The use of evidence to guide decision-making during the COVID-19 pandemic: Divergent perspectives from a qualitative case study in British Columbia, Canada (preprint)

Background: The challenges of evidence-based decision-making in a public health emergency have never been so notable as during the COVID-19 pandemic. Questions about the decision-making process, including what forms of evidence were used, and how evidence informed – or did not inform – policy have been debated. Methods: We examined decision-makers' observations on evidence-use in early COVID-19 policy-making in British Columbia (BC), Canada through a qualitative case study. From July 2021- January 2022, we conducted 18 semi-structured key informant interviews with BC elected officials, provincial and regional-level health officials, and civil society actors involved in the public health response. The questions focused on: 1) the use of evidence in policy-making; 2) the interface between researchers and policy-makers; and 3) key challenges perceived by respondents as barriers to applying scientific evidence to COVID-19 policy decisions. Data were analyzed thematically, using a constant comparative method. Framework analysis was also employed to generate analytic insights across stakeholder perspectives. Results: Overall, while many actors’ impressions were that BC's early COVID-19 policy response was evidence-informed, an overarching theme was a lack of clarity and uncertainty as to what evidence was used and how it flowed into decision-making processes. Perspectives diverged on the relationship between 'government' and public health expertise, and whether or not public health actors had an independent voice in articulating evidence to inform pandemic governance. Respondents perceived a lack of coordination and continuity across data sources, and a lack of explicit guidelines on evidence-use in the decision-making process, which resulted in a sense of fragmentation. The tension between the processes involved in research and the need for rapid decision-making was perceived as a barrier to using evidence to inform policy. Conclusions: Areas to be considered in planning for future emergencies include: information flow between policy-makers and researchers, coordination of data collection and use, and transparency as to how decisions are made—all of which reflect a need to improve communication. Based on our findings, clear mechanisms and processes for channeling scientific evidence into decision-making need to be identified, and doing so will strengthen preparedness for future public health crises.

Investigating the influence of institutions, politics, organizations, and governance on the COVID-19 response in British Columbia, Canada: A jurisdictional case study protocol (preprint)

Background:Research on public health responses to COVID-19 globally has largely focused on understanding the virus’ epidemiology, identifying interventions to curb transmission, and assessing the impact of interventions on outcomes. Only recently have studies begun to situate their findings within the institutional, political, or organizational contexts of jurisdictions. Within British Columbia (BC), Canada, the COVID-19 response in early 2020 was deemed highly coordinated and effective overall; however, little is understood as to how these ‘upstream’ factors influenced policy decisions.Methods:Using a conceptual framework we developed, we are conducting a multidisciplinary jurisdictional case study to explore the influence of institutional (I), political (P), organizational (O), and governance (G) factors on BC’s COVID-19 public health response in 2020-2021. A document review (e.g. policy documents, media reports) is being used to: (1) characterize relevant institutional and political factors in BC; (2) identify key policy decisions in BC’s epidemic progression; (3) create an organizational map of BC’s public health system structure; and (4) identify key informants for interviews. Quantitative data (e.g. COVID-19 case, hospitalization, death counts) from publicly accessible sources will be used to construct BC’s epidemic curve. Key informant interviews (n = 15-20) will explore governance processes in the COVID-19 response and triangulate data from prior procedures. Qualitative data will be analyzed using a hybrid deductive-inductive coding approach and framework analysis. By integrating all of the data streams, our aim is to explore decision-making processes, identify how IPOG factors influenced policy decisions, and underscore implications for decision-making in public health crises in the BC context, and elsewhere. Knowledge users within the jurisdiction will be consulted to construct recommendations for future planning and preparedness.Discussion:As the COVID-19 pandemic evolves, governments have initiated ‘post-mortem’ examinations of their policies to identify lessons learned. Our conceptual framework articulates how interrelations between IPOG contextual factors might be applied to such analysis. Through this jurisdictional case study, we aim to contribute findings to strengthen governmental responses and improve preparedness for future health crises. This protocol can be adapted to and applied in other jurisdictions, across sub-national jurisdictions, and internationally.