Preparing for and responding to public health emergencies requires scientific evidence to save lives, prevent disruption to the social fabric of society, and mitigate unprecedented damages and costs. Public health emergencies are becoming increasingly common and complex—a trend that is likely to continue. State, local, tribal, and territorial public health agencies play a vital role in responding to these emergencies. They must do so effectively, and as in other fields, effectiveness requires scientific evidence. The Centers for Disease Control and Prevention (CDC) recognizes the need to provide clear guidance on evidence-based practices to those public health emergency preparedness and response (PHEPR) practitioners routinely required to make difficult decisions about how to respond effectively to a wide range of public health threats. Accordingly, CDC charged the National Academies of Sciences, Engineering, and Medicine with developing the methodology for and conducting a systematic review and evaluation of the evidence for selected PHEPR practices that fall within the 15 PHEPR Capabilities defined in CDC’s Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health1 and to make recommendations for future research needed to address critical gaps in evidence-based PHEPR practices, as well as processes to improve the overall quality of evidence in the field. As described in this report, the committee found that despite the investments that have been made in PHEPR research over the past two decades, the science underlying the nation’s system of response to public health emergencies is seriously deficient, hampering the nation’s ability to respond to emergencies most effectively to save lives and preserve well-being. The lack of a clear, progressive research agenda and sporadic funding, among other things, has resulted in a sparse and uneven evidence base reflecting broad variation in research design, implementation, reporting, synthesis, and translation.
1 CDC (Centers for Disease Control and Prevention). 2018. Public health emergency preparedness and response capabilities: National standards for state, local, tribal, and territorial public health. https://www.cdc.gov/cpr/readiness/00_docs/CDC_PreparednesResponseCapabilities_October2018_Final_508.pdf (accessed March 11, 2020).
To address this deficiency, this report aims to move the PHEPR field forward in terms of identifying and using evidence-based practices. The committee provides herein eight overarching recommendations (summarized in the four points below)2 that, if implemented, would transform the infrastructure, funding, and methods of PHEPR research and enhance the nation’s capacity for comprehensive and effective response to public health emergencies:
- An enduring national science framework is needed for PHEPR. CDC, in collaboration with relevant agencies, researchers, and practitioners, should develop a National PHEPR Science Framework to ensure a coordinated approach to the development and implementation of a unified PHEPR research agenda (Recommendation 3). CDC and its partners should create the infrastructure necessary to support the production of high-quality PHEPR research (Recommendation 4).
- Improving and expanding PHEPR research will require incentives for both researchers and public health agencies. CDC and other relevant funding agencies should use funding requirements to drive improvements in the conduct and reporting of effectiveness and implementation research for PHEPR practices (Recommendation 5). CDC should convene an expert panel to advance a process for quality improvement in the PHEPR arena and enhance the quality and utility of postincident after action reports as tools for evaluating effectiveness (Recommendation 6).
- The research and other evidence driven by the proposed National PHEPR Science Framework needs to be translated into clear evidence-based practices for public health agencies through an ongoing evidence review process. CDC should support an independent group charged with reviewing all relevant research and distilling it into evidence-based practice guidelines for the benefit of practitioners, further developing the PHEPR evidence review methodology developed by the committee (see below), and identifying evidence gaps (Recommendation 1). CDC should establish the infrastructure necessary to support this group and ensure a sustained process for conducting these evidence reviews (Recommendation 2).
- It is essential to get these evidence-based practices into the hands of the public health practitioners who most need them. CDC should use a multipronged dissemination approach to ensure that evidence-based practice recommendations achieve broad reach and become the standard of practice of the target audience(s) (Recommendation 8). Working with professional and academic organizations across relevant disciplines, CDC should develop the workforce capacity development programs necessary to both ensure the conduct of quality PHEPR research and improve the implementation capacity of public health agencies (Recommendation 7).
In conducting this study, the committee developed a fit-for-purpose evidence review methodology, drawing on the elements of existing frameworks to carry out a systematic review and evaluation of the evidence for four PHEPR practices that fall within the 15 PHEPR Capabilities and to understand the associated benefits and harms. To ensure that the methodology would be applicable to practices from across the full range of PHEPR Capabilities (see Box 1-2 in Chapter 1), the criteria and process for selecting the four review topics (depicted in Figure 3-1 in Chapter 3) were developed with the aim of yielding a set of diverse PHEPR practices for which the evidence base would be expected to differ in nature. Applying its
2 The numbering of the recommendations reflects the order in which they are presented in the report chapters. Recommendations are presented out of sequence in the bullets in this abstract to support a focus on the committee’s proposed National PHEPR Science Framework.
methodology, the committee reviewed the available evidence and provides in this report evidence-based practice recommendations and/or implementation guidance relating to
- engaging with and training community-based partners to improve the outcomes of at-risk populations3 after public health emergencies (falls under Capability 1, Community Preparedness);
- activating a public health emergency operations center (Capability 3, Emergency Operations Coordination);
- communicating public health alerts and guidance with technical audiences during a public health emergency (Capability 6, Information Sharing); and
- implementing quarantine to reduce or stop the spread of a contagious disease (Capability 11, Non-Pharmaceutical Interventions).
This report and the committee’s recommendations show that implementing strategies to build the foundations for a robust scientific evidence base in the PHEPR field is feasible, and that an investment in PHEPR research and an evidence review system has the potential to yield significant public benefits in terms of preventing the needless loss of lives and disruption to communities in future public health emergencies. As the PHEPR research field continues to evolve and mature, the committee asserts that such an evidence base should be the foundation for future changes in both policy and practice.
3 For the purposes of this report, the committee defined at-risk populations as comprising individuals with social and/or structural vulnerabilities whose access and functional needs may not be fully met by traditional service providers or who feel they cannot comfortably or safely use the standard resources offered during preparedness, response, and recovery efforts. A more comprehensive description of at-risk populations is provided in Box 4-1 in Chapter 4.