Half a Century of Wilson & Jungner: Reflections on the Governance of Population Screening

Abstract

Background: In their landmark report on the “Principles and Practice of Screening for Disease” (1968), Wilson and Jungner noted that the practice of screening is just as important for securing beneficial outcomes and avoiding harms as the formulation of principles. Many jurisdictions have since established various kinds of “screening governance organizations” to provide oversight of screening practice. Yet to date there has been relatively little reflection on the nature and organization of screening governance itself, or on how different governance arrangements affect the way screening is implemented and perceived and the balance of benefits and harms it delivers. Methods: An international expert policy workshop convened by Sturdy, Miller and Hogarth. Results: While effective governance is essential to promote beneficial screening practices and avoid attendant harms, screening governance organizations face enduring challenges. These challenges are social and ethical as much as technical. Evidence-based adjudication of the benefits and harms of population screening must take account of factors that inform the production and interpretation of evidence, including the divergent professional, financial and personal commitments of stakeholders. Similarly, when planning and overseeing organized screening programs, screening governance organizations must persuade or compel multiple stakeholders to work together to a common end. Screening governance organizations in different jurisdictions vary widely in how they are constituted, how they relate to other interested organizations and actors, and what powers and authority they wield. Yet we know little about how these differences affect the way screening is implemented, and with what consequences. Conclusions: Systematic research into how screening governance is organized in different jurisdictions would facilitate policy learning to address enduring challenges. Even without such research, informal exchange and sharing of experiences between screening governance organizations can deliver invaluable insights into the social as well as the technical aspects of governance.

Diagnostic tool or screening programme? Asymptomatic testing for SARS-CoV-2 needs clear goals and protocols

“…Many authors have produced criteria to describe appropriate screening programmes, perhaps most famously Wilson and Jungner for the World Health Organization [47] ; an example of a modern set of criteria is the set used by the United Kingdom National Screening Committee ( Panel 1 ). Evaluation of screening for SARS-CoV-2 in asymptomatic individuals should be considered in light of each of these, or similar, criteria, and in light of our experiences of screening programme governance [ 19 , 49 ]. It is particularly instructive to consider how, with regard to these criteria, screening for SARS-CoV-2 differs from screening for other conditions, and what the implications for a screening programme are in light of these differences.…”

Towards Next-Generation Sequencing (NGS)-Based Newborn Screening: A Technical Study to Prepare for the Challenges Ahead

“…In Figure 2 , we present the study flow that will be used. We selected treatability as the first criterium based on Wilson and Junger’s criteria that “There should be an accepted treatment for patients with recognized disease.” [ 26 , 27 , 28 ]. However, a disease for which a treatment has been reported sporadically [ 21 , 23 , 32 ] will not be considered to fulfill this criterium.…”

“…The criterium “treatability” from the Wilson and Junger criteria [ 26 , 27 , 28 ] was previously used in the decision-making about which diseases to include in the current Dutch NBS program [ 29 , 30 ]. Therefore, in NGSf4NBS, we decided that treatability will also be the main selection criterium to identify IMDs eligible for NGS-first testing.…”

Guiding Organisational Decision-Making About COVID-19 Asymptomatic Testing in Workplaces: Mixed-Method Study to Inform an Ethical Framework

“…Key ethical requirements for screening programmes include test properties such as sensitivity, speci city, and positive/negative predictive value (74,75), and the tolerability and acceptability of tests (74)(75)(76)(77)(78). Public health principles further stipulate the need for re ection on the burdens or harms associated with an intervention, including the need for mitigating steps for potential burdens or harm (51).…”