March 23, 2020, by Brigitte Nerlich

Controlling covid19: Where science meets policy

This is a GUEST POST by Abigail Woods, Professor in the History of Human and Animal Health, King’s College London.

Since covid19 control shot up the agenda just over a week ago there has been an ongoing stream of commentary about how ‘the science’ connects up with ‘the policy.’ Many people seem to be struggling to make sense of why different countries are pursuing different measures and why those measures keep changing. There’s a prevailing perception that the correct policy is dictated by science, and that all of the others are ill-informed, politically motivated and just plain wrong.

While it’s heartening to see certain politicians proved wrong in their belief that Britain has had enough of experts, the belief that scientific experts shouldn’t just do science but also dictate policy is grounded in misconceptions about both activities as well as the relationships between them.

Science, politics and society

Having spent 20 years researching and teaching the histories of epidemics, I can confidently state that there is no apolitical way of managing epidemics. There are always hard choices about how to balance civil liberties against state intervention, and individual freedom against the greater good. Different political traditions produce different interventions. As with other policies, there are winners and losers. Choices about how and where to intervene are shaped by the dynamics of power, politics, money, class, gender, ethnicity etc. Different population demographics and behaviours produce different disease risks. Different societal characteristics and traditions affect the feasibility and acceptability of govt responses. The reason why historians study epidemics is because they reveal so much about societies.

‘The science’ isn’t neutral either. As a product of society, it is equally shaped by power, money and hierarchy. They determine what counts as good science, who gets to perform it, and who policy makers consult in a crisis (normally someone they know and trust already). There is no obvious direct line from science to policy. Policy shapes science as much as science shapes policy. Trying to control disease often reveals what isn’t known about it. This drives investigations whose findings can change disease responses. Ie the situation is continually evolving. No-one has all the answers up front.

It’s also important to recognise that science isn’t monolithic. It has different forms which produce different insights which can underpin quite different policies. Policy makers don’t rely on all forms equally. History reveals their shifting emphasis on (say) biological science versus social science, and on observations made in the field, the lab or by computer modelling.

Putting people into the policy

What counts as success in epidemic control? Is the goal to hold back or eradicate disease, leaving a susceptible population, or to dampen its effects by building immunity? There are successful examples of both, but they involve quite different approaches, assumptions and impacts on peoples’ lives. Over time, many policies have failed because they’ve paid more attention to the pathogens than the people. Common oversights are: whether implementation is practically possible, how people are likely to respond, what social and economic costs are inflicted and to whom.

If policies are to work, they need to be grounded in trust. Too often in the past, policy makers have attributed people’s failure to comply with disease controls to ignorance and a lack of education rather than differences in values, world-views, and personal circumstances. These differences mean that even with complete knowledge of a epidemic disease it is impossible to reach consensus on the correct way of controlling it. Epidemics are wicked problems, and we have to accept that there is no single definitive solution to them.

Image: Boston Red Cross volunteers during the 1918 Influenza epidemic.

Source: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD)

Posted in infectious diseasespublic service