Listening to science in policy design

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Antoine Lemor discusses the role of information selection and processing in policy design by studying school closure decisions during the early days of the COVID-19 pandemic.

Image courtesy of interviewee. September 11, 2024

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This video discusses the contrasting public health approaches taken by Sweden and Quebec during the COVID-19 pandemic, particularly focusing on their distinct public health advisory systems and decision-making processes. Sweden's public health agency operated autonomously, allowing scientists to lead and influence policy decisions, resulting in the choice to keep schools open during the pandemic based on evidence suggesting lower risks for children. In contrast, Quebec's public health agency was politically centralized and subordinate to the government's authority, leading to more conservative measures such as closing all educational institutions due to perceived risks.

The comparison highlights how differences in the organization of public health systems influenced responses to uncertainty and the framing of the pandemic as a health threat. In Sweden, uncertainty was interpreted in a way that prioritized children's development and minimized unnecessary measures, while in Quebec, uncertainty was viewed as a broader threat, justifying more stringent measures. The discussion emphasizes that political decision-makers, when equipped with less evidence, tended to enforce stricter policies, whereas scientific perspectives cautiously balanced health risks with societal impacts.

Moreover, the text explores how public health framing affected policy decisions, with Quebec’s framing emphasizing imminent threats leading to swift actions, compared to Sweden's moderate approach that considered various societal factors. Ultimately, the effectiveness of pandemic responses in Sweden and Quebec can be traced back to the power dynamics between political authorities and public health scientists in their respective systems.

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Here are five key points from the video discussing the comparison between public health decision-making in Sweden and Quebec during the COVID-19 pandemic:

1. **Institutional Differences in Public Health Advisory Systems**: The video emphasizes that Sweden and Quebec have fundamentally different public health advisory systems. Sweden's public health agency operates with significant autonomy and influences governmental decisions, especially during the pandemic. In contrast, Quebec's public health agency remains subordinate to the provincial government, particularly the premier, leading to a more centralized decision-making process.

2. **Impact of Decision-Making Processes on Policy Outcomes**: The contrasting institutional structures in Sweden and Quebec resulted in different policy outcomes during the pandemic. For example, Quebec chose to close all primary schools at the onset of the pandemic, while Sweden kept primary schools open, recommending remote learning only for secondary schools. This divergence highlights how the organization of public health systems affects the selection and application of evidence in policy-making.

3. **Handling of Uncertainty**: The video discusses how uncertainty regarding COVID-19 influenced decision-making. Swedish public health officials viewed uncertainty as a risk to children’s development if they implemented unnecessary measures, such as closing schools. In contrast, Quebec authorities perceived uncertainty surrounding potential transmission risks as a threat to the broader population, leading to more precautionary measures, such as school closures.

4. **Framing of the Pandemic**: The framing of the pandemic significantly affected public health responses. Quebec officials framed the pandemic as an imminent and severe threat, justifying stringent and immediate actions like lockdowns. Conversely, Sweden adopted a more moderate framing, balancing health risks with societal impacts, which allowed for more flexible measures regarding school closures.

5. **Influence of Political Convideo on Policy Decisions**: The analysis illustrates how the political convideo and the nature of political leadership impact public health decisions. In Quebec, the political leadership's interpretation of uncertainty led to conservative, risk-averse decisions. In Sweden, the scientific perspective guided the response, where more evidence was required to justify strict measures, reflecting a reliance on scientific guidance rather than political pressure alone.

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Here are some key quotes from the video, highlighting the main ideas and themes discussed:

1. **Comparison of Regions**:
- "It makes them comparable... [because they have] similar population and trust towards governments."

2. **Public Health Advisory Systems**:
- "Quebec and Sweden have, uh, fundamentally different public health advisory systems."
- "Only Sweden's public health agency operates with, uh, true autonomy."

3. **Decision-Making Process**:
- "This comparison allows us to observe the outcomes when public health scientists lead the decision making process as in Sweden versus when political leaders in Quebec are in charge."

4. **School Closure Decisions**:
- "Quebec chose to close down all primary schools... Sweden chose to maintain the opening of schools while recommending remote learning for secondary schools."

5. **Handling Uncertainty**:
- "The way political decision makers and scientists handle and interpret uncertainty can actually differ significantly and then have an effect on policy."
- "Scientists that tend to be more accustomed to uncertainty... but political decision makers... can perceive uncertainty as a threat for the public."

6. **Role of Evidence in Decision-Making**:
- "In Sweden, the public health agency... considered that the lack of solid knowledge... could not lead to the implementation of measures that could actually harm children's development, such as school closures."
- "The dangerous frame created a sense of urgency and justified the implementation of precautionary measures... even though the level of evidence can be low."

