COVID-19 has highlighted the importance of qualitative evidence as part of an effective response – and it is key to an inclusive recovery too

Key learnings from the pandemic include the need to challenge longstanding assumptions of quantitative evidence as ‘gold standard’ if we are to truly engage with the complex social, political and cultural aspects of COVID-19 in the UK and beyond

Alex Tasker

COVID-19 is a social virus. Millions of dollars have been invested in understanding the biology of the virus and the manufacture of technological solutions, yet the social dimensions of the pandemic remain a critical and under-considered part of the story. New behaviours have driven new relationships, forming new social groups. Bonds of trust have been broken and remade between individuals and institutions. Inequalities and anxieties have been magnified.

These effects were not unexpected; history has shown that disease outbreaks can have profound impacts on all aspects of our lives, including deeply-held personal beliefs. Yet government communication on the pandemic has largely shied away from these complex questions, opting instead to ‘follow the science’.

The clarity of this message is highly attractive, hinting at a single science that provides a uniquely ‘best’ option – yet the truth of scientific enquiry is far more complex, and all the richer for it. As the UK Chief Medical Officer has said: ‘The science is not settled.’

Quantitative research remains central

Despite calls to consider multiple perspectives, it is clear that specific types of evidence dominate others in the fight for political attention. Quantitative research – research that employs numerical or ordinal data – remains central to policymakers’ assessments. Quantitative mathematical models captured UK headlines as the pandemic began to unfold; yet we know from multiple evaluations that models can be highly dependent on a range of assumptions.

A recent study on ‘The Use and Misuse of Mathematical Modeling for Infectious Disease Policymaking’ noted that ‘the uncritical acceptance of modelling results will not serve public health or the field of modeling’. This report echoed earlier findings from West African experiences of Ebola in 2014, when morbidity and mortality models were found to have overlooked the significant impact of indigenous social responses, leading to the diversion of some scarce resources into medical interventions that ultimately remained unused.

Such examples do not, of course, mean that quantitative techniques are of no use in epidemics – far from it. But they are not the only tools with which to answer many of the specific questions that the pandemic raised. To understand COVID-19 as a social phenomenon, we should look to other forms of research for answers to many pressing questions.

Accounting for ‘big unknowns’

As COVID-19 struck, the vast unknowns of the pandemic challenged many public health assumptions of viral diseases. Who was most vulnerable, and to what? What risks were posed by action, or exacerbated through inaction?

While the inherent assumptions and generalisations of quantitative approaches can struggle to account for these ‘big unknowns’, qualitative approaches – those that employ non-numerical data – are better positioned to engage with subjective topics such as uncertainty and vulnerability. Qualitative research has a long history of analysing complex social phenomena such as beliefs, behaviours and the power to understand the interplay of social, political, biological and environmental factors in public health research.

Qualitative researchers gather data from a wide range of sources, using diverse methodologies to search for new insights. Interviews, observations, participation, videos and text all provide rich sources of material for qualitative analyses; these data are interpreted using a range of iterative and reflexive techniques to understand key themes and questions from participant perspectives.

Striving to better understand unheard voices is a hallmark of qualitative research, searching for new questions and ways of knowing, instead of testing pre-generated hypotheses. Qualitative approaches have been used in the past to explore the influence of political and social factors on health; for example, among people living with AIDS in marginalised communities. These approaches are now being used to demonstrate how social and political factors drive the unequal distribution of COVID-19 across communities and countries.

The pandemic has also led to rapid changes in behaviours, either through compulsion (such as mask wearing, quarantine and social distancing) or, in some cases, subversion of rules and social norms. Epidemiologists often struggle to account for ‘hidden’ health behaviours and effects using quantitative tools, especially when working across cultures. The Zika epidemic of 2016 has left a complicated legacy of impacts differentiated across genders, societies and communities, linked to maternal-foetal transmission of the disease.

Qualitative approaches were used effectively to understand the impacts of Zika across care, disability and public policy; these same techniques are now being employed to answer social and political questions around COVID-19, including quarantine compliance, social cohesion and policing by consent. As the pandemic progresses, vaccines have become a key pillar of the UK strategy; the need for qualitative understandings of social drivers of non-compliance and hesitancy has never been more important.

The ability not just to answer questions, but uncover them

While qualitative techniques have demonstrated their utility for explaining the complexities of COVID-19, they also offer further opportunities for researchers and policymakers to look to the future. As the UK approaches greater degrees of vaccination coverage, qualitative researchers have considered such questions as: what will vaccine passports mean for individual and collective rights, and how will this shape behaviours? How has government’s handling of the situation influenced the trust of the public? What is Long COVID, and what does it mean for individuals, families and communities as we move beyond our initial responses?

From education to the economy, understanding people’s beliefs, feelings and behaviours has never been more important. In these situations, qualitative approaches offer the unique ability not just to answer questions but to uncover them. Working with seldom-heard populations allows researchers to better understand the realities of life in these communities more quickly, enabling public health teams to tackle hidden problems rapidly.

COVID-19 has led to the global production and distribution of unprecedented amounts of research. The legacies of previous epidemics such as Zika and Ebola remind us that no single type of evidence is uniquely able to answer all questions, just as no single science exists.

The impacts of COVID-19 are not equally felt, and experts suggest that inequalities will continue to worsen. To change this direction of travel will require a genuinely intersectional approach, able to represent and engage multiple sectors and communities in recovery planning. The real-world experiences of those previously excluded from conversations must be heard by those in power; to do this requires challenging the assumed dominance of quantitative approaches.

Alongside these quantitative analyses, robust qualitative research has the potential to bring in those previously left out. Without it, there is a high chance that, for many people, the path to recovery from the many complex impacts of COVID-19 will be far longer than necessary.

Dr Alex Tasker is a Teaching Fellow in Human Ecology/Health and Environment at UCL Anthropology, and an Embedded Scientist within the UK Government’s Cabinet Office