We need professional prioritization, coordination and communication of research on non-pharmacological interventions (NPI)
QUEST Center (Quality, Ethics, Open Science, Translation), Berlin Institute of Health (BIH),
German Network for Evidence-based Medicine (DNEbM),
German Academy of Ethics in Medicine (AEM)
Rapid and professional clarification is needed as to whether the non-pharmacological interventions (NPIs) in place, such as school closures and contact restriction, are showing the desired effectiveness while justifying the health-related, social and economic side effects.
Therefore, an entity similar to a task force should rapidly be set up or integrated into an existing task force such as the RKI (Robert Koch Institute) to determine which data are required on the topic of COVID-19 and in which priority and quality they should be obtained. If these high priority data are not available, they should be generated as soon as possible in Germany in the context of a "regulation to create evidence". The task force must therefore not only prioritize but also coordinate the necessary research. Furthermore, society must be informed about these activities and the resulting evidence in a science-based, comprehensible and objective manner.
Selection and consideration of evidence in a continuing emergency
Assessing the proportionality of benefits and harms of NPIs requires two steps. The first is to select the most relevant and reliable data (evidence) on the effectiveness and harm of NPIs. The second is to balance the positive and negative effects of this extremely complex and existentially important information. Both steps require professional implementation that is as objective, systematic, and transparent as possible given the circumstances.
In an emergency, this requirement for professional action is particularly difficult to implement. There is very little time available to select data and weigh the positive and negative effects in consultation with the few people involved. In addition, there is often a lack of relevant data available that can inform many upcoming decisions.
The current COVID-19 threat, in combination with the NPIs that are already underway and may still come, is no longer an emergency; it is an ongoing, severe national (and international) crisis that will keep us busy for years to come. Policy makers will be confronted almost daily with complex decisions relating to COVID-19 and NPIs over the coming months. Society must be able to understand these decisions and their main underlying justifications.
What evidence is needed?
An interdisciplinary task force should be tasked with defining the research needed to best assess the effectiveness and harm of NPIs.
In addition to the continuously updated figures for confirmed infections and deaths, cohort studies that investigate the population-wide infection rate in symptom-free individuals could be helpful. If the majority of the German population is already infected, NPIs such as school closures or contact restrictions are only of limited effectiveness. At the same time, these cohort studies provide data on the effectiveness of NPIs over time and when may be a good time to stop them.
Furthermore, the undesirable but unavoidable health, social, and economic side effects of NPIs need to be investigated. The many different types of undesirable side effects make it all the more important to implement a professional prioritization involving different departments and representatives of different population groups.
Centralized and decentralized
A government--organised task force should not preclude the possibility of complementary, decentralized research activities. On the contrary, part of its professional coordination should be to facilitate independent research projects on COVID-19 such as through the current calls for proposals by the BMBF and DFG. However, this valuable decentralized research does not replace centrally prioritized, coordinated, and communicated research on NPIs.
Further research areas on the effectiveness and safety of vaccines, antivirals, and intensive care measures are essential for the prevention and (acute) care of COVID-19. The potential need for a “COVID-19 Evidence” national task force for the prioritization, coordination, and communication of these research areas should be addressed separately.
Evidence and ethics
The “COVID-19 Evidence” national task force should promptly consider ethical challenges arising from this “national research agenda”. For example, research communication should present the infection rates such that they do not lead to stigmatization or discrimination of certain population groups.
Ethical challenges also arise when balancing the positive and negative effects on the basis of the relevant data. How are the expected positive effects of NPIs (e.g. slowing of infection rates, reduction of deaths) to be weighed against the negative effects (e.g. financial crises of companies and private households, psychosocial crises, worsening of social inequalities)? These trade-offs are inevitably linked to value judgements. Relevant and reliable data, encompassing the full extent of positive and negative effects, increase the objectivity and comprehensibility of these value judgements.
Evidence for the future pandemics
The experiences and outcomes of a “COVID-19 evidence” national task force are relevant not only to the current pandemic, but also to long-term planning and future emergencies.