Thanks to Adam Green, Baptiste Gaillard, Christian Dedié, Christoffer Eide, Dave O'Flynn, garichner, Kevin Sheedy, Lukasz Rozek, Matt Garner, migore, pimlottc, Pavel Boldyrev, Piotr Wielgolaski, Rajnish Srivastava, Robert Handschmann, Thomas Queste, Tom Eicher and Ulf Bamberg for reporting these issues and providing fixes.
Beneficial knowledge about COVID-19 aetiology, pathophysiology, prevention, vaccination, treatment and care has rapidly advanced through rigorous scientific, medical and public health inquiry, debate and collaboration53,54,55,56. Notwithstanding these advances, the responses of individual countries have been heterogeneous and often inadequate, in part because they lack coordination and clear goals.
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Given the disproportionate impact that the pandemic has had on vulnerable groups to date87,88,89, the panel voiced concern that policy decisions must aim to find ways of lowering risk within these groups after resumption of the aforementioned activities (STMT6.1). As those vulnerable to COVID-19 in many countries can no longer rely on other individuals practising basic prevention measures (such as the use of face masks and isolating after testing positive), the structural changes recommended in this study (for example, indoor ventilation and filtration) assume heightened importance. Furthermore, COVID-19 continues to prompt global discussion and vigorous debate, particularly about tensions among medical ethics, civil liberties and pandemic control measures80. This study is no exception, with statements STMT1.6 (blaming unvaccinated individuals) and STMT3.2 (individual decisions regarding vaccination) receiving the highest levels of disagreement, underscoring the need for equitable structural interventions. In countries with widespread availability of vaccines, it is important for health authorities to distinguish between those who have clearly refused and are unlikely ever to seek vaccination and those who remain hesitant and continue to delay vaccination90. In the latter case, specific factors prolonging the delay can be addressed by targeted interventions. Finally, continued uncertainty about the widespread consequences of long COVID and its implications for public health policy (REC2.9) is an ongoing concern91,92.
One of the strengths of this study is its use of Delphi methodology. By demonstrating increased agreement with each subsequent round, this method enabled us to determine whether our incorporation of feedback was successful in refining the statements and recommendations, increasing the degree of consensus and, in some cases, reaching unanimity. The consistently increasing mean levels of agreement with the consensus statements and recommendations observed across all three survey rounds strengthens our confidence in the relevance of the iterative Delphi process in eliciting feedback to improve subsequent rounds. This is particularly noteworthy given that the effort to incorporate feedback from the expert panel may have resulted in more complex (for example, multiple item) statements and recommendations. Generally, there may be concerns as to the clarity of such statements; however, levels of agreement tended to be either maintained or increased, providing greater confidence in their resonance with the panel. The overall high response rates across three survey rounds speaks to both the rigorous implementation of the method and the commitment of the assembled panel of experts. Endorsement of the resultant consensus statements and recommendations by 184 organizations in 72 countries (Supplementary Table 2) at the time of publication further testifies to their global relevance. 2ff7e9595c
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