In this interview, WHO Chief Scientist Dr Soumya Swaminathan recounts some of the pathways WHO took during the pandemic to translate evidence into health policy and why dialogue between researchers, community, and politicians is crucial for driving policy change.
Interviewer: The WHO’s Evidence-Informed Policy Network (EVIPNet)
has been operational in regions around the globe since 2005. Thus, the
vision of a world in which policy-makers and other actors use the best
available research evidence to inform policy-making is not a new one.
Why is it now more important than ever?
Dr. Soumya Swaminathan:
Knowledge translation or evidence-to-policy processes are certainly not
something new. The COVID-19 pandemic, however, called for rapid and
agile translation of evidence into public health policies and
programmes. We had to move fast, and balance response speed with the
certainty and quality of evidence.
This is where I think WHO played an
important role, together with many other public health actors and global
partners. In an emergency, we don’t have the luxury to wait for years
to collect the
evidence we need, but must nonetheless justify global recommendations
and adapt policies based on latest data and emerging evidence.
The pandemic, however, also put public health policy into the spotlight,
as policy decisions had an impact for millions of people. It was also a
time of great uncertainty, and there is still a veritable “war” going
on between evidence built on facts and data, versus decisions taken
based on prior believe or anecdotal evidence. This is a good time to
bring forward new ideas in the evidence-to-policy area, certainly those
building on best available evidence such as the EVIPNet toolkit.
Interviewer: Many
countries, especially low- and middle-income countries, were not well
prepared for such an outbreak. Too often, response efforts were only
partially or not at all informed by evidence during the pandemic.
How do you think knowledge translation and evidence-to-policy pathways can be strengthened and improved?
Dr. Soumya Swaminathan: The
first step is identifying knowledge gaps, assessing what information is
needed for a particular decision, followed by evidence retrieval and
evidence synthesis. At WHO, we were preparing a daily overview of
research conducted globally, which we made available to the public. We
set up new mechanisms like living meta-analyses, which offer a much
better, weighted evidence base than a single piece of work. Along the
same lines, we created living guidelines, regularly reviewing and
updating our formerly more static guidance documents. And we have the
Evidence Collaboration on COVID-19 Network which was established to
share COVID-19 information and collaboration on evidence retrieval
efforts.
Yet, the pandemic also reminded us that it is never scientific evidence
alone that informs policy-making. Political, economic, social and
cultural factors are equally important. Only a multidisciplinary team
can make successful policy recommendations, bringing together public
health experts, jurisprudence, behavioral scientists, and economists.
Interviewer: How
did the WHO Science Division help countries to quickly mobilize the
best available evidence to respond to the COVID-19 pandemic?
Dr. Soumya Swaminathan:
We (WHO’s R&D blueprint team) first conducted a global forum on
research and innovation in February 2020. A coordinated global research
roadmap for COVID-19 was put together, including research priorities.
Whenever we saw a need, we helped launch new research, like the Unity
Studies, a global sero-epidemiological standardization initiative, or
the Solidarity Trial Vaccines, a randomized controlled clinical trial
that helped to evaluate the efficacy and safety of multiple drugs
against COVID-19.
Leveraging WHO’s unique position as a normative and standard-setting
Organization with global reach, we also set up guideline development
groups that worked in tandem with the prequalification team. We quickly
learned that to implement these guidelines locally, the specific context
needs to be considered. For instance, lockdowns were very effective in
limiting transmission where people were able to isolate in their own
homes. In more dense living environments, however, the same lockdowns
would have forced people to be even closer together, increased infection
risks, and exacerbated other pressing issues such as poverty and
undernutrition.
Interviewer: During
your time as Secretary to the Government of India for Health Research
and as Director General of the Indian Council of Medical Research, you
gained extensive experience in bringing science and evidence into health
policy-making, for example through building research capacity in Indian
medical schools and forging south-south partnerships in health
sciences.
Building on your experience, what concrete recommendation do you have for improving evidence to policy translation?
Dr. Soumya Swaminathan: First
and foremost, there must be a dialogue between policy and research,
which is often missing. In a continuous dialogue, policy-makers can
articulate what their pain-points and policy gaps are, which helps
academics to design their research studies accordingly.
Research, consequently, also has an applied
and communicative side. To have impact, researchers also need to engage
with policy-makers. This was my first big learning. We must work hand
in hand, build trust and invest into the relationship.
Interviewer: … and how do you react if politicians are not interested in your research, for example due to a diverging political agenda?
Dr. Soumya Swaminathan: This
can be challenging for researchers but is something they must learn to
accept. There are different kinds of research skills that are valuable
in such a scenario, for instance cost effectiveness research and health
technology assessments (HTA). With competing priorities, policy-makers
often base their decisions on what is the best buy for the available
evidence-base and budget.
It also comes back to having different stakeholders at the table, like
with India’s National Technical Advisory group for immunization, a
multidisciplinary group of experts responsible for providing information
to the national government on vaccine and immunization policy. Such
knowledge translation platforms are able to produce tailored
evidence-briefs for policy and deliberative dialogue formats, which
EVIPNet has helped scale in many countries over the past years. These
tools build bridges between researchers and decision-makers, and are a
backbone of evidence-informed health policy-making.
Unfortunately, at country-level, such knowledge translation skills are
still very limited. From my experience, when I was a Director General, I
set up the first HTA program in India, as I found that policy-makers
were faced with difficult choices and different options on how to pick a
policy option with the most public health benefits?
Interviewer: How important is communication and involving journalists into translating science into policy?
Dr. Soumya Swaminathan: Communication
is very important. Science and evidence must be communicated
strategically to be effective. By exclusively speaking scientific
jargon, we risk losing policy-makers’ interest and the public’s trust.
Strategic communication involves working
with the media, and the public. Scientists need to speak the language of
others, and policy-makers need to make an effort to source and leverage
the best available evidence. It is also beneficial for researchers’
reputation and broad public support if scientific findings can be
explained in lay terms and is understood more widely.
To make sure that more evidence is reflected in policy actions, there is
also a need to work on the demand side. Community demand, for instance,
is a strong motor driving change. The positive impact of this demand
can be strengthened by investing into health awareness and literacy. And
communities should continue to demand better health services. Only then
can policy-makers react to their concrete needs – and work hand in hand
with researchers to translate evidence into action.