Time to Scale-up Research Collaborations to Address the Global Impact of COVID-19 – A Commentary

Abstract

Objective:

In this commentary, we suggest that the unprecedented global impact of the COVID-19 pandemic provides a compelling reason for researchers to stretch beyond usual limits and find new ways to engage in global collaborations.

Methods:

We point to data that have emerged on the mental health and economic consequences of the pandemic to illustrate the extent to which these common issues cross national borders. There is high likelihood that these burdens will continue to persist long after the pandemic is declared “over.”

Results:

We urge researchers, particularly those from countries with higher income economies, to share resources to increase international collaborative research efforts. We present a case study of an ongoing project and offer some lessons learned for individual investigators.

Conclusion:

Global problems require global solutions. The COVID-19 pandemic is a global crisis that should prompt researchers to engage in science and research across national borders.

The impact of the coronavirus 2019 (COVID-19) pandemic on human life and health has been devastating. In early April 2021, 15 months after the first COVID-19 case was confirmed outside of China, there were over 132 million global cases and 2.8 milliondeaths.¹ Stay-at-home orders and lockdowns were implemented in varying degrees across countries and some orders have continued nearly a year into the pandemic. The United States US, which has the highest number of deaths among nations, and other countries began implementing stay-at-home orders in March 2020, which were meant to reduce activities that contribute to community transmission of COVID-19.² Although a necessary, critical, and proven public health strategy for curbing community spread of the virus, long-term restrictions on population movement and physical distancing has never been practiced on this scale. As such, global data continue to emerge on the physical, mental, emotional, and financial consequences of the pandemic.

The Global Impact of the COVID-19 Pandemic

Emerging data suggest that the COVID-19 pandemic has taken a toll on mental health. Significantly elevated mental health and psychological challenges like depression and anxiety have been documented in multiple countries,^3,4 with more adults reporting symptoms of depression and anxiety compared to the pre-pandemic period.⁵ In addition to the disease and medical burdens associated with COVID-19, the social burdens caused by the pandemic have had significant effects on families, interpersonal relationships, and communities.^6–8 Quarantine and isolation protocols cause disruptions and increase caregiver burden for families in caregiving situations.^9,10 Studies also have shown increases in the prevalence of food insecurity and concerns about hunger in Bangladesh,¹¹ Australia,¹² the US,¹³ Mexico,¹⁴ and Uganda.¹⁵ Households in different countries also report reductions in monthly income or other struggles with finances and economic opportunities.^11,14,16 These are all common issues that manifest similarly across different cultural contexts.

Global Collaborations are Needed to Answer Global Questions

The COVID-19 pandemic is unlike any global disease event in more than 100 years, and the importance of global research collaborations cannot be understated. Now is the time for scientists and researchers to break away from academic silos to form globally coordinated research responses. Early on in the COVID-19 pandemic, contributions to the research literature were dominated by studies conducted in the US and China. These countries, along with the United Kingdom remain the primary funders of COVID-19-related research.¹⁷ Overall, international research collaborations have increased over the course of the pandemic compared to the pre-pandemic period. However, Lee and Haupt ¹⁸ demonstrate in their analyses of published research performed during the pandemic era that not all countries participated equally. Countries with relatively lower income economies were more likely to engage in global collaborations. They suggest that researchers in countries with higher income economies may have access to resources in terms of skillset, funding, and staffing to engage in research sufficiently and independently without need for outside collaborators. We argue that in times of global crisis, countries with higher income economies, in particular, should make reasonable efforts to share or offer resources to address global questions.

We recognize that this is a tall order and that truly effective and sustainable global collaborations require systematic organization, funding incentives, and political capital. However, we hold the view that even within our local institutions, laboratories, and research environments, individual investigators can take some small steps towards this goal. For example, uniform measures should be used to document the impact of COVID-19 on mental health and economic conditions worldwide so that datasets can be harmonized. Researchers working on COVID-related studies locally should consider ways they can share survey questionnaires and volunteer resources and labor to collaborate with colleagues across international borders. One way to do this is to tap into the networks of our professional organizations. Many large, discipline-oriented professional organizations have international members or sections. A query through the membership listserv to identify potential collaborators is a simple first step. This type of global collaborative thinking can help answer emergent research questions.