7. **Framing the Pandemic**:
- "Framing can then highlight certain aspects of a problem while downplaying others... and thereby shape the policies that are considered then appropriate."

8. **Impact of Political Control**:
- "When political decision makers are central in advisory systems, they tend to rely less on evidence."
- "When scientists are more essential, more evidence is needed to implement stringent policies."

These quotes encapsulate the significant themes of the video, focusing on the differences in public health strategies between Sweden and Quebec, the influence of political autonomy on decision-making, and the role of evidence and uncertainty in shaping health policies during the pandemic.

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Here are a few articles that discuss similar themes regarding public health responses to the COVID-19 pandemic, particularly focusing on differences in decision-making processes, the role of political authority versus scientific input, and the implications of these approaches:

1. **"The Role of Science in Public Health Decision-Making during COVID-19"**
This article examines how different countries integrated scientific advice into their public health policies during the pandemic, contrasting nations like Sweden that emphasized autonomy of health experts with those that relied heavily on government directives.

2. **"Public Health Responses to COVID-19: A Comparative Analysis"**
This research paper provides a comparative analysis of various countries' public health strategies during the pandemic, highlighting how political structures and scientific leadership influenced their approaches and outcomes.

3. **"Policy-Making in a Pandemic: The Influence of Politics on Public Health"**
This article discusses the tension between public health experts and political authorities throughout the pandemic, analyzing case studies from countries including Canada and Sweden to demonstrate how different governance models affected public health measures.

4. **"Framing Public Health: The Impact of Messaging on COVID-19 Responses"**
This piece explores how the framing of public health threats, like COVID-19, shaped responses in various regions, including a focus on how perceptions of risk influenced the implementation of measures such as school closures or lockdowns.

5. **"Learning from the COVID-19 Pandemic: Global Public Health Strategies"**
This overview highlights lessons learned from different countries' responses to COVID-19, focusing on the interplay between scientific guidance and political authority when addressing public health crises.

6. **"Children and COVID-19: Policy Responses in Different Jurisdictions"**
This article specifically examines the varied responses regarding children's education and health during the pandemic, analyzing how public health policies in different regions reflected broader societal values and risk assessments.

These articles should provide relevant insights into the themes discussed in the video regarding the interplay between public health decision-making, political authority, and scientific expertise during the COVID-19 pandemic.

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Important to, interesting to compare Sweden and,

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and, and Quebec.

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Well, it's two regions

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with distinct institutional structures

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and decision making processes, but similar population and,

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and trust towards governments.

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So, so it makes it, it makes them comparable.

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But more precisely, why is it interesting

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to compare these two regions?

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Well, Quebec and Sweden have,

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fundamentally different public health advisory systems.

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Basically, avise systems are structures through,

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through which governments, organize the use

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and the productions of evidence.

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So in public health, what you can do when you create a a,

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when, well, in your organiz of your address system, is

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to create a public health agencies

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that would produce the evidence in, in, in, in public case,

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and give it, give to the agency powers

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regarding health policies to design them.

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Only Sweden's public health agency operates with,

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true autonomy, meaning it get designed public, policies

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and through public re recommendations they did during,

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during the pandemic,

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and influence governmental decisions.

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But in Quebec, the public health agency, the NS Pku

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and the NS were during the pandemic

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and are still subordinate to the government,

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and particularly the premier, who was the main, well,

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the primary decision maker during the, during the pandemic.

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So one which is autonomous in Sweden, in in Sweden,

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in, in Sweden, sorry.

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And the other one who is government controlling Quebec.

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And this comparison actually allows us

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to observe the outcomes when public health scientists,

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lead the decision making process

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as in Sweden versus when political leaders in Quebec,

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lead, lead, lead, lead well are in charge.

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So in this context, one particular decision, the, the, the,

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the decision to close down school at the beginning

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of the pandemic can serve as a very interesting case,

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of, of the, of the effect of this differences in,

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in the organization of, of public health advisor systems.

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While Quebec chose to close down all primary schools

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and well all actually educational school, institutions

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during the pandemic, at the beginning of the pandemic,

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Sweden chose to close down to, to maintain,

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the opening of, of, of schools,

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while recommending remote learning for secondary schools

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and also, universities.

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Uh, and these differences can actually be linked

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to the way the public health visionary systems are,

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are organized in each country, which, as we said,

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influence the way the the evidence was selected, used,

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and even their, their uncertainty.

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We all remember during the, the pandemic policy makers that,

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that were stating,

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that they were following the science, right.

