Posts Tagged ‘LSE Comment’

COVID-19 as the ultimate leadership challenge: making critical decisions without enough data

Portrait photo of Professor Martin LodgeHeadshot of Prof Arjen Boin, University of LeidenMartin Lodge and Arjen Boin discuss the political decision-making challenges of the novel coronavirus pandemic. They look at past crises and analyse three types of coping strategies available.

We are in crisis. The COVID-19 pandemic is causing an escalating number of victims and a free-falling global economy. It is likely to get much worse before we will see any improvements. COVID-19 is emerging as the ultimate test for political leaders. Competing views exist as to whether national political leaders are ahead or behind ‘the curve’ of fast-changing dynamics. They are clearly struggling.

Leaders are facing an inevitable task. They have to make critical decisions, but they lack data. The most basic knowledge is missing: we don’t know how many people have been infected, how many people have died from this disease, how many patients will flood the hospitals in the coming weeks, and how the essential economic and state infrastructure is going to perform.

But there is more uncertainty. There is uncertainty about the reliability of information flows (can we trust the data from this or that country?), uncertainty about how to evaluate advice (how do we deal with health experts who offer competing interpretations of the data?), and uncertainty as to how different interventions will effect populations and achieve desired outcomes (will social distancing protect the particularly vulnerable?). There is uncertainty as to whether proposed strategies will come with irreversible consequences (will our economy recover?). In short, leaders have to make life-or-death decisions under conditions of deep uncertainty.

Making sense of a crisis is one of the hardest tasks in crisis management. Having to decide without knowing creates a terrible conundrum that weighs down on leaders. How do leaders deal with such pressing uncertainty? We know that most people do not like uncertainty. There is, we are told, a human and organisational tendency to create a convincing narrative based on the little information they have – a narrative that explains what’s going on and suggests an answer, a strategy. People, and organisations, are also said to stick with that narrative for a long time, disregarding emerging evidence suggesting they are wrong in their assessment.

How do leaders respond to such existential uncertainty? If we look at past crises, we can recognise three types of coping strategies.

Sit tight, do nothing: it can pay to wait it out. If it works, leaders will be praised (they are ‘shrewd’). If it does not work, history won’t be kind (leaders were ‘paralysed’). The Dutch Prime Minister Hendrikus Colijn famously dismissed the threat of a German invasion, hoping to remain neutral as the Dutch had managed to do during World War I.

A principled approach: leaders adopt a principle (‘minimise harm’) and apply consequential logic (in this case, this is widely known as the ‘better safe than sorry’ precautionary principle). It has the advantage of sending a clear signal to wider society. It seems, at first sight at least, to address the problem. Politically, it has the advantage of looking statesmanship-like. Also, if it works nobody will revisit it in hindsight. This is a favourite approach of leaders, because history suggests it is what real leaders do: we shall fight on the beaches (Churchill), we will smoke ‘em out of their holes (Bush), we will do whatever it takes (Draghi) or we will turn the tide (Johnson).

Debates about this precautionary leadership principle are widespread in everyday life: think GM-foods, e-cigarettes or the use of personal data. In situations of crisis, such a ‘better more than less’ approach seems reasonable given widespread uncertainty. It nevertheless comes with a few challenges: it requires a high degree of state authority, it is difficult to change tack if the dynamics of the situation seems to be requiring an altered course of action, and it may be prone to knee-jerk reactions and over-investment.

A Pragmatist approach: leaders forego dominant principles and base their actions on a mixture of reasoning and feedback. They treat the situation as an experiment: try something that might work, study the consequences, and adjust where necessary. The underlying idea is that a crisis will gradually yield its secrets, when probed in a careful manner.

This is undoubtedly an advantageous approach in many respects, as it foregoes big, irreversible decisions that result in large unintended consequences. Instead, it allows for immediate adjustments on the basis of instant feedback. This Pragmatic approach is, however, dependent on some fundamental pre-requisites. The working hypothesis needs to be carefully argued, based on scientific reasoning (the way NASA built its moon rocket). Quick feedback needs be organised and requires almost immediate responses. Time-lags, therefore, need to be extremely short and responses need to be ready to deal with sudden non-linear dynamics. Feedback will create a constant stream of dilemmas, if not polylemmas. Perhaps most challenging, leaders need to explain that they are experimenting in the face of crisis and other jurisdictions’ contrasting approaches (a principled approach is a much easier sell). If all these pre-requisites are in place, then decision-makers can utilise incoming information to respond ‘thermostat-like’ to emerging knowledge.

