Bamboozled!

The UK Covid-19 Inquiry shows that political leaders need policy advice not science lessons

Exponential curves! Ha, ha!!

Earlier this week, Patrick Vallance — the United Kingdom’s Chief Scientific Advisor from 2018 to 2023 — gave testimony to the UK COVID-19 Inquiry. Vallance’s testimony drew headlines because in his 2020 diary entries, he wrote that Prime Minister Boris Johnson had been “bamboozled” by the science presented to him by his advisors.

Vallance wrote on 4 May 2020:

“Late afternoon meeting with PM on schools. My God this is complicated and models will not provide the answer. PM is clearly bamboozled."

Vallance lamented:

"Watching PM get his head round stats is awful. He finds relative and absolute risk almost impossible to understand."

and,

"PM struggled with whole concept of doubling [times] ... just couldn't get it."

When asked about these entries earlier this week, Vallance explained that the fault was in the prime Minister’s knowledge and education:

Well, I think I'm right in saying that the Prime Minister at the time gave up science when he was 15, and I think he'd be the first to admit it wasn't his forte, and that he did struggle with some of the concepts, and we did need to repeat them often.

Boris Johnson was not a scientist and had minimal training in science. In other words, he was a lot like most all leaders in democracies.

In further explaining, Vallance provided a telling anecdote:

[A] meeting that sticks in my mind was with fellow science advisers from across Europe when one of them, and I won't say which country, declared that the leader of that country had enormous problems with exponential curves and the entire phone call burst into laughter, because it was true in every country. So I do not think that there was necessarily a unique inability to grasp some of these concepts with the Prime Minister at the time . . .

The anecdote hints at a mismatch between the information provided by science advisors and that information needed by policy makers to inform decision making. the anecdote also reveals a degree of contempt for political leaders — They don’t understand exponential curves! Ha, ha!

Below is an example, from 4 March 2020, of “advice” provided to Boris Johnson by his advisors.

If anyone should be laughing, it should be all of us at the idea that the stylized curves on this graph had any real-world meaning whatsoever and could be useful in making specific decisions about an unfolding global pandemic.

We now know, with the advantage of hindsight that basic data on the extent of COVID-19, its transmission and the efficacy of various interventions was lacking in March, 2020. And that is just in respect to public health outcomes, setting aside the effects of interventions on the economy, school children and so on.

The stylized curves in the image above are science-like, but they are actually policy advice. The figure advocates a policy approach, described in the text on the right and reflected in the red curve. Science advisors were not providing policy options but instead, recommending a simplistic preferred approach — don’t pick one of these two extremes, so do this red thing in the middle.

However, the UK’s approach to science advice under SAGE — Science Advisory Group for Emergencies — was not remotely capable of providing expert advice on policy options. It would have been like empaneling a group of economists to offer advice on COVID-19 transmission rates.

A 2021 House of Commons report on science advice in the pandemic noted that SAGE was in fact designed to provide integrated expert advice across “the full range of issues”:

SAGE guidance indicated that “to ensure the full range of issues are considered advice needs to stem from a range of disciplines, including the scientific, technical, economic and legal”. The provision of expert economics advice to Government throughout the pandemic is one issue that we have sought to understand, particularly given the wide ranging impact the coronavirus has had on the public as a whole and at the individual level.

UK Chief Medical Officer Chris Whitty told the House of Commons in 2020 that SAGE did not follow its mandate and thus was not prepared to offer advice on economics:

Professor Chris Whitty told us that SAGE was not giving economics advice to Government and did not have a “specific economic group”. He also suggested that SAGE was “not constituted” to give economics advice and would require a “different membership” in order to do so.

With a main issue in the early response to Covid-19 involving trade-offs between public health and the economy associated with lockdowns, it is remarkable that the highest-level expert advisory body in the United Kingdom (like many places) had no capability to assess policy options in terms of these trade-offs.

Chief Scientific Advisor Patrick Vallance told the House of Commons that “science” and economics should remain separate, contrary to the SAGE mandate:

It is very clear that SAGE exists to provide the science advice. The Treasury and the Cabinet Office bring in the other parts of the equation, particularly on the economy. I do not think it is right to think that SAGE would be the place that you integrate all of this . . .

The notion that “science advice” focuses narrowly on “science” and that it is someone else’s job to integrate various forms of advice is a clear recipe for bamboozlement — not just of the prime minster, as no one would have integrated expert guidance on policy options and their possible outcomes.

In its 2021 report, the House of Commons to its credit, picked up on this institutional flaw:

The Government must, in response to this Report, set out how advice to central Government on the indirect effects (for instance impacts on mental health and social wellbeing, education and the economy) of covid-19, and the Government’s policy response to it . . .

The UK government’s response to this request was simply to dodge the issue by noting that several cabinet committees make decisions, and that “advice to these Cabinet Committees may need to be kept confidential to ensure advisors can express their views frankly.”

Ultimately, the UK experience shows us clearly that the notion of “science advice” can be a misnomer. What decision makers need is policy advice informed by expertise. As constituted, the UK SAGE was simply incapable of providing expert-informed policy advice because it was not constituted to do so — The result was a group with narrow technical expertise that was providing freelance policy guidance well outside their capabilities.

Boris Johnson was no doubt bamboozled, but that was not because he did not have training in epidemiological modeling, but because the UK government had created a policy advisory mechanism that was not fit for purpose.

The UK, of course, was not alone. Many countries similarly emphasized public health expertise over every other form of relevant expertise in its pandemic advisory mechanisms. There are broader lessons here for institutionalizing expert advice in support of decision making. At the top is the fact that politicians need advice on policy options and their possible consequences, and not basic training in science.

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