Difficult balance between science, economics and politics in times of pandemic

Science alone does not solve all problems; adequate public policies based on the knowledge produced are needed, as well as guidance to politicians by scientists

Science, which was already so contested, proves to be essential in the context of the pandemic, the greatest challenge facing humanity since the World War II and which has been producing global repercussions and impacts, not only of an epidemiological nature, but also of political and economic orders. Text signed by the researcher from Fiocruz Minas, Dr. Rômulo Paes, highlights that “the health crises resulting from the great epidemics and pandemics of the 20th and 21st centuries have many similarities. They sometimes promote convergence and sometimes confrontation between two of the most influential organized social actions: science and politics. Like any event of great social impact, diseases are a matter of politics, both in the sense of public action aimed at the power struggle, as well as coordinated public action in response to the health and social demands they create. There must be a minimum agreement so that the first concept of politics does not render the second unfeasible”.

The scientists who advise on COVID-19 face a very complex situation because everything happens very quickly. Epidemiology is almost real-time-updated, even when governments try to adjust science-based policies, infection data is reviewed and revised based on new facts. So, what is the weight of scientists opinion in political decisions? Should public authorities systematically follow expert judgement? Do the scientists receive or teach on politics? The fact is: the pandemic confronts governments with harsh issues. Specifically, in the COVID-19 context, there is still the aggravation of uncertainty, although science has advanced a lot in these six months of living and contact with this disease.

For the professor at the Institute of Social Medicine at the State University of Rio de Janeiro (UERJ) and associate editor of the American Journal of Public Health, Kenneth Rochel de Camargo Jr., the issue of politics has always been addressed to the majority of people who work, mainly with collective and public health. “The Unified Health System (SUS), a health policy, was one of the greatest contributions to Public Health”, he recalls. Still according to the professor, the problem is that politics has been changed in such a way that the perspective on science became partisan and, thus, accepting scientific findings or not became a matter of having or not a determined political affiliation.

In the opinion of Dr. Camargo, the presence of epidemiologists and virologists in governments is essential. “It is this technical staff, trained in specific areas of health, that helps in the formulation of policies. But he warns: instead of becoming a reference – it would be great if people listened to experts – in Brazil and the United States the opposite is true, professionals are being threatened by correctly informing the population about the risks brought by the pandemic. I have seen colleagues in the United States, public health officials, resign from their positions because they were threatened, including life threats, to say the obvious, about the need for social distancing, about the use of protective masks, he laments.

The opinion of researchers in the midst of the pandemic ends up directly affecting the opinions of citizens, the perspectives of companies, government policies and the economy. This is natural and reasonable. But Dr. Camargo points out aspects that must be taken into account. “When an issue involves the collective and has a technical component, I understand that, at the very least, whoever is an expert in a certain area must be heard”, he stresses. Still according to the professor, the problem involves two orders: one when stating something without a solid basis while ensuring to speak in the name of science – as happened with chloroquine, which started with the publication of articles and with statements without factual basis and without adequate studies. The other, when there is a deliberate distortion of scientific knowledge, whether economic, political, or any other order, which causes confusion in the population. Dr. Camargo recognizes that the big problem is the mercenary scientist, hired not to produce research, but to give the impression that there is controversy, divergence or disagreement where it does not exist. A great example of this is given by the tobacco industry, when there were avalanches of evidence showing the relationship between smoking and various diseases and the industrys effort trying to raise the idea that the evidence was not a solidly established knowledge.

Chaos between science, police, economy and the pandemic

Dr. Camargo explains that chaos occurs because there is a conflict of interests. For him, if the various actors involved put general well-being first, there would hardly be a situation of so many conflicts. “There are economic and political interests for people to not follow the confinement recommendations that go in the same direction, and on the other hand, research that presents robust data on the development of the pandemic. This causes great disinformation, and involves political actors who are likely to create confusion so what should be done does not happen”, he observes. In relation to science, the professor admits that the recommendations change over time and that this the nature of scientific investigation itself. The recommendation of wearing masks by everyone is a clear example.

