As the world tries to ready itself for the inevitable spread of the H5N1 avian flu virus, it’s unsettling to see another pandemic creeping up on us for which we seem frighteningly unprepared. The meeting will be the start of a worldwide communication infrastructure to respond to global public health outbreak. While this infrastructure will be constructed to respond to the challenge of pandemic influenza, it also should be versatile enough to be used for any global public health emergency. Pandemic, outbreak of infectious disease that occurs over a wide geographical area and that is of high prevalence, generally affecting a significant proportion of the world’s population over the course of several months. Learn about how pandemics arise and about pandemic preparedness and historical pandemics. Pandemic Academic is a startup based in the Washington DC area founded by Dr Nishal Mohan in 2012. As consultants, Pandemic Academic provides unique solutions to public health problems using science, policy, technology, and digital marketing.
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The 2009 H1N1 influenza pandemic confronted critical care researchers with a challenge: how to mobilize a research response to a rapidly emerging and incompletely understood international threat, and how to communicate the data emerging from any studies to decision-makers who were charged with leading a global clinical response. This challenge framed InFACT’s initial forays into international research collaboration. It is fair to say that we were largely unsuccessful, but that failure shaped ideas about how we might respond more effectively to future challenges.
Building on a CIHR- and PHAC-funded meeting in Toronto in 2011, and on a follow-up meeting in Pittsburgh later that year, and working in close collaboration with the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC), we embraced the concept of creating, in the inter-pandemic period, the research architecture that could be seconded to rapidly launch one or more clinical trials in response to an acute need.
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The model we embraced was the platform trial. A platform trial uses Bayesian models, and evaluates multiple interventions, simultaneously and sequentially; it is, in essence, a hybrid model of research and continuous quality improvement. The resulting trial – the Randomized, Embedded Multinational Adaptive Platform (REMAP) trial – selected as its focus severe community-acquired pneumonia (CAP) as the dominant phenotype for an emerging infectious disease. REMAP-CAP has now been funded in the EU as part of the PREPARE initiative, in Australia, New Zealand, and most recently, Canada. Additional funding applications are being considered for the USA, Brazil, and Africa.
REMAP-CAP will not only explore the creation of a platform for global collaboration in pandemic research, but also build a mechanism for better international research collaboration in investigator-led clinical trials. The opportunities for, and barriers to this are a key focus of this preliminary work.