Pandemic Preparedness Plans Research Articles

PaCAR: COVID-19 Pandemic Control Decision Making via Large-Scale Agent-Based Modeling and Deep Reinforcement Learning.

Policy makers are facing more complicated challenges to balance saving lives and economic development in the post-vaccination era during a pandemic. Epidemic simulation models and pandemic control methods are designed to tackle this problem. However, most of the existing approaches cannot be applied to real-world cases due to the lack of adaptability to new scenarios and micro representational ability (especially for system dynamics models), the huge computation demand, and the inefficient use of historical information. We propose a novel Pandemic Control decision making framework via large-scale Agent-based modeling and deep Reinforcement learning (PaCAR) to search optimal control policies that can simultaneously minimize the spread of infection and the government restrictions. In the framework, we develop a new large-scale agent-based simulator with vaccine settings implemented to be calibrated and serve as a realistic environment for a city or a state. We also design a novel reinforcement learning architecture applicable to the pandemic control problem, with a reward carefully designed by the net monetary benefit framework and a sequence learning network to extract information from the sequential epidemiological observations, such as number of cases, vaccination, and so forth. Our approach outperforms the baselines designed by experts or adopted by real-world governments and is flexible in dealing with different variants, such as Alpha and Delta in COVID-19. PaCAR succeeds in controlling the pandemic with the lowest economic costs and relatively short epidemic duration and few cases. We further conduct extensive experiments to analyze the reasoning behind the resulting policy sequence and try to conclude this as an informative reference for policy makers in the post-vaccination era of COVID-19 and beyond. The modeling of economic costs, which are directly estimated by the level of government restrictions, is rather simple. This article mainly focuses on several specific control methods and single-wave pandemic control. The proposed framework PaCAR can offer adaptive pandemic control recommendations on different variants and population sizes. Intelligent pandemic control empowered by artificial intelligence may help us make it through the current COVID-19 and other possible pandemics in the future with less cost both of lives and economy. We introduce a new efficient, large-scale agent-based epidemic simulator in our framework PaCAR, which can be applied to train reinforcement learning networks in a real-world scenario with a population of more than 10,000,000.We develop a novel learning mechanism in PaCAR, which augments reinforcement learning with sequence learning, to learn the tradeoff policy decision of saving lives and economic development in the post-vaccination era.We demonstrate that the policy learned by PaCAR outperforms different benchmark policies under various reality conditions during COVID-19.We analyze the resulting policy given by PaCAR, and the lessons may shed light on better pandemic preparedness plans in the future.

A Pilot Study of Using Smartphone Application vs. Routine Follow-Up for Patient Care in Advanced Non-Small Cell Lung Cancer During the COVID-19 Pandemic Era.

IntroductionCancer care monitoring should be adapted regarding COVID-19 pandemic preparedness plans. Lung Cancer Care application was a mobile application program to monitor adverse events and report outcomes. This study is aimed to invent a new mobile application evaluating patient-reported outcome (PRO) for patients with non-small cell lung cancer (NSCLC) and to evaluate the validity of a mobile application, particularly during the COVID-19 pandemic era.MethodsThe validity of the application was tested, and Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaires were contained in the mobile application-based PRO. Patients were randomly assigned to use mobile application-based PRO vs. routine follow-up. The primary end point was to compare the quality of life (QoL) scores between two groups. A secondary end point was overall survival (OS) and the outcomes of progressive disease (PD) between the two groups.ResultsIn total, 33 patients with advanced NSCLC were enrolled. Patients in the mobile application group had higher FACT-L scores at 3 months than patients with a routine follow-up arm (106 ± 5.97 vs. 99.96 ± 5.74, p-value = 0.07). The median follow-up time was 5.43 months; patients with mobile application had an insignificant increase in median OS when compared with patients using routine follow-up (4.53 vs. 2.93 months, p-value = 0.85). The sensitivity, specificity, positive predictive value (PPV), and negative predictive (NPV) value of this application for predicting disease progression were 50, 83.3, 66.7, and 70%, respectively.ConclusionSelf-reported symptoms by Lung Cancer Care application improved QoL and were similar in monitoring outcomes to face-to-face follow-up. This tool is applicable for patients with cancer to make monitoring as safe as possible for physical distancing during the COVID-19 pandemic era.

