The COVID-19 pandemic offers a unique opportunity to analyze how scientific advice influences policymaking and public acceptance during a global crisis. This qualitative study, part of the international ESCAPE project, focuses on Italy's experience in 2020. Italy was among the first countries, after China, to confront the pandemic, facing high uncertainty regarding the novel pathogen. The study investigates the role of expert advisory bodies in shaping Italy's COVID-19 containment measures. The Italian context is particularly relevant because it reveals the interaction between expert advice and the political decision-making process during an unprecedented health emergency. The Italian political system, with its parliamentary republic structure and regional federalism, plays a crucial role in understanding how expert advice was integrated into national policy. Italy's history of technocratic governments provides an additional lens for interpreting the role of experts. The timeline of events, from the initial cases in late January 2020 to the national lockdown in March and subsequent measures, shapes the backdrop against which expert advice was sought and acted upon. The study delves into the specifics of Italy's preparedness plan and the advisory bodies involved, providing a crucial contextual understanding.

The paper draws upon existing literature on expert politics, highlighting the interplay between scientific advice and political decision-making during crises. It references studies showing the tendency for hard sciences to dominate expert advice, often at the expense of social sciences and economic considerations. The study also acknowledges the challenges of integrating diverse forms of expertise into public health policy during emergencies. The authors refer to prior research demonstrating the difficulty in balancing competing values (liberty, equality, and utility) in pandemic response. The concept of 'issue advocates', who seek to narrow the scope of policy options, is introduced as a framework for understanding the role of experts in shaping policy choices.

This case study utilizes a qualitative approach, combining primary and secondary data. Ethical approval was granted by King's College London. Primary data comprised nine semi-structured interviews with key stakeholders, selected to achieve theoretical representativeness and include experts from various advisory committees (Technical and Scientific Committee (CTS), Economic and Social Committee (CES), Italian National Institute of Health (ISS), and the national bioethics committee (CNB)). Interviews were conducted in Italian via Zoom, video-recorded, and transcribed. Secondary data included official documents, communications from expert bodies, ministerial decrees, and policy documents. The analysis employed an abductive approach, combining deductive categories from the ESCAPE project protocol with inductively derived themes from the qualitative data. The data collection spanned from the declaration of the international health emergency to the end of 2020. The authors acknowledge challenges in recruitment, citing the high workload and sensitivity surrounding the pandemic response.

The study reveals three major findings: First, during the initial phase of the pandemic (spring 2020), there was a near-complete overlap between technical advice and the government's response. The CTS played a key role, providing advice that was directly translated into policy, often with a verbatim adoption of the committee's minutes into official decrees. This close alignment led to the CTS functioning, in effect, as a quasi-legislative body, a role the committee members initially resisted, seeking to maintain their advisory capacity. Second, the mobilization of experts heavily favored epidemiologists and infectious disease specialists over social scientists and ethicists. The Economic and Social Committee (CES), designed to incorporate social science perspectives, had limited influence on policy decisions, highlighting a knowledge hierarchy that prioritizes hard sciences. The Bioethics Committee also had minimal influence except in the area of vaccine prioritization. Third, the approach to containment shifted from a strict, nationwide lockdown in the spring to a more proactive, regionally tailored system of color-coded restrictions in the fall and winter of 2020. This shift reflects a greater consideration of regional epidemiological data and varying risk levels. The algorithm used to determine regional risk levels was frequently challenged, leading to conflict between the central government and regional authorities. The study also points to a gender imbalance in the expert committees, largely due to the unpaid nature of the work and the disproportionate burden on women with caring responsibilities.

The study's findings shed light on the complexities of expert advice during a pandemic. The initial close alignment of expert advice and policy reflects a strategic attempt by policymakers to depoliticize the response. However, this close collaboration blurred the lines between advisory and legislative functions, leading to discomfort among expert committee members. The dominance of epidemiologists highlights existing knowledge hierarchies within expert communities and showcases the difficulties of integrating social and economic perspectives into public health policy. The shift towards regionally focused measures reflects an attempt to balance public health concerns with economic and social factors. However, the conflicts between the central government and regional authorities underscore the challenges in implementing a nationally consistent approach. The gender imbalance within expert committees reveals systemic biases that disproportionately affect women's participation in high-level decision-making during crises.

This study offers valuable insights into the mobilization of expert knowledge during a major public health emergency. The close interaction between expert advice and policy during the initial phase transitioned to a more complex dynamic as the pandemic unfolded. The limitations of relying primarily on a narrow range of scientific expertise were revealed, while the shift towards a regionalized response reflects attempts to balance public health and socioeconomic factors. Future research should examine the long-term impacts of knowledge hierarchies and the influence of different forms of expertise on pandemic response. Further studies could also delve into the ethical dimensions of expert decision-making and the effectiveness of different governance structures in managing large-scale crises.

The study's limitations include the relatively small sample size of interviews. The focus on 2020 limits the scope of analysis to the first year of the pandemic, preventing a comprehensive assessment of the long-term impacts of Italy's response. The reliance on self-reported data from stakeholders may introduce biases. Finally, the focus on officially recognized expert committees excludes the perspectives of independent experts and the general public.