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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Public Health Lessons for Non-Vaccine Influenza Interventions Looking Past COVID-19 Alexander Capron, Patricia García, and Ellen Schenk, Editors Committee on Public Health Interventions and Countermeasures for Advancing Pandemic and Seasonal Influenza Preparedness and Response Board on Global Health Health and Medicine Division A Consensus Study Report of and NATIONAL ACADEMY OF MEDICINE PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001 This activity was supported by a contract between the National Academy of Sciences and the Office of Global Affairs with the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations ex- pressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13:  978-0-309-XXXXX-X International Standard Book Number-10:  0-309-XXXXX-X Digital Object Identifier:  https://doi.org/10.17226/26283 Library of Congress Catalog Number: XXXXXXXXXX Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2021 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Public health lessons for non-vaccine influenza interventions: Looking past COVID-19. Washington, DC: The National Academies Press. https://doi. org/10.17226/26283. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typi- cally include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opin- ions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

COMMITTEE ON PUBLIC HEALTH INTERVENTIONS AND COUNTERMEASURES FOR ADVANCING PANDEMIC AND SEASONAL INFLUENZA PREPAREDNESS AND RESPONSE ALEXANDER M. CAPRON (Chair), University Professor, Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, and Professor of Medicine and Law, University of Southern California PATRICIA J. GARCÍA (Vice Chair), Professor, Cayetano Heredia University LUKOYE ATWOLI, Professor of Psychiatry and Dean, Aga Khan University Medical College of East Africa PETER DASZAK, President and Chief Executive Officer, EcoHealth Alliance ADOLFO GARCÍA-SASTRE, Director, Global Health and Emerging Pathogens Institute; Professor of Microbiology and Medicine, Department of Microbiology, Icahn School of Medicine at Mount Sinai DENISE GRAY-FELDER, Founding President and Chief Executive Officer, Communication for Social Change Consortium GABRIEL LEUNG, Dean of Medicine, Helen and Francis Zimmern Professor of Population Health, The University of Hong Kong CHANDINI RAINA MacINTYRE, Professor, Kirby Institute, University of New South Wales Australia LINSEY C. MARR, Professor, Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University TOLBERT NYENSWAH, Senior Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health ROSANNA PEELING, Professor and Chair of Diagnostics Research, London School of Hygiene & Tropical Medicine MARYBETH SEXTON, Assistant Professor of Infectious Diseases, Emory University School of Medicine; Medical Director of Antimicrobial Stewardship, Emory University Hospital; Epidemiologist, Emory Clinic Consultant to the Committee MARC LIPSITCH, Professor of Epidemiology, Harvard T.H. Chan School of Public Health v PREPUBLICATION COPY—Uncorrected Proofs

Study Staff ELLEN SCHENK, Study Director (until July 2021) EMILIE RYAN-CASTILLO, Senior Program Assistant CLAIRE MOERDER, Research Associate (until June 2021) ADRIENNE FORMENTOS, Research Associate (until July 2021) PATRICIA A. CUFF, Senior Program Officer JULIE A. PAVLIN, Senior Director, Board on Global Health Consultants ANNA NICHOLSON, Science Writer MEGAN SNAIR, Consultant (from July 2021) PEAK SEN CHUA, Research Consultant (from April 2021) SARAH ANNE NEW, Research Consultant (from June 2021) vi PREPUBLICATION COPY—Uncorrected Proofs

Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manu- script remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: ROSHAN BASTANI, University of California, Los Angeles LYDIA BOUROUIBA, Massachusetts Institute of Technology CARRIE BYINGTON, University of California Health BENJAMIN COWLING, The University of Hong Kong EZEKIEL J. EMANUEL, University of Pennsylvania BETSY FOXMAN, University of Michigan MARY-LOUISE McLAWS, University of New South Wales Australia ARTHUR REINGOLD, University of California, Berkeley NELSON SEWANKAMBO, Makerere University CHRIS SEYMOUR, University of Pittsburgh Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by SUSAN CURRY, The vii PREPUBLICATION COPY—Uncorrected Proofs

viii REVIEWERS University of Iowa, and SANDRO GALEA, Boston University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Re- sponsibility for the final content rests entirely with the authoring committee and the National Academies. PREPUBLICATION COPY—Uncorrected Proofs

