What is the relationship between dominant modes of thinking about Covid-19 and skepticism about the pandemic’s severity and need to prioritize societal and state responses to the public health emergency? In our SSRC Rapid Response Grant on Covid-19 study, we draw on the experiences of Brazil, the United Kingdom, and the United States to help answer this question. We opted for a “most similar” approach, where we selected three countries that were characterized by patchwork initial responses to Covid-19 that led to uncontrolled disease spread. Furthermore, in an 18-country comparative report on Covid-19 responses, these three countries were classified as “chaos countries” characterized by “contested public health sovereignty,” “conflicts between center and states,” and “distrust in expertise.”1Sheila Jasanoff et al., “Comparative Covid Response: Crisis, Knowledge, Politics,” January 12, 2021.
In our study, we draw on qualitative data from media reports to reconstruct statements and events in the three countries. Here, we review the concept of sociotechnical imaginaries and discuss how thinking in terms of blind spots can help explain the rise of Covid-19 skepticism—which we understand broadly as the doubt and hesitancy expressed in the seriousness of the pandemic. We then draw on our study to discuss how a focus on the interplay of dominant, state-backed, expert discourse and counter-discourses of Covid-19 skepticism should push us toward a more reflexive approach to handling future public health emergencies.
Sociotechnical imaginaries and blind spots
As Sheila Jasanoff and Sang-Hyun Kim explain, sociotechnical imaginaries motivate individuals, organizations, and societies to shape developments in science and technology by becoming “powerful instruments of meaning-making and goal-selecting.”2Sheila Jasanoff and Sang-Hyun Kim, “Containing the Atom: Sociotechnical Imaginaries and Nuclear Power in the United States and South Korea,” Minerva 47, no. 2 (2009): 119–46. Andrew Lakoff has applied the concept of sociotechnical imaginaries to the imaginary of global health security or the biosecurity infrastructures that has emphasized need for preparedness for new emerging infectious diseases.3Andrew Lakoff, “Global Health Security and the Pathogenic Imaginary,” in Dreamscapes of Modernity: Sociotechnical Imaginaries and the Fabrication of Power, ed. Sheila Jasanoff and Sang-Hyun Kim, 1st edition (Chicago; London: University of Chicago Press, 2015), 1–33. These sociotechnical imaginaries bring into focus certain sets of problems, leaving other concerns in its penumbra.“We draw broadly from agnotology or the study of the cultural production of ignorance, which recognizes that Covid-19 skepticism can be both purposively produced or an unintended consequence.”
In our study, we argue that Covid-19 skepticism seen in the three countries is linked to how dominant forms of sociotechnical imaginaries endorsed by public health experts and policymakers displaces important considerations about how to respond to Covid-19. We draw broadly from agnotology or the study of the cultural production of ignorance, which recognizes that Covid-19 skepticism can be both purposively produced or an unintended consequence.4Robert Proctor, “Agnotology: A Missing Term to Describe the Cultural Production of Ignorance (and Its Study),” in Agnotology: The Making and Unmaking of Ignorance, ed. Robert N. Proctor and Londa Schiebinger (Redwood City, CA: Stanford University Press, 2008), 1–33. Skepticism emerges as a reaction to sociotechnical imaginaries but can also be the product of organized political movements. We borrow from Karen Cerulo’s work on cultural blind spots, which argues US society suffers from positive asymmetry or the inability to imagine the worst-case scenario, making preparedness for disasters and crisis particularly difficult.5University of Chicago Press, 2008More Info → The blind spots that we identify in our cases illustrate how Covid-19 skepticism emerged in relation to expert-backed imaginaries of the pandemic.
To trace discussions about the pandemic, we gathered reporting from January to June 2020 from the three most widely circulated newspapers in these three countries in an attempt to capture the popular and elite discourse. We paid attention to how key slogans associated with each dominant sociotechnical imaginary were articulated by different stakeholders during the “first wave,” and also were eventually used by Covid-19 skeptics to critique public health interventions. In doing so, we are able to see how the slogans were invoked—by supporters and skeptics—and how the blind spots of its associated dominant sociotechnical imaginary produced susceptibility to populist, anti-lockdown discourses that became the center of media scrutiny by summer 2020.
