An integrated framework for better decision making around Covid Pandemic

By Dr. Nadejda Komendantova

Covid19 pandemic reached many countries to a large extent unprepared for such situation. Several decisions had to be taken under a high degree of uncertainty and with limited evidence. Also, public had to be persuaded about usefulness of the chosen set of actions and public officials’ statements mostly framed the problem unilaterally, basing their narratives on warnings coming from the medical and public health scientific community.

Several compelling narratives seem to have played a significant role in the decision-making processes regarding which risk mitigation and management measures to implement. These decisions might have been influenced by cognitive and behavioural biases. We believe that a framework of representing complex scenarios in socioeconomic systems has the potential to decrease influence of biases and to reduce the number of measures with insignificant effects or with highly uncertain or undesirable side-effects. We suggest an integrated framework for a more elaborated decision analysis under the ambiguity of how to contain the virus spread from a policy point of view, while considering epidemiologic estimations and socioeconomic factors in a multi-stakeholder-multi-criteria context based on a co-creative work process for eliciting attitudes, perceptions, as well as preferences amongst relevant stakeholder groups.

We apply the framework in three phases, in Botswana, with a focus on the epidemiological model, in Romania where we tested the decision model and questionnaire reception, and in Jordan in a slightly broader study. We thus tested the full-scale model in the latter two cases for evaluating mitigation measures for the Covid-19 situation, to mobilise better response strategies for future scenarios related to pandemics and other hazardous events, as well as to structure the production and analysis of narratives on the current pandemic effects.

The framework can be useful for pandemic modelling, including epidemiological and socioeconomic factors, as well as to emphasize that such analyses should really be done, before, during and after a crisis, as a basis for evidence-based policymaking regarding pandemic situations and a learning opportunity. The application of our framework in three case studies showed that it is a feasible methodology even with imprecise evidence and preferences.

Our results show that the framework, which we developed, can be used for the evaluation of different response measures which various countries took for mitigation and management of the Covid-19 pandemic emergency. The framework can be implemented both during emergency preparedness and ongoing response, by relevant authorities and experts alike. The framework is supposed to be updated and correlated with data when such becomes available and it should be regionally adapted and used, given differing socioeconomic conditions across a state, as well as in accordance with different spread patterns.

However, obtaining regional socioeconomic data can pose some difficulties as it depends, among other things, on reporting protocols and chain effects with other regions but the set of criteria employed can be tailored to the needs in, and capabilities of, any region. Also, it might be difficult to make comparisons between risk mitigation measures in various countries as their strategies have to be adapted to various characteristics of healthcare systems, demographics, telecommunication situations, authority trust and relations to social contracts, travelling patterns and so on.

Our main point is that without an adequate decision mechanism to aggregate and evaluate data, and without a stakeholder consultation process to establish the local priorities in mitigation response, epidemiologic data alone cannot automatically translate into appropriate policies. Our recommendation to policymakers at national and regional levels to use multi-criteria decision support tools and multi-stakeholder frameworks in deliberating upon actions. Stakeholder consultation component is meaningful since different sociocultural groups can have different priorities for particular regions. The application of our framework among various groups of stakeholders will also increase understanding of various measures taken. It also makes them more aware about various risk mitigation options and their preferences on risk management. Our framework can be also used to raise awareness about various national and regional conditions in Covid19 pandemic risk mitigation and management.