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A thread on policy responses to epidemics – from someone who’s spent 20 years researching and teaching their histories. These are observations not answers, that aim to contextualise not condone the UK govt response to #covid19. 1/13
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. 2/13
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. Historians study epidemics because their control reveals so much about societies. 3/13
‘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). 4/13
Different forms of science produce different insights, ie wildly different policies can claim to be science-based. History reveals the changing emphasis placed (say) on biological versus social science, and on observations made in the field, the lab or by computer modelling 5/13
Even with consensus on ‘the science’, there is no obvious direct line to policy. Different population demographics and behaviours produce different disease risks. Different societal characteristics and traditions affect the feasibility and acceptability of govt responses. 6/13
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. 7/13
(So it’s sort of ironic that the workshop on incorporating insights from the social sciences into epidemiological models that @RowlandKao and @ewancolman were due to run under @field_wt has been delayed by #COVID19) 8/13
Policy shapes science as much as science shapes policy. Policy proposals and their effects flag up what isn’t known about disease. This drives investigations whose findings can change policy. Ie the situation is continually evolving. No-one has all the answers up front. 9/13
What counts as success’? Is the goal to 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. 10/13
Govts will use cost/benefit analyses of policy, but these involve choices over what time periods to analyse, what externalities to include, and how to deal with things that can’t be quantified. Who gets to decide, and whose perspectives are not considered? 11/13
Trust is crucial. Too often in the past, failure to comply with disease control policy has been interpreted as ignorance and lack of education. In fact it was due to mistrust and/or fundamental disagreement with the message and messengers. 12/13
Like other epidemics, #covid19 fits the definition of a #wickedproblem: it is unique, challenging and complex. Knowledge is incomplete, it affects multiple stakeholders with different needs and values, and there is no single definitive solution 13/13
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