Policy formulation is an important and complex function of the government. It is akin to the complex process a physician undertakes in formulating a management plan for a patient. Physicians are trained to undertake this process through a structured clinical assessment based on history and on physical examination, supplemented by diagnostic assessment undertaken as per the provisional diagnoses arrived at by the clinical assessment. The treatment plan is generally in alignment with evidence-based practice guidelines. However, many times physicians are also called upon to use their ethical judgment to decide on a course of action, especially for patients presenting with medical emergencies. In some countries, medicolegal systems and payment systems influence decision-making.

Leadership, in general, is not trained formally in public policy making. Many of the elected representatives come from varied backgrounds. Even public administrators may need formal education and training in policy making. In the absence of objective evidence, many stakeholders try to influence policies to their advantage. Even a sound policy may not get formulated on account of the partisan behavior of political parties. Many countries may not have the capacities to undertake policy research to generate objective evidence. In an emergency, researchers may be cautious in providing definitive guidance as the evidence may keep changing.

Countries with functioning integrated national health information systems could generate evidence rapidly during the COVID-19 pandemic to inform leadership to make appropriate decisions. It will not be of help to generate evidence if the leadership doesn’t respect or include the evidence in their decisions. Hence, there is a need for countries to build policy research capacities, nurture a culture of evidence-informed policy formulation, and build a national integrated health information system to generate evidence rapidly during a public health crisis to become resilient.

Even with strong evidence, leadership faces ethical dilemmas in arriving at a policy during a health crisis. These were clearly evident across countries during the Covid pandemic. There were ethical dilemmas galore during the pandemic related to individual liberty versus collective safety, lives versus livelihoods, safety versus speed in approving vaccines and repurposed drugs, in giving boosters to their population versus supplying vaccines to those who are yet to get the first dose, etc.

Hence, there is a need to have ethical frameworks in hand during an emergency for rapid policy formulation. Every country has gone through these dilemmas in the past, just as many are passing through the current pandemic. A dialogue should ensue to discuss various ethical dilemmas faced, actions taken, and the outcomes experienced to arrive at informed ethical frameworks that can be put to use during a future crisis. Great epics from India and Greece provide many examples of these dilemmas that leadership undergoes through storytelling.

We all are going through the phase of learning during a health shock. The objective of these learnings is to build back stronger and more resilient health systems. We need an integrated, interoperable, national health information system for better surveillance of potential threats and to generate rapid evidence to inform policies. There should be national capacities to research during a rapidly emerging pandemic or other health crises. There should be institutional mechanisms to base policies on sound evidence so as not to leave the outcomes to chance. There should also be defined ethical frameworks with case examples to guide decisions that impact millions of people.

Dr. Krishna Reddy Nallamalla

Photo Credits: Express Healthcare 

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