gms | German Medical Science

Background/research question: Public health decision-making requires the balancing of numerous and often conflicting factors. During the SARS-CoV-2 pandemic, sound and fair decision-making processes were challenged by time constraints and inherent limited evidence. Uncertain effects on the course of the pandemic had to be weight against public health impacts beyond COVID-19, broad societal consequences, or the infringement individual liberties, among other factors. Evidence-to-decision frameworks are neither able nor intended to replace stakeholder participation, but they can serve as a tool to ensure the relevance and completeness of criteria to be considered for evidence-informed decision making in PH and guideline development, despite scarce resources.

Methods: To enable processes with significant participation of stakeholders in times of crisis, we used the WHO-INTEGRATE framework [1] as a starting point to develop the WHO-INTEGRATE COVID-19 framework version 1.0 [2] employing "best-fit" framework synthesis. WICID 1.0 is based on a content analysis of comprehensive strategy documents to guide policy makers in implementing new or decrease existing measures to protect against COVID-19 in Germany. To address the needs of decision-makers and decision-making realities at the local level, the generic WICID 1.0 is being revised based on a systematic analysis of relevant policy documents.

Results: WICID 2.0 consists of 11+1 criteria considered as relevant to enable local decision-makers to weigh factors after appropriate evaluation. The criteria cover implications for the health of individuals and populations due to and beyond COVID-19, infringement on liberties and fundamental human rights, acceptability and equity considerations, societal, environmental and economic implications, as well as implementation, resource and feasibility considerations. The validation showed high consistency with minor revisions between WICID 1.0 and 2.0.

Conclusion WICID can be a tool to support researchers, practitioners, and policy makers to systematically integrate evidence and ethics and to balance of health, societal and other considerations when reflecting on public health interventions targeting COVID-19. The practical guide will help public health practitioners to adapt WICID 2.0 to the reality of (policy) decision-making processes at the community level in times of crisis.

Competing interests: none