Cutting through the noise during crisis by enhancing the relevance of research to policymakers

Background:It is widely recognised that policymakers use research deemed relevant, yet little is understood about ways to enhance perceived relevance of research evidence. Observing policymakers' access of research online provides a pragmatic way to investigate predictors of relevance.Aims and objectives:This study investigates a range of relevance indicators including committee assignments, public statements, issue prevalence, or the policymaker's name or district.Methods:In a series of four rapid-cycle randomised control trials (RCTs), the present work systematically explores science communication strategies by studying indicators of perceived relevance. State legislators, state staffers, and federal staffers were emailed fact sheets on issues of COVID (Trial 1, N = 3403), exploitation (Trial 2, N = 6846), police violence (Trial 3, N = 3488), and domestic violence (Trial 4, N = 3888).Findings:Across these trials, personalising the subject line to the legislator's name or district and targeting recipients based on committee assignment consistently improved engagement. Mentions of subject matter in public statements was inconsistently associated, and state-level prevalence of the issue was largely not associated with email engagement behaviour.Discussion and conclusions:Together, these results indicate a benefit of targeting legislators based on committee assignments and of personalising the subject line with legislator information. This work further operationalises practical indicators of personal relevance and demonstrates a novel method of how to test science communication strategies among policymakers. Building enduring capacity for testing science communication will improve tactics to cut through the noise during times of political crisis.

The role of 'non-knowledge' in crisis policymaking: a proposal and agenda for future research

Background: Recent complex and cross-boundary policy problems, such as climate change, pandemics, and financial crises, have recentred debates about state capacity, democratic discontent and the 'crisis of expertise'. These problems are contested and open to redefinition, misunderstanding, spin, and deception, challenging the ability of policymakers to locate, discriminate, comprehend, and respond to competing sources of knowledge and expertise. We argue that 'non-knowledge' is an under-explored aspect of responses to major policy crises. Key points: While discussed in recent work in sociology and other social sciences, non-knowledge has been given less explicit attention in policy studies, and is not fully captured by orthodox understandings of knowledge and evidence use. We outline three main forms of non-knowledge that challenge public agencies: amnesia, ignorance and misinformation. In each case, 'non-knowledge' is not simply the absence of policy-relevant knowledge. Amnesia refers to what is forgotten, reinvented or 'unlearned', while claims of ignorance involve obscuring or casting aside of relevant knowledge that could (or even should) be available. To be misinformed is to actively believe false or misleading information. In each instance, non-knowledge may have strategic value for policy actors or aid the pursuit of self-interest. Conclusions and implications: We demonstrate the relevance of non-knowledge through a brief case study, emerging from the inquiry into the COVID-19 hotel quarantine programme in the Australian state of Victoria. We argue that both amnesia and 'practical' forms of ignorance contributed to failures during the early part of the programme. © Policy Press 2023.

Beyond evidence: experimental policy-making in uncertain times

Evidence-based policy-making (EBP) is widely seen as a key instrument for good policy-making. Yet in the wake of the Covid-19 pandemic, the debate on the relation of science and policy-making gained new momentum. The premises of EBP, its narrow understanding of what kind of knowledge counts and how to make decisions, appeared inapt to provide a sound foundation for policy-making under conditions of high complexity and uncertainty. This paper addresses the major shortcomings of EBP and argues for revising its evidentialist framework. First, the idea of evidence itself has to be extended and pluralized by including alternative forms of knowledge. Second, uncertainty has to be taken seriously as a fundamental epistemic condition. To arrive at a more apt model of policy-making, this paper suggests to adopt a pragmatist perspective on the relation of politics, science and the public. This leads to an experimentalist account in the meliorist spirit. Such an account highlights the role of experience, participatory processes and collective learning. Furthermore, and in contrast to scientistic models, it underlines political responsibility and demands to cultivate sensitivity for possible failures and tragic constellations. Finally, a non-evidentialist model of policy advice is outlined. [ FROM AUTHOR] Copyright of Inquiry is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Undoing elimination: Modelling Australia's way out of the COVID-19 pandemic.

