Science, expertise and trust in COVID times - Part 3 - why do experts differ?

In the last instalment I argued that whilst experts have valuable contributions to make in relation to COVID-19, trust in experts and faith in science should not be unconditional. Trust needs to be earned.  Here I look at why experts differ.

We are already seeing lots of differences in expert opinion.  Some say we should wear facemasks, others not.  Considerations may not be purely health related, that is how much various masks reduce the likelihood of transmission.  There are cultural factors which experts might consider: mask wearing is seen as ‘normal’ in some countries but not others.  There are shortage factors: promoting mask use may make it more difficult for health professionals to obtain them.  There are psychological factors: wearing a mask may enhance the sense of security the wearer has, which in turn may improve a feeling of well-being, or conversely may encourage risk-taking.

Are the experts behind the Swedish strategy of limited social and economic restrictions, less expert than those behind the UK strategy or the Taiwanese one?  The differences of approach can’t simply be attributed to experts taking different national circumstances into account, although that may be part of the explanation. 

Some experts support closing schools, others not.  Experts in different countries have reached different conclusions about the number of intensive care beds that will be needed.  Countries which have adopted broadly similar lockdown regimes, as advised by experts, have produced very different infection and mortality outcomes.  There has been extensive modelling of the likely progression of the pandemic, but the numbers of those predicted to die vary widely.  And there are different expectations around when the pandemic will ‘peak’.  If experts are such experts, it is asked, why do they so often differ?  

There are good and less good reasons for such differences.  Differences may arise from being alert to local conditions, surely admirable.  Ignorance is another good reason.  There are many, many things which are not well understood about the COVID-19 pandemic.  These include the infection rate, the infection-fatality rate, the role and numbers of asymptomatic carriers of coronavirus, what level and duration of immunity those who have recovered from infection might have, whether the numbers dying are being fully captured (in old age homes for example), and so on.  

Strategies seem to have been heavily influenced by epidemiological modelling.  All modelling rests on deciding which data can be relied upon, which variables to include in the model, and on assumptions about the relationship between variables.  These models will improve as knowledge about these variables and their relationship increases. Is there, for example, and as some have suggested, a warm weather effect or an air quality effect?  And modellers must also make assumptions about what the efficacy of measures taken will be on infection and mortality rates. We can be confident that knowledge about such things will improve over time.  Public health experts have generally been frank, so far, in conveying where they are ignorant and uncertain.

In the USA, a recent survey of experts (conducted 13-14 April) resulted in an ‘expert consensus’ that the death toll in the USA would reach about 50,000 by 1^st May.  But this was not exactly a consensus.  More accurately, it was the most common answer given by the experts surveyed and the range of answers was striking given they were predicting a situation only 3 weeks away. High-end estimates reached as much as 200,000.  Low end estimates were around 20-30,000 deaths.  At the time of writing, 25^th April, deaths in the USA had already surpassed 50,000 and were rising around 2,000 per day, although even this probably excludes thousands of deaths not (yet) attributed to COVID.  50,000 deaths by 1^st May therefore looks likely to be an underestimate, although not wildly so.

A more complex reason for differences arises from the effects of pre-emptive action and lockdowns in one form or another.  Estimates need to be made as to the effect of, say, closing (or re-opening) cafes, on the spread of the pandemic.  Some countries, where housing conditions are cramped, may find it practically impossible to physically isolate whatever the lockdown regulations say.  Estimates of the actual compliance with regulations are also important.  These may differ markedly from place to place.  They will be significantly affected by levels of trust in the authorities, and the extent and effectiveness of state coercion. Other social circumstances will be critical, from traditions of compliance (or not), to practices of social greeting and gathering, to family structures (such as whether extended families live together and co-habit across generations).

In short, some of the expert differences may result from ignorance and things still unknown or unclear, and some from different local or national conditions.  Only some of these differences will be reduced in time through further study and peer review. 

Importantly, there will also be differences which arise from competing perspectives on what counts as important. There are legitimate grounds to reach different conclusions and prescribe different answers to the question: what is to be done? ‘Ensuring public health’ or ‘getting the economy moving again’ is one common public form that such competing perspectives take in the current crisis, and neither view is only about facts.  

An Australian example relates to shutting down schools.  The federal government and Chief Medical Officer argued, and still argue, that expert medical opinion held that schools were not a major vector of transmission. There was therefore no need to close schools.  But parents started withdrawing their children from schools unilaterally. Further, teachers’ unions complained that their members, some of whom were health vulnerable, were being exposed and were unable to effectively keep children physically distant from them and from each other, or ensure good handwashing practices.  State Premiers then stepped in, also claiming to have received expert advice, and shut the schools.  What expertise was drawn upon in deciding this? Clearly expert advice is as much dependent on its reception as on its veracity.  Premiers may have decided that to retain their own authority they needed to be receptive to public opinion.  Better to shut the schools in a fairly orderly way than to allow attendance to dissipate, may have been their thinking.  Perhaps the best science was that which also engaged with public opinion!

