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A multinational Delphi consensus to end the COVID-19 public health threat

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Lazarus, Jeffrey V., Romero, Diana, Kopka, Christopher J., Karim, Salim Abdool, Abu-Raddad, Laith J., Almeida, Gisele, Baptista-Leite, Ricardo, Barocas, Joshua A. +344 more·2022·Nature
DOI 10.1038/s41586-022-05398-2PMC PMC9646517
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Abstract

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic 1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches 1, while maintaining proven prevention measures using a vaccines-plus approach 2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities 3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

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  • Locations with poorer health-care infrastructure were less equipped to handle the surge in infections that occurred, although strong health-care systems did not singularly influence the outcome of the pandemic.

    “By contrast, locations with poorer health-care infrastructure were less equipped to handle the surge in infections that occurred,20 although strong health-care systems did not singularly influence the outcome of the pandemic.19”

    From Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [20]

    The Main section says that during high community transmission, demand for services exceeded the capacity of many health systems. It does not establish that locations with poorer health-care infrastructure were less equipped than other locations; that comparison is unsupported. The clause about strong systems is attached to citation 19, not this source’s citation 20. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The delivery of care and services-whether basic and routine care like vaccinations or immediate COVID-19 medical aid-was hampered.

    “The delivery of care and services—whether basic and routine care like vaccinations or immediate COVID-19 medical aid—was hampered.28”

    From Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [28]

  • Country-specific national medical curricula that incorporate digital health learning objectives vary widely and overlook more recently introduced digital health tools such as symptom checkers and conversational agents.

    “There are several country-specific national medical curricula that incorporate digital health learning objectives.[43][44][45][46] However, these curricula vary widely and overlook more recently introduced digital health tools such as symptoms checkers and conversational agents (eg, chat bots).”

    From The Digital Health Competencies in Medical Education Framework (2025) · cites this paper as [43]

    The cited sentence attaches the references to the existence of country-specific national medical curricula with digital health learning objectives. The paper’s 'Strengthen health systems' section discusses digital health infrastructure, telehealth and training, but the passages found when searching for medical curricula and learning objectives do not address national medical curricula. The subsequent claim about symptom checkers and conversational agents has no citation attached in the printed sentence. (LLM, conf=0.76)

