By Tom J. Obengo
Setting priorities in research requires we consider which research topics or approaches should be preferred in factors such as funding, staffing, and approval. This is important especially where resources are scarce and can be challenging for institutions, governments, and funders.
The role of research prioritization in epidemics
When epidemics occur, normal life and research are interrupted for individuals and communities. Challenges that influence the setting of research priorities during epidemics include a shortage of resources, uncertain evidence landscapes, and the impact of neglecting non-emergency research. During an epidemic, the most pressing questions for clinicians and public health professionals, as well those offering the potential of the greatest health benefit to the people, should inform which research gets priority. There is need for a decision-making process that enables effective use of scarce resources, both to avoid wastage and to ensure priority subjects receive adequate attention.The research prioritisation process should consider questions about which kinds of research ought to be supported or conducted in emergency situations. It should also determine which research is likely going to be of the greatest health benefit to the relevant populations. In doing this, prioritisation in research should lead to support for the relevant research. In practice, the need for priority setting exercises to be inclusive and accountable emphasises the importance of considering relevant ethical concepts and values, how such decisions should be made, who should be involved, and what interests should be represented. According to the World Health Organization a three-step criteria for research prioritization in emergency and disaster-management situations should be followed. The first step involves forming a leadership team; understanding context and collecting necessary data; identifying and engaging with stakeholders; and collecting background information. The second step is to identify research options, decide on what criteria to use, and rank the research options. This should involve conducting a literature review on the current state of knowledge, current research, research gaps, and previously established research priorities. It should include asking for stakeholders’ views about research options ahead of the meetings where consensus on a list of priorities is established. The third step involves actions after the priority-setting exercise, namely conducting the prioritized research projects, implementing their findings, evaluating the impact of those findings, reporting and publishing the priority-setting exercise, evaluating the process and outcome of the exercise, and feeding the results back to inform future exercises. The evaluation and feedback are especially important to inform future prioritization. In addition, local research which is likely to promote effective problem-solving in communities should be prioritised.
Research Priority Setting in Low-Income Countries
In low-income settings, such as those found in many parts of Africa, past research experiences in previous epidemics may inform research priority setting. At the Africa Centres for Disease Control (ACDC), a task force for COVID-19 has worked with experts to identify six key priority areas in relation to COVID-19. These are: epidemiology and surveillance of COVID-19; development of diagnostics; clinical characterization of cases; drug and vaccine clinical trials; investigation of the impact of COVID-19 on the health systems; and social science and policy research (ACDC, 2021). We can see these research priority areas are broad and may not be easy to fund, if each aspect is to receive adequate attention in research. The team engaged experts from various research institutes in the six research areas and proposed “a limited number of actionable policy statements”. The recommendations from the experts provided further details on each research priority area for ease of understanding and implementation, providing a useful example of how some of the procedural considerations outlined above have been met in practice.
In determining which research is likely going to be of the greatest health benefit to the relevant populations, on the one hand there may be uncertainty about what type of knowledge would be most valuable to address the emergency, and on the other there are assumptions about the relative utility of some types of research over others. The need to prioritize specific research themes related to the epidemic may generate controversies on what is a more significant priority: clinical research versus epidemiology; people’s social behaviour versus the mutations of a virus; public safety versus the economic impact of the epidemic. For instance, there may be a focus on health science research rather than research in the humanities, even though the latter may be equally important for the design of interventions that are widely supported by the people who need to adopt those interventions. Concerns have arisen, for example, that the initial absence of social science research during the West African Ebola outbreak played a role in the design of interventions that were not broadly supported (Klitzman, 2015). The absence of local support for the way the interventions had been designed resulted in the continuation of traditional burial practices, and avoidance of clinical care facilities, which contributed to further spread of the epidemic.
Challenges in Research Priority Setting
Research prioritization exercises can be complex and challenging. For example, research priority setting during an epidemic may introduce questions about whether research that is on-going should be de-prioritized or stopped. Where researchers are already engaged in other research activities, new priorities may deprioritize current research and constrain researchers’ freedom to engage in a subject that they consider important and would like to develop to a conclusion. For example, researchers have had to postpone research on other topics in order to prioritize COVID-19 prevention and infection control. Challenging questions arise about de-prioritising research projects, which, if stopped or de-escalated, may lead to compromised, or altogether unhelpful, results.
Finally, it is important to recognise that priority setting activities should be accompanied by a plan. Such a plan should outline implementation and/or a broad commitment by the research community (including funders) to consider taking the priorities into account, so as to ensure the exercise is meaningful.
ACDC 2021. Research and Development Priorities for COVID-19 in Africa. Addis Ababa.
KLITZMAN, R. 2015. Evolving challenges and research-needs concerning Ebola. American journal of public health (1971), 105, 1513-1515.
NASSER, M., VIERGEVER, R. F. & MARTIN, J. 2021. Prioritization of Research. WHO Guidance on Research Methods for Health Emergency and Disaster Risk Management
Tom J. Obengo is an Epidemic Ethics Post-Doctoral Research Fellow in the Department of Medicine at the University of Cape Town. ORCID 0000-0002-1002-7122; LinkedIn https://www.linkedin.com/in/tom-j-obengo-99357656/ ; https://twitter.com/TomJObengo1 ; https://www.researchgate.net/profile/Tom-Obengo/research