So far the theory. How are leaders actually doing in this crisis? The current crisis provides an example of decision-making under conditions of deep uncertainty, where the potential harm is irreversible (in terms of death count and economic damage, not just political careers). It also throws light on how ‘precautionary’ or ‘pragmatist’ approaches work in practice.

Let’s start with what we know and don’t know. We know the novel coronavirus is super contagious and that it can cause a nasty death. We know that the elderly are much more likely to die from it. And they will occupy scarce commodities for a long time, placing already over-stretched health systems under potentially unbearable pressure.

How do leaders cope with this limited knowledge challenge? The ‘wait and see’ approach has been popular with autocratic leaders: Iran, Russia, and the United States have long denied the presence and potential impact of COVID-19. No response was initiated, at least initially.

A few leaders have sought to adopt a Pragmatist approach. The Dutch Prime minister Rutte is a prime example. Rutte explained that ‘the reality is that nobody knows what the correct approach is [..] with 50% of the knowledge we have to make 100% of the decisions’. Rutte roundly rejected the principle of a societal lockdown. The Dutch would rely on scientific data, ‘adjusting the dials’ when and if necessary. Rutte has found it hard to explain the working hypothesis underlying his Pragmatist approach, even in the face of mounting criticism.

Sooner or later, most leaders seem to adopt a principled approach in this crisis. In the early phases of the pandemic, some leaders embraced the principle that the economy should be protected. The ferocious backlash pushed most leaders to adopt the principle of minimise harm, in health and economic terms. The language is clear: we are in a battle! This will hurt. We will have to wait this out. There is no turning back. This frame provides a clear and actionable path: supposedly ‘hollowed out’ nation-states can display their coercive ‘muscle’ in intervening in societal and economic spheres, national boundaries are being reasserted, and solidarity comes as a bonus. The price of this approach will be considered at some later point in time.

This is not the time or place to condemn one approach or support another, or to suggest that one government’s approach is superior to another. For advocates of the Pragmatist approach, one lesson is clearly emerging. Under conditions of uncertainty, creating and communicating a Pragmatist frame is super difficult. It simply cannot work if the underlying logic is not clear and consistent (within and across countries). For the Pragmatist leaders, the drama of today’s crisis leadership may well be the premature convergence towards a principle that is costly and unproven. For those leaning towards a precautionary position, in contrast, the drama of today’s crisis leadership is likely to be the belated convergence towards a precautionary approach where questions of cost and lack of early decisiveness will have caused unnecessary strain.

As we seek to learn from crises, we must study decision-making in situations of uncertainty. Post-crisis judgments of leaders can get rough. But they are trying to make sense of a crisis, one way or another. The current crisis can help us understand – especially when the evidence rolls in – how these approaches perform.

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Note: the above was first published on the TransCrisis blog. Featured image credit: Brian McGowan on Unsplash.

About the Authors

Portrait photo of Professor Martin LodgeMartin Lodge is Professor of Political Science and Public Policy and Director of the Centre for Analysis of Risk and Regulation (CARR) at LSE.

Headshot of Prof Arjen Boin, University of LeidenArjen Boin is Professor of Public Institutions and Governance at the University of Leiden.

Abortion and COVID-19: why we need to support women’s right to abortion in health emergencies

Clare Wenham, Ernestina Coast, Katy Footman, Tiziana Leone, Rishita Nandagiri, and Joe Strong discuss the UK government’s apparent U-turn over medical abortion during the novel coronavirus outbreak. They draw on their own research and other evidence to make the case for women being able to take abortion medication at home, following a phone or video consultation.

On 23 March, the Secretary of State for Health and Social Care approved emergency measures relating to abortion regulation which would have revolutionised abortion practice in England. Women would be able to take abortion medication in their homes, without having to travel to a clinic first, with a consultation over the phone or video link. This was explained as accounting for self-isolation guidelines and the limited opportunity women would have during the COVID-19 outbreak to seek abortion, potentially  leading to a number of unwanted pregnancies being forced to continue or women being forced to resort to illegal or unsafe methods to terminate them. Moreover, self-isolation may lead to an increase in sexual activity amongst some, not to mention the increased risk of sexual violence within quarantine settings. Thus, this change in regulation was heralded as a major breakthrough for emergency management of COVID-19 and meeting women’s reproductive needs. That being so, it was remarkable that within five hours of this announcement, came the following ‘This was published in error. There will be no changes to abortion regulation‘.

