Anais
Resumo do trabalho
Administração Pública · Gestão em Saúde
Título
Crisis Without a Manual: Building a Clinical Protocol During Brazil’s Yellow Fever Emergency
Palavras-chave
Knowledge governance
Epistemic authority
Public health crisis management
Agradecimento:
The author gratefully acknowledges the support of the Coordination for the Improvement of Higher Education Personnel (CAPES – Brazil), whose scholarship allowed dedicated time for the development of this research.
Autores
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Maria Carolina Fóscolo GomesUNIVERSIDADE FEDERAL DE MINAS GERAIS (UFMG)
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Alexandre de Pádua CarrieriUNIVERSIDADE FEDERAL DE MINAS GERAIS (UFMG)
Resumo
Introdução
How can a clinical protocol be produced when science does not yet have all the answers? This article investigates that question through the case of Brazil’s yellow fever outbreak.
Problema de Pesquisa e Objetivo
How did Brazil’s public health system build a clinical protocol during a health crisis, despite the absence of consolidated scientific consensus and under institutional pressure for action?
Fundamentação Teórica
This study builds on Haas (1992) to explore epistemic communities, Ferlie et al. (2012) on knowledge governance in public systems, and Jasanoff (2004, 2021) and Latour (1987) on the sociology of scientific authority. It incorporates Bourdieu’s concept of symbolic capital and Argyris and Schön’s theory of organizational learning. These frameworks support the analysis of how expert legitimacy is constructed through institutional hierarchies, disciplinary prestige, and state knowledge regimes.
Metodologia
This mixed-methods study combined qualitative document and interview analysis with quantitative prosopography. Sixty-two authors of the national clinical protocol were examined via their Lattes CVs. Standardized variables and thematic categories were triangulated with institutional sources and 212 official documents to map disciplinary, institutional, and regional profiles shaping the protocol’s production.
Análise dos Resultados
The analysis revealed four competing epistemic schools involved in the protocol’s development, each with distinct disciplinary, institutional, and territorial traits. A concentration of medical professionals from elite universities shaped symbolic authority, while epidemiological and nursing experts were marginalized. These dynamics exposed asymmetries in recognition and participation, reinforcing strategic lock-in and limiting epistemic diversity in national health policy design.
Conclusão
The study shows how clinical protocols were shaped by institutional hierarchies and disciplinary exclusion, concentrating epistemic authority in elite medical profiles. This dynamic limited diversity in health policy design. The article proposes tools such as epistemic dashboards, participatory reviews, and regional impact metrics to improve transparency, coordination, and legitimacy in crisis knowledge governance.
Contribuição / Impacto
This article contributes to strategic public management by revealing how knowledge production in crisis is shaped by epistemic competition, institutional lock-in, and symbolic asymmetries. It offers an original analytical model to understand expert selection and legitimacy in federated health systems. The findings inform policy design by proposing concrete governance tools that enhance transparency, coordination, and responsiveness in national clinical protocol development.
Referências Bibliográficas
Key references include Haas (1992) on epistemic communities; Ferlie et al. (2012) on knowledge governance in public systems; Jasanoff (2004, 2021) and Latour (1987) on scientific authority and co-production; Bourdieu (1989) on symbolic capital; and Argyris & Schön (1996) on organizational learning.