Overview of Included Strategies
We identified 154 potentially eligible documents of OECD or BRICS countries through a systematic desktop search (n=138) and WHO document repository (n=16). 0 was excluded as duplicates. 118 documents did not meet the inclusion criteria. After exclusions, 36 strategy documents remained for analysis, including 14 OECD countries (Australia, Czech, France, Greece, Iceland, Ireland, Korea, Luxembourg, New Zealand, Poland, Spain, Switzerland, United Kingdom and United States of America), and 3 BRICS countries (Brazil, China and Russia) (see Figure 1, Table 1). Every country has both pre-and post-pandemic strategies, except the United States, which has 4. We only found post-pandemic strategies in Switzerland and Russia, especially those targeted at COVID-19. The purpose, aim, or vision of each NHPSP was described verbatim (see Table 1).
Themes or priorities
Within the included NHPSPs of selected countries, more than half of 18 policy documents before COVID-19 included a theme or priority around providing a package of high-quality integrated and people-centered health services (55.6%) and promoting and protecting the health of communities and public health (focus on prevention) (88.9%). After COVID-19, some new themes or priorities besides the above two became mainstream, with more than half of the documents covering theme or priority domains of promoting and protecting the health of communities and public health (focus on prevention) (94.4%), promoting innovation in health research, technologies, and products and improving laboratory capacity (61.1%) and promoting one health (66.7%). Other themes or priorities were less identified. Eight priority domains had a similar frequency of occurrences in pre and post-pandemic strategies, namely ensuring financial health protection, promoting the equity of health, promoting and protecting the health of communities and public health (focus on prevention), strengthening health information system and health literacy, enhancing the capabilities, education, and training of the health workforce, enhancing both local and international collaboration, cross-sector collaboration, promoting environmental health and establishing monitoring, evaluation and revising mechanisms. In contrast, the other six priority domains showed significantly different occurrence frequencies in pre-and post-pandemic strategies. Among these domains, occurrences of enhancing surveillance and control of infectious diseases (22.2% versus 50.0%) and building capacity to deal with health emergencies and crises (22.2% versus 44.4%) increased at least two times compared with pre-pandemic strategies (see Table 2).
The weighting of themes or priorities
Although eight domains had similar occurrence frequency before and after COVID-19 across all strategies, pre-and-post-pandemic strategies emphasized them differently. The most commonly addressed theme or priority domain across all strategies was promoting and protecting the health of communities and public health (focus on prevention), with 26 documents identifying this domain as a primary theme. Compared to the pre-pandemic strategies, two-thirds of post-pandemic strategies of OECD countries, namely ten documents (Ireland, Australia, France, Korea, Czech, Luxembourg, USA, Spain, New Zealand, and the U.K.), put increased emphasis on the eight domains except for the domain of establishing monitoring, evaluation and revising mechanisms, among which the domain increased the most was promoting One Health (see Table 3-1). However, none of the post-pandemic strategies of BRICS countries showed this pattern (see Table 3-2).
Increased themes or priorities
The contents of theme or priority domains that showed significantly increased occurrence frequency after COVID-19 of post-pandemic strategies were analyzed, and 13 common focuses of sub-themes were identified, including promoting lifelong prevention, improving primary health care, ensuring health services for key groups, developing early warning surveillance systems, developing national health emergency preparedness and response plan, reinforcing leadership and management, ensuring clarity around roles and responsibilities, promoting sectoral coordination, developing and promoting health research and technologies, supporting researchers, enhancing surveillance and control of infectious diseases, improving vaccination and strengthening notification of infectious diseases. More than half of the post-pandemic strategies of OECD countries focused on the domains of improving primary health care (86.7%) and developing and promoting health research and technologies (73.3%) (see Table 4-1). All the post-pandemic strategies of BRICS countries focused on improving primary healthcare. However, none of the documents of the BRICS countries focused on supporting researchers and improving vaccination (see Table 4-2).
The comparison of OECD and BRICS countries
14 out of 38 OECD countries and 3 out of 5 BRICS countries introduced or revised new NHPSP after COVID-19 in OECD countries. More than half of OECD countries identified the domain of promoting and protecting the health of communities and public health as a priority in both pre-and post-pandemic strategies (86.7% and 93.3%). Besides the above domain, more domains identified as priorities by more than half of BRICS countries included providing a package of high-quality integrated and people-centered health services (100%) and promoting innovation in health research, technologies, and products, and improving laboratory capacity (100% and 66.7%) (see Table 2). Compared with pre-pandemic strategies, post-pandemic strategies of OECD countries showed increased occurrences of building capacity to deal with health emergencies and crises (20.0% versus 46.7%) and promoting innovation in health research, technologies and products and improving laboratory capacity (33.3% versus 60.0%) and put increased emphasis on promoting One Health (see Table 2, Table 3-1). In contrast, we only observed an increased occurrence of enhancing surveillance and control of infectious diseases (0% versus 66.7%) in BRICS countries (see Table 2, Table 3-2). In addition, the proportion of countries that focused on the domains of supporting researchers in OECD countries far exceeds that in BRICS countries (46.7% versus 0) (see Table 4-1). On the contrary, BRICS countries are more likely than OECD countries to focus on promoting lifelong prevention (66.7% versus 33.3%) and improving primary health care (100% versus 53.3%) (see Table 4-2).
Policy background and Implementation mechanism
Five domains, including accountability, health challenge analysis, compliance with international context, population consultation, and situation analysis, were compared between included pre-and-post-pandemic strategies to display the variations of background and implementation mechanism of national health strategies of selected countries (see Figure 2). Furthermore, selected countries in our analysis seemed to show slightly increasing attention to implementation mechanisms, including monitoring and evaluation of health strategies, capabilities of data manipulation, and data sources. Besides these, we did not find many significantly different occurrence frequencies of other domains due to COVID-19.