Normal Island: COVID-19, Border Control, and Viral Nationalism in UK Public Health Discourse.

In this contribution, I present emergent analysis of a preoccupation with managing COVID-19 through border control, among non-Governmental public health actors and commentators. Through a reading of statements, tweets, and interviews from the 'Independent Sage' group - individually and collectively - I show how the language of border control, and of maintaining immunity within the national boundaries of the UK, has been a notable theme in the group's analysis. To theorize this emphasis, I draw comparison with the phenomenon of 'green nationalism', in which the urgency of climate action has been turned to overtly nationalistic ends; I sketch the outlines of what I call 'viral nationalism,' a political ecology that understands the pandemic as an event occurring differentially between nation states, and thus sees pandemic management as, inter alia, a work of involuntary detention at securitized borders. I conclude with some general remarks on the relationship between public health, immunity, and national feeling in the UK.

Regulatory, health technology assessment and company interactions: the current landscape and future ecosystem for drug development, review and reimbursement.

BACKGROUND: Multi-stakeholder interactions have evolved at product and policy levels. There is a need to assess the current and future landscape of interactions between companies, and regulatory and HTA agencies to address challenges and identify areas for improvement. OBJECTIVES: The aims of this study were to review the current interactions within and across regulatory and HTA agencies, and companies' experiences in engaging in these activities; to assess the added value of interactions as well as limitations; to explore the future ecosystem for stakeholder interactions. METHOD: Three separate questionnaires were developed for companies, regulators and HTA agencies, respectively, to assess their experiences and perceptions. The responses were analyzed using descriptive statistics and discussed at a multi-stakeholder workshop. Key outcomes from the surveys and workshop discussion were reported. RESULTS: All seven regulators and seven HTA agencies in the survey indicated that they had stakeholder interactions. More formal collaboration occurred with regulators compared with HTA agencies. All nine companies have taken early advice but indicated the need for future prioritization. Success indicators can be built at the product and therapy levels, with the added value of faster patient access. Four principles were proposed for the future ecosystem: separate remit and functions between regulators and HTA; align processes; converge evidence requirements where possible; increase transparency. CONCLUSIONS: This research brought together regulators, HTA agencies, companies to examine how they interact with one another. We propose measures of value and make recommendations on future evolution to enable better evidence generation and improve regulatory and HTA decision-making.

How did UK policymaking in the COVID-19 response use science? Evidence from scientific advisers

Background:Responses to COVID-19 have invested heavily in science. How this science was used is therefore important. Our work extends existing knowledge on the use of science in the pandemic by capturing scientific advisers’ experiences in real time.Aims and objectives:Our aim was to present generalisable messages on key qualifications or difficulties involved in speaking of ‘following the science’.Methods:Ninety-three interviews with UK scientific advisors and government officials captured their activities and perceptions during the pandemic in real time. We also examined Parliamentary Select Committee transcripts and government documents. This material was analysed for thematic content.Findings and discussion:(1) Many scientists sought guidance from policymakers about their goals, yet the COVID-19 response demonstrated the absence of a clear steer, and a tendency to change course quickly;(2) many scientists did not want to offer policy advice, but rather to provide evidence;and (3) a range of knowledge informed the UK’s pandemic response: we examine which kinds were privileged, and demonstrate the absence of clarity on how government synthesised the different forms of evidence being used.Conclusions:Understanding the reasons for a lack of clarity about policy goals would help us better understand the use of science in policy. Realisation that policy goals sometimes alter rapidly would help us better understand the logistics of scientific advice. Many scientists want their evidence to inform policy rather than determine the options selected. Since the process by which evidence leads to decisions is obscure, policy cannot be said to be evidence-based.

Science, policy and resilience: reflections on the role of scientific advice to government during pandemic crisis response

Purpose>The SARS epidemic in 2003 and the COVID-19 pandemic had a disruptive impact on countries around the world and highlight the importance of using scientific evidence to inform policy decisions and priorities during crises. The purpose of this article is to reflect upon the term “following the science” and examines the differences between SARS in 2003 and COVID-19.Design/methodology/approach>This study is exploratory, adopts a qualitative approach and reflects on the synthesis of scientific evidence into advice informing government decisions on health interventions. Random sampling of the literature was used to avoid bias and was guided by the keywords.Findings>It considers preparedness activities and the need for these to be integral in the design of future planning. It argues that simulation exercises be intrinsically linked to all aspects of crisis management and provide the opportunity to use the scientific evidence base as part of preparedness planning. The article concludes that more transparency in the use of scientific advice in strategic decision-making would support building more resilience into health emergency preparedness through an integrated systems approach.Originality/value>This article contributes to the literature on the evaluation of the “following the science” approach and its implementation. It also contributes to the limited literature on simulation exercising to deal with health crises, like pandemics and identifies potential areas for further research or work on developing an integrated systems approach to pandemic preparedness.

