Source ｜ Interface News
Author ｜ Ma Liang Researcher, National Institute of Development and Strategy, Renmin University of China, Professor of School of Public Management
Head image ｜ Visual China
China has achieved staged victories in epidemic prevention and control, but backflow of epidemic from overseas has become the biggest threat at present. On March 11, Tanside, Director-General of the World Health Organization, announced that New Crown Pneumonia could be characterized as a global “pandemic.” However, many countries, especially European countries and the United States, have not only been relatively slow in responding to the epidemic, but have also adopted defensive and control strategies. Their approach is unbelievable and unacceptable.
On March 12, the Swedish government announced the contraction of the epidemic prevention and control front, stopped detection and protection of mild and suspected patients, no longer released statistics on confirmed cases, and used major medical resources for the treatment of critically ill patients. . Countries such as Britain and Germany also believe that the epidemic is difficult to control. The only way is to let it spread and reach the so-called “herd immunity” limit, so that the spread of the epidemic is halted. On March 13, the US government announced that the country had entered a state of emergency. Whether or not the epidemic prevention and control can be effectively promoted remains to be seen.
Evidence-based decision-making behind the sword?
These decisions in Western countries may seem stupid, but they are by no means groundless, and they can even be said to be decisions under the guise of science. For example, “herd immunity” is indeed scientifically based, especially for viruses with strong transmission and low lethality.
However, the scientific community knows very little about new coronary pneumonia, whether its spreading ability will increase, whether its toxicity will increase, whether its mutations will accelerate, and whether its severity and lethality will increase are still a series of unknowns. At this time, rashly choosing a possible evidence without considering other possible evidences is tantamount to taking a gamble on the lives of all citizens.
Behind herd immunity is naked natural selection and survival of the fittest. This seemingly rational and absolutely scientific cold policy choice is not only ethical, moral and emotional, but also violates the basic principles of evidence-based decision making. .
Evidence-based policy-making is a set of decision-making theories developed based on evidence-based medicine. Evidence-based medicine believes that in the past, doctors’ clinical decisions on patients mainly depended on personal medical training and clinical experience, but they may ignore the latest medical research progress. For example, a certain disease can be better treated under the new therapy, but the doctor may still treat it according to his limited medical knowledge and clinical experience, so that the latest evidence cannot be quickly converted into a diagnosis and treatment plan. Evidence-based medicine therefore emphasizes that doctors need to pay attention to the latest medical evidence and update their diagnosis and treatment plans, and combine these scientific evidence with their clinical experience and the patient’s personal wishes to make the best clinical diagnosis.
Evidence-based decision-making is inspired by evidence-based medicine. It is believed that policy decisions should also absorb and use the latest scientific evidence to make public policies formulated by government departments stand the test and can really play their due role.
For example, in many policy areas such as poverty alleviation, education, health care, and employment, researchers have conducted a lot of research and accumulated a lot of scientific evidence, providing an evidence basis for government decision-making. If government departments can make decisions based on evidence, then the policies formulated will be scientific and effective, which may increase the pertinence and effectiveness of the policies and reduce the side effects of the policies.
Evidence-based decision-making helps to avoid possible mistakes that governments have made in the past based on experience. It also helps to prevent government officials from making narrow decisions for the sake of partisan interests.
Behavioral science and nudge have become the mainstream methods of evidence-based decision making in recent years. Researchers have conducted a lot of research on the behavior of citizens and enterprises, so that government departments can formulate policies based on these research evidence, And more effective and precise interventions in social behavior.
The so-called boost is that after the government department has grasped people’s behavioral motivations and laws, it can take some effective mild intervention measures to intervene and change people’s behavior with less effort, so that they can achieve the expected goals of the policy. For example, providing people with information reminders and changing people’s policy options may seem trivial, but the effect is four or two.
How does evidence-based decision-making evolve into evidence-based decision-making?
The prospects for evidence-based decision making are enviable, but whether they can be achieved is another matter.
This is because government decisions have a strong political color and are affected and influenced by many factors. Scientific evidence is just one of the factors that influence government decision-making, and it is not even the most important factor. For example, partisan politics and business interests have a stronger influence on decision-making, and scientific evidence is often difficult to compete with.
At the same time, scientific evidence is always accompanied by uncertainty, and scientists often do not vow 100% guarantees. This is due to the exploratory nature of science and the prudent performance of scientists, but it provides an opportunity for politicians to play with evidence.
Even if the evidence is conclusive, politicians will use the uncertainty of the evidence to attack, instead, evidence-based decision-making will become anti-evidence policy-making. For example, climate change and global warming are mainly caused by human activities, so human society needs to take action to reduce emissions. However, there are also a few studies that have reached ambiguous or different directions, which provides information for policy makers to ignore other large amounts of evidence.
In this western country’s epidemic prevention and control, evidence-based decision-making has evolved into policy-based evidence, and scientific evidence has become a trick for politicians to play between applause and a cover for government endorsement policies.
On the one hand, China has accumulated rare and valuable experience in the prevention and control of the epidemic, and the relevant practices have also been highly affirmed by the World Health Organization expert group. However, Western countries always wear colored glasses on their experience and evidence from China, and refuse to admit that China’s prevention and control measures have achieved unquestionable success.
On the other hand, the choice of prevention and control strategies in western countries is also related to their inadequate medical resources to support comprehensive prevention and control, which is a suboptimal option that is a last resort. Adopting such a slanting approach to prevent and control the sword can ensure that limited medical resources are preferentially allocated to critically ill patients and prevent the medical system from dying. Therefore, this also reflects the high attention paid by the government departments to the vulnerable groups, which is actually a dilemma where the rights of the two evils are the least.
In addition, behind these choices in Western countries, we cannot say that there is no instinct to survive without politics. It is also related to the interests of political parties and election politics. The spread of the epidemic has provided excellent materials for the opposition parties to make a fuss, and the ruling party may also ignore the national interests in order to seek re-election. Economic growth and employment are the key foundations for the ruling party to win votes, which has made it erratic between disaster relief and market rescue.
However, when the disaster comes, the party will not work together and the party will fall togetherThe difference is the same as self-digging the grave.
No matter how the development of evidence-based decision-making, the core is to recognize the limitations and flaws of evidence, and to comprehensively consider all the latest evidence to make the optimal decision, and should not deliberately ignore or rely on some kind of evidence. Evidence related to neo-coronary pneumonia is currently scarce, and not only are we poorly informed, but we are also unprepared. It is even more prudent to make evidence-based decisions in this situation.
Decision makers must be scientific and not be distorted by evidence. Evidence is only a means. We cannot forget the purpose because we have used the means. That would be tantamount to putting the cart before the horse and putting the cart before the horse. Avoiding misuse of evidence by policy makers is undoubtedly just as important as avoiding evidence being left unused.
Therefore, it is very important to establish the evidence-based decision-making system and culture of government departments so that people respect science and use evidence when making decisions, and fully understand the limits of scientific evidence and the political color of policy decisions.
In the context of the global pandemic of new crown pneumonia, people deeply feel that the concept of a community of shared future for humanity is so relevant. In the face of this crisis, no country can stand alone, and the irresponsibility of any country will cause irreparable harm to other countries. We expect that the governments of western countries can truly practice the spirit of evidence-based decision-making, face up to and consider the evidence exchanged by China’s arduous epidemic prevention, and take responsibility for the global community of human destiny while safeguarding the health of their own people.