent investigation of it, and work has subsequently been published looking at the impact of this particular phenomenon.
Counsel Inquiry: And this issue was exposed, over time at least.
Yes, thank you, we can take that down.
Finally, Professor, I want to ask you, I hope quite briefly, just about a few unrelated matters. The first of them is the resignation of Neil Ferguson from SAGE, something we all remember, and if we can perhaps call up on screen INQ000267746. If we hadn’t remembered, I hope this is the document which will remind us of that event.
We can see it’s a BBC News article from 6 May 2020, so only a couple of weeks, in fact, after those emails we were just looking at. It refers to him quitting what’s described as his “government role” after “‘undermining’ the lockdown”. We see there’s a reference to him having quit after admitting “an error of judgement”.
If we can go over to the next page, please, we see the Health Secretary, Matt Hancock, quoted as saying it was extraordinary that Professor Ferguson – but he had taken the right decision to resign. Then he says, this is Mr Hancock saying it was “just not possible” for Professor Ferguson to continue advising the government.
We read on, possibly with some degree of irony, that Mr Hancock said that the social distancing rules were there for everyone and were deadly serious, and there is a reference to Scotland Yard having made a statement as well.
If we could go over to the next page, please, page 3, the BBC correspondent refers to Professor Ferguson’s resignation as being “a really big deal”, says he is “the most influential scientist” in the virus outbreak apart from Chris Whitty and Patrick Vallance.
Then further down the page there is a Sir Robert Lechler, said he didn’t think that Professor/’Ferguson’s resignation would “have any material impact” on the work of SAGE. He says that although Professor Ferguson made an important contribution, he is sure the group would continue to provide valuable support.
The point I want to ask you about, Professor, is that although, as we see here, Professor Ferguson on this occasion resigned from SAGE, he in fact remained a member of SPI-M-O, did he not?
Professor Graham Medley: He did.
Counsel Inquiry: We can look at an email from you to Paul Allen and Angela McLean, in fact I think it was the day before that BBC report, but obviously very much at the same time. If we can look at the bottom half, please, we can see you in the second paragraph saying that you are quite keen to keep him on SPI-M, he is a modelling expert, you don’t want to lose his expertise. You say that his input into forming SPI-M consensus is greatly valued but then you say his presence might damage the science and SPI-M and there is a reputational risk, and then you refer at the end to the fact it’s a DHSC decision.
So we know he did stay on SPI-M. We can see in this email that you understood the tension perhaps between the statements that were being made publicly about Neil Ferguson not being an appropriate person to advise government, but your desire to keep him on the committee. Presumably that’s what you mean by the reputational risk?
Professor Graham Medley: Yes, well, and I saw SPI-M’s role as mainly providing evidence rather than advice. You know, this process of creating evidence that then gets transformed into advice to be given to decision-makers.
Counsel Inquiry: As a matter of –
Professor Graham Medley: SPI-M-O is one step further away from decision-makers.
Counsel Inquiry: As a matter of transparency and public confidence, Professor, did you think that perhaps it was important that the public should understand that, notwithstanding the public statements that had been made, although he was resigning from SAGE he was in fact continuing to be a regular member of SPI-M-O?
Professor Graham Medley: So the reason why we were all doing this is for the public good, because we wanted – I firmly believe that modelling is essential and important within an epidemic, and we wanted the government to make the best decisions it could, because, you know, we’re living through it as well.
I greatly value Neil Ferguson’s professional expertise. I think he is, you know, undoubtedly one of the leading modellers internationally, and wanted SPI-M-O to produce the best evidence it could, and therefore was making clear to my policy co-chair and the head of – Paul Allen’s the head of the SPI-M-O secretariat, that that was what I felt. But on the other hand, you know, it wasn’t – it’s their committee, not mine.
Counsel Inquiry: Exactly. And do we therefore assume from what you say that in the end the decision that he should stay on SPI-M-O was not your decision, but do you know whether it was –
Professor Graham Medley: He didn’t come for many meetings, I can’t remember how many, but then he reappeared.
Counsel Inquiry: Do you know whether it was a decision taken by Mr Hancock or not?
Professor Graham Medley: I have no idea how far up that chain it went, but I was very glad for two reasons. One was because the – it’s not only Neil Ferguson himself, but, I mean, he has a large group with a national investment in it to provide that – this kind of evidence, and I was also worried about the kind of morale on the committee at the time, and, you know, felt it important that his expertise was recognised in order to keep the committee functioning.
Counsel Inquiry: Yes. Thank you.
I want to ask you about a separate matter now, and in fact this involves going back to the consensus – sorry, no, the agenda, the SPI-M-O agenda that I showed you before lunch, so that’s INQ000233688, please.
You’ll remember looking at this earlier. One of the agenda items I didn’t refer you to earlier because I knew we were coming back to it, it’s the fifth one down, paragraph 8, Long Covid.
Now, we noted earlier that this is a meeting quite late in the pandemic, it’s February 2021. Can you tell us how it came to be that you were discussing Long Covid on that occasion?
