Building trust and global cooperation is critical to halting COVID-19 threat

Published online 3 November 2022

A multinational panel calls for coordinated global action to strengthen healthcare infrastructures to end the pandemic.

Lara Reid

Phil Lowe / Alamy Stock Photo
Complex challenges remain if the world is to comprehensively end COVID-19 as a public health threat. The global response has been hindered by wider political, social and behavioural factors, such as the erosion of trust and the spread of misinformation. 

Governments need robust, effective recommendations that all countries agree on, which are viable and can be implemented quickly, and that stand the test of time should another pandemic arise. To facilitate consensus across nations, Jeffrey Lazarus of the Barcelona Institute for Global Health (ISGlobal), in Spain, convened a multidisciplinary panel of 386 experts from 112 countries to recommend specific actions to end this pandemic threat.  

“The panel unanimously agreed that managing a pandemic must involve the whole of society: everyone’s talents, skills and persistence are needed,” says Lazarus. “However, none of our recommendations will be implemented if we do not act vigorously to restore trust in governments, in health systems, and most of all, in each other.”

Lazarus’s team employed a specific methodology known as the Delphi consensus method to put forward statements of potential action to the panel for consultation over several rounds. In each round, the statements were ranked and refined, until the panel agreed on a set of 41 statements and 57 recommendations across six major areas: communication, health systems, vaccination, prevention, treatment and care, and inequalities. 

“To be clear, we do not think that governments have failed completely to control COVID-19,” says Lazarus. “However, most of them initially underestimated the enormity of the problem and many have tried to take a victory lap before the chequered flag has been waved.”

The highest-ranked recommendations involve ‘whole-of-society’, ‘whole-of-government’ and ‘vaccine-plus’ approaches. These are designed to enhance cohesive efforts between countries, address resilience in healthcare systems, and tackle behavioural factors such as the spread of misinformation. 

“In the battle against COVID-19, the first casualty was almost certainly trust. Trust in science. Trust in governments. Trust in each other,” says Lazarus. “To end this public health risk, decision-makers must address human behaviour as it is now, not how we’d like it to be. Effective, consistent communication lies at the heart of this.” 

The panel highlights the vital need for adequate ventilation and air filtration in enclosed spaces, particularly public spaces and healthcare settings. Widespread mask wearing is of significant benefit, particularly for vulnerable groups, while all protective measures reduce the considerable impacts of long COVID. 

“This ‘whole of society’ approach is critical, and there is much to be done in the Middle East in this regard,” says Onder Ergonul at Koç University in Istanbul, Turkey, who was on the study’s consensus panel. “Inequity is a major challenge of this pandemic, and there are fundamental inequalities between the health systems in North African countries and those in the Arab Gulf.” 

In recent years, Arab Gulf countries have prioritized spending on health, meaning their infrastructure and provision of therapeutics and vaccines is better than North African nations, notes Ergonul. The infrastructure underpinning all health systems in the region must be strengthened, and Ergonul believes this requires improvements to the organisation of society as a whole. 

“Community leaders, scientific experts and public health authorities should collaborate to develop clear, accurate public health messages that enhance trust,” says Ergonul. “We must prioritize equal access to healthcare provision. Distribution of vaccines is important, but countries with well-organized healthcare and better communications achieve faster, more effective results.”

“Despite what many leaders and individuals are saying, the COVID-19 pandemic is not over. We cannot wish it away,” says Lazarus. “We must work together better to bring this public health crisis to a more durable conclusion, and be better prepared for future global health emergencies.”  


Lazarus, J.V., et al. A multinational Delphi consensus to end the COVID-19 public health threat. Nature (2022).