‘Following the science’: the role of an independent advisory structure in the COVID-19 pandemic response and beyond

Background As the COVID-19 pandemic spread in 2020, many governments across the globe put structures in place to access rapid independent scientific evidence. The South African Minister of Health established an advisory committee in March 2020 to provide high-level strategic advice. This technical guidance, developed as topic-specific ‘advisories’, was expected to be context-specific and based on the best available evidence, locally and internationally. The authors developing the advisories could draw on systems-wide, multidisciplinary experience. Approach This chapter provides a reflective experience of the process of preparing advisories, the development of rapid evidence syntheses and their use in decision-making, the outputs and the lessons learned from that process, and the structural and operational changes over the course of the pandemic. As South Africa has moved out of the acute phase of the pandemic, the lessons learned must be embraced and best practices adopted to inform future pandemic preparedness. Advisories needed to use the best available evidence rather than wait for the best possible evidence. Some advisories were therefore revised multiple times, as new evidence emerged. Advisories were submitted to the Minister of Health for consideration prior to public release. However, in some cases, delays in such release led to confusion as to the scientific basis of policy decisions. The confidentiality of the committee debates also needed to be balanced against the need for engagement with the public. In order to promote accountability and build public trust, from March 2022 all advisories were published on a dedicated website within seven days of receipt by the Minister. The public were thus informed of the scientific basis of the advice, providing important context for subsequent executive decisions. Consistent feedback to the committee from decision-makers was also important, as their advice was only one of many inputs considered by a complex array of government bodies, across different departments. Conclusions The world faces a significant risk of further pandemics and other public health emergencies and is engaged in high-level negotiations on strengthening global capacity to respond. Whether that involves a global pandemic accord, strengthened International Health Regulations, or a strengthened global approach to medical countermeasures, rapid, credible, independent and country-specific scientific advice will remain essential. The lessons learned during COVID-19 should not be lost. Submitted on behalf of the Ministerial Advisory Committee on COVID-19.