In many ways, the complex interplay between fear, trust, and evidence have been the hallmarks of our collective pandemic experience. We have learnt to fear large numbers in the form of mounting cases, all the while trusting the vaccines by the way of their efficacy data. How policy-makers communicate evidence has been crucial to which impulse our attention rests at—fear or trust.
In this insightful interview, visiting Professor of Immunology at the Indian Institute of Science Education and Research Satyajit Rath in conversation with Rutuparna Deshpande answers the perennial dilimmeas of evidence-based policymaking.
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The pandemic has revealed that ‘fear’ is a powerful emotional contagion among the non-expert population. How do you think policy-makers can balance stating the facts ‘as is’ and avoiding unrealistic speculations in public opinion?
It might be useful to make three preliminary points. One is that the distinction between ‘expert’ and ‘non-expert’, commonly thought of as clear, is anything but. ‘Expertise’ is a complex landscape, and most of us have a bit of it in some area and very little in most others. Therefore, ‘experts’ speaking to the rest of us poor souls ex cathedra is more pretence than substance. And a lot if not most of the times, policy-makers are not actually ‘experts’, they are simply getting advice from semi-randomly chosen groups of people with some expertise. A second point is that fear for oneself, one way or another, is not restricted to the ‘non-experts’; so-called ‘experts’ have it quite as much, and sometimes perhaps even more. And finally, neither the category of ‘policy-makers’ nor the ‘rest of us’ are a homogeneous body; both groups vary widely in perspectives, prejudices and predilections. There is as much cacophony in policy-making corridors as there is out on the streets.
That said, the only meaningful way we have of dealing with fear is through empowerment, which comes from evidence-based, self-correcting and cautious narratives of cause and effect. For this, governing authorities need to stop pretending that they have more ‘facts’ than they do, that their ‘facts’ are more clear than they actually are, and that these ‘facts’ indicate certain policies more unequivocally than they do. This elaborate pretence has long been a norm of governance in India, and we are all aware of and accustomed to it. That is in part why we, as the governed, trust government pronouncements less that the crazed claims of random weirdos on social media. It is crucial for ‘the authorities’ to explain the strengths as well as the weaknesses of currently available evidence, to explain the ongoing efforts to fill the gaps, and to discuss both the robust and the tentative components of the resultant policies. Mature collective sharing of the current state of evidence, explanations and strategies, warts and all, is the only way to avoid falling into diverse kinds of private terror-filled frenzies.
Numbers have played a large role in how we perceive the soundness of restrictions. Do you think absolute numbers rather than relative numbers are useful in having a well-informed population?
I think that both absolute and relative numbers matter; I think it is useful to have as many ways of looking at and thinking about evidence as possible. But there is an additional point involved here. I think we have needed much more by way of numbers than we have had. People tend to look at their local experience, and they notice the discrepancies between those local experiences and the ‘national’ or ‘state’ numbers that come up prominently in public discourse. I think that it has been important to provide local numbers, not simply of ‘cases’, but of tests done, ‘positivity rates’, numbers of people who are seriously ill, numbers of local critical care beds available and occupied, so that the gap between what people experience anecdotally and what numbers are discussed as the bases for local restrictive policies is reduced as much as possible, helping policies make sense.
Some social media users have expressed confusion over the rapidly changing guidelines and advisories by the ICMR. How can policy-makers efficiently respond to an evolving pandemic while communicating rules in a timely manner?
In an emerging and new situation, when the evidence is still fragmentary, when interpretations are changing, and when policies do need to be changed periodically in response to better, though still provisional, understanding, these kinds of confusions are almost unavoidable. Paradoxically, acknowledging that would help more than making each iteration sound like it was written in stone.
As Omicron has surged, breakthrough infections have become increasingly common. In light of this, how do you think policy-makers can distill convincing evidence for the vaccine’s effectiveness in the Indian context?
To begin with, it must be noted that all covid vaccines have been tested for protection against serious illness, and not so much against ‘infection’ of the asymptomatic or mild-illness kind. This protection appears to be still quite robust even against the omicron strains. However, sadly, India’s vaccine effectiveness monitoring has never been particularly reliable. Despite a year-long vaccination campaign, and apparent access to large-scale evidence about who is vaccinated, who is testing positive, and who is landing up in hospital, we still do not know how well our current two vaccines have protected and are protecting against severe covid illness, whether there is a difference between them, whether they have been differently effective in mid-2021 versus early 2022, and so on. While claims, including official ones, have been made about some of these questions, the actual evidence has been scarce. It is therefore unclear if these questions can ever be clarified with reliable, substantial and large-scale numbers, though one lives in hope.
Dr. Satyajit Rath is a visiting professor of immunology at the Indian Institute of Science, Education, and Research.
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