Despite the fact that the number of cases is now rising sharply again and we have now entered a lockdown ‘light’, we in Germany are rightly pleased that we have so far come through the corona crisis much better than many of our neighbors or the USA. Was the ‘German way’ perhaps so successful because politicians in Germany had an open ear for science and therefore prescribed the right measures based on evidence?
That sounds plausible, but unfortunately there is little evidence for it. Because up to now, science has provided little evidence as to whether and which measures (e.g., lockdown) or scenarios (e.g., a functioning and well-prepared health care system) were effective. This is tragic and does not cast a good light on science. Because this knowledge would now provide us with important arguments as to what should be done and what should be avoided to prevent overcrowding in intensive care units in autumn and winter, while at the same time ensuring as normal a life as possible.
A closer look will also show that there has been little evidence-based advice from science to politicians. But wait, in Germany we have the Virologist Christian Drosten, who advises politicians and also communicates science better and more widely than anyone before him? And a physicist as chancellor, who kicks off meetings of the federal prime ministers with keynote speeches by epidemiologists? And a Minister of Health who, although trained as a banker, argues rationally and seems open to advice from science? Is that not enough? I am afraid not.
Without exception, politicians in all countries, from Albania to Zambia (including the USA), stress that their corona measures are based on ‘best available science’. But who decides what this best available scientific evidence is? The politicians themselves, of course. Because the evaluation, prioritization and use of scientific evidence follows political reckoning. This means taking into account other state interests, such as the functioning of the economy. And of course a view on upcoming elections. One could call this, in Darwinian terminology, ‘Political selection: The survival of the ideas that fit’.
Moreover, what would ‘best available science’ be in times when ‘Covidization’ is further increasing the already impressive mountain of scientific waste? Where the inflation of hastily produced results, some of which are communicated at press conferences, makes it increasingly difficult to separate signal from noise, and where evidence synthesis is doomed because of ‘garbage in, garbage out’. In a very short time, ‘Research exceptionalism’ has spread with the maxim: ‘In times of a pandemic, bad data is better than no data’. Several thousand clinical trials are currently testing COVID therapies. And many more are in the make. Unfortunately many these studies will never deliver useful results – among other reasons because the will be unable to recruit the planned number of patients.
But what attributes must scientific policy advice have to serve as robust basis for decisions on non-pharmacological interventions against the virus? It would have to be committed to four principles, of which, alarmingly, not a single one is currently taken into account. The principles are: Inclusivity, rigousness, transparency, and accessibility.
Inclusivity means that all available sources of evidence and expertise must be systematically taken into account. This means not only from virology, but also from epidemiology, immunology, hygiene, public health, and of course from other relevant non-biomedical domains. The quality of available evidence from studies has to be evaluated objectively by means of clearly formulated validity criteria. Thorough and robust advice is given when it considers limitations, biases and conflicts of interest underlying the knowledge base as completely as possible and minimizes them. Consulting is transparent when its mandate and task is clearly formulated. Assumptions, limitations, uncertainties and open questions must be clearly identified. Potential conflicts, which can be personal, political, commercial or organizational, must be disclosed and controlled. Consultation results are freely accessible and available to everyone and formulated in understandable language.
It all sounds simple and obvious, but is this even possible in times of a potential massive threat? Especially when decisions have to be made very quickly? Yes, this is possible, but one needs to be well prepared for an emergency, such as that caused by a previously unknown virus. Then at least structures would be in place that allow the establishment of such an advisory body in the shortest possible time, adapted to the specifics of the current threat. In addition, one could start with an acute evidence synthesis, which does not yet meet all the criteria mentioned above, but which will be further optimized over time. Reagarding Corona, considerably more than half a year has passed, and nothing has yet happened in this direction.
Perhaps you might object that plenty of advice is already available to politics. Experts have spoken out, in Germany the likes of Drosten, Streeck et al. The Germany National Academy of Sciences (Leopoldina), which gives recommendations. In addition, a large number of professional societies and organizations have formulated well-meaning analyses and proposals. Yes, one could even fear that there is too much, and not too little, policy advice. But the currently available advice, and its influence on political decisions, does not follow any of the principles mentioned above. It is essentially eminence-based, because it comes from ‘leading virologists’, or a ‘National Academy’, not from systematic analysis. It remains completely intransparent which experts were heard with which arguments – and which not. Which scientist or group has access to politics, when and why? Which opinions or findings have ultimately found their way into political action? What knowledge is particularly lacking and where should systematic procedures and studies therefore be prioritized? Due to the current lack of transparency in the procedure, it can only be assumed that the consultation was not inclusive. However, it is clear that important scientific disciplines were not involved in this discourse, if ever there was one.
There must also be strong doubts about the thoroughness of the current approach. Especially with regard to robustness, control of bias and conflicts of interest and the like, at least biomedicine already has its difficulties in normal operation. But doesn’t the course of the pandemic in Germany so far, especially in comparison to some other industrialized nations, prove that science and politics have done everything right in this country? The number of infections in Germany, as elsewhere, are rising massively, again. We have just introduced a curfew. On what basis? Do people then return home from pubs and get infected at private parties? Does the virus only become dangerous after 23 hours? In the media, virologists condemn this measure with the sound of conviction, shortly afterwards others defend it. What evidence is there for such measures? Has it been taken into account? And what evidence is there on the closure of restaurants or school?
Why didn’t we systematically produce the missing evidence in the past months? The effectiveness of a curfew is a classic example of an ‘evidence gap’, a gap in the assessment that one tries to close once it is identified. The same applies, for example, to the question of what actually happens when patients are no longer admitted to hospitals for elective procedures, or even sent home to keep beds free for COVID patients. After more than 8 months of the pandemic there are now over 50 million confirmed cases and over 1 million deaths worldwide. A Pubmed search with the term “COVID” results in over 70,000 hits (as of 14.11.2020). Rational scientific policy advice should have identified the most relevant gaps in knowledge much earlier and urged policy makers to provide funding to overcome them through high-quality research.
There is little evidence that evidence-based, inclusive, thorough, transparent, and accessible scientific advice for corona policy-making will emerge in the coming months after all. What remains is the hope that after the end of this pandemic, we will be better prepared for the next crisis – which will certainly come. This will not only include the need for enough masks, respirators, and medical staff. It will also involve a very fundamental reorganization of the relationship between science and politics in times of crisis.
A German version of this post has been published as part of my monthly column in the Laborjournal: http://www.laborjournal-archiv.de/epaper/LJ_20_11/22/index.html