Where to draw the line on letting science drive policy

Expert recommendations must be critically scrutinized in light of their likely impact on long-term health and well-being

 Dr Tony Holohan, Chief Medical Officer, Department of Health, third left, Dr Ronan Glynn, Deputy Chief Medical Officer, right Department of Health, Dr Colm Henry, second left Chief Clinical Officer, HSE and Professor Philip Nolan, Chair of the NPHET Irish Epidemiological Modelling Advisory Group pictured  Thursday 14th May at a Covid -19 update press conference at the Department of Health. Picture Colin Keegan, Collins Dublin

Dr Tony Holohan, Chief Medical Officer, Department of Health, third left, Dr Ronan Glynn, Deputy Chief Medical Officer, right Department of Health, Dr Colm Henry, second left Chief Clinical Officer, HSE and Professor Philip Nolan, Chair of the NPHET Irish Epidemiological Modelling Advisory Group pictured Thursday 14th May at a Covid -19 update press conference at the Department of Health. Picture Colin Keegan, Collins Dublin

 

In the context of an unfolding pandemic, expert scientific opinion assumes a privileged position in public deliberation and policy making. For example, the UK Government’s decision to abandon its softer mitigation strategy and instead implement a national lockdown is widely attributed to the grim mathematical projections of a professor of mathematical biology at Imperial College.

In a scenario of incomplete and shifting information, citizens and public officials inevitably lean heavily on scientific experts for orientation in their personal and political decisions. However, that the fate of over 60 million people could hang on the accuracy of a single mathematical model raises serious questions about the proper role of science in deciding a nation’s response to a pandemic.

It may be tempting to rely passively upon expert opinion to provide us with algorithmic solutions to complex problems. However, scientists and clinicians are in no position to single-handedly decide how a nation should cope with the fallout of a pandemic. They are only competent, as scientists, to provide advice on the likely consequences of a certain range of social or medical interventions.

For example, epidemiologists and other medical experts can advise us on the value of frequent hand-washing, the success rates of different methods for treating Covid-19, the reliability of various methods for detecting infections, and the potential of different social distancing measures to reduce the rate of transmission, hospitalisation, or mortality.

Nonetheless, neither medical nor social science is a silver bullet that can automatically validate the soundness of public policy through fool-proof algorithms. While we are well advised to pay heed to the recommendations of medical and public health experts, nobody is infallible. Expert recommendations must be critically scrutinized in light of their likely impact on long-term health and well-being.

Furthermore, choices about how to manage a pandemic cannot be determined exclusively by the methods of any particular science, whether mathematics, epidemiology, or social science. On the contrary, they require a complex, hybrid form of deliberation that is responsive to medical, social, economic, and ethical considerations.

If the management of pandemics could be entrusted exclusively to scientists, we could replace our elected rulers with a scientific counsel. But until we decide to elect medics and epidemiologists to rule our society, political leaders and not scientists must answer for the consequences of public choices made under conditions of uncertainty.

Political leaders should explain to the public the considerations and evidence that swayed them to act as they did, and make relevant scientific evidence available in a public access repository. But it would be extremely disingenuous to suggest that their choices are dictated straightforwardly by the findings of science, in an evolving situation whose complexity involves too many unknowns to be mastered by any scientific method.

For example, it is disingenuous to present national lockdowns as a method of disease control dictated by science. The use of large-scale lockdowns in the context of pandemics was historically unprecedented prior to China’s dramatic interventions in Wuhan on January 23rd of this year. Consequently, we have limited data for assessing their overall efficacy and their net social, medical, and economic impact, when compared with more moderate approaches to disease control such as reduced social interaction and selective quarantines.

Unintended effects of prolonged lockdowns may include untreated illnesses and non-covid-related deaths, loneliness, depression, spikes in domestic abuse, extensive job losses, and widespread economic hardship. Political leaders consciously assume these risks when they order lockdowns. That gamble may be justified, but it ought not to be presented straightforwardly as the voice of science.

In public emergencies, we are often compelled to take risky decisions weighed down by the baggage of our accumulated errors and armed with incomplete information. We may be required to draw on estimates and hunches that go beyond the available scientific evidence.

For example, political leaders must make tricky decisions about how to balance public health risks against the need to keep an economy afloat. They may have to carefully calibrate when and how to ease up on lockdown measures, and how much time and resources to devote to fighting Covid-19, when there are many other pressing problems, including the provision of non-covid related healthcare and the protection of small and medium businesses.

Ordinary citizens will face important existential questions. For example, should an elderly person begin to socialize again when the risk of contagion starts to subside, or should she play a waiting game until we have reached full herd immunity or else have developed a vaccine?

These sorts of decisions may be more or less scientifically informed, but they cannot be determined exclusively by the opinions of scientific experts or the latest mathematical model. They are ultimately a matter of prudence and sound judgment.

Our personal and political choices ought to be informed by the best available evidence. However, we must firmly resist the temptation of “expertocracy” - the notion that scientific experts can single-handedly drive our national response to covid-19. Reliance on science cannot excuse us from making hard choices about how to cope personally, socially, and economically with the fallout of this pandemic.

Scientists and clinicians can help us choose wisely, but they cannot choose for us.

David Thunder is a researcher and lecturer at the University of Navarra’s Institute for Culture and Society in Pamplona, Spain.

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