Professor Graham Medley: Thank you. So you alerted me to this. I looked it up yesterday. I was trying to remember or trying to find out whether this was members suggesting we talk about it or the secretariat asking us to talk about it, and I couldn’t find out which, so presumably it was done in a phone conversation rather than by emails. But we knew from the outset that there were likely to be post-infection sequelae, I think clinically they’re known as, the consequence of infection. Principally I remember discussion about whether or not Covid increased susceptibility for bacterial infections. That turned out not to be true. But without formal case definitions and good data we can’t include it explicitly in the models, which is really the conclusion of this discussion. Clearly we can and we do include infections, so we were always talking about infections, but there is little we can do in terms of modelling to enhance the data and the information that’s available.
Counsel Inquiry: Does it follow from what you’ve said that following this discussion there wasn’t any modelling of Long Covid, at least at that stage?
Professor Graham Medley: Yes.
Counsel Inquiry: Has there in fact to your knowledge ever been any SPI-M, SPI-M-O modelling of Long Covid?
Professor Graham Medley: Not to my knowledge. And until we, for example, have case data and good data then it wouldn’t be possible.
Counsel Inquiry: You may not be able to answer this, in which case say so, but from your understanding about what is known about Long Covid now, is there enough data, enough understanding to model it if one wanted to?
Professor Graham Medley: Well, because, as where we started, that models are a combination of data and assumptions, so if you wanted to put some assumptions in you can model anything. If you want to be able to provide policy-specific evidence from a model then the data do not exist to be able to include Long Covid in a model that actually produces realistic numbers.
Counsel Inquiry: Thank you.
Just one or two more short topics. The first of those is to do with interactions with the media by members of your committee. We will all, I’m sure, recall during the pandemic hearing about the latest announcement by the government or the latest decision by SAGE or one of its committees, and then perhaps hearing one of – a scientist who may or may not have been on that committee, but may have been, expressing their own view, and the broadcasters were always very careful to introduce the person as expressing his or her own view rather than the view of SAGE or SPI-M or whichever committee it was.
Do you have a view about whether – well, perhaps I’ll ask the question in this way: can we have a look at a document, please.
It’s INQ000102129.
This is a series of WhatsApp messages, Professor. So they’re WhatsApp messages from Matt Hancock’s phone, and we can see it’s June 2020. It starts with Boris Johnson saying:
“These sage geezers now saying we should have gone into lockdown earlier … can we gently ask them why they did not make their anxieties public at the time???”
Then Patrick Vallance, relevantly for our purposes, says:
“I think there is too much enthusiasm for the camera at the moment and will speak to them again. All the minutes of SAGE are published and so dates of recommendations are clear.”
Then Matt Hancock says:
“It is exceptionally unhelpful having individual members of SAGE making comments like this. It undermines us all.”
So we see apparently a view being expressed by Patrick Vallance and Matt Hancock which is disapproving of members of SAGE and other committees making media statements.
We know that you did talk to the media during the pandemic. Help us with that issue as to whether, looking forward, people like you who attend these committee meetings and feed into these consensus statements ought or ought not to express contrasting views publicly?
Professor Graham Medley: As I said, I think this is a difficult area in terms of kind of the inside/outside government and independence. Clearly the government values independence, and so wishes to have independent people giving advice or providing evidence, and of course if we’re independent we can say what we like.
Slight irony of saying, well – in here, a paradox of, you know “Well, why weren’t they speaking out publicly at the beginning?” as a defence or a criticism for why they’re speaking out publicly now.
So – and it is a difficult area, because in an epidemic, you know, one of the key things that determines outcome is the coherence of the population, and we’re very well aware of that. So being on message, as it were, supporting government communications, even if you might think that they are personally wrong, you know, is – puts you in a difficult position. I’m not – whereas – as other scientific groups were quite happy to advocate for things that the government weren’t supporting.
So it just creates a minefield.
Counsel Inquiry: One way of looking at it is it undermines the consensus statements we were talking about earlier, because of course the SAGE minutes were being published –
Professor Graham Medley: I think we didn’t have it as a consensus statement. If we had a series of, you know, “Five people think this and three think that”, then potentially you get arguments in public about which of the – which is right, the three or the five.
And so having a consensus statement I think helps because that does give people a clear guideline of what we were, what our position was as a group. But we don’t have any – we weren’t asked to follow that in public, so people quite happily go out and – quite within their rights to go out and disagree with their own consensus, which might sound incoherent, but we are independent academics and, you know, it’s that – that’s the nature of the beast.
I mean, in some ways it would have been much easier for me and for others if they had agreed to pay my salary and co-opted me into the civil service and taken me into government. Then that would have made my life a lot easier. But then I wouldn’t have been independent. So that independence question and how you use it across the barrier, across into government, I do think is a critical one for understanding how SAGE works.
Counsel Inquiry: It is, Professor, and it actually brings me to the very last point I wanted to mention, because as you say, as we’ve heard, certainly you and your academic colleagues were independent, you weren’t being paid for all of the work you did on SAGE and the like committees.
If we could finally then look back at your statement, please, and go to page 25, and look at paragraphs 3.48 and 3.49, you make the point which you refer to in various places in your statement, Professor, that – picking it up towards the end of 3.48, you say:
“[You] expected that SPI-M-O would be mostly involved in supporting the technical functions of government and boosting the modelling capacity and creating the breadth of models required to generate ensembles and provide SAGE with scientific advice.
