Leadership in public health crisis: a review to summarize lessons learned from COVID-19 pandemic

Abstract Background During the COVID-19 pandemic, several public health challenges were faced, requiring worldwide leaders able to direct, guide, and establish appropriate strategies. The aim of this review was to summarize evidence on public health leadership during the COVID-19 era. Methods The systematic literature review was conducted according to the PRISMA 2020 checklist. A search of relevant articles was performed in the PubMed, Scopus, and Web of Science databases. Eligible articles were any type of publication, published between 2020 and 2022, that outlined one or more characteristics of effective public health leadership during the COVID-19 pandemic We excluded all articles that did not explicitly address the COVID-19 pandemic or had a different setting. Results A total of 2499 records were screened, and 45 articles were included. We identified 93 characteristics, clustered in six groups, that were reported as fundamental to be an effective leader in public health crises worldwide. Emotional intelligence and human traits (reported by 46.67% of the articles) were considered essential to build trust in the population and ensure cooperation with working groups. Communication skills (47%) are considered necessary to enable people to understand and accept measures. A supportive, multidisciplinary team and accountability mechanisms (33,33%) were highlighted as central elements, especially in the international field, to ensure reliability and consistency in action. Management skills (35,56%), adaptability (44,44%), and evidence-based approach (33,33%) were reported as key capabilities to ensure a prompt and rapid response to the challenges created by the pandemic. Conclusions The identification of the attributes of an effective public health leader conducted in this study is useful in choosing the key personalities who must lead public health today and in the training of tomorrow's European and worldwide leaders to be ready to face future threats. Key messages • Effective public health leaders in crisis are empathetic and trustworthy people, who have developed management and communication skills, and are able to make timely and evidence-based decisions. • In order to create leaders capable of facing future threats, more emphasis in the training of public health workforce on soft skills and management competencies should be recommended.

Evidence-informed decision-making (EIDM) requires the balancing of numerous and often conflicting factors. During the SARS-CoV-2 pandemic, sound and fair EIDM procedures were challenged by time constraints and limited evidence. Beneficial effects had to be weight against public health impacts beyond COVID-19, broad societal consequences, or individual liberties. Evidence-to-decision (EtD) frameworks are neither able nor intended to replace stakeholder participation, but can serve as a tool to ensure the relevance and completeness of criteria to be considered for EIDM in public health and guideline development. Employing 'best-fit' framework synthesis, we used the WHO-INTEGRATE framework as a starting point to develop the WHO-INTEGRATE COVID-19 framework version 1.0. WICID 1.0 is based on a content analysis of comprehensive strategy documents to guide policy makers in implementing new or decrease existing measures to protect against COVID-19 in Germany. WICID 1.0 was validated by coding the framework against an updated set of the key strategy documents, and key strategy documents addressing non-pharmacological measures in long-term care facilities. In total, 12 key strategy documents were analysed to develop WICID 1.0, and 18 + 23 documents were analyzed for its refinement towards WICID 2.0. The revised framework consists of 11 + 1 criteria and includes implications for the health of individuals and populations due to and beyond COVID-19, infringement on liberties and fundamental human rights, acceptability and equity considerations, societal, environmental and economic implications, as well as implementation, resource and feasibility considerations. Validation found high consistency with minor revisions between WICID 1.0 and 2.0. WICID can be a tool to support researchers, practitioners, and policy makers to systematically integrate evidence and ethics and to balance of health, societal and other considerations when reflecting on PH interventions targeting COVID-19. Key messages: Due to the rapidly developing pandemic, decision-making process often did not include the views of all affected stakeholders and did not adequately include all criteria and considerations of relevance.
The WICID Framework can serve as a tool to support decision-makers in accounting for relevant considerations and criteria, even when not all stakeholders could be included.

9.B. Pitch presentations: Lessons learned from COVID-19
Background: During the COVID-19 pandemic, several public health challenges were faced, requiring worldwide leaders able to direct, guide, and establish appropriate strategies. The aim of this review was to summarize evidence on public health leadership during the COVID-19 era.

Methods:
The systematic literature review was conducted according to the PRISMA 2020 checklist. A search of relevant articles was performed in the PubMed, Scopus, and Web of Science databases. Eligible articles were any type of publication, published between 2020 and 2022, that outlined one or more characteristics of effective public health leadership during the COVID-19 pandemic We excluded all articles that did not explicitly address the COVID-19 pandemic or had a different setting.

