COVID, transparency and trust

I shouldn’t try to speak for everyone, but it seems as though we are all news junkies at the moment. One of the frustrations with this is that, like prospecting for gold, one scans and sifts tons of stuff, and real nuggets only emerge quite rarely.

So I was rather stunned when I saw three particularly sizeable nuggets in the Guardian’s report of yesterday’s No 10 Press Briefing. Specifically:

1. The Government refuses to discuss publicly its ‘lockdown’ exit strategy. Seemingly it would be a mistake to start a national conversation before the peak of the epidemic is over. Really? Well, they could at least tell us what the strategy and thinking for the lockdown entrance was, because we don’t even know what went into that decision, other than ‘following the science’.
2. It has refused to name all members of SAGE on the basis that “withholding the names protected SAGE members from being subject to undue influence”. Do they not see that withholding the names of SAGE members makes the whole process subject to the perception of undue and obscure influence?
3. A spokesperson said that the Government thought China had lessons to learn about “the provision of transparent and accurate information”. That may be true, but it doesn’t mean that our Government has already learned that lesson.

This collection of responses from No 10 illustrates quite tidily the reason why some serious concerns have been expressed about important elements of the Government’s handling of the current crisis. Most of the concern centres on three core issues:

• First, what values are being engaged in their decision-making, and how? (‘Following the science’ is good, but decisions also involve values and judgements.)
• Who (in particular providing ethical perspectives) is being consulted and has a voice in these discussions?
• Third, what has happened to the idea of transparency? These decisions and processes desperately need to be opened up.

The questions raised with No 10 today about the exit strategy, and the members of SAGE, are not the only ones where these concerns have been expressed, and are becoming more acute. There are others:

• Why has the Government not given advice or guidance to medical practitioners about how to allocate resources (e.g. ventilators and intensive care beds) if there are not enough to meet need? How should such decisions be made? This cannot be left to individual judgements of front line staff, or subject to variation across regions and Trusts. There is some guidance from BMA and RCP, but it is not definitive or sufficiently authoritative: the Government needs to be open and accountable on this fundamental question. Failure to do so places an unacceptable burden on individual staff on the front-line.
• What is the role of the Moral and Ethical Advisory Group, first set up last year (pre-coronavirus and Covid-19) to provide “independent advice to the UK Government on moral, ethical and faith considerations on health and social care related issues”? There is no published information suggesting that it has been consulted. If it has not, why not? If it has, what was said and how has Government responded?
• What thinking has been going on about the introduction of a contact-tracing app – which is apparently imminent – in terms of privacy protections in the short and long term, and other social and ethical implications of such a strategy?
• Similarly, the use of immunity certification, which the Health Secretary promoted very recently. As antibody testing is introduced and expanded, serious questions arise about how test results might be used, recorded, shared. Immunity certification is fraught with potential problems in terms of e.g. privacy, stigma, discrimination. Let us talk about it!

Already there is widespread unease with the way that the Government has responded to questions about its preparedness for a pandemic and about its ability to secure and distribute PPE where it is needed. If the Government is not open and honest it will not secure trust.

When the Government is facing situations or contemplating measures that will affect people profoundly, then trust is going to be vital. And that trust will only be afforded to a Government that is engaging with wider public groups, listening, explaining, responding openly and transparently.

In expressing these concerns, I do not claim that we have answers, nor that we are the source of all ethical wisdom. But in our reports on public health (2007); on the collection, storage and use of biological and health data (2015); and on research in global health emergencies (2020) we have time and again stressed the need for public justification of policy measures; for wide engagement in policy processes; for explicitly setting out the values engaged.

There is urgency to the situation that we all face. But urgency does not absolve those responsible for decision-making of the moral duty to involve those who are affected; to engage with the communities that they represent and seek to protect; and to be transparent about the basis on which decisions are being considered and are being made.