In the middle of 2020, with its borders tightly closed to the rest of the world, Australia almost achieved the local elimination of COVID-19 and subsequently maintained 'COVID-zero' in most parts of the country for the following year. Australia has since faced the relatively unique challenge of deliberately 'undoing' these achievements by progressively easing restrictions and reopening. Exploring the role of mathematical modelling in navigating a course through the pandemic through qualitative interviews with modellers and others working closely with modelling, we argue that each of these two significant phases of Australia's COVID-19 experience can be understood as distinct forms of 'model society'. This refers at once to the society enacted through the governance of risk, and to the visions of societal outcomes - whether to be sought or to be avoided - that are offered up by models. Each of the two model societies came about through a reflexive engagement with risk facilitated by models, and the iterative relationship between the representations of society enacted within models and the possibilities that these representations generate in the material world beyond them.

Impact assessment culture in the European Union. Time for something new?

Current approaches and cultures for the economic evaluations of environmental and health policies may suffer from excessive reliance on a standard neoclassic economic toolbox that neglects alternative perspectives. This may prematurely limit the spectrum of available policy options. Here we show how the inclusion of neglected currents of thought such as non-Ricardian economics, bioeconomics and a set of qualitative-quantitative methods from post-normal science leads to richer perspectives for a more inclusive uses of quantitative evidence, and opens the analysis to more possible futures. We also present some case studies in the energy, water, health and climate domains that highlight the point in a practical context for a more policy-oriented audience. We situate our analysis in the context of recent calls in the EU for the inclusion of more perspectives from the social sciences and the humanities in environmental assessment works.Copyright © 2023 The Authors

A comment-driven evidence appraisal approach to promoting research findings into practice when only uncertain evidence is available.

BACKGROUND: Comments in PubMed are usually short papers for supporting or refuting claims, or discussing methods and findings in original articles. This study aims to explore whether they can be used as a quick and reliable evidence appraisal instrument for promoting research findings into practice, especially in emergency situations such as COVID-19 in which only missing, incomplete or uncertain evidence is available. METHODS: Evidence-comment networks (ECNs) were constructed by linking COVID-19-related articles to the commentaries (letters, editorials or brief correspondence) they received. PubTator Central was used to extract entities with a high volume of comments from the titles and abstracts of the articles. Among them, six drugs were selected, and their evidence assertions were analysed by exploring the structural information in the ECNs as well as the sentiment of the comments (positive, negative, neutral). Recommendations in WHO guidelines were used as the gold standard control to validate the consistency, coverage and efficiency of comments in reshaping clinical knowledge claims. RESULTS: The overall positive/negative sentiments of comments were aligned with recommendations for/against the corresponding treatments in the WHO guidelines. Comment topics covered all significant points of evidence appraisal and beyond. Furthermore, comments may indicate the uncertainty regarding drug use for clinical practice. Half of the critical comments emerged 4.25 months earlier on average than the guideline release. CONCLUSIONS: Comments have the potential as a support tool for rapid evidence appraisal as they have a selection effect by appraising the benefits, limitations and other clinical practice issues of concern in existing evidence. We suggest as a future direction an appraisal framework based on the comment topics and sentiment orientations to leverage the potential of scientific commentaries supporting evidence appraisal and decision-making.

Evidence-Based Policy Making during the Coronavirus Disease 2019 Pandemic: A Systematic Review.

