Cite this asLepelletier D, Souhard C, Chauvin F, Mansour Z (2023) How to anticipate and control possible future health crises through foresight approaches using the COVID-19 pandemic crisis? Arch Community Med Public Health 9(2): 034-037. DOI: 10.17352/2455-5479.000199
Copyright License© 2023 Lepelletier D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Prospective studies have evolved towards a more integrated, complex, and diachronic way of thinking about the future. What is the future? It is a set of possibilities, delimited by what we think is impossible (limits of plausibility) and by the difficulty of estimating the degree of plausibility of an event in a V.U.C.A. period. The term V.U.C.A. refers to the four characteristics that reflect the world according to military thinking: Volatility; Uncertainty; Complexity; Ambiguity. The COVID-19 crisis is an example of V.U.C.A with an uncertain situation. Foresight is a discipline that allows us to understand the forces at work in the construction of the future. Resolutely oriented towards action, it aims to enlighten the choices of the present by exploring possible futures. Strongly linked to strategy, it allows the determination of a desirable future, a vision, and the implementation of the means to achieve it. Foresight is exploratory (of possible futures), normative (creating a chosen future), quantitative (using statistical data), and qualitative (using survey data). Foresight does not foresee, it anticipates. Prospective approaches could be used more in particular in the field of health to define more or less pessimistic scenarios in order to define strategies of anticipation of futures that we do not want to see happen. The foresight for pandemics and epidemics initiatives can create a space for dialogue and bring together diverse perspectives and lived experiences.
We emphasize in this communication the potential benefits and outcomes of foresight thinking, such as improved resilience, better resource allocation, and effective response strategies.
From a search for certainties about the future (forecasting), and in response to the growing complexity and uncertainties of subjects and issues, prospective studies have evolved towards a more integrated, complex, and diachronic way of thinking about futures.
Thinking about the future allows us to get out of the daily routine and short-term objectives and to give ourselves the capacity to be actors of our future. This approach is not always in the minds of decision-makers as our environment and education do not put us in a position to think easily about different futures. Thinking about the future forces us to disrupt our present .
What is the future? It is a set of possibilities, delimited by what we think is impossible (limits of plausibility) and by the difficulty of estimating the degree of plausibility of an event in a V.U.C.A. period. The term V.U.C.A. refers to the four characteristics that reflect the world according to military thinking: Volatility; Uncertainty; Complexity; Ambiguity. It aims to describe an uncertain world .
The COVID-19 crisis is an example of V.U.C.A. situation [3-5]: Volatility (COVID-19 has spread at an impressive rate around the world ; Uncertainty (for a long time we did not have vaccines or effective curative treatment, we have suffered the number and intensity of the “waves”, we do not know if the barrier measures or other administrative measures are still necessary, if the virus will mutate...) ; Complexity (Each state has managed this pandemic in its own way, which has not allowed for a global, international management of the crisis The dimensions to be taken into account (sanitary, economic, political, social, environmental...) have made complex the analysis of the situation and the search for solutions ; Ambiguity (The diversity of sanitary, economic and social interests have generated paradoxical situations, such as the obligation for students to wear masks in class while they are exempted at lunch, the obligation to respect the one meter distance that cannot be respected in public transport, a qualification of non-essential products that is based on criteria that are not necessarily logical for all).
Foresight is a discipline that allows us to understand the forces at work in the construction of the future. Resolutely oriented towards action, it aims to enlighten the choices of the present by exploring possible futures. Strongly linked to strategy, it allows the determination of a desirable future, a vision, and the implementation of the means to achieve it. Foresight is indeterministic and humanistic. Its objective is to solve new problems, even before they arise, if possible, thus making it possible to build a better world. Its general method is to analyze, understand and produce the forces of change. To do this, it uses the collective intelligence of the world. Foresight is exploratory (of possible futures), normative (creating a chosen future), quantitative (using statistical data), and qualitative (using survey data). Foresight does not foresee, it anticipates. Anticipation is not a goal in itself but an intermediate step that must lead to the development of levers for action. The future depends in part on the decisions we make here and now. Anticipating a catastrophe allows us, if not to avoid it, at least to limit its human cost. In a dialectic of the present and the future, the anticipating subject acts on the anticipated object.
Foresight uses different successive approaches as an example: 1) The “Understand-Anticipate-Propose” meta-method has the merit of simplicity and the ability to integrate all the tools of French and foreign foresight [6,7]. It consists of three distinct cognitive steps: understanding, anticipating, and proposing action. Each of these stages has its own characteristics for thinking about the future and can produce a specific type of study (such as a diagnosis for comprehension, a scenario for anticipation, and a strategic analysis for the proposal for action). However, it is the integrated process, in its entirety, that gives meaning to future thinking; 2) The morphological analysis was subsequently incorporated into the scenario methodology.