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Lazarus, J. V., Romero, D., Kopka, C. J., Karim, S. A., Abu-Raddad, L. J., Almeida, G., Baptista-Leite, R., Barocas, J. A., Barreto, M. L., Bar-Yam, Y., Bassat, Q., Batista, C., Bazilian, M., Chiou, S.-T., del Rio, C., Dore, G. J., Gao, G. F., Gostin, L. O., Hellard, M., Jimenez, J. L., Kang, G., Lee, N., Matičič, M., McKee, M., Nsanzimana, S., Oliu-Barton, M., Pradelski, B., Pyzik, O., Rabin, K., Raina, S., Rashid, S. F., Rathe, M., Saenz, R., Singh, S., Trock-Hempler, M., Villapol, S., Yap, P., Binagwaho, A., Kamarulzaman, A., El-Mohandes, A., Panel, T. C.-1. C. S., Barreto, M., del Rio, C., Abdulla, S., Addleman, S., Aghayeva, G., Agius, R., Ahmed, M., Ramy, M. A., Aide, P., Aleman, S., Alfred, J.-P., Ali, S., Aliaga, J., Aloudat, T., Alqahtani, S. A., Al-Salman, J., Amuasi, J. H., Agrawal, A., Anwar, W., Araujo-Jorge, T., Artaza, O., Asadi, L., Awuku, Y., Baker, M., Barberia, L., Bascolo, E., Belcher, P., Bell, L., Benzaken, A., Bergholtz, E., Bhadelia, N., Bhan, A., Bilodeau, S., Bitrán, R., Bluyssen, P., Bosman, A., Bozza, F. A., Brinkmann, M. M., Brown, A., Mellado, B., Bukusi, E., Bullen, C., Buonanno, G., Burgess, R., Butler, M., Byakika-Kibwika, P., Cabieses, B., Carlsson, G., Cascini, F., Chabala, C., Chakroun, M., Cheng, K. K., Chetty, A., Chumachenko, D., Consalves, G., Conway Morris, A., Cordie, A., Corrah, T., Crabtree-Ramírez, B., Dashdorj, N., Davidovitch, N., de Souza, L. E., Dhariwal, A. C., Druică, E., Ergonul, O., Erondu, N. A., Essar, M. Y., Ewing, A., Fanjul, G., Feierstein, D., Feigl-Ding, E., Figueroa, R., Figueroa, J. P., Fisher, D., Flores, W., Forero-Peña, D. A., Frumkin, H., Gamkrelidze, A., Gandhi, M., Garcia, P., Garcia-Basteiro, A. L., García-Sastre, A., Garg, S., Gbeasor-Komlanvi, F. A., Gershenson, C., Gilada, I., Giovanella, L., González, M., Green, M. S., Greenhalgh, T., Griffin, P., Griffin, S., Grinsztejn, B., Anand, T., Guerra, G., Guinto, R., Gujski, M., Guner, R., Hamdy, A., Hâncean, M.-G., Haniffa, A., Hartigan-Go, K. Y., Hassan, H. K., Hay, S. I., Heino, M. T. J., Hel, Z., Hotez, P., Hu, J., Hukić, M., IJsselmuiden, C., Iroko, D., Iskarous, M., Izugbara, C., Jacobs, C., Jadad, A. R., Jehan, F., Jordan, A., Jroundi, I., Kain, K., Kamberi, F., Karamov, E., Karan, A., Katz, R., Katzourakis, A., Kazembe, A., Khamis, F., Khamzayev, K., Khanyola, J., Khunti, K., Kiguli-Malwadde, E., Kim, W. J., Kirenga, B. J., Klimovský, D., Kmush, B. L., Knaul, F., Kogevinas, M., Kristensen, F., Kumar, D., Kumar, R., Kvalsvig, A., Lacerda, M. V., Lal, A., Lawton, T., Lemery, J., Leonardi, A. J., Li, Y., Löttvall, J., Lounis, M., Maceira, D., MacIntyre, C. R., Madani, A., Magiorkinis, G., Malekzadeh, R., Choisy, M., Marcelin, J. R., Marks, G. B., Marr, L., Marrazzo, J., Martina, A., Martín-Moreno, J. M., Mateos, C., Mayxay, M., Mazarati, J. B., Mboup, S., McDonald, J., McMillan, F., Mechili, E., Medici, A., Davis, S. L. M., Meier, P., Memish, Z. A., Menon, J., Menon, P., Mesiano-Crookston, J., Michie, S., Mikolasevic, I., Milicevic, O., Mishra, A. K., Mohamed, R., Mokdad, A. H., Monroy-Valle, M., Morawska, L., Moschos, S. A., Motawea, K., Mousavi, S. H., Mumtaz, G., Munene, P. K., Muñoz Almagro, C., Muriuki, J., Muyingo, S., Naniche, D., Naylor, C. D., Ndembi, N., Nemec, J., Nesteruk, I., Ngaruiya, C., Nguyen, H., Nikolova, D., Nitzan, D., Norheim, O., Noushad, M., Ntoumi, F., Nyborg, G. A., Ochodo, E., Odabasi, Z., Okwen, M. P., Olivia, K., Ong, D. S. Y., Opara, I., Orozco, M., Oshitani, H., Pagel, C., Pai, M., Pálsdóttir, B., Papatheodoridis, G., Paraskevis, D., Leigh, J. P., Pécoul, B., Peichl, A., Perez-Then, E., Duc, P. P., Philippe, C., Pineda Rojas, A., Pladsen, C., Pozniak, A., Quiroga, R., Qureshi, H., Rampal, S., Ranney, M., Rathe, L., Ratzan, S., Raventos, H., Rees, H., Reis, R., Ricciardi, W., Rizk, N., Robalo, M., Robertson, E., Robinson, L., Rokx, C., Ros, T., Røttingen, J.