“3.49. In the event, [you] were solely responsible for the majority of the formal government modelling during the epidemic.”
And you describe then the vast amount of work that was done.
Then finally – if we can go, please, to page 101 – you pick up on very much the same point. At paragraph 9.9 you say:
“… personally [you] were not comfortable that SPI-M-O, a group of volunteers, was producing a government statistic …”
And you’re referring to the R number here, aren’t you?
“… which had been given prominence in government strategy, as our role was providing evidence rather than fulfilling operational functions.”
You’re making very much the same point in those two paragraphs, are you not, which is that you had expected to be, as it were, providing an additional later to government –
Professor Graham Medley: Yes.
Counsel Inquiry: – work, and in fact you found yourself week in, week out calculating the R number?
Professor Graham Medley: Yeah, so even when SAGE didn’t have to meet, SPI-M-O had to meet. And the setting up of the Joint Biosecurity Centre, JBC, in June, I think, 2020, I was hoping that they would take up this function but it took them over a year to get their act together to do that. And, you know, a lot of what we did would have been done by PHE had PHE had the capacity to do it. But, you know, a lot of the people we knew in PHE on SPI-M had left PHE and there was a loss of capacity. And so we did, to some extent, step in and fill that gap.
Counsel Inquiry: Looking forward, on your understanding of how things work now and how they might work in the future, were there to be another pandemic, would the government be reliant on, as it were, the volunteer academics to provide that basic modelling function, or –
Professor Graham Medley: That’s under discussion, and clearly UKHSA which, you know, is a new body put in, but has many of the same functions that PHE has, I think now, at this point in time, has much more capacity. How that would fit in with an equivalent SPI-M-O, I don’t know. But of course the danger is not now, the danger is in ten years’ time, that that capacity being reduced again.
Mr O’Connor: Professor, thank you very much. I’ve taken you through some quite lengthy points.
My Lady, those are all the matters I have for this witness.
Lady Hallett: Thank you very much indeed, Professor. I’m very grateful to you, and of course for all the work that you and your colleagues did. Thank you.
The Witness: Thank you.
(The witness withdrew)
Lady Hallett: Right. Well, as you know, Mr O’Connor, but others may not, I have to finish by 4 o’clock at the latest, so I shall return at 20 past, and I’m afraid anything you can’t elicit by way of oral evidence this afternoon, I’m going to have to rely on the written statement.
Mr O’Connor: My Lady, yes.
Lady Hallett: Thank you.
(3.08 pm)
(A short break)
(3.20 pm)
Lady Hallett: Mr O’Connor.
Mr O’Connor: My Lady, our last witness of the day is Professor Matthew Keeling.
Professor Matthew Keeling
PROFESSOR MATTHEW KEELING (affirmed).
Questions From Counsel to the Inquiry
Mr O’Connor: Thank you, Professor. Do sit down. Could you give us your full name, please.
Professor Matthew Keeling: Yeah, Matthew James Keeling.
Counsel Inquiry: Professor, you have prepared a witness statement at our request for the Inquiry. We see it on screen. At the end of the statement – again we don’t need to go to it – you’ve signed the statement underneath the statement of truth saying that you believe that the facts it contains are true, and your signature was made on 5 July of this year; is that right?
Professor Matthew Keeling: That’s correct, yes.
Counsel Inquiry: Thank you.
Professor, you are a professor of mathematics and life sciences at the University of Warwick, I think?
Professor Matthew Keeling: Yep.
Counsel Inquiry: And you also explain in your witness statement that you are, I think, the director or possibly a director of the Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research at the University of Warwick as well?
Professor Matthew Keeling: Yes.
Counsel Inquiry: In a couple of sentences, tell us something about the work of that institute?
Professor Matthew Keeling: Okay. I mean, it’s a large institute, so it’s also in some ways virtual, so we don’t have a specific membership but we do have individuals that are sort of highly connected with it and interact fully, and it spans people who are interested in using quantitative tools to address challenges in biology, and this is everything from sort of cellular biology and genetics through to a large range of different problems in infectious diseases, everything from sort of childhood diseases such as measles through to human papillomavirus or HPV, Mpox –
Lady Hallett: More slowly.
Professor Matthew Keeling: Sorry.
Mr Keith: I know. I appreciate we’ve got a time limit, but we have to remember the stenographer.
Professor Matthew Keeling: Sorry. So, yeah, human papilloma virus, monkeypox and then also livestock infections. So we cover a huge gamut of work.
Mr O’Connor: Mathematical modelling of that whole range you just gave us of epidemiological issues?
Professor Matthew Keeling: Yeah.
Counsel Inquiry: So, as we’ll hear, Covid was well within the range of the type of work that you were already doing?
Professor Matthew Keeling: Yes, I’d say that’s a good … yeah.
Counsel Inquiry: You joined SPI-M in early 2009, so by the time of the pandemic you had been a member for over ten years. Did that make you one of the longer serving members or not?
Professor Matthew Keeling: I believe Neil Ferguson and John Edmunds were on at around the same time. I believe they were both members when I joined, but they’d only recently become members. So I’d also sort of been there when we’d gone through the 2009 swine flu outbreak, so that gave a sense of perspective.
Counsel Inquiry: Yes, and in fact you say that you were the acting or an acting chair of the committee in 2009 at the time of the swine flu pandemic.
