Public Health Lessons for Non-Vaccine Influenza Interventions Looking Past COVID-19 (2022) / Chapter Skim
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6 Concluding Thoughts
6 Concluding Thoughts
Pages 155-170
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From page 155... ...
Effective strategies to prepare for and respond to novel respiratory viruses, including influenza, must therefore also include comprehensive and coordinated surveillance to detect, trace, and quantify the virus; non-vaccine interventions to reduce viral transmission; and innovative, international means to discover and test therapeutic agents that can diminish morbidity and mortality and protect health systems and the wider society. PRIORITIZING NON-VACCINE PUBLIC HEALTH INTERVENTIONS Based on the study analyses, the committee reached a number of key conclusions that reaffirm the importance of non-vaccine control measures in preparing for and responding to a respiratory virus event.
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From page 156... ...
Ensuring the integrity and validity of surveillance data collection and analysis is also critically important; the committee recognized that such data obtained during COVID-19 sometimes suffered from ascertainment biases and were not always collected or shared efficiently. Non-vaccine control measures -- such as face masks, distancing, and lockdowns–are used to help mitigate the spread of respiratory viruses.
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From page 157... ...
Quantifying the Data informing public health surveillance, including influenza and COVID-19, are vulnerable to ascertainment biases spread of a pandemic and therefore may not reflect the true underlying epidemiology; these biases happen particularly as a novel strain is first emerging. When the means used to collect data cannot be changed to avoid these problems, they can be taken into consideration during the analysis and interpretation of data being used in policy decisions.
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From page 158... ...
Unless such barriers are removed, reporting structures cannot provide complete, accurate, and timely information about possible disease outbreaks. Harmonization of information from multiple data sources is essential for quickly identifying the origins and spread of novel agents and strains and for providing useful information for decision makers and the public.
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From page 159... ...
On the other hand, the available studies indicate that barriers and face shields worn without face masks are ineffective and hence inadvisable because they give a false sense of security and use resources that could better be devoted to improving the implementation of efficacious measures. Moreover, airflow can play a significant role with respiratory viruses, so proper building ventilation and filtration systems are critical to reducing transmission.
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From page 160... ...
A number of factors should be considered when determining the approach that is best for a particular setting to reduce harm to livelihoods, including the effectiveness of measures in reducing viral transmission as well as economic and other contextual factors. There is a need for a research framework to address the gaps in evidence for particular public health interventions that takes into account that the way evidence is best assessed for each measure may differ, because some interventions cannot be tested in a RCT, that assesses measures in combination as well as separately, and that tests mandates for influenza.
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From page 161... ...
Because the SARS-CoV-2 virus had been spread by travelers to a number of countries before WHO recognized the novel coronavirus as a Public Health Emergency of International Concern -- and even more so, before it declared COVID-19 a pandemic -- there is little evidence that the restrictions on cross-border travel that many countries imposed were effective in reducing viral transmission during COVID-19, as is likely to be true in an influenza pandemic as well. Nonetheless, border closures -- for example, by island nations -- can be effective when imposed before community transmission is established, provided that any persons allowed to enter are quarantined, as should be true for all entrants who have recently been in countries where the virus is known to be present.
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From page 162... ...
The COVID-19 pandemic also emphasized the potential therapeutic benefits of repurposed drugs, initially developed for other diseases, and the advantages of rapid research on the efficacy of therapeutics during a pandemic via adaptive platform trials. Research efforts highlighted the feasibility and necessity of collaborative international platforms and innovative partnerships focused on developing treatments for existing and novel respiratory viruses.
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From page 163... ...
Trust in such persons and confidence in what they said about interventions was undermined when the policies were shown not to rest on a strong evidence base, the reasoning behind the policies was not well communicated, and when the personal behavior of such persons did not coherently and consistently adhere to the practices that they had recommended or required. Data and frameworks The variety of interventions implemented in response to the COVID-19 pandemic has not always been informed by evidence of effectiveness but, in some cases, has been based on contextual factors and policy makers' individual views. This experience highlights a need to both generate evidence that is relevant across a wide range of settings and use this evidence when implementing non-vaccine control measures.
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From page 164... ...
Going forward, maintaining libraries of drugs that show antiviral effects and that have completed safety testing in humans could serve as a starting point for therapeutic research during a pandemic. It will also be important to test drugs -- separately and in combination -- that act on targets that respiratory viruses have in common (e.g., possible broad-spectrum inhibitors of RNA polymerase, an enzyme common to both COVID-19 and influenza)
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From page 165... ...
COVID-19 has shown the feasibility of performing rapid research on therapeutic efficacy during a pandemic through the use of adaptive platform trials with common global protocols, adding and deleting interventions in light of accumulating evidence. The REMAP-CAP, RECOVERY, and Solidarity platforms all demonstrated that this type of trial platform has many advantages, including the ability to adjust study enrollment, include patients from many countries to achieve sufficient power to make evidence-based treatment recommendations more quickly, react to changing evidence prior to study conclusion, and compare interventions to one another, singly and in combination.
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From page 166... ...
It is worth keeping in mind (as described in Chapter 2) that the countries with the highest health security preparedness scores on the Global Health Security Index had some of the poorest performances during the pandemic in terms of detection response times and mortality outcomes (Haider et al., 2020)
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From page 167... ...
. For instance, WHO's 2019–2030 Global Influenza Strategy, which builds on the knowledge gaps identified in the 2010–2011 WHO Public Health Research Agenda for Influenza, does not address nonpharmaceutical interventions, which underlines the dearth of research initiatives that aim to strategically strengthen the evidence base for non-vaccine control measures for respiratory viruses (WHO, 2019b)
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From page 168... ...
With the devastating health, social, and economic harm wrought by the pandemic fresh in the public's mind comes an unprecedented opportunity to harness the resulting political will and public support, along with the research capacity and technological advances that were created to overcome the pandemic. As officials launch the efforts needed to prepare for the coming epidemics of novel respiratory viruses, this study demonstrates that policy makers, public health authorities, and other stakeholders should not only plan to rely heavily on non-vaccine control measures for seasonal and pandemic respiratory viruses but also support the research necessary to expand and improve such measures and the means by which they are implemented.
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From page 169... ...
2020. The global health security index and joint external evaluation score for health preparedness are not correlated with countries' COVID-19 detection response time and mortality outcome.
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