A South African example has important implications for the very decision to lockdown.  The lockdown order came into force in late March (27^th).  It was clearly communicated, decisive, very far-reaching and widely lauded by the population (or at least the elites).  It required all citizens to stay at home. It was enforced, often with violence, by the security forces.  In practice, the majority of the population live in crowded accommodation, often with limited access to soap and running water, making physical distancing extremely difficult. The capacity for the state to provide food is limited, there have been calls to simply hand out cash, and some steps, belatedly, to increase social transfers.  The result has been real hunger, looting of shops, and the beginnings of civil unrest.  As one commentator has noted ‘while the lockdown has been an inconvenience for the middle class, it has been a double whammy for millions of poor South Africans who have lost jobs and livelihoods and thus the ability to have food on the table’.  Not surprisingly, expert advice to the effect that a lockdown was needed, is being contested by others, equally but differently expert. Calls are growing ‘to manage all the risks associated with the epidemic, and not only the disease itself’ and avoid lockdown dependent strategies.  As leading thinker on science and technology, Harvard’s Professor Sheila Jasanoff, has noted: ‘We’ve modeled the progression of the disease, but not the social consequences of the preventative measures that we’re taking.’

Expert differences are not something to be scared of.  They are certainly not a reflection of ‘truth’ versus ‘error’.  Expert differences can even be welcomed.  They can both reveal the limits of ‘expert’ knowledge and the value of experts critically engaging with the publics and societies within which they are located.  Indeed, as the COVID-19 crisis affirms, Knowledge is never simply about unveiling the ‘true facts’.  It is also shaped by the Values of the expert (hence the common charge that elite values are different to those of ordinary folk), by the relations of Power that exist within society, and the Political objectives our rulers wish to pursue.  Expert knowledge exists within this messy confluence, not hovering above it.  Remember this next time you hear a politician tell you they are 'being guided by' or 'following' the science.

Part 1 of this series is available here and Part 2 here.

Science, expertise and trust in COVID times - Part 2 - why trust experts now?

There have been many well-publicised examples, in recent years, of politicians expressing mistrust in experts.  ‘People in this country have had enough of experts’ was the view of leading UK politician Michael Gove in 2016, although he later clarified he mainly had economists in mind. US President Donald Trump has called global warming ‘bullshit’ and a ‘Chinese hoax’. In Australia we have seen some parliamentarians assert that vaccination causes autism, or that climate change is a fabrication, despite strong evidence to the contrary. We have seen a special commissioner appointed in Australia to investigate ‘Wind Turbine Syndrome’ despite no expert believing such a syndrome exists.  Not all suspicion of expert knowledge was unfounded. Leading economists, blinded by economic orthodoxy, had not seen the 2008 financial meltdown coming, although there were some honorable exceptions.

In this crisis, faced with something new, dramatic and dangerous, most political leaders turned to the experts - infectious disease and public health experts, virologists and epidemiologists especially.  Not surprisingly, and with some notable exceptions, they wanted to know how serious COVID-19 was, what devastation it might wreak, and what they should do.  

It is now common to hear politicians of various political stripes talk of how their actions will be ‘guided by the science’, by the health experts and epidemiologists in particular (see for example the UK but not Brazil‘s Bolsonaro).  In the USA, those of a ‘liberal’ disposition (in the US sense of the word) have been re-assured by the presence of Dr. Anthony Fauci.  He has been seen to be a well-informed and calm voice of reason amidst the daily briefings, rantings, and policy flip-flops of a dysfunctional White House and its blame-others boss.  

It is important to acknowledge quite how unusual this is.  Despite common talk of evidence-based policymaking being the gold standard, it is more common to find evidence being recruited to support a desired policy.  We should expect to see this approach returning as the pandemic progresses. Further, strong evidence has not always resulted in strong policy and action.  Climate change is the most obvious, but not the only, example.  Expert opinion is that dramatically cutting fossil fuel use is needed to avoid catastrophic climate change, but actions by government to address climate change have been largely underwhelming and indeed such ‘expert’ opinion has often been rejected outright.  Expert opinion is that hunger is the lot of 842 million people worldwide. Nine million people in the world die of hunger each year, more than the combined death toll for malaria, AIDs and tuberculosis - but action in response is modest. According to experts, air pollution kills millions annually, mainly poor people.  Many have noted the improvement in air quality as one positive side-effect of the COVID-19 lockdowns.  In short, evidence does not normally result in action. 

