Asthana Sumegha, Mukherjee Sanjana, Phelan Alexandra L, Woo J J, Standley Claire J
Center for Global Health Science and Security, Georgetown University, Washington, DC, USA.
O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA.
Lancet Reg Health West Pac. 2024 Jul 8;49:101137. doi: 10.1016/j.lanwpc.2024.101137. eCollection 2024 Aug.
Decision-making during health crises differs from routine decision-making and is constrained by ambiguity about evolving epidemiological situations, urgency of response, lack of evidence, and fear. Recent analyses of governance and decision-making during COVID-19, focusing on leadership qualities, involvement of specific stakeholders, and effective resource management, do not adequately address a persisting gap in understanding the determinants of decision-making during health crises at the national level.
We undertook a study to understand the processes and characteristics of decision-making during the COVID-19 pandemic in Singapore. We used a case study approach and collected empirical evidence about public health decision-making, using a combination of key informant interviews and focus group discussions with stakeholders from government, academia and civil society organizations.
We argue that administrative centralization and political legitimacy played important roles in agile governance and decision-making during the pandemic in Singapore. We demonstrate the role of the Singapore government's centralization in creating a unified and coherent governance model for emergency response and the People's Action Party's (PAP) legitimacy in facilitating people's trust in the government. Health system resilience and financial reserves further facilitated an agile response, yet community participation and prioritization of vulnerable migrant populations were insufficient in the governance processes.
Our analysis contributes to the theory and practice of crisis decision-making by highlighting the role of political and administrative determinants in agile crisis decision-making.
This study is funded by the U.S. Centers for Disease Control and Prevention through a Cooperative Research Agreement (NU2HGH2020000037).
卫生危机期间的决策不同于常规决策，受到不断演变的流行病学情况的不确定性、应对的紧迫性、证据的缺乏以及恐惧等因素的制约。最近对新冠疫情期间治理与决策的分析，侧重于领导素质、特定利益相关者的参与以及有效的资源管理，但未能充分解决在国家层面理解卫生危机期间决策决定因素方面持续存在的差距。
我们开展了一项研究，以了解新加坡在新冠疫情大流行期间决策的过程和特点。我们采用案例研究方法，通过与政府、学术界和民间社会组织的利益相关者进行关键信息人访谈和焦点小组讨论相结合的方式，收集有关公共卫生决策的实证证据。
我们认为，行政集权和政治合法性在新加坡疫情期间的灵活治理和决策中发挥了重要作用。我们展示了新加坡政府集权在创建统一连贯的应急治理模式方面的作用，以及人民行动党（PAP）的合法性在促进民众对政府信任方面的作用。卫生系统的韧性和财政储备进一步促进了灵活应对，但社区参与以及对弱势移民群体的优先考虑在治理过程中不足。
我们的分析通过强调政治和行政决定因素在灵活危机决策中的作用，为危机决策的理论和实践做出了贡献。
本研究由美国疾病控制与预防中心通过合作研究协议（NU2HGH2020000037）资助。