Healthcare Workers' Perceptions and Medically Approved COVID-19 Infection Risk: Understanding the Mental Health Dimension of the Pandemic. A German Hospital Case Study.

IntroductionThis study analyses how healthcare workers (HCWs) perceived risks, protection and preventive measures during the COVID-19 pandemic in relation to medically approved risks and organizational measures. The aim is to explore “blind spots” of pandemic protection and make mental health needs of HCWs visible.MethodsWe have chosen an “optimal-case” scenario of a high-income country with a well-resourced hospital sector and low HCW infection rate at the organizational level to explore governance gaps in HCW protection. A German multi-method hospital study at Hannover Medical School served as empirical case; document analysis, expert information and survey data (n = 1,163) were collected as part of a clinical study into SARS-CoV-2 serology testing during the second wave of the pandemic (November 2020-February 2021). Selected survey items included perceptions of risks, protection and preventive measures. Descriptive statistical analysis and regression were undertaken for gender, profession and COVID-19 patient care.ResultsThe results reveal a low risk of 1% medically approved infections among participants, but a much higher mean personal risk estimate of 15%. The majority (68.4%) expressed “some” to “very strong” fear of acquiring infection at the workplace. Individual protective behavior and compliance with protective workplace measures were estimated as very high. Yet only about half of the respondents felt strongly protected by the employer; 12% even perceived “no” or “little” protection. Gender and contact with COVID-19 patients had no significant effect on the estimations of infection risks and protective workplace behavior, but nursing was correlated with higher levels of personal risk estimations and fear of infection.ConclusionsA strong mismatch between low medically approved risk and personal risk perceptions of HCWs brings stressors and threats into view, that may be preventable through better information, training/education and risk communication and through investment in mental health and inclusion in pandemic preparedness plans.

'Imperfect but useful': pandemic response in the Global South can benefit from greater use of mathematical modelling.

Mathematical modelling has been a helpful resource for planning public health responses to COVID-19. However, there is a need to improve the accessibility of models built within country contexts in the Global South. Immediately following the overwhelming ‘second wave’ of COVID-19 in India, we developed a user-friendly, web-based modelling simulator in partnership with the public health experts and health administrators for subnational planning. The purpose was to help policy-makers and programme officials at the state and district levels, to construct model-based scenarios for a possible third wave. Here, we describe our experiences of developing and deploying the simulator and propose the following recommendations for future such initiatives: early preparation will be the key for pandemic management planning, including establishment of networks with potential simulator users. Ideally, this preparedness should be conducted during ‘peace time’, and coordinated by agencies such as WHO. Second, flexible modelling frameworks will be needed, to respond rapidly to future emergencies as the precise nature of any pandemic is impossible to predict. Modelling resources will, therefore, need to be rapidly adaptable to respond as soon as a novel pathogen emerges. Third, limitations of modelling must be communicated clearly and consistently to end users. Finally, systematic mechanisms are required for monitoring the use of models in decision making, which will help in providing modelling support to those local authorities who may benefit most from it. Overall, these lessons from India can be relevant for other countries in the South-Asian-Region, to incorporate modelling resources into their pandemic preparedness planning.

COVID-19 Pandemic, Risk, and Blame Attributions: A Scoping Review.

