Policy in a Pandemic – Part 1

Military vehicles cross Westminster Bridge after members of the 101 Logistic Brigade of the British Army delivered a consignment of medical masks to St Thomas' hospital in London, England, on March 24, 2020. Leon Neal/Getty Images

Commentary

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.” — Charles Dickens, “A Tale of Two Cities.”

We all recognize the dichotomies Dickens ascribes to the period of the French Revolution in the way people and governments are responding to our present pandemic.

Most of us recognize the wisdom in washing our hands frequently and not touching our faces. And we see the foolishness of hoarding large quantities of toilet paper. Beyond that, though we see the same pairs of opposites, we disagree about what actions belong in which category.

We are all subject to the temptation to look for news that confirms what we already think. Policy options and medical treatments may look more or less promising, based less on evidence than on what we think of those proposing them.

I want to suggest a way to think about and discuss with others the problem we face and the alternatives for addressing it.

It’s a more systematic approach than we commonly employ in everyday discussions, but one less driven by emotion, unexamined assumptions, and preconceived solutions. It asks, as a policy analyst might, how we should define and structure the problem, what alternatives we want to consider and what criteria we will use to select one, what relevant evidence we can gather, what trade-offs we must consider, and what outcomes we project. At each step there are traps to avoid.

Going through this process may make us less, not more certain about what “they” should be doing, less blinded by partisanship, more aware of what we don’t know, and more inclined to the virtue of humility.

I draw here on the work of Eugene Bardach, who taught policy analysis for decades at Berkeley, and whose practical guide I myself used (in an earlier edition) in teaching policy analysis. I offer it here, not because I have come up with answers, but as a way to participate in discussions about the crisis, seriously but dispassionately, in a spirit of problem-solving rather than name-calling.

What Is the Problem?

We all want the pandemic to end. It seems simple enough. To end as soon as possible, with as few deaths as possible, with the least damage to economic and social life or mental health, in a way that does not leave us at the mercy of future waves of the epidemic with no more protection than before? Or what?

One mistake here is to define the solution into the problem. For example, if we define the problem as a lack of testing, the solution will be more testing, and we will know we have succeeded when ample testing occurs. But testing was not the problem, it was a solution we had in mind for a problem.

What is that problem and how will we know if testing was the best solution to that problem?

Gathering Evidence

What evidence is there that can reduce the substantial uncertainty in which policymakers must make their decisions? In determining the best policy option to pursue, all governments rely on evidence about what is happening and where.

The U.S. government relies on its own sophisticated projections, which track closely with the modeling of the Institute for Health Metrics and Evaluation in projecting when and where mortality from COVID-19 will peak. Those data are used to determine the point at which COVID-19 will overwhelm the capacity of health care systems to care for patients as the disease spreads from one region to another.

Individuals lack these kinds of resources. We get our information from unreliable and partisan media sources. The president’s press briefings attract large audiences, but are controversial with most of the broadcast media. Except for Fox News, the media ignore or cut away from them.

News, accurate and fake, is all over the Internet all day every day. There are wild conspiracy theories and advice on treatment and prevention based on testimonials of a couple or handful of non-professionals. We do our best to maintain our critical faculties, consult several different sources, and consider well-supported arguments, resisting the impulse to believe whatever confirms our prior views and prejudices.

Alternatives

Having defined the problem and gathered evidence as best we can, we ask what the most promising policy alternatives are for addressing the underlying problem as we have defined it.

The problem itself may change its definition as the pandemic goes through its course, new resources become available, and measures to mitigate or suppress the disease take effect. Several countries, such as Italy, Israel, and the UK are already under a national lockdown. At first the period of lockdown varies from two weeks to a month, but the period is typically extended and its requirements become more stringent. How to get out of it?

A recent article by the Telegraph’s science editor lays out four likely scenarios for getting the UK out of lockdown. In all countries that have imposed severe restrictions, the question of how and when to get back to normal life imposes itself and cannot long be swept aside—especially when a short-term lockdown announced as lasting two weeks gets extended to a month or three.

The question of an exit strategy, as in wartime, becomes inescapable as the struggle continues and economic and social life are disrupted, with no end in sight. Demoralization, doubt, and disobedience set in.

All the proposed British exit strategies involve waiting until the virus has peaked and the number of deaths have begun to fall. They range from waiting it out in national lockdown until an effective treatment or vaccine is available, possibly early next year; through an intermittent rolling release as fatality rates decline in different parts of the country; expanded programs of testing, contact tracing, and isolation or quarantine; to requiring those who are old or with underlying health conditions to remain in place while others return to normal work and life.

Most policy thinking about a path out of lockdown includes a combination of similar stratagems. They draw on the experience of others, such as Germany, Singapore, and South Korea, which, learning from recent pandemics like SARS, had extensive testing, tracing, and monitoring programs in place.

Choosing

Clarifying the problem and identifying a number of alternatives are only the first steps in a policy analysis that culminates in a good decision.

How do we choose among the shortlist of alternatives we have selected—from a potentially infinite number we could imagine—as worth closer analysis?

Now we have to select the criteria we will use to assess our alternatives, project the outcomes or impact of each of them, and consider the trade-offs involved, before making our decision. I take up these steps in my next column.

Most mistakes in policy analysis, as in philosophy (as Wittgenstein said), come from moving too quickly, jumping over steps in the process, and leaping to the conclusion (often the one we started with or the one backed by whatever leader we support on other grounds).

Paul Adams is a professor emeritus of social work at the University of Hawaii and was a professor and associate dean of academic affairs at Case Western Reserve University. He is the co-author of “Social Justice Isn’t What You Think It Is” and has written extensively on social welfare policy and professional and virtue ethics.

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Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.