The UK’s COVID inquiry is putting pandemic policymaking under the microscope. One of the key questions is who should make decisions in an emergency, and how.
In a government committee hearing before the inquiry began, Dominic Cummings, former chief adviser to Boris Johnson, suggested a “kind of dictator” should be in charge in such times of crisis, relying on the guidance of a small group of scientific and mathematical experts.
But as former chancellor George Osborne pointed out in his testimony to the inquiry, expert advice isn’t necessarily enough on its own. Even the most detailed expert analysis won’t tell us whether we should close schools to protect vulnerable residents in care homes. These are questions about what we value as a society.
Melanie Field, executive director of the Equality and Human Rights Commission, has mentioned the involvement of members of the public in these decisions. She gave the example of the Welsh government using online platforms to consult with people with certain characteristics protected under the Equality Act.
But discussion of public involvement in pandemic decision-making has been minimal during the inquiry so far. As a bioethicist who has worked on public deliberation, I believe ordinary citizens should be a made an active part of policymaking in the next pandemic.
Engaging the public
Deliberative democracy is the process of engaging a cross-section of the public in making decisions. A group of citizens learns, discusses, deliberates and makes policy recommendations in bodies like citizens’ juries and larger citizens’ assemblies.
These can engage up to over 100 citizens and make recommendations on a variety of topics. To date citizens have deliberated on issues from local budgets, to how to deal with the climate crisis, to the ethics of genome editing and artificial intelligence.
Researchers and experts outside government have often led experiments in citizen participation. However, there have been successes in involving ordinary citizens in government decision-making. Citizen participation is now a permanent part of government in Paris, Brussels, and the European Union, for example.
But how could greater citizen involvement have helped the UK’s COVID response? A major focus for the inquiry so far has been the initial COVID lockdown. According to a 2022 government report, the decision to delay locking down was partly based on the “widespread view that the public would not accept a lockdown for a significant period”.
Widespread perhaps, but not necessarily true. Members of the public largely complied with COVID restrictions, showing themselves willing to sacrifice some liberty in exchange for fewer lives lost to COVID. And evidence shows most people continued to abide by the rules during the second and arguably tougher lockdown.
One way to prevent this kind of misconception happening again could be to directly involve citizens in the ethical trade-offs of emergency decisions.
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There have been some public deliberations on COVID-related issues in the UK during the pandemic, led by academics, public sector bodies and independent research groups. These included citizens’ juries on allocating limited intensive care resources if the health system became overwhelmed, weighing up the benefits of health data sharing with privacy concerns, and building public trust in contact tracing apps.
Citizen deliberation has also happened in devolved and local government. In Scotland a citizens’ panel informed the Scottish government’s oversight of its COVID restrictions. A citizens’ assembly in Camden, London, considered the effects of COVID on local residents while one in Bristol set priorities for the city’s COVID recovery.
However, there’s no evidence the UK government heeded any of the findings from these deliberations when designing policy.
Diverse experiences and perspectives
A major benefit of engaging the public is the diverse experiences and perspectives they bring. Citizen engagement can reveal ideas and arguments that may not have been raised otherwise.
For example, a public deliberation on colorectal cancer screening recommendations revealed concerns around the lack of information available about different screening options. This concern had not been considered by an expert panel which had focused on clinical benefits and cost-effectiveness.
Members of the public are capable of sophisticated moral reasoning. The deliberation on intensive care resource allocation mentioned earlier balanced the ethical values of efficiency, vulnerability, and equality in their recommendations that age should not be directly considered in triage policy.
Moving beyond expert voices can also help bring attention to the perspectives of marginalised communities who are often politically ignored. This was the case when deliberative democracy in Brazil led to a focus on the priorities of poor and minority citizens in regional spending decisions.
Ultimately, citizen participation can have a big impact. One major success story is the Irish Citizens’ Assembly which in 2017 recommended the legalisation of abortion and called for the matter to be put to a referendum.
The Irish government accepted the call for a referendum, and recommendations from the assembly became a valuable public resource during the campaign. In 2018, 66% of Irish voters chose to overturn the ban on abortion.
Preparing for the next pandemic
While the UK government regularly claimed COVID policymaking was “following the science”, this obscured the complexities that had to be considered during the pandemic.
Pandemic decisions involve values-based dilemmas, complex trade-offs, and long-term challenges. These are the same three factors researchers at the OECD have identified as making a topic suitable for public deliberation.
Would public deliberation take too long in a crisis? On the contrary, it can be designed for speed. Take the online deliberative event on contact tracing which took place more rapidly than usual so recommendations could be made quickly.
And speed wouldn’t be a problem if structures are built for citizen participation in time for the next pandemic. With permanent deliberative bodies that citizens could be randomly selected to participate in, with compensation to ensure they could take time off work to do so, deliberations could take place rapidly and efficiently.
If this seems fanciful, just consider that jury service, an everyday part of public life, works the same way.
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Citizen-led deliberation has become a formal part of governments across the world. The UK COVID inquiry should recommend Britain follow their example. Doing so could empower citizens, improve public trust, revitalise British democracy, and prepare us for the next pandemic.