Tuesday, November 23, 2021

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