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For us non-epidemiologists, it’s hard to know whom to trust. The Centers for Disease Control and Prevention reverses itself on masks; scientists get into Twitter fights; politicians deceive their constituents. The answers that have been provided so far—the bailout, the makeshift hospital beds, the eviction moratoriums, the new injunctions to wear masks on the streets—seem inadequate or incomplete.
There are ruptures between medical science, the public, and the political response. It’s hard to know how to think about it—which, thankfully, is where science and technology studies (STS) comes in. The small but influential discipline takes an interdisciplinary approach to understanding how areas of knowledge that we’re often happy to concede to experts function in our lives. As Sheila Jasanoff, a pioneer in the field, writes, STS studies aims to parse the ethical, legal, and political dimensions of science so that it “takes its rightful place within and not above society.” The current crisis began with a medical problem, but it doesn’t mean that those of us without an MD should let the doctors take the full burden of the response.
Like the rest of us, Jasanoff, who founded and directs Harvard’s STS program, has been keeping a close eye on the coronavirus pandemic. Unlike most of us, she’s equipped with decades of experience analyzing how democracy and science interact across countries and time periods. In our interview, compiled from two conversations, she explained how she’s been thinking through the crisis.
Nawal Arjini: Have there been any recent developments that have surprised you?
Sheila Jasanoff: The thing that strikes me is where explanations stop short. Germany’s fatality rates are low compared with other European countries that have corresponding infectivity rates, but they’re not fully taking on board the implications of their own explanations. Better testing and contact tracing are two answers given as to why some countries have been better able to control their fatalities than others. But it’s not just the contract tracing by itself, right? There’s the question of what you do with those contacts, and that goes back to the infrastructure of health care, of communications, of traditions of dealing with a population-wide crisis.
A friend in the Netherlands told me about their shortage of intensive care units. Germany has one of the highest ratios of intensive-care beds-to-population of Northern European countries. They’re economically very comparable countries, so why the lower percentage of ICUs in the Netherlands than Germany? My intuition is that the Dutch have a much more stringent idea of when ICUs are allowed to be used—that is, their social definition of what patients should get ICUs seems to be different from Germany’s. What is a life worth saving? When do we declare that further measures should not be undertaken, when do we not call it triage but a sensible medical decision? These are cross-cultural questions that we haven’t really thought about.
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NA: Would you talk about the difference in responses between the affected countries?
SJ: I’ve been struck at how a certain public health model is widely accepted in all the countries that I’ve been following. If you look across Europe and the US, the restrictions being imposed on people are very similar. The variations are in degrees of stringency and how these things are being enforced. The idea that you have to intervene early, that you have to have draconian restrictions, that you have to not just self-isolate but maintain social distancing—those things have spread every bit as quickly as the epidemic. I had never heard of “social distancing” as a phrase, but now it’s picked up as a term of art across a wide array of places. The public health model has spread rapidly, and one of the reasons is, it was already present. The apparatus was already there: hospitals, the reliance on the kinds of statistics that we’re seeing.
NA: How did this public health model become so widespread?
SJ: In America, the public health enterprise, with departments of public health and so forth, began to be put in place from the middle of the 19th century. There were constitutional issues over whether the state had the right to mandate public health interventions, but those were fought over 100 years ago, and it was established that compulsory vaccinations, testing of infants before they leave the hospital—these were well within the powers of the state. We’ve all grown up with that, even if there is rebellion against it in some places. People understand concepts like herd immunity, even if they don’t know the technical term. They know it’s risky to have a segment of the population going around unprotected. Health crises like HIV/AIDS rammed home the importance of the public health enterprise within very recent memory.
NA: Then this model has very little to do with style of government—the Chinese understanding of public health is similar to the Italian one, even though those governments would in theory have different ideas about the responsibilities they hold toward their citizens.