-A., Rubin, M., Ruxrungtam, K., Sadirova, S., Saha, S., Salgado, N., Sanchez, L., Sangaramoorthy, T., Santamaria-Ulloa, C., Santos, R., Sawaf, B., Schneider, M. F., Schooley, R. T., Sener, A., Sepulveda, J., Shah, J., Shibani, M., Shoib, S., Sikazwe, I., Šimaitis, A., Gill, A. S., Skhvitaridze, N., Sokolović, M., Solomon, R., Solórzano, X., Springer, S. A., Šrol, J., Staines, A., Stelfox, H. T., Strathdee, S., Sulaiman, L. H., Sutton, B., Svanæs, D., Swed, S., Sypsa, V., Sørensen, K., Tajudeen, R., Tan, A., Tang, J., Tanner, M., Sethi, T., Temmerman, M., Than, K. K., Tinto, H., Tomètissi, S. P., Torres, I., Tshering, K. P., Tsiodras, S., Tsofa, B., Vahlne, A., Vargas, J. R., Bernal, I. D. V., Ventura, D., Vilasanjuan, R., Vipond, J., Wamala-Andersson, S., Wargocki, P., West, R., Weyand, A., White, T. M., Wolff, G., Yao, M., Yates, C. A., Yeboah, G., Yee-Sin, L., Yi, S., Teo, Y.-Y., Yong, P., Zamora-Mesía, V., & Øvrehus, A.
Affiliations
  • City University of New York (US)
  • Cornell University (US)
  • World Health Organization Regional Office for the Americas (US)
  • University of Colorado Anschutz (US)
  • Institució Catalana de Recerca i Estudis Avançats (ES)
  • Médecins Sans Frontières (CH)
  • Colorado School of Mines (US)
  • National Yang Ming Chiao Tung University (TW)
  • UNSW Sydney (AU)
  • Chinese Center For Disease Control and Prevention (CN)
  • Georgetown University (US)
  • Burnet Institute (AU)
  • Cooperative Institute for Research in Environmental Sciences (US)
  • Christian Medical College, Vellore (IN)
  • Wilton Park (GB)
  • University of Ljubljana (SI)
  • London School of Hygiene & Tropical Medicine (GB)
  • University Teaching Hospital of Butare (RW)
  • Centre National de la Recherche Scientifique (FR)
  • University College London (GB)
  • Dr. Rajendra Prasad Government Medical College (IN)
  • BRAC University (BD)
  • University of Auckland (NZ)
  • Houston Methodist (US)
  • University of Malaya (MY)
  • Ifakara Health Institute (TZ)
  • University of Ottawa (CA)
  • University of Manchester (GB)
  • Mogadishu University (SO)
  • Manhiça Health Research Centre (MZ)
  • Karolinska University Hospital (SE)
  • Moi University (KE)
  • King Faisal Specialist Hospital & Research Centre (SA)
  • Salmaniya Medical Complex (BH)
  • Kwame Nkrumah University of Science and Technology (GH)
  • Ain Shams University (EG)
  • University of Alberta (CA)
  • University of Health and Allied Sciences (GH)
  • Universidade de São Paulo (BR)
  • AIDS Healthcare Foundation (US)
  • Boston University (US)
  • Yenepoya University (IN)
  • Delft University of Technology (NL)
  • Fundação Oswaldo Cruz (BR)
  • Management Sciences for Health (US)
  • University of the Witwatersrand (ZA)
  • Università degli studi di Cassino e del Lazio Meridionale (IT)
  • King's College London (GB)
  • Università Cattolica del Sacro Cuore (IT)
  • University of Zambia (ZM)
  • Hospital Fatuma Bourguiba Monastir (TN)
  • Ministry of Health (SC)
  • National Aerospace University – Kharkiv Aviation Institute (UA)
  • University of Cambridge (GB)
  • Cairo University hospitals (EG)
  • Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (MX)
  • Ben-Gurion University of the Negev (IL)
  • National Center for Disease Control (IN)
  • Koç University (TR)
  • Kabul University (AF)
  • Barcelona Institute for Global Health (ES)
  • Consejo Nacional de Investigaciones Científicas y Técnicas (AR)
  • University of the West Indies (JM)
  • National University of Singapore (SG)
  • Center for the Study of Equity and Governance in Health Systems (GT)
  • University of Washington (US)
  • National Center for Disease Control and Public Health (GE)
  • University of California, San Francisco (US)