Results:
A total of 2499 records were screened, and 45 articles were included. We identified 93 characteristics, clustered in six groups, that were reported as fundamental to be an effective leader in public health crises worldwide. Emotional intelligence and human traits (reported by 46.67% of the articles) were considered essential to build trust in the population and ensure cooperation with working groups. Communication skills (47%) are considered necessary to enable people to understand and accept measures. A supportive, multidisciplinary team and accountability mechanisms (33,33%) were highlighted as central elements, especially in the international field, to ensure reliability and consistency in action. Management skills (35,56%), adaptability (44,44%), and evidence-based approach (33,33%) were reported as key capabilities to ensure a prompt and rapid response to the challenges created by the pandemic.

Conclusions:
The identification of the attributes of an effective public health leader conducted in this study is useful in choosing the key personalities who must lead public health today and in the Background: More than two years into the pandemic, many European countries have begun to evaluate their COVID-19 public health responses and draw lessons for future preparedness. As the COVID-19 crisis has exacerbated intersectional social and health inequalities, it is pertinent to evaluate the extent to which COVID-19 responses have successfully responded to the diverse needs of various vulnerable groups. We present a comparative analysis of how evaluations of European COVID-19 responses have assessed efforts to adapt or tailor COVID-19 responses to vulnerable groups, focusing on public testing and tracing strategies and vaccination campaigns.

Methods:
We draw on data collected in the H2020 project COVINFORM. We combine insights from qualitative interviews conducted with public health policy-and decision makers in COVINFORM partner countries with a document review of available evaluations of COVID-19 responses published by both government and academic actors between March 2020 and June 2022.

Results:
Across countries, evaluations of COVID-19 responses show that efforts to adapt or target public health responses to specific vulnerable groups became more common as the pandemic stretched on. Differences across countries were observed in relation to which groups were considered particularly vulnerable; the types of responses considered successful; as well as the organisational/governmental level at which responses were coordinated. Analyses reveal that the heavy emphasis on medical vulnerability distracted from efforts to address broader, structural inequalities, complicating the development of tailor-made policies.

Conclusions:
The results inform ongoing policies that deal with the longterm consequences of the COVID-19 pandemic and aim to reduce disproportionate impacts faced by vulnerable groups. Our findings also add to a better understanding of how future preparedness structures should take into account how pandemic measures have unequal impacts.

Key messages:
As the COVID-19 crisis has exacerbated intersectional social and health inequalities, it is important to learn from efforts to adapt or tailor COVID-19 responses to vulnerable groups. The findings demonstrate how across Europe, the combination of particular sets of country-specific COVID-19 responses, tailor-made or not, yield specific consequences for vulnerable groups.
Brazil is one of the countries with the highest COVID19 mortality numbers. COVID19 deaths affected disproportionally different populations/communities, tending to be higher among more vulnerable ones. Brazil has a public-funded unified health system (SUS) built on the aegis of equity and social control. Its Primary Health Care (PHC) is organized by the Family Health Strategy (FHS) through Family Health Teams (FHT), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, health promotion activities, and serve as liaisons between health units and communities. In this context, CHAs have the potential to play an important role in fighting the pandemic by working on contact tracing, collecting information on infected people, and providing guidance to them and the community in order to contain community transmission. However, not much is known about their readiness regarding the COVID19 pandemic in one of the Brazil's poorest regions. Thus, this study evaluated, though CHA perspective, aspects related to their preparedness for COVID19 in Brazil's northeast region. Questionnaires were applied to CHAs from 8 different municipalities -4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed at their workplace in 2021. 77.8% said that they were acting in the COVID19 frontline, but only 16% referred to have received training for this function. Furthermore, only 13.7% mention to have had access to adequate individual protective equipment during their work, and 91.6% believe that they can get infected by SAR-COV-2 during their work duties. Additionally, 93.9% considered themselves a transmission vehicle due to work. Despite their potential in the fight against COVID19, CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic. Key messages: CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic. Addequate trainning and work environment are essencial for proper work development.
Abstract citation ID: ckac129.547 The top three causes of prematuremortality in Belgrade 2020