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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Background & Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach & Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over two rounds a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. Priorities were revised between rounds and in R2 panelists also ranked the priorities within six domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2 the mean percentage of ‘agree’ responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% ‘agree’). The highest ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reducing fatty liver disease prevalence and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.

CONFLICTS OF INTEREST Jeffrey V. Lazarus acknowledges grants and speaker fees from AbbVie, Gilead Sciences, MSD, and Roche Diagnostics to his institution, speaker fees from Intercept, Janssen, Novo Nordisk, and ViiV, and consulting fees from Novavax, outside of this work. Zobair M. Younossi acknowledges consulting fees from Quest, Abbott, Astra Zeneca, Bristol-Myers Squibb, Gilead Sciences, Intercept, Madridgal, Merck, Novo Nordisk, and Siemens Healthineers, outside of this work. Alina M. Allen acknowledges grant support to her institution from Novo Nordisk, Pfizer, and Target Pharma and advisory board participation for Novo Nordisk, outside of this work. Christopher J. Kopka has no conflicts of interest to disclose.

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