Best Care Everywhere: a conversation on clinical evidence and global health equity during COVID-19
In a follow-up Q&A with Denise Basow and Vikram Savkar, Vice President and General Manager, Health Learning Research and Practice, we explore highlights from the panel event and pose new questions about the future of evidence and its potential to impact a global equity-driven approach to achieve the best care everywhere.
Why weren’t more countries ready for the COVID-19 pandemic and what steps can we take as a global community to ensure preparedness next time?
Dr. Denise Basow: The pandemic shined a light on healthcare challenges shared across the world. The impact of globalization and shortcomings in public health, health equity, and accurate information dissemination hindered pandemic response.
The information needs during the COVID-19 pandemic were unprecedented, which presented a challenge from an information dissemination perspective that continues today. Even with more than 25 years of perfecting how we synthesize widely disparate clinical evidence so it can get into the hands of care decision-makers, the healthcare industry was put to the test. At one point, our UpToDate solution had more searches for COVID-19 than there were actual cases. Researchers were working at a rapid pace – there are upwards of 400,000 clinical studies on COVID-19 as of August 2021. Fortunately, Wolters Kluwer had a unique window into what kind of questions arose as the largest provider of evidence-based medicine information, with 2 million clinicians around the world who were searching UpToDate® about 1200 times a minute. This insight helped us meet the intense and shifting medical information needs.
Considering the impact of globalization needs to be at the forefront of pandemic response and preparedness. It is in everyone's best interest to control the pandemic across the world. The longer this virus is around, the more it can change and continue to affect everyone globally, so we are all in this together. That is why community action, public health, and health equity are so necessary.
Future preparedness hinges on everyone coming together as a global community to remove obstacles that stand in the way of achieving the best care everywhere. That means first and foremost getting the facts into the hands of the physicians, nurses, pharmacists – everyone who cares for patients. At the same time, we can’t forget that patients are a crucial part of the healthcare team, so we need to get the right information into their hands as well. There are programs to disseminate health information, supported by excellent data showing that getting the right information to the right people can improve health outcomes and save lives.
This was the first global event in history where technology and social media played a pivotal role in the dissemination of information. What did we learn and how do we begin to combat the “infodemic”?
DB: Early on, the technology and tools we had available were instrumental to getting information about social distancing and wearing masks out to the public. They’ve also regrettably become a source of widespread misinformation and given everyone the ability to widely share a plethora of medical information. The World Health Organization identifies this infodemic* as a primary concern for global health and suggests four actions to combat the problem.
The first action is to listen to communities’ questions and concerns, which should encompass both healthcare professionals and patients. The second step involves getting the real science – as Dr. Fauci calls it – into the hands of those communities and helping them evaluate risk. The third action is to build resilience to misinformation by figuring out ways to combat it. And lastly, we need to engage and empower communities to take positive action.
How do you view the evolution of clinical evidence and the role of preprints in the spectrum of research as we move forward?
Vikram Savkar: Peer reviewed journals are a powerful tool to ensure that trusted, community-validated medical research can be disseminated to every corner of the world. During the COVID-19 pandemic, the research community faced an urgent need to accelerate publications to much less than the traditional 6-12 months it takes for research (in the best circumstances) to go through the necessary peer-review process.
Much of the output was in the form of fast-tracked peer-reviewed articles – over 400,000 on COVID-19 were published in 2020 – but many key findings were published even more rapidly in the 23,000 preprints that were globally distributed in the same timeframe. As Dr. Fauci pointed out, the emergence of preprints upended the conventional research process, bypassing peer review and making results publicly available within days. The media often mined these findings and surfaced them on the nightly news.
Many preprints played a significant and transformative role in helping the clinical community coalesce around treatment and preventative strategies in the early months of the pandemic, when more formally evaluated evidence was not available. At the same time, because they do not go through a peer-review process, some conclusions turned out be invalid in the long run –balance and critical judgment will be key here. With the power of preprints well established, we should expect that they are here to stay as a major channel for medical research dissemination in the future.
How do we even begin to assimilate this massive amount of new clinical research to ensure it can foster the best care everywhere?
VS: It's important to emphasize that best care everywhere doesn’t mean the same care everywhere – it involves localizing and even personalizing clinical pathways to produce optimal outcomes in the broadest possible range of patients with their diverse biological, social, and environmental determinants.
This means that medical research can’t simply be divided into “valid” and “invalid.” There’s a lot of research – many preprints and even some peer-reviewed papers – that the community can decide should be set aside. But within the massive amount of validated literature, there is still a wide range of conclusions. Clinicians looking to improve patient outcomes by evolving and innovating clinical pathways need to sift through hundreds of thousands of valid papers in their field. Many papers have diverse recommendations and clinicians need to find the strongest research that can impact their particular clinical environment, and their specific patient population including background, environmental, economic and technological constraints.
This is a complex task, and that’s why our Ovid platform – which utilizes advanced technology to make the task of finding and sorting through enormous volumes of research – are so central to the global medical research community. Each of the 254M annual database searches is a highly specific and personalized query leading clinicians and researchers to the literature best aligned with their clinical needs. Advanced technology platforms can empower clinicians around the world to deliver effective, evidence-based care to their local communities.
In examining access to care for all, what are your thoughts on public health versus individual health, and how can we raise awareness of the impacts?
DB: A recent study examined pandemic outcomes for countries with different levels of willingness to make sacrifices for the common good, public cooperation, and adherence to health guidelines. The researchers found that countries with “individualistic” cultures experienced more COVID-19 cases and mortality than those with “collectivist” cultures. These results are not too surprising. We’ve known for a long time that public health and individual health are not always completely aligned. Unfortunately, this issue has really come to the forefront during the pandemic.
It is crucial to consider the impact of globalization with the realization that it is in everyone’s best interest to control a pandemic not just in their own country, but collectively around the world. Many people have been resistant to public health efforts, and it is incumbent on us to raise awareness of the efficacy of taking a collective approach to fight communicable diseases.
What are the best ways to apply what we've learned – and what is the role of researchers?
VS: The key to global medical progress is ensuring that key findings in one location are shared with researchers and clinicians everywhere, enabling every region of the world to be both consumer and creator of new knowledge. As we witnessed with the COVID-19 pandemic, the community learns and progresses as an interconnected whole, which is why ensuring pace, quality, and access of medical information dissemination is critical to global health.
Individual researchers play a vital role in that effort by upholding the commitment the global scientific community has always had to share new insights broadly and openly; but key institutional stakeholders also have a significant role to play, by ensuring that the right structures, technologies, and regulation are in place to facilitate individual collaborations. If governments, institutions, and researchers work together to make the vision of the global medical community a reality, we will be well on the way to ensuring that clinicians in every region of the world can deliver the best care everywhere.
*“Infodemic” is a term introduced by the World Health Organization to describe the explosion of available medical information, both accurate and misleading.