Coproducing value during the COVID-19 pandemic.

Service users, professionals, and civil society all contribute to public health. Inclusion of all relevant actors in a network community coproduction approach can improve public health crisis responses. Using the Swiss canton of Vaud's COVID-19 response as an example, we describe ways in which a network approach can add value to public health services.

The acute onset of the COVID-19 pandemic, well managed in some nations by a top-down response from federal and regional authorities, has given way to a second, longer phase of the pandemic with a growing societal impact. In this extended phase, a community coproduction model [1], drawing on contributions from public health authorities, individual citizens and community groups, can augment traditional public health approaches. Pandemic response services can be improved in a value-creating network architecture where actors, which can include service users, professionals and/or civil society, are connected to facilitate information exchange and problem-solving [2, 3]. We demonstrate the potential of a network community coproduction approach using the Swiss canton of Vaud’s COVID-19 response as an example.

Collaboration

In the first phase of the pandemic, Swiss public health authorities adopted a classic crisis team approach, relying on top-down, centralized decision-making and dissemination to mitigate the novel crisis. A coproducing network of citizens and professionals is a better fit for the continuing second phase of the pandemic. This would involve exchange among citizens, public health authorities and civil society as those interdependent community members work together to manage the continued COVID-19 impact and coproduce better health and social outcomes.

Further, expert panels for pandemic crisis management often rely solely on biomedical expertise. A coproduced reaction to the pandemic should rely on citizen action as much as on development and production of diagnostics, therapeutics and vaccines. Therefore, adding social scientists to expert panels is warranted for the ongoing management of COVID-19.

Communication

Communicating information to citizens and health system stakeholders has been a key priority for Vaud public health authorities. These efforts began in a top-down manner, focused on disseminating directives through web pages and messaging campaigns. Public health authorities soon enhanced communication by providing a decision aid to citizens and health professionals to support evidence-based decisions about COVID-19 testing [4]. Additionally, public health authorities established a hotline through which citizens could seek individualized health advice about COVID-19 testing, symptoms and preventative measures. Public health authorities’ use of a dashboard, including key indicators such as incidence, hospitalizations, testing and contact tracing measures, helped inform where to target communication efforts.

A network approach would further improve these communication efforts. For example, broad top-down communication efforts are not accessed and understood consistently across populations, with differences common between age groups and literacy levels. Civil society organizations working together with the Vaud public health authorities could help engage and share key information with harder-to-reach populations within the canton.

Citizens

Vaud citizens have made extensive use of the canton’s hotline. The hotline benefits not only the individual citizens who call seeking support but also the public health authorities who manage the hotline. Through this hotline, the general public has taught public health authorities important information about the virus before it became known in the scientific community, including identifying common symptoms such as loss of taste and smell. Vaud citizens have also offered extensive feedback to public health authorities on the canton’s COVID-19 response. An electronic survey developed by public health authorities sought to assess citizens’ knowledge and attitudes about the COVID-19 recommendations enacted in Vaud—for example, whether the imposed public health measures were too strict or perhaps not strict enough. It was distributed through social media by community organizations and generated more than 450 responses from Vaud residents on the very first day of data collection [5]. Through participation in this survey, the general public contributed valuable insight about the canton’s pandemic response and informed future public health outreach efforts.

These public health authority efforts to engage citizens were helpful in the acute first phase of the pandemic response, although there was minimal resident involvement in ongoing dialogue and decision-making. In the extended continuing response to the pandemic, involving a working group made up of a network of residents from varied backgrounds in routine public health decision-making could improve the value that public health authorities contribute to health in Vaud communities.

Civil society

To increase collaboration during the first phase of the pandemic, public health authorities were contacted by community organizations including the university’s unit for participatory research and science dissemination. However, during the acute phases, these partnerships were limited in scope and depth. Public health resource limitations precluded more in-depth engagement. Civil society should play an important role in Vaud’s continuing response to the pandemic, particularly in supporting the practical and social needs of citizens. Involvement of community organizations would therefore improve both the outputs of the pandemic response (e.g. dissemination of information and resources) and its outcomes (e.g. better citizen well-being) [6].

Future directions

The Vaud COVID-19 response has prioritized best practices [7], including a hotline for disseminating information and giving advice to the public, a survey collecting public feedback on the canton’s approach and a dashboard tracking key indicators. However, current best practices for crisis management seldom include formal involvement of residents and civil society organizations within the management team. While a top-down crisis response was helpful during the pandemic’s acute first phase, incorporating a value-creating network approach will benefit continued pandemic response efforts. Formally involving Vaud residents and community organizations to contribute expertise could improve interaction between citizens and authorities, thereby enhancing the canton’s long-term response to COVID-19.