How National Public Health Institutes Exercised Scientific Independence during the COVID-19 Pandemic
On November 9, 2022, the IANPHI Europe Regional Network hosted a webinar about National Public Health Institutes Exercising Scientific Independence during the COVID-19 Pandemic. Many NPHIs have been center-stage in their nation’s response to the COVID-19 pandemic, and their roles and interactions with major stakeholders such as policymakers at the national and local levels, the media, healthcare services, and other public entities have been put to the test.
Moderated by Prof. Fu Meng Khaw, the webinar featured leaders from member National Public Health Institutes (NPHIs): Prof. Johannes (‘Hans’) Brug (Netherlands) and Prof. Dr. Herwig Ostermann (Austria). The focus of this session was to explore if NPHIs can produce and disseminate scientific evidence without political influence and how NPHIs can work with stakeholders, including policymakers, the media and health services, to advocate effectively for the collective benefit of independent scientific advice.
Exercising Scientific Independence during the COVID-19 Pandemic at RIVM
by Professor Johannes Brug, Director-General of the Netherlands Institute for Public Health and the Environment
The National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheiden Milieu, RIVM) in the Netherlands is an agency of the Ministry of Health. RIVM’s most visible function in the public’s eye, especially proceeding the response of the COVID-19 pandemic, is the outbreak management team (OMT).
Because of the scale of the COVID-19 pandemic, RIVM had to work with a range of newly established organizations. Many ministries were reaching out to RIVM during this time of uncertainty, so RIVM shifted to fit the needs of the society by developing a new program directorate on COVID-19 vaccination, implementation, and a newly made IT program for COVID testing (CORON-IT) and vaccination registration; hiring additional staff for external communications; and acquiring new stakeholders and partners that had a direct or indirect influence on the community. Prof. Brug also touched on a more personal matter when he spoke about a lawsuit against him for ‘mass murder’ signed by several citizens due to the pandemic and shared how that impacted his emotional state during this extremely vulnerable time for the world and public health professionals on the frontlines.
Prof. Brug stated that interactions with stakeholders and outside agencies shifted during the pandemic and that policymakers on the national and local levels and the media became much more intense daily. Prof. Brug said that, in his opinion, RIVM maintained their independence throughout the pandemic, but it was not without challenges. He shared the three main challenges RIVM faced in the pandemic response and how the institute was able to navigate them and maintain its independence with a code of conduct, external supervisory committee, peer review and audit procedures:
A slide of Dr. Brug's presentation showing the challenge to RIVM's independence
Every day, there were outsiders doubting our independence on a very frequent basis which was related to the intense relationship with policymakers and decision makers. It has to do with role strictness and proper distance and I think in times of crisis, proximity to decision makers is of crucial importance. You need to be there at the table, because otherwise decisions may roll in a very unfavorable direction. But of course, proximity might give the impression that you are on the same chair, that you go hand-in-hand and I think what needs attention is the interaction between proximity and role strictness.
Exercising Scientific Independence during the COVID-19 Pandemic at GOeG
By Professor Dr. Herwig Ostermann, Executive Director, Austrian National Public Health Institute
Gesundheit Österreich GmbH (GOeG) is Austria's National Public Health Institute. Scientifically independent by law, it oversees the broader public health agenda, advising the Ministry of Health in various areas, starting from public health, health promotion, health planning, and long-term care. Because Austria is a federal state, pandemic management can be challenging when it comes to diverse interests of the regions and the regional governments.
Dr. Herwig Ostermann explained the interplay between politics and science during each wave of the pandemic, which showed how scientific advice and policymakers can interact when responding to an outbreak. He shared an outline of the interplay between GOeG and politicians:
- First wave - Predominantly politicians addressing the public (Chancellor, vice-chancellor, minister of health, minister of internal affairs)
- Second wave (beginning) - Politicians and scientists addressing the public (Chancellor, minister of health, two experts)
- Second wave (end - prior to Alpha-wave, 12/2020 onwards) - Scientists addressing/informing the public first, politicians seek advice afterwards and address the public with the decisions taken
- Third wave - Predominantly politicians addressing the public and asking scientist for advice in a public setting
Dr. Ostermann suggested that potential solutions for pandemic management are nothing more than an exercise of health technology assessment (HTA). Looking at the framework below, there are two border lines which can also represent the two challenges faced by the Austrian NPHI. The first initial challenge that still exists to some extent, is the one of limited evidence. The second challenge was that not all scientists were familiar with handing over the power of decision making to politicians.
From Dr. Ostermann's slides: pandemic management as an HTA-exercise
Sometimes I had the impression that scientific advice was mistaken as decision-making from both sides. Policymakers at some point said: Tell us what to do, we will do whatever you tell us to do.
He also explained that scientists began to publish papers that only included recommendations and no real scientific analysis. When it comes to political trade-offs, Dr. Ostermann stated that “it is not the role of the scientific community to communicate these trade-offs, rather it is the responsibility of the decision makers with regard to health, the Ministry of Health, with regard to broader societal issues, obviously the heads of government.”
Discussion
Following the panelist’s presentations, Professor Fu Meng Khaw asked the panelists how their institutes worked with the scientific community outside their organizations and if there were mechanisms to build consensus if they disagreed. Dr. Ostermann replied that, “GOeG has a voluntary group in operation where basically any scientist in Austria is invited to participate in this group, which is not solely focused upon health issues. It also focuses on broader issues of the economy.” He also stated that these spaces have evolved creating a range of subgroups of various focuses and mentioned that “the idea of this platform was to link, so to say, rather National Research Institutes, and not only necessarily Public Health Institutes, but also a National Institute on Economic Forecasting, National Office for Statistics, with the scientific community. What we always focused on within this group was an absolute scientific independence so the group decides on what will be published, on what kind of paper will be communicated to the public, and it was to some extent not only self-organized, but also self-controlling. That whenever somebody tried to exert political influence, actually, the group would sanction this.”
Professor Brug answered, “Collaborating with outside scientists, outside researchers is, luckily, a part of our infrastructure. We, as a public health institute, don’t see ourselves as the main scientist, we don’t do the research ourselves. Of course, we are involved in research ourselves, but we see ourselves as a trusted advisor that collects research and knowledge from all kinds of sources, and we have an infrastructure established to get knowledge and that expertise in.”
Writer: Christabelle Toso. Editor: Marie Deveaux