Who should lead on the response to a public health crisis such as the COVID-19 pandemic?
Our political leaders are quick enough to say they are 'being led by the science', but this is to a large extend disingenuous. Science cannot tell politicians what to do. It can only advise and given assessments of the probable consequences of decisions. But those decisions must be taken by politicians.
The decisions are based on balancing different objectives - the economy, social impact, the effectiveness of any course of action, public attitudes and compliance - there is no one set of expertise on these. Psychologists, sociologists, public health experts, epidemiologists, clinicians, economists, logicians, so much knowledge is required.
I am not convinced that 'empowering' public health officials to make decisions is the answer to the problem.
The authors of the commentary make the point that
"in the United States (US) today, health care providers seem appropriately confused about the present and future issues concerning coronavirus disease 2019 (COVID-19)."
So they would be. Confusing messages are coming from the top, from a President who seems unwilling to grasp the seriousness of the pandemic.
Trump likes to sound optimistic. He knows that positive messages are better than negative ones from the view of a populist politician. He wants to call something red when to most people it is green. What is perhaps strange is his ability to get his followers to believe him.
Trump's message is inevitably confused as much as it is confusing. But the answer is not to assume that empowering pubic health experts. Public Health experts would have to agree on a strategy, and no doubt there would be some mixed messages that came from that process.
A key question, then, is how best can the public be informed about the decisions taken. What will the priorities in health care be, and how will these be decided, and on what basis?
Leadership isn't merely about being an expert. Many experts would fail miserably at making decisions and conveying those decisions to a sceptical or anxious public. This is politics as well as it is public health.
Yes, there is an urgent need for leadership. But that reflects a political void more than it does a lack of public health leadership.
Political leadership in a crisis requires trust. Many people are willing initially to put their trust in their political leaders, but leadership comes when that trust becomes fragile. People need to pull together to beat COVID-19.
As the number of deaths rises, as it inevitably will, people will question the strategy.
In the United Kingdom, there is talk of some kind of government of national unity, or cooperation across parties, reflecting wartime Britain.
Such cooperation is required because the government has taken exceptional powers to control peoples lives. There isn't a pearl of unique wisdom on one side of the political spectrum. We are feeling our way through this crisis. Difficult decisions will have to be made.
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