National Academy of Medicine Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Series This study, Public Health Lessons for Non-Vaccine Influenza Interven- tions: Looking Past COVID-19, provides recommendations on how pub- lic health interventions and countermeasures can be used to mitigate the spread and effects of influenza both before and after vaccines are available. It is one of four studies conducted under the Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Initiative, which explores how the scientific and technological breakthroughs throughout the COVID-19 pandemic could inform and advance future pandemic and seasonal influenza vaccine preparedness and response efforts. The three companion studies to this study examine how the lessons learned from COVID-19 around vaccine research and development, vaccine distribution and supply chain, and global coordination, partnerships, and financing could be best utilized to improve the development and distribu- tion of future pandemic and seasonal influenza vaccines. Together, the four consensus studies present a path toward better preparedness in addressing pandemic and seasonal influenza. Launched by the National Academy of Medicine with support from the Office of Global Affairs, U.S. Department of Health and Human Services, the Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Initiative acknowledges that influenza is here to stay. The unprec- edented scope of this initiative allowed for international experts to look at this issue from multiple angles and provide recommendations that set out a pathway to more effective influenza vaccines worldwide. Driven by international cooperation, this independent initiative provides a platform to highlight why we need to act as a global community to better prepare for pandemic and seasonal influenza. ix PREPUBLICATION COPY—Uncorrected Proofs

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Acknowledgments This study, very broad in scope yet on an extremely intense timeline, would not have been possible without the contributions and support from many. The committee would like to thank the speakers at the full commit- tee meetings, whose names and affiliations are found in Appendix B. Many thanks are also extended to the Office of Global Affairs within the U.S. Department of Health and Human Services for sponsoring this effort, the international committee, coordinated by the National Academy of Medi- cine, for its thoughtfulness in developing the study’s Statement of Task, and Victor Dzau for his enthusiasm and support. The study staff would like to express deep appreciation to Leslie Sim and Taryn Young for coordinating the review process, Tina Seliber for fielding many questions on formatting, and Lauren Shern for providing guidance throughout the course of the project. Thanks also go to Rebecca Morgan with the Research Center for advice on literature search/reduction methodologies and EndNote. Acknowledgments also extend to Liz Ashby and Arjun Venkatesh for their initial research involvement, and Kenisha Jefferson, Hoda Soltani, and Janelle Winters from the other three influenza consensus studies for their support throughout the process. xi PREPUBLICATION COPY—Uncorrected Proofs

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Preface The first signal that a single nation, or the entire world, is about to experience a major problem—in the economy, the environment, public health, or any sphere that can touch the lives of countless people—is com- monly termed a “wake-up call.” Yet, the alarm sounded in this metaphor is unfortunately not one that brings a fire brigade to extinguish the flames but rather one that alerts us to the arrival of a peril that we knew—or could have anticipated—was coming but chose to disregard. In recent decades, as one novel infectious disease after another—H1N1 avian influenza, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome, and Ebola virus disease—emerged as a grave threat to human health, any public awakening to the weaknesses in national and global public health systems was only partial and seems to have soon subsided once the immediate threat had passed. Simply put, when the wake-up call came, we rolled over and went back to sleep. At the end of December 2019, a cluster of cases of atypical pneumonia was reported in Wuhan, China. The people affected were believed to have patronized a seafood market where wild animals were sold for human consumption. Chinese scientists rapidly sequenced the RNA of the novel coronavirus responsible for these cases—later named “SARS-CoV-2”—and submitted results to the U.S. National Center for Biotechnology Information on January 5, 2020. While that information was not immediately noticed, virologists around the world took note when the sequence data were pub- lished online on January 11. Two days later, Thai officials reported the first patient outside of China with coronavirus disease 2019 (COVID-19), a visi- tor from Wuhan who had not been to the seafood market, and the following xiii PREPUBLICATION COPY—Uncorrected Proofs

