The varied response to the COVID-19 pandemic has highlighted the crisis of expertise and power dynamics within different approaches to public health writes Gil Eyal for Pandemic Discourses.
The most glaring fact of this pandemic year is that the advanced Western liberal democracies have failed to control the pandemic, while the East Asian countries all do. This is true on any conceivable measure, but is most startling when one looks at cumulative confirmed COVID-19 deaths. The UK and the US top the list with more than a thousand deaths per million. The EU comes closely behind with 800. In contrast, Japan has 25, South Korea 17, China 3.3, Taiwan and Vietnam are below 1.
I am not going to offer a simple explanation for this huge, sprawling fact. I am not an expert on the East Asian countries. Moreover, I am fairly sure that there isn’t one explanation. Such a huge, sprawling fact is no doubt due to multiple, interacting factors. There is, for example, no singular “playbook,” some set of policies the East Asian countries followed and that explains their success. They’ve all been successful in different ways. No other country has imposed the kind of strict, take-no-prisoners quarantine that the Chinese still do. South Korea and Singapore have a very sophisticated program of digital contact-tracing, but Vietnam did it very effectively with pen and paper. Japan shut its borders, but South Korea did not. China and Hong Kong ramped up testing, but Taiwan, Vietnam or Japan did not. There is no one recipe that explains the difference. The East Asian countries were successful differently, and the western democracies have failed differently (huge health disparities contribute to what is happening in the US, but not in the EU).
This crisis is most evident in how the response to the pandemic in these countries has been mired in a struggle over making the future present, while in at least some of the East Asian countries the key obstacle that had to be overcome was a struggle over making the past present.
Instead of explaining the discrepancy, I want to leverage it as something that lends plausibility and significance to the idea that Western, liberal democracies are in the midst of a “crisis of expertise” dating at least from the 1960s. This crisis is most evident in how the response to the pandemic in these countries has been mired in a struggle over making the future present, while in at least some of the East Asian countries the key obstacle that had to be overcome was a struggle over making the past present.
Who has the relevant expertise to deal with the pandemic? Who gets to speak for the virus? Over the past year we have witnessed a changing cast of characters feuding over this power. Infectious disease specialists and epidemiologists are the most obvious groups with a claim to relevant expertise, but their disagreements and disputes have contributed to polarization of the pandemic response. This began early on when well-respected experts like John Ioannidis came out with all guns blazing against the CDC, continued with the public spectacle of disagreement between Birx and the CDC about school openings, and culminated in the “Great Barrington Declaration.” The claim to expertise relied on models, but epidemiological models often reached different results and some were clearly wrong. Statisticians suggested instead an “uber-model” that averaged the results of all the models, while physicists and economists in Israel publicly doubted the modeling skills of the epidemiologists. This has led people to turn to alternative experts, like the French virologist pushing hydroxychloroquine or “Coronavirus Influencers” like Tomas Pueyo.
In my book, The Crisis of Expertise, I have shown that the very word “expertise” is fairly recent in the English language and that it first appeared in contexts where it was not clear who were the experts and on what basis could they be recognized as such.
This situation of conflict among experts is not unique to the pandemic. In my book, The Crisis of Expertise, I have shown that the very word “expertise” is fairly recent in the English language and that it first appeared in contexts where it was not clear who were the experts and on what basis could they be recognized as such. We began to have need for this word – “expertise” – because since the 1960s, Western liberal democracies have had a prevailing situation in which there are multiple and competing claims to speak as experts. The bases for these claims have become more heterogenous and uncertain, and it is not clear how to decide between them. The pandemic has merely made this situation more evident.
Compare this with the situation in the East Asian countries. No doubt experts there too struggle over whose expertise is most relevant, but there is also a specific group of experts who enjoy more prominence and trust than the others. They are called “SARS Heroes.” People like Zhong Nanshan in China, Joseph Sung and Yuen Kwok-Yung in Hong Kong. In Taiwan, the vice-President is a well-recognized “SARS hero”. They are trusted now because they have accumulated credibility in the past, during the first SARS epidemic. So now we have to consider the argument that the success of the East Asian countries in controlling COVID-19 could be attributed to their previous experiences with infectious diseases: SARS in China and Hong Kong. MERS in South Korea. Avian flu in Vietnam. Tuberculosis in Japan. The argument is that because of this experience, the East Asian countries were ready. There were systems and protocols in place for detection, contact-tracing, testing and isolation. This explanation is partially correct, but it also opens up more questions than it answers: first, the Western countries had their own scare with H1N1 in 2009, and have been drawing up preparedness plans ever since. Why didn’t this experience suffice to make them, too, ready? In contrast, at least initially, in Wuhan in January, China’s previous experience with SARS clearly played a negative role. Local officials did not want to be the bearers of bad news once again, and so they engaged in a cover-up.
