Strategies to combat Covid-19 confused by rapidly changing research, say leading scientists

Policy missteps will continue to overshadow the global response to Covid because policymakers are overwhelmed with rapidly shifting research evidence, according to scientists writing in the peer-reviewed journal Nature. 

Faced with new challenges such as the Omicron variant, decision-makers can’t keep up with the flood of new research studies when drawing up policy. This results in muddled strategies, erodes trust in science and fuels controversy, according to the authors.

They are now urging countries to adopt a new scientific approach that summarises scientific research in near real time. 

This system called ‘living evidence’ produces rigorous and ready-to-go summaries of all relevant scientific research, and keeps them up to date by rapidly incorporating new research findings. 

Policy makers and clinicians can draw on a form of scientific knowledge that is both rigorous and trustworthy, and includes all the latest science – something that has not been available previously. 

Australia’s National COVID-19 Clinical Evidence Taskforce produces guidelines using this method, with over 70 versions published since March 2020. The UK’s National Institute for Health and Clinical Excellence and the World Health Organization (WHO) have both endorsed the living evidence approach and are using it for their Covid guidelines. 

Living evidence was first developed by researchers from Cochrane, a leading producer of scientific evidence on health topics, and tested by the Australian Stroke Foundation in their national clinical guidelines as a way to cut the time lag between research being published and implementation of new treatments.

“Decisions relevant to global challenges must be informed by the best available evidence,” says lead author Julian Elliott from the Australian Living Evidence Consortium at Cochrane Australia, Monash University, Melbourne.

“Otherwise, policy missteps with every new challenge of the pandemic, such as the rise of the Omicron variant, will lead to unnecessary and untold health, social and economic impacts. 

“It should no longer be acceptable for evidence to be out of date, biased or selective. Without trustworthy and up-to-date research reviews, the world risks making ill-informed decisions and wasting resources. 

“We call on policymakers as well as researchers in every scientific field, and their funders, to adopt the living-evidence model. Science doesn’t stand still, neither should its translation into action.” 

Typically, national policies and guidelines draw on formal summaries of research. Known as systematic reviews, scientists combine evidence from individual studies then analyse the data to calculate an overall result. 

Used since the 1980s, this approach is aimed at creating a clear understanding of the scientific knowledge available. Systematic review has been the basis for high-impact decision-making not only in health but also in other fields such as education and poverty eradication.    

However, the authors say these reviews are often of poor quality, duplicative and out of date, especially when there is ‘a flood of new research’ such as in the current pandemic.

The authors highlight the drug remdesivir which ‘weak but promising’ data suggested could treat Covid. In 2020, 30 systematic reviews were produced to assess remdesivir’s efficacy. Yet many were outdated before they were published because they omitted ‘recently published primary studies’, according to the authors.

Living evidence overcomes these issues. Researchers continuously identify new studies by monitoring databases of the latest journal publications and other digital collections, often enabled by artificial intelligence and other technologies.

Dr Jeremy Grimshaw, co-author and co-lead of COVID-END (a global umbrella organization of evidence synthesis groups), argues that living evidence has been essential to addressing COVID and similar models should be adopted to address other global challenges.
 
“Citizens, practitioners, managers and policy makers need trustworthy living evidence to address day-by-day decisions and ongoing challenges such as antimicrobial resistance,” said Dr. Grimshaw, a senior scientist at The Ottawa Hospital and the University of Ottawa in Canada. “The Global Commission on Evidence to Address Societal Challenges will be reporting early next year with further recommendations about how we can do this.”

Living evidence can help tackle some of the world’s greatest challenges such as climate change. Prof Jan Minx, co-author and a co-chair of the Campbell Climate Solutions Coordinating Group, says that “current knowledge on what solutions work to solve the climate crisis is still patchy. We need to respond quickly and cannot afford many mistakes. There is no alternative to an agile approach to evidence-based policy that can deal with the flood of research and rigorously inform the thousands of decisions required to decarbonize the world economy.  Using living evidence in the field of climate science is critical to meet this challenge”. 

You can read the full Nature Comment here: https://www.nature.com/articles/d41586-021-03690-1

The authors 
Julian Elliott directs the Australian Living Evidence Consortium, based at Cochrane Australia, Monash University, Melbourne, Australia and is chief executive of Covidence.org. 

Rebecca Lawrence is managing director, F1000 Research, London, UK, is a Board Member of Open Research Central and was a member of the Open Science Policy Platform of the European Commission.

Jan C. Minx heads the Working Group on Applied Sustainability Science at the Mercator Research Institute on Global Commons and Climate Change; is professor for climate change and public policy at the Priestley International Centre for Climate at the University of Leeds, UK; and co-chairs the Campbell Coordinating Group on Climate Solutions. 

Olufemi T. Oladapo is unit head, Maternal and Perinatal Health, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland. 

Philippe Ravaud is director of the Centre for Epidemiological and Statistical Research Sorbonne Paris Cité (CRESS-UMR1153), Inserm/Université de Paris, and director of the Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Paris, France.

Britta Tendal is director of the Department of Evidence-Based Medicine, Danish Health Authority, Copenhagen, Denmark.
James Thomas is professor of social research and policy, and deputy director, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, Institute of Education, University College London, UK.

Tari Turner is Associate Professor, Cochrane Australia, School of Public Health and Preventive Medicine, Monash University; Director, National COVID-19 Clinical Evidence Taskforce.

Per Olav Vandvik is professor at the Department of Health Management and Health Economics, University of Oslo, Norway; a researcher at the Norwegian Knowledge Centre; and chief executive of the MAGIC Foundation.

Jeremy M. Grimshaw is senior scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute; and full professor, Department of Medicine, University of Ottawa. 

Interviews are available with the following co-authors:

•    Prof Julian Elliott, Australian Living Evidence Consortium at Cochrane Australia, Monash University, Australia

•    Prof Jeremy Grimshaw, Senior Scientist, The Ottawa Hospital and the University of Ottawa, Canada

•    Prof Per Olav Vandvik, Department of Health Management and Health Economics, University of Oslo, Norway

Communications contacts:

Europe
Leanne Elliott
Director of Communications 
Taylor & Francis/F1000
leanne.elliott@f1000.com
+44 7865090018 

Australia 
Eloise Hudson 
Director of Communications
National Covid-19 Evidence Clinical Taskforce 
eloise.hudson@monash.edu 
+61 417 437 967 

North America 
Jenn Ganton
Director, Communications and Public Relations
Ottawa Hospital Research Institute
jganton@ohri.ca 
+1 613 614 5253