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Uh, but in reality, especially at the beginning

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of the pandemic in March, 2020 when they were implementing

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lockdowns and, and, and very stringent measures

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that we all know now, we actually

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didn't know much about the virus.

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We, didn't know.

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Well, it wasn't recognized at that time,

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even though there were studies about it,

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but the, about the prey, pre presymptomatic transmission or,

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Um, or even the, the, the characteristic, the,

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the exact characteristic of how the virus was spreading.

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So in some ways, policymakers were, were

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as much following the uncertainty

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as they were following the actual science.

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Uh, now what's interesting in that is that the way

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that political decision maker, and scientists handle

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and interpret uncertainty can actually differ significantly

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and then have an effect on policy in that, in that context.

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So scientists that tend to be more accustomed

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to uncertainty,

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because they actually work with it, their job is

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to actually reduce the uncertainty through more research.

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But political decision makers, on the other hand,

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they can perceive uncertainty as a threat for the public

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that they are, responsible for,

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and especially when it comes to, their health,

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leading them to approach it with more, coaching than,

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than, than than scientists.

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And this differences in the relationship

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with uncertainty then becomes very crucial

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during your health crisis.

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And when actually poli,

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public health visionary system grant more influence

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to scientists and their interpretation of uncertainty than

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to, politician

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who have different interpretation of uncertainty.

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So regarding school,

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school closure is a very good example of this.

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So in, in Sweden, where, as we said,

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the public health agency operated

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with significant o autonomy, well, the agency considered

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that the lack of solid knowledge, regarding,

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regarding the ity of the virus for,

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for children could not lead to the implementation of, of,

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of, of measures

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that could actually harm children's development, such as,

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so school closures, in other words, uncertainty was not seen

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as a health risk in itself,

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but as a risk if it led to a severe,

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but unnecessary measures for, for the children.

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Um, actually when, when they, when they, when they,

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when they recommended, to keep, schools open,

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they justified their, measure with a report,

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narrowly report of the WHO that was published at the end

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of February 20th, 2020, which was based on,

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on data from from China, which, showed that,

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the children were at lower risk

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of developing severe outcomes from COVID-19 than,

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for example, elderly people.

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And that they were also compared to other,

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other pandemics such as influenza, if, if influenza,

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not great, not big, vectors of transmission.

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So Swedish scientists, what they did is that they used this,

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this evidence to justify more targeted approach, a kind

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of unique approach compared to its neighbors and,

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and to Quebec, where they kept primary schools opens

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because they were not a, a high risk

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while recommending remote learning for,

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for a secondary school.

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Um, because actually, the report was showing that,

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individual plus 18 were, bigger vectors

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of transmission than the, than the children.

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And the strategy was part of what was coin as by literature

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as personalized, personalized lockdown approach

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where recommendations were tailored

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to specific groups based on their level of risk,

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evidence based level of risk,

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partly focusing on elderly people who were advised

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to stay at home at, at the beginning

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of the pandemic in which, was, criticized then,

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throughout the pandemic.

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But on the other hand, in Quebec, where,

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the public health adversary system was more politically

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centralized, it led actually led to a different outcome.

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The public health advisory system in Quebec, as we said, so,

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was more politically driven

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with a premier holding full control over the policies

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that were implemented.

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And the centralized, I, centralized, sorry,

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structures actually con contributed to a different,

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conception of, of the risk, a unified conception of risk

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where uncertainty this time was viewed as a danger

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to the en entire population, rather than

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as a danger if it led to unnecessary measures

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during press conferences.

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For instance, the premier and the head of the public,

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he health administration here, Dr.

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aa, who is a public official directly, subordinate,

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subordinated to the government.

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And the health ministry stated

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that while children were not at high risk themselves,

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they knew that,

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the government did not know, sorry.

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They could transmit the disease.

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They could actually transmit the disease to,

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to elderly, people.

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Um, this was said, even though at that time,

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the government could not know the prevalence

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of the virus throughout the population, so that uncertainty

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around the possibility of the children

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that could transmit the disease, even though they,

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they could not know about that transmission at that time,

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was seen as a threat to the entire population, leading

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to the closure of, of all educational institutions.

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So compared to to Sweden,

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this decision showed a more ous approach where the fear

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of the political consequences of underestimating the risks

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for everyone, and especially the elderly people,

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was considered too high leader

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to more conservative measures than in, in, in Sweden.

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But also, what I, what I wanna add is that responding

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to uncertainty, it also involve selecting certain pieces

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of information to fill the gaps

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that the uncertainty creates.