INTRODUCTION: The aim of this systematic review was to collect evidence and recommendations for the applicability of the concept of evidence-based policy making (EBPM) during the coronavirus disease 2019 (COVID-19) pandemic and to discuss the implementation of this concept from a medical science perspective. METHODS: This study was performed according to the guidelines, checklist, and flow diagram of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. An electronic literature search was conducted on September 20, 2022 using PubMed, Web of Science, Cochrane Library, and CINAHL databases with the following search terms: "evidence based policy making" and "infectious disease." Study eligibility assessment was performed based on the flow diagram of PRISMA 2020, and risk of bias assessment was performed using The Critical Appraisal Skills Program. RESULTS: Eleven eligible articles were included in this review and divided into three groups as follows: early, middle, and late stages of the COVID-19 pandemic. Basics of COVID-19 control were suggested in the early stage. The articles published in the middle stage discussed the importance of the collection and analysis of evidence of COVID-19 from around the world for the establishment of EBPM in the COVID-19 pandemic. The articles published in the late stage discussed the collection of large amounts of high-quality data and the development of methods to analyze them, as well as emerging issues related to the COVID-19 pandemic. CONCLUSIONS: This study revealed that the concept of EBPM applicable to emerging infectious disease pandemics changed between the early, middle, and late stages of the pandemic. The concept of EBPM will play an important role in medicine in the future.

The role of ‘non-knowledge' in crisis policymaking: a proposal and agenda for future research

Background:Recent complex and cross-boundary policy problems, such as climate change, pandemics, and financial crises, have recentred debates about state capacity, democratic discontent and the ‘crisis of expertise'. These problems are contested and open to redefinition, misunderstanding, spin, and deception, challenging the ability of policymakers to locate, discriminate, comprehend, and respond to competing sources of knowledge and expertise. We argue that ‘non-knowledge' is an under-explored aspect of responses to major policy crises.Key points:While discussed in recent work in sociology and other social sciences, non-knowledge has been given less explicit attention in policy studies, and is not fully captured by orthodox understandings of knowledge and evidence use. We outline three main forms of non-knowledge that challenge public agencies: amnesia, ignorance and misinformation. In each case, ‘non-knowledge' is not simply the absence of policy-relevant knowledge. Amnesia refers to what is forgotten, reinvented or ‘unlearned', while claims of ignorance involve obscuring or casting aside of relevant knowledge that could (or even should) be available. To be misinformed is to actively believe false or misleading information. In each instance, non-knowledge may have strategic value for policy actors or aid the pursuit of self-interest.Conclusions and implications:We demonstrate the relevance of non-knowledge through a brief case study, emerging from the inquiry into the COVID-19 hotel quarantine programme in the Australian state of Victoria. We argue that both amnesia and ‘practical' forms of ignorance contributed to failures during the early part of the programme.

Everyone Wins: Vaccine Lotteries Can Cost-Effectively Increase COVID-19 Booster Vaccination Rates.

Booster vaccination remains a key strategy to address the ongoing threat of coronavirus disease 2019 (COVID-19). However, take-up has been slow. By the fall of 2022, less than 50% of eligible US residents had received a booster dose. It is a central tenet in health economics that incentives or penalties are necessary to reach optimal vaccination rates. Six rigorous real-world studies provide evidence that COVID-19 vaccine lotteries cost-effectively raised vaccination rates at an estimated cost of $49 to $82 per additional dose. The 5 studies that found no impact of lotteries used statistical methods that underestimated the impact: They were statistically underpowered to detect a small yet cost-effective impact and did not adequately address selection bias. Vaccine lotteries are cost-effective because they not only provide financial incentives but also influence the public via nonfinancial channels: They garner media attention, tap into social networks, combat procrastination, and signal the importance of sustaining high vaccination rates. In fact, vaccine lotteries are likely to be more effective for booster vaccination than for initial doses because barriers to vaccination are higher. The ongoing threat of COVID-19 presents a unique opportunity to develop and implement innovative, evidence-based public health policies like vaccine lotteries to address current challenges.