Brazil: Inequality and the individualization of responsibility
In Brazil, the response to Covid-19 was critically hampered by President Jair Bolsonaro’s dismissal of expert advice. On March 20, after a pandemic was declared by the World Health Organization, Bolsonaro decried the warnings as “global hysteria” and called Covid-19 a “little flu.” According to O Globo, the Bolsonaro administration also opposed efforts aimed at mitigating the spread of Covid-19, arguing that “Our lives have to go on. Jobs must be maintained. Livelihood of families must be preserved. We must return to normalcy.” This behavior faced significant resistance in the early days of the pandemic. This stance stood in stark contrast to statements from the Minister of Health Luiz Henrique Mandetta, who on March 28, urged the public to “stay at home” and communicated the “importance of stopping” normal activities to reduce transmission. Mandetta attempted to bypass Bolsonaro and work directly with provincial governors, but on April 16 he was fired by Bolsonaro. In the absence of clear guidance from the federal government, critical voices from provincial public health and civil society began to repeat two phrases that captured the dominant forms of sociotechnical imaginary: “stay at home, but if you have to go out, wear a mask” and “take care of yourself.”“This framing of mitigation measures as a matter of individual choice fueled calls for returns to normalcy.”
While this guidance was meant in good faith, it reflects the blind spots in the dominant forms of sociotechnical imaginaries that overlook enduring forms of inequality in Brazil, which disproportionately exposes informal workers to Covid-19. Brazil’s public health system, Unified Health System (SUS), is also unevenly distributed across different provinces. Favelas or informal urban settlements, which have been the hardest hit by Covid-19, were also forced to organize mutual aid networks from the bottom up. Even as cases and death counts increased throughout April and May, these gradually became normalized as the “price to pay” to keep Brazil’s economy up and running. Ultimately, this individualization of responsibility for mitigating Covid-19 became an enduring feature of Brazil’s Covid-19 response. This framing of mitigation measures as a matter of individual choice fueled calls for returns to normalcy. Under pressure from the federal government and from Covid-19 skeptics, the governor of São Paulo, João Doria, who was praised for his willingness to stand up to Bolsonaro, announced the “flexibilization plan” on May 23 that would reopen businesses and public spaces. This Covid-19 skepticism further manifested in Brazilian politics: The cost-benefit calculation of adopting a more skeptical posture in relation to the pandemic stood out as politically more viable for Doria as he was increasingly pressured by investors, business associations, small business owners, self-employed professionals, etc. This then led to the prioritization of the economy both in the federal and state responses to the pandemic in Brazil.
United Kingdom: Protect the NHS. But what about…
While UK policymakers considered pursuing the “Swedish model” of herd immunity at the outset of the Covid-19 pandemic, modeling from public health experts showing the disastrous consequences of unchecked infection convinced the government to enact stricter measures to stop community transmission by mid-March. The slogan that captured the dominant sociotechnical imaginary put out by policymakers and state-backed public health experts was “stay home, protect the NHS, save lives.” Unlike Brazil, the National Health Service (NHS) was placed front and center in the United Kingdom’s response to Covid-19, partly due to its revered place in UK society. As Ashish Jha wrote, reflecting on a conversation with a patient he encountered, “This love for the NHS will sound unlikely to most people in the United States. But I learned that this patient’s love for the NHS is far from unusual.”6Ashish Jha, “Love of the UK’s National Health Service—and Its Lessons for Health Policy,” JAMA Health Forum 1, no. 3 (2021). Human interest stories documenting the everyday heroism of NHS workers filled the pages of the UK press during the early days of the pandemic. The dictate to stay home to protect the NHS thus mobilized the public in support of this cherished institution, linking individual actions to the survival of the healthcare system and its capacity to save lives.“Critics of strong public health interventions thus drew attention to the wider impact of the lockdowns, urging a broader consideration of institutions beyond the NHS to protect.”
Yet, as the pandemic continued, conservative opinion columnists would question the simplistic vision of simply staying home, and engaged in whataboutism. Similar to Brazil’s Covid-19 skeptics, the economic toll of lockdown measures was played up by the United Kingdom’s anti-lockdown critics. A May 17 editorial in the Sun stated: “the Prime Minister ordered a full lockdown of the UK economy to protect the NHS and build up its capacity—which it has now done. Yet eight weeks later and with about two thirds of activity totally shut down, the financial cost to the country has become eye-wateringly large.” A May 23 editorial in the Daily Mail questioned: “Yes, it was the perfect slogan: ‘Stay Home, Protect the NHS, Save Lives’. Too perfect, perhaps?… It’s no longer coronavirus that’s at risk of sweeping the nation, leaving death and economic destruction in its wake, but what’s being dubbed ‘coronachondria’—an irrational fear of the virus.” The columnist argues that the government ought to place Covid-19 in context of the wider spectrum of risks to the health and wellbeing of the nation. Critics of strong public health interventions thus drew attention to the wider impact of the lockdowns, urging a broader consideration of institutions beyond the NHS to protect.
United States: Flatten the curve… and then?
