Pandemic Preparedness – Ein Vorschlag für eine Forschungsinfrastruktur und ihre Funktionalitäten für ein resilientes Gesundheitsforschungssystem

Zusammenfassung

Während einer Pandemie muss Resilienz nicht nur als Eigenschaft des Gesundheitssystems, sondern auch des umgebenden Forschungsumfelds betrachtet werden. Um verlässliche, evidenzbasierte Empfehlungen aus der Universitätsmedizin an die Gesundheitspolitik und die Entscheidungsträger bereitstellen zu können, müssen wissenschaftliche Erkenntnisse schnell, integrativ und multidisziplinär generiert, synthetisiert und kommuniziert werden. Die Resilienz der öffentlichen Gesundheitssysteme und der Gesundheitsforschungssysteme sind somit eng verknüpft. Die Reaktion auf die SARS-CoV-2-Pandemie in Deutschland wurde jedoch durch das Fehlen einer adäquat vernetzten Gesundheitsforschungsinfrastruktur erschwert. Das Netzwerk Universitätsmedizin (NUM) wurde zu Beginn der Pandemie mit dem Ziel gegründet, Deutschland auf zukünftige Pandemien vorzubereiten. Ziel des Projektes „PREparedness and PAndemic REsponse in Deutschland (PREPARED)“ ist es, ein ganzheitliches Konzept für eine kooperative, adaptierbare und nachhaltige Gesundheitsforschungsinfrastruktur innerhalb des NUM zu entwickeln und damit einen Beitrag zu einer umfassenden Pandemiebereitschaft zu leisten. Das vorgeschlagene Konzept dieser Infrastruktur vereint vier Kern- und drei Unterstützungsfunktionalitäten in vier verschiedenen Handlungsfeldern. Die Funktionalitäten gewährleisten im Falle zukünftiger Gesundheitskrisen ein effizientes Funktionieren des Gesundheitsforschungssystems und eine rasche Übertragung entsprechender Implikationen in andere Systeme. Die vier Handlungsfelder sind (a) Monitoring und Surveillance, (b) Synthese und Transfer, (c) Koordination und Organisation sowie (d) Kapazitäten und Ressourcen. Die sieben Funktionalitäten umfassen 1) eine Monitoring- und Surveillance-Einheit, 2) eine Pathogenkompetenz-Plattform, 3) Evidenzsynthese und vertrauenswürdige Empfehlungen, 4) eine Einheit zur regionalen Vernetzung und Implementierung, 5) eine Strategische Kommunikationseinheit, 6) Human Resources Management und 7) ein Rapid Reaction & Response (R³)-Cockpit. Die Governance wird als Kontroll- und Regulierungssystem eingerichtet, wobei agile Management-Methoden in interpandemischen Phasen trainiert werden, um die Reaktionsfähigkeit zu verbessern sowie die Eignung agiler Methoden für die wissenschaftliche Infrastruktur für die Pandemiebereitschaft zu untersuchen. Der Aufbau der PREPARED-Forschungsinfrastruktur muss vor der nächsten Pandemie erfolgen, da Training und regelmäßige Stresstests grundlegende Voraussetzungen für deren Funktionieren sind.

Abstract

During a pandemic, resilience must be considered not only as an attribute of the health care system, but also of the surrounding research environment. To provide reliable evidence-based advice from university medicine to health policy and decision makers, scientific evidence must be generated, synthesized and communicated in a rapid, integrative and multidisciplinary manner. The resilience of public health systems and the health research systems are thus closely linked. However, the response to the SARS-CoV-2 pandemic in Germany was hampered by the lack of an adequate health research infrastructure. The Network University Medicine (NUM) was founded at the beginning of the pandemic with the aim of preparing Germany for future pandemics. The aim of the project “PREparedness and PAndemic REsponse in Deutschland (PREPARED)” is to develop a holistic concept for a cooperative, adaptable and sustainable health research infrastructure within the NUM and thus contribute to pandemic preparedness and rapid response. The proposed concept for a health research infrastructure includes four core and three supporting functionalities in four different fields of action. The functionalities aim to ensure efficient functioning within the health research system and a rapid translation to other systems in future health crises. The four fields of action are (a) monitoring and surveillance, (b) synthesis and transfer, (c) coordination and organization, and (d) capacities and resources. The seven functionalities include 1) a monitoring and surveillance unit, 2) a pathogen competence platform, 3) evidence synthesis and trustworthy recommendations, 4) a regional networking and implementation unit, 5) a strategic communication unit, 6) human resources management, and 7) a rapid reaction and the response (R³)-cockpit. A governance will be established as a control and regulatory system for all structures and processes, testing agile management in non-pandemic times to improve responsiveness and flexibility and to investigate the suitability of the methods for scientific pandemic preparedness. The establishment of the PREPARED health research infrastructure must take place before the next pandemic, as training and regular stress tests are its fundamental prerequisites.