SJ: I really don’t want to speak for or about China, because I’ve never worked there. Across the Western world, and also places where colonial systems of administration were imitated and took root, these ideas are widely understood, beginning with the fact that there is such a thing as public health, that transcends the individual. We’ve bumped that up to the international level, with the [World Health Organization]. The WHO defines what makes an epidemic and what makes a pandemic for the whole world. We’ve created a public health apparatus that’s becoming more sophisticated, better at tracking and recording. In this era of data science, it’s gained a lot more calculating power. One difference between the current crisis and other ones, including SARS and MERS, is the number and variety of the projections. Almost every day, there are new projections appearing in the lay media. I don’t remember any such transmission of models from any other health crisis I’ve observed.
NA: And these are being passed between people with little to no prior statistical knowledge, on average.
SJ: The news media has put it into visual terms. “The curve” has become another of these phrases, like “social distancing,” that everybody has learned. “Flattening the curve” tells you that there’s a visual imagination at work: People have some sense of what the curve would look like without flattening. Animation and visualization are two things that were not there during the HIV/AIDS crisis. During that crisis there was wide transmission, particularly among the gay population, but I don’t recall seeing any diagrams of what the likely spread would be, predictions of when things would peak. The terminology with which we’re thinking and seeing and depicting the crisis looks very different from crises 30, 40 years ago.
NA: What’s the value of visualization? Do people actually understand the crisis better, or do they only imagine they do?
SJ: It’s been shown over and over again that if you can visualize a phenomenon, that has more power than just telling people what the numbers are. There are entire schools of professional work devoted to displaying the result of science in ways that make them easier to read. These are even important for scientists themselves—doing comparisons, overlaying data, color-coding. If I say “ozone hole” to you, you imagine something the eye cannot see, and yet you have a visual imagination of what that looks like. It doesn’t come color-coded; that was something decided upon by scientists to convey a clearer sense of what the phenomenon “looks” like. These are techniques that people know are extremely powerful, that affect public understanding.
What isn’t shown is a different set of consequences. When governments impose controls, what does that mean for individual lives? If you drive the crisis into people’s homes, because you’ve shut down workplaces, you’ve shut down public-congregation places, you’ve vastly restricted the possibilities of relying on public services, even restaurants, then you’ve put things inside the social dynamics that prevail inside of households. That means, for instance, that the gender balance shifts. Take something extremely personal: I live in a household of two people. When I’m at work, as a professional woman, I normally don’t have to prepare lunches: I go out, or I go to my institution’s cafeteria, and I eat there. Now, at home with my partner, one of us, and most likely me, will have to be responsible for suddenly making one more meal a day. The responsibility for its preparation lies entirely inside the household and, because we still live in a gendered society, more on women than on men. That is not something anybody has chosen to model. We’ve modeled the progression of the disease, but not the social consequences of the preventative measures that we’re taking.
NA: Everyone understands at some level that it’s a social crisis, but it seems like there’s a sense that once the virus is cured, the social problems will go away.
SJ: Public health is not the only science that should be at work here. Social sciences and behavioral sciences have roles to play, and so far I’ve not seen them involved nearly to the extent that epidemiology has been involved. Can [biological] science come to the rescue? Well, it takes a long time for a cure to be discovered and then developed to the point where it’s reliable. Even in a speeded-up process, you’re not going to have a vaccine that’s proved to be effective, without side effects, and that can be produced at scale for at least 18 months. The idea that science comes on a white horse, and that as soon as a problem is detected you have a scientific solution, that’s a mirage.
NA: Then could modeling those social problems help?
SJ: Science covers a wide array of knowledge. When an epidemic strikes, we get understandably more interested in sciences that have to do with prediction, prevention, and cure. Cure is understood at the level of the individual body, and how we can make sure that we can either prevent the infection—that’s the vaccination route—or treat it—that’s the hospitalization and the ventilators. That’s the dominant discussion. I think it would be valuable to point out that there are also social sciences that have a lot to do with exactly the sort of thing we’re talking about—sciences that connect prices to inequality, for instance.
