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expected disease events could also be used to help plan for and consider larger ones. • National health authorities and international organizations should develop and more fully utilize social science research capacities. Social scientists should be consulted on potential community-level chokepoints, sites for cooperation, and meaningful reframing of public health objectives in locally relevant terms and practices. 6. Countries and WHO should develop and exercise plans for risk communication during high-impact respiratory events. • International, national, and local responders should prioritize risk communication as an important response element on par with other priority public health efforts. • WHO should establish a standing communications advisory committee to elevate the importance of timely, accurate, and effective risk communication. • Countries need dedicated efforts to build public trust in local public health workforces and collaboration with influential partners before, during, and after crises. Public trust is an essential component of effective communication, and partnerships with well-respected community members, who are able to engage with other local residents in culturally competent ways, can also be critical for facilitating effective response activities. • In an era of rapid exchange of information, misinformation, and disinformation, risk communication frameworks and practices should be modernized to utilize decentralized and distributive information networks, moving beyond a command and control model. The WHO and national public affairs offices need to embrace 11 and invest in leading technologies and strategies around communication in order to remain effective. 7. R&D aimed at rapid vaccine development for novel threats and distributed surge manufacturing should be a top global pandemic planning priority. Medical Countermeasures (MCM) Research and Development • There are a range of promising approaches to accelerate rapid vaccine development that should be concomitantly pursued and funded given the uncertainty in knowing which might bring the most important leaps forward. • Traditional approaches of big pharma and biotech to vaccine and medicine development for infectious diseases will remain fundamentally important in the near term, though this process is expensive and time-consuming. • Nucleic acid (RNA and DNA)–based vaccines are widely seen as highly promising and potentially rapid vaccine development pathways, though they have not yet broken through with licensed products. • Advancements in non-nucleic acid–based platform technologies offer some hope of improving the speed with which vaccines for novel pandemic threats are developed and should be expanded. • Contemporary advances in sequencing and structure function analysis—aided by artificial intelligence and big data analytic approaches—are yielding improvements in both speed and precision of immunologic design and should be supported. • Similar gains are evident in the antimicrobial arena; as machine learning enters the drug discovery field, approaches to identifying appropriate targets for microbial control are shortening the times to leads and subsequent sensitivity and specificity studies. Distribution and Dispensing • Mass vaccination strategies should be developed and put in place to increase immediate access. A standing collaboration among international organizations, national governments, and the private sector will be needed to enable and coordinate global distribution to ensure maximal effectiveness and equitable access. • The uptake of novel, needle-free administration technologies—specifically, those that enable either simplified or, potentially, self-administration—should be a priority to improve our collective ability to administer these countermeasures in clinically relevant timeframes. 12 • Industry, national regulatory bodies, public health authorities, and other stakeholders should invest in and promote the use of technologies that enable a rapid, streamlined approach to the administration of MCMs. • WHO should encourage and support the creation of a public-private partnership dedicated to planning for and executing the prioritization and distribution of MCMs in a severe outbreak. Surge Manufacturing in Crisis • Regulatory agencies should consider regulating some platform technologies by platform, rather than by product. • The relevant regulatory bodies, global authorization agencies, and public and private manufacturers should develop and exercise response plans. • National regulatory agencies should establish mechanisms dedicated to decreasing timelines associated with regulatory requirements for MCMs in emergencies, while continuing to ensure safety and efficacy. • WHO, industry, national regulatory bodies, and other stakeholders should work together to enable and radically increase MCM surge production and access globally. Localized distributed manufacturing could be one solution to this need if the technology and regulatory challenges can be addressed. • Given the current geographic disparities in where such production and manufacturing efforts are conducted, access and benefit-sharing agreements will be needed. Other Research and Development • During an event involving a high-impact respiratory pathogen, there will be a critical need to conduct clinical and operational research to inform the response. • Though there has been important progress in facilitating the conduct of emergency clinical trials, more work needs to be done to prepare to do them in very difficult conditions and rapidly. • The absence of dedicated mechanisms to facilitate operational research during outbreak responses can result in a failure to collect and analyze valuable, ephemeral data that are crucial for continued learning in the field and generalized improvement of outbreak response. • WHO, member countries, and philanthropies should develop dedicated resources and plans for the conduct of operational research during outbreaks, epidemics, and pandemics. To enable critical research to proceed without impeding response activities, pre-event planning is needed to identify priority research questions and evaluate potential