PHIRI Rapid Exchange Forum (REF): A key tool for cross-country exchange in times of crisis

Abstract   The COVID-19 pandemic demanded a quick exchange between experts and institutions supporting national governments in the crisis response literally from the first day onward to provide evidence-based information. There was no such regular cross-country forum established in the field of population health in the beginning of the crisis. Thus, devoted members of the Joint Action on Health Information started already in April 2020 to meet regularly online to foster cross-country exchange. In these meetings, partners could approach each other for questions and shared views in a trusted environment. The European Commission recognized this achievement and supported this exchange as part of the Population Health Research Infrastructure (www.phiri.eu), allowing a quick exchange of data, indicators, good practices and experiences in the COVID-19 crisis response in an efficient manner. Till May 2022 34 REF meetings have taken place, involving project partners, national advisors to ministers/heads of agency, representatives of expert networks (e.g. Healthy Cloud), EU services (ECDC, JRC) and different health stakeholders (e.g. ELIXIR). The bi-weekly 1 hour online meetings cover in a moderated, structured format pre-agreed COVID-19-topics that are proposed by the participating countries and chosen via a survey ex-ante to each meeting). Responses by the countries (backed up by national reports, andguidelines that are briefly presented in the meetings) are compiled and shared immediately after the meeting via the Corona-Corner of the Health Information Portal (www.healthinformationportal.eu/rapid-exchange-forum). Topics covered reach from a discussion on suitable non-pharmaceutical interventions and their application especially prior to the availability of vaccines to child vaccination strategies and overall testing regimes to the most suitable communication tools. In average, 25 to 30 delegates from different, mainly EU member states attend each exchange. Key messages • The PHIRI Rapid Exchange Forum demonstrated its importance for regular decision making in the field of population health not only in times of crisis. • The Rapid Exchange Forum is an integral part of the European Health Information Portal (www.healthinformationportal.eu) which shall be transformed into a sustainable infrastructure.


Issue:
Infodemics (i.e., overflow of information in physical and digital spaces that makes it difficult for people to make good health decisions) can undermine emergency response, but capacity for infodemic management has been limited in countries thus far. Specifically, there is a need to build capacities in the field with practical and scalable tools. Description of the problem: WHO has developed tools and trainings to quickly build and enhance infodemic management (IM) capacity at the countrylevel, such as tools for rapid generation of IM insights and a framework for conducting landscape analyses to establish sustainable IM capacities. These were developed in collaboration with multidisciplinary experts who provided feedback. We sought to create tools that can be a basis for introducing evidence-generation in health information systems to inform emergency preparedness and response, and mainstream methods into routine infodemic diagnostics activities.

Results:
The tools and trainings provide a comprehensive framework for diagnosing and addressing infodemics, such as a public health taxonomy to guide digital intelligence analysis and integrated analysis methods for generation of actionable insights. Additionally, the landscape analysis framework outlines steps for assessing strategic needs and assets for routinizing IM functions as part of existing public health systems and programs.

Lessons:
The tools and trainings will be deployed in the field to evaluate utility. Feedback from users in the global WHO infodemic manager community will be systematically captured.

Key messages:
Field responders need practical tools and trainings that guide quick infodemic response during health emergencies. These tools and trainings can be used to diagnose and intervene on infodemics, even in settings where infodemic insights units are not yet established.

Issue:
The COVID-19 pandemic and current recovery efforts have been complicated by a parallel infodemic. The infodemic has manifested itself in the rapid spread of questions, concerns and misinformation that can affect population attitudes and behavior harmful to health -promoting stigma and discrediting science, non-recommended treatments and cures, politicizing health programs and eroding trust in health workers and health systems. Description: WHO's COVID-19 Pillar 2 (risk communication, community engagement and infodemic management) developed an integrated public health infodemic insights methodology for weekly analysis of social media, traditional media and other data sources to identify, categorize, and understand the key concerns and narratives expressed, and inform risk communication and response activities.

Results:
The infodemic characterization, integrated analysis and insights generation consisted of a 3-step mixed-methods approach. First, data was collected from publicly available social and news media and categorized into categories of conversations by a COVID-19 public health taxonomy. Second, the dataset was analyzed and compared week-onweek to identify changes in narratives and conversation sentiment. Third, the digital infodemic intelligence was reviewed by a group of subject matter experts and triangulated with other data sources to derive infodemic insights and provide recommendations for action for the week. The methodology has been applied to inform COVID-19 response, COVID-19 vaccine demand promotion, and preparing for mass gatherings or mass immunization campaigns.

Lessons:
The methodology for infodemic intelligence generation and integration has introduced evidence-based analytical practices for generation of infodemic insights and recommendations for action into the work of WHO. It must be further adapted for use by different health programmes and preparedness functions, and is described WHO Field Infodemiology Manual.

Key messages:
Health authorities can use infodemic insights to respond to people's concerns, questions and information deficits in a timely and effective manner. An evidence-based methodology has been developed and validated to generate infodemic insights and recommendations for action during an acute health event or emergency.

Background:
In the Netherlands, since 2015, a paradigm shift towards client-centred 'care for youth' initiated a focus on client autonomy, enabling clients to make informed decisions in their care process. Client autonomy is assumed to positively correlate with mental and physical health and can be strengthened by autonomy-supportive behaviour from professionals. Aiming for client autonomy, three organizations developed an electronic health record (EPR-Youth), accessible for parents and adolescents. Although research shows that patient-accessible records contribute to patient autonomy, limited research is available about use of such records among adolescents. We investigated whether use of EPR-Youth in 'care for youth' contributed to experienced autonomy among adolescents and parents, and what role professional autonomysupportive behaviour played.

Methods:
A mixed methods design combined baseline and follow-up questionnaires with focus group interviews, over a two-year period. Clients completed a questionnaire about experienced autonomy and portal use at baseline (1202 parents, 202 adolescents) and after one year (914 parents, 89 adolescents). Professionals completed questionnaires about autonomysupportive behaviour at baseline (N = 100), after 5 months (N = 57) and 24 months (N = 110). After 14 months, focus group interviews were held with a purposive sample of parents (N = 8), adolescents (N = 4) and professionals (N = 12).

Conclusions:
The use of EPR-Youth was associated with increased autonomy among parents and adolescents. Autonomy-supportive professional behaviour enhanced this effect. Key messages: The possible contribution of EPR-Youth to client autonomy is promising, but follow-up research is needed to strengthen evidence. Implementation of client-accessible records with the aim to enhance client/patient autonomy needs to address autonomy-supportive professional behaviour to increase impact.
Access to medicines, equity and fair pricing have been intensely debated in the context of EU policies and global health priorities for many years prior to the COVID-19 pandemic. To this effect, there have been efforts to develop mechanisms to jointly assess health technologies (HTA Regulation) and to establish cross-border partnerships for price negotiation and procurement. Although TFEU (art.168) is limiting the scope of activities and decisions to be taken at the EU level for public health matters, the Commission has also played an active part in global health discussions in the G20 and in the G7 since 2010, and there is explicit commitment to SDGs, and in particular UHC (SDG3.8) 'leaving no one behind' (2019). Indeed, according to its commitments ''the EU advocates equitable, universal and high-quality healthcare coverage and promotes fair, effective financing of research to benefit the 15th European Public Health Conference 2022