HPLS (2020) 42:58

https://doi.org/10.1007/s40656-020-00353-8

NOTES & COMMENTS

The COVID‑19 pandemic: a case for epistemic

pluralism in public health policy

Simon Lohse1   · Karim Bschir2

Accepted: 19 November 2020 / Published online: 14 December 2020

© The Author(s) 2020

Abstract  This paper uses the example of the COVID-19 pandemic to analyse the
danger associated with insufficient epistemic pluralism in evidence-based public
health policy. Drawing on certain elements in Paul Feyerabend’s political philos-
ophy of science, it discusses reasons for implementing more pluralism as well as
challenges to be tackled on the way forward.

Keywords  Evidence-based policy · Paul Feyerabend · Expertise

We live in an age of evidence-based policy. Recent attacks on science in the US,

Germany and other countries and greater public scrutiny—sometimes leading to
outright denial—of scientific knowledge are no contradiction to this claim. Rather,
sceptical and anti-science movements must be understood against the backdrop that
science today is much more relevant to politics, public life, and the economy than it
ever was before.1

1
  Although we think that the rise of evidence-based policy, in particular within the last third of the twen-
tieth century, is an important background condition for current science denialism, this is not meant to
deny the importance of other, industry-driven factors that actively induce anti-science tendencies, for
example by “manufacturing doubt” (Oreskes and Conway 2010).

This note is part of the topical collection “Seeing Clearly Through COVID-19: Current and future
questions for the history and philosophy of the life sciences” edited by G. Boniolo and L. Onaga.

* Simon Lohse
simon.lohse@cells.uni‑hannover.de
1
Centre for Ethics and Law in the Life Sciences (CELLS) and Institute of Philosophy, Leibniz
University Hannover, Hannover, Germany
2
School of Humanities and Social Sciences, University of St. Gallen, St. Gallen, Switzerland

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Page 2 of 5 S. Lohse, K. Bschir

The significance of science for policy-making was hardly ever more visible than
during the COVID-19 pandemic in 2020. Scientific experts informed and drove gov-
ernmental crisis management and public health policy strategies in many countries
and on many levels. In the US, the UK and the EU, for example, epidemiological
models and scientific advice had a direct influence on the implementation of lock-
down measures to prevent disease spread and on the development of strategies to
deal with the pandemic on a long-term basis (e.g. Adam 2020).
There have been two main lines of criticism about the way science informed and
guided policy during the COVID-19 pandemic. The first type of criticism concerns
the fact that government action has been mainly driven by numbers of COVID-
19 cases and deaths at the expense of other aspects of the situation. For example,
Caduff (2020) claims that many governments failed to take into account the drastic
impact of lock-down measures on the economy and the lives of less affluent citizens.
It has also been argued that social consequences of lockdowns, such as the risk of
increased domestic violence or the amplification of social inequalities due to home
schooling, were not adequately taken into account.
The second type of criticism concerns in silico modelling and its central role in
strategic policy decisions. It has been pointed out that policy-making relied far too
much on epidemiological modelling despite the fact that even the best computer
models suffer from severe uncertainty and that they may be based on misleading
mathematical simplifications (Saltelli et  al. 2020). Computer models can help to
project possible scenarios. But they often contain estimations of initial conditions
and assumptions about the dynamics of a system which are made under uncertainty.
Uncertainties in the initial conditions or the dynamical structure of the model may
translate to the projections derived from these models. This effect is especially pro-
nounced in non-linear models. The amplification of structural model errors in predic-
tions has been described by Frigg et al. (2014) as hawkmoth effect (in analogy to the
butterfly effect that arises due to uncertainty in the initial conditions). The hawkmoth
effect may seriously compromise the usefulness of nonlinear models for predictive
purposes.2 As a consequence, policy-making may have been guided by only appar-
ently exact projections of the effects of certain policy measures while not paying
enough attention to alternative information for policy-making, in particular informa-
tion regarding different impacts of policy measures in different socio-economic sec-
tors of society.
While both types of criticism address different issues, they share a concern about
insufficient epistemic pluralism in the public health measures that were implemented
to address the COVID-19 pandemic. Generally speaking, epistemic pluralism is the
use of more than one perspective or approach to deal with a knowledge-related prob-
lem. We provide a short analysis of the problems arising from insufficient epistemic
pluralism in a public health context that is inspired by certain elements in Paul Fey-
erabend’s political philosophy of science. The goal is to deepen our understanding of

2
  Frigg et al. discuss the hawkmoth effect in the context of climate modeling. However, the authors also
provide arguments for the applicability of the effect to other modeling contexts that operate with nonlin-
ear models.