After sidestepping President Donald Trump’s resistance, by mid-March US public health experts in academia and then later within government urged the public to help “flatten the curve” of new cases of Covid-19. As Gil Eyal notes, this idea of flattening the curve is “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.” This is seen clearly in a March 13 editorial from the Wall Street Journal that urged policymakers to “explain how mitigation will ‘flatten the curve’ of the virus’s course by spreading it over 12 to 18 months, rather than letting it spike destructively across the population in two months.” With the public’s cooperation, the United States hoped to be able to put a dent in unchecked disease spread.“The blind spot of ‘flattening the curve’ led to anti-lockdown protests that spread to many parts of the United States during the summer of 2020, which exerted pressure on state and local policymakers to lift pandemic restrictions that were in place.”
While Covid-19 skepticism in the United States has similarities with the individualization of responsibility in Brazil and the whataboutism of the United Kingdom, its distinguishing feature is its focus on the duration of public health guidance aimed at flattening the curve. The enduring question for Covid-19 skeptics was when the economy could reopen. The uncertainty of how long it would take to flatten the curve was echoed by a USA Today columnist on March 31: “We don’t have any way of knowing whether the curve that medical experts and government officials speak of will have flattened by late April, mid-May, June, or July. We have no way of knowing if the spread of Covid-19 will come to a halt.” Crucially, the stay-at-home orders implemented haphazardly across the United States did reduce the spread of Covid-19 during the “first wave” and helped flatten the curve. But the fact that the worst-case scenario did not occur because of these interventions was lost on critics. As a May 9 op-ed in the Wall Street Journal puts it: “It seems as the worst fears haven’t been realized and the goal of ‘flattening the curve’ to avoid overwhelming hospitals has been met.” More broadly, however, the fact that the objective of flattening the curve was already met was taken up by anti-lockdown advocates. As the lawyer of a Staten Island tanning salon stated in a May 28 Wall Street Journal article, “it’s [my client’s] position that the curve has been flattened, Staten Island has reached all its goals and can open safely.” The blind spot of “flattening the curve” led to anti-lockdown protests that spread to many parts of the United States during the summer of 2020, which exerted pressure on state and local policymakers to lift pandemic restrictions that were in place. The subjugation of individual rights and freedoms were also emphasized by skeptics as they sought to end the pandemic lockdowns.
Future preparedness: why experts should pay attention to blind spots?
As we find in our study of Brazil, the United Kingdom, and the United States, dominant sociotechnical imaginaries endorsed by public health experts and policymakers bring into focus certain sets of priorities—taking care of yourself, protecting the NHS, and flattening the curve. But imaginaries also contain unintended blind spots that gave rise to Covid-19 skepticism that fueled opposition against stronger public health interventions, a consequence of the combination of skepticism of public officials and public distrust in expertise. While we focus on the different emphasis of Covid-19 skepticism in each country—individualization of responsibility, whataboutism, and when the economy could reopen—these dimensions of Covid-19 skepticism can also be detected within each case.
Thus, experts and policymakers need to recognize the feedback loops that their public health emergency guidance generates and actively address and counteract efforts that undermine the common good. Here, we recommend three steps that decision-makers can take to improve future preparedness of new public health emergencies. First, policymakers need to engage affected publics in the processes of decision-making, to make priorities and trade-offs clear for each option. As the skeptics highlighted in the three countries argue, the decision-making process to make certain trade-offs should be open and transparent, which in principle is something that should be easy to agree to. The lack of transparency of these decision-making processes only fuels skepticism and distrust in expert knowledge. Second, public health guidance needs to be continually re-assessed as the crisis progresses, to ensure that recommendations and rules respond to new concerns that arise. This should address how blind spots can be exploited by organized movements and misinformation campaigns. Third, public health policy cannot simply be reduced to scientific, technocratic, and medical concerns. As Hilgartner and colleagues wrote, “Expert elites who view the public as willfully ignorant and irredeemably irrational need richer resources for understanding those who feel marginalized… [to repair] the sorry state of science-society relations in the United States… [requires] forums where technical analysis and democratic deliberation can proceed in harmony.”7Stephen Hilgartner, J. Benjamin Hurlbut, and Sheila Jasanoff, “Was ‘Science’ on the Ballot?” Science 371, no. 6532 (2021): 893–894.
Actively locating blind spots in dominant sociotechnical imaginaries can be an effective way to dismantle the conditions for the growth of skepticism. As our analysis suggests, continuous monitoring of the public’s reactions to and adherence to recommendations is needed. Dedicating more time and creativity to science communication strategies, such as designing tools and procedures for data transparency and deliberation, could help us better prepare for the next pandemic.
Banner photo: Nina Childish/Flickr.