1
|
Wabnitz K, Rueb M, Rehfuess EA, Strahwald B, Pfadenhauer LM. Assessing the impact of an evidence- and consensus-based guideline for controlling SARS-CoV-2 transmission in German schools on decision-making processes: a multi-component qualitative analysis. Health Res Policy Syst 2023; 21:138. [PMID: 38115061 PMCID: PMC10729453 DOI: 10.1186/s12961-023-01072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, decision-making on measures to reduce or prevent transmission of SARS-CoV-2 in schools was rendered difficult by a rapidly evolving and uncertain evidence base regarding their effectiveness and unintended consequences. To support decision-makers, an interdisciplinary panel of scientific experts, public health and school authorities as well as those directly affected by school measures, was convened in an unprecedented effort to develop an evidence- and consensus-based public health guideline for German schools. This study sought to assess whether and how this guideline impacted decision-making processes. METHODS This study comprised three components: (1) we sent inquiries according to the Freedom of Information Acts of each Federal State to ministries of education, family, and health. (2) We conducted semi-structured interviews with individuals involved in decision-making regarding school measures in two Federal States, and (3) we undertook semi-structured interviews with members of the guideline panel. The content of response letters in component 1 was analysed descriptively; data for components 2 and 3 were analysed using deductive-inductive thematic qualitative content analysis according to Kuckartz. RESULTS Responses to the Freedom of Information Act inquiries showed that the guideline was recognised as a relevant source of information by ministries of education in nine out of 16 Federal States and used as a reference to check existing directives for school measures in five Federal States. All participants (20 interviews) emphasised the value of the guideline given its evidence- and consensus-based development process but also noted limitations in its usability and usefulness, e.g., lack of context-specificity. It was consulted by participants who advised policy-makers (5 interviews) alongside other sources of evidence. Overall, perceptions regarding the guideline's impact were mixed. CONCLUSIONS Our findings suggest that the guideline was relatively well-known in Federal States' decision-making bodies and that it was considered alongside other forms of evidence in some of these. We suggest that further research to evaluate the impact of public health guidelines on (political) decision-making is warranted. Guideline development processes may need to be adapted to account for the realities of decision-making during public health emergencies and beyond.
Collapse
Affiliation(s)
- Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | - Mike Rueb
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| |
Collapse
|
2
|
Liebe SH, Walendi A, Brethfeld L. [Recommendations for action for SARS-CoV-2 testing concepts for asymptomatic healthcare workers]. ZENTRALBLATT FUR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2023; 73:97-111. [PMID: 37197613 PMCID: PMC9975865 DOI: 10.1007/s40664-023-00496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/11/2023] [Indexed: 03/05/2023]
Abstract
Background and objective When implementing SARS-CoV‑2 testing concepts in healthcare facilities, different laws and regulations of equal rank apply. In the light of experienced impediments in translating legal requirements appropriately into legally secure concepts on an operational level, the objective of this paper was to develop corresponding specific recommendations for action. Methods On the basis of guiding questions on previously identified fields of action, a focus group consisting of representatives of administration, different medical disciplines, and special interest groups discussed critical aspects of implementation using a holistic approach. The transcribed contents were analyzed through inductive development and deductive application of categories. Results All contents of discussion could be matched with the identified categories legal backgrounds, requirements and objectives of testing concepts in healthcare facilities, responsibilities for implementing in operational decision-making chains, and implementing SARS-CoV‑2 testing concepts. Implications The correct implementation of the legal requirements into legally compliant SARS-CoV‑2 testing concepts in healthcare facilities previously required the involvement of ministries, representatives of different medical disciplines and professional associations, employer and employee representatives and data privacy experts as well as representatives of possible cost bearers. In addition, an integrative and enforceable composition of laws and regulations is necessary. Defining objectives for testing concepts is significant for the following operational process flows that need to consider aspects of employee data privacy as well as providing additional personnel for fulfilling the tasks. Also, in future one central issue of healthcare facilities concerns the finding of solutions for IT interfaces for information transfer to employees in accordance with data privacy.
