Sage coronavirus expert: We’ve had an epidemic that to some degree could have been avoided

It feels as if the whole of Jeremy Farrar's life has been a preparation for this crisis. A leading epidemiologist, he has been thinking about diseases, viruses and pandemics for most of his career. He is director of the Wellcome Trust, which funds a huge amount of scientific research. And now he sits on the government's Sage group of scientists offering advice (not always taken) on how to navigate the unprecedented crisis we currently face.

I sat down with Farrar—at either end of a Zoom connection—on Friday night to discuss all this, in the company of Lady Margaret Hall students, tutors and alumni. He talked frankly about how science and politics interact. About the billions needed to find medical solutions. About how the government missed the early opportunities to get ahead of the pandemic. And about whether or not schools should be re-opening.

 

Alan Rusbridger (AR): What is the relationship between science and policy? What do you think science is able to do in a crisis like this, and what are the limitations?

Jeremy Farrar (JF): When you're dealing with events like now, one of the greatest challenges is you're just dealing with total uncertainty. The uncertainty is obviously greater at the start and you hope—you hope—gets less as you go forward. On a personal level, I've actually always really enjoyed working in uncertainty because I think it's a really interesting place to be, but it does not suit everybody.

Then when you come to put science and uncertainty with policy, you actually have to make decisions. That is a very, almost unholy alliance in some ways, because you can't just base policy on hard science, particularly when that science is uncertain. Yet you can't wait until the science is certain just to make policy. In that grey zone between the unholy alliance, you've got some really tough things to do.

Seeing how advice is either taken or not and then trying to inform policy, that's a complex and difficult relationship. Which if I'm honest about, makes you feel at times very, very uncomfortable.

AR: What about the communication of the science? You're having conversations with advisers and politicians, but then there's a huge piece of this, which is trying to talk about very complex science in easily understood terms. Lots of people feel really quite confused.

JF: Yes, it seems to me that the crucial element is transparency. Everybody accepts, especially in a period like we're going through today, that you're going to make mistakes. You're trying to make the smallest number of mistakes and avoid the really bad outcomes. But you'll get a lot of those things wrong and the ability to respond and adapt is really important.

And people may not like what you're saying, but at least if they can see how you're making those decisions and you're honest enough to say “we got it wrong,” then transparency is the way forward.

Unfortunately, over the last few weeks and months, that hasn't always been sufficient. There isn't now sufficient transparency about why certain difficult decisions are made and with people really understanding how those decisions were reached. I think a lot of it is driven by fear, without an appreciation that transparency is actually a root to better decision making. But by being transparent, you'll be more trusted, even when you get it wrong.

AR: Can you give us just give us a flavour of what it's like to be a scientist in the room with policymakers and politicians?

JF: What is I think really important, and again the opacity of this doesn't help, but Sage has two formal meetings a week and then ad hoc meetings on the side of that, currently of course by Zoom or whatever. In that room are then, I don't know, 40 or 50 people who are fed information from about another 200 people who sit on subgroups of it, who are doing the detailed work. And of that 40 or 50 people, there are probably about 10 of us that are outside government and independent, and then a large group of civil servants from the department of health, education, whatever else.

And then, of course it's been in the press, people from No 10 and other ministries are sitting in to observe. And in my experience, and I'm not making any comment here about my own political views, but I would say I actually wish that those policy advisers from government had attended more meetings. Because one of the challenges of Sage is that it is a scientific group that advises and of course, rightly or wrongly, it doesn't make the decisions on policy. And there's a gap there. And the better that gap can be filled, so that advice goes directly into policy, in my view that would be better.

If you get behind the curve at any point, it's incredibly difficult to catch up at any later date. And I think that is the lesson that will be learned in future inquiries: the crucial phase in this epidemic was the last week or so of January and the weeks of February. The decisions that were made were absolutely critical to what happened. And actually, the fact that those decisions were not right, frankly, are why we've subsequently gone on to have an epidemic that at least to some degree could have been avoided.

If I pointed at one difference, let's say, between Korea, Germany, and the UK, it would be that those critical five or six weeks are when Germany reacted more boldly and more courageously, and Britain was slow.

AR: It feels as though there was an argument at some point in late January, early February, in which the phrase “herd immunity” was on the table. Is that right?

JF: Herd immunity is not a scientific strategy that has merit. Patrick Vallance is the chair of Sage—I know he's been quoted in the newsreel about how he talked about herd immunity. I am not aware… and I certainly never would have argued for a concept of herd immunity, which would mean naturally letting what is a very nasty virus pass through a population and accepting that there would be a very high amount of illness and people dying, in order to protect the rest of the population. To me, that's an unacceptable way to think about public health. I'm not aware that that concept was ever discussed at Sage in my presence.

AR: Is this virus something that you think as a species we're just going to have to live with for years?

JF: Yeah, what we've witnessed over the last three or four months is the emergence of a true, brand new novel human infection, which is now endemic in the human population, and it's not going to disappear. This will now be part of the infectious cycle that humanity has to live with.

And [potentially] we're… going to have to completely change the way we live, with some degree of physical distancing forever. But that’s a plaster over a problem, because as soon as you lift those restrictions, things will bounce back. And I can't think of any biological or social reason why we won't face rebounds and second waves of this infection. So the only exit from this is the production of interventions that totally reduce the risk of that. And ultimately, that means diagnostics and treatment and vaccines.

I think that a vaccine has a very good chance of working, but there's a glass shortage in the world at the moment, there isn't enough glass to put a vaccine into glass vials. There's a syringe shortage, so if we had to inject the vaccine, we wouldn't have enough syringes in the world. And then finally, you've got a horrible geopolitical structure at the moment, which means you're in grave danger of going into something akin to vaccine nationalism, where each country will have to look after itself in national stupidity, really, without thinking of the need to take a global perspective.

AR: Do you have a view about whether schools should be reopened?

JF: Well, firstly, if you keep schools closed, the disproportionate impact on society is massive. School closures is a massive societal issue, and nobody should underestimate that.

In my view, the infection rates in the UK are too high, at least today, to reopen schools. Will that be different in two weeks’ time when half term ends and schools are potentially open? It might be. But if the question was “should we open schools today?” My answer would be “no.” Although children have not suffered a severe disease so much, apart from a relatively small number of people, we're not confident enough to know whether children are playing an important role in transmission. Infection numbers would have to reduce significantly from where they are today to make it safe to open schools.

This interview has been edited for length and clarity