Global Living Evidence Platform

A platform of real-time evidence mapping, synthesis and monitoring to increase research value and provide decision makers and their intermediaries with the best quality, most up to date evidence to guide their response to the pandemic or health emergency.

The team leads are Isabelle Boutron (Prof of Epidemiology, Université de Paris, Inserm, Cochrane France, France) and Philippe Ravaud (Prof of Epidemiology, Université de Paris, Inserm, France)

Science is crucial to guide the best response to the challenges created by a pandemic. 

Despite massive amount of investment, the research response during this pandemic has been muddled, poorly coordinated and inefficient which led to waste of resources. Trial planning was hectic with more than 2 800 trials planned, frequently redundant and underpowered (half include less than 100 participants). 

Our ongoing monitoring of published trials’ quality showed that clinically important outcomes are frequently missing (eg, 50% RCTs were not reporting serious adverse events, 24% were not reporting all cause mortality); only 20% are at low risk of bias; 25% do not report main results as planned (switch in outcome); only 7% completely reported essential information as requested by international recommendations (Moher, BMJ 2010).

Furthermore, evidence syntheses, which is crucial to inform decision makers, lacked international coordination and infrastructure. It resulted in duplication, gaps and the proliferation of low-quality, outdated and rapid systematic reviews with conflicting results.

Finally, there was of an overabundance of misleading information rapidly disseminated which jeopardized the public health response with the implementation of policies that were not evidence-based. Access to trustful information and reliable guidance is needed.

Our solution serves the global research community, decision makers and the public in general:

• Journalists, general public and patients will have access to clearly presented and trustworthy information. This would help them better understand health evidence and limit the spread of false and misleading information.
• Physicians will have a clearer picture of the best therapeutic choices.
• Clinical practice guideline developers benefit from our publicly available databases to perform their own analysis; For example, the National Institute for Health and Care Excellence (NICE, UK), the Directorate National Department of Health (South Africa), the WHO Strategic Advisory group of Experts (SAGE) on Immunization are regularly using the curated data available to support their decisions.
• Governments and health authorities can make better informed decisions. 
• researchers and funders have access to an up-to-date picture of all research questions being investigated so as to prioritize research, identify gaps, avoid duplication and increase their research value. 


Stakeholders engagement

Interviews with stakeholders are ongoing. They are already shedding light on the impacts and importance of the platform, as well as insights on how to increase its audiences. We are also setting up stakeholder advisory groups (guideline developers; patients; trialists; funders) to guide us in our decisions.

The main public good provided by our solution are

1) Access to a source of curated data on ongoing research, updated in real-time, that can be used by anyone in the world. These data can be explored with various interactive tools and can be exported. These data are essential to guide and prioritize the future trials.

2) Access to a source of curated data on the validity of trials updated in real-time that can be used by anyone in the world.

3) An open-access to an accurate, up-to-date, and unbiased synthesis of available evidence on the efficacy and safety of any intervention for preventing or treating COVID-19. Data can be explored and tailored analyses can be performed. This information allows stakeholders to implement evidence-based decisions, disseminate accurate information and improve public health.

4) An increase in research value. The solution is useful to improve the quality, relevance, transparency and usefulness of primary research and evidence syntheses.

This solution will have considerable impact on the whole population:

1) Increase in research quality and transparency will provide more quickly trustworthy evidence of effectiveness and harms.

2) Access to high quality evidence syntheses informs health care decisions and improves public health

3) Access to high quality information will help tackle infodemic.

A quote for a key stakeholder relying on our solution clearly highlight its tangible impact:

“The COVID-19 pandemic has illustrated how poorly prepared we have been to mapping, summarising and acting on rapidly changing evidence on prevention and treatment. Initiatives such as COVID-NMA have been a Godsend to policy makers in the UK such as RAPID C-19 that has tried to speed up the process of evidence identification, evaluation and delivery to NHS patients by bringing together NICE, regulators (MHRA), the NHS and NIHR. The key now is to learn and prepare for future pandemics and health emergencies so that we hit the ground running next time for public good”

Hywel C. Williams former director of the NIHR Health Technology Assessment Programme NIHR, NIHR Scientific and Coordinating Centre Programmes Contracts Advisor.

The next one year will be dedicated to:

• Transformation of the platform’s user experience and data visualization to enable non-expert users access and experience the data - see below a map of the user experience we envision for the patients, designed by the Center for Design after a first round of users interviews:

• Implementation of the feedback mechanisms for improving research quality and reporting/transparency
• Strengthening the data warehouse
• Requesting individual patients data and providing a mapping of access to these data as well as conducting individual patient meta-analyses to identified patients most likely to benefit from treatments/vaccine

The longer term goals will be:

• Transforming the platform so it will be scalable, interoperable and sustainable
• Transforming the platform via a co-construction process involving collective intelligence for new users (patients, journalist, users from the public)
• Increasing our international partnerships and building coordination  

The success will be evaluated by:

1) Number of institutions relying on the data made available

2) Number of guidelines based on the data made available

3) Improvement in research value following the implementation of the feed-back loops (results posting, adherence to reporting guidelines, data sharing)

4) Number of access from other users (patients, public, journalists)

We will also survey users to evaluate impact of the platform.

The main barriers to accomplish our goal are financial resources.

Our international interdisciplinary and intersector solution team is able to provide all the expertise needed to accomplish our goals. However, financial resources are needed.

Currently, we have the resources to continue screening and extracting data for trials. However, we do not have the resources to transform our infrastructure and ensure scalability, interoperability and sustainability.

Further, we do not have the ressources to transform the platform and made it usable by patients, the public and journalists. 

Finally, currently, all the programming were tailored to the current situation (COVID-19 pandemic). However, we need to transform the infrastructure so it could be used for any public health condition.

• Université de Paris, Inserm
• Northeastern University
• University of Freiburg
• University of Southern Denmark
• National University of Ireland Galway
• University of Milan
• Pontificia Universidad Católica de Chile
• South African Medical Research Council
• University of Ioannina, Greece
• French National Centre for Scientific Research (CNRS)
• Université Paris Saclay
• Epistemonikos Foundation
• Cochrane
• COVID-END

Trinity challenge allowed initiating a very promising collaboration between the COVID-NMA initiative and the Center for Design at Northeastern University, Cochrane and COVID-End that will help with making our valuable data accessible to new users and stakeholders, broadening the scope and scale of the initiative.

We were able to elaborate a strong, innovative and ambitious project. Now, we need to implement it and the Trinity challenge will help overcoming the financial barriers.

We already have the relevant partners to achieve our goal.