Multinational consensus to end COVID-19 pandemic

By Tarun Sai LomteReviewed by Aimee MolineuxNov 7 2022

A recent study published in Nature recommended specific actions to end the coronavirus disease 2019 (COVID-19) pandemic.

Nearly three years since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified, pandemic fatigue may undermine the vigilance and efficacy of responses to the associated challenges. Many people and governments do not have the same level of concern as during the early pandemic; however, public health authorities regard COVID-19 as a dangerous and persistent health threat.

Knowledge of COVID-19 etiology, pathophysiology, vaccination, treatment, prevention, and care has advanced rapidly through scientific/medical research, collaboration, and debate. Despite the advances, there is heterogeneity in the responses of individual countries partly due to the lack of coordination and goals.

The study and findings

In the present study, researchers conducted a Delphi study to develop a consensus on ongoing COVID-19 challenges with a diverse multinational panel of 386 experts from 112 countries and territories. The study yielded 41 statements and 57 recommendations to end the COVID-19 pandemic. The three top-ranked recommendations suggest a whole-of-society action and vaccines-plus strategy.

First, pandemic preparedness and response must adopt a whole-of-society approach, including multiple actors, disciplines, and sectors. Secondly, whole-of-government approaches may identify, review, and address health system resilience. Third, countries must adopt a vaccines-plus strategy involving COVID-19 vaccines, preventive measures, and treatment and financial incentives.

The ranking exercise in the final round of the survey and the degree of consensus achieved led to six themes – 1) SARS-CoV-2 is still present, warranting continued efforts/resources despite governments moving on, 2) vaccines alone will not end COVID-19, 3) multi-sector collaboration that fosters trust is required, 4) responsive health systems are crucial and require coordinated government support, 5) adverse forces challenge efforts to end COVID-19, and 6) no one is safe until everyone is.

There were six recommendations in the Delphi process with less agreement. Of the two with more than 10% disagreement, panelists disagreed with the recommendations to 1) offer economic incentives to address vaccine skepticism and 2) adopt a syndromic approach for COVID-19 diagnosis in settings with low access to resources. The other four recommendations with disagreement were broadly related to the use of government enforcement and regulatory powers for disease control efforts.

A significant combined agreement among the panelists indicated that communication was a critical area of opportunity and risk to end the pandemic. Health systems experienced extreme circumstances throughout the pandemic, from times of near collapse to periods of relative calm. Broad agreement among panelists suggested that risks of health systems being overwhelmed again could be mitigated.

The role of primary healthcare must be strengthened to lower the burden on hospitals, and healthcare workers' mental, social, and physical well-being should be supported. There were recommendations to increase investments in digital health infrastructure and leverage implementation science to ascertain quickly-scalable digital health solutions.

Most experts (97%) on the panel agreed that vaccination alone might not be sufficient to end the COVID-19 pandemic. The panelists suggested that public, industrial, and philanthropic investors should fund programs/projects that develop vaccines with long-lasting immunity against SARS-CoV-2 variants. They recommended interventions to address vaccine hesitancy, such as engaging trusted local organizations and leaders in vaccination efforts.

Panelists largely agreed that an individual’s medical autonomy extends to the right to make decisions regarding vaccination. However, the panel also acknowledged that when the risk of harm is severe, governments can determine that the right to good health of all people overrides the medical autonomy of individuals choosing not to be vaccinated.

Infection rates increase when governments discontinue social measures. Therefore, all countries must adopt a vaccines-plus strategy, including vaccination, prevention, and financial and treatment incentives. Given the airborne transmission of SARS-CoV-2, governments may regulate and incentivize prevention measures such as air filtration and ventilation.

A substantially high level of agreement was observed among panelists regarding all aspects of treatment and care, implying that treatment continues to be an essential factor in ending the pandemic. Research on long COVID must be prioritized, and case definitions should be standardized. The panel also agreed that addressing inequities remained a challenge.

The panelists urged immediate efforts to decrease vaccine wastage and address infrastructure-related barriers in low-resource settings, such as cold storage and transport. Transfer agreements to scale production in the middle- and low-income countries should be accelerated.

Conclusions

The study echoed some of the previous findings but was distinct given the implementation of the Delphi method, diversity of panelists, and large sample size. The panel almost unanimously agreed on whole-of-society and -government approaches and prioritized recommendations for effective communication with the public. Overall, the study advances the vision of informed decision-making on how COVID-19 could be ended worldwide without risking the lives and health of vulnerable groups and without returning to limitations on civil liberty.