Non-pharmaceutical interventions during COVID-19 in the UK and Spain: A rapid realist review

The paper is located at the crossroads of two modern intellectual movements. The first, evidence-based policy, seeks to locate vital information that will inform and improve key policy decisions on such matters as population health, social welfare, and human wellbeing. The second, complexity theory, describes the nature of the social world and perceives human action as persistently adaptive and social institutions as incessantly self-transformative. The first assumes that policies and programmes can achieve sufficient control to meet specific and measurable objectives. The second assumes that social actions are sufficiently capricious so that the society never conforms to anyone's plans - even those of the most powerful. The unparalleled resources committed to control the unprecedented attack of the COVID-19 pandemic are the epitome of complexity. The long struggle to contain the virus thus constitutes an ideal test bed to investigate this paradigmatic split. The paper undertakes this mission - focusing specifically on the effectiveness non-pharmaceutical interventions and examining evidence from the UK and Spain. © 2022 Serrano-Gallardo P et al.

Cutting through the noise during crisis by enhancing the relevance of research to policymakers

It is widely recognised that policymakers use research deemed relevant, yet little is understood about ways to enhance perceived relevance of research evidence. Observing policymakers' access of research online provides a pragmatic way to investigate predictors of relevance. Aims and objectives This study investigates a range of relevance indicators including committee assignments, public statements, issue prevalence, or the policymaker's name or district. Methods In a series of four rapid-cycle randomised control trials (RCTs), the present work systematically explores science communication strategies by studying indicators of perceived relevance. State legislators, state staffers, and federal staffers were emailed fact sheets on issues of COVID (Trial 1, N = 3403), exploitation (Trial 2, N = 6846), police violence (Trial 3, N = 3488), and domestic violence (Trial 4, N = 3888). Findings Across these trials, personalising the subject line to the legislator's name or district and targeting recipients based on committee assignment consistently improved engagement. Mentions of subject matter in public statements was inconsistently associated, and state-level prevalence of the issue was largely not associated with email engagement behaviour. Discussion and conclusions Together, these results indicate a benefit of targeting legislators based on committee assignments and of personalising the subject line with legislator information. This work further operationalises practical indicators of personal relevance and demonstrates a novel method of how to test science communication strategies among policymakers. Building enduring capacity for testing science communication will improve tactics to cut through the noise during times of political crisis.

Pandemics, policy, and pluralism: A Feyerabend-inspired perspective on COVID-19.

We analyse insufficient epistemic pluralism and associated problems in science-based policy advice during the COVID-19 pandemic drawing on specific arguments in Paul Feyerabend's philosophy. Our goal is twofold: to deepen our understanding of the epistemic shortcomings in science-based policy during the pandemic, and to assess the merits and problems of Feyerabend's arguments for epistemic pluralism as well as their relevance for policy-making. We discuss opportunities and challenges of integrating a plurality of viewpoints from within and outside science into policy advice thus contributing to discussions about normative issues concerning evidence and expertise in policy-making.

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.

A computational approach to study the gap and barriers between science and policy

Research on the gap between science and policymaking and the barriers to utilizing science in policy remains controversial, since previous research methods have dominated data collection with perceived participant responses. This approach makes research findings applicable to particular contexts, particular participants, and particular times but cannot be generalized. We used a computational model to analyse linguistic text data from two communities and compared the results with self-reported research findings. The outcomes support that scientists and policymakers have their own linguistic characteristics, with scientists in the medical field preferring jargon and policymakers' language containing public satisfaction pressures. Language representation also validates the existence of barriers in the use of science.

SMS reminders to improve outpatient attendance for public dental services: A retrospective study.

