As the COVID-19 pandemic took hold in 2020, Chief Medical Officers (CMOs) entered the public spotlight like never before. Amidst this increased visibility, the role is deeply contested. Much of the disagreement concerns whether CMOs should act independently of the government: while some argue CMOs should act as independent voices who work to shape government policy to protect public health, others stress that CMOs are civil servants whose job is to support the government. The scope and diversity of debates about the CMO role can be explained by its inherently contradictory nature, which requires incumbents to balance their commitments as physicians with their mandates as civil servants who advise and speak on the government’s behalf. The long-haul COVID-19 pandemic has further tested the CMO role and has shone light on its varying remits and expectations across different jurisdictions, institutions and contexts. It is perhaps unsurprising, then, that calls to amend the CMO role have emerged in some jurisdictions during the pandemic. However, any discussions about changing the CMO role need a stronger understanding of how different institutional and individual approaches impact what incumbents feel able to do, say and achieve. Based on an ongoing comparative analysis of the position across five countries with Westminster-style political systems, we provide an overview of the CMO role, explain its prominence in a pandemic, examine some debates surrounding the role and discuss a few unanswered empirical questions before describing our ongoing study in greater detail.
Despite long-standing efforts to enhance evidence-informed decision-making in public health policy, tensions remain between the goal of basing decisions on the best available scientific evidence and the need to balance competing aims, interests, and evidentiary sources in representative democracies. In response, several strategies have been proposed both to democratize evidence production and evaluation, and to effectively integrate evidence into the decision-making processes of institutions of representative democracy. Drawing on a synthesis of the conceptual and empirical literature, this chapter describes and categorizes mechanisms that aim to reconcile political and scientific considerations in evidence-informed policymaking and develops an analytical typology that identifies salient dimensions of variation in their selection and design.
At the beginning of the COVID-19 pandemic, many leaders claimed that their public health policy decisions were ‘following the science’; however, the literature on evidence-based policy problematises the idea that this is a realistic or desirable form of governance. This article examines why leaders make such claims using Christopher Hood’s (2011) blame avoidance theory. Based on a qualitative content analysis of two national newspapers in each of Australia, Canada and the UK, we gathered and focused on unique moments when leaders claimed to ‘follow the science’ in the first six months of the pandemic. We applied Hood’s theory to identify the types of blame avoidance strategies used for issues such as mass event cancellation, border closures, face masks, and in-person learning. Politicians most commonly used ‘follow the science’ to deflect blame onto processes and people. When leaders’ claims to ‘follow the science’ confuse the public as to who chooses and who should be held accountable for those decisions, this slogan risks undermining trust in science, scientific advisors, and, at its most extreme, representative government. This article addresses a gap in the literature on blame avoidance and the relationship between scientific evidence and public policy by demonstrating how governments’ claims to ‘follow the science’ mitigated blame by abdicating responsibility, thus risking undermining the use of scientific advice in policymaking.
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