During the Covid pandemic, you were an active member of SPI-M-O, but you weren’t a regular attender at SAGE. I think you did attend it on a few occasions but, unlike Professor Medley, you weren’t there routinely?
Professor Matthew Keeling: That’s correct.
Counsel Inquiry: I want to ask you about a few of the matters you’ve raised in your witness statement, Professor Keeling, and the first of them is what you describe as the JUNIPER consortium. So it’s paragraph 10 of your witness statement where you start to describe this.
Perhaps you can tell us in your own words: it was I think a consortium that was formed during the pandemic, perhaps quite early on, I think in, you say, the spring of 2020; is that right?
Professor Matthew Keeling: Yes, yes.
Counsel Inquiry: And it was a coming together of epidemiological modelling academics from a number of different British universities?
Professor Matthew Keeling: Yeah, there were seven different universities represented.
Counsel Inquiry: At a later stage in your witness statement you talk about the fact that the sort of the field and SPI-M also had a very, a significant representation first of all from what we know we should call the London School, and secondly from Imperial College London, and was this consortium that you call JUNIPER an attempt, if you like, to gather together other universities who on their own had a much smaller presence, but working together could work at scale in the same way as those other two institutions?
Professor Matthew Keeling: Basically, yes, I mean, we wanted to sort of balance out the skills that we’d got, and I think also by having a large number of different universities we could tap into pools of other expertise as well, which I think helped.
Counsel Inquiry: There was, you describe in your statement, a problem with the funding for the consortium, which took several months to sort out. Should we see that as just one of those things in university life, or is it more fundamental and a matter that this Inquiry should sort of address?
Professor Matthew Keeling: I mean, I think it’s more just one of those things that happens. We’re all used to not getting funding on occasions, and things just taking longer than they should do. I mean, as soon as we got the funding we were able to do more, but we were pulling together before that as well.
Counsel Inquiry: One of the advantages of the JUNIPER consortium that you describe in your statement is being able to access regional data, and I take it you mean data from the regions represented by the different universities; is that right?
Professor Matthew Keeling: Yeah. So, I mean, we were certainly talking to local health charities – local health trusts, and I know the same was true of the Manchester group, they were very involved with their local health centres. So I think that gave us a different perspective. Just being outside London sort of quite often means that you view things quite differently.
Counsel Inquiry: It does, though, raise the question of whether you need to be at a university in Exeter or Warwick to get hold of regional data relating to those areas or whether – I mean, one might expect that data of that sort is available to modellers, if it needs to be, anyway?
Professor Matthew Keeling: I think the data’s available, I think what you lack is the perspective of actually going and being able to talk to the public health people who are on the ground, who will have a slightly different perspective to what is just in the data. So I think you just get a richer sense of what’s happening.
Counsel Inquiry: Now, I think I’m right in saying, Professor, that all of the universities that were part of the JUNIPER consortium were from England. Is that right?
Professor Matthew Keeling: Yes.
Counsel Inquiry: You may have heard us asking Professor Medley about how modelling works with regard to Scotland, Wales and Northern Ireland. First of all, have you got anything to add to what he said? But, secondly, was it in your mind that the JUNIPER exercise might include the devolved nations or not?
Professor Matthew Keeling: I would say we didn’t actively exclude them, it wasn’t that we wanted this to be an England-only grouping, I think it was more of a sort of circumstance of what was happening. Individuals who were working in comparative areas within SPI-M-O just came together and it just happened to be various people from England. But it’s worth saying that I think a lot of us were also involved with work that was going on in the devolved nations, so I attended the Welsh TAG several times and spoke to them at quite long length, I also did quite a lot of work with the Scottish, so Public Health Scotland, trying to understand when they were seeing sort of anomalous rises in cases in local areas. So I don’t think we had this dominated English point of view, I think we were all working across the devolved nations.
Counsel Inquiry: Yes.
I want to ask you one other further question about the imbalance, if you like, or at least the dominance on SPI-M-O of the London School and Imperial College.
In the questionnaire response, the initial questionnaire response that you provided to the Inquiry – let’s call it up, it’s INQ000056476, that’s it, and it’s page 37, please. If we could highlight the fourth paragraph, “In the very early stages …” That’s it, thank you.
“In the very early stages of the pandemic, modelling activities [as you have said] were dominated by Imperial College and … LSHTM.”
Then you say this:
“They had representatives on SAGE [so in the case of Imperial College that’s Professor Ferguson, in the case of the London School that’s Professor Edmunds] and therefore bypassed SPI-M-O.”
Before I ask you about that, let me remind you of something that Professor Woolhouse said in his statement. I’m not going to call it up, but he refers to very much the same situation and talks about SAGE marking – or rather SPI-M-O marking its own homework because there were essentially the same people on both committees.
Is that a problem that you’re identifying by using the word “bypassing SPI-M-O” there?
Professor Matthew Keeling: No, I think I’m referring to different things here. So I think in the very early days of SAGE it was very easy – and I’m not sort of laying the blame here, I’m not saying this is anyone’s fault – but it was very easy, if there was a modelling question, for either John Edmunds or Neil Ferguson to say “Oh, we can answer that”, and if that comes up in SAGE that seems a perfectly natural thing to do; and I think it was only later, when there were more groups involved with SPI-M-O, that the questions came to SPI-M-O and we addressed it as a larger group. So I think that was just a case of how it was.
