Science misuse and polarised political narratives in the COVID-19 response
Authors: Rômulo Paes-Sousa, Christopher Millett, Rudi Rocha, Mauricio L Barreto, Thomas Hone
Journal: The Lancet (2020)

Strategies to address the COVID-19 pandemic have elicited polarised debates that frequently focus on an economy versus health trade-off, and are often divided by politics.1Makridis C Rothwell JT The real cost of political polarization: evidence from the COVID-19 pandemic.https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3638373Date: June 29, 2020Date accessed: September 23, 2020Google Scholar Evidence has increasingly been used to justify these arguments, without due attention to its quality or reporting. Additionally, evidence suggests arguments over a trade-off are inappropriate as countries which have controlled the pandemic better have experienced smaller economic contractions.2Hasell J Which countries have protected both health and the economy in the pandemic?.https://ourworldindata.org/covid-health-economyDate: Sept 1, 2020Date accessed: September 23, 2020Google Scholar We were dismayed by a recent Correspondence3Pontes MRN Lima JP Brazil's COVID-19 response.Lancet. 2020; 396: e34Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar in The Lancet, in which Pontes and Lima argued against social distancing interventions in Brazil—a country lacking a comprehensive pandemic strategy and a catastrophic 150 000 COVID-19 deaths by Oct 15, 2020. The authors cite our work in The Lancet Global Health on the Brazilian recession and mortality4Hone T Mirelman AJ Rasella D et al.Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities.Lancet Glob Health. 2019; 7: e1575-e1583Summary Full Text Full Text PDF PubMed Scopus (96) Google Scholar but selectively report our findings to skew the debate. We analysed the 2014–16 Brazilian recession and found that recession-related increases in unemployment were associated with increases in mortality.4Hone T Mirelman AJ Rasella D et al.Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities.Lancet Glob Health. 2019; 7: e1575-e1583Summary Full Text Full Text PDF PubMed Scopus (96) Google Scholar This statement is often cited to argue against stay-at-home orders in Brazil. However, our findings are not that informative in the COVID-19 context because pandemic recessions are substantially different in impact and duration than traditional recessions. Whereas we examined the effects of recession on health, the causality is reversed during the pandemic where health is determining economic productivity. Indeed, evidence from the USA suggest health concerns, rather than official stay-at-home policies, drove reductions in consumer spending and economic contraction.5Chetty R Friedman JN Hendren N Stepner M Team TOI How did COVID-19 and stabilization policies affect spending and employment? A new real-time economic tracker based on private sector data. National Bureau of Economic Research, Cambridge, MA2020Crossref Google Scholar Furthermore, in our study, we found that unemployment-associated mortality only increased where local health and welfare systems were weak and underfunded—a statement less frequently reported but in line with evidence from Europe.6Stuckler D Basu S Suhrcke M Coutts A McKee M The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis.Lancet. 2009; 374: 315-323Summary Full Text Full Text PDF PubMed Scopus (1026) Google Scholar If strong health and welfare systems are key in protecting individuals from negative recession health impacts, then the argument should focus on promoting these services instead. This is not the first instance of our work being misreported in the media. We have been contacted by journalists to clarify the impacts of stay-at-home orders implemented in Brazilian cities, and we made a concerted effort to improve reporting with statements published in the BBC7Alegretti L Recessão aumentou mortes em cidades onde gasto com assistência e saúde foi menor, diz estudo.https://www.bbc.com/portuguese/brasil-52330852Date: April 20, 2020Date accessed: September 23, 2020Google Scholar and O Globo.8Paes-Sousa R Rocha R Barreto ML Salvar vidas ou a ecomia é falso dilema.https://oglobo.globo.com/opiniao/artigo-salvar-vidas-ou-economia-falso-dilema-24331127Date: March 27, 2020Date accessed: September 23, 2020Google Scholar Our experience is just one example of evidence misuse, but it is an experience shared by colleagues globally. We urge authors to continue promoting clarity in the reporting of their work and seek reliable platforms for disseminating findings. The solutions to addressing the COVID-19 pandemic are complex and multifaceted requiring careful and informed policy decisions to balance economic, social, and health priorities. We do not doubt that economic recessions will have profound health consequences, but distilling arguments into simple trade-offs is unhelpful. Evidence points to the importance in investing in health and welfare systems to protect both health and the economy, yet further polarising debates with misuse of evidence will only hamper effective pandemic responses in a desperate Brazil. We declare no competing interests.