The past experience with SARS, therefore, is important, but not merely as a technical variable. The past experience with SARS looms over these countries as a trauma. Indeed, a double trauma – not only the memory of fear, anxiety and quarantine, but also the memory of having been deceived by the authorities, having been lied to and told that there was nothing to worry about.
The credibility of the “SARS heroes,” in fact, is not simply due to the fact that they subdued the first SARS outbreak. No less importantly, they are revered because at the time they spoke against the cover-up. They contested the official line of downplaying the severity of the disease. The past experience with SARS, therefore, is important, but not merely as a technical variable. The past experience with SARS looms over these countries as a trauma. Indeed, a double trauma – not only the memory of fear, anxiety and quarantine, but also the memory of having been deceived by the authorities, having been lied to and told that there was nothing to worry about. Against this dark background, the SARS hero is illuminated, a shining example not only of scientific prowess, but also of honesty, standing up to corrupt local authorities, and an unwavering dedication to protecting the public.
I think, therefore, that the past experience with outbreaks is a crucial factor, but only as it was refracted through the prism of a struggle over making the past present. Past experience is not significant by itself. Somebody has to remind people about it, frame it, make people attend to specific aspects of it, and in doing so, one has to overcome resistances. I am drawing here on an as-of-yet unpublished paper by three outstanding graduate students – Larry Au and Zheng Fu of Columbia sociology, and Chuncheng Liu of UCSD sociology. As their paper makes clear, the intense struggle that took place during the early days of the pandemic in Wuhan, from late December to January 23, was about making the past present. Making the past present in contemporary China is politically tricky and liable to get you into trouble.
Memory is a form of social power. Whoever can tell you what to remember, what past is significant, tells you who you are. Hence in most societies there is a struggle over who gets to make the past present, but the stakes of this struggle in contemporary China are even weightier. The local government initially quashed any attempt to alert the public and to draw out the similarity to SARS. The memory of SARS was dangerous because it was not only memory of an epidemic, but also of a cover-up and failure by the authorities.
On the other hand, the few experts who raised the alarm expressed their warning with the phrase “SARS is back!” Wang Xinghuan, the Director of Wuhan Zhongnan Hospital, was alarmed by the report he received on January 2nd, indicating that the new coronavirus was 80% similar to SARS: “I felt something horrible was going to happen, SARS is back.” The phrase “SARS is back” is literally a way of making the past present. He tried to make this past present by compiling a list of the events in the 2003 SARS outbreak, and sending this list to government officials warning them that “the similarity is astonishing.” He also reminded them that the mayor of Beijing and the minister of health lost their jobs after the first SARS epidemic. He initially failed. Initially, local authorities would not listen to him because saying “SARS is back!” is potentially saying not only that the dangerous virus is back, but also that the coverup and failure are back. So, a taboo over the past was a barrier that Wang had to break through. This is confirmed by the fact that once the Chinese government imposed strict disciplinary controls on January 23rd, it did so within the frame of “SARS is back!”. The Global Times announced on January 20 that “China has learned from the SARS experience and has the capacity to control new diseases.” Forecasts and models, a struggle over making the future present, played a minimal role in this response. Instead, the government showcased “SARS heroes” like Zhong Nanshan to cleanse this frame from the possible implication that cover-up and failure were also back. The credibility of SARS heroes enabled to make the past present and mobilize the public in a politically safe way.
Compare this struggle over the past with what is happening in the Western liberal democracies. We are all familiar by now with “flatten the curve”. This familiar meme is literally a way of making the future present. We are exhorted to act in the present – “how you can help” – by being shown a forecast of what will likely happen in the future, given different courses of action. We have all become inured to multiple other, similar, devices drawing on the future to govern our actions in the present: positivity rates, models, risk estimates.
