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Title:

Modernizing and Expanding Outbreak Science to Support Better Decision Making During Public Health Crises: Lessons for COVID-19 and Beyond

Cover: Modernizing and Expanding Outbreak Science to Support Better Decision Making During Public Health Crises: Lessons for COVID-19 and Beyond
Authors:
Caitlin Rivers, PhD, MPH; Elena Martin, MPH; Diane Meyer, RN, MPH; Thomas V. Inglesby, MD; Anita J. Cicero, JD
Date posted:
March 24, 2020
Publication type:
Report
Publisher:
The Johns Hopkins Center for Health Security
See also:
Introduction:
The use of infectious disease modeling to support public health decision making, referred to in this report as “outbreak science,” has increased in prominence in the past decade. It has been used in the responses to several major outbreaks, from severe acute respiratory syndrome (SARS) in 2003, to H1N1 influenza in 2009, to the 2 most recent Ebola outbreaks in West Africa (2014-2016) and the Democratic Republic of the Congo (2018-current).
 
The purpose of this report is to characterize the origin and implications of the disconnect between modelers and public health decision makers and to develop a plan for the expansion of outbreak science as a capability to support public health. To accomplish this, we (1) conducted a literature review of past uses of modeling to support public health decision making, and (2) interviewed key informants from the modeling community and policymakers to identify themes and challenges related to using infectious disease modeling to support public health decision making. 
 
We found that outbreak science is critical to the United States’ ability to prepare for and respond to outbreaks, but the current landscape is poorly structured. There is currently limited formal capacity within the federal government. Expert surge capacity exists in academia but leveraging those resources during times of crisis relies primarily on personal relationships rather than a formal mechanism. There is also inadequate support for the foundational work needed to advance outbreak science, which limits the growth and evolution of the field. 
 
This report proposes potential approaches to addressing this problem. A first option is to create a permanent federal institution in the form of a new agency similar to the National Weather Service. This centralized service would serve the interagency, producing infectious disease analyses and advancing the foundational science. A second option would be to reinstate and redesign a previously existing capability comprised primarily of academics who served as experts on surge capacity in the event of an outbreak. A third option would be to employ some elements of both of these approaches. For this option, we recommend a life cycle approach, inspired by the CDC’s Epidemic Intelligence Service (EIS), in which outbreak scientists gain experience through 2-year field placements. Ultimately, as the COVID-19 pandemic underscores, modeling plays a key role in supporting decision making during outbreaks, epidemics and pandemics. For this reason, we must expand our national outbreak science capabilities in order to better prepare for and respond to infectious disease threats.

 

 

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