BackgroundThe production of high-quality guidelines in response to public health emergencies poses challenges for the World Health Organization (WHO). The urgent need for guidance and the paucity of structured scientific data on emerging diseases hinder the formulation of evidence-informed recommendations using standard methods and procedures.ObjectivesIn the context of the response to recent public health emergencies, this project aimed to describe the information products produced by WHO and assess the quality and trustworthiness of a subset of these products classified as guidelines.MethodsWe selected four recent infectious disease emergencies: outbreaks of avian influenza A—H1N1 virus (2009) and H7N9 virus (2013), Middle East respiratory syndrome coronavirus (MERS-CoV) (2013), and Ebola virus disease (EVD) (2014 to 2016). We analyzed the development and publication processes and evaluated the quality of emergency guidelines using AGREE-II.ResultsWe included 175 information products of which 87 were guidelines. These products demonstrated variable adherence to WHO publication requirements including the listing of external contributors, management of declarations of interest, and entry into WHO’s public database of publications. For guidelines, the methods for development were incompletely reported; WHO’s quality assurance process was rarely used; systematic or other evidence reviews were infrequently referenced; external peer review was not performed; and they scored poorly with AGREE II, particularly for rigour of development and editorial independence.ConclusionsOur study suggests that WHO guidelines produced in the context of a public health emergency can be improved upon, helping to assure the trustworthiness and utility of WHO information products in future emergencies.

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Background In the face of an unclear causal association between Zika virus in utero exposure and congenital abnormalities and urgent demand for guidance, the World Health Organization (WHO) had to produce timely and trustworthy guidelines during the 2016 Public Health Emergency of International Concern (PHEIC). Methods This is a cross‐sectional evaluation of WHO emergency guidelines produced during the Zika virus disease PHEIC from 1 February to 18 November 2016. We assessed adherence to WHO publication requirements and the reporting of guideline development processes associated with trustworthiness. In the absence of quality appraisal tools for guidelines developed under compressed timeframes, we applied the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Results We included 21 guidelines (13 de novo and 8 updates). Six guidelines used a formal evidence review process. Most guidelines involved external experts in the development process and collected declarations of interest. Peer review was reported in six documents. Most emergency guidelines included updating plans. The highest scoring AGREE II domain was clarity of presentation (median score 78%); the lowest scoring domain was applicability (median score 18%). Conclusion WHO developed moderate‐ to high‐quality emergency guidelines in the challenging context of a PHEIC. We found improvement opportunities for WHO guideline development teams in the use of evidence to formulate recommendations, the collection of declarations of interest, reporting of conflicts of interest, and the use of existing WHO organizational quality assurance processes.

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