COVID-19: what have we learned about rapid response?

THE coronavirus disease 2019 (COVID-19) pandemic has demonstrated Australia’s capacity for rapid innovation and flexibility in public health and medical research, while exposing some vulnerabilities in our current health and medical research structures. Commonwealth and state governments have highlighted the need for unprecedented mobilisation of health systems to mitigate the impact of the outbreak. What can we learn from COVID-19 to ensure Australia can respond rapidly and effectively to similar threats to individual and population health in future?

Since the start of this pandemic, the critical role of our capability in health and medical research has been visible. The majority of Australians now have some awareness of the epidemiology of COVID-19, as well as an increased understanding of the need for the rapid development of tools to assist in its detection and the need for an effective vaccine to safeguard against its re-emergence in the population.

There has also been a consistent and ongoing display of ingenious research and development from the health and non-health sectors alike. The innovation that has emerged has mainly focused on specific products, such as the pivoting of alcohol distilleries to develop hand sanitisers, repurposing of 3D printers to develop much needed personal protective equipment, and the rapid deployment of digitally enabled telehealth, as well as apps and platforms to facilitate this.

But we know that much of the new research needed for an optimal response to COVID-19, and to ensure rapid and widespread post-COVID-19 recovery, is in the more complex social and health systems domain. We need to be able to rapidly identify, test, adapt and evaluate new models of health service delivery and social investment; we need changing work, connectivity and transport patterns; and we need health service responses to post-COVID-19 risks such as mental health and undetected disease across the community.

Delivering an agile research response to complex issues is not easy. It requires timely collaboration across multiple organisations and sectors, rapid and flexible reallocation of funding and research staff, and quick decision making to prioritise research (ie, deciding both what to commence and what to stop).

In Australia, we have seen many such strong collaborations addressing major opportunities in response to this national emergency. At Deakin University, we have worked with our partner, Barwon Health and their University Hospital, Geelong, to establish a much needed mental health telehealth service, which will also be evaluated to inform future health and community service decision making. Many other organisations around the country have similarly teamed up to develop local and national solutions in their communities.

However, it is difficult to know who else around the country may be doing similar research and delivering innovations that may be good candidates for further and wider collaboration, or may in fact be redundant. While the national Department of Health has a COVID-19 landing page, and the Australian Academy of Science has recently developed a COVID-19 research expertise hub, there is as yet no single source of truth of, or ready pathway to, newly emerging COVID-19-related research.

A number of government and non-government organisations have moved to redirect their research funds to rapidly support COVID-19-related research. In Australia, the Medical Research Future Fund (MRFF) is an ideal source for rapid resource reallocation for emerging threats and opportunities. The MRFF has already announced three new COVID-19-related funding calls, specifically for a new vaccine, for effective treatments for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and for treatments for severe acute respiratory distress in patients with COVID-19. These are crucial investments in order to manage the current pandemic, and they align with the large global investment in a therapeutics accelerator by the Gates’ fund and collaborators.

However, there has been no comparable direct investment in research to identify effective public health interventions to control the spread of COVID-19, to evaluate the new models of care emerging, or to identify what interventions will be required to support the future health and wellbeing of the population and our health care workers.

It is critical that there is a similar investment in associated health services, health economics and long term health and wellbeing outcomes research to support a robust post-COVID-19 recovery, and to ensure that we can embed learnings from this acute pandemic to more robustly and effectively respond in future.

A further impediment to our capacity to deliver rapidly responsive health system outcomes is our ethics approval systems. The cumbersome nature of the Australian ethics landscape is not a new discussion, but its capacity to support rapid turnaround for multi-organisation health services research is limited.

Australian health and medical researchers are world class, and have been demonstrating their capabilities, collaboration and ingenuity since the start of the COVID-19 pandemic. However, there are serious questions to be asked about Australia’s capacity to enable the innovative health services research also required in the current situation.

We can learn from the current pandemic by:

• building and centralising digital tools for rapid synthesis and sharing of emerging research ideas;
• ensuring resource allocation includes a dedicated component for health services and public health research; and
• reviewing and addressing the practical impediments to a rapid, effective and more holistic health and medical research response that emerge during major health events.

Only then will we be able to meet these types of threats with evidence-based strategies targeted for an Australian context; build a robust post-COVID-19 recovery strategy and be prepared to respond to future major health events.

Anna Peeters is Director of the Institute for Healthcare Transformation, and Professor of Epidemiology and Equity in Public Health, at Deakin University. She is Past President of the Australian and New Zealand Obesity Society and in 2014 was awarded the World Obesity Federation Andre Mayer Award and a Churchill Award.

Professor Trish Livingston is the Associate Dean – Research in the Faculty of Health at Deakin University and an active researcher in the area of psycho-oncology in Deakin’s Institute for Health Transformation. She is recognised internationally with an Affiliate Professorship of Supportive Technology in Cancer Treatment at University of Copenhagen.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.