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Clinical research is needed to inform the development of medical countermeasures and to understand what medical interventions are likely to improve survival. There has been important progress in facilitating the conduct of emergency clinical trials, though more work needs to be done to prepare to do them in very difficult conditions and rapidly. Operational research is also needed to inform public health response questions, such as, “What intervention and communication strategies work best to limit transmission?” The absence of dedicated mechanisms to facilitate operational research during outbreak responses can result in a failure to consistently and systematically collect and analyze the valuable, ephemeral data that are crucial for improving outbreak response. During a public health crisis, limited public health and healthcare resources must be dedicated to performing response activities rather than conducting research efforts. Therefore, additional resources and pre-event planning will be needed to ensure that high-priority research can be conducted without impeding response efforts. WHO, member countries, and philanthropies should develop dedicated resources and plans for the conduct of operational research during outbreaks, epidemics, and pandemics. Pre-identified networks of researchers could help facilitate and prioritize research that is conducted. 8. Frameworks and plans articulating the evidence and role for nonpharmaceutical interventions need to be established. In contagious disease emergencies, particularly those for which MCMs are not available, countries will be inclined to use NPIs to limit spread. Guidelines from public health authorities such as WHO exist regarding the use of NPIs, but they do not provide sufficient information to guide the appropriate use of these measures. There is a need to explicitly identify in which contexts NPIs should be used, in which contexts they should 73 not be pursued, and what the negative consequences of use may be. There is great diversity of outbreaks, from the pathogen to the geographic setting, size, and epidemiologic characterization, and specific NPIs might work in one setting but fail in another. This would be particularly true in the midst of a high-impact respiratory pandemic, given that a number of potential NPIs would not logically be of any value for containment in those conditions. Countries and international organizations need to better analyze the potential value and impact of NPIs, determine where a particular NPI would be effective, and conclude in which contexts they are likely do more harm than good. NPIs would have a greater likelihood of being implemented effectively if they were well analyzed ahead of time than if considered ad hoc in the midst of a crisis. Public health authorities should provide this risk/benefit analysis regarding NPIs to decision makers before NPIs are initiated in a crisis. During an emerging outbreak with a novel pathogen for which no medical countermeasures will exist, countries may need external guidance regarding the implementation of NPIs to contain or slow the outbreak. WHO should retain the capacity to rapidly provide this critical guidance, driven by scientific evidence where it exists.
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