Science, policy and society

I attended a conference last week that focuses on how environmental damage drives drug resistant infections. Just as I was inspired by colleagues from around the world who described their work focusing on rivers, urban and rural landscapes, informal settlements and vulnerable settings, I was frustrated that there was no representation of Pakistani scientists or policymakers (I am aware of visa challenges these days, but I also know that at the same venue Pakistani researchers have presented recently in another conference focusing on AI and computing). Pakistan continues to face serious challenges in antimicrobial resistance that has been well-documented in dozens of studies. We also have serious issues with environmental degradation in urban areas with sewage, plastics and other forms of pollution. So why are we not present at global meetings that focus on the nexus of these two areas? Shouldn't we be concerned about public welfare and focus on good scientific evidence for better policy?

Somewhere towards the end of my time at the conference, I realised that I was asking myself the wrong question. Sure, there are ample reasons rooted in basic research to focus on environmental drivers of drug-resistant infections. But imagining that somehow this research would inform policy was simply naïve of me. I cannot imagine a world where someone in the policy world (think mayors, bureaucrats or ministers) would decide that they need to fix the sewage system, or have better trash collection, or reduce plastic consumption because there is strong lab and field data connecting rise of drug resistant infections and microplastics. The reason we do not fix the environmental mess is not because we lack scientific data, it is because we simply do not think this is worth time, money and effort. Perhaps it is inertia (i.e. it has always been this way), or someone else's problem (i.e. because this happens in poorer parts, not in the affluent enclaves where the policymakers live), or simply not a priority (i.e. a tight budget with no room for actual citizen welfare). But having another study, or a peer-reviewed paper, is not going to do anything.

I have been working on the issue of antibiotic resistance for nearly 15 years, and I know that at the broader public level, nothing has changed in this period. I know doctors who generously prescribe antibiotics (on the phone or via WhatsApp) where none are needed. Families self-medicate with antibiotics all the time. During Covid-19, even senior physicians told me that they were prescribing antibiotics despite knowing that it was a viral infection. Many said they are simply responding to the public demand and expectation!

Globally, scientific evidence-based policy is taking a hit these days, but in some societies it has never really existed. Some policy changes that we do see (e.g. enforcing seat belts on the motorway or rolling out plans for childhood vaccinations) are not coming because of local data, or lack thereof, instead they are coming because of international recommendations or a top-down approach. We have never really developed a culture where our own health and welfare policy is coming from locally-led, basic or applied science discoveries. It is not that local science is distrusted, it is largely irrelevant in the policy domain.

So, the obvious question is, how does a society make science relevant? There are many theories out there, and case studies in the US, Europe, Japan, Korea and few other countries. There is no consensus, but trust in science correlates with transparency in information gathering and sharing, local accessibility (in language and information) and community relevance. It is also a painstakingly slow process. I do not think that there is a set formula that works in every place. Translation of research into policy is a multi-faceted problem that requires not just scientists, but science journalists who can understand the science and share with the broader public, social scientists who study the impact, and politicians who care. These disparate groups need to be able to talk to each other, and trust, even when they disagree. There is a magic wand, but it has multiple pieces before it becomes operational. At the moment, we seem to be missing several of them.