Collapse
Affiliation(s)
- Susanne H. Liebe
- Arbeits- und Gesundheitsschutz der Hochschulmedizin Dresden, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Deutschland
| | - Anna Walendi
- Arbeits- und Gesundheitsschutz der Hochschulmedizin Dresden, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Deutschland
| | - Lukas Brethfeld
- Arbeits- und Gesundheitsschutz der Hochschulmedizin Dresden, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Deutschland
| |
Collapse
|
3
|
Moyano DL, Martínez ML, Martínez LL. Gender and social protection and health policies promoted during the COVID-19 pandemic: Global scoping review and future challenges. J Glob Health 2022; 12:05056. [PMID: 36579692 PMCID: PMC9798348 DOI: 10.7189/jogh.12.05056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Governmental interventions have been important tools for mitigating COVID-19 transmission, but they have also negatively impacted different gender-related components. We aimed to answer the following questions: What is the scope of the gender approach in the literature analysing health and social protection policies promoted during the COVID-19 pandemic? What are the challenges and recommendations for gender-sensitive policies for the post-pandemic and future crises? Methods The study design is based on three stages: a global synthesis of the evidence through a scoping review, the generation of a framework of emerging inequalities based on sociocultural markers, and the creation of a matrix with the challenges and recommendations. In this scoping review, we searched 10 online databases for studies published until April 2022 and conducted a content analysis on the extracted studies. Results Of the 771 identified records, 67 met our inclusion criteria. Most studies had a female person (52/67) as the first author. The binary model was the main approach addressed in the studies (61/67). The literature showed that the closure, distancing, and other social policies did not include a gender approach and generated negative gaps related to economic instability, reproductive roles, and gender violence. In the intersectionality dimension, multiple aspects emerged (macro, meso, micro-social level, and individual level). Greater gender gaps in connection with employment (related to increased housework) were observed during the closure and distancing stage of the pandemic. Asymmetries related to female participation in the management of the pandemic and an increase in discrimination and abuse of diversity groups were detected. Conclusions We observed gaps both in the gender approach both in knowledge and in policy implementation during the pandemic in the different countries explored in this work. This is a call to attention and action for researchers, political decision-makers, and other interested parties to incorporate and accentuate the gender perspective in all policies related to the post-pandemic period and future social and health crises.
Collapse
Affiliation(s)
- Daniela Luz Moyano
- National University of La Matanza, La Matanza, Argentina,National University of Cordoba, Cordoba, Argentina
| | | | | |
Collapse
|
4
|
Piel J, von Köppen M, Apfelbacher C. Politics in Search of Evidence-The Role of Public Health in the COVID Pandemic in Germany: Protocol for a Situational Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16486. [PMID: 36554359 PMCID: PMC9778467 DOI: 10.3390/ijerph192416486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
The protocol presents a research project that explores the relationship between science and politics in the COVID-19 pandemic from the perspective of public health (PH) scientists in Germany with situational analysis (SA). In context of this global crisis, we ask how PH scientists negotiate their roles as scientists and political citizens; how PH scientists perceive the relationship between their own and other scientific disciplines; and which normative assumptions PH scientists make in the production and dissemination of research findings. To conduct SA, we combine qualitative interviews with PH experts and published documents from scientific societies in PH and related disciplines (e.g., position and opinion papers) to analyze the complexity of integrating evidence-based knowledge into politics. Data are analyzed using different SA mapping tools, focusing on social worlds/arena maps and positional maps. The approach will reveal both explicit positions in the PH community and implicit or hidden voices and will reflect normative assumptions as well as internal structures of PH in Germany. The findings will be discussed with the philosophy sub-project and in a stakeholder workshop with politicians and the public. Further insights will be gained for politics and PH responses to future global crises.
Collapse
Affiliation(s)
- Julia Piel
- Correspondence: ; Tel.: +49-391-67-24308
| | | | | |
Collapse
|
5
|
Bschir K, Lohse S. Pandemics, policy, and pluralism: A Feyerabend-inspired perspective on COVID-19. SYNTHESE 2022; 200:441. [PMID: 36320863 PMCID: PMC9607765 DOI: 10.1007/s11229-022-03923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
We analyse insufficient epistemic pluralism and associated problems in science-based policy advice during the COVID-19 pandemic drawing on specific arguments in Paul Feyerabend's philosophy. Our goal is twofold: to deepen our understanding of the epistemic shortcomings in science-based policy during the pandemic, and to assess the merits and problems of Feyerabend's arguments for epistemic pluralism as well as their relevance for policy-making. We discuss opportunities and challenges of integrating a plurality of viewpoints from within and outside science into policy advice thus contributing to discussions about normative issues concerning evidence and expertise in policy-making.
