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Introduction

Emerging and persistent infectious disease threats such as Ebola, chikungunya, Zika, Middle East respiratory syndrome, severe acute respiratory virus, antibiotic resistance, and, in recent years, COVID-19 and mpox demonstrate the global and unrelenting nature of infectious threats and the pervasive human, social, and economic consequences they carry. The scale of the COVID-19 pandemic catalyzed unparalleled speed and cross-sector collaboration in the innovation of tools and technologies to address an emerging infectious disease outbreak. Continued innovation and cross-sector collaboration in rapid development and implementation of new vaccines, therapeutics, and diagnostics is central to future outbreak preparedness. It is critical for stakeholders across sectors—particularly in biomedical research, social behavior research, public health, and government—to collaboratively examine and apply lessons learned from the COVID-19 pandemic to create an environment that fosters scientific progress via partnerships, communication, and coordination. Broadening and strengthening stakeholder partnerships as part of the recovery efforts of the COVID-19 pandemic, in advance of the next crisis, is a key pillar of preparedness. To generate action steps at both the U.S. and global scales, researchers and practitioners from industry and academic research, public health, science communications, and financial and leadership support should build upon successful COVID-19 response efforts, identify areas in need of improvement, and consider sustainability in developing solid pandemic preparedness.

The Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine was established to provide a struc-

tured opportunity for stakeholder discussion and scrutiny of critical, and possibly contentious, scientific and policy issues of shared concern related to research on, prevention, detection, and management of, and responses to emerging and reemerging infectious diseases and dangerous pathogens. The Forum on Microbial Threats convenes workshops spanning a range of issues related to infectious diseases, from their economic drivers (NASEM, 2018) to cutting-edge technological innovations to counter microbial threats (NASEM, 2020a) including considerations for vaccine uptake (NASEM, 2021). In 2018, the forum examined the state of national and international readiness for pandemic threats in a workshop that explored lessons learned a century after the 1918 influenza pandemic (NASEM, 2019).

WORKSHOP OBJECTIVES

On December 7 and 8, 2022, a planning committee under the auspices of the Forum on Microbial Threats held a 1.5-day public workshop titled Applying Lessons Learned from COVID-19 Research and Development to Future Epidemics.¹ The aims of the workshop were to (1) explore innovative approaches sparked by COVID-19 to enhancing health systems preparedness and response to emerging infectious diseases, (2) consider basic scientific infrastructure and essential capabilities to support medical and behavioral countermeasures that were deployed during the COVID-19 pandemic response, (3) reflect on critical scientific infrastructure for stakeholder coordination and innovations that can facilitate rapid and effective responses to emerging threats, and (4) identify mitigation strategies. The workshop featured invited presentations and discussions to explore opportunities to²

• Broaden equitable collaboration, partnerships, and global coordination between academic, private, and public sectors, with participation of marginalized communities, to improve the research and development (R&D) of medical and behavioral countermeasures;
• Establish frameworks that address challenges to R&D stemming from the regulatory environment, including the review and approval of medical and behavioral countermeasures;

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¹ The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

² The full Statement of Task is provided in Appendix A. The workshop agenda is provided in Appendix B.

• Examine mechanisms for sustained financial, political, and operational support of the science behind health security and preparedness programs; and
• Enhance practical early- and later-stage communication strategies to support the adoption of scientific findings relevant to outbreak responses, including promotion of public trust in the biomedical research and public health enterprise.

ORGANIZATION OF THE PROCEEDINGS OF THE WORKSHOP

In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on information presented, questions raised, and improvements suggested by individual workshop participants. Chapter 2 focuses on lessons gleaned from the U.S. COVID-19 response to apply within the research community to future pandemic preparedness and response efforts. Chapters 3 and 4 explore the role of equitable scientific collaborations, partnerships, and coordination among groups in academia, industry, government, public health, civil society, and other stakeholders within the United States and at the global scale in developing, manufacturing, and distributing diagnostics, vaccines, and therapeutics. Chapter 5 discusses coordination and partnering between scientific researchers, policymakers, and the general public, with a focus on the role of public confidence in leaders and information sources, the politization of vaccine access and acceptance, and interventions shown to improve vaccine acceptance. Chapter 6 features an overview of social and behavioral strategies to motivate acceptance and uptake of public health recommendations within the realms of civil society, individuals and communities, and scientific organizations. Chapter 7 explores critical aspects of leadership and support in sustaining preparedness and response efforts, with a focus on U.S. federal efforts to coordinate responses to the COVID-19 pandemic and mpox outbreak. Chapter 8 focuses on innovative partnership structures and funding mechanisms that could be useful in enabling rapid development and delivery of vaccines for emerging infectious diseases.

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