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Hello, I'm David Edmonds and this is the Pandemic Ethics Accelerator Podcast.

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The UK Pandemic Ethics Accelerator was a project funded by the Arts and Humanities Research

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Council in 2021 22 to examine the ethical challenges faced during the COVID pandemic,

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it combined expertise from the University of Oxford, Bristol, Edinburgh University College, London and the Nuffield Council on Bioethics.

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This six part podcast series covers some of the themes that emerged from the research.

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During an emergency such as the COVID 19 pandemic.

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There's not a lot of time for official bodies to consult the public.

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So Cunningham Burley is a professor of medical and family sociology at Edinburgh University.

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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.

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Sarah Cunningham Burley, welcome. Hi. We're talking today about dialogues, public dialogues.

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You oversaw some public dialogues as part of the pandemic ethics accelerator.

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How do they work exactly? So the idea of a public dialogue is to really encourage or provide opportunities for members of the public

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and selected on various criteria to come together to discuss and deliberate the issues of relevance,

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in this case around COVID 19, both the experience of and government responses to the pandemic.

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So primarily, it provides an opportunity to discuss, to not take a position that one's views on something are kind of fixed,

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but are something that can be generative through deliberation.

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And through that process, you can come to sometimes agreed positions in some cases,

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or a collective position or an agreement that there are a range of different perspectives and tensions in relation to an issue.

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More practically, it involves bringing people together, combining both the presentation of some sort of key information.

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We brought in some experts in different areas that can kick start some of the discussions,

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but also involve the participants themselves in shaping and framing some of the sessions that we

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run so that the issues are ones that come from them and from their experience and their interests.

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So managing both of those things that kind of like framing of the issues and allowing participants themselves to bring things forward and

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then having small group discussions that allow everyone to have their say and some plenary discussions that bring people back together.

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But all of this is a small group, so size of our dialogue between 20 and 30 people.

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And what's the point of them?

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Why is it valuable to extract the views of, as you say, a very small number of people so increasingly across public services?

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There has been a movement to take on board the voices who are most affected by policy.

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So at a very local level that might be engaging service users in issues that affect then service design,

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new interventions, etc., or at a more democratic level in terms of issues around governance.

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So there's a kind of intrinsic value that there's something about dialogue that can help

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revitalise democracy by closing the gap between the decision makers and the public.

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Okay. So there's a value just in holding the exercise, but what about instrumental value?

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What do they actually tell us about the pandemic? Well, the two are related.

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So at one level, there's an intrinsic value.

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So it's an ideological position that the democratic process would benefit from more engagement so that more voices are heard and decision making,

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the argument is, would be better if there are more people engaged in that process.

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But obviously that intrinsic value, which is also reflected in what participants themselves say about the process,

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they both feel valued and learn something from that which would ripple out beyond them as individuals, of course.

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But the instrumental value is then, well, does that make a difference other than to the individuals that participated and their local contexts?

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So the instrumental value would be the ability then to feed this up in some way and to be able to demonstrate

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that subsequent decisions might have been improved or fall better with the population as a whole.

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So what did we learn? What did they tell us about the pandemic? A whole range of different things.

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We conducted two different dialogues one in 2021 and one in 2022.

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If you've never participated or been involved in facilitating one of these,

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one of the most obvious and deeply felt issues is the way in which people are keen to and enthusiastic

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about grappling with the complex issues that governments and others have to deal with in relation to,

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in this case, COVID 19, and that it surfaces some of the key ethical dilemmas that we all have to deal with.

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How do you balance individual and collective needs?

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We certainly found that there was a very strong sense of solidarity in relation to the need for collective action alongside compassion towards those.

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To most affected and most vulnerable, but also a sense that the big picture always has to be held in mind.

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And by the big picture here, we mean both the long term effects and the way in which the pandemic itself revealed starkly existing

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problems in society that are experienced and then experienced with a greater intensity through the pandemic.

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Say, by existing problems. I assume you mean structural inequality, perhaps racial disparities.

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But we knew already that there were concern about these issues. Why do we need these dialogues to extract these concerns?

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We knew about them and researchers have been researching this for decades.

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Evidence is that individuals will be directly experiencing inequality as we know.

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But the pandemic put this, first of all, really high on the kind of public agenda it could be seen everywhere.

