Mathematical models as public troubles in COVID-19 infection control: following the numbers.

Mathematical models are key actors in policy and public responses to the COVID-19 pandemic. The projections from COVID-19 models travel beyond science into policy decisions and social life. Treating models as 'boundary objects', and focusing on media and public communications, we 'follow the numbers' to trace the social life of key projections from prominent mathematical models of COVID-19. Public deliberations and controversies about models and their projections are illuminating. These help trace how projections are 'made multiple' in their enactments as 'public troubles'. We need an approach to evidence-making for policy which is emergent and adaptive, and which treats science as an entangled effect of public concern made in social practices. We offer a rapid sociological response on the social life of science in the emerging COVID-19 pandemic to speculate on how evidence-making might be done differently going forwards

Making evidence and policy in public health emergencies: Lessons from COVID-19 for adaptive evidence-making and intervention.

Background: In public health emergencies, evidence, intervention, decisions and translation proceed simultaneously, in greatly compressed timeframes, with knowledge and advice constantly in flux. Idealised approaches to evidence-based policy and practice are ill-equipped to deal with the uncertainties arising in evolving situations of need. Key points for discussion: There is much to learn from rapid assessment and outbreak science approaches. These emphasise methodological pluralism, adaptive knowledge generation, intervention pragmatism, and an understanding of health and intervention as situated in their practices of implementation. The unprecedented challenges of novel viral outbreaks like COVID-19 do not simply require us to speed-up existing evidence-based approaches, but necessitate new ways of thinking about how a more emergent and adaptive evidence-making might be done. The COVID-19 pandemic requires us to appraise critically what constitutes ‘evidence-enough’ for iterative rapid decisions in-the-now. There are important lessons for how evidence and intervention co-emerge in social practices, and for how evidence-making and intervening proceeds through dialogue incorporating multiple forms of evidence and expertise. Conclusions and implications: Rather than treating adaptive evidence-making and decision-making as a break from the routine, we argue that this should be a defining feature of an ‘evidence-making intervention’ approach to health

A model society: maths, models and expertise in viral outbreaks

Viral outbreaks and public health emergencies obligate an urgent need for evidence to inform rapid responses. In the case of SARS-Cov-2, a novel virus linked to the fast-moving COVID-19 pandemic, mathematical models projecting disease outbreaks and the potential effects of interventions are playing a critical role. Modelled projections are not only evidence-making policy decisions, but are afforded power-of-acting in public understandings and in social life. We propose here that COVID-19 is coming to be known in maths and models. We trace this process not only in policy but in media stories of maths, mathematicians and models. We accentuate the social life of maths and models, which feed citizen science and social actions in relation to COVID-19. There are general lessons from the emergent evidence-making of COVID-19 for how we do science for public health

Producing the 'problem of drugs': a cross national-comparison of ‘recovery' discourse in two Australian and British reports

The notion of ‘recovery’ as an overarching approach to drug policy remains controversial. This cross-national analysis considers how the problem of drugs was constructed and represented in two key reports on the place of ‘recovery’ in drug policy, critically examining how the problem of drugs (and the people who use them) are constituted in recovery discourse, and how these problematisations are shaped and disseminated. Bacchi's poststructuralist approach is applied to two documents (one in Britain and one in Australia) to analyse how the ‘problem of drugs’ and the people who use them are constituted: as problematic users, constraining alternative understandings of the shifting nature of drug use; as responsibilised individuals (in Britain) and as patients (in Australia); as worthy of citizenship in the context of treatment and recovery, silencing the assumption of unworthiness and the loss of rights for those who continue to use drugs in ‘problematic’ ways. The position of the organisations which produced the reports is considered, with the authority of both organisations resting on their status as independent, apolitical bodies providing ‘evidence-based’ advice. There is a need to carefully weigh up the desirable and undesirable political effects of these constructions. The meaning of ‘recovery’ and how it could be realised in policy and practice is still being negotiated. By comparatively analysing how the problem of drugs was produced in ‘recovery’ discourse in two jurisdictions, at two specific points in the policy debate, we are reminded that ways of thinking about ‘problems’ reflect specific contexts, and how we are invoked to think about policy responses will be dependent upon these conditions. As ‘recovery’ continues to evolve, opening up spaces to discuss its contested meanings and effects will be an ongoing endeavour

A ‘promising tool’? A critical review of the social and ethico-political effects of wastewater analysis in the context of illicit drug epidemiology and drug policy

Wastewater analysis has been taken up with enthusiasm in the illicit drugs field. Through a critical social science lens, we consider claims to what these ‘promising’ methods might afford in the context of drug epidemiology and policy, recognising that all methods have social effects in their specific contexts of use. We outline several ethico-political issues, highlighting how methods can have different effects as they move from one discipline (environmental science or analytic chemistry) into another (illicit drugs). Translated into the drugs field, wastewater analysis problematically shifts the focus of drug policy from harm reduction to drug use prevalence and entrenches stigma. Without comprehensive information about the social and contextual aspects of drug harms, effective drug policy is not possible

Uncomfortable science: How mathematical models, and consensus, come to be in public policy.

