Hello, I'm David Edmonds and this is the Pandemic Ethics Accelerator Podcast.
The UK Pandemic Ethics Accelerator was a project funded by the Arts and Humanities Research
Council in 2021 22 to examine the ethical challenges faced during the COVID pandemic,
it combined expertise from the University of Oxford, Bristol, Edinburgh University College, London and the Nuffield Council on Bioethics.
This six part podcast series covers some of the themes that emerged from the research.
During an emergency such as the COVID 19 pandemic.
There's not a lot of time for official bodies to consult the public.
So Cunningham Burley is a professor of medical and family sociology at Edinburgh University.
She oversaw some dialogues with members of the public in an attempt to assess public attitudes to the pandemic and to the government's response.
Sarah Cunningham Burley, welcome. Hi. We're talking today about dialogues, public dialogues.
You oversaw some public dialogues as part of the pandemic ethics accelerator.
How do they work exactly? So the idea of a public dialogue is to really encourage or provide opportunities for members of the public
and selected on various criteria to come together to discuss and deliberate the issues of relevance,
in this case around COVID 19, both the experience of and government responses to the pandemic.
So primarily, it provides an opportunity to discuss, to not take a position that one's views on something are kind of fixed,
but are something that can be generative through deliberation.
And through that process, you can come to sometimes agreed positions in some cases,
or a collective position or an agreement that there are a range of different perspectives and tensions in relation to an issue.
More practically, it involves bringing people together, combining both the presentation of some sort of key information.
We brought in some experts in different areas that can kick start some of the discussions,
but also involve the participants themselves in shaping and framing some of the sessions that we
run so that the issues are ones that come from them and from their experience and their interests.
So managing both of those things that kind of like framing of the issues and allowing participants themselves to bring things forward and
then having small group discussions that allow everyone to have their say and some plenary discussions that bring people back together.
But all of this is a small group, so size of our dialogue between 20 and 30 people.
And what's the point of them?
Why is it valuable to extract the views of, as you say, a very small number of people so increasingly across public services?
There has been a movement to take on board the voices who are most affected by policy.
So at a very local level that might be engaging service users in issues that affect then service design,
new interventions, etc., or at a more democratic level in terms of issues around governance.
So there's a kind of intrinsic value that there's something about dialogue that can help
revitalise democracy by closing the gap between the decision makers and the public.
Okay. So there's a value just in holding the exercise, but what about instrumental value?
What do they actually tell us about the pandemic? Well, the two are related.
So at one level, there's an intrinsic value.
So it's an ideological position that the democratic process would benefit from more engagement so that more voices are heard and decision making,
the argument is, would be better if there are more people engaged in that process.
But obviously that intrinsic value, which is also reflected in what participants themselves say about the process,
they both feel valued and learn something from that which would ripple out beyond them as individuals, of course.
But the instrumental value is then, well, does that make a difference other than to the individuals that participated and their local contexts?
So the instrumental value would be the ability then to feed this up in some way and to be able to demonstrate
that subsequent decisions might have been improved or fall better with the population as a whole.
So what did we learn? What did they tell us about the pandemic? A whole range of different things.
We conducted two different dialogues one in 2021 and one in 2022.
If you've never participated or been involved in facilitating one of these,
one of the most obvious and deeply felt issues is the way in which people are keen to and enthusiastic
about grappling with the complex issues that governments and others have to deal with in relation to,
in this case, COVID 19, and that it surfaces some of the key ethical dilemmas that we all have to deal with.
How do you balance individual and collective needs?
We certainly found that there was a very strong sense of solidarity in relation to the need for collective action alongside compassion towards those.
To most affected and most vulnerable, but also a sense that the big picture always has to be held in mind.
And by the big picture here, we mean both the long term effects and the way in which the pandemic itself revealed starkly existing
problems in society that are experienced and then experienced with a greater intensity through the pandemic.
Say, by existing problems. I assume you mean structural inequality, perhaps racial disparities.
But we knew already that there were concern about these issues. Why do we need these dialogues to extract these concerns?
We knew about them and researchers have been researching this for decades.
Evidence is that individuals will be directly experiencing inequality as we know.
But the pandemic put this, first of all, really high on the kind of public agenda it could be seen everywhere.
