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A recent report by the Royal Society examined the literature on the effectiveness of non-pharmaceutical interventions (NPIs) aimed at reducing the transmission of SARS-CoV-2 during the COVID-19 pandemic. It emphatically concluded that they were ‘effective’, which we argue may be misleading to policymakers. This paper performs a critical analysis of the Royal Society report and explains what a proper evaluation of NPIs would mean, arguing that theory-based evaluations are required to approach complex issues and nurture democratic debates on societal choices. We argue that, first, testing the relationship between NPI interventions and their effectiveness in reducing SARS-CoV-2 transmission over a bounded period (a single outcome) is irrelevant for policymaking, because several criteria must be balanced to evaluate any intervention, including efficiency, equity, acceptability, long-term impacts, and sustainability. Second, ignoring the disruptive and unintended effects of NPIs leads to wrong conclusions regarding their overall value. Third, we question the mere objective of NPIs, that is, reducing viral transmission. Finally, we question the methodology used by the Royal Society Report regarding the literature selection and quality. To conclude, we argue that the Royal Society report is not only irrelevant and weak from a methodological point of view but also dangerously misleading in terms of policymaking. Four years after the start of the COVID-19 pandemic, it is high time for researchers, journals, and policymakers to stop debating over NPIs’ mere effectiveness against a parameter that requires a PCR test to determine, but engage in public health-based evaluations that weigh all criteria of interest., SCOPUS: no.j, info:eu-repo/semantics/published

Objectives“Anti-science” accusations are common in medicine and public health, sometimes to discredit scientists who hold opposing views. However, there is no such thing as “one science”. Epistemology recognizes that any “science” is sociologically embedded, and therefore contextual and intersubjective. In this paper, we reflect on how “science” needs to adopt various perspectives to give a comprehensive and nuanced understanding of a phenomenon.Study designOpinion paper.MethodsBased on a targeted literature survey, we first clarify the known limits of traditional scientific methods and then reflect on how the scientific reporting about Covid-19 mRNA vaccines has evolved.ResultsThe first reports of the Covid-19 mRNA vaccines randomised controlled trial results showed impressive efficacy. Nevertheless, an abundant literature has since depicted a far more nuanced picture of the effectiveness and safety of those vaccines over the medium-term. We organise them around five themes: (i) differentiating between relative and absolute reduction; (ii) taking account of time in reporting effectiveness; (iii) taking account of all outcomes, including adverse effects; (iv) stratifying effectiveness and considering other decision criteria (efficiency, equity, and acceptance); (v) changing the outcome of concern and assessing vaccines’ effectiveness on mortality.ConclusionsScience offers a wide range of perspectives on a given study object. Only the process of deliberation amongst scientists and other stakeholders can result in accepted new knowledge useful to support decision-making. Unfortunately, by trying to reduce “science” to simple messages set in stone, scientists can become the worse enemies of science., SCOPUS: ar.j, info:eu-repo/semantics/published

SCOPUS: ed.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review., SCOPUS: ar.j, info:eu-repo/semantics/published

Current COVID-19 response policies have aimed to break Corona waves through non-pharmaceutical interventions and mass vaccination. However, for long-term strategies to be effective and efficient, and to avoid massive disruption and social harms, it is crucial to introduce the role of natural immunity in our thinking about COVID-19 control and prevention. We argue that any Corona control policy must appropriately balance five key elements simultaneously: balancing the various fundamental interests of the nation, as well as the various interventions within the health sector; tailoring the prevention measures and treatments to individual needs; limiting social interaction restrictions; and balancing the role of vaccinations against the role of naturally induced immunity. Given the high infectivity of SARS-CoV-2 and its differential impact on population segments, we examine this last element in more detail and argue that an important aspect of ‘living with the virus’ will be to better understand the role of naturally induced immunity in our overall COVID-19 policy response. In our eyes, a policy approach that factors natural immunity should be considered for persons without major comorbidities and those having ‘encountered’ the antigen in the past., SCOPUS: ar.j, info:eu-repo/semantics/published