Background:The COVID-19 pandemic and its associated psychological distress led people to engage in attributing several health-related behaviors and consequences at the community and international levels. A scoping review was conducted to explore the existing literature on the use of attribution theory in understanding the psychological phenomena underlying health-related behavior and consequences during the pandemic.Methods:We conducted the literature review using Arksey and O’Malley’s methodological framework for scoping review. Studies were identified through a comprehensive search of the following six databases: MEDLINE through PubMed, ProQuest, JSTOR, Scopus, ScienceDirect, and Google Scholar. All databases were searched for entries in English from September 2019 to September 2021 to correspond to the advent of the pandemic.Results:Several elements influence attributions and the influences of the attributions on people’s responses to information and the consequences of attributions in influencing people’s responses to information and behavior changes in the context of the COVID-19 pandemic. The importance of attribution errors leading to stigmatization and responsibility framing, both crucial for implementing pandemic control measures and enhancing psychological well-being, were also highlighted.Conclusion:More research is needed in this field to inform people-centered policies and pandemic preparedness plans to mitigate the potentially devastating psychosocial consequence of the pandemic or other public health emergencies.

Examining the Impacts of the Coronavirus Pandemic and Social Distancing on the Health of People With Mobility Disabilities.

ObjectiveTo understand the effects of the coronavirus pandemic on the health and participation of people with mobility disabilities living in the community.MethodsParticipants responded to a survey designed to assess the effects of the coronavirus pandemic on their health and access to health care. Participants identified if various life situations were worsened, unchanged, or improved during the pandemic. Participants could provide further information on their improved or worsened lived experience in open-ended questions.ResultsA total of 39 people with mobility disabilities responded to the survey. Results indicate that many experienced a worsening of life situations related to health, including access to medications, health care services, and transportation.ConclusionsResults show that many experiences were caused by the lack of appropriate policies, rather than the pandemic itself. Therefore, there is a need to modify pandemic preparedness plans and other policies to meet the needs of people with disabilities.

Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning.

Since the WHO’s “Influenza Pandemic Preparedness Plan” in 1999, pandemic preparedness plans at the international and national level have been constantly adapted with the common goal to respond early to outbreaks, identify risks, and outline promising interventions for pandemic containment. Two years into the COVID-19 pandemic, public health experts have started to reflect on the extent to which previous preparations have been helpful as well as on the gaps in pandemic preparedness planning. In the present commentary, we advocate for the inclusion of social and ethical factors in future pandemic planning—factors that have been insufficiently considered so far, although social determinants of infection risk and infectious disease severity contribute to aggravated social inequalities in health.

Kanta Subbarao—confronting influenza and COVID-19

Kanta Subbarao—confronting influenza and COVID-19

The COVID-19 pandemic has highlighted the need to invest in care home research infrastructure

The COVID-19 pandemic resulted in catastrophic levels of morbidity and mortality for care home residents. Despite this, research platforms for COVID-19 in care homes arrived late in the pandemic compared with other care settings. The Prophylactic Therapy in Care Homes Trial (PROTECT-CH) was established to provide a platform to deliver multi-centre cluster-randomized clinical trials of investigational medicinal products for COVID-19 prophylaxis in UK care homes. Commencing set-up in January 2021, this involved the design and development of novel infrastructure for contracting and recruitment, remote consent, staff training, research insurance, eligibility screening, prescribing, dispensing, and adverse event reporting; such infrastructure being previously absent. By the time this infrastructure was in place, the widespread uptake of vaccination in care homes had changed the epidemiology of COVID-19 rendering the trial unfeasible. Whilst some of the resources developed through PROTECT-CH will enable the future establishment of care home platform research, the near absence of care home trial infrastructure and nationally-linked databases involving the care home sector will continue to significantly hamper progress. These issues are replicated in most other countries. Beyond COVID-19, there are many other research questions that require addressing to provide better care to people living in care homes. PROTECT-CH has exposed a clear need for research funders to invest in, and legislate for, an effective care home research infrastructure as part of national pandemic preparedness planning. Doing so would also invigorate care home research in the interim, leading to improved healthcare delivery specific to those living in this sector.

Millions of Bangladeshi Children Missed Their Scheduled Vaccination Amidst COVID-19 Pandemic.

