Mobilization of expert knowledge and advice for the management of the Covid-19 emergency in Italy in 2020

The Covid-19 pandemic offers an unparalleled setting to observe how scientific advice is sought by policymakers, translated into measures, and received by the public in a context of global emergency. This study, part of the ESCAPE project, evaluates the role of expert advisory bodies during the Covid-19 outbreak in Italy in 2020 and analyzes how expert advice was sought, produced, and utilized in the design and implementation of containment measures. Italy is a particularly salient case because it was the first country outside China to face the SARS-CoV-2 outbreak, under extreme uncertainty about the pathogen. The research question centers on how expert knowledge was mobilized and integrated into policymaking during 2020 in Italy and what dynamics shaped the relationship between experts and political decision-making.

This qualitative case study combines primary and secondary data collection and analysis. Ethical approval was obtained from King's College London on September 1, 2020 (MRA 19/20-21073). Primary data comprised nine semi-structured interviews with key stakeholders who were members of expert bodies directly involved in Italy’s Covid-19 response in 2020, including the Technical and Scientific Committee (CTS), the Economic and Social Committee (CES), the Italian National Institute of Health (ISS), and the National Bioethics Committee (CNB). Interviews (conducted in Italian via Zoom between October and December 2020) explored roles in the response, changes between the first and second waves, the production and use of evidence, and the experts’ views on expert-policy relationships. Interviews were recorded with verbal informed consent, transcribed using automated services, curated by the team, and key excerpts translated into English. Recruitment was challenging due to the surge of infections in late 2020 and participants’ workload; snowball sampling partially mitigated non-responses and withdrawals. The study timeframe spans January 30, 2020, through December 31, 2020. Secondary data included official documents and communications by advisory bodies, ministerial decrees and ordinances, policy documents, and institutional websites. The analysis employed an abductive approach via thematic analysis, combining deductive coding (aligned with protocols across 19 ESCAPE country case studies) with inductive theme development from the qualitative material.

- Near-complete overlap of technical advice and political response during the first wave (Spring 2020): CTS minutes were directly reflected in Prime Ministerial decrees, effectively rendering CTS advice policy-ready and quasi-legislative in practice. - Predominance of epidemiologists and infectious disease specialists in advisory structures; social scientists, economists, and ethicists had limited direct policy impact. The CES (economic and social task force) produced a detailed report (June 2020) but had minimal influence on decrees; CNB opinions had limited impact except for vaccine prioritization guidance. - Shift in containment policies: from a stringent nationwide lockdown (March 9–May 5, 2020) to evidence-based, color-coded regional restrictions from November 2020, informed by 21 indicators processed by ISS and reviewed with CTS input. - Early reliance on external data and modeling (largely from China) transitioned to Italian region-generated data via Health Ministry’s Control Room (from April 30, 2020), enabling proactive, regionalized risk management. - Gender imbalance and unpaid advisory work: initial CTS (14 members) had no women; six female experts were added in April 2020. Unpaid, intensive pro-bono work disproportionately burdened female experts and constrained participation. - Transparency and communication: initial confidentiality of CTS minutes (later published with ~40-day delay) and strict NDAs for committee members coincided with a proliferation of non-appointed media experts and declining public trust in science. - Emergence of disagreement in late 2020 within CTS (e.g., gyms/pools closures; school closures; Christmas measures) and political tensions between central government and regions (e.g., Abruzzo zone reclassification) diminished the CTS’s perceived responsibility and consensus role. - Quantitative anchors: nine expert interviews; CTS worst-case early projection of 70,000 deaths in year 1 versus 77,291 reported deaths by January 7, 2021; CTS minutes (95 from Feb 7–Jul 20, 2020 subsequently published); transition to algorithm-driven regional risk assessments using 21 indicators.

The first wave in Italy (February–April 2020) saw an exceptional convergence of expert technical advice and political decision-making, with CTS minutes effectively “copied and pasted” into decrees, positioning experts as de facto policymakers despite their consultative mandate. This reliance on experts reduced political ownership of difficult decisions but generated discomfort among CTS members about assuming quasi-legislative roles. In the second half of 2020, the advisory landscape diversified with the Health Ministry’s Control Room and stronger regional roles, reducing the CTS’s singular authority and introducing value-laden trade-offs (public health utility versus economic and social liberties) into deliberations. Expert disagreement became more visible, reflecting implicit reweighting of public health ethics values (utility, liberty, equality) and ending the early unanimous “oracle-like” outputs. The knowledge hierarchy privileged natural science evidence (epidemiology, infectious diseases) over social sciences and ethics, marginalizing socioeconomic and ethical considerations in real-time policy. Transparency challenges—initially confidential CTS minutes and media NDAs—contributed to a surge of non-appointed media experts and declining public trust. Data use evolved from retrospective national emergency response based on external data to prospective, regionalized management via ISS indicators and color-coded restrictions. Political consensus that supported the first lockdown weakened as emergency conditions eased, culminating in political instability and the resignation of the Prime Minister in January 2021.

This qualitative case study of Italy’s 2020 Covid-19 response highlights three main features: (i) a near-complete overlap between expert technical advice and political response during the first wave; (ii) a shift from nationwide lockdown to a regionalized, risk-informed containment system in the second wave; and (iii) reinforcement of knowledge hierarchies privileging hard sciences over social sciences and humanities. The analysis suggests that expert-based politics is effective but inherently temporary; prolonged reliance risks eroding trust in experts. Integrating economic, social, and ethical expertise into public health advisory processes remains a major challenge for policymaking during health emergencies. Future research should examine mechanisms to transparently incorporate multidisciplinary evidence and ethical value trade-offs into advisory processes, strategies to balance central and regional governance during evolving crises, and communication practices that protect both decisional agility and public trust.

The study focuses on 2020 and does not cover developments beyond December 2020, limiting longitudinal insights. The number of interviews (n=9) and recruitment challenges during a surge in cases may constrain the breadth of stakeholder perspectives. Findings are context-specific to Italy’s governance and advisory structures and may not generalize to other systems. Reliance on publicly available documents and minutes published with delays could introduce information timing biases. The sensitivity of ongoing legal and political debates around preparedness plans and unpublished early CTS scenarios may have influenced participants’ openness.