In terms of marking our own homework, I’m not sure that’s true either. I mean, yes, there were members of SPI-M-O who were on SAGE, but actually the times I went to SAGE and presented work I got a grilling by people who were, you know, experts in their own field and would really take you to task on the assumptions. So I don’t think we ever did that.
Counsel Inquiry: The point made by Professor Woolhouse, and he’ll explain it for himself when he comes here, but he starts from the proposition that SAGE is supposed to be – one of its functions is to challenge the conclusions drawn or the evidence provided by SPI-M-O, and makes the point that if the same people or the same people from the same area of expertise are on both committees, then the challenge function that might be provided by SAGE is bound to be diminished.
Professor Matthew Keeling: Slightly. I think we’d already gone through rounds of modelling critique of the technical elements within SPI-M, or SPI-M-O, and I think, you know, that happened on the Tuesday meetings as well as the Wednesday meetings, and I think those were technical discussions that you wouldn’t have wanted to have at SAGE. Whereas SAGE offered a more wide-ranging challenge to some of the premises and assumptions that we’d put in.
So I think – I felt we’d got an awful lot of challenge. I don’t think it’s reflected terribly well in the minutes. You know, we’ve already had discussions of what the consensus statement is, but without wanting to list every single argument that was proposed and then defended, I don’t know how you’d do that in a systematic way.
Counsel Inquiry: Thank you. We can take that off the screen.
I’m going to move on, Professor, and I want to address with you, and I hope develop, an area that we discussed with Professor Medley, which is the question of the range of experience and expertise on SPI-M-O.
You’ll recall – I think you were watching at least some of Professor Medley’s evidence – the passage in, again, Professor Woolhouse’s statement where he made the point that SPI-M-O by its membership was eminently well qualified to address these epidemiological modelling issues, but couldn’t really provide an answer to issues around deprivation, inequality, the economic impact of the pandemic.
Let’s look, if we may, at part of your witness statement, which is paragraph 42, which starts on page 11, I believe. Yes. So it’s the last two lines of this page and then going over to the next. You make a very similar point, Professor. You refer to the discussion about interaction between epidemiological and economic modelling. You say it was made clear to you that the role of SPI-M-O and SAGE did not extend to considering the economic consequences of infection or control measures – so entirely as Professor Medley said – and you endorse that position precisely because of the limits of your own and your colleagues’ expertise.
You say that you would of course have been happy to collaborate with experts in these areas, and I think in another part of your statement you say you actually did more than that, you volunteered or you tried to –
Professor Matthew Keeling: Yeah.
Counsel Inquiry: – make that happen?
Professor Matthew Keeling: We certainly reached out at various times – I mean, not as part of SPI-M-O, but as independent academics – to try and work with groups who were looking at the economics.
Counsel Inquiry: And did that bear fruit? I’m going to come on and talk about your paper in a moment, but in terms of reaching out within the SAGE or SPI-M-O structure, did that work?
Professor Matthew Keeling: Well, not within SAGE and SPI-M-O, this was sort of from our academic group out to other academic groups.
Counsel Inquiry: So perhaps we are now talking about the paper and the work you did?
Professor Matthew Keeling: Yes.
Counsel Inquiry: You refer to that, I think – yes, so it’s in fact the paragraph 43, which is on the page. You say that in late 2020 you worked with a large group of academics to explore the wider costs and benefits of social distancing measures over two time periods, one which I think was in the past at the time you did your work and one which was just in the future.
Professor Matthew Keeling: Yes.
Counsel Inquiry: And you say in the paper you used a willingness to pay approach, considering the economic losses the country would be willing to sacrifice to preserve one year of healthy life, and then you go on to describe the paper; is that right?
Professor Matthew Keeling: Yes, that is correct.
Counsel Inquiry: Let’s actually have a look at the paper itself, if we may, so it’s INQ000205272. This is the paper that we see – as you say, there are a series of authors, you’re the third that we see on there, Professor.
If we can go to the second page, first of all, please, briefly, and let me say I’m not going to – I’m sure it’s fascinating, but not only given the time, I’m not going to get into the detail of the precise modelling that you did relating to those two time periods. I just want to look at the approach that you took.
So at the bottom of this page we see that the paper states at the last paragraph that:
“Much of the existing modelling literature on the pandemic has focused explicitly on the impacts of interventions that minimise the direct health impact of the Covid-19 pandemic, such as the number of individuals being admitted to hospital and/or dying …” and so on.
If we can go to the next page, please, at the top you refer to the fact that there are of course non-health benefits and harms that can arise as a result of the lockdown, and you list some sort of economic impacts, giving some examples in the hospitality sector and so on.
Then at the end of that paragraph you say:
“As a result, judicious use of lockdown measures may ultimately hasten economic recovery. It is therefore important to consider the effect of any control policy on the overall economic cost of an outbreak, taking into account both positive and negative health and economic effects.”
Then a few lines further down where we see there is a 15, so about six or seven lines down in that passage, just one sentence, you say:
“In this paper …”
And here I think you capture what you’re trying to achieve:
“In this paper, we analyse the effectiveness of different control scenarios … taking into account the positive impact on public health and the negative impact on the economy.”