The Government of Bangladesh imposed a movement control order as a mass quarantine strategy to control the outbreak of coronavirus disease 2019 (COVID-19). Adherence to the home quarantine may put children at risk by missing routine vaccination. In this study, we investigated the impact of COVID-19 on child routine immunization in a rural area of Bangladesh and consider the broader implications. Data for this study comes from the Chakaria Health and Demographic Surveillance System (HDSS) of icddr,b with a population of 90,000 people residing in 16,000 households in 49 villages in a rural, coastal area of Southeast Bangladesh. We used an explanatory sequential mixed methods design which involved two phases between March 1, 2020, and May 31, 2020: first, we observed 258 outreach sessions of 86 EPI centers. We calculated the number of Expanded Program on Immunization (EPI) outreach sessions suspended and the number of children who missed their routine vaccination due to the COVID-19. We extrapolated the number of Bangladeshi children who missed their routine vaccination using Chakaria HDSS observations. Secondly, we conducted in-depth interviews to explain the quantitative results. The EPI outreach session (EOS) declined to 74.42% (95% CI 63.97–83.22), 10.45% (95% CI 5.00–18.94), and 3.45% (95% CI 1.00–9.75) from 2019 levels in March, April, and May 2020, respectively. By extrapolation, in Bangladesh, between March and May 2020, 3.2 million children missed their scheduled vaccination compared to 2019. Results from in-depth interviews showed that the unwillingness of villagers to hold EOS and the absenteeism of the vaccinators due to social distancing recommendations and lack of personal safety measures were the main reasons for the discontinuation of the EOS. Resuming EPI outreach sessions and introducing a special catch-up program is essential to prevent future outbreaks and deaths due to vaccine-preventable diseases in Bangladesh and the countries where children missed their routine vaccination due to COVID-19. This health system failure should be considered a factor in all future pandemic preparedness plans.

The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time-series analysis

The coronavirus disease 2019 (COVID-19) pandemic and ensuing restrictions have negatively affected the mental health and well-being of the general population, and there is increasing evidence suggesting that lockdowns have led to a disruption of health services. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic, entailing the suspension of all non-essential activities and a complete ban of tobacco and alcohol sales. We studied the effect of the lockdown on mental health care utilisation rates in private-sector care in South Africa. We conducted an interrupted time-series analysis using insurance claims from 1 January 2017 to 1 June 2020 of beneficiaries 18 years or older from a large private sector medical insurance scheme. We calculated weekly outpatient consultation and hospital admission rates for organic mental disorders, substance use disorders, serious mental disorders, depression, anxiety, other mental disorders, any mental disorder and alcohol withdrawal syndrome. We calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly outpatient consultation and hospital admission rates and the weekly change in rates during the lockdown until 1 June 2020. 710 367 persons were followed up for a median of 153 weeks. Hospital admission rates (OR 0.38; 95% confidence interval (CI) 0.33-0.44) and outpatient consultation rates (OR 0.74; 95% CI 0.63-0.87) for any mental disorder decreased substantially after the introduction of the lockdown and did not recover to pre-lockdown levels by 1 June 2020. Health care utilisation rates for alcohol withdrawal syndrome doubled after the introduction of the lockdown, but the statistical uncertainty around the estimates was large (OR 2.24; 95% CI 0.69-7.24). Mental health care utilisation rates for inpatient and outpatient services decreased substantially after the introduction of the lockdown. Hospital admissions and outpatient consultations for alcohol withdrawal syndrome increased after the introduction of the lockdown, but statistical uncertainty precludes strong conclusions about a potential unintended effect of the alcohol sales ban. Governments should integrate strategies for ensuring access and continuity of essential mental health services during lockdowns in pandemic preparedness planning.

