Incomplete assessments: Including harms and trade-offs in assessing policy approaches to Covid-19

Policies to combat COVID-19 were often implemented without a systematic assessment of trade-offs with other public objectives. This approach implicitly assumed that these policies would do little harm to other aspects of public health. Recently published evaluations of pandemic-era policies have also largely avoided cost-benefit (or harm-benefit) analysis in public health decision-making. This is likely due to a narrow framing of their analyses to the possibility of underreaction to the pandemic. We argue that a disproportionate policy response framework can offer a valuable toolkit to understand the policy choices to combat the pandemic. This article first reviews The Lancet COVID-19 Commission and The BMJ COVID-19 series evaluating policies implemented during the pandemic in Canada, the United States, and the United Kingdom. We suggest that these documents, likely motivated by concern with underreacting to the pandemic, fall short in evaluating the trade-offs between the harms and benefits of COVID-19 policies to ensure that they are of net benefit to the public. We further argue that the failure to address these trade-offs contributed to an erosion in public trust in health authorities and the unequal impacts of the global COVID-19 response, especially among low-income countries.