Title: Translating Uncertainty into Policy: Influenza Transmission and Mask Choice
Author(s): Jacob Stegenga
Affiliation: University of California, San Diego
Presented At: STiS 2008
Primary Topic Area: Health Policy
Public health jurisdictions around the world have been expected to develop policies regarding a problem imbued with scientific uncertainty: in the case of an influenza pandemic, what kind of masks should be provided to healthcare workers? If influenza is transmitted via an airborne route, then respirator masks are required. If influenza is transmitted by contact, then surgical masks are sufficient. Occupational health experts argue (using mathematical models and animal experiments) that influenza could be transmitted via an airborne route, whereas infectious disease physicians argue (based on clinical experience and observational studies) that influenza is transmitted by contact.
This controversy is both an erudite epistemic problem – how is influenza transmitted? – and an important policy problem with high stakes – what kind of mask should be provided to healthcare workers? During the SARS outbreak, uncertainty regarding the mode of disease transmission led to fear and, in some tragic cases, death. Nurse unions have threatened work stoppages during a pandemic if their members were not to receive respirator masks. In their attempts to develop guidelines for mask use, policy makers have dealt with scientific uncertainty by appealing to consensus, common-sense, and the precautionary principle. However, achieving consensus may be impossible, and caution and common-sense will underdetermine policy construction, because different sides of this controversy have different notions of what it means to be cautious, and have competing dictates of common-sense. This paper describes the competing argumentative strategies, based on interpretively flexible evidence, and explores the process of translating scientific uncertainty into “regulatory objectivity” by public health organizations.