Impacting public health policy

Public health policy requires individuals from many disciplines to collect as much useful data as possible, analyse and interpret it, and communicate it to decision-makers who will then use it to set government policies.

Under ordinary circumstances, setting these policies is a balancing act between competing interests; scientists, civil servants and government officials must work together to find solutions that are both effective and acceptable to the public.

The COVID-19 pandemic crashed into this finely balanced system with little warning. New people, institutions and data needed to be brought urgently into the policy process. In the United Kingdom, this included an unprecedented level of genomic pathogen surveillance data to complement information about case testing, hospital capacity, and deaths. From very early in the pandemic, the UK used its strength in pathogen genomics to build a national surveillance system that could detect new mutations in the virus and track their spread geographically. This genomic surveillance swiftly provided insights into the early evolution of the virus, but it wasn’t clear how these discoveries could meaningfully influence policy. In the summer of 2020, local clusters of highly similar genomes were observed from “superspreader” events during an otherwise quiet time in the pandemic in the UK, but because the sequences were only available a few weeks after the events occurred, there was no opportunity for public health action.

The value of genomic surveillance in the UK became apparent in December 2020, when an otherwise unexplained increase in cases in Kent, in South East England, was discovered to be due to a new variant (later dubbed the ‘Alpha’ variant) of the Coronavirus. The team of academic and public health scientists who discovered the new variant alerted the broader pandemic science policy community. Within ten days, an unimaginably short time in the usual process of scientific discovery, the Prime Minister, Boris Johnson, imposed strict restrictions on social mixing during the Christmas holiday in large parts of England. By early January 2021, it was clear that the Alpha variant had spread widely in the UK, and a second national lockdown was required.

The Alpha variant, along with the simultaneous discovery of the Beta variant in South Africa, moved genomic surveillance from a niche interest among scientists to one of the most prominent data streams in pandemic policymaking. Would new variants spread so easily that lockdowns couldn’t contain them? Would they cause more severe disease? Could they evade the protection offered by vaccines?

The UK Health Security Agency needed to coordinate these data to provide timely, understandable, actionable input for policymakers. They convened a Variant Technical Group to serve as a regular forum for academic and public health scientists to use genomic surveillance data to improve the modelling of future waves, evaluate new variants in laboratory tests, and determine their effect on vaccines. The group regularly published technical reports to ensure scientists and policymakers around the world had access to the latest research. A number of public-facing websites were created to share anonymised genomic surveillance data in near real-time, thus allowing members of the press and public to see the new variant data that was being used to influence policy on travel, local restrictions and vaccine and treatment roll-out. This public focus also led to active (and sometimes vitriolic) debates on social media about policy responses to new variants of the virus. Organisations like the Science Media Centre helped to coordinate academics unaccustomed to that level of attention to share information so the press could accurately report on new developments.

The COVID-19 pandemic presented a unique challenge to science communication for public health policy. This included, for the first time, building a genomic surveillance system for a new pathogen, continuously improving the speed and interpretability of the intelligence it produced, and creating new channels of communication from scientists to policymakers. While created in emergency circumstances, there is now an opportunity to build a sustainable way for genomic surveillance to aid public health policy.

Further reading

COVID-19 Government response tracker