Below, we reflect on the experience and lessons learned so far from the Knowledge to Policy (K2P) Center, a WHO Collaborating Centre for Evidence-Informed Policymaking and Practice. Established within a university setting in Lebanon (a middle-income country), K2P Center seeks to bridge the gap between science, policy and politics by making research evidence more accessible to a broader range of stakeholders, building institutional capacities for evidence-informedpolicy-making and seizing opportunities to advocate and influence policy outcomes. The Center’s response to COVID-19 builds on years of work in raising the awareness of policy-makers, stakeholders, civil society organisations and media on the importance of evidence in informing decision-making, developing their capacities in accessing and using evidence, raising demand for evidence, building trust and establishing critical linkages. With the pandemic still unfolding, new lessons will likely emerge, making this a learning platform and an evolving living experience.
Activate rapid response services
During a public health crisis, decision-makers are under tremendous pressure to respond urgently to demonstrate capability and meet public health needs. The time limitation is a critical barrier to evidence use during a crisis, thus necessitating the provision of evidence in a timely manner to decision-makers. In this regard, the rapid response service presents a key element in the response to the COVID-19 pandemic. It can respond to urgent requests from decision-makers and stakeholders by delivering relevant and high-quality evidence in short periods of time, ranging from 3 to 30 days. Rapid response products use systematic and transparent methods to search, synthesise and appraise the existing evidence base (giving precedence to existing systematic/rapid reviews when possible) while tailoring the implications to local context in order to support policy and systems decisions. They also utilise user-friendly formats and plain language to facilitate the uptake of evidence in decision-making.
KT platforms should have the capability and flexibility to switch to rapid response mode during a crisis and tailor their suite of services to address the various aspects of the response. Operationalising the rapid response service is facilitated by the presence of Standard Operating Procedures and templates for preparing and disseminating rapid response products, the availability of a team with appropriate sets of skills and expertise, access to relevant databases, and flexibility in funding to re-orient human, financial and material resources to respond to the pandemic.
Position the KT platform as a credible source of evidence during a pandemic
At the time of crisis, KT platforms must rapidly position themselves as credible hubs that provide trustworthy evidence to policy-makers, stakeholders, citizens and media. This can be achieved by actively demonstrating the value of the platform early on rather than taking a back seat and waiting for people to turn to them for information. When the crisis hit Lebanon, the K2P Center launched the K2P COVID-19 Series Initiative and the first policy-relevant document produced in that series cemented and reinforced K2P’s role as a trusted reference centre for evidence and guidance related to COVID-19. At the downstream level, the K2P Center activated the ‘K2People’ initiative to educate and raise awareness of citizens and media about the virus and its mode of transmission as well as to address scepticisms and misconceptions through social media platforms. As part of the ‘K2People’ initiative, we sought to target vulnerable groups that are mostly affected by the COVID-19 pandemic such as smokers, cancer patients, elderly population, refugees and low socio-economic workers. We also tackled mental health problems affecting adults as well as children as a result of the COVID-19 pandemic. The abovementioned two initiatives also provided a clear portal for communicating COVID-19 information, which can be accessed for free by all relevant and interested stakeholders.
Importantly, KT platforms must maintain their credibility throughout the crisis by demonstrating a high degree of responsiveness to priorities and needs, remaining objective, truthful and politically neutral, and ensuring transparency in the evidence and recommendations generated. This is particularly relevant for KT platforms established independently or within an academic institution where trust is a pre-requisite to interacting with such platforms.
Remain alert and responsive to changing priorities and needs, both upstream and downstream
Decision-makers’ needs for evidence can vary, depending on the context, type of stakeholder, resource availability, or the specific phase of the pandemic cycle in a given country . To improve the translation of evidence into policy and practice, it is important for KT platforms to identify context-specific knowledge gaps, priorities and needs and to subsequently address them through a corresponding product (e.g. rapid evidence summary, guidance document, evidence brief, media bite) tailored to the target audience.
Moreover, given the high level of uncertainty associated with such a pandemic, there is a huge appetite for evidence to guide decision-making at all levels. This presents a critical opportunity for KT platforms to not only respond to decision-makers’ priorities and needs, but to also proactively shape the policy agenda by bringing important (often overlooked) issues to the attention of decision-makers. This requires KT platforms to remain vigilant of changes in the health system, closely monitor social media (e.g. through real-time content analysis of tweets) and keep abreast of how the COVID-19 situation is unfolding at the international level. Anticipating the types of needed decisions can help KT platforms prioritise and prepare ahead of time in order to ensure a more timely response to emerging priorities.