  • Universidad Peruana Cayetano Heredia (PE)
  • Maulana Azad Medical College (IN)
  • Universidad Nacional Autónoma de México (MX)
  • University of Oxford (GB)
  • The University of Queensland (AU)
  • University of Leeds (GB)
  • Indian Council of Medical Research (IN)
  • St. Luke's Medical Center (PH)
  • Medical University of Warsaw (PL)
  • University of Bucharest (RO)
  • Ateneo de Manila University (PH)
  • University of Helsinki (FI)
  • Baylor College of Medicine (US)
  • Academy of Sciences and Arts of Bosnia and Herzegovina (BA)
  • International Center for Research on Women (US)
  • Aga Khan University (PK)
  • Mohammed V University (MA)
  • University of Toronto (CA)
  • University of Vlora "Ismail Qemali" (AL)
  • Ministry of Health (OM)
  • University of Global Health Equity (RW)
  • University of Leicester (GB)
  • Korea University (KR)
  • Makerere University (UG)
  • Syracuse University (US)
  • University of Miami (US)
  • Coalition for Epidemic Preparedness Innovations (NO)
  • University of Otago (NZ)
  • Bradford Teaching Hospitals NHS Foundation Trust (GB)
  • St George's, University of London (GB)
  • University of Gothenburg (SE)
  • Ziane Achour University of Djelfa (DZ)
  • Universidad de Buenos Aires (AR)
  • National and Kapodistrian University of Athens (GR)
  • University of Alabama at Birmingham (US)
  • University of Cape Verde (CV)
  • Universitat de València (ES)
  • Ministry of Health (LA)
  • FIND (CH)
  • University of Glasgow (GB)
  • Alfaisal University (SA)
  • Amrita Institute of Medical Sciences and Research Centre (IN)
  • International Food Policy Research Institute (US)
  • University of Rijeka (HR)
  • Ollscoil na Gaillimhe – University of Galway (IE)
  • Queensland University of Technology (AU)
  • Northumbria University (GB)
  • New York State Department of Health (US)
  • Action Network (US)
  • Universitat Internacional de Catalunya (ES)
  • IntraHealth International (US)
  • African Population and Health Research Center (KE)
  • Masaryk University (CZ)
  • National Academy of Sciences of Ukraine (UA)
  • Yale University (US)
  • International Livestock Research Institute (KE)
  • Dar Al Uloom University (SA)
  • Fondation Congolaise Pour La Recherche Médicale (CG)
  • Kenya Medical Research Institute (KE)
  • University of Geneva (CH)
  • Wayne State University (US)
  • Tohoku University (JP)
  • McGill University (CA)
  • Dalhousie University (CA)
  • Drugs for Neglected Diseases Initiative (CH)
  • Ifo Institute for Economic Research (DE)
  • Chelsea and Westminster Hospital (GB)
  • Brown University (US)
  • American University of Beirut (LB)
  • NHS Greater Glasgow and Clyde (GB)
  • Erasmus MC (NL)
  • Norwegian Institute of Public Health (NO)
  • Chulalongkorn University (TH)
  • Ministry of Health of the Republic of Uzbekistan (UZ)
  • Instituto Nacional de Salud Pública (MX)
  • Center of Molecular Immunology (Cuba) (CU)
  • Universidad de Costa Rica (CR)
  • TU Dortmund University (DE)
  • Izmir Kâtip Çelebi University (TR)
  • Syrian Private University (SY)
  • Centre for Infectious Disease Research in Zambia (ZM)
  • Slovak Academy of Sciences (SK)
  • University of Calgary (CA)
  • University of California San Diego (US)
  • IMU University (MY)
  • Norwegian University of Science and Technology (NO)
  • University of Aleppo (SY)
  • African Union (ET)
  • University of British Columbia (CA)
  • Indraprastha Institute of Information Technology Delhi (IN)
  • Aga Khan University Nairobi (KE)
  • Centre National de la Recherche Scientifique et Technologique (BF)
  • Khesar Gyalpo University of Medical Sciences of Bhutan (BT)
  • University of Michigan (US)
  • Bruegel (BE)
  • Peking University (CN)
  • University of Bath (GB)
  • National Centre for Infectious Diseases (SG)
  • Odense University Hospital (DK)
