From the Margins to the Mainstream: Epistemic Injustice in Medical Crisis Decision-Making

This presentation explores epistemic injustice and structural exclusion in research-based decision-making during the COVID-19 pandemic, using Austria as a primary case study and drawing on comparative insights from global contexts. The analysis focuses on the marginalization of critical perspectives — including those of non-academic hospitals, women surgeons, BIPOC medical professionals, and clinicians from the Global South — from official pandemic advisory processes. The case of Vienna’s largest academic hospital, intentionally kept “COVID-free” in the early stages of the pandemic, illustrates how centralized authority structures prioritized academic hierarchies while sidelining frontline experiences. Key disciplines such as geriatrics, psychiatry, and anesthesiology were excluded from national expert boards, raising concerns about whose expertise was considered legitimate in shaping health policy. Rather than enabling inclusive deliberation, Austria’s approach privileged guideline-making power within university-affiliated institutions, largely disregarding international developments in countries such as Switzerland and the Nordic states. ... mehrThis fostered a form of insular policymaking that limited adaptive learning and reinforced narrow definitions of evidence. The authors further engage with critiques from Global South colleagues who provocatively labeled COVID-19 a “white men’s disease,” underscoring longstanding global inequities in knowledge recognition and resource allocation. Such critiques point to a systemic devaluation of expertise from the Global South and non-dominant disciplines, with direct implications for global health ethics and research integrity. In response, the presentation proposes a framework for democratizing institutional knowledge production: one that incorporates real-time feedback from frontline staff, fosters interdisciplinary dialogue, and establishes transparent, inclusive mechanisms for expert selection. Reconsidering epistemic authority is essential for building resilient, equitable, and ethically sound decision-making structures in times of crisis. The language of this abstract was adapted with the assistance of a large language model (LLM); all ideas, interpretations, and conclusions are solely those of the authors. ORAL PRESENTATION