New year, new hope

This edition of the International Journal of Risk & Safety in Medicine includes an article by Breggin on the MMR vaccine – autism controversy. He takes up two issues: the temporal pattern of the supposed relationship and the definition of autism. It reminds us that vaccination on a large scale, particularly with new vaccines, will almost inevitably be followed by reports of clinical events, many of which will be only temporally, not causally, associated with the vaccine, but which all will need careful evaluation.

There is a great and justifiable relief that, after an unprecedented rapid development phase, the world now has an arsenal of effective vaccines against the new corona virus; but as the deployment starts we must consider if the world is equipped to manage not only the challenging logistics of this enormous undertaking, but the safety monitoring, risk assessment and communication of still evolving knowledge.

With COVID-19, as with all new global threats, complexity and uncertainty are the main ingredients. It takes time before we have learnt enough to know what the best course of action is, for the affected individuals, and for society as a whole. History should by now have shown us that responsive and responsible communication is key in building and maintaining public trust in decision makers. Unless communication is made with consideration to what may be unfounded but understandable fears, even the slightest perceived increased risk of harm - or the possibility that new mutations will render the vaccines ineffective - may have a strong negative impact on the willingness to get vaccinated.

Transparency is a major challenge since most of the public will wish to know what is happening. There will be different needs for different people, varying from those who are expert to those with no relevant knowledge; and varying from those with a rapid grasp of new issues and those without. Public trust will only come if the majority feel their needs are fulfilled, and that those charged with responsibility for action are capable of managing the known threats and working rapidly and effectively to handle and reduce uncertainty. This includes making clear that any actions taken must be regarded as tentative, and that they will be actively monitored for success or failure. Any changes needed should be presented, with the reasons justified and openly explained, so that professionals involved and the public are appropriately informed.

Because of the complexities and differences associated with COVID-19 management across different countries, worsened by political controversies and sometimes misleading, even false news, there can be little disagreement that many feel that the situation is chaotic.

It appears to us that the challenges the world faces cannot, and should not, be evaluated and managed piecemeal by individual nation states: the potential for conflict is much too serious. Given that a problem is global, a global framework is desirable so that all territories can feel that their specific needs are considered and that they are supported and not ignored.

How do we achieve a global framework and concerted effort that brings the best outcomes for individuals, and for humanity as a whole?

We already have the United Nations, the World Health Organization, and world economic groups such as the Word Bank and World Economic Forum as posited global authorities, but are they playing their parts fully and with maximum benefit?

It would seem from media reports that they are criticized from time-to-time by many countries and regions for not representing them and their problems. To avoid this, global organisations should have active expert input selected for a specific global crisis context; with every territory appointing experts of their choice to the international bodies from all major disciplines relevant to the emergency. In a pandemic these might be experts in hospital care, general public health care, epidemiology, sociology, economics, microbiology, vaccination, logistics etc.

From the outset, all the above expert groups should be tasked not only with producing plans in their own areas of expertise, but working together to produce a global holistic outline plan of actions, taking all aspects of the crisis into account. This requires open and constructive interaction going beyond the self-interest of nations and various interest groups. One prerequisite is a selection process that is transparent and seen as fair, both in terms of competence and representation. Another is transparency of the work being done. Expert working groups often deliberate out of the public eye until the final reports are ready. This should change by introducing open peer reviews of ongoing work, providing opportunities to scrutinise not only the evidence and metrics involved, but the choice of expert knowledge.

It is, however, national politicians who have the final authority over the way expert evidence is used, and trust in governments has been of concern. How politicians interpret expert advice must naturally lead to some differences in utility depending on the circumstances within each territory. They should ensure that decisions, utilities and operations to achieve agreed international goals in the global plan are fulfilled. In our view, they should be judged by their ability to see to that proposals and guidelines are implemented with wisdom, justice, humanity, empathy and practices that will improve the circumstance and self-fulfillment of all humans and living things on earth.

An open and honest global peer review system should be extended also to include e.g. philosophers, psychologists, ecologists, lawyers, decision theory experts and others that would also be able to signal where there are neglected humanitarian considerations and if there is overriding self-interest, indulgence and corruption. Such review should alert us all to risk situations and recommend actions, with an emphasis on correction, not on recrimination or retribution (unless the failures are gross).

We can imagine many will say that all this is in place. Others will think that a stronger holistic global framework is impractical, that it infringes on sovereignties, that it impinges on political practices, that it undermines evidence-based practices and there will be many other criticisms. We, however, believe that unless there is a future that has a prime motivation of love over hate, cooperation rather than competition, the prospect for individuals self-fulfillment rather than just material gain, and finally conscious and conscientious care for our planet we will be facing more global catastrophes.

Is all this a concern for the International Journal of Risk & Safety in Medicine? Let us know what you think.

I. Ralph Edwards and Marie Lindquist