Chimamanda Ngozi Adichie showed how a single story is limited and thereby distorts the true nature of an issue. During this COVID-19 pandemic there have been, at least, three consecutive single stories—the ‘lethal threat’ story, followed by the ‘economic threat’ story, and finally the ‘vaccine miracle’ story. None of these single stories can convincingly and permanently capture the dynamics of the pandemic. This is because countries experienced different morbidity and mortality patterns, different socioeconomic disadvantage, age and vulnerability of population, timing and level of lockdown with economic variability, and, despite heavy promotion, vaccines were beset with a significant and variable degree of hesitancy. Lack of transparency, coherence and consistency of pandemic management—arising from holding on to single storylines—showed the global deficiency of public health policy and planning, an underfunding of (public) health and social services, and a growing distrust in governments' ability to manage crises effectively. Indeed, the global management has increased already large inequities, and little has been learnt to address the growing crises of more infectious and potentially more lethal virus mutations. Holding onto single stories prevents the necessary learnings to understand and manage the complexities of ‘wicked’ problems, whereas listening to the many stories provides insights and pathways to do so effectively as well as efficiently., SCOPUS: re.j, info:eu-repo/semantics/published

The global community has disproportionately invested in vaccines to fight Covid-19.- This is at the expense of alternative strategies and health system strengthening.- Social determinants and co-morbidities should be factored as part of any response strategy.- Risk-benefit analysis and the precaution principle should guide vaccination policy.- A more diversified response to Covid-19 and future diseases should be adopted., SCOPUS: no.j, info:eu-repo/semantics/published

Background: Since the beginning of the pandemic, Covid-19 has been regarded as an exceptional disease. Control measures have exclusively focused on "the virus", failing to account for other biological and social factors that determine severe forms of the disease.Aim: We argue that if it is understandable that Covid-19 was initially considered a form of exceptionalism, justifying extraordinary response measures, this situation has changed – and so should our response.Main arguments: We now know that Covid-19 shares many features of common infectious respiratory diseases, and better understand that SARS-CoV-2 has not invented new problems out of the blue. Instead, it has unveiled and exacerbated existing problems in health systems and underlying population health. Of course, Covid-19 is not an extra-terrestrial disease. It is a complex zoonotic disease, and it needs to be managed as such, following long proven principles of medicine and public health.Conclusion: A complex disease cannot be solved through a simple, magic bullet cure or vaccine. The heterogeneity of population profiles susceptible to develop a severe form of Covid-19 suggests adopting varying, targeted measures, enabled to reach risk profiles in an appropriate way. The critical role of comorbidities in disease severity calls for complementing short-term virus-targeted interventions with medium-term policies aimed at reducing the burden of comorbidities, as well as mitigating the risk of "transition" from infection to disease. Complementary strategies are needed including upstream prevention, early treatment, and the consolidation of the health system., SCOPUS: sh.j, info:eu-repo/semantics/published

info:eu-repo/semantics/nonPublished

SCOPUS: ar.j, info:eu-repo/semantics/published

Strategic purchasing is branded as an approach that is necessary for progress towards universal health coverage. While we agree that publicly purchased health services should respond to society's needs and patient expectations, and thus generally endorse strategic purchasing, here we would like to explore two emerging concerns within current discussions in low‐ and middle‐income countries. First, there exists a great deal of misunderstanding and conceptual unclarity, within practitioner groups, around the concept of strategic purchasing and what instruments it incorporates. Second, there is a growing trend to regularly fuse strategic purchasing into a performance‐based financing (PBF) discourse in ways that increasingly blur their distinctive properties and policy orientations, while perhaps too easily obfuscating potential tensions. We believe the discourse on strategic purchasing would benefit from better conceptual clarity by dissociating and prioritising its two objectives, namely: priority should be given to needs‐based allocation of resources, while rewarding performance is a subsequent concern. We argue there is a need for a more thoroughgoing conceptual and empirical re‐examination of strategic purchasing's priorities, its link with PBF, as well as for a wider evidence‐base on what strategic purchasing tools exist and which are most appropriate for diverse contexts., SCOPUS: ar.j, info:eu-repo/semantics/published