So I think something to do with the intensity of the revealing of these inequalities in ways that were
deeply shocking and obviously deeply traumatic for those directly affected and those around them.
So I think it's not that we didn't know about inequality before,
but actually you could not avoid confronting inequality almost in your day to day life as a service provider or as an individual.
What about the issue of government communication about lockdown measures and so forth?
Were people happy with the way the government explained policy?
Do they trust government? Yes and no has to be the answer to that.
So there was an awareness that there was a need to make difficult decisions in a very complex and rapidly changing environment.
But there was not a strong sense of trust for a number of reasons.
One, there was a feeling that the communications were not always robust and meaningful and didn't always reflect
the uncertainty that was present at the time and still is when making decisions in uncertain times.
The public are aware of that and have the ability and desire to embrace that uncertainty.
There was also the issue of politicians themselves not following the rules that they were expecting other people to do,
which of course is not generative of trust. If the individuals in whom one is putting one's trust are themselves not trustworthy,
it rather undermines many aspects of government response and publics own response to that.
However, there were also occasions where leadership, partly through good communication, could develop a more trustworthy environment.
And in the UK with the different nations, the home nations and devolved administrations,
there were examples used in the dialogues of the ages that seemed to generate more trust between the politicians,
the decision making and their publics. How do they do that?
Sometimes clearer communication ways of communicating that somehow seemed to narrow the gap between the political sphere and the citizens.
Now there were polling companies that are constantly probing public opinion on a wide range of matters,
including issues of trust, concerns about equality and so forth.
And of course, they're using a much larger dataset.
So what, if anything, emerges from the dialogue process that we couldn't extract from opinion polls?
So they're serving different ends,
and they're definitely a place for both opinion polls surveys that aim to generate an understanding of public attitudes and of their views.
And they can then inform decision making. But a dialogue goes into much more depth and actually engages participants almost in
aspects of decision making in a way that you can't do with a poll and also in a dialogue,
participants learn from each other. You learn aspects of developing respectful arguments, managing tensions,
all of these things that are actually very important in complex decision making processes.
Reading about the process,
I saw that participants felt quite strongly that meaningful public involvement should be built into the response for future pandemics.
Now that's obviously easier said than done.
If the next pandemic is anything like the last one, then there just might not be time to set up public engagement processes.
I wonder how you think public engagement could be built into the system?
Yes. So there was different types of public engagement going on from early on in the pandemic.
But there is not an overall strategy or. Embedding is public engagement.
You could imagine that that would be possible. Yes. Sometimes decisions have to be made so quickly that that is impossible.
But if you have public engagement embedded into existing structures, then first of all, you won't come at all these issues absolutely new.
You will have been doing public engagement.
And I think the challenge is for that to be a combination of bottom up engagements going on at local level,
but that moves up to local and national governments and also the other way around.
But we don't have either the structures or processes that join or this up together.
So I think individual engagements may have an impact, but we can't always be sure that they have an impact or have the processes in place to do that.
What would a permanent structure look like? Are we talking about long standing citizens assemblies not just brought in for a particular emergency?
Yes, you can have structures like that alongside bespoke elements where you need to conduct
something that maybe be particularly controversial or a review of legislation.
For example, you could have citizens panels like citizens assemblies,
but also just where there is ongoing policy decisions being made that there is linked to that.
Some formal structure for public engagement might be that you have to renew each time.
It's not the same citizens assembly, but there are a number of different methods that can be used that would suit what level
you're operating at local government or national government or international agency.
So you've been through this process now, and obviously the exercise you've overseen has been quite time consuming and probably not cheap.
Has anybody in government paid any attention? Well, I hope so.
We ran a workshop at Westminster where a number of policymakers, politicians and various other interested parties came for the day,
heard feedback from the dialogues as well as from other aspects of the pandemic ethics accelerator.
So I think that's very positive. We have hope through the work of the Pandemic Ethics Accelerator that our briefings
and other online material is picked up and read by policymakers and others.
And so gradually and I think it is a kind of drip, drip that we begin to open minds to the possibilities of dialogue,
which should hopefully make a difference in the future. Sarah Cunningham Burley, thank you very much indeed.
Thank you. Thanks for listening to the Pandemic Ethics Accelerator podcast.
You can hear more in this six part series on University of Oxford Podcasts or at Pandemic Ethics dot UK.