ArticleBMJ global health2025
Decision-making under epistemic, strategic and institutional uncertainty during COVID-19: findings from a six-country empirical study.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Formal and informal science-policy interaction during public health emergencies of international concern: a scoping review.BMC global and public health · 2026Pooled it
- Participation of civil society organizations and academia in COVID-19 governance: insights from a six country study.Health policy and planning · 2026Article
- Beyond coexistence: the asymmetric interplay of health risk and promotion pathways driven by communication legacies across emerging and recurring epidemics.Frontiers in public health · 2026Article
- Enhancing epidemic forecast usability for policymakers: A global mixed-methods study.PLOS global public health · 2026Article
- Confronting "Socio-Political Inertia" on the Long and Winding Road to "Healthy Societies" Comment on "How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks".International journal of health policy and management · 2025Article
Corrections and comments
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUncertainty is defined as limited knowledge or lack of predictability about past, present or future events. The COVID-19 pandemic management was significantly impacted by uncertainty, as the gaps between existing information and the necessary knowledge hindered decision-making. Current uncertainty literature primarily focuses on natural disasters, leaving a gap in understanding decision-making under uncertainty in times of public health emergencies. Analysing strategies for making decisions under uncertainty during the pandemic is crucial for future pandemic preparedness.
methodsUsing a comparative research design, we study the strategies governments used to make decisions under uncertainty during the COVID-19 pandemic. We collected data through desk reviews, stakeholder interviews and focus group discussions with stakeholders from government, academia and civil society from six purposefully selected countries: Nigeria, Singapore, South Africa, Bangladesh, Jordan and the UK.
resultsRegardless of political, geographic and economic context, all six countries adopted common strategies to make decisions under three types of uncertainties. Decision-making under epistemic uncertainty involved seeking expert advice and collecting evidence from other countries and international organisations. Decision-making under strategic uncertainty involved coordination, collaboration and communication. Decision-making under institutional uncertainty involved using or adapting pre-existing experiences, structures and relationships and establishing new institutions and processes.
conclusionsWe contribute to the theory and practice of public health crisis decision-making by presenting a unified national-level applied decision-making framework for events involving uncertainty. We provide practical guidance for approaches to enhance decision-making in future health crises that could also be used for other emergencies.
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