It’s well known from disaster studies that effects on vulnerable populations are much more severe and long-lasting. The wealthier may have better insurance, they may live in circumstances where social distancing is easier to implement than for people living in crowded quarters, they may have the resources to take themselves out of danger zones. These things are not available to people on lower levels of the socioeconomic scale. In my university, for example, undergraduates were evacuated with only five days notice. Clearly the burden of that evacuation fell differently on people who could immediately afford a ticket home and people who could not. It took a few days for the university to recognize that a single order, which was justified on grounds of public health, would fall very differently on people depending on their particular circumstances. Multiply that problem out by millions and millions of people, and you get a crisis that can be tracked by social science.
NA: How quickly should policy be expected to catch up with social science? Should the emergency welfare provisions in France, for example, have waited for better social-science research?
SJ: Social-scientific studies of risk, risk-communication, and public understanding of science have been there for decades, so the question is why, even under emergency conditions, people still ignore something that’s well established. This is not “catching up” in the sense that the relevant sciences are rapidly moving ahead and policy institutions are somehow slow. It’s more that policy institutions are resistant to certain kinds of knowledge. One kind of knowledge that policy institutions are not particularly good at is how democracy interacts with policy. It’s been shown over and over that people will accept, trust, and comply with [directives] if they understand the reasoning, if there’s a certain degree of transparency, if there’s participation. Decisions that are perceived as remote, authoritarian, unexplained—those decisions are not accepted.
This is something that we’ve known for decades upon decades, and yet decision-makers typically don’t see the value of involving the very people who are going to be affected by those decisions. They’re driven by urgency, a need to act; they don’t necessarily have the most socially sensitive people implementing their policies; they don’t necessarily have the best advice on how you communicate to people. The way the reasons are being given out by many public authorities just don’t measure up to standards of consistency, inclusion—that people have been listened to—or even standards or reliable expertise. How do you go from the CDC, which used to be one of America’s most trusted agencies, saying one week we don’t think masks are necessary and the next week it is necessary? This is not a matter of policy catching up, it’s a matter of authority not liking to make its own mechanisms transparent and available for public review and acceptance.
NA: Is the focus on the individual body rather than the body politic part of public health orthodoxy?
SJ: Attention to physical and material causes is always more highly valued than attention to social causes and consequences. Social sciences and social problems get lower billing and lesser attention than physical and material causes that we think we can control more easily. The HIV/AIDS crisis is a good historical precedent, because the attention to creating an AIDS vaccine preceded the attention paid to preventative policies, such as very basic things like safe sex and condom use. But the presidential commission formed to study AIDS had quite a sizable impact, because it directed people’s attention to the fact that there were social and behavioral components of transmission. Today, public health for STDs looks very different as a result of people being forced to consider the social dimensions of creating a sensible, population-wide HIV/AIDS policy. But people forget the social ramifications, even though they endure long past the physical ones.
NA: Is there a limit to American civic faith in experts? Does putting someone like Mike Pence in charge, after he so badly mishandled the HIV/AIDS crisis in Indiana, test it?
SJ: Simple faith in experts is every bit as unwarranted as faith in angels. We should never trust people because they say they’re experts; we should always ask on what basis they became experts. It’s an all-hands-on-deck crisis; everybody with relevant knowledge ought to be providing that knowledge and meeting other people who will knowledgeably question them. None of us can claim to be prescient. We should be deciding how we pool society’s considerable knowledge against what could become a disaster of unprecedented proportions. My point is we already know a lot about how to do those things.
Science has become as powerful as it has because it has adopted the idea of peer review—that you don’t trust one person, you trust one person’s judgment, because it’s been questioned by other people. Modern science has specialized, and peer review is pretty good when it functions inside a narrow community. Peer review is not good when you need to confront different bodies of knowledge with and against each other. Someone who understands the dynamics of what happens inside a family when you’re cooped up together for week upon week—that person is not going to tell you very much about how a virus acts inside a body, or how quickly contagion spreads if you don’t self-isolate.
