US Academic and NGO Engagement in Pandemic Preparedness and Response

Introduction

The COVID-19 pandemic has posed unprecedented challenges and galvanized activities related to pandemic preparedness and response across a wide range of sectors and institutions at global, national, and local levels. In policy statements about the need for enhanced preparedness for future pandemics, however, the roles of academic institutions and nongovernmental organizations (NGOs) have received relatively little attention. For example, in the report of the Independent Panel for Pandemic Preparedness and Response, there is no mention of roles for these entities. ¹ At the same time, universities are positioned to play significant roles in biomedical research and training. One way that academic centers respond to new opportunities and challenges is to establish centers of excellence and programs that bring together relevant components of the institution.

We conducted a landscape analysis of US academic institutions and NGOs involved in pandemic preparedness and response to understand the current status of their engagement in pandemic preparedness efforts, including the range of technical and geographic foci of their efforts and the trajectory of their development. Our findings highlight opportunities for academic institutions and NGOs to play more active roles in pandemic preparedness and response, policy development, behavioral interventions, and communications, in addition to other, more traditional roles in biomedical innovation and capacity strengthening.

Landscape Analysis Description

In 2022 and 2023, we performed internet searches and a detailed review of websites to identify and characterize academic centers of excellence or programs and NGOs with major activities focusing on pandemic preparedness, prevention, and response that were outward-facing and extended beyond education and training. We used a defined set of search terms to identify centers and programs. Each identified center website was reviewed in detail and information related to the program or center operations and scope was extracted and categorized. The internet search was supplemented by a review of key documents for each identified program and center.

We examined available mission and vision statements, as well as information provided about program operations, activities, research initiatives, funding sources, partnerships, interventions, and lists of faculty members. We categorized this information according to core priorities, focus pathogens, mission, core activities, geographic reach, multi-institutional partners, and administrative information including the number of faculty, center structure, budget, and funding sources.

Landscape Analysis Findings

The 2022 internet search and analysis of websites, supplemented by a review of key documents, identified 52 pandemic disease centers of excellence, with 38 based in academic institutions^2-45 and 14 in NGOs.^46-59 Twenty-seven (52%) of these were established between 2020 and 2022.^{2,4,8-10,16,18-22,24-27,29-31,34-38,42-45,49,52-53,56-58}

There was considerable variation in the primary focus of activities among the centers, with 60% of academic institutions^{2,4,6,8,10-13,15,17-18,20,22-27,30-31,36-38,40-42} and 78% of NGOs^{46-47,50-55,57-59} reporting efforts to address capacity strengthening. In addition, 60% of academic centers^{2,6-8,12-13,16-21,23,27,29,31,33-35,39-42} and 36% of NGOs^{46-47,52,55,59} targeted innovative biomedical efforts; 21% of academic centers^{2,4,8-9,20,24-25,27,32,40} and 29% of NGOs^46,48,53,56 focused on communications; and 26% of academic institutions^{2-3,5,16-17,22,26,28,40-41} and 21% of NGOs^48-49,56 addressed vulnerability mapping. In contrast, 7% of academic institutions^20,28,40 and 14% of NGOs^53,56 mentioned a focus on nonpharmaceutical behavioral interventions, and 16% of academic institutions^{2,15,17,24-25,32,40} and 28% of NGOs^48-49,53,56 reported efforts to address policy development.

The 2023 internet search reevaluated previously identified institutions and noted 3 new academic centers.^43-45 In addition, 4 academic centers and 1 NGO no longer appeared in our search.^{18,21,35-36,49} We identified changes in the core foci of existing academic centers, with a 27% increase in centers reporting activities in capacity strengthening,^{7,14,19,28,32,45} a 7% increase in focus on biomedical innovations,^22,37,43-45 an 81% increase in policy development activities,^{4-5,10,14,20,45} and a 61% increase in work on communications.^{5,17,37-38,43} Among NGO centers, there was an 18% increase in capacity-strengthening activities^48,56 and a 71% increase in vulnerability mapping efforts,^54,58 but otherwise limited change in the foci of their activities. The 2023 review included a search for activities identified as a One Health approach, and we found that 29% of academic institutions and NGOs identified had specific One Health research foci or other activities.^{2,7-8,22,26-28,34,37,40-41,48,50,54,56}