Schlüsselwörter

Pandemiebereitschaft - Capacity Building - Krisenmanagement - Forschungsinfrastruktur - Versorgungsforschung

Keywords

Pandemic Preparedness - Capacity Building - Epidemic Response Plan - Crisis Management - Health Services Research - Scientific Research Infrastructure

Publication History

Received: 04 March 2024

Accepted after revision: 25 June 2024

Accepted Manuscript online:
15 July 2024

Article published online:
31 October 2024

• Literatur

• 1 Pfaff H, Schmitt J. Reducing uncertainty in evidence-based health policy by integrating empirical and theoretical evidence: An EbM+theory approach. Journal of evaluation in clinical practice 2023; 29: 1279-1293
• 2 Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen. Resilienz im Gesundheitswesen – Wege zur Bewältigung künftiger Krisen. Berlin: MWV Medizinisch Wissenschaftliche Verlagsgesellschaft; 2023
• 3 Wissenschaftsrat. Empfehlungen zur zukünftigen Rolle der Universitätsmedizin zwischen Wissenschafts- und Gesundheitssystem. Köln: 2021
• 4 Panchyrz I, Hoffmann J, Harst L. et al. Maßnahmen und Empfehlungen für die Sicherstellung adäquater stationärer Versorgungskapazitäten für das Pandemiemanagement innerhalb einer Region – Ergebnisse eines hybriden Delphi-Verfahrens. Gesundheitswesen 2023; 85: 1173-1182
• 5 Panchyrz I, Pohl S, Hoffmann J. et al. The role of university hospitals in regional health care management for coping with the COVID-19 pandemic. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 2021; 167: 68-77
• 6 Heyder R, Kroemer HK, Wiedmann S. et al. Das Netzwerk Universitätsmedizin: Technisch-organisatorische Ansätze für Forschungsdatenplattformen. Bundesgesundheitsbl 2023; 66: 114-125
• 7 Busse R, Karagiannidis C, Augurzky B. et al. Der Vorschlag der Regierungskommission für eine grundlegende Reform der Krankenhausvergütung. In: Klauber J, Wasem J, Beivers A, Mostert C, Hrsg. Krankenhaus-Report 2023: Schwerpunkt: Personal. Berlin, Heidelberg: Springer; 2023: 267-280
• 8 Liberato SC, Brimblecombe J, Ritchie J. et al. Measuring capacity building in communities: a review of the literature. BMC public health 2011; 11: 850
• 9 Nickel S, Trojan A. Capacity Building/Kapazitätsentwicklung 2024;
• 10 Bornmann L. What is societal impact of research and how can it be assessed? a literature survey. Journal of the American Society for Information Science and Technology 2013; 64: 217-233
• 11 Abu El Sood H, Abu Kamer SA, Kamel R. et al. The Impact of Implementing the Egypt Pandemic Preparedness Plan for Acute Respiratory Infections in Combating the Early Stage of the COVID-19 Pandemic, February-July 2020: Viewpoint. JMIR Public Health Surveill 2021; 7: e27412
• 12 Daszak P, Keusch GT, Phelan AL. et al. Infectious Disease Threats: A Rebound To Resilience. Health affairs (Project Hope) 2021; 40: 204-211
• 13 Kidd MR. Five principles for pandemic preparedness: lessons from the Australian COVID-19 primary care response. The British journal of general practice 2020; 70: 316-317
• 14 World Health Organization. Pandemic preparedness. 2011 https://www.who.int/europe/news-room/fact-sheets/item/pandemic-preparedness
• 15 Robert-Koch-Institut. Nationaler Pandemieplan Teil I. 2017;
• 16 Bell JA, Nuzzo, Jennifer B Global Health Security Index: Advancing Collective Action and Accountability Amid Global Crisis 2021 https://ghsindex.org/wp-content/uploads/2021/12/2021_GHSindexFullReport_Final.pdf
• 17 Centers for Disease Control and Prevention. National Strategy for Pandemic Influenza. Washington. 2005 https://www.cdc.gov/flu/pandemic-resources/pdf/pandemic-influenza-implementation.pdf
• 18 Crain MA, Bush AL, Hayanga H. et al. Healthcare Leadership in the COVID-19 Pandemic: From Innovative Preparation to Evolutionary Transformation. J Healthc Leadersh 2021; 13: 199-207