xiv PREFACE week, the national government acknowledged human-to-human transmis- sion in China. At the end of January, the World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern, by which time, all nations might have been expected to have begun tak- ing steps to contain the virus. But repeatedly, around the world, complete, transparent data were not communicated in a timely manner. Even as the warning signs became unmistakable, some governments censored doctors and journalists who drew attention to the disease, while leaders in other countries denied or downplayed the risk to their populations, even object- ing to testing because it could reveal infections among asymptomatic people and thus make the situation seem more dire. Yet, had basic public health measures been implemented more quickly, modeling shows that some of 216 million cases of COVID-19—and more than 4.5 million deaths—that have occurred globally as of this writing would have been avoided. Numerous observers have found further wake-up calls in the COVID-19 pandemic itself: for example, leading medical journals have told their read- ers that it has revealed everything from the special vulnerability of elderly patients with cardiovascular disease and the stark health inequities that exist based on wealth and race (as seen in the unequal distribution of death and serious illness from the virus) to the fragility of the global economy and from the need for better global disease surveillance systems to the effectiveness of global collaboration in tackling pandemics. The question facing us now is whether we have truly heeded these calls and, like an errant schoolboy, “learnt our lesson”? That too, draws on a familiar metaphor for what a reasonable person would expect to occur as the world takes stock of the social, economic, and personal devastation wrought by this pandemic. But how confident can we be that the core public health “lessons” of COVID-19—to say nothing of the broader mes- sage about the everyday effects of health inequities within and between na- tions—will result in adequate plans being created and implemented globally before the next pandemic strikes? And, in drawing lessons, we can learn not only to avoid governmental mismanagement and denial, which created public distrust and dissension and exacerbated the harms created by the pandemic, but also to replicate positive actions—such as the international cooperation among laboratory scientists, the ingenuity of researchers in creating—or repurposing—international clinical trial platforms to speed up the discovery of effective therapies, the selfless dedication of doctors, nurses, and other frontline health care workers, and the candor and clarity of some national officials in responding to the pandemic and thus promot- ing solidarity and cooperation among their citizens. Trusting that that this time the alarm has really woken countries up and that the lessons from COVID-19 will be taken to heart, the Office of Global Affairs in the U.S. Department of Health and Human Services asked PREPUBLICATION COPY—Uncorrected Proofs

PREFACE xv the National Academies of Sciences, Engineering, and Medicine to convene four ad hoc committees to step back and see what knowledge can be gained from the response of various actors, from the local to the global, to the present pandemic. We were asked to provide guidance on how to improve national and global preparations for and response to seasonal influenza and, more important, to the next influenza pandemic, which public health experts describe in terms of “when,” not “if.” Our particular committee was charged with examining a wide variety of issues, as detailed in the Statement of Task that appears in Chapter 1. This assignment led us to explore topics ranging from zoonotic and medical surveillance along the frontier where novel viruses typically enter human society to the methods of testing for, and responding to, their occurrence in the community; from the efficacy of the nonpharmaceutical interventions used against SARS-CoV-2 that might also be relevant for influenza to the means of, and barriers to, implementing these measures effectively; and from the care of COVID-19 patients, especially when health care systems, in high- as well as low-income nations, are overwhelmed by sudden surges in hospitalizations, to the ways that therapy and innovation can be aligned through innovative trial designs when a new respiratory disease arises for which no biologic or pharmaceutical cures are known. Because COVID-19 is a problem for all of humankind, and under the premise that “No one is safe until everyone is safe,” the Office of Global Af- fairs requested that we produce advice that would be useful for all nations and the international organizations and other bodies that assist them in seeking to contain the spread, and mitigate the consequences, of novel—and potentially pandemic—strains of respiratory diseases. From the committee’s first meeting at the beginning of March 2021, it was apparent how very fortunate we were to have five members from outside the United States and another three who are foreign scientists working in the United States, which provided us with detailed knowledge of country- and region-specific capabilities and weaknesses in responding to public health emergencies. Given the breadth of topics in our mandate, we are also grateful for the wide range of disciplines represented—not only medicine, virology, clinical research, epidemiology, and public health but also engineering, law, ethics, and communication science. Furthermore, the five members who have held high positions in international and national health agencies, including as minister of health, brought to our deliberations their firsthand experience with the real-world challenges of preparing for and responding to outbreaks of infectious diseases. We also thank the experts and members of the public who contributed their knowledge and experience during our public meet- ings, our consultant Marc Lipsitch, and our project staff at the National Academies who, as always, deserve credit for what is good in this report but no blame for any shortcomings. PREPUBLICATION COPY—Uncorrected Proofs