Public health and expert failure.

In a modern democracy, a public health system includes mechanisms for the provision of expert scientific advice to elected officials. The decisions of elected officials generally will be degraded by expert failure, that is, the provision of bad advice. The theory of expert failure suggests that competition among experts generally is the best safeguard against expert failure. Monopoly power of experts increases the chance of expert failure. The risk of expert failure also is greater when scientific advice is provided by only one or a few disciplines. A national government can simulate a competitive market for expert advice by structuring the scientific advice it receives to ensure the production of multiple perspectives from multiple disciplines. I apply these general principles to the United Kingdom's Scientific Advisory Group for Emergencies (SAGE).

Science and policy in extremis: the UK's initial response to COVID-19.

Drawing on the SAGE minutes and other documents, I consider the wider lessons for norms of scientific advising that can be learned from the UK's initial response to coronavirus in the period January-March 2020, when an initial strategy that planned to avoid total suppression of transmission was abruptly replaced by an aggressive suppression strategy. I introduce a distinction between "normatively light advice", in which no specific policy option is recommended, and "normatively heavy advice" that does make an explicit recommendation. I argue that, although scientific advisers should avoid normatively heavy advice in normal times in order to facilitate democratic accountability, this norm can be permissibly overridden in situations of grave emergency. SAGE's major mistake in early 2020 was not that of endorsing a particular strategy, nor that of being insufficiently precautionary, but that of relying too heavily on a specific set of "reasonable worst-case" planning assumptions. I formulate some proposals that assign a more circumscribed role to "worst-case" thinking in emergency planning. In an epilogue, I consider what the implications of my proposals would have been for the UK's response to the "second wave" of late 2020.

Public perceptions of scientific advice: toward a science savvy public culture?

OBJECTIVES: Both the political appetite for a science-based coronavirus disease 2019 (COVID-19) policy and its acceptability to the public are little understood, at a time of sharp distrust not only of governments but also of scientists and their journals' review practices. We studied the case of France, where the independent Scientific Council on COVID-19 was appointed by President Macron on March 12, 2020. STUDY DESIGN: We conducted a survey on a representative sample of the French adult population. METHODS: Our data were collected by the French Institute of Public Opinion using a self-administered online questionnaire. This was completed by a sample of 1016 people stratified to match French official census statistics for gender, age, occupation, and so on. We conducted statistical analysis using Python (Pandas-SciPy-Statsmodels) with Chi-squared and Wilcoxon rank-sum tests to control for statistical significance. RESULTS: Intense media coverage has given the council a very high public profile, with three respondents out of four (73%) having heard about it. Perceptions are positive but complex. French citizens expect science to be important in political decision-making. Four of five (81.5%) want political decisions, in general, to be based on scientific knowledge. But one in two (55%) says that the government has not relied enough on science and only 36% are satisfied with the government's crisis management to date. Although most feel that the council has a legitimate advisory role even in situations of uncertainty (only 15% disagree), it is not perceived as fully independent. Only 44% think that it directly represents the scientific community, and only one of three people considers it completely independent from the government (39%) and the pharmaceutical industry (36%). CONCLUSIONS: Our study confirms that while the transparency of scientific advice is important, it alone cannot ensure public confidence in political decision-making. We suggest that efforts made today to instill a 'science-savvy' public culture-one that allows the complex articulation between scientific knowledge, uncertainty, and political decision-making to be understood and accounted for would greatly benefit evidence-based policy in future crises.

Understanding the policy dynamics of COVID-19 in the UK: Early findings from interviews with policy makers and health care professionals.

The UK government response to COVID-19 has been heavily criticised. We report witnesses' perceptions of what has shaped UK policies and how these policies have been received by healthcare workers. Such studies are usually affected by hindsight. Here we deploy a novel prospective approach to capture real-time information. We are historians, social scientists and biomedical researchers who study how societies cope with infectious disease. In February 2020 we began regular semi-structured calls with prominent members of policy communities, and health care professionals, to elicit their roles in, and reactions to, the pandemic response. We report witnesses' perceptions that personal protective equipment (PPE) stocks were too small, early warnings have not led to sufficiently rapid policy decisions, and a lack of transparency is sapping public trust. Significant successes include research mobilisation. The early experiences and reactions of our witnesses suggest important issues for investigation, notably a perception of delay in decision making.