Patients who miss scheduled appointments reduce clinical productivity and delay access to care for other patients. Reminders have improved attendance for healthcare appointments previously, but it is not known if short message service (SMS) implementation reduces incidence of patients unable to attend (UTA) or who fail to attend (FTA) appointments in the public dental service. This paper studied the effectiveness of SMS reminders in increasing appointment attendance at outpatient public dental services in Queensland. Data were sourced from the adult service and the children and adolescent oral health service (CAOHS) at West Moreton Hospital and Health Service, a public dental service in Queensland. A total of 63,238 appointments pre-implementation of SMS reminders and 55,028 appointments post-implementation over a period of 2 years were analysed for rates of attendance, UTA and FTA. Characteristics of UTA and FTA appointments were analysed to identify factors that hindered improvement after implementation of reminders. For the CAOHS, the attendance rate decreased 4% (95% CI: 2%, 6%) following SMS implementation. The UTA rate also increased by 20% (95% CI: 15%, 25%). Following SMS implementation in the adult service, the attendance rate increased from 73.5 (95% CI: 72.6, 74.4) to 77.7 (95% CI: 76.6-78.8) per 100 appointments. The FTA rate post-implementation was 1.08 (95% CI: 1.00, 1.16) times that from pre-intervention, and the UTA rate decreased from 21.7 (95% CI: 21.2, 22.2) to 17.1 (95% CI: 16.6, 17.7) per 100 appointments. The SMS reminders had a mixed effect on the attendance, UTA and FTA rates for the CAOHS and adult services. Reminders reduced the rates of UTA for the CAOHS service and increased the rate of attendance for the adult service. There was an increase in the FTA rate for both services.

Evidence based policy making during times of uncertainty through the lens of future policy makers: four recommendations to harmonise and guide health policy making in the future.

The Covid-19 pandemic has not only outlined the importance of using evidence in the healthcare policy making process but also the complexity that exists between policymakers and the scientific community. As a matter of fact, scientific data is just one of many other concurrent factors, including economic, social and cultural, that may provide the rationale for policy making. The pandemic has also raised citizens' awareness and represented an unprecedented moment of willingness to access and understand the evidence underpinning health policies.This commentary provides policy recommendations to improve evidence-based policy making in health, through the lens of a young generation of public policy students and future policymakers, enrolled in a 24-hour course at Sciences Po Paris entitled "Evidence-based policy-making in health: theory and practice(s)".Four out of 11 recommendations were prioritised and presented in this commentary which target both policymakers and the scientific community to make better use of evidence-based policy making in health. First, policy makers and scientists should build trusting partnerships with citizens and engage them, especially those facing our target health care issues or systems. Second, while artificial intelligence raises new opportunities in healthcare, its use in contexts of uncertainty should be addressed by policymakers in terms of liability and ethics. Third, conflicts of interest must be disclosed as much as possible and effectively managed to (re) build a trust relationship between policymakers, the scientific community and citizens, implying the need for risk management tools and cross border disclosure mechanisms. Last, well-designed and secure health information systems need to be implemented, following the FAIR (findable, accessible, interoperable and reusable) principles for health data. This will take us a step further from data to 'policy wisdom'.Overall, these recommendations identified and formulated by students highlight some key issues that need to be rethought in the health policy cycle through elements like institutional incentives, cultural changes and dialogue between policy makers and the scientific community. This input from a younger generation of students highlights the importance of making the conversation on evidence-based policy making in health accessible to all generations and backgrounds.

