Re: Non-pharmaceutical interventions: evaluating challenges and priorities for future health shocks
Dear Editor,
The study highlights the need for evaluation of non-pharmaceutical interventions (NPIs) effectively during health crises [1].
In contrast to the UK, many LMICs cannot have enough data for assessing outcomes and establish programs for pandemic preparedness. It is crucial to acknowledge financial difficulties related to prevention strategies and other NPIs. Developing a comprehensive preparedness program requires substantial investment in long-term infrastructure, workforce training, and ongoing research. Unfortunately, my country (Azerbaijan), like many other LMICs may face difficulties in securing the necessary funding to create, implement, and sustain these programs. As a result, the population may remain vulnerable during times of crisis.
Assessing the impact of NPIs is vital for effective pandemic management. For instance, measures like lockdowns significantly reduced COVID-19 transmission across Europe [2]. However, faster data collection and analysis to enable policy adjustments are important [2]. Likewise, acting early with measures like travel restrictions and stay-at-home messages played an effective role in preventing contamination worldwide [3]. Also, regarding the effectiveness, it has been found that actions such as banning large gathering and closing schools could significantly decrease transmission, especially when combined with other strategies [4]. Study by Majeed et al. [1] shows that worldwide school closures had an impact on children's education, maybe with long-term effects. The digital gap was brought to light by the move to online education, since kids who didn't have access to sufficient technology or the internet at home suffered greatly with potential long term implications [1].
As mentioned in the study [1], while routine data can help identify where mitigation measures are needed, the lack of detailed information on factors like ethnicity, deprivation, and occupation in both high-income and low- and middle-income countries (LMICs) can lead to biased results about who is most at risk during a pandemic.
Evaluation of NPIs can be difficult, especially when multiple measures are introduced simultaneously across various settings. The efficacy of various NPIs shows the difficulty in isolating the effects of individual interventions [5]. This points to the need for standardized evaluation frameworks, as advocated by professor Majeed and colleagues [1].
The broader impacts of NPIs, such as economic inequality, should be considered. Lockdowns in Italy disproportionately affected lower-income areas, showing the importance of considering socioeconomic factors when NPI planning and evaluation [6]. Robust data systems are essential for evaluating NPIs effectively. In low- and middle-income countries (LMICs), unreliable data systems create significant issues. The weak surveillance infrastructure in these settings often slows down the ability to evaluate NPIs in real-time, making it harder to implement them effectively [7].
As cases decrease, countries can use more targeted approaches like testing, contact tracing, and quarantine [8]. However, if suppression measures are eased too soon, the virus could quickly spread again. Mitigation, focusing on short-term measures like isolating cases and protecting high-risk groups, can help reduce deaths and ease the strain on healthcare [8].
The key to success is timing: early action is crucial for suppression, while mitigation should focus on the peak of the outbreak; continuous monitoring and flexibility in policies are vital to keep the situation under control [8].
References
[1] Majeed A, Quint JK, Bhatt S, Davies F, Islam N. Non-pharmaceutical interventions: evaluating challenges and priorities for future health shocks. BMJ 2024 /10/07;387:e080528.
[2] Flaxman S, Mishra S, Gandy A, Unwin HJT, Mellan TA, Coupland H, et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature 2020 -08;584(7820):257–261.
[3] Hsiang S, Allen D, Annan-Phan S, Bell K, Bolliger I, Chong T, et al. The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature 2020 August 1;584(7820):262–267.
[4] Brauner JM, Mindermann S, Sharma M, Johnston D, Salvatier J, Gavenčiak T, et al. Inferring the effectiveness of government interventions against COVID-19. Science 2021 -02-19;371(6531):eabd9338.
[5] Haug N, Geyrhofer L, Londei A, Dervic E, Desvars-Larrive A, Loreto V, et al. Ranking the effectiveness of worldwide COVID-19 government interventions. Nat Hum Behav 2020 December 1;4(12):1303–1312.
[6] Bonaccorsi G, Pierri F, Cinelli M, Flori A, Galeazzi A, Porcelli F, et al. Economic and social consequences of human mobility restrictions under COVID-19. Proc Natl Acad Sci U S A 2020 -07-07;117(27):15530–15535.
[7] Verhagen LM, de Groot R, Lawrence CA, Taljaard J, Cotton MF, Rabie H. COVID-19 response in low- and middle-income countries: Don’t overlook the role of mobile phone communication. Int J Infect Dis 2020 October 1;99:334–337.
[8] Ferguson NM, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K, Baguelin M, et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College London. 2020 Mar 16. Available from: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-...
