Discussion
These data suggest that that original WHO COVID-19 Research Roadmap remains broadly globally applicable. Here, we also show which research questions require the most emphasis and also that potential new priorities have emerged that were not within the initial roadmap.
Some newly suggested priorities reflect the progress of the pandemic and acquisition of knowledge as to where the gaps lie; notably research in children, pregnancy, long-term health impacts of the disease and that there is a strong call for research that assesses the effectiveness of public health measures put into place across the globe to reduce transmission of this virus. These were alongside a demand for greater social science research to determine public perception, and better ways to change behaviours and build trust (including a need for social sciences to cross-cut the other more biomedical priorities). We also identified a range of new priorities relating to addressing COVID-19 in lower resource settings, where multiple pressures including ongoing endemic infectious diseases and other comorbidities are competing within the health and policy systems for limited resources. These pressures have led to emphasis on cheaper and field applicable tools and research and health capacity strengthening.
The need for further studies to evaluate public health measures and studies on other potential interventions as they arise were ranked highly by the survey respondents and workshop participants. These studies must be undertaken as quickly as possible, in highly varied social contexts, if we are to gain evidence now on just how effective measures such as lockdown, handwashing and social distancing are on reducing transmission and to understand the relative risks and benefits. The need for social science research and mixed methods came through very strongly, with an emphasis on determining how to gain trust and successfully deliver public health messages. This needs evidence-based community engagement strategies; tested and evaluated everywhere.
Limitations of our approach include the fact that we built the questions to align with the original WHO broad priority headings, this would have inherently focused the survey respondents around the largely biomedical focus of these priorities and this meant that some headings (eg, the animal human interface) had relatively few suggested priorities, while others (eg, social sciences in the outbreak response) had much larger numbers. We also retained the original order of priorities from the WHO Research Roadmap and the AAS survey and this may have influenced the ranking given by respondents. The workshops however were open and purposefully invited researchers to make whatever comments they wanted in regard to where current research priorities lie, beyond the scope of the WHO Research Roadmap. Therefore, taken together, we suggest that these data support the importance of the WHO Research Roadmap approach and highlight where funders and researcher should be placing emphasis as well as identifying potential new areas that should be tackled within this pandemic.
Consideration of both immediate and long-term priorities is important to address this specific pandemic and to better prepare for the future. There are studies that need ongoing transmission, at a high enough rate to answer the question they set. These might be essential for this pandemic, for example, clinical trials to determine the efficacy of drugs or vaccines, or address questions to guide future outbreaks, such as evaluating the effectiveness of public health interventions. Other studies do not need circulating virus and could still guide the effort to address COVID-19 or might help for future pandemics. Figure 1 shows these four situations and gives examples.
Figure 1Priority assessment matrix for research within the COVID-19 pandemic. PPE, personal protective equipment.
Consideration of these findings in the context of where we are now with the global shifting and evolution of the pandemic requires both research teams and funders to ensure research across all these key areas within this finite window. This complements ongoing work by the UK Collaborative on Development Research and Global Research Collaboration for Infectious Disease Preparedness to map research funding against the WHO roadmap priorities to enable funders and researchers identify gaps and opportunities, and inform future research investments or coordination needs.8
Finally, we want to highlight both the importance of fully involving the global research community in priority settingand the ongoing need to review priorities where knowledge and practice is advancing rapidly. We recognise that these efforts need to be complemented by further research priority scoping work, beyond the global health focus to further strengthen cross-disciplinary efforts. Here, we have shown that the global health research community supports the recommendations of the WHO Research Roadmap, but that important new priorities have emerged both due to the transition through the pandemic and consideration of differing global epidemiological, health system, policy and research contexts.