Rajan D, Koch K, Rohrer K, et al Governance of the Covid-19 response: a call for more inclusive and transparent decision-making BMJ Global Health 2020;5:e002655.
Summary box
Not all countries make their Covid-19 task force membership list public—the available information varies by country.
There is currently a predominance of politicians, virologists and epidemiologists in the Covid-19 response at the country level.
Experts on non-Covid-19 health, social and societal consequences of Covid-19 response measures are, for the most part, not included in Covid-19 decision-making bodies.
There is little transparency regarding whom decision-making bodies are consulting as their source of advice and information.
From the available data on Covid-19 decision-making entities, female representation is particularly paltry.
In addition, civil society is hardly involved in national government decision-making nor its response efforts, barring some exceptions.
We need to be more inclusive and multidisciplinary: the Covid-19 crisis is not simply a health problem but a societal one—it impacts every single person in society one way or another.
Decision makers need to address more systematically the suffering from mental illness exacerbations, domestic violence, child abuse, child development delays, chronic diseases and so on, during lockdown.
Introduction
As SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) ravages the globe, heads of state are making swift decisions to put large swathes of the world’s population under mass isolation in the race to heed off Covid-19’s lethality, particularly in certain population subgroups. How are these decisions—that affect each and every one of us, some groups disproportionately and regardless of Covid-19 status—made? How far have policy makers and politicians consulted those who have experience and expertise on the secondary effects of lockdowns, social isolation measures and movement restrictions?
We attempted to address these questions with a rapid analysis of 24 countries’ Covid-19 task force compositions. The countries were selected to represent a range of geographies and income levels. As far as possible, we focused on governance bodies set up or activated to give scientific, or evidence-based, advice to national decision makers. In some countries, the advisory and decision-making bodies were one and the same, often taking the form of government-only interministerial committees. We excluded committees which were established to focus on a specific area, for example, research related to vaccination; rather, we examined committees whose explicit mandate (based on available information) was to provide advisory guidance on the overall national response.
We scanned publicly available documentation from government websites, media articles, and in specific cases, contacted our networks in governments and health ministries for official documentation. We then researched the task force members’ backgrounds and triangulated from different sources to classify them based on their current professional role or area of specialisation. Experts were thus categorised based on the principal reason for their appointment to the task force. For example, a physician with a current public health role would be classified as a public health specialist and not a clinician, the assumption being that their current role is most relevant for the task force. The ‘government’ or ‘Ministry of Health’ category was allocated to career civil servants, that is, posts which are usually filled by generalists rather than specialists. Most other task force members, including public health institute staff, were categorised according to their expertise since the rationale for their task force membership is their specific skill set (mathematical modeller, virologist, etc) rather than their institutional affiliation.
At least two coauthors independently categorised the task force members and crosschecked categorisations with each other.