This crisis has seen an unusually prominent role played by Chief Medical Officers, Chief Scientists and other leading public health experts. Acknowledging the need for expert perspectives was not always there from the start … witness the persecution of Chinese doctors in Wuhan who first flagged the problem, or Trump’s reluctance, even in late March, to acknowledge that anything needed to be done to combat what was only ‘flu’.  But once the crisis was recognised the general trend was to turn to public health experts, virologists and epidemiologists for advice. 

Why this renewed use of experts?  I can think of four basic reasons. 

Firstly, the political class genuinely didn’t know what to do in the face of this unprecedented event, COVID-19.  They could not draw upon their stock solutions (trade good, taxes bad, ‘it’s the economy stupid’, and so on).  Their initial attempts were usually confused and slow.  Having neither knowledge nor experience themselves, they looked around for those who might have. This knowledge was often unavailable in-house following years of degrading the capabilities of the public service.

Secondly, for many, but not all, citizens, being seen to take expert medical advice would enhance trust in the political leaders.  Politicians could benefit from being seen to be taking advice. A lack of trust in the political class, its motives and competence, has been widely observed in recent years.  Not surprisingly, therefore, there was good reason for the political class to draw on existing public health expertise.  Bolsanaro’s open rejection of such advice, and his dismissal of his Health Minister, is hurting him politically.

Thirdly, rich and middle-class people are affected.  Unlike hunger, COVID-19 is said not to discriminate.  But, like hunger, it hits the poorest… witness the profiles of those dying from the virus in the USA, or the shockingly unjust treatment of rural migrant workers in India.  Whilst the very wealthiest can ensure more comfortable lockdown conditions and better medical treatment if required, they can’t avoid being infected.  When it is said ‘this disease does not discriminate’ this means the rich are getting it too and so the political class must act.

Finally, one can also anticipate some political leaders using experts as the ‘fall guy’ if management of the pandemic does not go according to plan or too many undesirable effects occur.  We already see this in Trump’s attacks on the World Health Organisation (WHO) and his re-tweeting of attacks on Fauci.  The most high-profile expert advisors, those appearing on TV regularly alongside their political bosses, would be well-advised to project independence of mind now, both in words and body language, if they want to survive.  

An official reckoning with how the pandemic was managed will surely come.  Expect it to reveal the hollowness of the claim that policy was ‘guided by the best available science and evidence’.  What science and what evidence?  Scientific views differ, different disciplines produce different insights, and evidence can be contradictory.  Perhaps it will also expose the limits of ‘follow the science’ thinking itself, the perils of scientism more generally, and the need to understand that science and technology is a social institution needing social inquiry.

Leading scientists are themselves worrying about being sucked into a vortex.  'As a scientist', Prof Devi Sridhar, chair of global public health at the University of Edinburgh, is reported as saying, 'I hope I never again hear the phrase "based on the best science and evidence" spoken by a politician. This phrase has become basically meaningless and used to explain anything and everything.”  According to Prof Mark Woolhouse, an infectious diseases epidemiologist at the University of Edinburgh, modelling has had a disproportionate influence: 'scientific advice is driven far too much by epidemiology - and I’m an epidemiologist'.

Trust in experts and faith in science should not be a given.  Trust needs to be earned.

In the next instalment I will focus on ‘why experts differ?’

Part 1 of this series is available here

Science, expertise and trust in COVID times - Part 1

Are ‘experts’ and scientists fashionable and trusted again?  The high profile role of medical experts and chief medical officers on daily TV, suggests that they are.  ‘It has already forced people back to accepting that expertise matters’ is the view of Professor Tom Nichols, author of The Death of Expertise.  On this reading, COVID-19 may herald a welcome reversal of the ‘post-truth’ turn and an acceptance that facts matter and expertise counts.  

There are, however, many reasons not to embrace such re-assertions of expert authority uncritically.  Many challenging questions about science and this crisis, and expertise more generally, will start (re-)emerging.  They already are.  Whilst experts may indeed have specialised insight into particular issues, they are not simply bearers of ‘truth’ or there to unveil facts which have hitherto been hidden.  And when politicians say they will be ‘guided by the science’ we should be as alert to deception as when they told us ‘people have had enough of experts’.

Much depends on how the science is conducted, for whom, and the ends to which it is mobilised.  In a democratic society, experts must be open to challenging questions beyond those envisaged by peer review: how do they know what they know? what knowledge and wisdom have they included and what have they omitted? what assumptions and values infuse their research? what are the social costs and benefits of their research? what conflicts of interest might exist? and so on…. If we want experts to be taken seriously and expertise to be recognised, then rather than proclaiming the need to trust scientists and have faith in the authority of experts, we should acknowledge that the rightful place of science is within, not above, society. 