xvi PREFACE As we finish our work, it is daunting to realize that increasing numbers of scholars are concurrently publishing new findings about various aspects of the ongoing pandemic, which necessarily lends a provisional cast to our conclusions. Still, we have been reassured when other bodies engaged in dissecting the pandemic arrive at points that align with our findings, con- clusions, and recommendations. For example, regarding surveillance, the Independent Panel on Pandemic Preparedness and Response, appointed by WHO, recognized in May the need for both devising better means to regulate the forces that are causing zoonoses to become an increasing health threat to domestic animals and the humans who tend them and implement- ing the One Health strategy to ensure rapid identification of “spillovers” from wild animals that pose pandemic risks. Likewise, others have identi- fied the need to revise the International Health Regulations to strengthen WHO’s ability to investigate outbreaks and share its findings and to rec- ognize that, under certain conditions, controlling cross-border movement of people and goods can be effective in preventing the initial spread of a novel pathogen. As many groups have also acknowledged, the barriers that caused many people to suffer adverse health outcomes when they were un- able to fully comply with recommended COVID-19 countermeasures did not arise solely from the lack of necessary supplies in many communities at the outset of the pandemic. Rather, whether the countermeasure depended on having effective face masks, living in housing that made physical distanc- ing possible, or receiving income support that would permit quarantining or isolating, noncompliance resulted from the systemic factors in society that already prevent certain people from achieving “the highest attainable standard of health,” which is their right as human beings. It is our hope that beyond specific lessons of the sort described in the pages that follow, the COVID-19 pandemic and the horrific human toll, economic devastation, and troubles for all sectors of society that it has wrought have finally convinced governments, civil society, the business community, and the general public the truth of the adage that, when it comes to public health, an ounce of prevention is unquestionably worth far more than a pound of cure. It would be folly indeed if we wait for another “wake-up call” before using what this pandemic has taught us to ready our societies for the next one. Alexander M. Capron, Chair Patricia J. García, Vice Chair Committee on Public Health Interventions and Countermeasures for Advancing Pandemic and Seasonal Influenza Preparedness and Response PREPUBLICATION COPY—Uncorrected Proofs

Contents ACRONYMS AND ABBREVIATIONS  xxi SUMMARY1 1 INTRODUCTION  11 Project Origin and Statement of Task, 13 Committee Approach and Study Scope, 15 Organization of the Report, 16 References, 17 2 SURVEILLANCE  19 Preparedness for Surveillance During the COVID-19 Pandemic, 19 Role of Surveillance in Mitigating Respiratory Virus Outbreaks, 20 One Health Approach, 23 Relevant Findings and Case Studies from the COVID-19 Pandemic, 27 Challenges in Public Health Surveillance Highlighted During the COVID-19 Pandemic, 32 Surveillance Innovations, 41 Conclusions and Recommendations, 43 References, 46 3 EFFECTIVENESS OF NON-VACCINE CONTROL MEASURES  55 Economic Implications of Non-Vaccine Control Measures, 56 Evidence for Individual-Level Actions, 57 xvii PREPUBLICATION COPY—Uncorrected Proofs

xviii CONTENTS Evidence for Building and Environmental Controls, 65 Evidence for Government and Public Health Controls, 70 Evidence for Combinations of Measures, 80 Overarching Evidence, 81 Conclusions, 82 Recommendations, 85 References, 86 4 IMPLEMENTATION OF NON-VACCINE CONTROL MEASURES  97 Contextual Factors Affecting Implementation, 98 Communication Approaches to Promote Uptake, 104 Government Response and Leadership to Support Implementation, 109 Strategies for Optimizing Population Uptake of Non-Vaccine Control Measures, 115 Conclusions and Recommendations, 116 References, 118 5 THERAPEUTICS  125 Impact of Pandemics on Health System Capacity, 126 Findings, Opportunities, and Challenges in the Use of Therapeutic Resources During Outbreaks, 127 Therapeutics Previously Used for Influenza and Those Trialed in COVID-19 with Potential Applications to Pandemic Influenza, 132 Research and Development of New Drugs and Repurposed Drugs, 139 Conclusions and Recommendations, 144 References, 147 6 CONCLUDING THOUGHTS  155 Prioritizing Non-Vaccine Public Health Interventions, 155 A Way Forward, 162 References, 169 APPENDIXES A COMMITTEE AND STAFF BIOGRAPHIES  171 B PUBLIC MEETING AGENDAS  183 C STUDY APPROACH  189 PREPUBLICATION COPY—Uncorrected Proofs

Boxes, Figures, and Tables BOXES 1-1 Statement of Task, 14 2-1 Summary of Major Surveillance Collaborations, 22 2-2 Examples of Research Topics Regarding One Health, 27 2-3 Ascertainment Bias and COVID-19 Case Fatality Ratios, 33 2-4 Examples of Research Topics Regarding Ascertainment Biases, 34 2-5 Examples of Research Topics Regarding Transmission, 36 3-1 Examples of Research Topics Related to Non-Vaccine Control Measures Related to Individual Actions, 65 3-2 Examples of Research Topics Related to Non-Vaccine Control Measures for Building and Environmental Controls, 70 3-3 Examples of Research Topics Related to Non-Vaccine Control Measures for Government and Public Health Controls, 80 4-1 Examples of Research Topics Related to Contextual Factors Affecting Implementation, 98 4-2 Examples of Research and Programmatic Opportunities for Communication Approaches, 104 4-3 Examples of Research Topics Regarding Leadership and Governmental Response, 110 xix PREPUBLICATION COPY—Uncorrected Proofs