Foresight is action-oriented. Central to foresight is participatory ownership, to embrace a variety of alternative futures imagined through active engagement in scenario planning. In the business world, future-preparedness depends on corporate foresight, with striking evidence of the superior performance of “future-prepared” firms [8,9]. In this context, the Scientific Advisory Group for Emergencies (SAGE) published in February 2022 medium-term scenarios to illustrate the possible evolution of the COVID-19 pandemic in the UK. The four medium-term scenarios (12 months - 18 months) scenarios proposed, positioned on a scale of “Best - Optimistic - Pessimistic - Worst”, were built exclusively around the evolution of the virus components and its circulation . In March 2021, the International Science Council (ISC), in partnership with the WHO and the United Nations International Strategy for Disaster Reduction (UNDRR), built three scenarios positioned on a “Best - Probable - Worst” scale . Those scenarios take into account more diverse factors of change such as the economy, governance, geopolitics, society, environment, and science and technology. In France, the French High Council for public health (HCSP) defined five different COVID-19 crisis scenarios: 1) living with the virus; 2) a pediatric crisis; 3) the normality of the crisis; 4) return to an epidemic situation similar to that of March 2020 and 5) the ultra-crisis . Twenty-eight global guidelines were described to help public decision-making to anticipate the further evolution of the COVID-19 pandemic in France.
The term VUCA was coined almost 30 years ago by management advisors and popularized by military strategists. This concept dominated the business world and boardrooms during the last 20 years. It has been useful to describe the times we have lived in so far and helped us to understand the first impact of the pandemic situation. Is the new acronym B.A.N.I  with B for Brittle, A for Anxious, N for Nonlinear, and I for Incomprehensible about to replace V.U.C.A.? This new world corresponds to situations in which conditions are not simply unstable, they are chaotic. Situations in which the outcomes are not simply difficult to predict, they are completely unpredictable. The incomprehensible, finally, occurs when a non-linear and interconnected crisis, like a pandemic, borders on the absurd. When neither data nor explanations allow us to make sense. Policymakers try to find answers but the answers don’t make sense. At this ultimate stage, it is difficult to distinguish the signal from the noise. This incomprehensible situation would be the result of the information avalanche. The B.A.N.I. world would be at the heart of the artificial intelligence systems we are building.
In the foresight initiative, core pillars and key themes have been identified that offer practical ways forward. Trust, solidarity, and equity, as well as sustainable development, are the principles and values that determine our future actions. These pillars are crucial to guiding preparedness for future pandemics. In addition, the process brought to light five key themes . Each theme offers an area of focus that collectively ensure pandemic preparedness. The five themes identified by the WHO are the followings:
In stable contexts, we can rely on the tried and true practices of planning and analysis. When the future, not to mention the present, is uncertain and unpredictable, we must make a mindset shift toward preparing and entering a state of readiness. Leaders in sanitary or industry environments can use a prospective approach to anticipate difficulties and for decision-making. Prospective approaches could be used to define more or less pessimistic scenarios in order to define strategies of anticipation of futures that we do not want to see happen (Natural disasters, global health crises, supply chain disruption such as drugs and vaccines, labor disputes, technology breach, geopolitical instability, and ethics Scandal). Sanitary future crises could probably be environmental and climatic (water, exposure of populations to toxins/pesticides, global warming), military or nuclear (armed conflicts, overexploitation..). For example, with climate change and the risk of drinking water shortages for the most vulnerable populations, particularly in developing countries, governments should anticipate strategies for environmental water monitoring and epidemiological surveillance of cases of hepatitis A, typhoid, cholera, and polio, in order to identify logistical scenarios for possible vaccination campaigns if the epidemiology of these diseases changes.
We would not have the excuse of inexperience that was used in the spring of 2020 for infectious next pandemics. Have we entered an era of epidemic pandemics? Anticipation and foresight are more than ever a responsibility, the nature of which is indissolubly ethical and political.
The foresight for pandemics and epidemics initiatives can create a space for dialogue and bring together diverse perspectives and lived experiences. The foresight approach offers a reflection on the complex reality through which we all move and provides an opportunity for thinking ahead about the actions that must be taken now to achieve the world we want in the future. The Foresight dialogue confirmed that advancing the sustainable development goals will strengthen epidemic and pandemic preparedness in our interconnected world. Foresight allows us to imagine approaches grounded in equity, trust, and solidarity. In doing so, we become better prepared to detect and respond to future threats. While some say that “hindsight is 20/20”, we must now make every effort to develop foresight to bring to the world a safer, more equitable, better-prepared future.
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