#COVID19 – Evidence and Policymaking: Personal Reflections from an LMIC Setting
by George Gotsadze, President of Curatio International Foundation
and Executive Director of Health Systems Global
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers. Governments are forced to balance policy choices between minimizing the death toll caused by the infection while reducing the negative economic impact expected in the aftermath of the COVID19 outbreak, when hard-hit economies with rising unemployment are expected to leave millions of households without subsistence income.
By now, most of us realize that post-COVID-19 times will come at a significant societal and economic cost, slowing the pace of global development for some years to come. Wealthy nations, at least, are announcing hefty economic packages, supporting middle and low-income families and responding to the economic downturn. Poor countries, meanwhile, are left to choose between: (a) using social distancing to delay the epidemic spike and reduce its magnitude, thereby allowing weak health systems to cater to their patients; and (b) deciding on the length of the “lock-down”, which curtails economic activity for a significant length of time but is highly detrimental to many people living on subsistence, or even average, incomes. Such decisions demand evidence about the virus and its epidemiological characteristics, modeling results estimating the burden on the health system and the economic cost arising from social distancing, information about health systems capacity and available human resources, etc.
The policymaking process in my own country revealed numerous shortcomings in the available evidence, but it also opened up promising and welcoming developments. I decided to reflect on these experiences to reveal the developments, challenges, and possible knowledge gaps that need to be filled:
- Firstly, disease models are essential when dealing with an epidemic of such magnitude. They help to estimate (with a significant degree of uncertainty) the growth of infection spread and the possible burden on the health system – a critical element for health sector preparedness planning. While a search on Google Scholar using the “Epidemic AND Modelling AND LMIC” search term, which was constrained to the last decade, produced 4,130 [1] search results, we were only able to locate a single user-friendly Excel-based modeling tool developed by US CDC FluSurge2.0 for seasonal flu. This was the only tool in the public domain, but it was not suitable for COVID19 estimates. Thus, if you live in an LMIC setting not surrounded by experienced disease modelers (which I assume is the case in many similar settings), you are most likely left without any support. In the current, interconnected world, it should not be allowed for valuable weeks to be lost when drawing up hospital and health sector preparedness plans, especially when hundreds of millions are spent on the disease modeling globally. The Penn Medicine – COVID-19 Hospital Impact Model for Epidemics emerged during the week of March 15th, and thanks to our colleagues around the world, user-friendly modeling tools were developed swiftly and placed online in free public space legally within the subsequent two weeks. I think that in the future, research funders should mandate modelers not only to publish their papers but to also make the models publicly accessible if the world has to prepare for the next pandemic in the Global North and South alike.
- Secondly, it seems there is a significant gap around the impact of non-medical interventions for epidemic control. Most questions asked by policymakers about the impact of social distancing measures on transmission spread and economic costs were hard to answer due to largely patchy evidence. It seems this is an area for future research, not only in high-income settings. It is also important for systematic reviews to support answering such questions when asked in the future.
- Thirdly, close to 390 published papers and pre-prints emerged during the month of March 2020 alone (based on our search). New evidence is being produced almost daily, conveying the “fresh” and essential information needed for preparedness planning and for learning from different country experiences (good and bad alike), etc. Thanks to all those making pre-publications available freely online. Nobody should underestimate the value of this public good, especially in settings similar to ours. While these papers were not peer-reviewed, the benefits probably outweigh the shortcomings, especially when the papers are disseminated through social media and peers render immediate reactions revealing the strength and weaknesses of the studies in question. Looking at peer comments on social media, which was extremely helpful, I was left wondering whether global health journals should consider using artificial intelligence to capture these comments for re-imagined and accelerated peer-review process? It may take time, but if this were possible, it could accelerate the publication of quality and peer-reviewed papers and could be hugely beneficial for the scientific field.
- Finally, the challenges of evidence search revealed the value of global networking, especially for those operating online. We were lucky, as part of Health Systems Global as well as other networks that allowed us to call for help (using appropriate social media and other communication channels), which came without delay. It was great to observe the value of peer support with suggestions, offering online help when faced with technical or other challenges, referring to great websites and repositories, etc. However, I wondered how many of our peers who work on knowledge production-translation are aware of or are able to mobilize such peer support at short notice? All of this led me to the desirability of collecting personal stories around the world about the peer-support channels one could tap into when conducting rapid evidence review. Such stories could help to develop a knowledge product – guidance document benefitting many around the world and enhancing our collective ability to support knowledge to policy links.
To conclude, I am sure that COVID-19 will be over, and that we will learn to live with it after paying a high cost as a society. We will return to “new normal” lives with new lessons and with new opportunities to explore. Of course, this is far from being a full account of our experiences, and I hope to have more time in the future to better reflect on policymaking and evidence needs, knowledge gaps, and emerging opportunities. But it is time to stop here and wish you all good health in this COVID-19-challenged world.