We explore messy translations of evidence in policy as a site of 'uncomfortable science'. Drawing on the work of John Law, we follow evidence as a 'fluid object' of its situation, also enacted in relation to a hinterland of practices. Working with the qualitative interview accounts of mathematical modellers and other scientists engaged in the UK COVID-19 response, we trace how models perform as evidence. Our point of departure is a moment of controversy in the public announcement of second national lockdown in the UK, and specifically, the projected daily deaths from COVID-19 presented in support of this policy decision. We reflect on this event to trace the messy translations of "scientific consensus" in the face of uncertainty. Efforts among scientists to realise evidence-based expectation and to manage the troubled translations of models in policy, including via "scientific consensus", can extend the dis-ease of uncomfortable science rather than clean it up or close it down. We argue that the project of evidence-based policy is not so much in need of technical management or repair, but that we need to be thinking altogether differently

How to think with models and targets: Hepatitis C elimination as a numbering performance.

The field of public health is replete with mathematical models and numerical targets. In the case of disease eliminations, modelled projections and targets play a key role in evidencing elimination futures and in shaping actions in relation to these. Drawing on ideas within science and technology studies, we take hepatitis C elimination as a case for reflecting on how to think with mathematical models and numerical targets as 'performative actors' in evidence-making. We focus specifically on the emergence of 'treatment-as-prevention' as a means to trace the social and material effects that models and targets make, including beyond science. We also focus on how enumerations are made locally in their methods and events of production. We trace the work that models and targets do in relation to three analytical themes: governing; affecting; and enacting. This allows us to situate models and targets as technologies of governance in the constitution of health, which affect and are affected by their material relations, including in relation to matters-of-concern which extend beyond calculus. By emphasising models and targets as enactments, we draw attention to how these devices give life to new enumerated entities, which detach from their calculative origins and take flight in new ways. We make this analysis for two reasons: first, as a call to bring the social and enumeration sciences closer together to speculate on how we might think with models and targets differently and more carefully; and second, to encourage an approach to science which treats evidencing-making interventions, such as models and targets, as performative and political

Futuring a world without disease: visualising the elimination of hepatitis C

Informed by work on futurity in science and technology studies, we trace how global disease elimination targets perform a world without disease through their translations in visual advocacy campaigns. Treating disease elimination targets and their visualisations as performative, we take the case of hepatitis C elimination to interrogate how futuring practices in public health govern the present and make effects. We focus specifically on how World Health Organization targets in the Global Health Sector Strategy on Viral Hepatitis entangle with visual resources produced by the World Hepatitis Alliance NOhep advocacy campaign. Targets and their visual representations in campaigns perform a disease elimination future which is set apart from the present, and yet urges action in-the-now. It enacts global health citizens but separates them from localised experiences of living with, and being cured of, disease. This disease elimination future relies heavily on instrumental rationalities and logics of the present, including the privileging of biomedical technoscientific knowledge, implementation science and global health governance, to the exclusion of other matters of concern, flattening out complexity to perform its certain achievability. These enactments raise political questions about how disease elimination futures might be made in a different mode

Towards an ontological politics of drug policy: Intervening through policy, evidence and method.

Increasing attention has been paid to matters of ontology, and its accompanying politics, in the drug policy field. In this commentary, we consider what an 'ontological politics' might mean for how we think about what drug policy is and what it might become, as well as for how we think about (and do) research in drug policy. Thinking ontopolitically questions the tacitly accepted status of 'drug problems', calls into question the realist presumptions which underpin much drug policy analysis, and provokes thinking about what counts as 'evidence' and the 'evidence-based policy' paradigm itself. We call attention to the inventive possibilities of method when grappling with the challenges thrown forth by the ontological turn, with a renewed focus on practice and relations. An ontological politics disrupts consensual claims and draws critical attention to objects that might otherwise appear 'finished' or 'ready-made', not least the things we call 'drugs' and 'drug policy'. Working with 'drug policy multiples' invites new thinking and dialogue to provoke an ethico-political mode of intervention in the field of drug policy and drugs research