Abstract
Early in the pandemic, pre-print servers sped rapid evidence sharing. A collaborative of major medical journals supported their use to ensure equitable access to scientific advancements. In the intervening three years, we have made major advancements in the prevention and treatment of COVID-19 and learned about the benefits and limitations of pre-prints as a mechanism for sharing and disseminating scientific knowledge. Pre-prints increase attention, citations, and ultimately impact policy, often before findings are verified. Evidence suggests that pre-prints have more spin relative to peer-reviewed publications. Clinical trial findings posted on pre-print servers do not change substantially following peer-review, but other study types (e.g., modeling and observational studies) often undergo substantial revision or are never published. Nuanced policies about sharing results are needed to balance rapid implementation of true and important advancements with accuracy. Policies recommending immediate posting of COVID-19-related research should be re-evaluated, and standards for evaluation and sharing of unverified studies should be developed. These may include specifications about what information is included in pre-prints and requirements for certain data quality standards (e.g., automated review of images and tables); requirements for code release and sharing; and limiting early postings to methods, results, and limitations sections. Academic publishing needs to innovate and improve, but assessments of evidence quality remains a critical part of the scientific discovery and dissemination process.