Mobilizing evidence in health emergencies: Working hand in hand to balance response speed with safe and effective policies
10 November 2021
In this interview, WHO Chief Scientist Dr Soumya Swaminathan recounts some of the pathways WHO took during the pandemic to translate evidence into health policy and why dialogue between researchers, community, and politicians is crucial for driving policy change.
Interviewer: The WHO’s Evidence-Informed Policy Network (EVIPNet) has been operational in regions around the globe since 2005. Thus, the vision of a world in which policy-makers and other actors use the best available research evidence to inform policy-making is not a new one.
Why is it now more important than ever?
Dr. Soumya Swaminathan: Knowledge translation or evidence-to-policy processes are certainly not something new. The COVID-19 pandemic, however, called for rapid and agile translation of evidence into public health policies and programmes. We had to move fast, and balance response speed with the certainty and quality of evidence.
"We had to move fast, and balance response speed with the certainty and quality of evidence."
This is where I think WHO played an important role, together with many other public health actors and global partners. In an emergency, we don’t have the luxury to wait for years to collect the evidence we need, but must nonetheless justify global recommendations and adapt policies based on latest data and emerging evidence.
The pandemic, however, also put public health policy into the spotlight, as policy decisions had an impact for millions of people. It was also a time of great uncertainty, and there is still a veritable “war” going on between evidence built on facts and data, versus decisions taken based on prior believe or anecdotal evidence. This is a good time to bring forward new ideas in the evidence-to-policy area, certainly those building on best available evidence such as the EVIPNet toolkit.
Interviewer: Many countries, especially low- and middle-income countries, were not well prepared for such an outbreak. Too often, response efforts were only partially or not at all informed by evidence during the pandemic.
How do you think knowledge translation and evidence-to-policy pathways can be strengthened and improved?
Dr. Soumya Swaminathan: The first step is identifying knowledge gaps, assessing what information is needed for a particular decision, followed by evidence retrieval and evidence synthesis. At WHO, we were preparing a daily overview of research conducted globally, which we made available to the public. We set up new mechanisms like living meta-analyses, which offer a much better, weighted evidence base than a single piece of work. Along the same lines, we created living guidelines, regularly reviewing and updating our formerly more static guidance documents. And we have the Evidence Collaboration on COVID-19 Network which was established to share COVID-19 information and collaboration on evidence retrieval efforts.
Yet, the pandemic also reminded us that it is never scientific evidence alone that informs policy-making. Political, economic, social and cultural factors are equally important. Only a multidisciplinary team can make successful policy recommendations, bringing together public health experts, jurisprudence, behavioral scientists, and economists.
"Only a multidisciplinary team can make successful policy recommendations, bringing together public health experts, jurisprudence, behavioral scientists, and economists."
Interviewer: How did the WHO Science Division help countries to quickly mobilize the best available evidence to respond to the COVID-19 pandemic?
Dr. Soumya Swaminathan: We (WHO’s R&D blueprint team) first conducted a global forum on research and innovation in February 2020. A coordinated global research roadmap for COVID-19 was put together, including research priorities. Whenever we saw a need, we helped launch new research, like the Unity Studies, a global sero-epidemiological standardization initiative, or the Solidarity Trial Vaccines, a randomized controlled clinical trial that helped to evaluate the efficacy and safety of multiple drugs against COVID-19.
Leveraging WHO’s unique position as a normative and standard-setting Organization with global reach, we also set up guideline development groups that worked in tandem with the prequalification team. We quickly learned that to implement these guidelines locally, the specific context needs to be considered. For instance, lockdowns were very effective in limiting transmission where people were able to isolate in their own homes. In more dense living environments, however, the same lockdowns would have forced people to be even closer together, increased infection risks, and exacerbated other pressing issues such as poverty and undernutrition.
Interviewer: During your time as Secretary to the Government of India for Health Research and as Director General of the Indian Council of Medical Research, you gained extensive experience in bringing science and evidence into health policy-making, for example through building research capacity in Indian medical schools and forging south-south partnerships in health sciences.
Building on your experience, what concrete recommendation do you have for improving evidence to policy translation?
Dr. Soumya Swaminathan: First and foremost, there must be a dialogue between policy and research, which is often missing. In a continuous dialogue, policy-makers can articulate what their pain-points and policy gaps are, which helps academics to design their research studies accordingly.
Research, consequently, also has an applied and communicative side. To have impact, researchers also need to engage with policy-makers. This was my first big learning. We must work hand in hand, build trust and invest into the relationship.
Interviewer: … and how do you react if politicians are not interested in your research, for example due to a diverging political agenda?
Dr. Soumya Swaminathan: This can be challenging for researchers but is something they must learn to accept. There are different kinds of research skills that are valuable in such a scenario, for instance cost effectiveness research and health technology assessments (HTA). With competing priorities, policy-makers often base their decisions on what is the best buy for the available evidence-base and budget.
It also comes back to having different stakeholders at the table, like with India’s National Technical Advisory group for immunization, a multidisciplinary group of experts responsible for providing information to the national government on vaccine and immunization policy. Such knowledge translation platforms are able to produce tailored evidence-briefs for policy and deliberative dialogue formats, which EVIPNet has helped scale in many countries over the past years. These tools build bridges between researchers and decision-makers, and are a backbone of evidence-informed health policy-making.
Unfortunately, at country-level, such knowledge translation skills are still very limited. From my experience, when I was a Director General, I set up the first HTA program in India, as I found that policy-makers were faced with difficult choices and different options on how to pick a policy option with the most public health benefits?
Interviewer: How important is communication and involving journalists into translating science into policy?
Dr. Soumya Swaminathan: Communication is very important. Science and evidence must be communicated strategically to be effective. By exclusively speaking scientific jargon, we risk losing policy-makers’ interest and the public’s trust.
"Science and evidence must be communicated strategically to be effective."
Strategic communication involves working with the media, and the public. Scientists need to speak the language of others, and policy-makers need to make an effort to source and leverage the best available evidence. It is also beneficial for researchers’ reputation and broad public support if scientific findings can be explained in lay terms and is understood more widely.
To make sure that more evidence is reflected in policy actions, there is also a need to work on the demand side. Community demand, for instance, is a strong motor driving change. The positive impact of this demand can be strengthened by investing into health awareness and literacy. And communities should continue to demand better health services. Only then can policy-makers react to their concrete needs – and work hand in hand with researchers to translate evidence into action.