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These stockpiles would ideally include not only basic supplies, such as IV tubing and fluid, but also disease-specific supplies, such as PPE (eg, gloves, surgical masks, N95 respirators, powered air-purifying respirators, or PAPRs), and medical countermeasures (eg, antivirals, antibiotics, vaccines). These stockpiles would help to ensure that facilities are self-sustaining during a protracted public health emergency. Other critical logistics and infrastructure—including plans for maintaining access to critical medical gases (eg, oxygen, nitrogen), clean water, electricity, data and telecommunications, and sanitation services during a widespread pandemic—should be ensured or developed. Global or regional stockpiles with operational plans for deployment and sharing may be needed to assist countries that are unable to afford or maintain individual stockpiles. 5. Countries and international health authorities should more fully incorporate community engagement and social science in preparedness. International guidelines should be developed that demonstrate specific clear use cases for community engagement in the context of a potential high-impact respiratory pathogen outbreak. A rich library exists of general guidance on community engagement as well as its applications to specific public health issues, including Ebola and Zika outbreak management. Despite that, community engagement is underappreciated as a core health security capability. To operationalize what many still consider to be an intangible or vague objective, WHO should develop guidance—via a multidisciplinary consultation and drawing on WHO’s CEQ model—that illustrates concrete use cases for community engagement before, during, and after a potential severe outbreak of a high-impact respiratory pathogen, including reduction of an outbreak’s social and economic—and not just health—effects. Community engagement has been recognized as a vital part of disease outbreak response efforts, a sentiment that was strengthened after the 2014-2016 Ebola outbreak in West Africa. However, little has been done to implement community engagement into national preparedness planning and mechanisms. Building trust within communities takes time but is necessary to strengthen the response effort. If initial outreach and engagement occurs before a disease outbreak, relationships that are built and strengthened could be leveraged during response efforts, which could in turn mitigate community resistance and other factors that may hinder or complicate a response. By ensuring local stakeholders are involved in decision making and preparedness planning, countries can develop more inclusive plans over which community leaders can take ownership. The kind of community engagement used to help prepare for smaller outbreaks or expected 69 disease events could also be used to help plan for and consider larger ones like pandemics with high-impact respiratory pathogens. This way, community engagement efforts could be put to routine benefit. When designing or refining systems to prevent, detect, respond to, and recover from major outbreaks, social scientists should be consulted on potential community-level chokepoints and sites for cooperation. National health authorities and multilateral health organizations should develop and utilize their social science research capacities further. Attuned to social context, using people-centered methodologies, and leveraging in-depth knowledge of specific communities and regions, social scientists can serve as important advisors on and enablers of community engagement in the context of a high-impact infectious disease outbreak. Local cultural beliefs and practices were often presented as barriers to the swift, effective control of the Ebola outbreak in West Africa. Yet, community engagement exercises specific to pandemic influenza planning have also shown how cultural values (eg, Maori concepts of solidarity, neighborliness, mutual aid) can be leveraged for greater preparedness. Social scientists, and anthropologists in particular, can help with 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. Risk communication should continue to be prioritized as an important response element on par with other public health efforts. WHO should establish a standing communications advisory committee to elevate both the prioritization of and the capacity to implement timely, accurate, and effective communication. Risk and crisis communication with the public and key partners should be included as a key component of infectious disease response, on equal footing with other response components such as medical surge, medical countermeasure development/manufacturing/distribution, and surveillance. By acknowledging the need for and prioritizing risk communication early, other aspects of the response will likely encounter fewer barriers and challenges. Dedicated efforts to build public trust in local public health workforces and collaborations with influential partners before, during, and after crises should be made. Public trust is an essential component of effective communication. Yet, this is not something that can be delivered “just-in-time.” WHO has noted the importance of public trust and community engagement, and it should keep moving forward on this with a commitment to long-term building of public trust and partnerships. Partnerships with well-respected community members who are able to engage with other local residents in culturally 70 competent ways can also be critical for facilitating effective response activities. These communication channels and relationships must be set up ahead of an emergency in order to be effective communication conduits during a crisis. Communication during the response to a high-impact respiratory pandemic would be affected by the way that communication works during smaller, more routine responses. Communication frameworks and practices to use distributive information networks should be modernized, moving beyond a command and control model. Communication
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