• 19 Haldane V, Jung AS, De Foo C. et al. Strengthening the basics: public health responses to prevent the next pandemic. Bmj 2021; 375: e067510
• 20 S20 Academies Joint Statement. Pandemic preparedness and the role of science. 2021 https://www.academie-sciences.fr/pdf/rapport/S20_Joint_Statement_2021.pdf
• 21 Interdisziplinäre Kommission für Pandemieforschung der Deutschen Forschungsgemeinschaft (DFG). Wissenschaften in der Coronavirus-Pandemie. Erkenntnisse, Wissens- und Handlungslücken sowie Schlussfolgerungen für die Vorbereitung auf künftige Pandemien. Bonn: 2022
• 22 Haldane V, De Foo C, Abdalla SM. et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med 2021; 27: 964-980
• 23 Hashim A, Jean-Gilles L, Hegermann-Lindencrone M. et al. Did pandemic preparedness aid the response to pandemic (H1N1) 2009? A qualitative analysis in seven countries within the WHO European Region. J Infect Public Health 2012; 5: 286-296
• 24 Wu S, Neill R, De Foo C. et al. Aggressive containment, suppression, and mitigation of covid-19: lessons learnt from eight countries. Bmj 2021; 375: e067508
• 25 Godshall CE, Banach DB. Pandemic Preparedness. Infect Dis Clin North Am 2021; 35: 1077-1089
• 26 Singh S, Bartos M, Abdalla S. et al. Resetting international systems for pandemic preparedness and response. Bmj 2021; 375: e067518
• 27 Johnson Sirleaf HEE, Clark H. Transforming or Tinkering. Inaction lays the groundwork for another pandemic. 2022 https://live-the-independent-panel.pantheonsite.io/wp-content/uploads/2022/05/Transforming-or-tinkering_Report_Final.pdf
• 28 Geraedts ME-G, Hecker M, Schneider R. et al. Stationäre Versorgung: Empfehlungen für ein künftiges Pandemiemanagement. Dtsch Arztebl 2021; 118: A-991 / B-822
• 29 Lünsmann BJ, Polotzek K, Kleber C. et al. Regional responsibility and coordination of appropriate inpatient care capacities for patients with COVID-19 - the German DISPENSE model. PloS one 2022; 17: e0262491
• 30 Strobl R, Misailovski M, Blaschke S. et al. Differentiating patients admitted primarily due to coronavirus disease 2019 (COVID-19) from those admitted with incidentally detected severe acute respiratory syndrome corona-virus type 2 (SARS-CoV-2) at hospital admission: A cohort analysis of German hospital records. Infection control and hospital epidemiology 2024; 1-8
• 31 Reinoso Schiller N, Usipbekova K, Hille K. et al. Pandemic management: Analysis of availability and relevance of surveillance indicators by COVID-Task-Forces in the German federal state of Lower Saxony. Infect Prev Pract 2023; 5: 100294
• 32 Pfaff H, Schmitt J. The Organic Turn: Coping With Pandemic and Non-pandemic Challenges by Integrating Evidence-, Theory-, Experience-, and Context-Based Knowledge in Advising Health Policy. Frontiers in public health 2021; 9: 727427
• 33 World Health Organization. Infodemic. 2023 https://www.who.int/health-topics/infodemic#tab=tab_1
• 34 Billings J, Ching BCF, Gkofa V. et al. Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis. BMC health services research 2021; 21: 923
• 35 Chew QH, Wei KC, Vasoo S. et al. Psychological and Coping Responses of Health Care Workers Toward Emerging Infectious Disease Outbreaks: A Rapid Review and Practical Implications for the COVID-19 Pandemic. The Journal of clinical psychiatry 2020; 81
• 36 Eyles E, Moran P, Okolie C. et al. Systematic review of the impact of the COVID-19 pandemic on suicidal behaviour amongst health and social care workers across the world. J Affect Disord Rep 2021; 6: 100271
• 37 Galanis P, Vraka I, Fragkou D. et al. Impact of personal protective equipment use on health care workersʼ physical health during the COVID-19 pandemic: A systematic review and meta-analysis. Am J Infect Control 2021; 49: 1305-1315
• 38 Ghahramani S, Kasraei H, Hayati R. et al. Health care workersʼ mental health in the face of COVID-19: a systematic review and meta-analysis. Int J Psychiatry Clin Pract 2023; 27: 208-217
