Policymaking Is A Contact Sport Involving Competing Narratives, Institutions, and Interests...,

authorea |  This paper offers a critique of UK government policy based on mode of transmission of SARS-CoV-2 (which in turn followed misleading advice from the World Health Organisation) through the lens of policymaking as narrative. Two flawed narratives—“Covid is droplet- not airborne-spread” and “Covid is situationally airborne” (that is, airborne transmission is unusual but may occur during aerosol-generating medical procedures and severe indoor crowding)—quickly became dominant despite no evidence to support them. Two important counter-narratives—“Covid is unequivocally airborne” and “Everyone generates aerosols; everyone is vulnerable”— were sidelined despite strong evidence to support them. Tragic consequences of the flawed policy narrative unfolded as social dramas. For example, droplet precautions became ritualised; care home residents died in their thousands; public masking became a libertarian lightning rod; and healthcare settings became occupational health battlegrounds. In a discussion, we call for bold action to ensure that the science of SARS-CoV-2 transmission is freed from the shackles of historical errors, scientific vested interests, ideological manipulation and policy satisficing.

Policymaking is a contact sport involving competing narratives (about problems, how they arose, and how they will be resolved), institutions (especially government and its bureaucratic machinery) and interests (financial, political, ideological).^{1 2} Policy may—ideally—“follow science” but a key question is whosescience and why? Science shapes policy narratives via an “inside track” (e.g. official advisory committees) and to a lesser extent by an “outside track” (e.g. less mainstream scientists, citizen movements).³

 

Pandemic policymaking has been characterised not by clearly-identified knowledge gaps which science obligingly fills but by toxic clashes between competing scientific and moral narratives. Policymakers have risked losing control of the “dramaturgy of political communication” (page 78⁴).

Getting the mode of transmission for a contagious disease right matters, because preventive strategies follow (Table 1).⁵ Being honest about scientific uncertainty also matters, because—among other reasons—it is hard to back-track after declaring a policy “evidence-based”.

 

Table 1: Droplet versus airborne transmission: implications for public health and healthcare worker protection