Framing evidence synthesis production with the lens of sustainable knowledge

Systematic reviews are widely recognized as the cornerstone of evidence-based health decision-making. Individual studies are synthesized into coherent summaries, providing clarity amid the complexity of modern scientific research. However, the systematic review model is facing a crisis. The rapid increase in the number of reviews has paradoxically undermined their utility, with many becoming outdated, redundant, or of low quality. Despite methodological advancements and the introduction of rapid and living reviews, the evidence ecosystem remains fragmented and inefficient. In this paper, it is argued that current reform efforts fall short because the crisis is not addressed holistically, and the concept of "sustainable knowledge" is proposed to frame evidence synthesis with the lens of sustainability.Lessons learned during the COVID-19 pandemic and emerging innovations are drawn upon to reframe the problem as systemic, calling for a reconsideration of the entire lifecycle of systematic reviews, including their creation, updating, and application in practice. Stronger networks of collaboration are encouraged, alongside careful use of automation and artificial intelligence where genuine value is added. Academic incentives are suggested to be reshaped so that quality and relevance are prioritized over the sheer number of publications. It is proposed that by adopting sustainability as a guiding principle, systematic reviews can better fulfill their purpose of providing timely, high-quality, and actionable evidence for health decision-making.