Challenges to evidence-informed decision-making in the context of pandemics: qualitative study of COVID-19 policy advisor perspectives

Abstract

IntroductionThe exceptional production of research evidence during the COVID-19 pandemic required deployment of scientists to act in advisory roles to aid policy-makers in making evidence-informed decisions. The unprecedented breadth, scale and duration of the pandemic provides an opportunity to understand how science advisors experience and mitigate challenges associated with insufficient, evolving and/or conflicting evidence to inform public health decision-making.ObjectivesTo explore critically the challenges for advising evidence-informed decision-making (EIDM) in pandemic contexts, particularly around non-pharmaceutical control measures, from the perspective of experts advising policy-makers during COVID-19 globally.MethodsWe conducted in-depth qualitative interviews with 27 scientific experts and advisors who are/were engaged in COVID-19 EIDM representing four WHO regions and 11 countries (Australia, Canada, Colombia, Denmark, Ghana, Hong Kong, Nigeria, Sweden, Uganda, UK, USA) from December 2020 to May 2021. Participants informed decision-making at various and multiple levels of governance, including local/city (n=3), state/provincial (n=8), federal or national (n=20), regional or international (n=3) and university-level advising (n=3). Following each interview, we conducted member checks with participants and thematically analysed interview data using NVivo for Mac software.ResultsFindings from this study indicate multiple overarching challenges to pandemic EIDM specific to interpretation and translation of evidence, including the speed and influx of new, evolving, and conflicting evidence; concerns about scientific integrity and misinterpretation of evidence; the limited capacity to assess and produce evidence, and adapting evidence from other contexts; multiple forms of evidence and perspectives needed for EIDM; the need to make decisions quickly and under conditions of uncertainty; and a lack of transparency in how decisions are made and applied.ConclusionsFindings suggest the urgent need for global EIDM guidance that countries can adapt for in-country decisions as well as coordinated global response to future pandemics.

Youth-developed Recommendations on Public Health Planning for Future Pandemics or Public Health Emergencies: A National Delphi Study

“…While all youth in this study agreed that science plays a critical role in public health preparedness, a qualitative study of COVID-19 policy advisors reported the challenges that scienti c advisors experienced over the COVID-19 period. (57) These challenges included the inability to stay up-to-date on the evidence given the overwhelming, rapid generation of evolving and sometimes con icting evidence; scienti c uncertainty about different pandemic-related scenarios; the misinterpretation and misapplication of evidence; concerns about research integrity; and the lack of clarity on the integration of multi-sectoral evidence. At the same time, scienti c advisors reported that they experienced a lack of transparency with governmental decision-makers on how pandemic-related decisions were made (57).…”

AI in the hands of imperfect users

“…Trust plays a particularly critical role when decisions are made in contexts of uncertainty. Uncertainty, of course, is a central feature of most clinical decision making, particularly for conditions (e.g., COVID-19 30 ) or treatments (e.g., deep brain stimulation 31 or gene therapies 32 ) that lack a long history of observed outcomes. As Wang and Busemeyer (2021) 33 describe, "uncertain" choice situations can be distinguished from "risky" ones in that risky decisions have a range of outcomes with known odds or probabilities.…”

Public health ethics: critiques of the “new normal”

“…Similar requirements have been suggested in other jurisdictions, yet the pandemic revealed a lack of transparency even where decisions affected an entire population, often for prolonged periods of time. Many jurisdictions also appear to lack a standardised mechanism for making relevant conflicts of interest among health officials a matter of the public record.There is thus an opportunity to develop more transparent and accountable processes for evidence-informed decision-making during pandemics and other public health crises(Vickery, Atkinson et al 2022 ).…”