Collapse
Affiliation(s)
- Karim Bschir
- University of St. Gallen, St. Gallen, Switzerland
| | - Simon Lohse
- Institute for Science in Society, Radboud University, Nijmegen, The Netherlands
- Centre for Ethics and Law in the Life Sciences, Leibniz University Hannover, Hannover, Germany
- African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
6
|
Hanney SR, Straus SE, Holmes BJ. Saving millions of lives but some resources squandered: emerging lessons from health research system pandemic achievements and challenges. Health Res Policy Syst 2022; 20:99. [PMID: 36088365 PMCID: PMC9464102 DOI: 10.1186/s12961-022-00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO's framework for research systems. It has four functions-governance, securing finance, capacity-building, and production and use of research-and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges.We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom's healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users' needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries.
Collapse
Affiliation(s)
- Stephen R Hanney
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, United Kingdom.
| | - Sharon E Straus
- St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Bev J Holmes
- Michael Smith Health Research BC, Vancouver, BC, Canada
| |
Collapse
|
7
|
Kuhlmann S, Franzke J, Dumas BP. Technocratic Decision-Making in Times of Crisis? The Use of Data for Scientific Policy Advice in Germany’s COVID-19 Management. PUBLIC ORGANIZATION REVIEW 2022; 22:269-289. [PMCID: PMC9185129 DOI: 10.1007/s11115-022-00635-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 has demonstrated the importance of data for scientific policy advice. Mechanisms by which data is generated, shared, and ultimately lead to policy responses are crucial for enhancing transparency and legitimacy of decisions. At the same time, the volume, complexity and volatility of data are growing. Against this background, mechanisms, actors, and problems of data-driven scientific policy advice are analysed. The study reveals role conflicts, ambiguities, and tensions in the interaction between scientific advisors and policy-makers. The assumption of a technocratic model, promoted by well-established structures and functioning processes of data-driven government, cannot be confirmed. Reality largely corresponds to the pragmatic model, in parts also the decisionist model, albeit with dysfunctional characteristics.
Collapse
Affiliation(s)
- Sabine Kuhlmann
- Faculty of Economics and Social Sciences, University of Potsdam, August-Bebel-Straße 89, Building 7, 14482 Potsdam, Germany
| | - Jochen Franzke
- Faculty of Economics and Social Sciences, University of Potsdam, August-Bebel-Straße 89, Building 7, 14482 Potsdam, Germany
| | - Benoît Paul Dumas
- Faculty of Economics and Social Sciences, University of Potsdam, August-Bebel-Straße 89, Building 7, 14482 Potsdam, Germany
| |
Collapse
|
8
|
Lohse S, Canali S. Follow *the* science? On the marginal role of the social sciences in the COVID-19 pandemic. EUROPEAN JOURNAL FOR PHILOSOPHY OF SCIENCE 2021; 11:99. [PMID: 34703507 PMCID: PMC8532106 DOI: 10.1007/s13194-021-00416-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/10/2021] [Indexed: 05/07/2023]
Abstract
In this paper, we use the case of the COVID-19 pandemic in Europe to address the question of what kind of knowledge we should incorporate into public health policy. We show that policy-making during the COVID-19 pandemic has been biomedicine-centric in that its evidential basis marginalised input from non-biomedical disciplines. We then argue that in particular the social sciences could contribute essential expertise and evidence to public health policy in times of biomedical emergencies and that we should thus strive for a tighter integration of the social sciences in future evidence-based policy-making. This demand faces challenges on different levels, which we identify and discuss as potential inhibitors for a more pluralistic evidential basis.
Collapse
Affiliation(s)
- Simon Lohse
- Institute for History of Medicine and Science Studies, University of Lübeck, Lübeck, Germany
- Centre for Ethics and Law in the Life Sciences, Leibniz University Hannover, Hannover, Germany
- African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa
| | - Stefano Canali
- Department of Electronics, Information and Bioengineering and META - Social Sciences and Humanities for Science and Technology, Politecnico Di Milano, Milan, Italy
| |
Collapse
|