In an analytical piece, ‘Never Waste a Crisis’, written in mid-March, my co-author and I suggested that faith in experts will increase short-term but decrease longer-term.  We didn’t elaborate at that time.  Here I try to do so.

First, some preliminary observations.

A pandemic was not unexpected.  Observers of global trends have long been aware of the risk of a major global pandemic, that it was a question of when not whether.  Historians of infectious disease have known of the devastating impacts these have had in the past.  Infectious disease specialists, virologists and epidemiologists have long flagged up the need to prepare for such an eventuality.  Specialist facilities exist in many countries charged with tracking, planning for, and responding to potential outbreaks – the Center for Disease Control (CDC) in the USA being only one example.  The World Health Organisation (WHO) has significant responsibilities too.

Many governments and public health specialists conduct regular exercises to test their preparedness for such events. Examples include Exercise Cygnus in the UK in 2016, and a major global pandemic preparedness exercise, Event 201, held in the USA and organised by Johns Hopkins University, the Gates Foundation and the World Economic Forum (WEF) in October 2019.  In both these exercises it became clear that governments and health authorities were not well prepared.  The Gates Foundation has many shortcomings, as does philanthro-capitalism generally, but warning of pandemic risk over many years is not one of them.

Although pandemic risk was widely known, it was low on the priority list of many political leaders and thus received little, if any, attention: although there is some evidence that the leadership of countries in East Asia and parts of Africa, with recent experience of SARS, MERS and Ebola may have been more attentive.  

Global business leaders were aware of the risk but generally regarded it as low priority, perhaps not surprising given that their horizons are typically short-term and self-interested. The latest WEF-sponsored Global Risks Report, released in mid-January 2020 ahead of the annual Davos elite-fest, and with coronavirus already spreading, hardly mentions pandemics.  It was not on the Report’s list of ten ‘most likely’ global risks and was rated 10^th on the list in terms of impact should it occur.  This expert assessment now looks ridiculous.

Whilst in a general sense a pandemic was not unexpected, it is also true that this particular pandemic, COVID-19, was not expected. There was also, perhaps, complacency that any new pandemic might be contained, like SARS and MERS had been.  Some have called COVID-19 a ‘black swan’ event, an event with major effects but which comes as a surprise (and also an odd term in Australia where black swans, the birds, are not uncommon).  COVID-19 is a novel coronavirus in the sense that it is new and previously unknown in humans.  We are still in the early stages of understanding its progression, infectiousness and characteristics, and how to manage it absent a vaccine … although scientists and intensive care medicos on the frontline are learning fast.  In this context it is important to acknowledge ignorance.  There are many things about COVID-19 which experts do not know, at least not yet.

We are therefore in a paradoxical situation.  Experts have warned of pandemic risk for many years and governments mainly chose to remain ignorant, or at least failed to invest in preventative strategies and public health. Now with governments struggling to catch-up and learn about pandemic management, the experts find themselves, not surprisingly, deeply ignorant of this particular virus, and rushing to catch-up.

In the next instalments I’m going to reflect on four questions in relation to COVID-19:

1.     Why trust experts now?

2.     Why do experts differ, and does it matter?

3.     Which experts should we be relying upon in this crisis, and what facts matter?

4.     What to do about obvious misinformation?

Science, expertise and trust

I'm working on a lengthy blog post on expertise and COVID-19.  Here's the intro.  The rest is still to come ....  Watch this space.

Are ‘experts’ and scientists fashionable and trusted again?  The high profile role of medical experts and chief medical officers on daily TV, suggests that they are.  ‘It has already forced people back to accepting that expertise matters’ is the view of Professor Tom Nichols, author of The Death of Expertise.  On this reading, COVID-19 may herald a welcome reversal of the ‘post-truth’ turn and an acceptance that facts matter and expertise counts.  

There are, however, many reasons not to embrace such simplistic re-assertions of expert authority.  Many challenging questions about science and this crisis, and expertise more generally, will start (re-) emerging.  They already are.  In the analytical piece which kicked off this blog, we suggested that faith in experts will increase short-term but decrease longer-term.  But we (my co-author and I) didn’t elaborate at that time.

There are bad reasons for the widespread mistrust of experts.  But there are good reasons too.  Our challenge is not to proclaim the need to trust scientists, to ‘follow the science’, and to have faith in the authority of experts.  Rather, it is to acknowledge that the rightful place of science is within, not above, society.  Science is a social practice too, not simply a knowledge revealing one.

Bear with me as I work through the issues as I see them.