There is a lot of handwringing in the Western liberal democracies at the moment about loss of trust in science. But the crisis of expertise is not about science. There’s no assault on quantum mechanics or molecular biology, and there is still a great deal of faith in “science.” The crisis is about regulatory science and all these little devices that make the future present. In my book, I use the analogy of a three-lane highway to draw the distinction. The left, fast lane, belongs to law and policy. It is a fast lane because law and policy need to arrive at a decision about how to act. The right, slow lane, belongs to basic scientific research. It is slow because it does not need to make a decision about how to act. Instead, scientific research is carried within a peculiar temporal frame, a sort of “reversible time.” At least in principle, one can always roll time back and run the experiment again, modifying another element. The middle lane, finally, where the fast and the slow must adjust to one another, belongs to regulatory science. To bridge scientific facts with actionable legal and policy facts, reversible time with unidirectional time, regulatory facts take the specific temporal form of cutoffs, thresholds and acceptable risk levels. It is a temporal form because these regulatory numbers are essentially forecasts. They are risk estimates extrapolating from past data into the future and, by the same token, they make this future the basis for regulatory action in the present.
But the crisis of expertise is not about science. There’s no assault on quantum mechanics or molecular biology, and there is still a great deal of faith in “science.” The crisis is about regulatory science and all these little devices that make the future present.
The crisis of expertise revolves around these regulatory thresholds and cutoffs. Every time these numbers are discovered to be wrong or are disputed, we become more skeptical regarding expertise and its forecasts. This dynamic is even more pronounced during the pandemic, because the pace of change has accelerated, and because what normally takes place in the background is now foregrounded. This is what happened with the facemasks’ debacle. The Surgeon General told us that facemasks are not effective, but very quickly it became clear that his main concern was to prevent a run on the stores. This of course led to… a run on the stores. When he reversed himself and public health experts began exhorting people to wear masks, there was open season on all the backstage calculations behind the guidelines, and the masks became a political affiliation symbol. There are countless such examples – from COVID-19 positivity percentages to ICU capacity rates – that exemplify the struggle over making the future present.
At the heart of this struggle are two opposing strategies for dealing with uncertainty. On the one hand, there is risk analysis which aims to reduce uncertainty by turning it into calculable risk. Insurance is the best example of risk analysis. The key is to have reliable statistics about past events. If you can claim that these are the same events, you can make reliable forecasts. On the other hand, there is the opposite strategy of deconstructing risk back into uncertainty. Proponents of this approach argue, for example, that it is impossible to estimate a particular danger probabilistically because it is so rare, unpredictable and yet catastrophic; it is therefore better to take a precautionary approach. There is a constant interplay between these two movements, because it is not obviously or naturally clear whether something is a calculable risk or an irreducible uncertainty, whether something belongs in a predictable series or is unprecedented; whether it is “like the flu” or something else altogether.
The clash between these two strategies characterized the field of emerging infectious diseases already before the pandemic. I am drawing here on Andrew Lakoff’s work on the global response to the SARS in 2003, H1N1 in 2009 and Ebola in 2014. He describes a clash between two groups of experts: The orthodox epidemiological approach was actuarial – risk analysis and risk management. You forecast the probability of future events on the basis of past data in order to compare the cost of an intervention with its likely yield. This approach was originally formulated as a critique of administrative measures like quarantines that try to immobilize the progress of an epidemic. The problem with this approach is that to estimate risk you have to make certain assumptions and these can blind you to what is unprecedented about the threat.
The orthodoxy of risk analysis is confronted by an upstart, the vigilance or preparedness approach, which emerged during the AIDS epidemic. Vigilance means that you deconstruct risk back into radical uncertainty. The claim was that the era of globalization increased the chances that a newly emergent pathogen would jump from animals to humans, and then would become efficient in transmitting from person to person. While the probability is low, the impact would be so catastrophic and irreversible, that probability estimates and cost-benefit analyses are useless. Instead, you need sentinels that will provide early warning. The problems with this approach were evident ever since the 2009 H1N1 pandemic. The vigilant sentinel is like the proverbial boy who cried “wolf.” Inevitably, at one point or another, there will be an overreaction, and overreaction at t1 is destined to lead to under-reaction at t2. This exacerbates the crisis of expertise.
Actuarialism and vigilance are locked in struggle over the power to make the future present, to speak in its name and use it as a resource in present struggles. The ability to do so is a formidable form of social power, and as a result it is constantly contested. If we have become by now addicted to risk talk – risk estimates, forecasts, assessments, simulations, scenarios – this is because we conduct our struggles – our political differences, our value conflicts, our clashing interests – on the terrain of the future present.
Gil Eyal is Professor of Sociology at Columbia University and author of The Crisis of Expertise (Polity, 2019).