Leveraging International Influenza Surveillance Systems and Programs during the COVID-19 Pandemic

A network of global respiratory disease surveillance systems and partnerships has been built over decades as a direct response to the persistent threat of seasonal, zoonotic, and pandemic influenza. These efforts have been spearheaded by the World Health Organization, country ministries of health, the US Centers for Disease Control and Prevention, nongovernmental organizations, academic groups, and others. During the COVID-19 pandemic, the US Centers for Disease Control and Prevention worked closely with ministries of health in partner countries and the World Health Organization to leverage influenza surveillance systems and programs to respond to SARS-CoV-2 transmission. Countries used existing surveillance systems for severe acute respiratory infection and influenza-like illness, respiratory virus laboratory resources, pandemic influenza preparedness plans, and ongoing population-based influenza studies to track, study, and respond to SARS-CoV-2 infections. The incorporation of COVID-19 surveillance into existing influenza sentinel surveillance systems can support continued global surveillance for respiratory viruses with pandemic potential.

Pandemic Covid-19 Preparednes Plan in the Workplace: a Case Study in Mining Company

COVID-19 Pandemic preparedness plans in mining companies are very important, so standards are needed as valuable input for all mining companies to make continuous improvements. preparedness plans, so that mining companies do not have to stop operating due to the impact of the COVID-19 pandemic. This study aims for a COVID-19 pandemic preparedness plan in mining companies. The methodology used in this study was to compare mining companies' COVID-19 preparedness plans with ISO/PAS 45005:2020 Standard General guidelines for working safely during the COVID-19 pandemic. The results The results suggest several elements for COVID-19 pandemic preparedness including leadership, risk management. , case management, health protocols, 3Ts (tracing, testing and treatment), emergency management, and case investigations have been identified as key elements for inclusion. The scoring system can be based on the level of implementation of each element. In conclusion, to be better prepared for future pandemics, several strategies have been identified to better manage the pandemic including worker and community participation, worker and public led crisis communication and the RCCE strategy.

Not the great equalizers: Covid-19, 1918–20 influenza, and the need for a paradigm shift in pandemic preparedness

Despite common perceptions to the contrary, pandemic diseases do not affect populations indiscriminately. In this paper, we review literature produced by demographers, historians, epidemiologists, and other researchers on disparities during the 1918–20 influenza pandemic and the Covid-19 pandemic. Evidence from these studies demonstrates that lower socio-economic status and minority/stigmatized race or ethnicity are associated with higher morbidity and mortality. However, such research often lacks theoretical frameworks or appropriate data to explain the mechanisms underlying these disparities fully. We suggest using a framework that considers proximal and distal factors contributing to differential exposure, susceptibility, and consequences as one way to move this research forward. Further, current pandemic preparedness plans emphasize medically defined risk groups and epidemiological approaches. Therefore, we conclude by arguing in favour of a transdisciplinary paradigm that recognizes socially defined risk groups, includes input from the social sciences and humanities and other diverse perspectives, and contributes to the reduction of health disparities before a pandemic hits.

Factors associated with transmission of COVID-19 in long-term care facility outbreaks

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a disproportionate impact on residents in long-term care facilities (LTCFs).AimTo identify risk factors associated with outbreak severity to inform current outbreak management and future pandemic preparedness planning efforts.MethodsA retrospective cohort study design was used to evaluate the association between non-modifiable factors (facility building, organization level, and resident population characteristics), modifiable factors (measured through an assessment tool for infection prevention and control (IPC) and pandemic preparedness), and severity of COVID-19 outbreaks (attack rate) in LTCFs.FindingsFrom March 1st, 2020 to January 10th, 2021, a total of 145 exposures to at least one confirmed case of COVID-19 in 82 LTCFs occurred. Risk factors associated with increased outbreak severity were older facility age, a resident (vs staff) index case, and poorer assessment tool performance. Specifically, for every item not met in the assessment tool, a 22% increase in the adjusted rate ratio was observed (1.2; 95% confidence interval: 1.1–1.4) after controlling for other risk factors.ConclusionScores from an assessment tool, older building age, and the index case being a resident were associated with severity of COVID-19 outbreaks in our jurisdiction. The findings reinforce the importance of regularly assessing IPC measures and outbreak preparedness in preventing large outbreaks. Regular, systematic assessments incorporating IPC and outbreak preparedness measures may help mitigate impacts of future outbreaks and inform future pandemic preparedness planning.

