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Analysis Research priorities for future shocks

Non-pharmaceutical interventions: evaluating challenges and priorities for future health shocks

BMJ 2024; 387 doi: https://doi.org/10.1136/bmj-2024-080528 (Published 07 October 2024) Cite this as: BMJ 2024;387:e080528

Rapid Response:

Non-pharmaceutical interventions: response to Mona Kuroiwa

Dear Editor,

We thank Mona Kuroiwa for their response to our BMJ article.[1] Mona Kuroiwa raises an important issue regarding the balance between public health protection and economic stability, especially in the context of low- and middle-income countries (LMICs) where resource constraints can complicate the challenges of managing health crises.

The economic impact of non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic was substantial, especially where stringent measures resulted in large declines in economic activity. This raises important questions around prioritisation in public health policy; such as whether the focus remain primarily on safeguarding health, or should economic stability also weigh more heavily in decision-making?

Context-specific strategies are important, especially in LMICs where healthcare infrastructure limitations and high rates of comorbidities increase the vulnerability of populations. This underscores the need for an adaptable approach, one that tailors interventions to the specific epidemic, social, and economic landscapes of each country. However, a narrow focus on economic impacts of NPIs risks overlooking broader structural issues, including persistent poverty and the need for systemic economic reforms. While NPIs can be effective for immediate public health benefits, addressing these other challenges is essential for long-term economic, social and public health resilience.

Identifying country-specific NPIs that are both effective and economically viable is important. Systematic reviews ranking NPIs provide a useful starting point for this, offering LMICs a basis to prioritise interventions that align with their unique health, social, and economic contexts. Implementing evidence-based and context-sensitive interventions can help mitigate health risks while also respecting financial constraints and other societal needs, creating a more balanced approach that LMIC policymakers can more realistically implement.

1. Majeed A, Quint J K, Bhatt S, Davies F, Islam N. Non-pharmaceutical interventions: evaluating challenges and priorities for future health shocks BMJ 2024; 387 :e080528 doi:10.1136/bmj-2024-080528

Competing interests: No competing interests

29 October 2024
Azeem Majeed
Professor of Primary Care and Public Health
Imperial College London
Department of Primary Care and Public Health, Imperial College London, London W12 0BZ