Complexity, uncertainty and ambiguity
One of the basic premises in public health crises is the distinction between and integration of risk assessment, risk management and risk communication – three different worlds that are often confused. The covid-19 pandemic is a prime example of systemic risk. Ortwin Renn, scientific director of the Institute for Advanced Sustainability Studies (IASS) in Potsdam, Germany, has defined systemic risk as risks to health and the environment that are strongly rooted in a broad context of social and economic risks and opportunities. As with other risks, the key is to properly combine risk identification and assessment, a fundamentally scientific task, with risk regulation and management being both technical and political in nature. In order not to succumb to risks, it is necessary to distinguish three key dimensions: complexity, uncertainty and ambiguity.
Complexity refers to the difficulty of scientifically understanding the risks. This is a task for the experts in the different risk areas concerned. Since complexity is multidimensional, experts in different, sometimes disparate, areas are required, who may often differ in their assessments. Agreement between experts is rarely the norm. In the management of a crisis, there is a need for a synthesis of existing knowledge and consensus among experts, a consensus that is not easy but very necessary. Any complex risk in a civilized society requires the contribution of carefully selected committees of experts capable of formulating knowledge-based and consensual recommendations. Suitable fora for this are expert committees that should be independent, chaired by individuals with appropriate qualifications and whose periodic assessment of risk should be publicly available. An example of this approach is that of the covid-19 Scientific Advisory Group (SAGE) in the United Kingdom, whose reports are available online.
Let's go now to the uncertainty. We are still in the realm of experts and expert committees. The uncertainty is due to the lack of knowledge about certain aspects of the risk in question. In the case of covid-19, the uncertainty is major. Uncertainty requires sizing, adding uncertainty ranges to the estimates and launching research to reduce it. And above all, humility in the certainties, something that often does not sit well with science. The greatest challenge in assessing the risks of covid-19 is that of uncertainty, something that requires concerted global action and almost daily monitoring of the available scientific evidence that can often change the recommendations made. A key concept for risk management, when uncertainty dominates, is the precautionary principle, something introduced years ago in European Union legislation. It is about establishing recommendations to protect health in the absence of evidence or with limited evidence. For instance, the recommendation to use masks indiscriminately may not be based on the available scientific evidence, but may be recommended under the precautionary principle.
Let's finally move on to ambiguity. The same scientific evidence can be interpreted in different ways, sometimes contradicting each other. Even among experts. However, the different points of view are not due to uncertainty but to the influence of our values, our culture, our political or religious preferences, our gender. Ambiguity poses an immense challenge in managing the crisis. It requires democracy, ethics, discursive processes.
The covid-19 pandemic is testing our societies. It is surely a formidable challenge, potentially exceeding our capacities. There are no sure-fire recipes. But those we know should help: scientific knowledge, above all, committees of independent experts, technical and political management based on knowledge, transparency and democracy. And in all this, values of solidarity and ethics. Unfortunately, in today’s world, this seems to be the exception rather than the rule.
Josep Maria Antó is Professor of Medicine at the Universitat Pompeu Fabra (UPF) and senior researcher at Barcelona Institute for Global Health, ISGlobal. Member of the GLOBE Project.