Asked about the main challenges for science that ended up engulfed by politics and economics during the pandemic, Dr. Camargo is categorical in stating that the greatest one is to make people understand and believe in what evidence and research demonstrate. For him, another challenge is to communicate this and the difficulty lies in the interaction, as science tries to get stuck and stay within its world and not address itself properly to the population. “For example, we must present not only the result of a research, but how a certain conclusion was achieved. Likewise, drug testing should better publicize how tests are performed and what guarantees that the drug is effective, whether or not there is a risk, and not just talk about the end result of the drug trials”, exemplifies the researcher.

Two sociologists from a British university who studied science and write on the “role of expertise” report that there are two equally undesirable opposites: thinking that all decisions that involve technical aspects should not listen to scientists because they are part of a single political view. The other is to exclude important sectors of the population and leave everything to the specialists. Sociologists call the first technological populism and the second technological fascism. Professor Camargo stresses that both opposites must be avoided. The risk lies in incurring one of these two pitfalls, that is, finding that the solution for public policies is simply to give a scientist authority over everyone, or the opposite, to submit science to political interests around the world, he adds. We do have historical examples that these two opposites are equally bad.

Speaking of history, it has taught us a lot. The worldwide experience with major pandemics of this level of health risk is quite old. We note that reactions we see nowadays were already practiced in 1918 (Spanish Flu). There are plenty of examples: people who did not want to stay at home, refused to wear a mask, and by the way, at that time there was much less knowledge than today. Another experience was during the HIV/AIDS epidemic, when a series of misinformation and conspiracy theories were observed regarding the origin of the virus and the idea that it would have been produced to be used as a weapon of war. A series of misconceptions also regarding possible treatments that at the same time affirmed the efficacy of treatment without scientific evidence and denied the efficacy of proven treatments. “Unfortunately, now we see some of these practices being repeated and the great trouble we find is how to transform these relationships. Today, unfortunately, the political investment in science denial has become much greater than it was 30 or 40 years ago. I would like there to be a rethinking of the issue of economic relations, of politics itself, of the use of science, but unfortunately, I see no indication that this may happen, and as it happened other times in history, once the emergency is over, it is possible that people return to what they were doing before”, points out Dr. Camargo.

Regarding the economy during pandemics, from a capitalist standpoint, people should remain producing, consuming and, creating restrictions to people impacts this process of circulation of goods. But in times of a pandemic, it was shown not to have worked out very well, and it served almost as a natural experiment, as happened in the Scandinavian countries, in which Sweden adopted one approach opposing the other countries, and Sweden recorded higher mortality by adopting a more liberal policy and that, from an economic point of view, made no difference. For Dr. Camargo, the question is to review certain deeply rooted and criticized economic dogmas. According to him, the fragility of this economic mechanism that drives the world economy was evident in 2008 and it seems that nothing was learned and the people who make decisions have not made the necessary changes. He emphasizes that the economy must be at service of people and not the other way around.

“When a given economic interest favors short-term profit, in any way, and alternatives are not considered, will eventually become a problem. So, the political world is at the mercy of that. On the other hand, if there are public policies, it is possible to find alternatives that can, if not avoid, or at least mitigate the negative economic effects brought by social distancing. If this were taken seriously, we would be able to resume economic activity much more quickly and without taking the risk of what is happening in Brazil and the United States – the pandemic will start to spread again – and then the government will resort to more closing draconian measures, which leads to greater losses”, stresses the professor.

Finally, Dr. Camargo suggests that we think of quarantine and distancing measures not as a duty, but as a right that is not available to all, where the less privileged portion of the population, the poorest, those subjected to social vulnerability, people with precarious jobs, do not have the privilege of working from home.  “We should, yes, have public policies that allow these people to get by. It would also be essential that the design of these policies be discussed, clarified as much as possible with the population. In this sense, on the one hand, I am very sorry that we do not have the necessary assistance for the needy population, but on the other, I am amazed that certain areas, such as Paraisópolis, one of the poorest locations in the city of São Paulo, people have organized themselves to do their own pandemic control process. It is sad that we have reached this point, but at the same time I praise the initiative of the residents. However, the ideal is that no one needed this or that the actions could be carried out with the assistance of the Government and that these people should not be left to their own devices”, concludes the professor.