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The COVID‑19 pandemic: a case for epistemic pluralism in public… Page 3 of 5  58

potential epistemic shortcomings of evidence-based public health policy and to pro-

vide part of a multi-layered answer to a key question in this context: How should we
design future evidence-based policy-making in the context of public health threats?
The diagnosis of insufficient epistemic pluralism is rather straightforward in both
lines of criticism mentioned above. In both cases, policy-making seems to have
been constrained in that it mainly focused on one epistemic perspective or approach.
According to the first line of criticism, public health policy was developed primarily
from a biomedical perspective at the expense of alternative viewpoints, e.g. view-
points based on local knowledge or non-scientific forms of knowledge. According to
the second line, policy making was constrained by epidemiological modelling ignor-
ing relevant perspectives form other biomedical disciplines and the social sciences.
The first type of criticism mainly concerns a lack of pluralism regarding viewpoints
that are external to science, while the second type concerns a lack of pluralism
within science itself. Both forms of insufficient pluralism—external and internal to
science—are problematic from an epistemological point of view.3
First, there is a risk of developing a myopic, epidemiology-centric description of
reality that can lead to imbalanced policy decisions. For instance, the strong focus on
the numbers of COVID-19 cases and deaths may have led to one-sided harm-benefit
analyses that only addressed COVID-19-related health threats while disregarding
potential and/or latent social issues that have been consequences of pandemic crisis
management. Likewise, the overreliance on Susceptible-Infected-Recovered (SRI)
models may have structurally excluded potentially useful knowledge from other bio-
logical disciplines or the social sciences, knowledge that could have been crucial for
more rational policy interventions (Manzo 2020).
Second, we have limited knowledge  about pandemics and their development in
general. But even if this were the case, there are always good reasons to take a fal-
libilistic stance towards our current best scientific knowledge. Disease statistics can
always misrepresent, and models can always be wrong. We should thus keep our
options open and promote the development and use of alternative ways to under-
standing what is going on. In Feyerabend’s words: “[T]he world which we want to
explore is a largely unknown entity. We must, therefore, keep our options open and
we must not restrict ourselves in advance” (Feyerabend 1993[1975], p. 12).
Third, and in line with another key argument by Feyerabend (1999[1968]), it is
always rational to develop alternative approaches to any given epistemic problem
to better understand the shortcomings of each alternative. It is only when one has
an independent perspective on the local side-effects of policy-measures that deal
with the COVID-19 pandemic that one can see what (else) might be missing from
the picture of a specific public health strategy, and insights and methodological
approaches from social scientists can be vital in identifying misguided assumptions
in the predictions of epidemiological models.

3
  We wish to thank Thomas Reydon for his helpful comments and for encouraging us to further develop
the plea for more pluralism in public health policy, which will be done in a forthcoming publication on
the topic.

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Page 4 of 5 S. Lohse, K. Bschir

What follows from the observed lack of epistemic pluralism in the manage-
ment of the COVID-19 crisis? It seems that the right move would be to strengthen
epistemic pluralism in evidence-based public health policy. Many more perspec-
tives should be included in providing the evidence for policy-making and many
more stakeholders should get a voice in policy-counselling (instead of criticizing
policy-making from the outside). This would include not only epidemiologists,
social scientists and scholars from other fields but also experts who could con-
tribute local knowledge of relevant social spheres, such as nurses or education
department heads who know which hygiene measures can realistically be imple-
mented in their primary schools.
It is important to note, however, that most of Feyerabend’s arguments for plu-
ralism are negative in the sense that they are directed against all forms of epis-
temic monism and methodological hegemony. Feyerabend is less pronounced
when it comes to developing a constructive and positive account of how pluralism
can be implemented in practice. In fact, the promotion of epistemic pluralism is
fraught with challenges. Among the most pressing are the following three: (a)
There are pragmatic constraints on the inclusion of more, diverse perspectives
and types of evidence in policy-making, especially in times of acute public health
threats. How many perspectives can be included without completely paralyzing
the policy process? (b) Exchange between diverse perspectives has to be facili-
tated while avoiding the inclusion of what Feyerabend has called “cranks” (see
the discussion in Shaw 2020), i.e. stakeholders who are only interested in defend-
ing their own point of view or interests, and not in the open exchange of ideas
and in learning from each other (think “conspiracy theorists”). (c) Differences in
epistemic standards and authority have to be overcome. Everybody who has ever
worked in an inter- or transdisciplinary environment knows how challenging it
can be to discuss different methods, findings and other types of knowledge when
epistemic standards are divergent. We should also expect differences in authority
(and prestige) between policy experts, scientists and experts on local knowledge.
Those may lead to imbalanced discussions, instead of genuine dialogue, and need
to be alleviated by actively designing deliberative processes in order to facilitate
a productive form of pluralistic exchange at eye level (Barker and Kitcher 2014,
p. 155ff).
Addressing the issue of insufficient epistemic pluralism as well as the sketched
challenges associated with pluralism is essential for improving evidence-based
public health policy, in particular in the context of acute public health threats.
Both aspects should therefore be on the agenda of scholars who think about
evidence-for-use and normative issues in scientific expertise in the context of
policy-making.

Funding  Open Access funding enabled and organized by Projekt DEAL.

Compliance with ethical standards 

Conflict of interest  The authors declare no competing interests.

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The COVID‑19 pandemic: a case for epistemic pluralism in public… Page 5 of 5  58

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