So does that summarise what you were trying to achieve?
Professor Matthew Keeling: Yes.
Counsel Inquiry: We see further on down the page these terms that you referred to in your witness statement that you had used, you see:
“To establish the COVID-related health impacts, we calculate the quality adjusted life year (QALY) loss for each scenario.”
You also then refer to the societal willingness to pay conversion factor.
Can you explain, I hope in lay terms, what you mean by those terms?
Professor Matthew Keeling: I will try my best.
So QALY, or quality adjusted life year, is the idea of just counting how much health benefit you get from any particular intervention, so this could be giving someone a new type of drug, it could be vaccination, and what you look at is how many years of good healthy life have you saved, and what needs to be done in all of health economics is to balance that against the cost of the drugs, the cost of the vaccine, the cost of any intervention. We do that by having a willingness to pay. In the UK we usually set that at £20,000 to £30,000 per QALY, so per healthy life year, and that’s the sort of standard metric that we have.
So that seems to sort of balance out all these costs and benefits, and so we wanted to try and apply the same logic to NPIs, so what was the economic consequence of doing certain interventions compared to the benefits that we got in terms of health, and we do that by balancing at this willingness to pay, which is usually £20,000, but we went across an entire range because it wasn’t clear to us whether you’re willing to pay more because it’s a pandemic and you want to minimise the loss of life, or whether you’re willing to pay less because it’s a larger scale thing and we know that there’s going to be some loss of life associated with it. So we looked across an entire range.
Counsel Inquiry: It’s important to emphasise, isn’t it, Professor, that this was not – it sounds a rather cold hearted calculation to do, but it is something that is done routinely, as you say, both in the context of vaccines and also whether to purchase new drugs, for example?
Professor Matthew Keeling: Yeah, it’s the routine way. So JCVI, which I also sit on, has to go through this sort of process every time we put a new vaccine through the pipeline.
Counsel Inquiry: We heard from Professor Medley earlier a plea, almost, the point he was making that in order to – for modellers to assist policymakers, they need to understand, policymakers need to explain what their objectives are. And is what you’ve just explained as the sort of choice of the willingness to pay figure, would that be something that you, as a modeller, would look to the politician or the policymaker to tell you about in order to inform your modelling?
Professor Matthew Keeling: It’s certainly a possible way of doing it. I mean, there’s multiple ways of doing this balancing. One of the other things that’s worth pointing out is that we look at a level of NPIs, but there’s lots of ways of buying the same level of control. So, you know, deciding which elements of society you limit becomes the political decision, so it’s not – you know, it’s not for SPI-M-O to say whether or not you shut schools or pubs; that then becomes a politician’s type of decision.
Counsel Inquiry: Well, that leads me to another point I was going to raise with you, because we can see what you’ve been doing in this paper is taking a step beyond the sort of normal, if you like, epidemiological modelling and added a new dimension for economic impact. But of course, as we have heard in evidence in the last week or so, the pandemic had impacts that went well beyond economic impacts: we have schools closing, children not going to school, we have impact on various parts of society, we have impact on women and girls, domestic abuse; the list is very long.
In principle, would it be possible to extend this type of modelling to address those sorts of issues as well?
Professor Matthew Keeling: In principle. This was very much set up as almost a pilot or a, you know, proof of principle to show what could be done. I think it’s hard to put every single category in because you need to put a monetary value on them. It’s probably also worth saying that, you know, I’m not an economist, and so our view of what the costs were of lockdowns are probably quite trivial compared to, you know, what an economics person would see and say “Ah, well, you know, there’s long running implications for various businesses”. But we just did GDP as the easiest single measure that we could take at the time.
Counsel Inquiry: Perhaps in that regard if we can have a look back at your statement, please, page 14, paragraph 51. You’ve just indicated that perhaps the economic input into that paper was a little bit rudimentary, but you make the point here, picking it up three lines down:
“Developing the methodology to understand and quantify the broader impacts of pandemics, including mental health and societal wellbeing, requires a wide spectrum of academic disciplines.”
So even wider than that group who wrote that paper with you. You describe it at that stage new, groundbreaking interdisciplinary work that takes time and is best undertaken before a pandemic.
Is it – well, first of all, are you aware that these types of models, this type of work, taking forward that work that you did, is actually happening or not?
Professor Matthew Keeling: I don’t know of anyone who’s undertaking it at the moment. I know several people who are applying for funding. There’s various new funding initiatives that are around, so there’s people applying for it. Whether it gets funded or not is a matter that we’ll see in the future, but it’s certainly an area that a lot of people are thinking about.
Counsel Inquiry: Again you’ve echoed a point that Professor Medley raised but, it seems self-evident that if this work is to be done it would be much more sensible to do it before the next pandemic rather than trying to do it in a rush before the next pandemic?
Professor Matthew Keeling: Definitely. I mean, we’ve learnt a lot during the pandemic but it’s much more important to keep that going and to build on it.
Counsel Inquiry: Thank you.