In the 2023 assessment, the vast majority (85%) of the identified programs reported a primary focus on SARS-CoV-2,^{2-7,10-11,14-17,19-20,22-34,37-38,40-45,47-48,51-53,55,57-59} with almost as many (78%) also reporting initiatives to address a broader array of other pathogens with pandemic potential.^{2-15,17,19-20,22-34,38-41,44-448,50-59} Center size in terms of number of personnel remained relatively stable across the 2 assessments (academic institutions: median 26, ranging from 1 to 200; NGOs: median 10.5, ranging from 1 to 84), with the most significant changes in center size occurring within programs established between 2020 and 2023. Funding for centers was reported from a variety of sources, most notably from research and program grants from the US Department of Health and Human Services through the National Institutes of Health and the Centers for Disease Control and Prevention or from the Department of State through the US Agency for International Development. In 2023, 65% of newly established and current centers reported receiving federal funding^{3,5,8,11-15,17,19-20,26,30-33,37-39,42,44,47,57,59} and 58% reported receiving funding from private companies and philanthropic foundations.^{3,6,8-11,14-15,17,19,23,26,34,37,42,47,50,53,55-57,59}

Further Thoughts

Our assessment found that the COVID-19 pandemic led to a surge in academic and NGO activity focused on pandemic preparedness, prevention, and response. Our search, while not exhaustive, documented robust and expanding work in these areas, with a broad range of engagement from capacity strengthening to disease surveillance and biomedical innovations. The unique role of universities in some of these areas cannot be overstated. Universities are the training ground for future generations of program managers, policymakers, clinicians, and researchers. The rapidly changing nature of epidemics, and the sophistication of tools, such as genomic techniques to detect, track, and manage outbreaks, demand a well-trained global workforce that can adapt to new challenges. Similarly, biomedical research conducted in academic institutions played a key role in the response to COVID-19 and other emerging disease threats. Partnerships with the commercial sector that capitalize on the complementary strengths of university-based researchers and industry have been critical in the rollout of vaccines, diagnostics, and therapeutic countermeasures. While our assessment found that pandemic centers were active in training, capacity strengthening, and biomedical research, activities devoted to other areas remain more limited, including policy development, behavioral interventions, and communications, where it would seem that academic institutions could make important contributions. These findings suggest opportunities for centers to enhance approaches and respond more effectively because often nonpharmacological measures are the first line of defense against a newly recognized pandemic pathogen while biomedical interventions are being developed and tested. After biomedical innovations become available, nonpharmacological measures remain as equally crucial components of comprehensive pandemic preparedness and response efforts, as they are implemented at scale, as seen with HIV and COVID-19 prevention and care programs.^60,61

The COVID-19 pandemic highlighted not only the importance of communications and community engagement in outbreak situations, but it also showcased the critical need for these essential components in future pandemic prevention and control programs. ⁶² In light of these important roles, initiatives that leverage the strengths of academic institutions and NGOs by linking strong, interdisciplinary, and intersectoral research and expertise with equally robust expertise in implementation science and capacity development are likely to be particularly valuable in future pandemic preparedness and response efforts. In addition, there is a need to enhance communication between academic and NGO efforts and those of policymakers and governments. Rapid, robust knowledge dissemination and communication during an outbreak are key to a successful response. However, priorities and communications channels in academia, such as research grants and academic publications, often differ from those of governments and policymakers when preventing and responding to pandemics. Normalization of multidisciplinary and multisectoral organizational structures (eg, teams, task forces, and advisory committees) and strategies, supported by innovative training approaches that bridge traditional silos, could facilitate improvements in knowledge dissemination, data sharing, communication, and collaborative program and policy implementation in future pandemic preparedness and response efforts. Future work might include interviews with academic and NGO center personnel identified in this study to explore additional ways to strengthen linkages between academic and NGO efforts and the efforts of policymakers and government agencies.

Conclusion

Academic institutions and the nonprofit sector pivoted rapidly to assume roles in pandemic preparedness and response efforts. Their continued participation in enhancing global health security will require sustained domestic and global funding. As governments and multilateral agencies declare the end of the COVID-19 pandemic, there is a historic opportunity to break the cycle of panic and neglect that has repeatedly marked both US and global approaches to pandemic diseases by leveraging not only the lessons but also the interdisciplinary academic and NGO infrastructures that have been built during the last 3 years. We squander this opportunity at our own peril.