Planning for the next pandemic: what The BMJ’s research team learnt from covid-19
BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1137 (Published 19 May 2023) Cite this as: BMJ 2023;381:p1137
Pandemic reflection is in the air as we pass the three year anniversary of the global shutdown in response to the emergence and spread of SARS-CoV-2. Governments, hospitals, funders, and other institutions will have their own reckonings and plans for future pandemics, but what about medical journals? What did the research team at The BMJ learn from covid, and how should we best plan for future outbreaks and other shocks, given that it’s just a matter of time?
One lesson is that we must be prepared for a big increase in the number of research submissions, and pressure to publish them quickly. Research submissions to The BMJ more than doubled, a deluge that was unexpected and challenging. The BMJ already had research editors around the world, including China, and held meetings virtually, so the switch to videoconferencing that befuddled others was not a problem for us. Many of our research editors are practising clinicians, so we had in-house clinical and frontline experience to guide the rapid appraisal and selection of papers for external review and publication. The type of research submitted to The BMJ changed, with an increase in case series, small observational studies from single institutions, and other research types that under ordinary circumstances The BMJ would not publish. We had to be flexible in our view of what was worth publishing early in an outbreak.
The surge in submissions stretched resources. Editors worked overtime to meet the need and contribute to the pandemic response. Retired editors returned to help, and editors from other sections at The BMJ were redeployed to triage research and preprint submissions. Peer reviewers were generous with their expertise and time. These efforts were exceptional, but they proved difficult to sustain. Workforce planning is critical for future preparedness, which might include an emergency response team that would agree to pick up work quickly if and when it is needed. New models of rapid peer review will need to be considered.
Maintaining standards
Calibrating speed with the need to maintain robust standards and trust in science was a challenge for all journals.123 The increase in the number of pandemic research submissions was not matched by an increase in quality. We had to deal with not just more research, but more bad research.4 Some researchers showed disregard for ordinary safeguards such as ethical approval of risky experimental therapies, patient consent, or study registration.5 This rapid pivot to covid research was on one hand a triumph, but on the other hand encouraged people to step outside their lane of expertise. Too often this appeared opportunistic and a response to other pressures, including the “publish or perish” culture of academic medicine.67 Our view as editors is that at least some of those doing covid research would have been more valuable at the bedside than the bench.
Another lesson, learnt not just by The BMJ but by other journals, is that fraud and bad behaviour don’t disappear in a global emergency. Editors at medical journals had to sift through a huge amount of research and curate it for a public and policy makers that were hungry for reliable information. The extent to which social media provided a platform for harmful and unscientific ideas was dismaying8 and exacerbated the pressure for editors and journals to offset such misinformation. The Surgisphere scandal, which led the New England Journal of Medicine and the Lancet to retract two high profile covid-19 papers, showed that even the best journals and their editors can be duped.9
Covid-19 challenged our ability to meet the standards we set for ourselves to improve diversity, equity, and inclusion in research and publishing. Much documentation has shown the extent to which women academics and others from under-represented groups were sidelined by covid-19.1011 Journals and the mainstream media were part of the problem by over-relying on the expertise and perspectives of men.12 One clear lesson from this pandemic is how quickly progress on equity can disappear, and how we must do better.
Health topics other than covid-19 were neglected in the pages of medical and science journals worldwide. For future pandemics we need to strike a balance between the demands of health emergencies and existing health problems that will worsen if ignored, as they were during the covid-19 publishing rush.
We expect governments, health systems, and other institutions to be planning for the next pandemic. As journals and editors we are a critical front line for the response to future pandemics and other shocks. Therefore, we will do the same and welcome feedback from readers about how we should make these plans.
Footnotes
Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.