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A multinational Delphi consensus to end the COVID-19 public health threat

Jeffrey V Lazarus et al. Nature. 2022 Nov.

Abstract

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

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Conflict of interest statement

J.V.L. reports research grants to his institution from AbbVie, Gilead Sciences and MSD, and speaker fees from AbbVie, Gilead Sciences, Intercept, Janssen, MSD and ViiV, and an advisory board fee from AbbVie and Novavax, all unrelated to this work. R.A. is a co-chair of the Occupational Medicine Committee of the British Medical Association and a member of the Industrial Injuries Advisory Council (UK). S.A. reports honoraria for lectures and educational events from Gilead, AbbVie, MSD and Biogen, and reports grants, not related to COVID-19, from Gilead and AbbVie. The A.G.-S. laboratory has received research support from Pfizer, Senhwa Biosciences, Kenall Manufacturing, Avimex, Johnson & Johnson, Dynavax, 7Hills Pharma, Pharmamar, ImmunityBio, Accurius, Nanocomposix, Hexamer, N-fold, Model Medicines, Atea Pharma, Applied Biological Laboratories and Merck. A.G.-S. has consulting agreements for the following companies involving cash and/or stock: Vivaldi Biosciences, Contrafect, 7Hills Pharma, Avimex, Vaxalto, Pagoda, Accurius, Esperovax, Farmak, Applied Biological Laboratories, Pharmamar, Paratus, CureLab Oncology, CureLab Veterinary, Synairgen and Pfizer. A.G.-S. has been an invited speaker in meeting events organized by Seqirus, Janssen and AstraZeneca. A.G.-S. is listed as an inventor on patents and patent applications (US patent numbers: 5,820,871; 5,854,037; 6,001,634; 6,146,642; 6,451,323; 6,468,544; 6,544,785; 6,573,079; 6,635,416; 6,649,372; 6,669,943; 6,740,519; 6,852,522; 6,866,853; 6,884,414; 6,887,699; 7,060,430; 7,384,774; 7,442,379; 7,494, 808; 7,588,768; 7,833,774; 8,012,490; 8,057,803; 8,124,101; 8,137,676; 8,591,881; 8,629,283; 8,673,314; 8,709,442; 8,709,730; 8,765,139; 8,828,406; 8,999,352; 9,051,359; 9,096,585; 9,175,069; 9,217,136; 9,217,157; 9,238,851; 9,352,033; 9,371,366; 9,387,240; 9,387,242; 9,549,975; 9,701,723; 9,708,373; 9,849,172; 9,908,930; 9,968,670; 10,035,984; 10,098,945; 10,131,695; 10,137,189; 10,179,806; 10,251,922; 10,308,913; 10,543,268; 10,544,207; 10,583,188; 10,736,956; 11,254,733; and 11,266,734) on the use of antivirals and vaccines for the treatment and prevention of virus infections and cancer, owned by the Icahn School of Medicine at Mount Sinai, New York. S.G. reports being a member of Independent SAGE and member of the Pfizer Antivirals Advisory Board. P.H. reports being co-inventor of a COVID-19 recombinant protein vaccine technology owned by the Baylor College of Medicine (BCM) that was recently licenced by BCM non-exclusively and with no patent restrictions to several companies committed to advance vaccines for low- and middle-income countries. The co-inventors have no involvement in licence negotiations conducted by the BCM. Similar to other research universities, a long-standing BCM policy provides its faculty and staff, who make discoveries that result in a commercial licence, a share of any royalty income. To date, BCM has not distributed any royalty income to the co-inventors on the COVID-19 recombinant protein vaccine technology. Any such distribution will be undertaken in accordance with BCM policy. A.K. has served as a paid consultant to the Independent Panel on Pandemic Preparedness and Response in 2020–21. K.K. is Chair of the Ethnicity Subgroup of the UK Scientific Advisory Group for Emergencies (SAGE) and Member of SAGE. J.L. reports owning equity in Codiak BioSciences and Exocure Biosciences, both having developed experimental COVID-19 vaccines. G.M. reports honoraria for a presentation from Novartis and consulting fees from AstraZeneca. S.M. reports being founder and chief scientific officer of PulmoBioMed. T.S. serves as the scientific director of the O’Brien Institute for Public Health and reports funding from the Canadian Institutes of Health Research. V.S. is a member of the National Scientific Committee of Experts for COVID-19 in Greece and reports grants from Gilead and Abbvie that are not related to this work or to COVID-19 research. A.T. reports grants from the Foundation for Advancing Family Medicine Janus Research Grant; Canadian Frailty Network Research Grant, Speaking Honoraria: University of Ottawa, McMaster University, Northern Ontario School of Medicine, McGill University, University of Calgary, BC Bereavement Hotline, Early Education Teachers of Ontario-Yok Region Union, Ontario Council for Cooperation, TELUS Science World-Vancouver. R.B. has been COVID-19 adviser to UK government and acts as a senior scientific adviser for a communications company working for the UK Government on COVID-19. A.W. reports research funding from Pfizer (unrelated to COVID-19) and a consulting fee from Ocugen. K.Y. is an unpaid member of the Independent SAGE group of scientists. The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Delphi panel generation and data collection.
Study methodology, including sample and data collection. Top, the iterative sampling approach used to generate a large, diverse Delphi panel (n = 386): four project co-chairs identified a core group of 40 academic, health, NGO, government and policy experts from 25 countries; the core group identified individuals with expertise in COVID-19; under-represented countries (that is, with fewer than one invitee) were identified and targeted through PubMed/Medline searches for authors of COVID-19 research studies in these countries. Bottom, the iterative digital data-collection process, including two survey rounds (R1 and R2) of draft statements; an online consensus meeting of the core group (Supplementary Discussion 3); one round of draft recommendations (R2); and a final survey round (R3) of the consensus statements and recommendations. Earlier rounds included text boxes for panellists to provide comments and suggest edits to individual statements (R1, R2) and recommendations (R2); the final statement and recommendations round (R3) allowed for overall comments at the end of each domain. For the final set of recommendations in R3, panellists ranked the top half in each of the six domains. RR, response rate.
Extended Data Fig. 1
Extended Data Fig. 1. Top half of the ranking of the recommendations in each domain.
In the third and final round of the Delphi process, panel members were asked to rank the recommendations per domain (n = 6) based on importance. This figure shows the top half of the recommendations for each of the six domains (communication; health systems; vaccination; prevention; treatment and care; and inequities).
See this image and copyright information in PMC

Comment in

  • Ending the COVID-19 pandemic.
    Attwaters M. Attwaters M. Nat Rev Microbiol. 2023 Jan;21(1):3. doi: 10.1038/s41579-022-00830-w. Nat Rev Microbiol. 2023. PMID: 36396828 Free PMC article.

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