Comparison of WHO versus national COVID-19 therapeutic guidelines across the world: not exactly a perfect match
Mia Cokljat, Cintia Valeria Cruz, Verena Ilona Carrara, Kanoktip Puttaraska, Camila Capriglioni, Sabrina Marcela Insaurralde, Maximo Rousseau-Portalis, Agustina Roldan, James A Watson, Joel Tarning, Nicholas J White, Professor Philippe J Guerin
BMJ Global Health, doi:10.1136/bmjgh-2023-014188
Background The COVID-19 pandemic affected all WHO member states. We compared and contrasted the COVID-19 treatment guidelines of each member state with the WHO COVID-19 therapeutic guidelines. Methods Ministries of Health or accessed National Infectious Disease websites and other relevant bodies and experts were contacted to obtain national guidelines (NGs) for COVID-19 treatment. NGs were included only if they delineated specific pharmacological treatments for COVID-19, which were stratified by disease severity. We conducted a retrospective review using the adapted Reporting Checklist for Public Versions of Guidelines (RIGHT-PVG) survey checklist and a derived comparative metric based on the WHO guidelines was performed. Results COVID-19 therapeutics NGs could be obtained from 109 of the 194 WHO member states. There was considerable variation in guidelines and in disease severity stratifications. Therapeutic recommendations in many NGs differed substantially from the WHO guidelines. Overall in late 2022, 93% of NGs were recommending at least one treatment which had proved to be ineffective in large randomised trials, and was not recommended by WHO. Corticosteroids were not recommended in severe disease in nearly 10% of NGs despite overwhelming evidence of their benefit. NGs from countries with low-resource settings showed the greatest divergence when stratified by gross domestic product per year, Human Development Index and the Global Health Security Index. Discussion Our study is limited to NGs that were readily accessible, and it does not reflect the availability of recommended medicines in the field. Three years after the start of the SARS-CoV-2 pandemic, available COVID-19 NGs vary substantially in their therapeutic recommendations, often differ from the WHO guidelines, and commonly recommend ineffective, unaffordable or unavailable medicines.
BMJ Global Health 4 Institute of Global Health, Faculty of Medicine, University of Geneva, Geneve, Switzerland 5 Laboratorio de Estadistica Aplicada a Ciencias de la Salud (LEACS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina 6 Instituto de Investigacion, Swiss Medical Group, Buenos Aires, Argentina 7 Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Twitter Cintia Valeria Cruz @MedicaMigrante Contributors CVC and MC are both first coauthors of this paper and responsible for the overall content as the guarantors. NJW, PJG, CVC and MC conceived the project. NJW, PG, JT, CVC and MC designed and implemented the study. CVC, MC and JAW conducted the statistical analysis. CVC led all aspects of project management and MC led all aspects of data extraction training and overseeing. CVC, MC, VIC, KP, CC, SMI, MR-P and AR were involved in acquiring the national guidelines and extracting the data. CVC and MC led the project and and wrote the first and final draft of the manuscript. VIC, KP, CC, SMI, AR, JAW, JT, NJW and PJG read and critically revised the manuscript. All authors read and approved the final manuscript. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research. Patient consent for publication Not applicable. Provenance and peer review Not commissioned; externally peer reviewed. Data availability..
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