Evaluation of the COVID-19 response in Spain: principles and requirements

Abstract

A resurgence of COVID-19 infections is occurring in Spain, with some of the worst figures in Europe.1Ministerio de SanidadActualización no 193: enfermedad por el coronavirus (COVID-19).https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/Actualizacion_193_COVID-19.pdfDate: Aug 26, 2020Date accessed: September 16, 2020Google Scholar, 2European Centre for Disease Prevention and ControlCOVID-19 situation update for the EU/EEA and the UK, as of 16 September 2020.https://www.ecdc.europa.eu/en/cases-2019-ncov-eueeaDate: Sept 16, 2020Date accessed: September 16, 2020Google Scholar In August, 2020, we urged the Spanish Central Government and regional governments to independently evaluate their COVID-19 response to identify areas where public health and the health and social care system need to be improved.3García-Basteiro A Alvarez-Dardet C Arenas A et al.The need for an independent evaluation of the COVID-19 response in Spain.Lancet. 2020; 396: 529-530Summary Full Text Full Text PDF PubMed Scopus (62) Google Scholar Although we received widespread support from more than 50 scientific societies and associations representing public health, medical, and nursing professional communities; there is now a need to define such an evaluation in terms of its timing, scope, and leadership. Here, we suggest three major requisites and four guiding principles, adapted from McKee and colleagues,4McKee M Gill M Wollaston S Public inquiry into UK's response to COVID-19.BMJ. 2020; 369m2052Crossref PubMed Scopus (20) Google Scholar which we believe would ensure a successful independent evaluation. The first requirement is urgency; the evaluation should start immediately and report periodically until the end of the pandemic. In a country where political tensions are high, the second requirement is widescale support from political parties, scientific associations, health-care professionals, patients and carers, civil society, and the society as a whole. The reaction to our first letter3García-Basteiro A Alvarez-Dardet C Arenas A et al.The need for an independent evaluation of the COVID-19 response in Spain.Lancet. 2020; 396: 529-530Summary Full Text Full Text PDF PubMed Scopus (62) Google Scholar was positive among all stakeholders, and governments should capitalise on that consensus. The third requirement is a firm commitment from the Central Government and regional governments to listen to the recommendations proposed in the evaluation and act accordingly. Once the requirements have been agreed, we suggest four guiding principles to guarantee a successful process. The first, and most important, principle is the independence of the members of the evaluation committee. The people who select the members of the evaluation team, and the members themselves, should be independent from government, not have worked in government, and have no competing interests. Independent Spanish academics, working both in Spain and abroad, and international experts could take part in the selection committee and the evaluation team. Second, a no-blame culture is needed, focusing on providing recommendations that can improve the situation without apportioning blame. Third, the evaluation team should be gender balanced and multidisciplinary to promote broader critical evaluation. Fourth, the evaluation should have a broad scope, analysing the health, economic, and social effects with input from both the Central Government and the autonomous communities, given the high level of decentralised competencies. The organisation of the evaluation can be chosen from existing models, such as the evaluation proposed by WHO,5WHOIndependent evaluation of global COVID-19 response announced.https://www.who.int/news-room/detail/09-07-2020-independent-evaluation-of-global-covid-19-response-announcedDate: July 9, 2020Date accessed: September 16, 2020Google Scholar the All-Party Parliamentary Group model used in the UK, or the inquiry that was done in Victoria state, Australia.6Parliament of VictoriaInquiry into the Victorian Government's response to the COVID-19 pandemic.https://parliament.vic.gov.au/images/stories/committees/paec/COVID-19_Inquiry/Report/PAEC_59-07_Vic_Gov_response_COVID-19_Interim_report.pdfDate: July, 2020Date accessed: September 16, 2020Google Scholar One proposal could be to select a panel of experts supported by a scientific team who are responsible for collecting and analysing the evidence. Working groups and a call for evidence could also complement that process, involving relevant scientific societies representing health-care and other professionals, patients' organisations, and civil society in the provision of evidence and expertise. We continue to encourage the Spanish Central Government and regional governments to take forward this evaluation, which could become an example for other countries to replicate. We will continue to offer more detailed proposals. This evaluation, based on scientific evidence, is now urgently needed to guide public health policy and contribute to overcoming the COVID-19 pandemic. We declare no competing interests. Download .pdf (.16 MB) Help with pdf files Supplementary appendix