Principalism in public health decision making in the context of the COVID-19 pandemic

Background: The COVID-19 pandemic lead scientists and governmental authorities to issue clinical and public health recommendations based on progressively emerging evidence and expert opinions and many of these fast-tracked to peer-reviewed publications. Concerns were raised on scientific quality and generalizability of this emerging evidence.

Main argument: However, this way acting is not entirely new and often public health decisions are based on flawed and ambiguous evidence. Thus, to better guide decisions in these circumstances, in this article we argue that there is a need to follow fundamental principles in order to guide best public health practices. We purpose the usefulness of the framework of principalism in public which has been proved useful in real life conditions as a guide in the absence of reliable evidence.

Conclusions: It is recommended the implementation of these principles in an integrated manner adopting an holistic system approach to health policies adapted to specificities of local contexts.