xx BOXES, FIGURES, AND TABLES 5-1 Adaptive Trial Design: Opportunities and Limitations, 141 FIGURES 1-1 Crosswalk between the report chapters and study Statement of Task, 17 2-1 Figurative description of the multi-scale, multi-step process of pandemic emergence, 23 TABLES 3-1 Individual-Level Measures: Evidence Supporting Efficacy/ Effectiveness in Reducing Transmission of Respiratory Viruses, 63 3-2 Building and Environmental Control Measures: Evidence Supporting Efficacy/Effectiveness in Reducing Transmission of Respiratory Viruses, 69 3-3 Governmental and Public Health Measures: Evidence Supporting Efficacy/Effectiveness in Reducing Transmission of Respiratory Viruses, 78 5-1 Overview of Therapeutics with Potential Application to Influenza, 133 6-1 Study Conclusions on Surveillance (Chapter 2), 157 6-2 Study Conclusions on Effectiveness of Non-Vaccine Control Measures (Chapter 3), 160 6-3 Study Conclusions on Implementation of Non-Vaccine Measures (Chapter 4), 163 6-4 Study Conclusions on Therapeutics (Chapter 5), 164 PREPUBLICATION COPY—Uncorrected Proofs

Acronyms and Abbreviations ACT Access to COVID-19 Tools ACTT-1 Adaptive COVID-19 Treatment Trial 1 AI artificial intelligence AMR antimicrobial resistance API active pharmaceutical ingredients ARI acute respiratory infection CEIRS Centers of Excellence for Influenza Research and Surveillance CFR case fatality ratio CI confidence interval COVID-19 coronavirus disease 2019 CREID Centers for Research in Emerging Infectious Diseases DNA deoxyribonucleic acid ECDC European Centre for Disease Prevention and Control EISN European Influenza Surveillance Network EMS emergency medical services EUA Emergency Use Authorization FDA U.S. Food and Drug Administration xxi PREPUBLICATION COPY—Uncorrected Proofs

xxii ACRONYMS AND ABBREVIATIONS GHSI Global Health Security Index GIS Global Influenza Strategy GISAID Global Initiative on Sharing All Influenza Data GISRS Global Influenza Surveillance and Response System GPHIN Global Public Health Intelligence Network HEPA high-efficiency particulate air HIV human immunodeficiency virus HVAC heating, ventilation, and air conditioning ICU intensive care unit IHR International Health Regulations ILI influenza-like illness JEE Joint External Evaluations LMIC low- and middle-income country mAb monoclonal antibody MERS Middle Eastern respiratory syndrome MERS-CoV Middle Eastern respiratory syndrome-related coronavirus NAM National Academy of Medicine NIAID National Institute of Allergy and Infectious Diseases NIH National Institutes of Health NPI nonpharmaceutical intervention OECD Organisation for Economic Co-operation and Development PAHO Pan American Health Organization PANDORA-ID-NET Pan-African Network for Rapid Research, Response, Relief and Preparedness for Infectious Disease Epidemics PCR polymerase chain reaction PPE personal protective equipment qPCR quantitative polymerase chain reaction PREPUBLICATION COPY—Uncorrected Proofs

ACRONYMS AND ABBREVIATIONS xxiii R&D research and development RCT randomized controlled trial RECOVERY Randomized Evaluation of COVID-19 Recovery Therapy REMAP-CAP Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia RNA ribonucleic acid Rt effective reproduction number RT-PCR reverse transcription polymerase chain reaction R0 basic reproduction number SARInet Severe Acute Respiratory Infections Network SARS severe acute respiratory syndrome SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 SSA sub-Saharan Africa UKAID UK Aid Direct U.S. CDC U.S. Centers for Disease Control and Prevention USDA U.S. Department of Agriculture UV ultraviolet UVGI ultraviolet germicidal irradiation WHO World Health Organization PREPUBLICATION COPY—Uncorrected Proofs

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The COVID-19 pandemic has challenged the world's preparedness for a respiratory virus event. While the world has been combating COVID-19, seasonal and pandemic influenza remain imminent global health threats. Non-vaccine public health control measures can combat emerging and ongoing influenza outbreaks by mitigating viral spread.

Public Health Lessons for Non-Vaccine Influenza Interventions examines provides conclusions and recommendations from an expert committee on how to leverage the knowledge gained from the COVID-19 pandemic to optimize the use of public health interventions other than vaccines to decrease the toll of future seasonal and potentially pandemic influenza. It considers the effectiveness of public health efforts such as use of masks and indoor spacing, use of treatments such as monoclonal antibodies, and public health communication campaigns.

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