Fact‐value framework for adjudicating public health policy debates

That policy should be evidence‐based has become a widely accepted dictum, especially in public health, where evidence‐based policy is strongly emphasized. Yet, most public health controversies arise because there is a conflict over values, which facts alone cannot resolve. Moreover, promoting population‐based health interventions requires the art of political actors to arouse public support. In discussing this tension in public health, studies often frame value conflicts as a barrier to rational decision‐making rather than viewing value considerations as an inherent part of democratic policymaking. We argue that by failing to engage value‐conflicts directly, public health professionals actually stymie evidence translation, which requires public and political buy‐in. We suggest a two‐by‐two framework that seeks to make value concerns more explicit in public health policymaking by breaking out policy controversies and alternatives along two dimensions—factual debates and value debates, creating four categories: uncontested alternatives, value debates, fact debates, and contested alternatives. We demonstrate that the policies that are most likely to be contested are those with a strong value conflict and where the evidence‐base is less solid. We also show that the framework is dynamic: fact and value conflicts are neither static nor inevitable. Rather, interested actors use both fact and value to try to push issues from contested to uncontested and vice‐versa. We conclude by demonstrating how the framework can help specify the role of both value and fact debates in public health policymaking through examples from U.S. public health policy controversies, including during the present COVID‐19 crisis. (English) [ FROM AUTHOR] Resumen Que la política debe basarse en la evidencia se ha convertido en un dictamen ampliamente aceptado, especialmente en la salud pública, donde se enfatiza fuertemente la política basada en la evidencia (EBP). Sin embargo, la mayoría de las controversias sobre salud pública surgen porque existe un conflicto de valores que los hechos por sí solos no pueden resolver. Además, promover intervenciones de salud basadas en la población requiere el arte de los actores políticos para despertar el apoyo público. Al discutir esta tensión en la salud pública, los estudios a menudo enmarcan los conflictos de valores como una barrera para la toma de decisiones racional en lugar de considerar las consideraciones de valor como una parte inherente de la formulación de políticas democráticas. Argumentamos que al no abordar directamente los conflictos de valores, los profesionales de la salud pública en realidad obstaculizan la traducción de la evidencia, lo que requiere la aceptación pública y política. Sugerimos un marco de dos por dos que busca hacer que las preocupaciones de valor sean más explícitas en la formulación de políticas de salud pública al dividir las controversias y alternativas de políticas en dos dimensiones: debates fácticos y debates de valores, creando cuatro categorías: alternativas indiscutibles, debates de valores, debates de hechos. y alternativas cuestionadas. Demostramos que las políticas que tienen más probabilidades de ser cuestionadas son aquellas con un fuerte conflicto de valores y donde la base de evidencia es menos sólida. También mostramos que el marco es dinámico: los conflictos de hechos y valores no son estáticos ni inevitables. Más bien, los actores interesados usan tanto el hecho como el valor para tratar de llevar los asuntos de disputados a no disputados y viceversa. Concluimos demostrando cómo el marco puede ayudar a especificar el papel de los debates sobre valores y hechos en la formulación de políticas de salud pública a través de ejemplos de controversias sobre políticas de salud pública de EE. UU., incluso durante la actual crisis de COVID‐19. (Spanish) [ FROM AUTHOR] 摘要 政策应询证(evidence‐based)已成为广泛接受的名言，尤其是在极其强调循证政策(EBP)的公共卫生领域。不过，大多数公共卫生争议的出现是因为存在价值观冲突，而这种冲突仅靠事实是无法解决的。此外，促进以人口为基础的卫生干预需要政治行动者具备激发公众支持的能力。 在探讨公共卫生中的这种紧张关系时，研究通常将价值冲突视为理性决策的障碍，而不是将价值考量视为民主决策的固有部分。我们论证认为，由于未能直接参与价值冲突，公共卫生专业人员实际上阻碍了证据的转化，这种转化需要公众和政治的认可。 我们提出一个二乘二的框架，该框架通过在两个维度(事实辩论和价值辩论)上划分政策争议和替代方案，使价值问题在公共卫生决策中更加明确，并因此产生四个类别:无争议的替代方案、价值辩论、事实辩论、有争议的替代方案。我们证明，最有可能受到质疑的政策是那些具有强烈价值冲突且证据基础不那么可靠的政策。我们还表明该框架是动态的:事实和价值冲突既非静态、也非不可避免。相反，有利害关系的行动者使用事实和价值来尝试将问题从有争议转向无争议，反之亦然。我们的结论通过美国公共卫生政策争议(包括当前COVID‐19危机期间)实例，展示了该框架如何帮助明确价值和事实辩论在公共卫生决策中的作用。 (Chinese) [ FROM AUTHOR] Copyright of Review of Policy Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Keeping Doors Open: Another Reason to Be Skeptical of Fine-Based Vaccine Policies

