We need an interdisciplinary approach to solve real world problems: a case study from the COVID-19 pandemic

As a research community, we need to change our ways of working to solve real world problems in real time. An interdisciplinary approach is urgently needed, bringing together experts and knowledge from across the full spectrum of research disciplines.

In this blog, Trisha Greenhalgh, Mustafa Ozbilgin, and Damien Contandriopoulos consider how a lack of interdisciplinarity impacted the public health discourse and policy around the transmission of COVID-19. Keep reading to learn more about their fascinating Research Article on Wellcome Open Research.

COVID-19 is most certainly an airborne virus, but policies for managing its spread remain focused on handwashing, and place little emphasis on airborne precautions. This ‘droplet dogma’ has prevailed since the beginning of the pandemic, despite the clear (and ever-growing) evidence for airborne transmission.

But how did we get here? How have public health discourse and policy failed to properly consider airborne transmission? Why does droplet science continue to hold its position in the mainstream?

Power and knowledge

The concepts of orthodoxy and heterodoxy are central in answering these questions.

Every field of research has its own set of orthodoxies (beliefs which are established and considered legitimate) and heterodoxies (marginal, fringe beliefs which are dismissed and not widely accepted yet, legitimate only in another field of science), but the COVID-19 pandemic brings the stand-off between these positions into the spotlight.

Our article on Wellcome Open Research draws on the work of French sociologist Pierre Bourdieu to look at how knowledge and power played out between orthodox and heterodox groups of scientists throughout the pandemic.

Orthodoxy and heterodoxy in the COVID-19 pandemic

Even before the coronavirus outbreak, two groups of scientists in different fields held very different views on the transmission of respiratory viruses.

The accepted, orthodox position is held by infectious disease researchers and IPC (Infection Prevention and Control) scientists, including doctors and nurses based in hospitals. This group traditionally research diseases for which handwashing is a key preventative measure.

Conversely, the heterodox position consists of aerosol scientists who study the flow of airborne particles – including engineers, chemists, architects, and others interested in the physical environment and how things move through it.

Since the beginning of the COVID-19 pandemic, researchers in the heterodox position have found it difficult to challenge the orthodoxy because they lacked the power needed to successfully assert that the virus is airborne against the accepted droplet discourse.

How did the ‘droplet dogma’ begin?

It’s interesting to consider a case study from the World Health Organization when asking how the orthodox position became so entrenched, particularly in the West.

At the WHO’s first international press conference on COVID-19 back in February 2020, Director-General Tedros Adhanom declared “corona[virus 19] is airborne”. He then immediately corrected himself: “Sorry, I used the military word, airborne. It meant to spread via droplets or respiratory transmission. Please take it that way; not the military language.” A little over a month later, the WHO confirmed on Twitter that “COVID is not airborne”, and the recommendations and public health measures that followed were all based on droplet transmission.

When comparing this case study with Japan, where the possibility of aerosol transmission of COVID-19 was accepted from the outset, the difference is clear.

Japan’s ‘three Cs’ campaign advised the public to avoid closed spaces, crowded places, and close-contact settings. Inter-field struggles between orthodox and heterodox positions were not so marked in Japan, allowing their local policymakers to embrace a wider range of hypotheses and research methods.

The solution: an interdisciplinary approach

What is interdisciplinarity?

Ironically, interdisciplinarity is defined differently by different disciplines. Some definitions focus on interdisciplinarity as collaboration, where a combination of different skills and knowledge come together to address a complex research challenge.

For the purpose of our research, we have followed Rowland and defined it as contestation. This means that although interdisciplinary approaches can bring inevitable conflict, the outcomes of these clashes could be positive – for example, generating new insights or knowledge.

What does an interdisciplinary approach look like?

An interdisciplinary approach to any real world issue, including the COVID-19 pandemic, needs to incorporate two key areas:

• Inclusive work practices
• Radical changes to governance

We recommend the adoption of what Nowotny et al call ‘Mode 2 knowledge production’ – an approach to science which is:

• Socially distributed
• Application-oriented
• Inherently transdisciplinary
• Involves a wide range of stakeholders, including researchers and the lay public

Acknowledging the evidence on airborne transmission opens up a range of possibilities, including:

• Creation of higher-grade, better-fitting masks
• Improvement of building safety through ventilation and air filtration
• Support for work-from-home policies, to reduce crowding in shared workspaces

During the last 22 pandemic months, science has sometimes progressed at breakneck speed. New discoveries such as vaccines were rapidly implemented and scaled up. But in other areas such as preventive public health, policy has simply not kept pace with the latest research. Our paper puts forward a political and sociological explanation for this entrenchment.

We hope that better understanding of why aerosol science is being ignored, and a move towards interdisciplinary ways of working, may help break droplet orthodoxy’s current grip on infection control policy.

You can read the full Research Article and the peer review reports via Wellcome Open Research, ‘Orthodoxy, illusio, and playing the scientific game: a Bourdieusian analysis of infection control science in the COVID-19 pandemic [version 2; peer review: 2 approved]’ >>