Countries around the world are working at break-neck speed to pull together appropriate and effective responses to the growing COVID-19 pandemic. There are many working on understanding the virus, the disease it causes and how to care for those who have the virus. Others are taking on health systems questions, trying to re-organize services in the face of the pandemic, such as moving consultations online and over the phone or ensuring community care for people living with long-term chronic conditions. And then there are those looking at the social, political and economic responses to the pandemic.
In each of these cases, it is important that these responses are informed by the best available evidence that we have. One way to generate such evidence is rapid reviews of evidence about what works – and when and how.
The Alliance has a long track record of supporting rapid evidence synthesis for health policy and systems research. Indeed, rapid review platforms we have supported are already contributing to the COVID-19 effort. We also have a number of guides and resources available to support health policy and systems researchers to undertake rapid reviews.
Rapid reviews are already informing policy and practice in LMICs
The Alliance established Systematic Review Centres in a number of countries over a decade ago, and more recently we have been supporting the Global Evidence Synthesis Initiative. We also currently have projects in four countries to support Embedded Rapid Review (ERA) Platforms in collaboration with local decision-making institutions.
In March, our ERA platform in India run by the George Institute published a rapid evidence synthesis on ‘Frontline health workers in COVID-19 prevention and control’ in response to a query from the national government. This document has already informed guidelines and decisions at state and national level in India and has been translated for other neighbouring countries as well. It was also referenced in WHO guidance on violence against women during COVID-19.
In Georgia, the ERA platform at Curatio International Foundation published a rapid response on ‘The COVID-19 epidemic in Georgia Projections and Policy Options’. The paper includes modelling that has been considered by the government, as the authors have participated in several high-level policy-making meetings and are part of a working group for an effective COVID-19 response. The report also generated significant media coverage.
There is also emerging work from the systematic review centres that we previously supported. In Lebanon, the Knowledge to Policy Center has already published several rapid responses to the pandemic, one on ‘Informing Lebanon’s response to the COVID-19 pandemic’ and another on ‘Strengthening the role of local and international non-governmental organizations in pandemic responses’. And in South Africa, the Medical Research Council just released a qualitative evidence synthesis on ‘Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services’, which is relevant in the current circumstances.
Resources to help speed up evidence synthesis
Given the quickly evolving nature of this global pandemic, how can we reliably speed up evidence synthesis activities? The Alliance has produced several resources that can help.
A recent article from the Alliance, ‘Using rapid reviews to strengthen health policy and systems and progress towards universal health coverage’, highlights some tips for speeding up the process:
- Narrowing the scope: Limiting the number of populations, interventions and outcomes considered;
- Parallelisation of tasks: Increasing the intensity of work on review processes where multiple reviewers simultaneously complete review steps, for example, eligibility screening, data abstraction and risk-of-bias assessment;
- Using review shortcuts: One or more systematic review steps may be reduced or omitted;
- Automating review steps: Developing, adapting and using new technologies to fast-track the standard systematic review steps, for example, screening or data abstraction.
In 2017, we published a practical guide on using Rapid reviews to strengthen health policy and systems, which includes a good overview of how to approach rapid reviews along with key tips, readings and resources. There is a brief version of each chapter and key messages are also available as a series of presentations.
Our more recent methods guide on Evidence synthesis for health policy and systems also includes an annex of resources to support evidence synthesis, from checklists to software and databases. This living annex has been converted to a searchable online database.
COVID-19 evidence resources
There are a number of initiatives already underway to organize and prioritize the growing body of scientific knowledge about the novel coronavirus and the disease it causes, not least within the Science Division at the World Health Organization.
In terms of prioritizing and aligning research questions, the World Health Organization has developed a global research and development blueprint for the coronavirus disease and has established Evidence Collaborative for COVID-19. Cochrane has also setup a question bank for rapid reviews on COVID. And the African Academy of Science has just launched a survey to help identify what research is most important in Africa.
There are also several groups working to organize the growing knowledge base about the disease itself as well as the various policy responses to its prevention and control and their social and economic impacts. The World Health Organization has a downloadable Database of publications on coronavirus disease (COVID-19) and the Pan American Health Organization (PAHO) is collecting COVID-19 guidance and the latest research in the Americas. The EPPI-Centre at University College London is curating a living map of COVID-19 evidence. For broader policy responses, the European Regional Office of the World Health Organization has also just launched a Health System Response Monitor (HSRM).
This is by no means an exhaustive list of resources. As this is an evolving situation, we will update this article as new resources and activities become available.
Disclaimer: The provision of a link from the Alliance/WHO website to other sites does not indicate endorsement of those sites by the Alliance or WHO, and neither the Alliance or WHO accept any responsibility for the validity or accuracy of their content.