In a pandemic, policymakers have to deal with uncertainty and rapidly evolving information. Ramathi Bandaranayake and Merl Chandana use examples from COVID-19 to draw guidance for how policymakers might respond to these challenges. They argue that Quick, decisive, transparent and inclusive policy is key to successfully responding to pandemics and their socioeconomic effects.
Responding to pandemics inclusively, especially those caused by previously unidentified pathogens, places policymakers in unenviable positions. Uncertainty abounds in a pandemic, much of which is due to the time it takes to reliably establish the pathogen’s epidemiological characteristics – basic reproductive number, mode(s) of transmission, incubation period, transmission periods, etc. – which need to be considered in tandem with population demographics, community characteristics, the phase of the pandemic and the availability of resources in planning containment strategies. The slow emergence of such information means policymakers are often compelled to make quick decisions with limited knowledge and resources to curtail the disease’s spread; they can ill afford to wait for fuller information. Speed of response is often a key determinant of the quality of outcomes. However, while public health goals involve reducing the number of individuals exposed to the pathogen and improving the health outcomes of those infected, public health officials are compelled to act within limits to reduce the unintended consequences of pandemic control measures.
How can policymakers make good evidence-based decisions when the evidence itself is often uncertain and is evolving rapidly? How do governments communicate with the public in ways that are transparent and consistent? What measures can be taken to mitigate the unintended consequences of public health measures? Concerns about privacy and individual rights underlie many of these debates; so do the serious disruptions to normal life experienced by many citizens who undergo psychological distress and socioeconomic costs. Good policy needs to effectively curtail the virus while balancing these various needs. In responding to epidemics effectively, policymakers need to act quickly and decisively and balance conflicting interests.
Acting quickly and decisively
A key philosophy for making decisions under uncertainty is the precautionary principle, which posits that if there is a threat, precautionary measures should be taken against the threat, even if prevailing scientific evidence is inadequate to confirm this threat with (scientific) certainty. One cautionary tale was the debate over whether mask-wearing should be mandated. The World Health Organization (WHO) long insisted that mask-wearing need not be mandated for the general public, only to reverse its stance later. The WHO had previously determined that there was not enough evidence to recommend population-level mask wearing. While it is difficult to estimate how many lives would have been saved in the past with consistent messaging around mask-wearing, a recent study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine has estimated that consistent mask-wearing could save about 70,000 lives by December in the United States alone. Government policies in support of mask wearing by the general public have been linked to reduced per capita mortality due to COVID-19.
How can policymakers make good evidence-based decisions when the evidence itself is often uncertain and is evolving rapidly?
Consistent messaging is also vital to good risk communication during public health emergencies. Even before the WHO reversed its advice, in early April the Chief Public Health Officer of Canada reversed guidance on masks, from stating that those who were not sick or exposed to a sick person need not wear masks, to stating that wearing non-medical masks could help mitigate COVID-19 transmission a week later. It has been noted that such rapid reversals can reduce trust in authorities, making people less likely to follow guidelines. Hence, quick and decisive action as well as openness about uncertainty can contribute to the effectiveness of pandemic response.
Balancing Conflicting Interests
While each public health measure has a rationale behind its deployment, most, if not all, carry different risks that require the balancing of multiple conflicting interests. Consider, for example, digital contact tracing technologies. An early epidemiological study argued that the SARS-CoV-2 virus spread too fast to be controlled using purely manual methods and that digital solutions were needed to augment the speed and efficacy of traditional methods. However, the benefits of digital contact tracing come with risks for user privacy. For example, the Norwegian Government had to discontinue the use of its “Smittestopp” app for contact tracing after the country’s data protection authority warned that the app could excessively endanger the privacy of users, for instance through the continual upload of people’s location. Further, digital contact tracing also risks alienating those who do not have access to smartphones, since most solutions require compatible smartphones. Singapore was recently seen taking the issue of access into account where, upon the limited uptake of the smartphone app, a wearable digital contact tracing token was introduced, which was first distributed among the elderly.
Policy making often involves trade-offs between the needs of different segments of society. How these trade-offs are managed is particularly vital during crises such as pandemics, where life and health hang in the balance.
Tradeoffs also need to be carefully considered when imposing measures that limit people’s movement. Epidemiologically, it is essential that contact between infected and non-infected individuals is reduced to slow the spreading of the pathogen. Limiting people’s movement can manifest through different measures – including isolation, quarantine and lockdowns – with each country/jurisdiction deciding the degree of severity based on their circumstances. However, limiting movement imposes serious restrictions on citizens’ lives, including their ability to participate in social and economic activity. In the case of lockdowns, it can even entail unemployment and business failures in the worst cases and painful separation between family and friends for extended periods of time. For daily wage earners, the impact has been particularly devastating. These effects are exacerbated in the developing world, where many nations do not have the budget to spend on economic bailout packages. The costs of the measures imposed must be spread equitably across society with governments providing support for the most vulnerable. Transparency also needs to be maintained throughout with clear information on guidelines to follow, schedules of planned measures, and procedures to lodge grievances and seek support.
Policy making often involves trade-offs between the needs of different segments of society. How these trade-offs are managed is particularly vital during crises such as pandemics, where life and health hang in the balance. Quick, decisive, transparent and inclusive policy making can go a long way in successfully responding to pandemics and their socioeconomic effects.
This blog post is based on the authors’ policy brief on the same topic: Guidance on Making Policy Decisions in a Pandemic
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