Henri Bergeron, Olivier Borraz, Patrick Castel, and François Dedieu on the Covid-19 Pandemic

Interview with Henri Bergeron, Olivier Borraz, Patrick Castel, and François Dedieu on their latest co-authored book, Covid-19: une crise organisationnelle (Les Presses de Sciences Po, 2020). Interview conducted by SASE Executive Director Emerita, Martha Zuber

Could you tell us a bit about yourselves and how this book came together?
We are four sociologists trained at the Centre for the Sociology of Organisations (CSO), where the so-called “French school of the sociology of organisations” was founded (Michel Crozier, Erhard Friedberg, Jean-Claude Thoenig, Catherine and Pierre Grémion, etc.). Henri Bergeron and Patrick Castel are specialised in the analysis of health policies and professional practices; Olivier Borraz and François Dedieu are specialists in the sociology of risk and crisis management. We drew on the press, gray literature, and forty interviews to write this short book on how the pandemic was managed in France between March and June 2020. We also drew on the rich literature on decision-making in crisis situations to highlight similarities with past crises. Our approach was scientific and non-prescriptive. We dissected what seemed to be the main constraints in situations where surprising decisions were made, such as not resorting to emergency procedures that had been planned for, creating multiple ad hoc organizations, or locking down an entire country. In addition, we were surprised to see an unprecedented level of cooperation within the hospitals, and wanted to produce hypotheses to explain this. To be clear, although we did conduct many interviews and collected a significant amount of data, this is less a research book than an essay. It still lacks the precise empirical data we would need to refine and validate our hypotheses. We have continued our fieldwork since its publication and, although new data seems to confirm our initial hypotheses, we remain cautious. We just won a grant from the French National Agency for Research (ANR) to continue collecting data on Organisations in Crisis (CrisOrg) with other colleagues from the CSO (Renaud Crespin and Etienne Nouguez) and other centres (Valérie November – LATTS -, Cécile Fournier – IRDES -, Audrey Vézian – Triangle -). We hope that this will provide material that will confirm and refine our hypotheses.

Why were the French public authorities convinced at the outset that they could handle the pandemic – until they discovered they could not? Why did it take so long for France to learn from what was occurring in China and Italy? To what do you attribute the underestimation of the alert in January?
Warning systems were triggered in January, so no one can say that the threat was overlooked. We hypothesize that there was no negligence, but rather an excess of confidence. This overconfidence may be explained by the fact that previous epidemics, such as SARS, Ebola, and H1N1, had not produced significant effects, which made France believe that its health system was ready to handle highly infectious diseases. Furthermore, the first three clusters at the beginning of the pandemic were quickly controlled, giving the impression that if further outbreaks occurred, they could be contained. Overall, the high level of confidence in the French healthcare system, which authorities like to present as one of the best in the world, was a significant factor, particularly when you consider that at that time the government was engaged in dealing with other issues, such as pension reform, the highlight of President Macron’s five-year mandate.

Bear in mind that we should not succumb to the illusion of hindsight and draw easy lessons. We should not draw conclusions about “all” crisis management based on the responses provided. Nor should we believe that every pandemic, and especially this one, can be “controlled” (as most governments and experts have tried to convince us). The biological and viral uncertainties of the virus were then and still are important: its modes of transmission remain difficult to comprehend, particularly because of asymptomatic and pre-symptomatic cases. The German government was praised for its “management” of the first wave in Spring 2020 and has had much less “success” at containing the second wave, despite early restrictions. This is a good reminder that we should not be tempted to judge the success or failure of government actions too rapidly. More broadly, it teaches us to be careful about suggesting that any government can actually “control” the pandemic.