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So, in other words, when we, don't know about something,

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we tend, to rely on other sources

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and of information to inform us about,

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about the thing that we wanna know.

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Well, in an up upcoming study, that we've contacted

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with, with colleagues, we show that in Quebec,

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during the pandemic, actually public opinion data,

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so political information significantly influenced the way

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that the government

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and the decision makers used the hospitalization projection

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during, during the pandemic.

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What we show is that the more the government was supported

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by the public, and the more, they tended to follow,

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hospitalization, projections, the projects of

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of their own experts,

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and this is actually one way to manage uncertainty.

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'cause since it was impossible to know

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with certainty the evolution of the pandemic,

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because the projections were still uncertain, we,

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we could not know how the people were reacting to measures.

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Well, one way to manage that uncertainty was

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to rely on other, so sources of information here,

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political information, public opinion data,

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and the fact that Quebec's Public Health advisory system was

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politically centralized,

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it actually played a key role in allowing,

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allowing such influence.

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The beginning of the pandemic. The, the government asked,

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asked a firm to produce this, these data,

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and we tried, actually tried to conduct a comparative study

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with, with Swedish Sweden.

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So we asked the public health agency to give us,

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the data, public opinion data

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that they could have produced, but they just didn't.

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Um, so what it shows is that the way that public health,

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system are organized, have an influence on

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how uncertainty is, is, is interpreted,

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how evidence is used,

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but also how other information,

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what informations are produced to,

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as a response to that uncertainty.

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And in Sweden, in Sweden,

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because it was public health agency,

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which was leading the response, well,

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the focus was more directly on health related studies.

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They actually made studies, but it was opinion studies,

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but it was based on the relation, the, the,

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with the relationship of, of people with their health,

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not the, the support for the government

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or the measures themselves.

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These differences in handling uncertainty were not just

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about cous versus a more evidence driven approach.

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It was, it was also deeply rooted in

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how the COVID-19 was, was defined and framed.

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So in social science framing refers to the way that,

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problems are, defined, presented

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and inter interpreted

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because, problems are multidimensional.

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So we tend to focus on one dimension

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of the problem rather than on, on another.

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But focusing on one dimension of the problem tend

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to then influence the way that we interpret the problem.

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And so the solution that we, want to use to, to,

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put an end or to, to fix the problem.

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So framing can then highlight certain aspects of,

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of a problem while downplaying others,

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and thereby shape the, the policies

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that are considered then appropriate.

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So, for example, we can frame the pandemic as an imminent

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and survey threat to threat, sorry, to human health,

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focusing on, on the dangers of the disease in terms

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of death, hospitalization,

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yeah, death or, or hospitalization.

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But the hospitals are just overwhelmed, overwhelmed of,

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of overwhelming of hospitals,

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what we might call here a dangerous frame.

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So a dangerous way to define the, the,

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the, the, the pandemic.

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But alternatively, you can also define the, the problem,

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such as to, moderate the, per that perceived threat to,

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human health by also emphasizing other dimensions

11:52.565 --> 11:55.205
of the problems such as the ne ne negative impacts

11:55.205 --> 11:57.445
of drastic measures on mental health, on,

11:57.445 --> 11:58.525
on economic downturns.

11:58.585 --> 12:01.485
And as the, the, the case of, the case of,

12:01.585 --> 12:03.965
of schools show on the development of children,

12:04.435 --> 12:07.485
what we might call so moderate, moderate frame,

12:07.765 --> 12:09.565
moderate way to define the, the problem.

12:10.625 --> 12:13.765
So in an upcoming research with Con, with Eric Monti,

12:14.065 --> 12:16.645
we used a, a data set of all the press conferences

12:16.645 --> 12:19.885
that were held in Quebec and, and,

12:19.905 --> 12:22.765
and Sweden by public health, representative,

12:22.905 --> 12:24.205
but also policy makers.

12:24.585 --> 12:27.045
And by applying up applying natural language,

12:27.325 --> 12:28.965
language processing techniques, we were able

12:28.965 --> 12:32.845
to measure the prevalence in each, press conferences

12:33.065 --> 12:36.045
of the, the, the actual frames that we just talked about.

12:36.225 --> 12:38.045
So the dangerous frame, the moderate frame,

12:38.065 --> 12:40.605
but also the number of evidence that were seated,

12:41.065 --> 12:42.365
in each sentence.

12:42.825 --> 12:45.165
And what we found is that in Quebec,

12:45.425 --> 12:47.285
at least at the beginning of the pandemic of,

12:47.405 --> 12:49.165
'cause of course, it fluctuated over time,

12:49.825 --> 12:53.445
but at the beginning of the pandemic, the problem was,

12:53.465 --> 12:55.685
initially framed as an imminent

12:55.685 --> 12:57.525
and severe threat to, to, to public health.

