Commentary: Making sense of shifting goalposts in public policy and the science of COVID-19
COVID-19 has demonstrated the need for scientific literacy, an understanding of the trade-offs behind public policy and clear government communications, says Michael Wee.
OXFORD: A tweet had gone viral recently for suggesting that, up until this pandemic, many people had never seen the scientific method “unfold in real-time”, with new evidence emerging, changing methodologies – and, yes, even errors.
To the man on the street, what should be robust science in the middle of this coronavirus crisis can look like cluelessness.
That would certainly explain why some do not take well to governments constantly updating their advice on COVID-19 in response to the evolving science.
In Singapore, misperceptions about how science works might account for some of the public unhappiness at the Government’s changing policy on face masks, when it U-turned from an earlier stance that masks should only be worn by healthcare workers and those feeling ill, to making mask-wearing in public spaces compulsory for everyone in April.
Yet it is worth recognising that at the same time, the pandemic has tested governments, not just in their flexibility in policy making, but also in their communication skills. The public may accept that science changes, but they still need clarity on the rationale behind each new set of rules.
Given that this global health crisis still has some way to go, three key lessons can be learnt from these experiences that should inform public policy when it comes to COVID-19.
NO EXACT SCIENCE ON CORONAVIRUS
The first lesson is for the public to be aware that there is no single thing called “the science”.
Particularly given that countries are dealing with a new virus, and data from studies and lab tests is streaming in from different places, we should be wary of calling the latest evidence “facts” that will not change with the passage of time.
For example, at the moment one very clearly changing aspect of coronavirus science concerns the debate over aerosols.
While the prevailing assumption among scientists and health officials has been that the virus is not transmitted through the air, some notable examples of indoor transmission taking place despite social distancing are leading some to suggest otherwise.
This does not mean we disregard whatever new research makes us uncomfortable, but it requires us to develop a healthy sense of inquiry about scientific studies.
It is easy to forget that there was a time when asymptomatic spread of the virus was not well-established, and the World Health Organization (WHO) did not think that there was sufficient evidence to support wearing masks as a general practice.
Only on Apr 2 did the WHO finally report evidence of pre-symptomatic and asymptomatic transmission. Just a day later, the Singapore Government announced it would not discourage the use of face masks among those who were not unwell. Other countries have since also implemented different, and at times changing, policies on mask-wearing.
The problem is not that science changes, but that we sometimes fall prey to a certain idealised perception of science.
In the popular imagination, science is almost synonymous with a fixed set of facts and objectivity. Ordinary citizens are generally less concerned about its actual methods and the hugely varying quality of its studies.
Even governments are not immune to this.
In the early days of the UK’s response to coronavirus, British Prime Minister Boris Johnson continually insisted that his government was “following the science”. He would appear daily before the media, flanked by his top scientific advisers who, to their credit, were often first-rate communicators of scientific evidence.
Back then, the British government was still talking about the need for herd immunity, before new modelling from Imperial College London suggested a terrifying scenario of 250,000 deaths under the government’s strategy. Johnson then changed tack and imposed a nationwide lockdown.
Since then, however, many have questioned the modelling, or the exact efficacy of lockdowns. And ultimately, we may never know with exact certainty which side is right, and which studies have been the most reflective of reality.
After all, modelling disease outbreaks or studying the effectiveness of social distancing rules is not straightforward. It depends on what assumptions you have, what factors you decide to control for, and so on.
For example, during earlier periods of the pandemic, when it was uncertain exactly what the incubation period of the virus will be, or how the capacity of testing and contact tracing was evolving in a particular country, modellers had to make assumptions about these variables. Future models may change depending on the results of studies of airborne transmission.
Likewise, counting COVID-19 deaths is not straightforward. Different countries have made different decisions, such as whether to count all suspected cases or only confirmed cases. Even calculating fatality rates of total cases depends on whether you count only deaths and recoveries, or deaths and total cases – some of whom may eventually die.
As James Forsyth, a British journalist, once put it, epidemiology is “more like economics than physics”. There is more than one answer, and evidence is often only as good as the study.
SCIENCE AND POLICY TRADE-OFFS
A second vital lesson of this pandemic is that science alone does not make decisions for us.
Public health policy cannot be based purely on medical advice, as there may be concerns about fairness and resource allocation, or other concurrent policy goals to consider. Every policy comes with trade-offs, and how much risk or cost is acceptable while pursuing a certain public health benefit is a question of ethics, not science.
Consider, for instance, the different factors involved in the decision regarding face shields.
Singapore's Ministry of Health (MOH) had previously said all types of masks, including face shields, disposable masks and home-made masks, would offer adequate basic protection.
However, MOH changed this advice in June. Health Minister Gan Kim Yong acknowledged that although face shields offered less robust protection than masks, these risks were “less of a concern” during the circuit breaker period when fewer people were out and about. But once the circuit breaker lifted, masks had to become compulsory again.
One might have concerns about how well these points were communicated when the relevant policies were first announced, but the point here is that governments are never just “following the science”.
While science gives crucial information for decisions, governments still must weigh up and prioritise different policy goals, while taking into account changing circumstances.
Perhaps, then, we should not be quick to judge policy “U-turns” as a sign of dishonesty or a question of competence. When there is new scientific evidence, or when new policy concerns alter the risk-benefit analysis, a change in policy may well be a mark of responsible governance.
THE IMPORTANCE OF CLEAR COMMUNICATION
None of these thoughts, however, should eclipse our third lesson, which relates to clear communication. Governments should always be open to the public about the full set of considerations, so that citizens can make better sense of policy shifts and new rules, and to prevent distrust from setting in.
In the short term, this may concern explaining trade-offs.
Just because some level of risk is deemed acceptable does not mean that governments are recklessly endangering public health, but citizens have a right to understand what goals are being aimed at, such as economic recovery or allowing for social goods such as seeing family and friends again.
In the longer term, clear communication is also about managing public expectations, even if it means tempering optimism.
The temptation, perhaps, is for everyone to think that the solution to a public health crisis will essentially be a medical one. Accordingly, many have pinned their hopes on a vaccine.
But it is worth saying that there has never been a successful vaccine developed for any coronavirus, including those strains that cause the common cold. Even a successful COVID-19 vaccine may, like yearly flu jabs, not be a permanent, one-off solution.
Should a vaccine come to fruition, other policy questions will remain, such as who should be prioritised for vaccination, and how it should be funded.
The road ahead is likely to be long. And in all of this, preserving trust between governments and citizens is a two-way street.
Those in authority will need to continually account for the rationale behind their decisions, and not be afraid to discuss both scientific and more qualitative policy considerations that have influenced them. But as ordinary citizens we can also do our bit by developing both our scientific literacy and by appreciating the different facets of the crisis.
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Michael Wee is Education and Research Officer at the Anscombe Bioethics Centre, an Oxford-based research institute. In 2020 he became the first Singaporean appointed to the Holy See’s bioethics advisory body, the Pontifical Academy for Life.