Equity in the development of COVID-19 formal recommendations and good practice statements

Date & Time
Tuesday, September 5, 2023, 12:30 PM - 2:00 PM
Location Name
Session Type
Global health and equity
Dewidar O1, Bondok M2, Abdelrazeq L3, Alieyva K4, Solo K5, Welch V1, Brignardello-Petersen R5, Mathew J6, Hazlewood G7, Pottie K8, Hartling L9, Khalifa D5, Duda S5, Falavigna M10, Khabsa J11, Lotfi T5, Petkovic J1, Elliott S9, Chi Y12, Parker R13, Kristjansson E4, Riddle A1, Darzi A5, Magwood O1, Saad A4, Rada G14, Neumann I15, Loeb M16, Mertz D5, Piggott T5, Turgeon A17, Schünemann H5, Tugwell P18
1Bruyère Research Institute, Canada
2University of British Colombia, Canada
3Carleton University, Canada
4University of Ottawa, Canada
5McMaster University, Canada
6Post Graduate Institute of Medical Education and Research, India
7University of Calgary, Canada
8Western University, Canada
9University of Alberta, Canada
10Federal University of Rio Grande do Sul, Canada
11American University of Beirut Medical Center, Canada
12Cochrane Campbell Global Ageing Partnership, UK
13The Cochrane Collaboration, UK
14Pontificia Universidad Católica de Chile, Chile
15Universidad San Sebastián, Chile
16WHO Regional Office for the Americas/Pan American Health Organization, United States of America
17Université Laval, Canada
18Ottawa Hospital Research Institute, Canada

Background: We developed an interactive living map that presents the latest evidence-based recommendations for the prevention and care of COVID-19 (eCOVIDRecMap). Given the inequities in the COVID-19 pandemic, guideline developers must consider equity in the issued recommendations.
Objectives: To identify COVID-19 formal recommendations and Good Practice Statements (GPS) focused on specific disadvantaged populations in eCOVIDRecMap and describe how health equity was assessed in the development of the formal recommendations.
Methods: We employed the PROGRESS-Plus framework (Place, Race, Occupation, Gender, Religion, Education, Socioeconomic Status, Social Capital, Plus for other contextual factors) to identify disadvantaged population-specific recommendations and GPS. Of those, we assessed how likely impact on health equity was assessed in the evidence to decision (EtD) frameworks of these recommendations using criteria based on differences in baseline risk, value of outcomes for disadvantaged populations, differences in the magnitude of effect, and applicability. We also assessed how equity was considered in the certainty of evidence.
Results: Of the 1,577 actionable statements published on the eCOVIDRecMap as of July 29th, 2022, we identified 310 (20%) disadvantaged population-specific actionable statements (124, 40% formal recommendations and 186, 60% GPS). Formal recommendations were most frequently focused on children (40%) followed by pregnant women (16%). GPS focused mostly on children (25%) and populations working in high-risk occupations (16%). Seventy-six percent (94/124) of the recommendations were accompanied with EtDs. More than half (55%, 52/94) of those considered indirectness of the evidence for disadvantaged populations. In most of the recommendations (49/52, 94%), the assessment led to reduction in the certainty of the evidence. Considerations in impact on health equity criterion most frequently involved implementation of the recommendation for disadvantaged populations (17%, 16/94).
Conclusions: COVID-19 recommendations focused on disadvantaged populations were developed with insufficient considerations for equity. The urgent need for guidance during the pandemic may have made the consideration of equity in the development of disadvantaged population-specific recommendations challenging. Pragmatic guidance, focused on the evidence already available, might help to overcome this limitation. Patient, public, and/or healthcare consumer involvement: Patients and healthcare consumers were involved in the development of the living recommendations map.