Process Development for Newcastle Disease Virus-Vectored Vaccines in Serum-Free Vero Cell Suspension Cultures.

The ongoing COVID-19 pandemic drew global attention to infectious diseases, attracting numerous resources for development of pandemic preparedness plans and vaccine platforms—technologies with robust manufacturing processes that can quickly be pivoted to target emerging diseases. Newcastle Disease Virus (NDV) has been studied as a viral vector for human and veterinary vaccines, but its production relies heavily on embryonated chicken eggs, with very few studies producing NDV in cell culture. Here, NDV is produced in suspension Vero cells, and analytical assays (TCID50 and ddPCR) are developed to quantify infectious and total viral titer. NDV-GFP and NDV-FLS (SARS-CoV-2 full-length spike protein) constructs were adapted to replicate in Vero and HEK293 suspension cultures using serum-free media, while fine-tuning parameters such as MOI, temperature, and trypsin concentration. Shake flask productions with Vero cells resulted in infectious titers of 1.07 × 108 TCID50/mL for NDV-GFP and 1.33 × 108 TCID50/mL for NDV-FLS. Production in 1 L batch bioreactors also resulted in high titers in culture supernatants, reaching 2.37 × 108 TCID50/mL for NDV-GFP and 3.16 × 107 TCID50/mL for NDV-FLS. This shows effective NDV production in cell culture, building the basis for a scalable vectored-vaccine manufacturing process that can be applied to different targets.

Rationing With Respect to Age During a Pandemic: A Comparative Analysis of State Pandemic Preparedness Plans

BackgroundFaced with possible shortages due to COVID-19, many states updated or rapidly developed crisis standards of care (CSCs) and other pandemic preparedness plans (PPPs) for rationing resources, particularly ventilators.Research QuestionHow have US states incorporated the controversial standard of rationing by age and/or life-years into their pandemic preparedness plans?Study Design and MethodsThis was an investigator-initiated, textual analysis conducted from April to June 2020, querying online resources and in-state contacts to identify PPPs published by each of the 50 states and for Washington, DC. Analysis included the most recent versions of CSC documents and official state PPPs containing triage guidance as of June 2020. Plans were categorized as rationing by (A) short-term survival (≤ 1 year), (B) 1 to 5 expected life-years, (C) total life-years, (D) “fair innings,” that is, specific age cutoffs, or (O) other. The primary measure was any use of age and/or life-years. Plans were further categorized on the basis of whether age/life-years was a primary consideration.ResultsThirty-five states promulgated PPPs addressing the rationing of critical care resources. Seven states considered short-term prognosis, seven considered whether a patient had 1 to 5 expected life-years, 13 rationed by total life-years, and one used the fair innings principle. Seven states provided only general ethical considerations. Seventeen of the 21 plans considering age/life-years made it a primary consideration. Several plans borrowed heavily from a few common sources, although use of terminology was inconsistent. Many documents were modified in light of controversy.InterpretationGuidance with respect to rationing by age and/or life-years varied widely. More than one-half of PPPs, many following a few common models, included age/life-years as an explicit rationing criterion; the majority of these made it a primary consideration. Terminology was often vague, and many plans evolved in response to pushback. These findings have ethical implications for the care of older adults and other vulnerable populations during a pandemic.

Predictors of COVID-19 epidemics in countries of the World Health Organization African Region

Countries of the World Health Organization (WHO) African Region have experienced a wide range of coronavirus disease 2019 (COVID-19) epidemics. This study aimed to identify predictors of the timing of the first COVID-19 case and the per capita mortality in WHO African Region countries during the first and second pandemic waves and to test for associations with the preparedness of health systems and government pandemic responses. Using a region-wide, country-based observational study, we found that the first case was detected earlier in countries with more urban populations, higher international connectivity and greater COVID-19 test capacity but later in island nations. Predictors of a high first wave per capita mortality rate included a more urban population, higher pre-pandemic international connectivity and a higher prevalence of HIV. Countries rated as better prepared and having more resilient health systems were worst affected by the disease, the imposition of restrictions or both, making any benefit of more stringent countermeasures difficult to detect. Predictors for the second wave were similar to the first. Second wave per capita mortality could be predicted from that of the first wave. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa that should be taken into account in future pandemic preparedness planning.