Since the concern of pandemics at the beginning of this century, this country’s government was trying to put together a team of experts. From my standpoint, it might have been too narrow a body of expertise even then, but at least there was an attempt to have a response capability in place. That was dismantled in 2018. That was short-sighted. It should be replaced, and broadened to include legal and constitutional expertise, social expertise, including understanding of inequality and understanding of gender, to name two very important things.
NA: The suggestions for victory gardens, the idea that people will have internal resources to revert to in a crisis, implies that people have those resources to begin with.
SJ: They’re drawing on this American tradition of self-sufficiency and individualism, but it’s a serious political question whether that is the best way to meet a collective epidemic, or whether that has to be coupled to public infrastructures that obey some of these first principles of risk decision-making: consistency, coherence, explanation, transparency. We’re getting incoherence, non-transparency, sudden about-faces at the top, and a reliance on self-sufficiency from below. But you need some resources to be self-sufficient, and people at the very bottom of the ladder need something to be self-sufficient with.
[With the new directive about masks,] this assumption that you can issue an order from above, and a highly heterogeneous population under conditions of stress and scarcity can suddenly comply without the government supplying the necessities—that is astonishing. If the government said, everybody has to wear a mask, it doesn’t need to be the most protective kind, and we will open centers where people who don’t have masks can come and pick one up, that would be a way of going about this that would make people comply, and also be fair.
NA: If we don’t have the infrastructure that South Korea or Germany have, does it still make sense for the US and the rest of Europe to look to their example?
SJ: It’s an all-important time for us to be looking at other societies. The fundamentals I come back to in my research is that it comes down to philosophical ideas of who cares for whom and how. When you have a government, what do you delegate to that government? It’s not surprising that the countries that seem to have “done well” are the countries that have well-developed infrastructures for taking care of society as a whole. There are costs to being very centralized, but there are equally costs to being extremely individualized, extremely decentralized.
When I was very young and reading a lot of Bengali poetry, I was much inspired by a poem of [Rabindranath] Tagore’s in which a king was unable to deal with a famine. A Buddhist nun said, “I’ll solve this problem,” and went with a begging bowl from door to door, saying, “Whatever you have to spare, give it to me.” She collectivized the problem and solved it, where the king was unable to. I often remember that: what it means to pool resources together, and whose responsibility it is [to do so]. As a person involved in political theory, I worry about that all the time. Can we say the kind of democracy we want is one in which there are institutions that care for us in moments of trouble?
NA: We’re all worried about how people are going to be left adrift, and that the privatization of public goods, or further monopolization over consumer ones, is going to happen in the wake of this crisis. Do you see patterns in terms of political or economic forces capitalizing on the crisis?
SJ: Absolutely. We tend to devolve social costs, the burden of caring for oneself, onto the individual. America is an individualist society, but we have been moving further in the direction of saying that all goods and services are basically matters of consumption, and therefore the responsibility to deal with them should be delegated more and more to individuals. Here is a crisis that hits all at once, with very little time to respond, and we already have devolved much of the responsibility. We decide, here is a rule, but it is your personal responsibility to obey it.
We don’t think of the individual costs, the social costs of spreading these decisions out to everybody. A student of mine wrote to me that she was “sort of self-isolating” at home, which I thought was interesting phrasing: She went home in the knowledge that she could be a source of danger to her parents. Is Harvard University responsible for sending someone who could be an undiagnosed carrier to a house with older parents on five days’ notice? These are issues that we haven’t debated. I imagine that we will be debating these things as ethical issues, as moral issues, and to political issues for some time to come.
I would like to see a society that emerges from this period of crisis with a heightened understanding of what it means to individualize things that were once seen as collective and social. Maybe this concentrated shock will finally be enough to make people sit up and say, “Everything has to have its limits, and we cannot simply dissolve what was public and collective into individual and solitary responsibilities without paying a lot of penalties for that.” My political preferences are for a society in which solidarity means more, in which there is more shared infrastructure, where in the context of a crisis we do not have to depend only on our wits and whether we have enough land and enough seed and enough water and fertilizer to create a victory garden of our own.