Furthermore, given the scale and breadth of COVID-19, a top-down approach will likely fail to achieve the desired impact; organisations, initiatives and networks that support evidence-informedpolicy-making can help balance top-down with bottom-up approaches by catering to the needs not only of governments and policy-makers but also of policy implementers, including municipalities, healthcare providers, civil society organisations and communities. For the latter groups, the lack of clarity on their roles and responsibilities may hinder their involvement in the pandemic response. To overcome this, the K2P Center produced a number of evidence-based guidance documents specifying the roles of the different actors and the link to the national pandemic response. These guidance documents played a role in empowering the different actors and prompted government to strengthen its stewardship function for a more effective and efficient response.
Search for evidence beyond ‘conventional’ types and sources
During pandemics, evidence-informeddecision-making may be challenged by scientific uncertainties and scarcity of research, especially during the early phases of the crisis. Conventionally, systematic reviews and randomised controlled trials are considered the gold standards for informing decisions on what works. However, in crisis situations, evidence is needed to address a broad range of questions beyond what works. Moreover, the ‘best’ evidence, i.e. the most valid and reliable evidence, may not be available, yet decisions have to be made fast and under great uncertainty. In many instances, there may only be a single case study or an observational study available, rendering these the best available evidence. Furthermore, indirect evidence becomes particularly valuable during the early phases of the pandemic when there is limited research directly addressing COVID-19. Under such circumstances, turning to indirect evidence from closely related viruses like influenza, SARS (severe acute respiratory syndrome) or Ebola virus may be necessary to inform policy response. As such, KT platforms should aim for the best available evidence while acknowledging the tension between rigor and speed; waiting until more research and better data become available may risk decisions being made with no evidence at all due to time constraints.
Unfortunately, evidence at time of crisis is scattered around different databases, journals, websites and in the grey literature . Therefore, the search for the best available evidence should not be restricted to peer-reviewed journals and electronic databases but also to other sources of information such as reports by national and international agencies, governmental websites, social media platforms (e.g. Twitter), media websites, email subscriptions and blogs, and direct correspondence with senior decision-makers and health professionals in the field. This non-traditional way of searching for evidence may be necessary in a context of rapid evolution and complexity with knowledge constantly changing and evolving. Thus, what constitutes evidence in a crisis setting is often broader than the research generated through the ‘scientific method’. The key is to exercise transparency and be explicit about the sources of evidence informing a policy response and acknowledge any limitations and uncertainties in the evidence base.
The emergence of international initiatives like the COVID-19 Evidence Network to support Decision-making (COVID-END) partners, which are compiling COVID-related evidence from partners around the world in one repository, is a much needed step in addressing the fragmentation of the evidence base and reducing the duplication of efforts. Establishing similar initiatives at the country level is much warranted.
Harness the strength of complementary evidence networks
The highly dynamic trajectory of the COVID-19 pandemic and the large number of intertwined health, social and economic factors associated with it mean that no single entity can provide all the needed support for a comprehensive response to the pandemic. Researchers, public health specialists, guideline developers, epidemiologists, data analysts and evaluation experts from both health and non-health sectors are all generating relevant and timely evidence to inform the various aspects of the pandemic — from controlling the spread of virus to assessing the effectiveness of public health and social interventions to evaluating the impact on health and the economy. Yet, the absence of a mechanism to bridge the different entities can result in ad hoc, fragmented and delayed engagement, which can undermine the efficiency and effectiveness of the pandemic response.
The COVID-19 pandemic has exposed the deficiencies of siloed approaches to informing decision-making processes and re-enforced the need to build bridges to the organisations, institutions and networks working in complementary areas to inform decision-making related to different aspects of the pandemic. Moving forward, it is critical to establish mechanisms for coordinating and integrating research, data and expertise across stakeholders and sectors in transparent ways for a more effective policy response during pandemics.
Leverage multiple dissemination channels tailored to different audiences
Dissemination of the evidence to target the right audience is crucial to achieve the desirable impact. In a time of pandemic, where conventional dissemination methods like policy dialogues may not be feasible, it is critical for KT platforms to innovate and leverage multiple dissemination channels suited to the context and audience at the right time.
Social media is an increasingly important platform to disseminate evidence from research and knowledge translation products during pandemics . KT platforms should invest in developing a robust social media presence and should establish relationships with key journalists that they can leverage to help disseminate the evidence to a wide range of audiences, including policy-makers, healthcare professionals, non-governmental organisations and the general public. Therefore, KT platforms should have a communication strategy set in place to allow a timely response in times of crisis and emergencies. In addition, media messages, including Twitter and other social media platforms, should be evidence-based yet concise and simple, utilising videos, visuals and infographics whenever possible in order to engage lay people and decision-makers. Television/radio interviews, podcasts and online webinars constitute other ways to disseminate relevant evidence to decision-makers, practitioners and the public during pandemics.