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COVID-19: Experts give advice on how to end this threat to public health


Maíra Menezes (IOC/Fiocruz)


An article published in Nature magazine includes a list of 57 recommendations with a high degree of consensus amongst experts to end the threat to public health represented by COVID-19. The work was drawn up by a panel consisting of 386 scientists from 112 countries.

Led by the Barcelona Global Health Institute (ISGlobal), the study boasts the participation of ten Brazilian scientists, of which five are from Fiocruz (Mauricio Barreto, Tania Araujo-Jorge, Fernando Bozza, Ligia Giovanella, and Marcus Lacerda).

Divided in six areas, the recommendations highlight the importance of developing effective communication; strengthening health systems; emphasizing vaccination, but not exclusively; promoting prevention measures; expanding treatments; and fighting inequalities.

Persistent and dangerous threat

Scientists list a series of factors that make COVID-19 still a persistent and dangerous threat. Among other data, researchers state that Sars-CoV-2 caused more than 630 million cases and over 6.5 million deaths up to October 2022. The virus also hampered medical treatment against other diseases and is still challenging health systems due to long COVID. In addition, the virus has been accumulating mutations, which may eventually allow it to escape the immune response provided by vaccines and by previous infections.

According to the scientists, “Despite notable scientific and medical advances, broader political, socioeconomic and behavioral factors continue to undercut the response to the COVID-19 pandemic, including false information, vaccine hesitancy, inconsistent global coordination, and the inequitable distribution of supplies, vaccines and treatments”.

Union against the pandemic

In this context, some of the recommendations with higher level of consensus amongst experts are: whole-of-society and whole-of-government approaches to fight the pandemic; adopting a vaccines-plus approach that employs a range of public health and financial support measures to complement vaccination; and improving communication, rebuild public trust and engage communities in the management of pandemic responses.

In order to get to these recommendations, researchers used the Delphi methodology, with the goal of obtaining a consensus on the answers to complex survey questions. The experts panel is multidisciplinary and geographically diverse, relying on the participation of academic, health, non-governmental organization (NGO), government and other experts in COVID-19 response.

According to the methodology, the statements and recommendations were submitted to different rounds of evaluation until a high degree of consensus was achieved. Of the 57 recommendations, 51 had a degree of approval of 95% or more, and only six had divergence levels above 5%.

In addition to the recommendations, the article also includes 41 statements that express consensus on the current state and challenges of this fight against the pandemic.

According to these experts, “the resulting consensus statements and recommendations can serve as a strong basis for decision-making to end COVID-19 as a public health threat, and permit a more durable resumption of social, cultural, religious, political, healthcare, economic and educational activities, with less burden on vulnerable populations”.

Below are the 10 recommendations. Access the article (in English) to read the complete list of recommendations and statements.

1 – Area: Health systems. Recommendation: Preparation and response planning to the pandemic should adopt an approach that involves the entire society and includes various disciplines, sectors and actors (for instance, business, civil society, engineering, religious communities, mathematical models, military, media, and psychology).

2 – Area: Communication. Recommendation: Community leaders, science experts and public health authorities should collaborate to develop public health messages that build and increase individual and community trust and use the preferred means of access and communication for different populations.

3 – Area: Prevention. Recommendation: All countries should adopt a vaccines-plus approach, which includes a combination of COVID-19 vaccination, other prevention measures, treatment and financial incentives.

4 – Area: Pandemic inequities. Recommendation: Preparation and response to the pandemic must address pre-existing social and health inequalities.

5 – Area: Communication. Recommendation: Public health authorities should create partnerships with reliable individuals and organizations in their communities to provide accurate and accessible data on the pandemic and inform behavioral changes.

6 – Area: Vaccination. Recommendation: Government, philanthropic and industry funding should invest in developing vaccines that provide long-lasting protection against multiple SARS-CoV-2 variants.

7 – Area: Communication. Recommendation: Public health professionals and other authorities should use clear, culturally responsive messaging free from unnecessary scientific jargon to combat false information.

8 – Area: Health systems. Recommendation: Preparation and response strategies should adopt all-of-government approaches (for instance, multi ministry coordination) to identify, revise and address resilience in health systems.

9 – Area: Pandemic inequities. Recommendation: Global commerce and health organizations should coordinate with countries to negotiate the transfer of technologies that allow manufacturers from low- and medium-income countries to develop vaccines, tests and treatments that are accessible and have guaranteed high quality.

10 – Area: Treatment and care. Recommendation: To promote multi sector collaboration to accelerate the development of new therapies across all stages of COVID-19 (outpatients clinic, hospitalization, and long covid).

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