Decision Focused Public Engagement model

The Decision Focused Public Engagement model was developed by Roger Bernier, a U.S. Department of Health official, who sought a way to engage the public and involve 'ordinary citizens' in formulating health policy regarding ethical issues. The model stands out with its focus on only 'non-expert' participants, making a clear a separation between scientific (or medical) facts and ethical values.

Background

When trying to formulate government policy on infant vaccination, Roger Bernier was shocked to see how anti-vaccination activists were quick to dismiss concrete scientific evidence showing no connection between vaccines and the development of autism in infants. He realized that ‘hard’, empirical evidence was not enough to convince a public already entrenched in their views. There was a basic trust issue with many citizens simply not willing to listen to the scientific and medical experts.

Bernier decided that increased public engagement was needed to bridge this gap of mistrust. Instead of trying to engage the public in the debate around vaccinations and autism, he decided to try his experiment on the issue of pandemic influenza. He believed that while the public already had entrenched opinions that would be hard to change about the autism claims, the issue of pandemic influenza was relatively unknown and the participants could therefore begin the experiment with a ‘clean slate’.

He decided to use the problem of pandemic influenza vaccination prioritization to try a new public engagement model.

Purpose

The purpose of the engagement would be to formulate a clear policy regarding the use of the vaccine for pandemic influenza. The U.S. holds only a limited stock of the vaccine, so a decision had to be made regarding who to give the vaccine to in the event of a breakout. Bernier and the Health officials realized that this issue was not purely a professional, medical issue, but that there were ethical considerations that needed to be taken as well. Citizens are the “repository of our core public values” and therefore are the best to decide on ethical and normative issues (Bernier & Wills-Toker, 2014). Therefore, the officials decided that (legitimate) ethical decisions must be made by the public.

They developed a process based on three premises: First, the formulation of the vaccination policy required the policy-makers to understand the society’s values regarding the issues. Second, the values would be best expressed through a public engagement process. Finally, there would need to be an inclusive model that would best reflect the common values.

Recruitment

With the above goal in mind, the organizers carefully selected the participants using both “inclusion” and “exclusion”. They selected participants that would reflect and represent the spectrum of the citizenry, while purposefully choosing participants without a medical or professionally-related background to focus solely on society’s values as opposed to the empirical findings. In this way, the organizers attempted to engineer their participating public to express norms that reflected the kind of public the organizers wished to reach.