Table 1

Criteria of the WICID framework and description of what the criteria are intended to cover

CriterionDescription of the criteria
I. Implications for the course of the pandemic and its impact on healthCovers implications of the interventions or measures for the course of the SARS-CoV-2 pandemic, including the number of new infections, the resulting health-related consequences (eg, COVID-19-related mortality and morbidity), the implications for the capacity of the healthcare system to treat patients with COVID-19, as exceeding this capacity is associated with a pronounced increase in mortality. It furthermore covers the direct SARS-CoV-2-related health risk of individuals affected by the measures (probability of infection and probability of adverse consequences).
II. Implications for quality of life, social well-being and mental healthCovers the way the interventions or measures affect overall well-being and quality of life, which includes the degree to which the capability to shape everyday life according to one’s own wishes and needs is affected (eg, through restricting daily routines) or the experience of self-efficacy and of sense of coherence. It furthermore covers the social well-being of individuals (eg, the experience of loneliness) and the social cohesion of communities (eg, cohesion of families or non-family communities). The criterion furthermore captures the implications for the mental health of individuals and populations (eg, depression, anxiety disorders), including risk-factors—such as the experience of stress or fear, ability to practice coping mechanisms, receive support and other adverse mental health consequences (eg, suicides).
III. Implications for the physical health, health behaviour, health risks and healthcare beyond COVID-19Focuses on implications of the intervention for behavioural, environmental, and interpersonal risk factors for health (including accidents and domestic violence) other than those directly related to COVID-19 (eg, physical activity) and their consequences for health. It furthermore covers the implications of the measures for availability, accessibility, acceptability, and quality of medical and care services and institutions for conditions other than COVID-19 (eg, willingness to seek emergency care in the case of myocardial infarctions).
IV. Proportionality and accordance with individual autonomy and fundamental rightsCovers whether the interventions or measures are in accordance with and how they—directly or indirectly—affect autonomy, self-determination, individual liberties and fundamental individuals’ rights (eg, privacy and data protection implications of a contact tracing app). It furthermore covers the intrusiveness of the intervention eg, providing information being a measure with a low intrusiveness; and restricting choice one with a high intrusiveness).36 The aspect of proportionality addresses whether intrusiveness and infringement of individual rights and liberties are proportionate to the expected benefit (or expected avoidance of harm).
V. Acceptability of and willingness to implement the measuresFocuses on the degree of acceptability and accepance of the measures and their consequences to the general population and different affected population groups. This includes the personal willingness to implement, adhere to, or enforce the measure (eg, whether reopening schools without any protective measures is acceptable to teachers with a high-risk profile such as pre-existing health conditions). While acceptability is an end in itself, this criterion is strongly linked to feasibility and assumed effectiveness.
VI. Equity, equality and the fair distribution of benefits and burdensCovers the implications of the measure for vulnerable population groups, whether and how it affects stakeholder groups differently and thereby the risk for increasing or reducing inequalities (eg, men benefiting less from a measure in comparison with women, exacerbating health inequities), considerations of equity (treating people differently according to their need to allow them the same capability of achieving an outcome), considerations of equal treatment (eg, not treating people differently without sufficient justification), and implications for the risk of individuals or population groups to be stigmatised or be discriminated against.
VII. Societal and environmental implications & considerationsCovers the implications for civil society, social life, and culture from an individual-level and system-level perspective, and the implications for the functioning and cohesion of the society. It furthermore covers the implications of the measures for social determinants of health, including household income, social participation and education. A further aspect covered is the implications for the ecosystems resulting from the measures.
VIII. Economic implications & considerationAddresses the implications for the economy as a whole (population perspective/systems perspective) and of stakeholders in their role as economic actors and their activities (individual perspective). Including the implications of the measures for the work force (eg, closing of schools forcing parents to stay at home to take care of their children).
IX. Resource implications & considerationsCovers the requirements of the measures for different resources in the context of the availability of these resources as well as how the measures affect the availability and quality of these resources (eg, how many face masks would be required to provide every teacher with a high-risk profile with one, are these masks available, and would this lead to a shortage of masks for, for example, health service providers).
X. Feasibility implications & considerationsCovers the practical, technical and political feasibility of implementing the measures, as well as their legal conformity. Other aspects address feasibility-related characteristics of the measures, such as the flexibility in extension, adjustment or withdrawal of the measures, and the possibility of evaluating the implications of the measure and reacting adequately to new information (eg, ability to test those affected by the measure and conduct contact tracing if needed).
XI. Interaction with and implications for the health systemAddresses how the intervention will interact (synergistically or adversely) with other measures to control and contain the SARS-CoV-2 pandemic and other not directly COVID-19-related components of the health system (within a broad understanding of health system in accordance with the WHO).73 For example, the combination of school reopening and lifting travel bans on other countries in close proximity timewise can have an interacting, synergistical (negative) effect that could be different from the effects of each of these measures by themselves.
Quality of evidenceThis metacriterion is intended to be applied across all criteria and aspects. For example, taking the quality of the evidence on health impacts alongside with its strength and direction into account. This metacriterion reflects the confidence that the available evidence is appropriate, applicable, and adequate to support the decision or recommendation. Evidence is interpreted in a broad sense, beyond an understanding focusing on quantitative evidence of effectiveness derived from systematic reviews or randomised controlled trials. Different forms of evidence can be used and be the most appropriate type of evidence to inform on the criteria (eg, an appropriate form to assess the accordance with selected fundamental rights can be a legal assessment). Decision-making under uncertainty—as is often the case in a pandemic—often requires a decision based on stakeholder experience and judgement, when stronger evidence is unavailable.