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Re: Non-pharmaceutical interventions: evaluating challenges and priorities for future health shocks
Dear Editor,
The study highlights the need for evaluation of non-pharmaceutical interventions (NPIs) effectively during health crises [1].
In contrast to the UK, many LMICs cannot have enough data for assessing outcomes and establish programs for pandemic preparedness. It is crucial to acknowledge financial difficulties related to prevention strategies and other NPIs. Developing a comprehensive preparedness program requires substantial investment in long-term infrastructure, workforce training, and ongoing research. Unfortunately, my country (Azerbaijan), like many other LMICs may face difficulties in securing the necessary funding to create, implement, and sustain these programs. As a result, the population may remain vulnerable during times of crisis.
Assessing the impact of NPIs is vital for effective pandemic management. For instance, measures like lockdowns significantly reduced COVID-19 transmission across Europe [2]. However, faster data collection and analysis to enable policy adjustments are important [2]. Likewise, acting early with measures like travel restrictions and stay-at-home messages played an effective role in preventing contamination worldwide [3]. Also, regarding the effectiveness, it has been found that actions such as banning large gathering and closing schools could significantly decrease transmission, especially when combined with other strategies [4]. Study by Majeed et al. [1] shows that worldwide school closures had an impact on children's education, maybe with long-term effects. The digital gap was brought to light by the move to online education, since kids who didn't have access to sufficient technology or the internet at home suffered greatly with potential long term implications [1].
As mentioned in the study [1], while routine data can help identify where mitigation measures are needed, the lack of detailed information on factors like ethnicity, deprivation, and occupation in both high-income and low- and middle-income countries (LMICs) can lead to biased results about who is most at risk during a pandemic.
Evaluation of NPIs can be difficult, especially when multiple measures are introduced simultaneously across various settings. The efficacy of various NPIs shows the difficulty in isolating the effects of individual interventions [5]. This points to the need for standardized evaluation frameworks, as advocated by professor Majeed and colleagues [1].
The broader impacts of NPIs, such as economic inequality, should be considered. Lockdowns in Italy disproportionately affected lower-income areas, showing the importance of considering socioeconomic factors when NPI planning and evaluation [6]. Robust data systems are essential for evaluating NPIs effectively. In low- and middle-income countries (LMICs), unreliable data systems create significant issues. The weak surveillance infrastructure in these settings often slows down the ability to evaluate NPIs in real-time, making it harder to implement them effectively [7].
As cases decrease, countries can use more targeted approaches like testing, contact tracing, and quarantine [8]. However, if suppression measures are eased too soon, the virus could quickly spread again. Mitigation, focusing on short-term measures like isolating cases and protecting high-risk groups, can help reduce deaths and ease the strain on healthcare [8].
The key to success is timing: early action is crucial for suppression, while mitigation should focus on the peak of the outbreak; continuous monitoring and flexibility in policies are vital to keep the situation under control [8].
References
[1] Majeed A, Quint JK, Bhatt S, Davies F, Islam N. Non-pharmaceutical interventions: evaluating challenges and priorities for future health shocks. BMJ 2024 /10/07;387:e080528.
[2] Flaxman S, Mishra S, Gandy A, Unwin HJT, Mellan TA, Coupland H, et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature 2020 -08;584(7820):257–261.
[3] Hsiang S, Allen D, Annan-Phan S, Bell K, Bolliger I, Chong T, et al. The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature 2020 August 1;584(7820):262–267.
[4] Brauner JM, Mindermann S, Sharma M, Johnston D, Salvatier J, Gavenčiak T, et al. Inferring the effectiveness of government interventions against COVID-19. Science 2021 -02-19;371(6531):eabd9338.
[5] Haug N, Geyrhofer L, Londei A, Dervic E, Desvars-Larrive A, Loreto V, et al. Ranking the effectiveness of worldwide COVID-19 government interventions. Nat Hum Behav 2020 December 1;4(12):1303–1312.
[6] Bonaccorsi G, Pierri F, Cinelli M, Flori A, Galeazzi A, Porcelli F, et al. Economic and social consequences of human mobility restrictions under COVID-19. Proc Natl Acad Sci U S A 2020 -07-07;117(27):15530–15535.
[7] Verhagen LM, de Groot R, Lawrence CA, Taljaard J, Cotton MF, Rabie H. COVID-19 response in low- and middle-income countries: Don’t overlook the role of mobile phone communication. Int J Infect Dis 2020 October 1;99:334–337.
[8] Ferguson NM, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K, Baguelin M, et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College London. 2020 Mar 16. Available from: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-...
Competing interests: No competing interests