Co-producing the covid-19 response in Germany, Hong Kong, Lebanon, and Pakistan

Building on established structures and ensuring inclusive representation

The speed and breadth of the covid-19 pandemic have underscored the need for a rapid co-produced response to create knowledge that can improve interventions. This has resulted in policy makers often collaborating with known researchers and groups who have the capacity to join such a response. For example, while there is no “one way” in which researchers and policy makers interact, there are often established channels, relationships, and structures of collaboration. In Germany, existing structures have been included in the response to the covid-19 pandemic, including scientific advisory boards, professional associations (the Fachgesellschaften), and formal and informal working groups and committees based in universities and research institutes such as the Max Planck Institutes and the national public health institute (the Robert Koch-Institute).

Similarly, since January 2020, policy makers and researchers in Hong Kong have closely collaborated to tackle and respond to the covid-19 crisis. At the political level, Hong Kong’s chief executive convened and continues to chair an expert advisory panel under a covid focused steering committee cum command centre. At the operational level, the Department of Health adapted its pre-existing scientific advisory committee to specifically advise on covid-19. These structures are supplemented by frequent outreach by the political and policy establishment to Hong Kong’s research community with the relevant expertise to inform policies and covid-19 interventions.

The emerging scientific knowledge on covid-19 has generated much interest in the media and from the public, and this attention has made collaboration more complex and challenging than usual. It has forced policy makers to rethink the formal and informal structures of how, where, when, and with whom they collaborate, including with researchers as well as the broader public, patients, and communities. Beyond existing structures, new structures with improved multistakeholder representation can also create the groundwork to change how knowledge is co-produced. For example, in Pakistan at the start of the pandemic the government adopted a “whole of government” approach with the establishment of a national coordination council chaired by the prime minister with health, finance, planning, defence, and other ministries. A key function of the council was to engage researchers in the national response, including by supporting the generation and use of local evidence and knowledge for strategic decision making.

In April 2020 Germany’s National Academy of Sciences convened an expert group, which included philosophers, historians of science, theologians, and jurists to advise the government on how to emerge ethically from the initial shutdowns and loosen its restriction policies.1 However, this inclusive approach seems to be an anomaly. A study of 24 countries’ covid-19 task forces found they mostly comprised politicians, virologists, and epidemiologists, and did not include other relevant health and social experts. There was also a notable exclusion of women.2

Although governments have primarily built on existing structures as a starting point for the response, this approach may have excluded some groups and exacerbated the marginalisation of stakeholders who do not have the relationships or resources to engage. Because of the political context as well as power imbalances between and across research institutions, many policy makers and research entities may not be able to pivot and shift long standing structures and practices at short notice. The availability of human and financial resources within research institutions means some are in a better position to respond to the rapidly evolving demands for evidence by policy makers, health and social workers, and the broader public. Policy makers may also depend on existing structures to collaborate with researchers to the detriment of more inclusive structures, such as patients, civil society groups, and communities.3

Working together to co-produce research to improve health outcomes

The scale of the covid-19 pandemic means no single entity can provide the needed support or engage with all the relevant data and possible constituencies. Researchers and policy makers are working together to pool resources, produce knowledge, and develop policy responses. For example, Hong Kong’s expert advisory panel, in collaboration with local clinicians and scientists, are jointly providing information on covid-19 directly to the public. Academics at the University of Hong Kong have been estimating and publishing real time results, known as “nowcasting,” to help inform how policy makers determine interventions based on risks and how communities and individuals adapt their behaviour, such as social distancing or working from home, in response.45 In Pakistan, researchers from the Medical Research Council, the National Institute of Health, and other academic and policy institutions collaborated on a new platform to collect and analyse local data to inform and shape the government’s response.

In Lebanon, researchers at the American University of Beirut engaged with the Ministry of Public Health in March 2020 to identify and prioritise needs around covid-19 preparedness and response. In close collaboration with policy makers, health workers, municipalities, non-governmental organisations, and communities, researchers produced Lebanon’s first national policy document on the pandemic response, reinforcing the need for stricter social distancing measures and to guide hospital and primary healthcare centre preparedness. The pandemic has also presented opportunities for researchers, communities, and public health advocates to shape the policy agenda by bringing pressing but often overlooked issues to the attention of policy makers. As part of efforts to advocate the banning of waterpipe smoking, representatives of the Tobacco Control Coalition in Lebanon underscored the association between covid-19 and waterpipe smoking in a targeted press conference with the head of the parliamentary health committee. In July 2020 the serving of waterpipes was banned in public places.

Researchers, public health specialists, epidemiologists, patients, community members, policy makers, data analysts, and evaluation experts are all generating relevant evidence to inform the covid-19 response. This has produced a massive amount of information. For example, by September 2020, the New England Journal of Medicine had already received more than double the number of submissions it received in 2019.6 However, much of this research has been produced in a fragmented way by researchers from a single discipline, and it undermines the efficiency of a collective response. In addition, much of the existing research has focused on the treatment and management of covid-19, while behavioural, environmental, social, and systems research and interventions have been largely overlooked in the covid-19 response.7

Disseminating research and engaging communities in the covid-19 response

Policy makers have needed rapid responses from the scientific community to inform the development of policies and approaches to the pandemic. The pandemic has also created new opportunities for policy makers and researchers to share information with a wider audience. For example, multiple platforms such as social media, emails, television and radio interviews, podcasts, press conferences, and online webinars are used to disseminate research findings. In Germany, as in many countries, academics and scientists have gained national prominence similar to that of media commentators or television personalities. Their straightforward communication style has helped to calm an unsettled public and build trust and understanding about why interventions are needed. Indeed, it has been noted that “scientists who were barely known outside a narrow academic circle are now household names, lauded and vilified in turn in the press and on social media.”8 The Lebanese policy document on the pandemic response mentioned above was launched in a prime time television interview as well as being shared with parliamentarians, policy makers, and representatives of the covid-19 national committee. Moreover, public awareness of research is increasing and reflects the growing popular interest to engage with, and contest, science in the ongoing covid-19 response.

In Pakistan, researchers coordinated broad communication and outreach initiatives with communities and the health workforce through print, electronic, and social media. Policy makers and researchers engaged religious leaders and celebrities as well as government leaders and athletes to share important health information with the broader public. Public audiences are also playing an active part in shaping research and the covid-19 response. For example, there is growing evidence of participatory action research transforming communities’ covid-19 responses across regions.9 There is also an increasing sense of a “new normal,” in which patient voices are integral partners in co-producing the response10 and in which new approaches capitalise on online and digital communication to ensure patient engagement.11 As a covid-19 vaccine is rolled out, continued community engagement will be crucial and will likely be feasible only with strong community participation.12

Given the nature of the pandemic, knowledge, recommendations and advice are constantly evolving, leading to shifts in positions and adaptations in strategy. Such changes can be destabilising and undermine trust in government authorities, even more so in situations of social unrest.13 Political and social pressures to communicate information may also run counter to the established culture of research and science, including in the way research is disseminated. The covid-19 pandemic has reinforced longstanding tensions within the research community about how best to engage with political stakeholders and share research findings with the public, while also maintaining scientific integrity and independence.

The pandemic highlights how co-production can help fill the “know-do” gap by accelerating implementation of interventions to tackle the pandemic. For example, Hong Kong’s nowcasting effort showcases how science can directly shape and influence both policy interventions and how individuals engage with science and data to understand interventions. Covid-19 is transforming how we understand those who are “knowledge users” and those who are “knowledge producers,” and this understanding is widening as the pandemic is affecting almost everyone, everywhere.