12:57.525 --> 12:59.045
So the dangerous frame that we talked about.

12:59.705 --> 13:03.685
So they emphasized the risks associated with the virus,

13:03.685 --> 13:06.845
the po potential death, the overwhelmed hospitals and, and,

13:06.845 --> 13:08.325
and the widespread transmission.

13:08.385 --> 13:10.445
But more importantly, what we found is

13:10.445 --> 13:15.045
that this framing was associated with, the enactment of,

13:15.065 --> 13:16.125
of suppression policy.

13:16.305 --> 13:18.405
So lockdowns closure, closure

13:18.465 --> 13:19.925
of schools and, and, and so on.

13:20.665 --> 13:22.775
But especially in times

13:22.915 --> 13:25.215
and even when the level of evidence was very low,

13:25.485 --> 13:28.975
less the evidence, the more the, the stringency

13:28.975 --> 13:30.055
of, of, of measures.

13:30.755 --> 13:33.495
And what, what it, what it shows is that, is

13:33.495 --> 13:36.575
that the dangerous frame, created a sense of, of urgency

13:36.635 --> 13:38.775
and justified the inflammation of,

13:38.775 --> 13:43.215
precautionary measures, but without

13:43.215 --> 13:45.975
however, relying

13:46.115 --> 13:48.895
or using as a justification, evidence.

13:48.995 --> 13:52.375
So it excuses that when political decision makers are at the

13:52.455 --> 13:56.735
helm, a a perceived threat is sufficient to, act,

13:57.125 --> 14:00.455
even though the level of evidence can be, can be low.

14:00.955 --> 14:05.015
But, in contrasting in, in Sweden at the beginning

14:05.015 --> 14:07.895
of the pandemic, as we just saw with the, the, the,

14:08.035 --> 14:09.855
the closure of school, well, they let,

14:09.855 --> 14:10.935
they let schools open,

14:11.035 --> 14:15.175
but the, the case of school, they initially adopted a,

14:15.195 --> 14:16.695
a more moderate frame.

14:16.695 --> 14:18.935
So the, the other definition that we just talked about

14:18.965 --> 14:22.335
that balance the health risk spur by COVID-19 with,

14:22.365 --> 14:25.135
with the societal impacts of, of stringent measures.

14:25.875 --> 14:30.735
But in interestingly, well, Sweden also implemented,

14:30.875 --> 14:34.175
stringent measures, for instance, they implemented,

14:34.175 --> 14:36.455
restrictions in, in, in restaurants.

14:37.115 --> 14:40.615
Um, and what we, what we show in that study is that

14:41.195 --> 14:43.615
the dangerous frame is also influential on

14:43.615 --> 14:44.815
stringent me measures.

14:45.275 --> 14:46.655
But compared to Quebec,

14:47.005 --> 14:49.455
only when the level evidence is high, the use

14:49.455 --> 14:50.855
of these frames have evolved over

14:50.855 --> 14:51.855
Time. Uh, what, what

14:51.855 --> 14:53.725
I detailed more, more

14:54.245 --> 14:55.445
specifically in my thesis, but

14:56.165 --> 14:58.375
what these findings clearly demonstrate is that

14:59.035 --> 15:00.775
the different relationship with evidence,

15:00.835 --> 15:03.415
but also with uncertainty in the two jurisdiction,

15:03.475 --> 15:06.335
and how the organization of the public health,

15:06.535 --> 15:11.175
advisory system, were organized, affected the use

15:11.235 --> 15:13.175
of scientific evidence and, and,

15:13.355 --> 15:15.055
and the interpretation of uncertainty

15:15.235 --> 15:17.655
and the policy that were implemented.

15:17.955 --> 15:20.575
So when political decision maker are central in

15:20.575 --> 15:21.775
that ary systems, they tend

15:21.775 --> 15:24.295
to rely less on evidence if a problem is

15:24.675 --> 15:29.055
or justify less, scientifically their, their policies.

15:29.055 --> 15:32.055
If, if a problem is framed as being a potential threat

15:32.055 --> 15:35.215
to human health, but when scientists are more essential,

15:35.215 --> 15:39.255
such as in Sweden, more evidence is needed to implement,

15:39.255 --> 15:41.415
stringent policies such as school closure,

15:41.525 --> 15:43.415
even if a problem is framed as being a threat

15:43.415 --> 15:47.215
to human health, which, which is, very interesting

15:47.755 --> 15:48.855
in, in that light.

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