The British Pregnancy Advisory Service has estimated that 44,000 women in England will seek early abortion in the next 13 weeks. There is a clear need to consider the impact of COVID-19 self-isolation on all reproductive health services, and notably abortion. Not only can remote provision of healthcare ease the growing pressure on the health system, but without this option, women who find themselves with an unwanted pregnancy will be forced to choose between exposing themselves or healthcare workers to the risk of infection with COVID-19 in clinic waiting rooms, or to continue with a pregnancy they do not want. Others may choose to access abortion medications online illegally, or resort to using unsafe methods. Within this discussion, there has also been no consideration of access to contraception, and whether this might be affected through supply chain disruptions.

This is part of a broader global debate surrounding the use of medical abortion (the use of misoprostol and mifepristone to interrupt early pregnancy). Considerable research has shown that medical abortion is an effective method for termination in early pregnancy; it is cheaper than surgical abortion; and when women have a choice, they express a preference for medical abortion. There is also evidence to show that the medications can be safely provided using telemedicine, and that there are no greater safety risks to taking the medications at home. Following regulatory changes in Scotland and Wales, regulations in England changed to allow women to take the second set of pills at home, but an unnecessary clinic visit is still required to take the first pill. Two doctors’ signatures are also still required for a woman to access an abortion in the first place, despite advocacy by the Faculty of Sexual & Reproductive Health of the Royal College of Obstetricians and Gynaecologists petitioning for this to be changed during COVID-19 for only one doctor, midwife or nurse required to ensure women can access care and reduce unnecessary burden on the health system.

As with all emergencies, COVID-19 allows for a time for regulatory pause, change, and reflection. We researched the impact of Zika on women’s decisionmaking on abortion in Brazil, Colombia and El Salvador. In places where abortion is highly restricted, requests for medical abortion services through telemedicine portals saw a significant increase during the Zika public health emergency. Whilst the nature of Zika was different to coronavirus – some women may have sought abortion because of concerns about congenital zika syndrome – this COVID-19 health emergency will impact women’s decisions around pregnancy and abortion. Self-isolation puts physical barriers to accessing services, including contraception, and for some women it increases the risk of pregnancy as a result of sexual violence. What we also know is that legislation does not impact women’s decisionmaking about whether to have an abortion. All it means is that women might be forced to consider illegal or unsafe abortion methods, which directly increases social, legal, and health risks to these women. However, as we discovered when we started our research on Zika and abortion, there was no evidence in the public domain on the intersection between health emergencies and abortion.

So much concerning the COVID-19 outbreak is unknown: medical research is desperately trying to come up with answers to how the virus spreads, whether vaccine or treatment options will work, whilst epidemiologists and modellers are deciding on transmission and the utility of public health interventions. Meanwhile, hospitals across the UK are at breaking point with over-burdened health workers and facilities which are putting the NHS on the brink of collapse. With all this uncertainty, some ability to be able to limit unnecessary in-person interaction with health services, which keeps women at home and safe, using evidence-based methods of providing reproductive health care would benefit all involved. Policy-making on abortion has a history of ignoring clinical evidence which makes it so disappointing that this very forward-looking policy of telemedicine for abortion was abruptly withdrawn without explanation or justification, despite parliamentary and public pressure.

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About the Authors

Clare Wenham is Assistant Professor of Global Health Policy at the LSE.

Ernestina Coast is Professor of Health and International Development at the LSE.

Katy Footman is Senior Researcher at Marie Stopes International.

Tiziana Leone is Associate Professor in Health and International Development at the LSE.

Rishita Nandagiri is Fellow in Health and International Development at the LSE.

Joe Strong is a PhD candidate at the LSE.

 

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: by Priscilla Du Preez on Unsplash.

COVID-19 and the language of pathology: when public health vocabularies advance into parallel domains

Jonathan White explains why analogies associated with public health tend to be used in areas unrelated to the latter, such as the economy and migration. He writes that such perspectives can often be a way to rationalise limited intervention on the part of authorities, as well as to detach issues from their social and political context, limiting this way individual responsibility. 

Much analysis of the new coronavirus focuses on the medical challenges and economic costs. But the problem also has significance for how policy-making is conceived and conducted. As the public agenda becomes focused on disease control, related political issues are liable to be cast in its image. Faced with a virulent pathogen, everything starts to look like a virus. An approach well suited to fighting infectious disease can re-emerge in fields less appropriate, weakening the capacity for directed change.