A Case Study – The MEHEWE Project

As a case study illustration, our team began as a hyper-local initiative to document the mental health and economic impact of the COVID-19 lockdown on a specific population of older people living with HIV in the US.¹⁹ What began as email correspondence among 3 investigators about a publication, subsequently resulted in a scaled-up project at a global level. This occurred without a funding source for the project, through key collaborations with academic colleagues in Nigeria and the US, and conceptual support and encouragement from public health colleagues at the Africa Center for Disease Control and Prevention and the WHO Regional Office for Africa. The study was termed the MEHEWE (Mental Health and Wellness Study Group; www.mehewe.com) project. Illustrating the global reach, data have been collected from over 21,000 people in 150 countries.

Preliminary descriptive analyses show that out of all participants in this global dataset, 4.7% reported having received a positive test for COVID-19, 11.2% had symptoms but did not test for COVID-19, and 17.1% reported that the pandemic severely impacted their lives. In terms of economic impacts, 7.8% reported job loss or had been laid off, 17.4% had lost or reduced wages, 3.3% lost their housing or became homeless, 18.2% had difficulty paying for basic needs and 11.3% were hungry because they could not afford to buy food. A large proportion (45.8%) reported being more socially isolated than before the pandemic, 13.5% reported the quality of relationship with family members worsened, 14.6% reported anxiety, and 8.5% reported depression because of the pandemic.

This effort consisted of nearly 50 researchers from multiple regions of the world, many of whom had never conducted international collaborative research prior to the pandemic. There were several key facilitators of team success. First, our collaborating group consists of a core team of lead researchers who were committed to data collection and as academic researchers, were motivated to write papers. Second, we designated a centralized data coordinating site from the beginning of the project to manage the global data and coordinate requests for datasets for manuscripts. Third, we established clear criteria for collaboration and authorship on papers leading to shared goals and vision. Fourth, we required signed data use agreements and a proposal process for analytical work plans to promote accountability for data use between and among partners and transparency by the data coordinating center.

IMPLICATIONS FOR HEALTH BEHAVIOR OR POLICY

The mental health and financial consequences of the COVID-19 pandemic are likely to have long-term effects. Multiple vaccines are now approved in many countries to help curb the spread of COVID-19 but millions of people worldwide will continue to face the mental health and economic consequences of the pandemic for some time to come. These are largely unknown due to the fact that this is a novel coronavirus. Researchers and mental health providers have cautioned that health systems will be tasked with addressing these COVID-19-related mental health needs but that the response could be stymied by the pandemic-related economic breakdown worldwide and burnout of those who normally would be available to address the needs.²⁰ Low-income and middle-income countries may continue to be particularly hard hit where existing inequities are exacerbated, and continued research is needed to highlight socioeconomic disparities to plan for a coordinated response in the aftermath of the pandemic. Kelley et al²¹ state that outbreaks can amplify existing vulnerabilities and inequities. Collaborating across sectors and geography has never been more urgent.

The World Health Organization (WHO) has increasingly recognized the importance of mental health as evidenced by its inclusion in the United Nations Sustainable Development Goals. These are a series of goals and targets that Member States have agreed to work towards achieving by the year 2030 to achieve a world “free from poverty, hunger, and disease”²² The WHO has called for increased investments to tackle all aspects of mental health including efforts to raise awareness, reduce stigma, and increase access to quality mental healthcare and effective treatments. The challenges brought on by the COVID-19 pandemic has exacerbated existing insults to mental health and reiterate the need for immediate and continued efforts for global collaborations to address mental health issues.