Public Health Lessons for Non-Vaccine Influenza Interventions Looking Past COVID-19 (2022) / Chapter Skim
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. Both before and after a vaccine is available, public health control measures -- such as face masks and improved physical distancing -- can combat emerging and ongoing influenza outbreaks by mitigating transmission.
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KEY FINDINGS AND CONCLUSIONS Event Preparedness • Preparedness should include investments to expand holistic strate gies, such as the One Health approach, to build surveillance capac ity, improve the accuracy of data collection through defining critical data elements, and develop and maintain data integration platforms to ensure the timely detection of zoonotic pathogen strains with pandemic potential and large antigenic drifts and shifts. • Preparedness efforts should consider the capacities to research, produce, and stockpile therapeutic drugs for respiratory viruses, including any supplies needed for their delivery.
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Knowledge gleaned from this type of collaborative, transdisciplinary approach could strengthen the abilities to detect, test, study, and monitor existing and novel zoonotic pathogen strains for antigenic drifts, shifts, and pandemic potential. Success with this strategy as a part of harmonized and coordinated pandemic preparation and response will depend on countries and intergovernmental bodies adopting a shared commitment to bolstering national and international surveillance capacities.
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Additionally, physical distancing measures have some evidence for effectiveness, but the current recommendations of 1–2 meters do not account for physiology and physics of exhalation flows, their interaction with airflows, and viral particle distribution in droplets and the exhalation cloud. These considerations highlight the importance of ventilation for reducing virus transmission in closed indoor public places where people do not typically wear masks (e.g., restaurants)
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, a legally binding framework, do not recommend strict border closures that may impact international travel and trade. To further explore the validity of these conclusions, a research framework using diverse evidence from multiple disciplines, such as physical sciences and engineering, is needed to assess individual and combined nonvaccine control measures for respiratory viruses.
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Such public responses can be profoundly shaped by a range of beliefs and norms that vary across communities around the world; policies and intervention plans need to take these into account when mitigation strategies for respiratory viruses are designed and implemented. The effectiveness and uptake of non-vaccine control measures is ultimately contingent upon cooperation that is spearheaded by strong leadership and coordinated governance and communication.
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and national governments, including their local and state health agencies, should adopt policies that are tailored to each affected population, taking into account its social, economic, and cultural characteristics, needs and resources, and other contextual factors, including norms, values, and beliefs, in order to optimize the implementation of public health interventions, especially those that rely on individual behaviors. Recommendation 4-2: Governments, leaders of departments of health at local, state, and national levels, and elected and appointed govern ment leaders should: • Take the systemic factors, such as race and socioeconomic dis advantages that affect the health of affected populations, into consideration and leverage behavioral health research and mar keting tactics when developing and implementing public health interventions; • Demonstrate, in their behavior, adherence to non-vaccine mea sures to prevent influenza in order to promote public trust in, and uptake of, these measures; • Engage the community -- including grassroots organizations, spiritual leaders, teachers, and sports coaches -- in making and communicating decisions about public health measures; and • Choose words to convey communications positively (e.g., "physical distancing," "social solidarity," and "stay at home" rather than "social distancing," "individual isolation," and "lockdown")
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Universal principles will need to guide this allocation in ways that build trust by preventing health systems' collapse and removing allocation decisions from frontline providers. Adaptive platform trials conducted with shared global protocols allow for comparing interventions and adjusting participant enrollment as evidence on therapeutics evolve.
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The frame work should identify • Who will evaluate guidance from global and national health organizations and from professional societies in order to define evidence-based treatment guidelines; • How guidelines for treatment selection and delivery will be communicated to health agencies in the country's states/prov inces/regions and to frontline health care facilities, with a focus on avoiding the use of non-evidence-based therapeutics outside of clinical trials; • How suitable places to administer care will be selected, with consideration of options that provide alternatives for care deliv ery outside of already overwhelmed health facilities and primary care clinics; • Which populations should be the focus for therapeutic delivery with scarce resource availability (e.g., prevention in those not yet infected, versus treatment of those who are mildly or criti cally ill) , who will make those determinations, and how com munity interests will be incorporated; and • How to distribute a treatment modality equitably throughout the country and among patients including when health systems have moved to crisis standards of care because the available resources have become inadequate to meet the needs of all patients.
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Therefore, research to develop and test non-vaccine control measures should be a priority, particularly in low- and middle-income country settings, to enable governments to best leverage such measures during respiratory virus events. The next novel influenza or other respiratory pathogen posing a severe threat to human health is a matter of when and where, not if.
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