In this lecture Professor at the Odense Patient data Explorative Network (OPEN) at the Faculty of Health Sciences at SDU and Professor in Global Health, Dr. Christine Stabell Benn, will discuss if health interventions against COVID-19 work as they are intended.
COVID-19 was an unknown enemy. It is a particularly harmful enemy if we do not learn from the encounter. We can do that with a new gaze on randomised trials.
Do face masks protect against COVID-19 or are they just a nuisance to the wearer and to the environment? Is testing and contract tracing an important part of Denmark's toolbox or have we spent 2 billion DKK a month on something that did not change the course of the pandemic – but merely brought people into queues and into isolation? Are vaccines a “super weapon”, or can they harm some more than they benefit? These are just a few of the questions we still do not know the answer to.
Things could have been different.
The way forward when considering the implementation of an approved health intervention, for which there is uncertainty regarding the effect, is to implement the intervention in a way that ensures a valid measure of "cost-effectiveness": does it make a difference on the overall health (the risk of death and morbidity) of those who receive the intervention versus those who do not? This question can be answered by ensuring that there are comparable groups that receive and do not receive the intervention - and this can be ensured in several different ways, of which the randomised trial is the best known. Such trials can randomise individuals or groups, e.g. workplaces, schools, municipalities, or regions (cluster-randomised trial) to receive a specific intervention or not, and then compare the groups with respect to overall health.
In a pandemic context, randomness - “a lottery” - can sound like an unpleasant raffle-like approach, where one plays with people's well-being. However, this understanding does not give randomised trials the recognition they deserve. Rather, randomised trials are a solid and valid instrument in the researcher's toolbox that does not have to cause any harm - on the contrary it can prevent harm.
From a researcher's perspective, it is surprising that there has been essentially no interest and demands for testing the effects of the pandemic's health interventions in randomised trials. Had we tested face masks, testing/contact tracing and vaccines for their effect on overall health while rolling them out, we would have been in a better place today. We could have omitted interventions that did not work. We could have presented clear data on the effect to the doubters of other interventions, ensuring a better implementation. We would have had a measure of the "cost-effectiveness" of the various interventions, so that we could compare them and assess which ones provided most overall health for the tax dollars and when to implement or abstain from using them. Confidence in the authorities and the interventions implemented would have been greater. We would have avoided the divisive discussions between people. We would have important knowledge going forward when the next pandemic arrives – and even just for next winter.
This lecture will be held at O-DIAS Seminarrum and can be viewed on our Youtube channel
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