A multinational Delphi consensus to end the COVID-19 public health threat.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic^1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches¹, while maintaining proven prevention measures using a vaccines-plus approach² that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities³ in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

The effect of COVID certificates on vaccine uptake, health outcomes, and the economy.

In the COVID-19 pandemic many countries required COVID certificates, proving vaccination, recovery, or a recent negative test, to access public and private venues. We estimate their effect on vaccine uptake for France, Germany, and Italy using counterfactuals constructed via innovation diffusion theory. The announcement of COVID certificates during summer 2021 were associated - although causality cannot be directly inferred - with increased vaccine uptake in France of 13.0 (95% CI 9.7-14.9) percentage points (p.p.) of the total population until the end of the year, in Germany 6.2 (2.6-6.9) p.p., and in Italy 9.7 (5.4-12.3) p.p. Based on these estimates, an additional 3979 (3453-4298) deaths in France, 1133 (-312-1358) in Germany, and 1331 (502-1794) in Italy were averted; and gross domestic product (GDP) losses of €6.0 (5.9-6.1) billion in France, €1.4 (1.3-1.5) billion in Germany, and €2.1 (2.0-2.2) billion in Italy were prevented. Notably, in France, the application of COVID certificates averted high intensive care unit occupancy levels where prior lockdowns were instated.

Vaccinate fast but leave no one behind: a call to action for COVID-19 vaccination in Spain.

During the first five months of 2021, Spain's COVID-19 vaccination campaign progressed slowly and failed to reach marginalised populations. Here, we discuss how, despite recent improvements, it remains important to further engage key stakeholders to ensure nobody is left behind.

Elimination versus mitigation of SARS-CoV-2 in the presence of effective vaccines.

There is increasing evidence that elimination strategies have resulted in better outcomes for public health, the economy, and civil liberties than have mitigation strategies throughout the first year of the COVID-19 pandemic. With vaccines that offer high protection against severe forms of COVID-19, and increasing vaccination coverage, policy makers have had to reassess the trade-offs between different options. The desirability and feasibility of eliminating SARS-CoV-2 compared with other strategies should also be re-evaluated from the perspective of different fields, including epidemiology, public health, and economics. To end the pandemic as soon as possible-be it through elimination or reaching an acceptable endemic level-several key topics have emerged centring around coordination, both locally and internationally, and vaccine distribution. Without coordination it is difficult if not impossible to sustain elimination, which is particularly relevant in highly connected regions, such as Europe. Regarding vaccination, concerns remain with respect to equitable distribution, and the risk of the emergence of new variants of concern. Looking forward, it is crucial to overcome the dichotomy between elimination and mitigation, and to jointly define a long-term objective that can accommodate different political and societal realities.

Green zoning: An effective policy tool to tackle the Covid-19 pandemic.

Green zoning has emerged as a widely used policy response to tackle the Covid-19 pandemic. 'Green zones'-areas where the virus is under control based on a uniform set of conditions-can progressively return to normal economic and social activity levels, and mobility between them is permitted. By contrast, stricter public health measures are in place in 'red zones', and mobility between red and green zones is restricted. France and Spain were among the first countries to introduce green zoning in April 2020. Subsequently, more and more countries followed suit and the European Commission advocated for the implementation of a European green zoning strategy, which has been supported by the EU member states. While there remain coordination problems, green zoning has proven to be an effective strategy for containing the spread of the virus and limiting its negative economic and social impact. This strategy should provide important lessons and prove useful in future outbreaks. Research in epidemiology indicates that thoroughly implemented and operationalised green zoning can prevent the spread of a transmittable disease that is poorly understood, highly virulent, and potentially highly lethal. Finally, there is strong evidence that green zoning can reduce economic and societal damage as it avoids worst-in-class measures.