If we are no longer “following the science,” what are we following?

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British ministers have now abandoned any pretence that they are “following the science” on covid-19. In their minutes from 10 February 2022, the Scientific Advisory Group for Emergencies (SAGE) warned against removing access to free testing as it would make it harder for people to take precautionary measures and increase anxiety among those who are clinically vulnerable.1 A consensus statement from SAGE’s modelling group, SPI-M, from 2 February, considered that, “a sudden change, such as an end to testing and isolation, has the scope to lead to a return to rapid epidemic growth.”2 And even before these changes are implemented, cases of covid-19 have been rising steeply, with the most recent data from the Office for National Statistics—which along with the now discontinued REACT study is considered the best source of data on the course of the pandemic—estimating that one in every 16 people in England had covid-19 in mid March.3

This poses a challenge for those of us who have been researching the pandemic and who are often asked to comment on government policies. It is impossible to reconcile what is happening with the information we have on health. As Rachel Clarke described recently, frontline NHS staff, some of the heroes of the pandemic, are struggling.4 Some are leaving the health service prematurely, others are burned out, and many have been severely traumatised by their experiences. Data from death certificates, which capture people dying from rather than with covid-19, are running at over 1,000 per week, far higher than at the end of the first and second waves.5 Hospitals in some parts of the country are barely coping.6 The situation is no better in the education sector. Schools have been facing unsustainably high levels of staff absences and over 200 000 children were off sick each day in mid March.7 And those looking for a holiday abroad over Easter are faced with flight cancellations because so many transport workers have covid-19.8 Faced with this seemingly irreconcilable paradox of abandoning covid-19 precautions while so many sectors are struggling, the temptation is to resort to the usual excuse when politicians do things that seem inexplicable. Worried that we should not be straying into politics, we say that politicians have to balance the scientific advice with other considerations brought to their attention. And there we leave it.

This is not an acceptable answer. Independent SAGE was created in response to the lack of transparency about the scientific advice that was being used to inform government policies.9 Almost immediately afterwards, the previously secret membership of SAGE was announced (albeit with a few names withheld). SAGE’s minutes also began to be published. It became possible for anyone to see whether ministers were following the scientific advice they were receiving. But can we see the other advice they are now acting on?

We can of course speculate as to the other factors, but we may struggle to make sense of them. It could be the cost of existing precautions. No one can deny that the pandemic has been expensive, but if this was the main consideration, then surely the government would sort out its procurement systems, which have wasted vast sums of money on personal protective equipment (PPE) that is unusable or do more to recover the vast sums fraudulently obtained in business loans.1011 Or is it the impact on the broader economy? The United Kingdom experienced a massive economic decline during the pandemic, far greater than other industrialised countries. But those other countries are now recovering rapidly while Brexit Britain lags behind.12 Here too, there is an obvious answer, even if it is one that neither the government or the Labour Party is willing to discuss. Or is it some broader measure of wellbeing in the population, however defined? If that was the case, then we might have expected the chancellor, Rishi Sunak, to have used his Spring Statement to offer some hope to those facing the largest hit to their cost of living in a generation.

Faced with these apparent contradictions, we must look to other possible explanations. To take one example, the Conservative Party is increasingly fragmented, with parties within the party. We have the COVID Recovery Group, which emerged from the European Research Group, and the Net Zero Scrutiny Group. We have a prime minister who, so very recently, seemed in peril from his MPs over the Partygate scandal, and who may be again when the long delayed Sue Gray report finally emerges.13 In these circumstances he must be acutely aware of the pressures from his own MPs.

It is entirely reasonable that a prime minister would take account of whether he has support from his back benches. However, if this is indeed the reason for the government’s current policy on covid-19, then we should be told, so that we can discuss its merits or otherwise. The alternative of saying things that are so at odds with the reality we are experiencing simply undermines the trust that is so essential when managing any threat to public health.

A public health perspective recognises that there are many determinants of health, in the scientific and social realms, but also the commercial and political. We are perfectly capable of assessing the wider social, political, and economic arguments for one policy or another. And if we are doing our job properly, we will study all issues that influence our health, from the changing biology of the virus to the political considerations that shape the responses to it. What is not acceptable is that we simply allow politicians to decide which causes of health and disease are “political” and let them decide what is off limits to us.