• 39 Houghton C, Meskell P, Delaney H. et al. Barriers and facilitators to healthcare workersʼ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. The Cochrane database of systematic reviews 2020; 4: Cd013582
• 40 Koontalay A, Suksatan W, Prabsangob K. et al. Healthcare Workersʼ Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review. J Multidiscip Healthc 2021; 14: 3015-3025
• 41 Poon YR, Lin YP, Griffiths P. et al. A global overview of healthcare workersʼ turnover intention amid COVID-19 pandemic: a systematic review with future directions. Hum Resour Health 2022; 20: 70
• 42 Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen und in der Pflege. Fachkräfte im Gesundheitswesen - Nachhaltiger Einsatz einer knappen Ressource 2024;
• 43 Saragih ID, Tarihoran D, Rasool A. et al. Global prevalence of stigmatization and violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. J Nurs Scholarsh 2022; 54: 762-771
• 44 Stevens MP, Doll M, Pryor R. et al. Impact of COVID-19 on traditional healthcare-associated infection prevention efforts. Infection control and hospital epidemiology 2020; 41: 946-947
• 45 Tursunbayeva A, Di Lauro S. Strengthening the ICUsʼ human resource-related responses to Covid-19: A rapid review of the experience during the first year of public health emergency. Int J Health Plann Manage 2023; 38: 22-39
• 46 Ülgüt R, Tomsic I, Chaberny IF. et al. Human resource management to assist infection prevention and control professionals: A scoping review. The Journal of hospital infection 2024;
• 47 Umbetkulova S, Kanderzhanova A, Foster F. et al. Mental Health Changes in Healthcare Workers During COVID-19 Pandemic: A Systematic Review of Longitudinal Studies. Evaluation & the health professions 2024; 47: 11-20
• 48 Vizheh M, Qorbani M, Arzaghi SM. et al. The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. Journal of diabetes and metabolic disorders 2020; 19: 1967-1978
• 49 Wang J, Liu F, Zhou M. et al. Will the status of infection prevention and control (IPC) professionals be improved in the context of COVID-19?. Am J Infect Control 2020; 48: 729-730
• 50 Lieb K, Wiegand HF, Beutel M. S3-Leitlinie Psychische Gesundheit von Gesundheitspersonal in anhaltenden Krisen und Katastrophen. In: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Registernummer 038 – 026. 2024
• 51 Sopka S, Jung C, Janssens U. et al. S1-Leitlinie Empfehlungen zu Schulungen von Mitarbeitenden im Gesundheitswesen bei Einsatz während der COVID-19-Pandemie. In: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Registernummer 001 – 045. 2024
• 52 Abdi Z, Lega F, Ebeid N. et al. Role of hospital leadership in combating the COVID-19 pandemic. Health Serv Manage Res 2022; 35: 2-6
• 53 Broom J, Williams Veazey L, Broom A. et al. Experiences of the SARS-CoV-2 pandemic amongst Australian healthcare workers: from stressors to protective factors. The Journal of hospital infection 2022; 121: 75-81
• 54 Cogan N, Archbold H, Deakin K. et al. What have we learned about what works in sustaining mental health care and support services during a pandemic? Transferable insights from the COVID-19 response within the NHS Scottish context. International Journal of Mental Health 2022; 51: 164-188
• 55 Hughes Spence S, Khurshid Z, Flynn M. et al. A narrative inquiry into healthcare staff resilience and the sustainability of Quality Improvement implementation efforts during Covid-19. BMC health services research 2023; 23: 195
• 56 Nilsson K, Landstad BJ, Ekberg K. et al. Physiciansʼ experiences of challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in Sweden. International Journal of Health Governance 2022; 27: 254-267
• 57 Phillips G, Kendino M, Brolan CE. et al. Lessons from the frontline: Leadership and governance experiences in the COVID-19 pandemic response across the Pacific region. Lancet Reg Health West Pac 2022; 25: 100518