Green Templeton Lectures 2021: Rafael Ramírez and Trudie Lang on the COVID challenge

In the first of the Green Templeton Lectures 2021, college was delighted to welcome Professor Rafael Ramírez and Professor Trudie Lang, to share their insights on ‘Framing the COVID challenge’.

Lisha Jeena, a medical doctor from South Africa currently reading for an MSc International Health and Tropical Medicine at Green Templeton reports:

Professor Rafael Ramírez, developer of the Oxford Scenario Planning Approach, and the first Professor of Practice at Oxford, asked a key question: ‘What is the [context] of your plan/policy/strategy?’ This framed his presentation poignantly, as he described how reframing of both business and healthcare systems depends on the context which is taken, and is informed usefully with the help of manufacturing a small set of bespoke multiple possible future contexts to build plans and strategies accordingly.

Professor Rafael Ramírez described the distinctive characteristics of the Oxford Scenario Planning Approach. It considers the user as a learner rather than decision-maker and the scenarios are unique to that learner. It focuses on providing useful plans, that are plausible, rejecting probability as irrelevant in light of the radical uncertainty about the future. And importantly, it recognises the process as an iterative one, re-framing and revisiting perceptions over time to continue learning in changing circumstances.

Drawing from his engagement with companies such as Rolls-Royce, Professor Ramírez highlighted that a shortcoming of strategic planning could arise from creating plans for future scenarios which fail to materialise. By considering alternative futures which over time might come, plans become more robust.

The approach creates a small set of contrasting points of view in the future, each termed a ‘scenario’ and then looks to the present from that point of view to inform decisions. Scenarios consider multiple potential contexts and can influence the transactional environment in which actors make decisions or strategies to engage opportunities and problems. Through the creation of multiple scenarios, the robustness of policy or plans can be better thought through and determined.

The same can be said for healthcare systems. Professor Ramírez drew on his experiences with Diabetes UK which is a leading diabetes charity advocating for diabetes research and improved levels of care to support those living with the disease.

Diabetes affects 4.8 million people in the UK (type 1 or 2) and has been a significant comorbidity for COVID-19 related deaths. Through the Oxford Scenario planning process, different potential future scenarios were developed helping the charity to highlight four key issues for government strategies: addressing inequality in who is most at risk of the disease, prevention measures through tackling obesity, availability of technology for long-term glucose monitoring and increased funding for research.

Despite the unpredicted current pandemic, patients with good glucose control and monitoring have had better outcomes than those without, further showing how scenario planning can lead to robust policy decisions that weather unforeseen circumstances.

In the end, planning necessitates action. If there is no ownership of the plan, there is no will to enact it, and thus the planning will have turned out to be useless. It would be helpful for the value of scenario planning to become more recognised by governments in order to build and learn from experiences as to better navigate the future.

Professor Trudie Lang echoed these sentiments in her presentation, urging the need to build an ‘eco-system’ of research to guide decision making. Professor Lang began her career in the pharmaceutical sector and has dedicated her career to clinical trials and capacity building research in lower and middle income countries.

Professor Lang raised key successes of the COVID-19 pandemic including how it has highlighted the importance of health research in combating all disease, and also in guiding policy and public health decision making.

And therefore we have also seen how inequities in research infrastructure and healthcare systems lead to country data gaps and the exclusion of vulnerable groups in research due to uncertain risks.

Professor Lang referenced Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organisation, in saying that the COVID-19 pandemic will likely have the worst effect on the poorest places in the world and deepen existing inequities.

Unlike endemic diseases like diabetes, Professor Lang suggested that the major challenge of emergencies such as the COVID-19 pandemic, is the urgency and demand for all the answers all at once. In many lower- and middle-income countries the infrastructure to meet this demand, in terms of hospital capacity, research centres and surveillance systems are not currently in existence.

Prior COVID-19, there were already global inequities in where research is conducted and by whom, and indeed on who benefits. Using diagnostic tests as an illustration of such inequities, Professor Lang discussed lesser prioritised investment into affordable, easy-to-use diagnostic tests that do not require laboratory testing, limited the capacity of lower- and middle-income countries to test and trace effectively early in the pandemic.

Delving further into the idea of an ‘eco-system’ of research, the types of research studies Professor Lang mentioned that are required in a pandemic response are observational, laboratory-based, social science, clinical trial and health system. While the initial rush of funding has been for vaccine development and hospital-level treatment, research understanding peoples’ behaviours and practices in response to public health interventions to prevent transmission and early treatment strategies have been relatively left behind.

The COVID-19 pandemic could negatively impact progress made over decades in other areas like malaria and tuberculosis, both in detracting from the available pool of funding, changes in the healthcare-seeking behaviour of communities and in health care provision and laboratories being taken up with COVID-19 workload.

The pandemic could provide an opportunity to challenge how societies think about science and how they fund research. Most funding comes from large international organisations, we need to ensure that funding is dispersed across all the pressing areas of research from where we need answers.

In addition, the precedent of awarding funds to a principal investigator with an impressive track-record excludes opportunity for development and research in areas currently neglected. While the literature is increasing awareness of these data gaps, changes in funding patterns requires the global research community to explore new approaches. In particular we need to think about how we could shift to supporting ‘team science’ better to foster real collaboration by funding and reward a group equally. Professor Lang called for parity in where funding goes, geographically and to which types of research projects. She said: ‘Oxford has done an incredible job, but maybe we could widen the impact from this if we build strong partnership and foster collaboration internationally.’

As the global community continues in the battle against COVID-19, strategic scenario planning which upholds equity is needed. Coordination and collaboration between institutions and countries will better ensure preparedness for future pandemics.

In a subsequent panel discussion, it was noted that COVID has provided a dramatic example of how many governments have underestimated the nature and extent of the uncertainty their policies need to address. They have embraced the economic growth that urbanisation and globalisation has fostered without recognising their reliance on the underlying natural and built environments, that do not recognise the political boundaries that define governments, being able to absorb these changes without any social costs. However, as the COVID pathogen has shown, the pursuit of efficiency without sufficient thought to resilience in terms coping with the response it may trigger in the ecosystems it draws on, can involve significant social costs. Society is just realising it must devote more effort in ensuring its push for economic growth involves technology and institutions with enough resilience to survive in the ecosystems we inhabit.

About the Green Templeton Lectures 2021

The Green Templeton Lecture Series is an annual series of lectures in which speakers are invited to explore a given contemporary theme. These are designed to appeal to the broad college community, and to engage with interested parties from outside college. The 2021 lectures on ‘Navigating the COVID challenge’ are being  held in partnership with Franklin Templeton, as an extension of their academic partnership scheme in which the college is a current partner. Under this overall theme, the lectures will focus on different aspects, ranging from framing the coronavirus challenge to key lessons for recovery strategies to measuring the actual progress towards a better future these strategies deliver.

Created: 29 January 2021