The language of pathology has been central to current affairs for some time, nowhere more so than in descriptions of the economy. ‘Contagion’ in the markets, ‘transmission mechanisms’ and the ‘exposure’ to risk are common terms of analysis. Well before Covid-19, epidemiology had become a rich source of analogy for grasping financial capitalism, encouraged in part by the experience of health emergencies. The concept of contagion became increasingly popular in the late 1990s during the Asian financial crisis (or ‘Asian flu’), as economists and IMF policy-makers took inspiration from colleagues in the study of disease. Historians observe that interest in the tools and terminology of epidemiology tracked a series of outbreaks – avian flu (1997), SARS (2002) and swine flu (2009) – that seemed to illustrate their utility. The effect was to popularize concepts that would shape the description and management of the Great Recession, notably in the Eurozone crisis of the early 2010s.

Migration policy is another area where this outlook has been adopted. Openly racist views, in which migrants are cast as spreading disease or even as a disease themselves, are just the crudest expression. One sees traces of epidemiological thinking also in less dramatic official responses to the movement of people. The concept of the ‘hotspot’ became central to Europe-wide policies aimed at controlling inward migration in the autumn of 2015, denoting places of concentrated irregular migration on the EU border. Hotspots would become sites of targeted measures and intensified monitoring, bringing together local officials and supranational agencies in ‘frontline’ member-states. EU border control continues to be administered in these terms.

As metaphors and analogies associated with public health advance into parallel domains, they join those drawn from other aspects of the natural world – storms, floods, forces and the effects of gravity. With the appearance of the new coronavirus, one can expect the immediate appeal of these naturalist imageries to grow – see recent talk of ‘vaccinating the economy’ and building its immunity. These perspectives are widespread because they suit some powerful interests, and resonate also with some ingrained ideas about the nature of economy and society. More than just suggestive turns of phrase, they express a deeper political logic.

Most of the time, naturalising perspectives can be a way to rationalise limited intervention on the part of authorities. When socio-economic challenges are cast as the extension of natural forces, they invite lowered expectations about what policy can achieve. Problems can at best be managed and tamed, and to the extent that causes are sought they tend to be treated as brute facts – things that can be factored in but not altered. Policy-making is cast as essentially reactive, responding to dynamics already in progress.

Conversely, when the costs of a laissez-faire outlook become unsustainable, the naturalising view doubles up as a licence to break with existing commitments, whether policy promises or legal constraints. When something is likened to an infectious disease, it is likened to what is unpredictable and apt to develop exponentially, inviting actions that bend to the demands of the moment. Logical as this may be for handling an epidemic, it offers a free pass for discretion and inconsistency in other aspects of government. And when restoring health is the implied goal, one can expect this to combine with a conservative orientation towards much of the status quo.

A key connotation of policy as contagion-control is that officials face challenges not of their making. The problems at hand – in finance, migration, social order and elsewhere – are cast as spontaneous developments rather than the effect of past choices. Comparisons with contagious disease detach issues from a broader social and political context. This is, of course, one way officials may seek to lighten their responsibility. When the challenges they face are naturalised, they arise through no fault of their own. For those charged with administering an economy prone to crisis, made that way partly by policy decisions, the appeal of notions like contagion is understandable. Similarly, one sees the attraction of attributing all manner of difficult circumstances to the appearance of a virus (see e.g. the March UK budget): economic stagnation whose causes are long-standing, along with a host of unwelcome social conditions, are then redefined as maladies that emerged from nowhere.

Perhaps the most basic reason these perspectives stick is because they accord with how economy and society tend to be viewed. Only once ‘the economy’ is seen as a system of its own with its own dynamics, independent of particular human wants, values and experiences, can it be approached in these naturalising terms. Before such an outlook can be applied, economy and society must be conceptually detached. Likewise, only once one has developed an abstract category of ‘migration’ can people on the move be approached as the bearers of natural forces. The naturalising view builds on the separation of systems from persons.

One implication of infectious disease is to build the appeal and plausibility of a policy-making template too easily transferred to other domains – a template in which the role of officials is to use discretionary means to manage problems of nobody’s making. However crucial the input of epidemiology today, such an outlook will hardly suffice to handle the socio-economic challenges heading our way, for which transformations rather than remedies seem needed. Today it is evident like rarely before how far crises are bound up in the structures and priorities that societies embrace. Out of the upheavals of the period to come one must hope a different kind of consciousness emerges, more receptive to how the social world is irreducible to the natural.

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About the Author

Jonathan White (@jonathanpjwhite) is Professor of Politics at the LSE.  His latest book, Politics of Last Resort: Governing by Emergency in the European Union, was published with Oxford University Press in 2019.

 

 

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science.

 

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