An impressive effort by the scientific community has quickly made available SARS-CoV-2 vaccines, indispensable allies in the fight against COVID-19. Nevertheless, in liberal democracies, getting vaccinated is an individual choice and a not-negligible number of persons might turn out to be vaccine refusers. Behavioral and Cognitive (B&C) scientists have cast light on the key behavior drivers of the vaccine choice and suggested choice architectures to boost vaccine uptake. In this paper, we identify a somehow neglected psychological phenomenon, that it is reasonable to believe to hamper the vaccine uptake whereby fine-based coercive policies are in place. We begin by presenting the default effect, peer pressure, and the case versus base-rate effect as examples of psychological mechanisms relevant for vaccine choice. We show interventions on the choice environment conceived to manipulate such mechanisms (§1). Next, we focus on what B&C scientists have investigated as well the conditions under which monetary disincentives become ineffective policy measures. To do this, we discuss in detail the case of the crowding-out effect (§2). In section 3 we present the original point of the paper. We argue that imposing monetary disincentives on vaccine hesitant could turn out to be ineffective also because of the human tendency to keep options open, albeit doing so bears some cost. In section 4 we draw an experiment aimed to begin testing whether the tendency to keep options open factually plays a role within the context of the vaccine choice (§4). Finally, concerning the COVID-19 emergency, we defend an attitude of epistemic humility in translating behavioral and cognitive research results into policy suggestions (§5). © 2021 University of Sassari

Learning from the Pandemic: Scientific Knowledge and Political Decision- Making Processes

This article addresses the issue of the relationship between political decisions and scientific knowledge: it focuses on the way in which the Italian Governments that faced the Covid-19 pandemic resorted to expert advice, in order to obtain the data, indicators and knowledge necessary to provide evidence-based decisions. The contribution offers an excursus of the reasons why part of the Italian doctrine theorized the existence of a constitutional principle of «science reserve», underlining how the principle itself stems from the constitutional case law. The analysis of the ways in which the relationship between scientific knowledge and political decision-making processes unfolded during the pandemic is conducted in order to draw some suggestions for the future from the experience still in progress. © 2022 Societa Editrice il Mulino. All rights reserved.

Aligning quality improvement efforts and policy goals in a national integrated health system.

OBJECTIVE: To describe the design and impact of a systematic, enterprise-wide process for engaging US Department of Veterans Affairs (VA) leadership in prioritizing scarce implementation and evaluation resources. DATA SOURCES: From 2017 to 2021, the VA Quality Enhancement Research Initiative (QUERI) identified priorities from local, regional, and national leaders through qualitative discussions and a national survey and tracked impacts via reports generated from competitively funded initiatives addressing these priorities. STUDY DESIGN: Guided by the Learning Health System framework and QUERI Implementation Roadmap, QUERI engaged stakeholders to nominate and rank-order priorities, peer-reviewed and funded initiatives to scale up and spread evidence-based practices (EBPs) using theory-based implementation strategies, and evaluated the impact of these initiatives using the QUERI Impact Framework. DATA COLLECTION/EXTRACTION METHODS: QUERI collected priority nominations through qualitative discussions and a web-based survey, and live voting was used to rank-order priorities. QUERI-funded teams regularly submitted progress reports describing the key activities, findings, and impacts of the quality improvement (QI) initiatives using a standardized form created in the VA Research Electronic Data Capture (REDCap). PRINCIPAL FINDINGS: QUERI launched five QI initiatives to address priorities selected by VA leadership. In partnership with 28 health system leaders, these initiatives are implementing 10 EBPs across 53 sites, supporting 1055 VA employees in delivering evidence-based care. The success of these initiatives led to an expansion of QUERI's process to address 2021 VA leadership priorities: virtual care, health disparities, delayed or suppressed care due to COVID-19, employee burnout, long-term and home care options, and quality and cost of community care. CONCLUSIONS: QUERI, a unique program embedded in a national integrated health system, deployed a novel approach to inform policy making and enhance the real-world impact of research through prioritization of limited resources, rigorous peer-review, and assessment of impacts on the health system, employees, and Veterans.