I want to move on, please. Could we look, staying with your statement, please, at page 6, paragraph 23. Picking it up three lines down, this is about the “following the science”, you say:
“In my opinion, the use of the term ‘following the science’ led to the impression that the balance of evidence was weighted towards the scientific advice that was being provided. In turn, this led to negative attention being received by members of the scientific community.”
Elsewhere you say that the term was confusing and unhelpful. Can you expand on those various thoughts, please?
Professor Matthew Keeling: Yeah. I mean, I think what the paper showed on the balancing economics and health is that you can’t just look at a single measure, and we know that politicians aren’t going to do that. You can’t just say “We want to save lives, reduce hospitalisations, no matter what”, and we wouldn’t expect them to. There needs to be a balance between health, economics, wellbeing, social care. And so I think just saying “following the science” made it sound like the science was being weighted more than anything else.
It was also the case that the science, certainly in terms of SAGE minutes and documents that went to SAGE, was being put into the public domain, whereas I don’t – I never saw any of the other evidence that we assume was being considered. I mean, we never saw it so we don’t know. We never saw any of that.
So it very much felt as if, certainly in the early stages, any documents that went to SAGE were what was driving policy and therefore if individuals didn’t like policy it reflected on the modellers, it reflected on the scientific advice that was going forward.
So I think quite often “following the science” sounded like we almost had too much power, and I don’t think that was ever the case, and certainly not in the first year.
It was very much that we were answering questions that we thought might want to be asked, but – you know, I think Professor Medley said this – it wasn’t until early 2021, when we started doing the roadmap documents, that there was a really good dialogue between scientists and policymakers, and I think by then we started to understand what –
Counsel Inquiry: Slow down. Sorry, I’m going to pause you a moment.
Professor Matthew Keeling: Sorry.
Counsel Inquiry: You were saying it wasn’t until early 2021 …?
Professor Matthew Keeling: That there was sufficient dialogue and understanding between policymakers and the scientists that we could actually do things like the roadmap to relaxation, which really was – I think it was really the first time when there was this sort of marriage between science and policy that we knew what they wanted to do and we could generate policy-ready answers on a timescale that was important.
Counsel Inquiry: Yes.
I think you expand on that theme a little, if we can look at page 15 of your statement, paragraph 56. You say:
“During the early epidemic period there was some degree of misunderstanding between modellers and politicians; 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 policymakers.”
It sounds as though what you’re describing is just missing each other?
Professor Matthew Keeling: Yeah. I mean, we quite often got – I can remember we had a question that came through of: what would be the impact of opening garden centres? Now, this sort of – you know, our models are very much a caricature of what’s going on in the real world. There are people who try and what’s called – form what’s called a digital twin, which is, you know, you have individuals moving round within your computer model that try and replicate what’s happening in the real world. Those are incredibly difficult to match to any data, so we’re taking a much more sort of aggregate approach, averaging over people of a given age group, and so we can’t address those sort of subtleties.
But in the same way I think when we communicate to policymakers we often do one figure and a page of caveats, and the caveats are as important as the figure, but it’s very easy for someone to just look at a graph and read off the top curve.
So I think there was miscommunication in both directions.
Counsel Inquiry: Yes, and you describe what Professor Medley described as the deeper engagement, if you like, between SPI-M-O and people from the Cabinet Office, which led to that more productive relationship –
Professor Matthew Keeling: Definitely.
Counsel Inquiry: – later in the pandemic.
I think one last topic, Professor, and that’s data. Can we have a look at paragraph 46, page 13, please. You start paragraph 46 by making the important observation that:
“Models are only as good as the data that feeds into them …”
It’s right, I think, that at various stages during the pandemic you struggled to get good enough data to put into your models?
Professor Matthew Keeling: Yeah, I’d say that was true.
Counsel Inquiry: And you give us various examples in this witness statement. So in the balance of this paragraph, you describe a problem related to being – related to being provided with the detail about the first time people tested but not subsequent tests; is that right?
Professor Matthew Keeling: Yeah. So in – up until, I think it was almost towards the end of 2021, we were only getting information on the first time someone tested positive, and if they tested subsequently that wasn’t information that got fed through to SPI-M-O and, you know, in the first few months there was good reason for that, because if people tested twice within a week that’s really the same infection. But as we started to get later, we needed to know about reinfections. As it was, reinfections weren’t really that much important until we hit Omicron and when they became much more common, but we didn’t know that without the, data and I think there’s lots of cases of this where – you know, modellers always want more data, but there were certain questions that we were handicapped from answering because of the format that the data came in.
Counsel Inquiry: Yes.
Looking down, in paragraph 47 you describe a disconnect between case and death data and hospital admission data. That may be an issue which – I’m going to show you an email in a minute which I think probably touches on that.
But also in paragraph 48 you seem to be referring to a slightly different problem where, towards the end of that paragraph, you refer to differences in the ways data is reported and recorded by the four nations causing difficulties. What were those difficulties?
Professor Matthew Keeling: So each of the devolved nations has its own way of recording data. So certainly for the first few months we were getting different datasets through from Wales, Scotland, Northern Ireland and England. Some of this is just how the data’s formatted; some of it is actually the definitions that underpin it. So I believe at certain times Wales counted people in hospital with Covid in different ways to what England did, and this changed during the pandemic.
