Report Recommends National Framework for Public Health Response

Jul. 23--With all the various "strategies" unfolding across the country to deal with the coronavirus outbreak, it would be helpful to collect data on what's really working and what's not, but that isn't in anyone's playbook.

It should be, and that's one of the recommendations from a report by the National Academies of Sciences, Engineering, and Medicine. One of the key recommendations of the report was the development of a National Public Health Emergency Preparedness and Response (PHEPR) Science Framework to be led by the Centers for Disease Control and Prevention (CDC).

The framework would serve as a mechanism for funding and collecting evidence on various health emergencies to be studied and analyzed that could become actionable data for the next emergency. Too often, funding and study is enhanced following a disaster or during times of heightened interest in a subject, but aren't sustained. This framework would provide a sustained mechanism to build on for future disasters.

"Preparing for and responding to public health emergencies requires scientific evidence to save lives, prevent social and economic disruption, and uphold national security," Ned Calonge, president and CEO of the Colorado Trust, and chair of the committee that wrote the report, said in a press release. "In the midst of the COVID-19 pandemic, now is the time for the nation to take stock of how we can improve the quality of research that is conducted before, during and after public health emergencies."

The report is a culmination of about a three-year study by a National Academies of Sciences, Engineering, and Medicine panel brought together by the CDC to look at the best ways to develop an evidentiary basis for public health and emergency preparedness and response.

The CDC looks at 15 capabilities for funding purpose that it expects health departments to be able to carry out and maintain. The panel looked at four of those for this study--standing up an EOC, quarantining, communicating with technical audiences, and engaging community-based partners for the purposes of public health preparedness and response.

"In other fields, and certainly in public health and medicine, there are bodies that exist that review evidence on a regular basis," said Dr. David Abramson, clinical associate professor at New York University's School of Global Public Health, who participated in the study.

For example, the CDC has what is called a community guide that reviews community public health interventions to determine the most effective ways to intervene. "Think about FEMA's directive to have three days of food and water," Abramson said. "Well, why should it be three, maybe it should be five or 50. That's sort of at the heart of what we're looking into."

In other words, actions and recommendations should be evidence-based, not based on a hunch or gut feeling by someone in leadership. For example, in the medical field, scientific research is done on medicines to determine which ones work best. There are randomized, controlled trials where people get a drug and others in the trial get a placebo and the results are examined.

There is no such methodology for emergency preparedness and response, and research is lacking. "You probably won't find it surprising that research goes up and down in waves depending on political interests, popular interests and a particular event," Abramson said. "It's not a sustained research funding and it's not organized and coordinated over time or even across the government agencies that are involved in the work."

The science framework would create that mechanism for a coordinated and organized effort among those groups.

"That's really creating the overarching structure for it because what we're seeing with the is the CDC and other agencies like the Department of Homeland Security, National Institutes of Health and others, is that there are many questions that are important to be answered and the first thing that all these agencies need to do is get together and create infrastructure for how to talk about it, how to fund it and how to set a research agenda," Abramson said.

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