Evidence synthesis communities in low-income and middle-income countries and the COVID-19 response

Evidence synthesis specialists have responded to the COVID-19 pandemic. In line with WHO's global roadmap for COVID-19 research,¹ we are working to summarise the available research to support evidence-informed decision making across all sectors for immediate and anticipated challenges, within the COVID-19 Evidence Network to support Decision-making (COVID-END). COVID-END is an umbrella organisation involving 50 evidence synthesis or evidence support organisations that are working together to promote collaboration and reduce duplication of effort in the conduct and translation of COVID-19-related evidence syntheses. As a network we have accelerated investment to enable infrastructure for evidence synthesis and to promote evidence use.

COVID-19 and its related impacts are likely to be felt for many years to come. As the low-income and middle-income country (LMIC) members of a global partnership, we believe that, for global evidence synthesis initiatives to benefit from LMIC expertise and be relevant to LMIC settings, it is important to recognise the conceptual and practical challenges that this pandemic presents to our evidence synthesis organisations.

LMIC evidence communities are well placed to support evidence-informed decision making. They include established, locally driven, experienced centres of excellence that are part of technical and regional networks and trusted by decision makers. Our teams and our strong networks are invaluable in promptly getting the best available evidence into the hands of policy makers. However, these achievements are often despite—and not because of—the circumstances in which we work.

Many of us work in countries where there are complex challenges. Weak health systems in LMICs are generally struggling to make the necessary responses to the COVID-19 pandemic and the prevalence of comorbidities are putting our populations at increased risk of the direct and indirect consequences of the pandemic.² Paramount to poorer and conflict-affected states are the pre-existing, and rapidly worsening, vulnerabilities due to inequalities and inequities, unemployment, hunger, and malnutrition.³ Violence against women and children, unintended pregnancies, and risks to incarcerated populations are all escalating, as are disruptions to child vaccination programmes.⁴ In addition to the mental health strain caused by a pandemic,⁵ lockdowns, and resulting social and economic pressures, we are observing fear and stigma associated with COVID-19, quarantine, and isolation.⁶ Home evictions linked to job losses, low levels of public health information in some settings, and the presence of migrant workers and refugees have exacerbated xenophobia and social unrest in some LMICs.⁷ Older people, migrant workers, refugees, and students have all found themselves vulnerable and inadequately supported.⁸

In many countries, these challenges have come on top of entrenched economic, social, and political pressures and present considerable demands on researchers seeking to generate evidence in the COVID-19 response. The demand for evidence to inform decision making, and for effective implementation of such policies, typically outweighs our ability to respond. This situation is compounded by an increased demand for transparency, amid all the mistrust about science that some groups, including certain politicians, bring to the public discourse.⁹

As a broad community of evidence synthesis specialists based in LMICs, many of us are experiencing common difficulties arising from limited access to computer hardware and software, restrictions on database access, limited data storage capacity, inadequate data coverage, and low internet bandwidth. Our institutions, like many in poorer settings, are relying on the commitment of individuals, many of whom are using personal computers, living in unfavourable conditions, and working under pressure as they and their families and friends suffer the health, economic, and social impacts of the pandemic. Constrained funds are being repurposed from other projects to enable the increased efforts to generate timely and locally relevant evidence syntheses. In some cases, researchers are working without salaries or with job insecurity.

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Despite these practical challenges, above and beyond those faced by all researchers producing rapid reviews during this period,¹⁰ our networks continue to generate evidence syntheses to support our governments and strengthen their capacities and resilience. The value of the knowledge translation efforts and rapid response mechanisms to provide timely evidence synthesis is coming into its own, with evidence reaching the highest levels of governments. COVID-19 represents an opportunity to further strengthen and institutionalise evidence-informed policy making across LMICs. We encourage our governments to continue to make good use of, and invest in, the evidence services available to them.

Coordination of the research response to COVID-19 is not only crucial to avoid duplication and maximise benefits, but also to ensure that the capacity within LMICs is secured and strengthened for the benefit of us all. Local voices are important for the contextualisation and integration of evidence into decision making. These voices also have a role in shaping the global research agenda for this and future crises. Global initiatives to generate evidence for tackling COVID-19 and for the post-COVID-19 recovery must consider the conceptual and practical challenges faced by research teams in LMICs and recognise the need to strengthen and sustain the voices of LMIC researchers on a global scale. We call for much needed donor support to bolster LMIC evidence synthesis communities and their capacities. We need action from individuals, organisations, governments, and donors to enable and sustain the generation and use of evidence synthesis in LMICs if we are to tackle COVID-19 globally.