The Scientific Advisory Group on Emergencies (SAGE) is an expert group activated in an emergency to integrate independent scientific research and analysis from across government, academia and industry. It provides a single source of co-ordinated scientific and technical advice to the Civil Contingencies Committee (COBR) and the cabinet. COBR, chaired by the prime minister or a senior secretary of state, directs the government’s response to the emergency.
SAGE is not a standing committee and its membership varies depending on the nature of the emergency.
When responding to a pandemic, the membership of SAGE includes epidemiologists, virologists, clinicians, behavioural scientists and data scientists.
The GCSA is responsible for appointing SAGE members, drawing experts from academic and research institutions, as well as government scientists and officials. The Government Office for Science keeps lists of leading experts for different types of crisis.
The guidelines for operating SAGE say its membership should not duplicate other advisory groups; should include representatives from a wide range of relevant disciplines; and should avoid overly relying on specific experts. They also state that membership of existing scientific advisory groups should form the ‘starting point’ to speed up the activation process and ensure continuity of advice. There are over 70 advisory committees and councils providing scientific and technical expertise across government.
SAGE is designed to work in conjunction with COBR in the initial stages of an emergency. SAGE was first used to provide advice on the H1N1 (swine flu) outbreak in 2009. Before the coronavirus outbreak in 2020, SAGE had been activated to provide emergency science advice on at least 10 occasions.
Prior to 2009, scientific expertise was provided to ministers either directly by specialist advisory groups, or through the government chief scientific advisor and the chief medical officer. During the foot and mouth crisis, in 2001, for example, the GCSA created the FMD Science Group, which met regularly between March and November 2001.
SAGE is supported by a secretariat staffed by civil servants from Go-Science. The secretariat prepares papers for review by SAGE members, and converts advice produced by SAGE into briefs for ministers.
In past crises, the minutes of SAGE meetings and the attendee lists have not been published until the crisis has concluded. At the start of the coronavirus pandemic, the government’s guidelines for managing SAGE advised that the most appropriate time for publishing minutes would be after the emergency is over. When the emergency involves issues of national security, such as the Salisbury chemical attack in 2018, the minutes of SAGE meetings are classified and are not published.
In May 2020, in recognition of the high level of public interest in the scientific advice provided to government, the government began to release minutes of meetings and research papers relating to the coronavirus pandemic. It also published a list of SAGE expert attendees. The government’s publication scheme stated that it would publish all minutes and papers within a month of the meeting, and earlier where possible. However, it has not always met this timetable.
In dealing with a public health crisis involving an emerging infectious disease, SAGE can draw on several independent expert groups.
The Scientific Pandemic Influenza group on Modelling (SPI-M)
SPI-M is a standing group attached to the Department of Health and Social Care that advises government on preparations to manage the risk of pandemics and keeps emerging evidence and research under review.
SPI-M is made up primarily of experts in epidemiology and disease modelling based at UK universities and research institutions. At the start of the coronavirus pandemic, it was made a formal sub-group of SAGE and provided regular consensus statements on the spread of the virus and the impact of interventions.
New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG)
NERVTAG is a standing expert advisory group of the Department of Health and Social Care (DHSC). It provides independent scientific risk assessments and advice to DHSC and Public Health England (PHE) regarding new and emerging respiratory viruses.
Its membership comprises experts in clinical medicine, epidemiology and public health, virology, animal health, health emergency preparedness and bio-statistical modelling.
In normal times, the committee supports Public Health England in developing its risk assessment of emerging respiratory viruses. It also advises DHSC on the appropriate stockpiling levels of face masks, respirators, and other equipment required in a pandemic.
When a new respiratory virus such as Covid-19 emerges, NERVTAG advises the CMO and DHSC on how to minimise the risk to the UK population and conducts research on the nature of the virus, its evolution, and transmission. NERVTAG held its first extraordinary meeting to discuss the emergence of a novel coronavirus on 13 January and has met regularly since then.
Advisory Committee on Dangerous Pathogens (ACDP)
ACDP is a standing expert group within DHSC and Public Health England, providing advice on the hazards and risks to workers from exposure to infection and disease. It supports the Health and Safety Executive, DHSC, the Department for Environment, Food and Rural Affairs (Defra) and their counterparts in the devolved administrations.
ACDP has produced guidance for laboratory procedures in clinical diagnostic laboratories in relation to Covid-19.
Independent Scientific Pandemic Influenza group on Behaviours (SPI-B)
SPI-B is an ad-hoc group, comprising behavioural scientists and academic specialists in health psychology, social psychology, anthropology and history. It was first convened during the 2009 H1N1 (swine Flu) pandemic.
It was convened again in February 2020 as a sub-group of SAGE to advise on behavioural issues relating to the pandemic. The primary focus of the group’s work is how to maximise the public’s adherence to social distancing rules.
The group has also reviewed guidance issued by Public Health England to support people to self-isolate. It has considered the risk of public disorder under various scenarios, including staff shortages in the police force owing to sickness and increased pressure on health services.
Joint Committee on Vaccination and Immunisation
The Joint Committee on Vaccination and Immunisation is a statutory advisory non-departmental public body. It advises the secretary of state for health and social care on the provision of immunisation and vaccination services and identify knowledge gaps relating to immunisation and immunisation programmes. The Health Protection (Vaccination) Regulations 2009 place a duty on the secretary of state for health in England to ensure that the recommendations of the JCVI are implemented as far as is reasonably practicable.
JCVI forms sub-committees as required to examine specific diseases and immunisation programmes, such as for influenza.
The JCVI plays a central role in gathering evidence on the safety, impact and effectiveness of vaccines for Covid-19.
The Civil Contingencies Secretariat (CCS) is responsible for building resilience and planning for major emergencies. CCS maintains the National Risk Assessment (NRA), first prepared in 2005, and its unclassified version, the National Risk Register (NRR), which was first published in 2008.
The government chief scientific adviser, Sir Patrick Vallance, and the network of departmental chief scientific officers contribute to the preparation of the National Risk Register and its classified version, the National Risk Assessment.
The National Risk Assessment includes a list of ‘reasonable worst case scenarios’. These are major accidents, natural events, and malicious attacks that fulfil the definition of a civil emergency and have a chance of at least one in 20,000 of occurring in the UK in the next five years. The National Risk Register, which was mostly recently updated in 2017, noted a “medium-high” likelihood of an influenza pandemic occurring in the next five years and lists it as a “high impact” risk. The risk of a new emerging infectious disease was rated as a “medium-high” likelihood, but the impact was rated as “medium”.