Saving millions of lives but some resources squandered: emerging lessons from health research system pandemic achievements and challenges

Abstract

During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO’s framework for research systems. It has four functions—governance, securing finance, capacity-building, and production and use of research—and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges.We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom’s healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users’ needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries.

Connections between health research systems and decision-making spaces: lessons from the COVID-19 pandemic in the province of Québec, Canada

“…Hanney et al. [ 13 ] present the benefits of coordination and integration within national health research systems, especially regarding vaccine and drug development. Our commentary adds some intangibles to improve the long-term management of those systems that facilitate coordination and integration of policy spaces and academic research systems.…”

“…The WHO developed a framework with macroscopic criteria for routine use of evidence in such spaces [ 12 ]. The latest was tested on the management of the pandemic in several developed countries [ 13 ]. A review of ups and downs of the management of the pandemic in Canada highlighted fragmented responsibilities and calls for a shift of culture in data access [ 14 ].…”

If Providing Best Care Means Being at the Cutting Edge of Research, Should It Be Implemented System-wide? Comment on "‘We’re Not Providing the Best Care If We Are Not on the Cutting Edge of Research’: A Research Impact Evaluation at a Regional Australian Hospital and Health Service"

“…Local ability to adapt was also crucial: “ the embedded research system was adapted and repurposed to support the COVID-19 response.” 11 Given their involvement in the RECOVERY trial, and the catastrophic outcome for many patients with COVID-19, UK hospitals were ready immediately to adopt the findings about the use of dexamethasone, and the extraordinarily high impact in terms of number of deaths averted was soon estimated. 1 , 13 …”

Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries

“…205 The importance of infrastructure and of leveraging existing resources and relationships in supporting rapid evaluation more widely was the subject of a number of commentaries identified by our searches but not eligible for inclusion. [216][217][218][219] However, most of the newly identified studies represented one of two approaches to rapid evaluation. There was an increase in the use of established rapid evaluation methodologies such as rapid appraisal.…”