Developing a WHO Rapid Advice Guideline (RAG) in the setting of a public health emergency

Article type
Authors
Garritty C1, Norris S2
1Ottawa Methods Centre, OHRI, Canada
2Guidelines Review Committee Secretariat, WHO Press, World Health Organization, Canada
Abstract
Background: In response to a public health emergency, the World Health Organization (WHO) must provide an evidence-informed guideline produced at times within one to three months. Such guidance must follow the basic steps for full guideline development, but with modifications to meet the accelerated timeline. Until now, WHO has lacked specific guidance on how best to accelerate guideline development across the planning phase; conduct of the evidence reviews used to inform recommendations; and the mobilization of a Guideline Development Group (GDG) to formulate recommendations.
Objectives: To describe newly established guidance for guideline developers at WHO on the process and procedures for developing evidence reviews within a shortened time frame of one to three months; guidance that complements, and is consistent with, the recently revised WHO Handbook on Guideline Development (2nd Edition).
Methods: Guidance was informed by in-depth discussions of issues related to rapid guideline development with WHO staff (n = 6) who deal most often with public health emergencies. Furthermore, we relied on established rapid review methods, which were incorporated into the current WHO guideline development structure.
Results: We will highlight potential criteria used to consider whether or not a Rapid Advice Guideline (RAG) is apt or feasible; and roles of the Guideline Review Committee (GRC) Secretariat, and the GDG across the RAG phases. We will focus on the methods and steps involved in doing rapid reviews, which are prone to post hoc changes given the fluid and iterative nature of the RAG process.
Conclusions: Important differences exist between developing a standard guideline and a RAG, which involves a shorter timeline, narrower scope, and use of abbreviated methods than the associated review. In turn, this may affect the risk of bias of the review’s conclusions. However, the core principles and standards for WHO guidelines apply to RAGs, including aims to minimize bias; apply transparent processes and the use of explicit methods.