The Effectiveness of Table-Top Exercises in Improving Pandemic Crisis Preparedness

The World Health Organization carried out a global survey in 2018 to ascertain the level of preparedness for pandemic influenza. It was discovered that simulation exercises to test national pandemic influenza preparedness plans were carried out in the previous 5 years, by 42 out of the 104 countries that completed the survey. The table-top exercise (TTX) being the preferred format, with 86% of the countries using them. Although no table-top exercise can convey a realistic picture of a pandemic, they can be used to assess plans, policies, and procedures, clarify roles and responsibilities, and identify resource gaps in an operational environment. However, table-top exercises are only effective if they are properly designed, carefully conducted, fully evaluated, and most importantly, the results and recommendations identified are actually implemented. TTXs used as part of preparedness for pandemics are not cost free, a failure to implement the lessons learned from them can have both human and economic consequences. To understand the value of TTXs, a sample of national and large scale TTXs are examined in an effort to identify the effectiveness of table-top exercises, as a part of improving pandemic crisis preparedness.

Politikberatung durch Expert*innenräte in der SARS-CoV-2-Pandemie in Deutschland: Eine Dokumentenanalyse aus Public-Health-Perspektive

IntroductionDuring the SARS-CoV-2 pandemic, policymakers have to make far-reaching decisions that should be supported by scientific evidence. This presents a major challenge, given the limited availability of evidence, especially in the early phases of the pandemic. Decision-makers thus turned to scientific experts to help to convey and contextualize the evidence for public health policymaking. The way in which these experts were consulted varied widely. Some decision-makers called on expert committees in which they convened multiple experts from different disciplines. However, the composition and role of these committees have raised questions of transparency and representation. This study examines whether and how expert committees in Germany were convened at the federal and national level to advise governments and ministries during the SARS-CoV-2 pandemic. We investigated the disciplinary composition, gender representation and the transparency related to the convening of these bodies, work processes and the accessibility of results. MethodsWe performed a multi-stage document analysis. Between May and July 2020, we submitted freedom-of-information requests to the governmental institutions at both a federal and a national level. In addition to analysing the responses to these requests, we conducted a thorough search and analysis of the i) pandemic preparedness plans, (ii) official press releases and (iii) minor interpellations (“Kleine Anfragen”) at the federal and state level. We included documents on expert committees in the SARS-CoV-2 context for the period from January to the beginning of December 2020 and carried out a qualitative content analysis. ResultsWe identified a total of 21 expert committees that were established in ten federal states and four federal ministries. In eleven committees, the members were known by name, with women making up 26 % of the members. Biomedical disciplines such as virology, hygiene, medicine, and biology were the most commonly represented. Other disciplines including economics, law and sociology, and non-scientific experts were represented in seven federal states. The members of ten committees were not known by name. These committees covered different thematic areas (school and day-care, civil participation, medicine and care, economic topics), and their members were more commonly practitioners or came from affected populations. DiscussionThe SARS-CoV-2 pandemic has led to an increased consultation of experts in public health policymaking. However, expert committees in Germany are not sufficiently representative and interdisciplinary to take different perspectives into account and ultimately advise politicians in complex pandemic situations. Furthermore, the work of these committees is not sufficiently transparent because access to information is limited. ConclusionDue to this lack of transparency, it is unclear whether and how the expert committees exerted an influence on politics. Transparency of political decision-making processes and the consideration of pluralistic perspectives are considered essential for the legitimation and quality of political decisions in a pandemic and should therefore be strengthened in pandemic management in Germany.