WADA’s work on prevalence of doping: Understanding the effectiveness of anti-doping programs

In this latest edition of ‘Spotlight’, which keeps stakeholders up to date on the activities being carried out by the World Anti-Doping Agency (WADA) team and its partners, we look at WADA’s efforts to provide tools to its stakeholders to estimate the prevalence of doping in sport. This and previous ‘Spotlight’ features are available here. 

One unanswered question in the field of anti-doping is how prevalent doping actually is in competitive sport.

Past attempts to quantify the extent of the problem have led to vastly differing figures due to the diversity in methods, population, definition of doping and timeframes involved. As a result, the figures are not representative, comparable, or even suitable to adequately inform anti-doping efforts.

Why is prevalence important?

WADA’s Associate Director, Research, Marcia MacDonald, says: “WADA recognizes that, without an adequate understanding of the magnitude of the prevalence of doping in sport, researchers, governments and sporting organizations are unable to properly assess the effectiveness of anti-doping programs. WADA is determined to address this long-standing issue, which is crucial to developing effective anti-doping strategies.”

“Without knowing the prevalence, we do not have a baseline measure against which we can actually assess that what we are doing is effective,” says Andrea Petróczi, Kingston University Professor and Chair of WADA’s Prevalence Working Group. “If we want an outcome-based evaluation of any measures that we implement, then we must be able to measure the outcome.”

Doping Prevalence Survey Tool

Looking to resolve this long-standing issue, WADA established a Prevalence Working Group, which was initially tasked with determining whether reliable strategies, methods and tools could be developed to provide a clearer picture of the prevalence of doping in sport. The challenges encountered during the initial phase of the project highlighted the complexities and nuances in developing a reliable tool for assessing doping prevalence.

The Working Group reassessed its activities in 2017, led by Chair Andrea Petróczi. Since then, the Group has made significant progress in a number of important areas, including development of the following new methods to establish doping prevalence:

1. A prevalence survey; and
2. A framework for combining different evidence sources and prevalence indicators into a doping prevalence index, a relative number that would allow International Federations, countries, athletes and researchers to quickly and easily see whether the problem is getting better or worse over time.

Andrea Petróczi suggests thinking about the index as a kind of ‘traffic light’ system. By combining the results into a quantitative framework, the cumulative evidence is intended to produce a picture of doping prevalence globally, as well as at the sport and/or country levels to indicate whether they are green (in good shape), yellow (has room for improvement) or red (requires immediate attention). Anti-doping resources could then be allocated according to the risk associated with each.

The prevalence survey has been designed as a new component informing the doping prevalence index. It is the only tool in the anti-doping arsenal that allows for an entire population to be assessed due to its simplicity and cost-effectiveness.

“The great advantage of the survey is that it is generally inexpensive and does not require specialist knowledge. WADA provides the survey and data analysis,” says Prof. Petróczi. “It is a five-minute exercise for the athlete so, technically, it could be used to reach a very high number of athletes worldwide.”

The Working Group is under no illusion that the prevalence survey is fool proof, but they are convinced that it can play an increasingly important role in anti-doping efforts going forward, especially when combined with results from testing figures and the Athlete Biological Passport, for example.

Motivating athletes to respond honestly

One of the most challenging aspects of the survey is convincing athletes who do dope or have doped to feel safe admitting to it.

Prof. Petróczi says the survey methodology the Prevalence Working Group developed was painstakingly created to ensure that the individual answers given by respondents are and will always be 100% unknown. “Taking an extreme example, even if I have the picture, the name and the response from an athlete, I still cannot tell how this athlete answered the prevalence question,” she explains. “It is absolutely safe to admit all kinds of performance-enhancing practices. (For more details on the methodology, click here.) But that does not mean that being safe motivates athletes to tell the truth. Motivation should come from the way the survey is implemented.”

One way to encourage athletes to take part in such a survey is to convince them that their answers can help current and future generations of athletes by exposing the truth about doping in their sport or country. One response often given by doped athletes is that they use prohibited substances because everyone else is, and to not do so would mean losing their competitiveness. If the survey can help show that the prevalence of doping in their sport is not as high as it is perceived to be, it could result in a change of thinking and, hopefully, reduce the use of banned substances and methods.

To help make athletes feel more involved in the process, the Working Group has included athletes from the beginning regarding the framing and development of the survey so that they could truly put their own mark on it.

“Now it is down to the athletes to come forward,” Prof. Petróczi says. “If there is higher or lower prevalence than we believe, we need to know. Maybe it is not the answer that we want, but the community needs to know.”

Implementation

As the survey is relatively simple as well as short (it is estimated to take between two and five minutes to complete for most athletes), Prof. Petróczi says it lends itself well to being conducted large-scale online or at multi-sports events, as well as at the same time athletes’ urine or blood samples are being collected.

Athletes at the upcoming Commonwealth Games in Birmingham, England from 28 July to 8 August 2022 will have the first opportunity to take part in the latest iteration of the survey, with further implementation set to follow at other events. Previous versions were administered at the 2018 Gold Coast Commonwealth Games, the 2019 European Games in Minsk, Belarus, the 2019 Pacific Games in Apia, Samoa and the 2019 Pan American Games in Lima, Peru.

The Spanish Commission for the Fight Against Doping in Sports (CELAD) has already implemented the survey and is planning to do more work with it during a sporting event later this year, while UK Anti-Doping (UKAD) launched the survey in May. Several other National Anti-Doping Organizations, including the Japan Anti-Doping Agency (JADA), have expressed their interest in running the prevalence survey.

The Prevalence Working Group would like to see more National Anti-Doping Organizations, International Federations and Major Event Organizers become early adopters of the tool as the more experience gained, the better the feedback and guidance the Working Group will be able to provide at the end of its mandate.

Get involved!

The Prevalence Working Group is set to provide a progress report at WADA’s 2022 Annual Symposium in Lausanne, Switzerland on 11-12 June and discuss the prevalence project at WADA’s Global Education Conference in Sydney, Australia in September. The goal is for the survey and other aspects of the doping prevalence index to be made available to increasing numbers of stakeholders in 2023.

In the meantime, should you wish to learn more about the Prevalence Project, or any other work being undertaken by the Working Group, please email science@wada-ama.org.