Getty Images / Behavioural Insights Team / WIRED
Last week, Boris Johnson delivered a speech that will define his premiership, admitting to the British public that the Codvid-19 pandemic would cause more families to lose “loved ones before their time”.
For many of those watching, it will have been the first time they had seen the two men flanking Johnson, who laid out the UK’s response to the crisis. But during public health emergencies, power in Whitehall shifts, and it will continue to do so over the coming months as the Department of Health moves all but essential staff to battle the coronavirus. This is how things have changed so far.
The CMO and CSA
At the top of this new chain of command is Chris Whitty, the government’s chief medical officer, appearing to Johnson’s left at the conference. Taking over from Sally Davies in June of 2019, Whitty is, coincidentally, an epidemiologist – a specialist in infective diseases. (He played a key role advising the UK on the response to the Ebola epidemic in 2014.)
The CMO acts as principal medical adviser to the secretary of state for health – currently, Matt Hancock – and, in a public health crisis like this one, the prime minister. He also represents the government to the World Health Organisation.
Whitty works for the Department of Social Health and Care, responsible for government policy on health and adult social care matters in England. The DSHC contains within it Public Health England, which provides the UK with further scientific expertise and support. The CMO often takes the public through a government’s response to health crises, hence Whitty’s current prominence. Get used to seeing his face a lot.
The man who stood to Johnson’s right at the conference is Sir Patrick Vallance, the government’s chief scientific adviser (CSA), a former president of research and development at pharmaceutical multinational GlaxoSmithKline. He acts as an intermediary between the scientific community and policymakers, ensuring that the UK enacts policy positions grounded in science. For this reason, during public health crises, his role grows more prominent – David King, CSA from 2000-2007, met Tony Blair daily over the six weeks of the foot-and-mouth crisis of 2001.
Sage and Cobra
During a public health emergency, these men become two of the most powerful and prominent figures in the country. They co-chair the Scientific Advisory Group for Emergencies (Sage), an independent group that delivers scientific advice on the management of crises for the UK cabinet. For instance, on March 14, Sage met to review the latest numbers of cases in the UK, updated modelling, interventions made by other countries, and proposals for monitoring and modelling the outbreak as it advances. They assess whether the government is succeeding in its aims to save lives and reduce the peak of the epidemic.
The strategies cooked up in these meetings are presented at the Cabinet Office Briefing Room (colloquially known as Cobra), a crisis group convened to handle national emergencies. The membership of both Cobra and Sage depends on the nature of the emergency, and the list of attendees is not published.
The conclusions drawn in these meetings plans will set the direction of the country for the crisis’ duration.
The Nudge Unit
Those who have followed the government’s crisis response closely, particularly the ways in which our response seemingly differs from other countries, may have heard two terms being debated and scrutinised – “The Nudge Unit” and “herd immunity”. The terms are somewhat related. The Nudge Unit, or Behavioural Insights Team, is an independent support group, partly owned by the Cabinet Office, established in 2010 by David Cameron. It advises the government on the application of behavioural science to public policy. The group gets its name from economist Richard Thaler’s theory of “nudges”, a strategy that attempts to influence the public’s behaviour through positive reinforcement.
The sway this group holds over government policy is unknown. Working with the DSHC, they are responsible for the idea that the public should sing Happy Birthday while washing their hands, but may also be influencing the government’s response more deeply. It is suggested that the government may have been slower and less severe than other countries in its imposition of isolation on the public because the Nudge Unit contends that people will develop “isolation fatigue”.
On March 11, David Halpern – the group’s chief executive and a member of the the Scientific Advisory Group for Emergencies – spoke to BBC News outlining an approach that depended on shielding vulnerable people until enough of the UK population had been infected with Covid-19, acquiring an immunity that would halt its spread. Senior Number 10 advisor Dominic Cummings also brought up the topic in a meeting with UK tech leaders on March 11.
That’s how the term “herd immunity” started making the rounds, which led to an extremely negative reaction among many experts, as it seemingly suggested the government was simply letting the population get infected.
Matt Hancock would tell the BBC on Sunday: “Herd immunity is not our policy. It’s not our goal. Our goal is to protect life and our policy is to fight the virus and protect the vulnerable and protect the NHS.” In the coming months, we will see whether the government, and the new figures at its head, can provide this protection.
Will Bedingfield is a staff writer for WIRED. He tweets from @WillBedingfield
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