Decision-making under epistemic, strategic and institutional uncertainty during COVID-19: findings from a six-country empirical study
Background Uncertainty is defined as limited knowledge or lack of predictability about past, present or future events. The COVID-19 pandemic management was significantly impacted by uncertainty, as the gaps between existing information and the necessary knowledge hindered decision-making. Current un...
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| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
5 February 2025
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| In: |
BMJ global health
Year: 2025, Volume: 10, Issue: 2, Pages: 1-18 |
| ISSN: | 2059-7908 |
| DOI: | 10.1136/bmjgh-2024-018124 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1136/bmjgh-2024-018124 Verlag, kostenfrei, Volltext: https://gh.bmj.com/content/10/2/e018124 
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| Author Notes: | Sumegha Asthana, Sanjana Mukherjee, Alexandra L Phelan, Ibrahim B Gobir, JJ Woo, Clare Wenham, Mohammad Mushtuq Husain, Tahmina Shirin, Nevashan Govender, Mohannad Al Nsour, Winifred Ukponu, Adachioma Chinonso Ihueze, Roujia Lin, Sumit Asthana, Renee Vongai Mutare, Claire J Standley |
| Summary: | Background Uncertainty is defined as limited knowledge or lack of predictability about past, present or future events. The COVID-19 pandemic management was significantly impacted by uncertainty, as the gaps between existing information and the necessary knowledge hindered decision-making. Current uncertainty literature primarily focuses on natural disasters, leaving a gap in understanding decision-making under uncertainty in times of public health emergencies. Analysing strategies for making decisions under uncertainty during the pandemic is crucial for future pandemic preparedness.Methods Using a comparative research design, we study the strategies governments used to make decisions under uncertainty during the COVID-19 pandemic. We collected data through desk reviews, stakeholder interviews and focus group discussions with stakeholders from government, academia and civil society from six purposefully selected countries: Nigeria, Singapore, South Africa, Bangladesh, Jordan and the UK.Results Regardless of political, geographic and economic context, all six countries adopted common strategies to make decisions under three types of uncertainties. Decision-making under epistemic uncertainty involved seeking expert advice and collecting evidence from other countries and international organisations. Decision-making under strategic uncertainty involved coordination, collaboration and communication. Decision-making under institutional uncertainty involved using or adapting pre-existing experiences, structures and relationships and establishing new institutions and processes.Conclusions We contribute to the theory and practice of public health crisis decision-making by presenting a unified national-level applied decision-making framework for events involving uncertainty. We provide practical guidance for approaches to enhance decision-making in future health crises that could also be used for other emergencies. |
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| Item Description: | Gesehen am 31.07.2025 |
| Physical Description: | Online Resource |
| ISSN: | 2059-7908 |
| DOI: | 10.1136/bmjgh-2024-018124 |