So what we needed to be careful of is: we’re trying to model the underlying mechanisms and not model the counting process. So if people start counting things in different ways, it can make our job more complicated. But, as it says there, later – DSTL and then UKHSA actually stepped in and did the routine data collection and cleaning, so we were starting to get it in a unified format, which made life so much easier.
Counsel Inquiry: Do you think that that improvement, that sort of lesson, as it were, has now been learnt or do you think that perhaps, were you to go back to needing to access, let’s say, hospital data or four nations data on a routine basis, these problems might crop up again?
Professor Matthew Keeling: I think the problems would crop up again simply because – I mean, for example we don’t have an integrated electronic healthcare system, so each hospital trust collects its own data, and so somewhere that has to be aggregated.
Now, if we have another pandemic, I expect for the first few weeks that will just come through as the raw data, and then as time moves on we will get, you know, whichever group it is, probably UKHSA, actually formatting that into a single unified data structure.
Counsel Inquiry: I’d like just – the last document, I think. We looked at that questionnaire which you filled in, it’s actually over a year ago now, but perhaps we could have another look at that, please. So that’s INQ000056476, and it’s page 39. Thank you.
So in fact a lot of the text that is included here you’ve adapted and used in your statement, so we can see next to the number 2 that statement about models only being as good as the data that feeds into them, and then the paragraph or so that follows, you’re describing those problems with hospital data that we were just discussing.
Then I want to pick it up about ten lines from that number 36, where it says:
“I had hoped that many of these difficulties would have been resolved for the [what I gather we call Mpox these days] Monkeypox outbreak, but if anything, the data access issues are worse.”
You say “are” because I take it that you were dealing with the Mpox outbreak in this time last year when you drafted this questionnaire; is that right?
Professor Matthew Keeling: That’s correct, yes.
Counsel Inquiry: You go on to say:
“Admittedly SAGE and SPI-M are not directly involved in [Mpox] modelling, but the academic community has still been asked for its help. With [Mpox] the UK data is only available to UKHSA affiliated staff with a UKHSA laptop and is again siloed so that the entirety of the datasets are not available to all users.”
Professor, we had a couple of days ago a data expert giving evidence to the Inquiry who expressed his own concerns that some of the advances in data sort of interoperability, if you like, that had been achieved during the pandemic might be slipping away – and we showed him this passage in fact – but it sound as though there is reason to be concerned that things might be just as bad in the next pandemic as they were in the last one?
Professor Matthew Keeling: I think there’s reasons to be concerned. Talking to people within UKHSA, it’s clear that they understand this is a problem and they are working towards solutions, but I don’t think any of these solutions are trivial. There’s a large amount of ethics, GDPR, lots and lots of regulations that surround being able to just freely give out data. There are partial solutions, as it says sort of towards the end. OpenSAFELY is a fantastic example of a repository where people can access health data in a very, very secure environment, but I don’t think that’s yet caught up to the computational demands that we have for modelling, which are vast. I mean, I was generally sort of maxing out our computer clusters at Warwick over a weekend to generate the next week’s projections. So that type of power isn’t available very often within these systems.
So I think there’s a conflict between how we make these things secure enough that data doesn’t go outside the system but still allow us to utilise the power of university computer systems.
Counsel Inquiry: Professor, we’ve talked a number of times, both with you and Professor Medley, today about, as it were, the roof needs to be fixed while the sun was shining – I think someone else used that analogy – but preparations for the next pandemic that need to be made in between pandemics; and it seems to me this is – what you’re saying is something in that category?
Professor Matthew Keeling: Yes, definitely. I mean, it’s not a small task, though. I think this is – you know, we need the protocols in place. It would need an awfully large amount of work to actually try and integrate this into a reasonable system, and I think we also have the problem of trying to second-guess what the next pandemic and the next data needs will look like. It’s very hard to say, yeah.
Counsel Inquiry: Presumably it’s work that needs to be continually refreshed because, as computers change, as datasets change, as perhaps the law changes, then the way in which it’s going to be stored and provided to modellers may change as well?
Professor Matthew Keeling: That’s correct, yeah.
Counsel Inquiry: But certainly something for this Inquiry to consider – you may have a view on this – as to whether it’s work that would be appropriate so that, when the next pandemic takes place, you in your modelling teams have data ready to go to assist policymakers from the start?
Professor Matthew Keeling: I mean, I think it’s vital, but I also think it is something that UKHSA is looking at at the moment. It’s not that everyone is sitting back and just saying, “We’ll do it the next time we have to”, I think it is being undertaken but it is going to be a slow process.
Mr O’Connor: Yes. Thank you, Professor.
My Lady, those are all the questions I have time for.
Lady Hallett: Thank you very much indeed, Professor Keeling.
You are obviously one of those people who worked extraordinarily long hours to serve the public, and I fear that you and your colleagues haven’t received the recognition that you deserve. So may I speak on behalf of all those who have been following the work that you and your colleagues did, and express my gratitude again. I’ve expressed it to other of your colleagues, but may I express it to you too.
The Witness: Thank you very much.
Lady Hallett: Thank you. I’m afraid doing public service doesn’t always get recognition.
(The witness withdrew)
Lady Hallett: 10 o’clock tomorrow, please.
(4.00 pm)
(The hearing adjourned until 10 am on Friday, 13 October 2023)