The recent Interim Report, Comparative Covid Response: Crisis, Knowledge, Politics rightly says: “The emergence of the novel coronavirus SARS-CoV-2 in 2019 presented the world with unprecedented challenges. Faced with fast-moving events, scientific and social uncertainty, and tight coupling of public health and economic systems, decision makers struggled to avert catastrophic outcomes.”
In my view, in response to Covid-19, the use of evidence and data in decision making for development has thrown in sharp relief two key aspects:
A) The crucial relationship between evidence and policy decisions during times of crisis.
B) When evidence is uncertain, emergent and evolving, yet policy decisions must be made rapidly, and revised frequently all in the context of heightened social, economic and political impact.
The Covid-19 pandemic has made the process of “what works” and “decision making” a simultaneous process of co-production. There are many aspects of the COVID-19 crisis which make it a complex policy problem.
If the last 10 months have shown why mis-information and disinformation thrived in the face of the Covid-19 response has been – one lesson for me has been the need for humility.
Humility in saying what can work and why and recognizing that might change.
The Covid-19 response involves and involved many types of uncertainty, data limitations; issues around immediacy; lack of consensus among experts and variations in expertise; the possibility of over and under reactions; and different levels of trust in government, technical know-how, political support for certain kinds of interventions, among many others.
This high level of uncertainty opened up more discretion in the political and official responses to expert advice than would normally be the case for crises with better-known causes and outcomes. This discretion combined with the inconsumable amount of data people were confronted with on a daily basis which changed before they made sense of it.
In development, we have to reckon with this new reality: that unambiguous evidence in situations of complexity that are also evolving is an impossible ideal. Therefore, development practitioners must orient themselves towards intervention development using multi-dimensional data sources, continuous data triangulation, participation of local communities and non-health experts in societal consequences in both the evidence generation and the policy design.
They need to be at home with the idea of “evidence-enough” for iterative decision making in-the-now. Development policy making, now more than ever, has to embrace methodological pluralism, pragmatic intervention design, and understand health wholly in its local social, cultural and economic situation.
This is not the first time development practitioners have confronted this. Following the 2013–2016 Ebola outbreak in West Africa a systematic review highlighted the value of methods such as Rapid Assessment models, outbreak science for identifying and addressing context-specific issues, acting as a guide for resource allocation, and providing data to plan long-term assistance.
So what can we learn from this?
The International Journal of Drug Policy in 2000 had an instructive article that makes the case for not just moving quickly from ‘assessment’ to ‘response’, but to recognize that the process of assessment as the beginning of the response itself.
This is the first sign of embracing that humility and non-deterministic approach to evidence and decision making for policy advice. We start with acknowledging that the assessment is the first step of response, which means that during the assessment we make choices that will change as the assessment progresses. We cannot wait for the completion of the assessment to give policy advice as the cost of that delay is unacceptable in a situation such as we confront with Covid-19.
In some ways the UN’s Socio-Economic Response Plans (SERPs) at the country level and the analysis underpinning their development, when done in a truly participatory manner, are the steps towards this approach. They indicate some priorities based on an assessment that will support the response and recovery from the pandemic. But they also are the harbingers of a new approach to not purely rely on knowing “everything” before recommending a course of action.
The UN SERPs offer the opportunity to open up evidence and expertise by making evidence and intervention design happen as an ongoing dialogue between experts, decision makers and communities to articulate the responses in-the now. Recognizing that the evidence is evolving about the disease itself and therefore the policy recommendations must evolve. This adaptive evidence-making and intervention design offers ways to address the uncertainties, but do so in a manner responsive to an emergent and evolving situation country by country.
Another sign of humility comes from the kinds of ‘solution’ or ‘solution mix’ that are available. A recent study looked at the dataset compiled by the OECD (2020) which provided the breadth of policy responses to the COVID-19 pandemic across wide range of policy areas. These include fiscal and monetary initiatives, employment and social initiatives, health policy, science and innovation policy, and tax policy, even though data on some of these is limited to OECD countries it offers the full gamut of policy actions available to decision makers.
Each country has to identify and adopt a combination of policy initiatives in a variety of policy areas – social, health, medical, economic – rather than just a single tool. Especially because, the response from one country to another varies not only in the composition of the policy mix but also in the timing of policy adoption as well as in the ‘stringency’ with which various tools are deployed – from compulsory quarantines to voluntary ‘lockdowns’ and social distancing measures.
Humility in responding is the recognition that those in the room first are not necessarily the ones with all the answers. The evidence and lessons from peace, disaster and private sectors suggest that lack of diversity and failing to leverage women’s expertise in decision-making limits an effective response. Women are users of health services, and they are agents of change in health, making critical contributions as parents, front-line responders, health promoters, influencers, researchers, scientists and decision-makers.
Learning lessons from this pandemic is up to each of us, each of our disciplines and institutions we are associated with. The long road ahead in mass inoculations is providing us an opportunity to learn the lessons we didn’t learn early on with Covid-19 response.