Was the first lockdown necessary?
Jean-François Delfraissy, the president of the French Scientific Council (an advisory body to the president created on March 10, 2020) declared in Le Monde that the lockdown “was not the best but the only possible solution.” We were struck by how that declaration echoed Allison’s famous analysis of the Cuban missile crisis: “In retrospect, whatever is finally chosen generally seems the only appropriate choice” (1971). Graham Allison and many other social scientists have warned us against the temptation to settle for narratives like Delfraissy’s that present decisions as purely rational, and have encouraged sociologists, historians, and political scientists to deconstruct them. Many, many forces are currently working to establish THE legitimate historical narrative of this crisis’ management. The stakes of imposing “the truth” are genuinely colossal – including institutional, academic, and professional reputations, and even legal risks. It is important to note that our comprehensive approach in this book assumes that, faced with the same constraints, we would probably have made the same decisions as the actors involved. But unlike the official accounts, our book was able to draw real lessons from the crisis. Our hope is that it will help to avoid such a situation – and the decisions that were made in response – from occurring again.

We identified three sets of conditions that help explain the decision to impose a lockdown. The first were organizational: the excess of confidence we mentioned above meant that a lot of time was lost responding to the virus as it spread. This meant that options that would have been available before the pandemic began were closed off. When you have just three or four days to respond, more draconian measures, such as lockdown, become necessary. Another crucial concept must be included in analyzing the decision to impose lockdown – what Diane Vaughan (1996) called “organizational drift” in her analysis of the Challenger accident: at the end of February, the French government found itself without sufficient masks to protect the population.

The second set of conditions are cognitive. Without the capacity to screen widely, authorities lacked sufficient data to accurately measure the epidemiological situation in France. Two influential members of the Scientific Council, an intensive care specialist and an infectious disease specialist, both worked in major research hospitals on the front lines of the pandemic. At the time the decision was made to lock down, these hospitals were overwhelmed with critical cases, and the doctors and nurses were stressed and frightened. This reinforced the dominant cognitive framework, which was that the epidemic was a medical problem, that the sickest required intensive care units, and that hospitals must be protected against the risk of being overwhelmed. Moreover, two other members of the council were members of the celebrated Pasteur Institute. They had alarming modelling predictions at their disposal that made the forecasts of the Imperial College, which had been taken with caution and even a little mistrust a week earlier, seem very credible. Finally, the choice was made to not take the possible consequences of the lockdown into account, since no concrete information yet existed as to what these might be.

The last set of conditions is political. In an international context, where China, and then Italy, had already decided on a lockdown, mimicry and issues of international reputation made it difficult to opt for another solution. Just consider how Sweden, which tried another strategy, has been stigmatized and accused of following a dangerous path. Additionally, France’s republican principle of equality made it difficult to envision anything but a uniform decision for the entire country, despite the fact that the epidemiological situation was very different from one region to another. Last but not least, it should be recalled that a lockdown is an instrument designed to maintain order, not a public health measure (in France, this included a requirement for written authorizations to leave one’s home.) Maintaining order remains France’s main goal in crisis management. Lockdowns and curfews are instruments of public order.

Your book goes into great detail about the many (too many?) government and ministerial agencies involved in managing this crisis. Who were they? Would it have been wiser to have one central agency in charge? What about the local level?
The management of the COVID-19 crisis reveals a gesture typical of French government, long identified by sociologists of public policy and administrations: decisions are made in an autonomous and elitist manner (in small groups), without mobilizing existing institutions, organizations, or decision-making mechanisms created precisely for that purpose. The last year has been a kind of organizational frenzy: the Scientific Council; the CARE Council; multiple new additions to the Interministerial Crisis Unit, which was then transformed into an Interministerial Crisis Centre; an audit mission; the Interministerial Task Force; five different anticipation units (including the Castex Mission); the Vaccine Strategy Orientation Council; etc. All this in a country that already counts legions of health and crisis management experts and organizations: independent agencies, High Councils, High Authorities, dedicated research bodies, General Secretariats, crisis units in all ministries, Government Information Service, Directorate General for Civil Security and Crisis Management, etc. Take the case of the Scientific Council, which was put together in the early days of the crisis. It nevertheless became the advisory body for all decisions made by the President of the Republic, the Prime Minister, and the Minister of Health, who did not rely on the influenza pandemic plan or the Interministerial Crisis Unit. Indeed, the ICC was only mobilized on March 17^th, after the key decisions, including the decision to impose lockdown, had been made. Of course, it was necessary to act quickly – “nimbly” to use a fashionable term – in a situation of uncertainty and emergency. But we also see here the reproduction of two technocratic tropisms – that is, an innate tendency to move in a given direction given a certain type of external stimulus:

1. The first consists in allowing autonomous decision-making for important decisions. Instead of activating intermediate bodies or consulting administrations in charge of implementing decisions, politicians can and do choose on their own – because they are able to do so. This may happen because the solutions proposed by these bodies are not those preferred by the politicians, or because these organizations are seen as having failed. This was the case with Santé Publique France at the time the crisis broke out. This may also occur because conflict exists among various organizations and individuals, and clouds debate, or because the routines and rules of these organizations remove control from politicians over the decisions that underlie the implementation of chosen solutions. This is highly problematic because it reproduces an old separation between strategy and implementation: what is considered noble by those in power (in the public or private sectors) is the design of the strategy or the law. This belief is bad for implementation, because it presumes that “stewardship will follow” (or that “stewardship will be blamed” if the outcome is not positive). Whatever one gains in autonomous decision-making capacity, one loses in implementation capacity.
2. The second tropism is also typical of the French technocracy, which cannot conceive of improving coordination and cooperation without appointing a leader with exceptional qualities and forming new organizations, procedures, or technologies. In other words, there is a pervasive belief that the simple creation of new coordination structures or the introduction of new technologies will, almost mechanically, lead to the cooperation and coordination of the actors responsible for implementing decisions and public policies, producing social states that are as complex as they are fragile. The unfolding of this phenomenon in a crisis situation highlights to us what is already happening in perfectly ordinary ones: there is a scarcity of human and intellectual resources dedicated to studying how to foster the type of cooperation that would improve the effectiveness of public action.

Your book makes a strong argument against putting medical authorities (including a newly created scientific council or task force) in charge of managing crises. What do you suggest instead?
It is understandable that in January-February 2020, the government considered the threat to be mainly health-related, particularly as the Ministry of Health declared ownership over it at that time, unobstructed by the Ministry of the Interior, which was still entangled in pension reform strikes and the Gilets Jaunes movement. The composition of the scientific council reinforced this framing by focusing attention exclusively on hospitals, which further ensured that the crises would be interpreted as predominantly medical. The frame has not really been challenged since then. Our book argues that, if other scientific disciplines and other agencies had been consulted from the outset, there might have been a different definition of the crisis. We might have opted for a definition that focused more broadly not just on the social and economic consequences of a lockdown, but also took a general public health perspective that included the consequences of focusing on just one disease to the detriment of all other health problems.

The pandemic seems to be picking up pace again, and we are still stuck with this frame, in which the solution is to declare either a curfew or a lockdown, for the sole purpose of protecting hospitals, whatever the other consequences might be. After almost a year of fighting this virus, it seems clear today that we cannot manage this crisis only as a medical crisis. Nor can we focus only on Covid-19 while overlooking the many other adverse health effects of the measures taken over the past year. We need to provide other interpretations of what this crisis is about, and to begin discussing what our priorities as a country should be.

There is something to be said about what comes out in the process of writing a book with a bevy of authors.  What did you take away from this experience?  What did you learn? What were the surprises?
We were surprised at how easy it was to write this book together in such a short time. Of course, the fact that we shared a common intellectual training helped, even though we work on different topics. Friendship and trust between each other also played a key role. As we watched the situation unfold, we were surprised by the fact that few scholars manifested any surprise at this novel situation, and took for granted what we found to be questionable decisions. In our regular exchanges among ourselves, we found comfort in the fact that each one of us was equally surprised at and uncomfortable with official discourses. Not that we wanted to reject them – as sociologists, we simply wanted to question them. As our discussions continued, we first decided to write a series of papers in an online journal (AOC – Analyse Opinion Critique). They quickly received praise from many readers, happy to finally find analyses that sidestepped official narratives, which ultimately encouraged us to write the book.