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So I think something to do with the intensity of the revealing of these inequalities in ways that were

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deeply shocking and obviously deeply traumatic for those directly affected and those around them.

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So I think it's not that we didn't know about inequality before,

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but actually you could not avoid confronting inequality almost in your day to day life as a service provider or as an individual.

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What about the issue of government communication about lockdown measures and so forth?

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Were people happy with the way the government explained policy?

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Do they trust government? Yes and no has to be the answer to that.

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So there was an awareness that there was a need to make difficult decisions in a very complex and rapidly changing environment.

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But there was not a strong sense of trust for a number of reasons.

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One, there was a feeling that the communications were not always robust and meaningful and didn't always reflect

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the uncertainty that was present at the time and still is when making decisions in uncertain times.

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The public are aware of that and have the ability and desire to embrace that uncertainty.

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There was also the issue of politicians themselves not following the rules that they were expecting other people to do,

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which of course is not generative of trust. If the individuals in whom one is putting one's trust are themselves not trustworthy,

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it rather undermines many aspects of government response and publics own response to that.

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However, there were also occasions where leadership, partly through good communication, could develop a more trustworthy environment.

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And in the UK with the different nations, the home nations and devolved administrations,

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there were examples used in the dialogues of the ages that seemed to generate more trust between the politicians,

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the decision making and their publics. How do they do that?

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Sometimes clearer communication ways of communicating that somehow seemed to narrow the gap between the political sphere and the citizens.

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Now there were polling companies that are constantly probing public opinion on a wide range of matters,

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including issues of trust, concerns about equality and so forth.

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And of course, they're using a much larger dataset.

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So what, if anything, emerges from the dialogue process that we couldn't extract from opinion polls?

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So they're serving different ends,

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and they're definitely a place for both opinion polls surveys that aim to generate an understanding of public attitudes and of their views.

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And they can then inform decision making. But a dialogue goes into much more depth and actually engages participants almost in

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aspects of decision making in a way that you can't do with a poll and also in a dialogue,

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participants learn from each other. You learn aspects of developing respectful arguments, managing tensions,

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all of these things that are actually very important in complex decision making processes.

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Reading about the process,

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I saw that participants felt quite strongly that meaningful public involvement should be built into the response for future pandemics.

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Now that's obviously easier said than done.

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If the next pandemic is anything like the last one, then there just might not be time to set up public engagement processes.

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I wonder how you think public engagement could be built into the system?

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Yes. So there was different types of public engagement going on from early on in the pandemic.

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But there is not an overall strategy or. Embedding is public engagement.

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You could imagine that that would be possible. Yes. Sometimes decisions have to be made so quickly that that is impossible.

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But if you have public engagement embedded into existing structures, then first of all, you won't come at all these issues absolutely new.

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You will have been doing public engagement.

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And I think the challenge is for that to be a combination of bottom up engagements going on at local level,

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but that moves up to local and national governments and also the other way around.

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But we don't have either the structures or processes that join or this up together.

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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.

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What would a permanent structure look like? Are we talking about long standing citizens assemblies not just brought in for a particular emergency?

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Yes, you can have structures like that alongside bespoke elements where you need to conduct

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something that maybe be particularly controversial or a review of legislation.

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For example, you could have citizens panels like citizens assemblies,

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but also just where there is ongoing policy decisions being made that there is linked to that.

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Some formal structure for public engagement might be that you have to renew each time.

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It's not the same citizens assembly, but there are a number of different methods that can be used that would suit what level

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you're operating at local government or national government or international agency.

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So you've been through this process now, and obviously the exercise you've overseen has been quite time consuming and probably not cheap.

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Has anybody in government paid any attention? Well, I hope so.

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We ran a workshop at Westminster where a number of policymakers, politicians and various other interested parties came for the day,

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heard feedback from the dialogues as well as from other aspects of the pandemic ethics accelerator.

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So I think that's very positive. We have hope through the work of the Pandemic Ethics Accelerator that our briefings

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and other online material is picked up and read by policymakers and others.

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And so gradually and I think it is a kind of drip, drip that we begin to open minds to the possibilities of dialogue,

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which should hopefully make a difference in the future. Sarah Cunningham Burley, thank you very much indeed.

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Thank you. Thanks for listening to the Pandemic Ethics Accelerator podcast.

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You can hear more in this six part series on University of Oxford Podcasts or at Pandemic Ethics dot UK.