‘Following the science’ is not enough in a pandemic

Making policy is the task of Government, not to shelter behind ‘objective science’

Where was the analysis to ensure that cancellation of medical screening and other restrictions wouldn’t kill more people than they saved lives afflicted with Covid-19? Photograph: Nick Bradshaw

As we approach the end of the second year of the coronavirus pandemic, it is time to ponder how we dealt with this emergency and lessons we might learn. The phrase “we are following the science” is frequently heard from politicians and others. While science was invaluable in combating Covid-19, science alone is too narrow a platform to underpin overall Government policy for dealing with the pandemic.

When a problem like Covid-19 comes along, requiring specialist scientific advice to Government to help formulate national policy, it is tempting for politicians to enthusiastically declare they are “following the science”. This lends an air of calm objectivity to Government policies as well as offering the opportunity to shelter behind science. If Government policy fails, the politicians can always plead “the science was wrong”.

Politicians’ claims that they are “following the science” are only partially true because their appeals to science are restricted to traditional health fields, including immunology, virology, epidemiology, clinical medicine and public health. There is little evidence that advice was sought from other relevant fields such as behavioural, sociological and economic sciences. This is reflected in the range of expertise on the National Public Health Emergency Team (Nphet) appointed in January 2020 to advise Government on how to negotiate a pathway through the pandemic.

Communication between scientific advisers and Government should be efficient but quiet

The Covid-19 pandemic is primarily a physical health issue and detailed advice to Government from health science advisers is essential, but certainly no justification for excluding other fields of expertise. For example, the strong Nphet advice that over-70s should "cocoon" at home during the first national lockdown was a mistake that surely would have been avoided had advice from psychologists and sociologists been followed about how people react to isolation in lockdown. I have discussed aspects of collateral damage and Covid-19 previously in this column.

READ MORE

To conserve scarce hospital resources to deal with the pandemic, the Government suspended or seriously curtailed health-screening and other programmes. Where was the analysis to ensure that cancellation of medical screening and other restrictions wouldn’t kill more people than they saved lives afflicted with Covid-19?

The Government also borrowed enormous monies to pay wages to workers whose employment was suspended due to regulations designed to control the pandemic, for example in the hospitality and entertainment areas. Where was the economic advice on how much borrowing the country could afford so that our economy will not be crippled when repayment time comes around?

When Government must take scientific advice to help to devise national policy the collaboration should be carefully fine-tuned for efficacy and maintenance of public trust both in Government and in science. Communication between scientific advisers and Government should be efficient but quiet.

Unclear policy

Clear public statements of policy should emanate from Government alone. But how many times have we seen the Government and Nphet seemingly arguing in public about developing policy? And most Government press conferences held during this pandemic featured several scientists flanking the Government Minister.

Science should inform, not make policy. Making policy is the task of Government

Also, science doesn't have all the answers. For example, early in this pandemic the World Health Organisation, and Nphet, advised that wearing face masks offered little or no protection. They reversed their position after a number of weeks. Nphet has dithered also about the usefulness of Covid-19 antigen testing. And much of the scientific advice offered to Government during the pandemic is based on modelling projections, but these are not scientific findings in the conventional sense – they are projections about what might happen under various scenarios. And as we know from weather forecasting, modelling is useful but far from infallible.

Scientists can also disagree among themselves. For example, the Independent Scientific Advisory Group, a group of professional scientists that comments publicly on how the pandemic should be handled, frequently disagrees with Nphet.

We are deeply indebted to science for the wonderful contributions it has made in battling this pandemic, particularly the speedy development of effective vaccines. But, at the end of the day, devising policies to handle a pandemic is a complex question often involving difficult ethical trade-offs, including assessment of collateral damage to the economy and to public physical and mental health. Science should inform, not make policy. Making policy is the task of Government.

William Reville is an emeritus professor of biochemistry at University College Cork