WHO's pandemic response recommendations after COVID-19: lessons learned or learnings lost?

Objectives: This article examines how the World Health Organization's (WHO) recommendations and guidelines on public health and social measures (PHSM) have changed since COVID-19. Doing so allows insights on what lessons WHO has learned from the COVID-19 response. Methods: The article analyses six recent WHO publications detailing recommendations on PHSM and compares them against three pre-COVID-19 WHO documents. The analysis also assesses the evidence-base used for these recommendations to better understand WHO's substantive basis and rationale for the PHSM changes. Results: The analysis reveals substantial changes in WHO recommendations, often without systematic evidence assessment. Several population-wide interventions including quarantine, travel measures, and universal masking have become normalized in post-COVID documents, despite being previously discouraged. When evidence is cited, it often pertains to narrowly defined short-term outcomes, with limited consideration of broader societal impacts. Adverse effects of PHSM are recognized, but mitigation takes priority over avoiding harms. Conclusion: Systematic evaluation of the evidence on PHSM during the COVID-19 pandemic, including their effectiveness and collateral effects, is imperative before revising changes in recommendations for future pandemics.