[1] Search carried on March 30th, 2020
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Inter-regional workshop in preparation for transitioning towards domestic financing in TB, HIV and Malaria programmes
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Memorandum of Cooperation between the Health and Social Issues Committee of the Parliament of Georgia and Curatio International Foundation
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Embedding Rapid Reviews in Health Systems Decision-Making (ERA)
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Curatio International Foundation at the Global Symposium on Health Systems Research
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
The civil society gathered for the fourth time to discuss healthcare system challenges in Georgia
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Project: HIV risk behavior among Men who have Sex with Men – Bio-Behavioral Surveillance Survey and Population Size Estimation
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Curatio International Foundation at AIDS2018
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Big Pharma Greed and Artificial Prices – Knocking on Door to Limit Access to HIV Medicines in Georgia
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Civil society is gathering for the third time to hold a discussion about the healthcare
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Webinar: Gavi Vaccine Prices Post-Transition
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Webinar: Mapping and consensus of global competencies set for the field of HPSR: A progress update and HSG round table discussion
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Health Systems Global Publishes Annual Report 2017
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Webinar: Vaccine Forecasting and Budgeting Tools and Best Practices
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Technical Assistance for evaluation of transition readiness and preparation of Transition and Sustainability Plan for Global Fund-supported programs in Tajikistan
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Technical Assistance for the preparation of Transition and Sustainability Plan for HIV program in Philippines
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Discussing the accessibility of medicines in Georgia
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Webinar: Integrating gender into health system strengthening in conflict and crisis-affected settings; what’s in our toolkit?
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Article: Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study
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Why Georgians second-guess their doctors – Deregulation has left Georgian medical care something many Georgians would rather avoid
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Ara Srinagesh from New York University Shares her Internship Experience
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Webinar on The peer review process – what happens when you send your manuscript to a journal
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Webinar on Improving Quality of Care during Childbirth: Learnings and Next Steps from the BetterBirth Trial
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Civil Society is Being United to Discuss Healthcare System Issues
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Curatio International Foundation for a TB-Free World
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Closing Project: Tuberculosis Community Systems Strengthening in Georgia
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Primary Health Care Systems: Georgia case study
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Integrated Bio-behavioral surveillance and population size estimation survey among Female Sex Workers in Tbilisi and Batumi, Georgia
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Applying a Health Policy and Systems Research lens to Human Resources for Health: Capacity building, leadership and politics
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CIF hosts Aradhana Srinagesh throughout the winter internship program
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Empowering civil society for engagement in and monitoring the decision making in health sector in Georgia
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Curatio International Foundation presented BBS and PSE study findings at the Civil Society Forum
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Article: Barriers to delivering mental health services in Georgia with an economic and financial focus: informing policy and acting on evidence
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
The Interview on population size and Human Immunodeficiency Virus risk behaviors of People who Inject Drugs in Georgia
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
HIV risk and prevention behaviors among People Who Inject Drugs in seven cities of Georgia, 2017
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Conference paper: The Study of Barriers and Facilitators to Adherence to Treatment among Drug Resistant Tuberculosis Patients in Georgia to Inform Policy Decision
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Article: Human immunodeficiency virus prevalence and risk determinants among people who inject drugs in the Republic of Georgia
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Conference paper about realist evaluation: Informing policy, assessing its effects and understanding how it works for improved Tuberculosis management in Georgia
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Georgian Healthcare and its Challenges: Healthcare Expert George Gotsadze will host the lecture
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17 years in Curatio International Foundation: President Ketevan Chkhatarashvili to Leave Organization
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Be ready for the Best Internship Experience
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Apply for Our Winter Internship Program
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Georgian Solution for a Post-Soviet TB Program: Can Integration into Primary Health Care Improve TB Care?
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Moving Forward: Second PT workshop with TB stakeholders in Georgia
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Article: Determinants analysis of outpatient service utilization in Georgia: can the approach help inform benefit package design?
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Designing and evaluating provider results-based financing for tuberculosis care in Georgia (RBF4TB)
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Forbes Georgia: The Importance of Evidence in Decision Making
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Barriers and Facilitators to Adherence to Treatment Among Drug Resistant TB Patients in Georgia
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Summer internship program 2017 is open now!
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
New Study Findings About Tuberculosis
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Curatio International Foundation: Transition and Sustainability Portfolio
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Article: Privilege and inclusivity in shaping Global Health agendas
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Eastern Europe and Central Asia Regional Sustainability and Transition Coordination Summit 20-21 October, 2016 Vilnius, Lithuania
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Internship Announcement, Winter 2016-17
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Evaluation of UNICEF’s Contribution in Central and Eastern European Five Countries
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CIF researchers represented on Global Conference AIDS2016
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
UHC 2030: Building an Alliance to Strengthen Health Systems
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
CIF Pharmaceutical Price and Availability Study (Fifth Wave Results)
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
HIV risk and prevention behaviours among Prison Inmates in Georgia, 2015
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Bio-Behavioral Surveillance Survey among Men who have Sex with Men in two major cities of Georgia, 2015
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
EPIC Studies – Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Bio-Behavioral Surveillance Survey among People Who Inject Drugs in 7 cities of Georgia, 2015
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
TB Community Systems Strengthening in Georgia
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
What can be done to improve treatment adherence among tuberculosis patients in Georgia: Looking through health systems lens
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
Announcing Winter Internship Program 2016
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Regional High Level Dialogue ‘Road to Success’, Tbilisi, Georgia
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CIF study results on 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention
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Response to the “Final evaluation of GAVI support to Bosnia and Herzegovina”
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The drivers of facility-based immunization performance and costs. An application to Moldova
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Curatio International Foundation Hosts Health Systems Global Secretariat in Tbilisi, Georgia
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An Impact Evaluation of Medical Insurance for Poor in Georgia: Preliminary Results and Policy Implications
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Civil Society Forum organized by Country Coordination Mechanism
As I embark on writing this blog, the global outbreak of COVID-19 is posing a growing threat to the health and well-being of our societies. The unfolding global health and economic crisis demands bold actions from all of us, but most importantly from policymakers.