Corresponding author
Lazarus, Jeffrey V.
ORCID
Venue
Nature
Publisher
Springer Science and Business Media LLC
Published
2022-11-03
Volume
611
Issue
7935
Pages
332-345
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
DOI
10.1038/s41586-022-05398-2
PMC
PMC9646517
OpenAlex
W4308045442
Cited by
226
References
15
Citations by year
2026: 15 · 2025: 34 · 2024: 65 · 2023: 98 · 2022: 14
FWCI
31.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
  • Conicet (publishedVersion, cc-by-nc-sa)
  • London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
  • Northumbria Research Link (Northumbria University) (acceptedVersion)
  • London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by)
  • Dspace Repository (Marmara Üniversitesi) (submittedVersion, other-oa)
  • HAL (submittedVersion, other-oa)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
  • Digital Commons-TMC (Texas Medical Center) (submittedVersion)
  • eCommons - AKU (Aga Khan University) (submittedVersion)
  • National University of Singapore (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Arca - Repositório Institucional da Fiocruz (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • CGSPace A Repository of Agricultural Research Outputs (Consultative Group for International Agricultural Research) (submittedVersion, cc-by)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • UCL Discovery (University College London) (submittedVersion)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi di Cassino (submittedVersion)
  • Veřejné služby Informačního systému (Masarykiana Brunensis Universitas) (submittedVersion, other-oa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Investigative News in Education (Universidad de Costa Rica) (submittedVersion)
  • NOAA Institutional Repository (submittedVersion, cc-by)
  • Investigative News in Education (Universidad de Costa Rica) (submittedVersion, cc-by)
  • RIUR (Universidad de La Rioja) (submittedVersion, other-oa)
  • PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, cc-by)
  • Technical University of Denmark, DTU Orbit (Technical University of Denmark, DTU) (submittedVersion, cc-by)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
  • Research Repository (Delft University of Technology) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Apollo (cc-by)
Funders
  • City University of New York
  • Johns Hopkins University
  • London School of Economics and Political Science
  • Ministerio de Ciencia, Innovación y Universidades (CEX 2018-000806-S)
  • Centres de Recerca de Catalunya (CEX2018-000806-S)
  • Coalition for Epidemic Preparedness Innovations
  • National Institute for Health and Care Research (NIHR-INF-1861)
  • University of Oxford
  • Generalitat de Catalunya (CEX2018-000806-S)
  • University of Hong Kong
  • Tehran University of Medical Sciences and Health Services
  • National and Kapodistrian University of Athens
  • Universidad de Buenos Aires
  • Medical Research Council (MR/T008768/1)
  • National Institute of Allergy and Infectious Diseases (UM1AI069476)
Topics
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Legal, Health, Environmental and COVID-19 Challenges
  • Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
Keywords
COVID-19 pandemic response, expert consensus recommendations, whole-of-government approach, whole-of-society approach, public health communication, public trust in health systems, community participation, health disparities, COVID-19 prevention measures, health policy
MeSH terms
COVID-19, COVID-19 Vaccines, Communication, Delphi Technique, Government, Health Education, Health Policy, Humans, International Cooperation, Organizations, Public Health, Public Opinion, Pandemics

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

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