Covid-19: Questions of conscience and duty for scientific advisersBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2102 (Published 28 May 2020) Cite this as: BMJ 2020;369:m2102
England is abandoning lockdown and possibly hope of containing a second wave of covid-19. From 1 June schools will open to children other than those of key workers. Outdoor markets and car showrooms will reopen. In two weeks, it will be the turn of all non-essential retailers. This is meant to be a moment of optimism, a green recovery, centred on the health of people and the planet (doi:10.1136/bmj.m2077, doi:10.1136/bmj.m2076), backed by an effective system of testing and contact tracing and possibly informed by a public inquiry (doi:10.1136/bmj.m2052).
Instead, England arrives here in a state of utter confusion (doi:10.1136/bmj.m1785). The public’s confidence in the official lockdown advice is shaken. The covid-19 response is short on testing, uncertain on contact tracing, and reliant on unreliable apps (doi:10.1136/bmj.m2085). Scotland, Wales, and Northern Ireland are not following England’s lead. The UK has the second highest number of covid-19 deaths of any nation and, by some calculations, the most deaths per capita.
England’s decisions seem rooted in a desire to restart the economy rather than an overabundance of science (doi:10.1136/bmj.m1847, doi:10.1136/bmj.m2045), an important aim except that it may backfire unless properly timed and with the right systems in place. Easing lockdown requires professional as well as public backing, and the decision on schools is opposed by teaching unions concerned about the lack of a proper system of test, trace and isolate.
These concerns are shared by the Independent Scientific Advisory Group for Emergenices (iSAGE), whose open meeting on 22 May and paper on school reopening recommend waiting until mid-June to reduce risks (doi:10.1136/bmj.m2079). The government published its own scientific advice soon after, although curiously its chosen method of reopening is not one of the nine scenarios modelled (https://www.theguardian.com/education/2020/may/22/ministers-rejected-school-reopening-plan-recommended-by-sage-experts).
Transparency and political interference in scientific advice was controversial even before a trip to Durham by Prime Minister Boris Johnson’s senior aide. It seems incredible that Dominic Cummings, who attended the government’s scientific advisory committee and plays a key role in the pandemic response, thought it reasonable to carry covid-19 from London to a region of lower infectivity and into a local hospital.
Johnson’s darkest hour, his decision to essentially prioritise Cummings over the pandemic response, had at least three immediate effects. First and foremost, it seriously damaged public trust and goodwill in complying with lockdown measures, risking a deadlier next wave of infection. Second, it belittled staff and patients who have risen to complex logistic, clinical and personal challenges while delivering care (doi:10.1136/bmj.m2043, doi:10.1136/bmj.m2055, doi:10.1136/bmj.m2062, doi:10.1136/bmj.m1987). Third, it forced the government’s scientific advisers into open dissent (doi:10.1136/bmj.m2109).
Scientists and doctors in advisory positions face a dual obligation to the state and to the public. But what happens when the government’s integrity no longer matches your personal or professional integrity, when your public accountability seems greater than that of the politicians you advise? Do you fight from within? Do you speak out, and even resign? What of the leaders of medical organisations working closely with the government? Regrettably, questions of conscience and duty must now be addressed.