As the U.S. reels from a more than 1 million reported deaths due directly to the Covid-19 pandemic, another infectious disease — monkeypox — is beginning to percolate. Cases of monkeypox, which scientists have been warning about for years, continue to rise worldwide.
Covid-19 followed by monkeypox offers an opportunity to reflect on what can be done to reduce the impact of this and future pandemics.
One of the most important actions that can be taken now is to bring together an external advisory group — a private-public partnership — to address disease modeling and interventions (both pharmaceutical and nonpharmaceutical), as well as be available before, during, and after a pandemic, just as we have external advisory groups for making clinical recommendations on vaccines to the Centers for Disease Control and Prevention and the Food and Drug Administration. Bringing in experts to guide government planning and implementation in these situations will bring additional perspectives and strengthen strategies.
As an operations research expert who has spoken regularly to the media and public audiences about the pandemic, I say this partly based on a question people have repeatedly asked me: Who should I believe in understanding what will (or might) happen with the pandemic?
Public-private partnerships that include modeling experts are the answer.
Disease outbreaks, especially those due to novel viruses such as H1N1a, SARS-CoV-2, and Zika, have demonstrated the challenges associated with predicting and responding to contagions. U.S. governmental agencies have made important strides in this realm in recent years, including:
- Investment by the CDC in a Center for Forecasting and Outbreak Analytics with a world-class modeler as the founding director
- Funding modeling teams to support state and local epidemiologists
- Investing in ensemble forecasting and scenario projections
Yet challenges remain in continually incorporating new types of data sources, bringing in the newest computational approaches, improving public health messaging, and ensuring that a diversity of perspectives are integrated into decision-making. This is especially clear with monkeypox, a disease that has been active in Africa for years but is now spreading worldwide.
A diversity of perspectives is especially important during a pandemic, as the pandemic experiences of the populations of New York City or Los Angeles are not necessarily the same as what plays out in the rural Southeast or in Africa. Specifically, academic and private industry experts can add a wealth of knowledge on logistics and technological innovations to support decision-making by governmental agencies. A diversity of worldwide backgrounds and participants can also help ensure that a wide set of scenarios and modeling possibilities are considered, including new channels of disease spread, variants with new properties, fast sequencing, and the interrelationships between disease spread and societal decisions related to schools or supply chains.
Since the beginning of Covid-19, my research group at North Carolina State University has been one of several chosen by the CDC and Council of State and Territorial Epidemiologists to provide modeling support for state and local health agencies. Our group — and other modeling groups like it — provided advance notice before a surge in hospitalizations in fall 2021 due to the Delta variant, and in January 2022 due to the Omicron variant. In December 2021, five modeling groups released a statement giving additional power to the expectation for high strain on common resources in the wake of the Omicron variant and population behaviors during the holidays. In these examples and others, the information gave additional time for systems to prepare, including identifying additional medical personnel who were able to work, creating policy and process changes, and implementing other actions to reduce hospitalizations and deaths.
Experiences in the United Kingdom have shown that its Scientific Advisory Group for Emergencies can use modeling as a powerful lever to quickly build scientific information to support decision-making. In the U.K., scientists found there was value in ensuring independence from government (leading to the Independent SAGE group) and to making sure that the process was transparent. Analysis by the Independent Sage group concluded there was value to drawing perspectives and evidence from a broad, diverse base and incorporating local involvement from affected stakeholders.
As part of a public-private partnership, an external advisory group can leverage the experiences and expertise relevant for a particular question while allowing for a neutral role that is free from politics. A group of this type would also complement the expertise provided to the FDA on vaccines and biologic products and to the CDC on immunization, by focusing especially on disease modeling and corresponding interventions, all while ensuring a diversity of perspectives that may not be achievable by government alone.
Since my involvement with the global H1N1 pandemic that began in 2009, I have seen positive changes in the use of disease modeling and advanced computation to improve decisions related to disease outbreaks, from the influenza pandemic of 2009-2010 to the Ebola outbreak of 2013 to 2016, the beginning of the Covid-19 pandemic, and the CDC’s recent decision to build a forecasting center. These positive changes can be leveraged further by setting up an advisory group external to the government to support disease modeling and pandemic response through a public-private partnership that builds upon numerous backgrounds and perspectives from neutral external observers.
Julie Swann is department head and distinguished professor in the Edward P. Fitts Department of Industrial and Systems Engineering at North Carolina State University, and a former advisor to the CDC for the H1N1 pandemic response.
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