Coronavirus (618) Uncertainty amidst COVI-19 (3)

18 May, 2020

Dear David,

Thanks for opening the debate.

"Sometimes many mainstream experts think WHO or other respected authority has it wrong. For example, WHO recommends Depoprovera for all women, although many experts say it raises women’s HIV risk."

I would like to invite discussion on this interesting point. Namely, how do health professionals and scientists make their case if they disagree with current WHO guidance and recommendations? Perhaps we could learn from the example of 'mainstream experts' who disagree with WHO's guidelines of use of Depo-Provera? If experts think WHO has it wrong, they should presumably present their evidence and debate this publicly, through professional networks, conferences and the scientific literature. The relevant WHO guideline development group should be given a chance to respond and continue the debate iteratively.

As a general comment I think WHO has a very solid and rigorous approach to the development of guidelines and recommendations, and its recommendations transparently reflect the quality of all available evidence. This is why so many of us see WHO guidance as so valuable. Such guidance represents the best available synthesis of the best available evidence - and it remains flexible to new research and understanding. (This is in stark contrast to 20+ years ago, when guidelines and recommendations were based on the opinions of 'mainstream experts' rather than on a rigorous synthesis.)

"So my question is: How can HIFA help people accept that some issues are not at all settled, so there is no “best” advice about what to do in some situations?"

I think Shabina's response is spot-on here. I would also suggest the biggest problem in global health is not to do with a failure to recognise that an issue is not settled. There are always plenty of scientists and others who will question the current recommendations of WHO and others, and WHO guideline development groups are ready to review the available evidence as and when it changes. For me, the far bigger issue is the failure to translate the best available evidence (rigorously produced guidelines and recommendations) into actual policy and practice.

I look forward to learn more about this topic.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org