Susan Michie, 65, is a professor of health psychology at University College London and leader of the Human Behaviour Change project funded by the Wellcome Trust. She has been part of the Covid-19 behavioural science team, a sub-group of the government’s Scientific Advisory Group for Emergencies (Sage). She also sits on the independent Sage committee chaired by Sir David King.
How important was behavioural thinking in the advice given to government by Sage initially. How interested were they in that aspect of the response?
The behavioural science advisory group is more than 30 people from many different disciplinary backgrounds, and types of expertise, many of them world leaders in their areas. We’ve probably published 60 or 70 papers over the past six months. I have to say I haven’t seen very much of that coming through in terms of the government’s response. Certainly not since the “Stay Alert” type messaging. It doesn’t appear to me that they’ve read the advice.
What was the most crucial thing you think they ignored?
The consistent message from us to government has been that, to maximise the adherence of the population, you need to build up trust. That means direct, honest and open communication and taking responsibility for things when they go wrong.
They seem to have a pathological fear of owning mistakes. Why do you think that is?
I’m not going to get into the politics of it. But I would say, one of the worst things leaders can do in terms of trust is to start to blame others when things go wrong. Ministers have started to blame young people for the increase of transmission of the virus, when they did what the government told them to do. They went to pubs and bars.
Do you think Sage could have been more robust in calling that out?
It’s a very difficult situation. I was on Sage in 2009 when I think there were just 14 scientists, during the H1N1 pandemic. It was a very independent, science-driven effort. The Sage meetings now are enormous with large numbers of people from other government departments, from Public Health England, and political advisers.
Why has that changed?
I don’t know. Obviously, PHE didn’t exist in 2009. Political advisers now have huge amounts of power. We had to sign something saying we won’t talk about anything that happens within Sage meetings. I think there has been a sense that advice and decisions happen behind the scenes.
Was there not a case for the scientific community to say: we are not going to operate on these terms?
The reason Sir David King set up the independent Sage was that he was so disturbed by the government strategy and the secrecy around the science. I was delighted to be invited. It’s a small group (with a small behavioural advisory group), so much more workable, and able to communicate directly with the public and the media.
I guess when the inevitable inquiry eventually happens, it will focus on those early weeks in the middle of March, when infection was rife, but we were slow to lock down. I was looking at an interview you did with Andrew Neil at that time, when you were concerned about the unintended consequences of, for example, cancelling sporting events. Do you think, with hindsight, we should have been more far concerned with direct consequences, rather than possible knock-on behaviours?
I do. And I remember that interview. And at the beginning, I was very uncomfortable about these events going ahead. But I also knew that trusted leadership was really important in terms of adherence. And so I supported what Chris Whitty was saying and what the government was saying. I stopped because there was too much of a contradiction between what I thought and what was being said and done. The thinking at that time was that if you prevent crowds going to these outdoor events, people will go and watch them in pubs. In retrospect, we should have also closed down the pubs.
We should have had outdoor summer camps for children, should have brought back retired teachers. None of that was done
The situation was so serious at the beginning that you wanted to give the government, in a sense, a chance to get it right?
The population was prepared to do that too. What happens in a crisis routinely, the default is to trust the leadership.
Was that delay based on a hunch about the British context – the British character – that we couldn’t go too far too fast? Why do you think there was an apparently instinctive reluctance not to just go along with World Health Organization advice?
I think there are now very few scientists who would question the fact that we should have locked down earlier and harder. People might speculate about the reasons – British exceptionalism, the Tory ideology of keeping businesses going at all costs, that we were putting too much emphasis on influenza models. It was probably a bit of everything. I don’t know. However, what I do think is a completely different situation is what’s been happening over these past two months, over July and August. We now do have the benefit of hindsight and learning from the rest of the world. On Independent Sage all through the summer we have been saying the government must use these months to drive down Covid transmission in the community towards zero. Specifically, we said bars and pubs and other indoor high-risk places should not be open. We should have had outdoor summer camps for schoolchildren, should have brought back retired teachers in the way that we brought back doctors and nurses, and should have utilised the many empty buildings so we could create proper distancing for schools. None of that was done. They wasted all that time.
Sage and the scientific community knew from the beginning that they were dealing with a government that had set itself against “experts” and had just been elected on a manifesto full of non-evidence-based promises. Do you think there was a subconscious sense of second guessing – of trying to meet them halfway in the advice given, in order at least to get something done?
No, we draw on published evidence, and on expert consensus where there isn’t evidence. In terms of the false promises, the government didn’t have to make them. Nobody needs a “world-beating app” – just one that works. We don’t need Operation Moonshot and hundreds of millions of pounds wasted on private test-and-trace contractors when there was an existing local public health infrastructure with a good track record. These offers and promises are just a wing and a prayer in the hope it will make people feel better. In the long run, that doesn’t work.
But this prime minister has built his career on the fact that, in the short term, those vast empty promises do appear to work. Should we not spend more time addressing that quite cynical, irrational, tribal idea of human motivation?
The motivations of this government appear to be quite ideological and that’s a whole other conversation. The fact remains that changing behaviour is at the heart of how to get out of this pandemic and behavioural scientists have not been used as they could have been.
Where do you think we will be in six months’ time. I imagine you fear the worst…
I don’t know what the worst is. At the start the government kept saying “we are following the science”. That generally meaningless mantra was a concern to many of us, because we thought we might be being set up to blame if things went wrong. Now, they have even stopped saying that. The current messages that pitch the economy against health are so wrong. There is only one way of getting the economy back on track and that is to consistently do all the things necessary to drive transmission of the virus down.