www.merit.unu.edu number 4, 2020 Overview The COVID-19 pandemic is not Hammer or nudge? Science- only confronting the world with a new and deadly virus – it has also based policy advice in the brought ‘science’ back into the lead of policymaking. One can only welcome this dramatic recognition of the value COVID-19 pandemic and role of science to society amid the COVID-19 public health challenge. However, the science-based policy he COVID-19 pandemic is not only confronting the world with a new advice for measures to combat COVID- and deadly virus – it has also brought ‘science’ back into the lead of 19 has also some worrying features. T Three are being discussed here. They policymaking. The global science community is busier than ever and open have led to a strong national bias in science is becoming the norm as researchers routinely share their data. both science-based policy advice and Meanwhile, the vaccine research community, both in public and private in the national policies implemented research labs, is working together day and night in developing, experiment- to combat COVID-19. Alternative ing and testing possible new vaccines. One can only welcome this dramatic approaches are discussed focusing in recognition of the value and role of science to society amid the COVID-19 particular on the European Union. public health challenge. As if scientists wake up in a new world of facts and evidence-based policy. Written by Luc Soete1. Edited by However, the science-based policy advice for measures to combat Howard Hudson, UNU-MERIT COVID-19 has also some worrying features. First, a certain degree of arro- gance of disciplinary knowledge with the rejection of any debate coming © United Nations University 2020 from researchers outside of the virology and epidemiological professions. ISBN 978-92-808-5015-4 Second, the imposition of confinement restrictions independently of other Licensed under the Creative Commons behavioural or social sciences insights on the broader impact of such unique Deed ‘Attribution-NonCommercial- societal experimentation. And third, the way current science-based policy NoDerivs 2.5’ advice combatting COVID-19 appears imprisoned in national data, leading to a strong national bias in policymaking. The views expressed in this publication are those of the authors and do not necessarily reflect the views of United It leads us to present some alternative, more speculative views on the Nations University. regional impact of the COVID-19 outbreak. These views are presented as illustrations of the need to remain in science-based policy advice, even when confronted with a dramatic pandemic such as COVID-19, open to alterna- tive views. They start from the wide disparity in COVID-19 contamina- tion, hospitalisation and fatalities. To what extent can the study of the local environments which became breeding grounds not just of COVID-19 con- tamination but also of COVID-19 illness and mortality, provide additional insights. And in the same vein, to what extent are regions confronted with www.unu.edu the differential impact of COVID- That variable will also be very differ- 19 not in a better position to design ent over time. Thus, historical com- appropriate exit policies. parisons with previous pandemics such as the ‘Spanish Flu’ in the early Crush the virus? 20th century, apart from the major differences in the characteristics of Viruses know no borders the infection with the Spanish Flu and in our globalised world, the – affecting more young people and undetected virus in pre- or asymp- having a shorter incubation period tomatic carriers – individuals not – ignore the very different social exhibiting any symptoms of the dis- and economic environments within ease (yet) – appears to have led to an which individuals interacted 100 unusually fast ‘super-propagation’ of years ago. COVID-19 across the world. Hence the calls for a radical ‘hammer The theoretical effectiveness approach’2 in the policy response of lockdown in these SIR models to the COVID-19 outbreak. combined with the limited medi- Such a policy response is based cal, and in particular intensive care on the well-known, so-called SIR facilities in most countries, even (Susceptible-Infectious-Removed) the most developed ones, has led model3. Susceptible population one naturally to focus on immedi- runs into infected population and ate policies to reduce the degree of gets infected at a rate β which is contact within a population leading the contact rate leading exponen- ultimately to various forms of con- tially to new infections minus the finement. And based on the histori- rate γ of the infected population cal evidence from the Spanish Flu 5 recovering or passing away. Policy pandemic in the USA, highlighting will be focused on reducing the so- the fact that states with the tightest called basic reproduction number restrictions fared best economically (R0=β/γ) indicating how many subsequently, strict confinement new cases one infected person gen- appears the best policy to imple- erates. Quite naturally, lockdown ment. Hence the standard policy will be considered the most effective view proposed and endorsed by the way of reducing this reproduction World Health Organization on the number because doing so reduces need for testing and the fast imposi- tion of strict confinement policies. About the Author both the number of susceptible and infected populations. However, and Luc Soete (born 15 September as pointed out by Daron Acemoglu4, ‘The hammer’ is there- 1950, Sint-Jans-Molenbeek) is the there is a lot of uncertainty about fore the preferred policy approach former director of UNU-MERIT, for virologists and epidemiolo- former Rector Magnificus of the parameters used in these epide- Maastricht University, and miological SIR models. Ultimately, gists. Through extreme measures now Dean of the Institute for the contact rate β is an economic like social distancing, confinement, European Studies and Vesalius and social variable which will reflect lockdown and travel restrictions, College, VUB (Free University very different types of interactions the ‘hammer’ crushes the spread of of Brussels). Correspondence to: between parts of the population the virus and brings the R0 value [email protected] with as a result different infection, quickly well below 1. From this per- hospitalisation and fatality rates. spective, all measures contributing 2 Policy Brief www.merit.unu.edu “ For the social scientist and social science-based policy adviser, a hammer represents anything but a useful tool. The focus will be rather on ‘nudging’. ” to such an immediate reduction are leading to continuous questioning welcome, and the stricter the con- by citizens of the internal logic of finement measures the better. individual measures. It also under- mines the organisational innova- Hammer or nudge? tion potential of entrepreneurs in personal service delivery coming up For the social scientist and with potentially safe alternatives6 to social science-based policy adviser, physical distancing. It will provide a hammer represents anything but a poor information on appropriate useful tool. The focus will be rather exit strategies as all major policy on ‘nudging’. In the face of a new measures have been introduced at virus like SARS-CoV-2 it would the same time, implying that it will consist of making sure that each be impossible to identify which incremental policy measure builds deconfinement policies are likely to up to ‘societal’ behavioural change. be the most effective. From this perspective, authorities should carefully weigh the addi- A national bias? tional, marginal impact of each mea- sure as it contributes to the overall The current virology and reduction in transmission of the epidemiological based approaches all virus, starting from simple behav- focus on the contamination and ioural changes such as routine hand- spreading of the virus within a washing to social distancing – and national setting. For years now, epi- then assess the impact of each. All demiological studies have taken indi- this within a framework of transpar- vidual countries as ‘containers’ for ency and consistency. Thus, imple- data collection and data analysis. menting physical (rather than social) The national setting also provides distancing will automatically prevent the framework for estimating the the occurrence of a large number capacity of medical facilities, espe- of social events (like public football cially the total number of available matches) or smaller social gather- intensive care units needed to handle ings in pubs or restaurants without COVID-19 patients. authorities having to specify exactly this or that set of new rules. The measurement of the pandemic and capacity of medical A ‘hammer policy’ approach infrastructure are therefore organ- combining all measures from social ised within the boundaries of indi- distancing to lockdown at once, is vidual states. In the case of Europe, from this perspective double up this explains why national health Hammer or nudge? Science-based policy advice in the COVID-19 pandemic 3 www.unu.edu prerogatives became so dominant, in the focus will be on the particular line with the national funding of regional environmental characteris- social and health security. It was the tics for ‘welcoming’ a COVID-19 national scarcity of intensive care outbreak. Thus, and limiting the facilities that became the red line for analysis to Europe, in the Northern introducing various national con- Italy case it is likely that it is not the finement policies