Abstract
During the 2009 A(H1N1) influenza pandemic, a suite of studies conducted in Canada showed an unexpected finding, that patients with medically attended laboratory-confirmed pandemic influenza were more likely to have received seasonal influenza vaccination than test-negative control patients. Different bodies, including scientific journals and government scientific advisory committees, reviewed the evidence simultaneously to determine its scientific validity and implications. Decision-making was complicated when the findings made their way into the media. The normal trajectory of non-urgent research includes peer-review publication after which decision-makers can process the information taking into account other evidence and logistic considerations. In the situation that arose, however, the congruence of an unexpected finding and the simultaneous review of the evidence both within and outside the traditional peer-review sphere raised several interesting issues about how to deal with emerging evidence during a public health emergency. These events are used in this article to aid discussion of the complex interrelationship between researchers, public health decision-makers and scientific journals, the trade-offs between sharing information early and maintaining the peer-review quality assurance process, and to emphasise the need for critical reflection on the practical and ethical norms that govern the way in which research is evaluated, published and communicated in public health emergencies.
Highlights
During the 2009 A(H1N1) influenza pandemic, a suite of studies conducted in Canada showed an unexpected finding, that patients with medically attended laboratory-confirmed pandemic influenza were more likely to have received seasonal influenza vaccination than test-negative control patients
The following description of events that occurred during the 2009 influenza pandemic will be used to highlight some of the challenges and critical issues that may arise at the interface of three cultures: researchers, public health decision-makers and scientific journals
Despite the existence of several paradigms for pandemic ethics [38], many of these values were challenging to operationalise when it came to knowledge translation in a public health emergency
Summary
The editors at PLoS Medicine stated ‘that before the public health emergency strikes, the scientific publishing establishment needs to ask itself how it can respond in the way the world needs’ [23] In this example, public health decision-makers dismissed the findings that did not fit with the existing paradigm irrespective of whether they had access to detailed reviews of the research. Creating a mechanism that allows for exceptional circumstances, similar to that of the United States Food and Drug Administration (FDA) emergency use authorisation mechanism, or the European Medicines Agency emergency procedures, with well-defined criteria and parameters [36,37], may help facilitate more effective communication Such a mechanism would ideally enable a comprehensive risk–benefit analysis to be carried out during an emergency, taking into account rapidly emerging but conflicting findings, their critical methodological appraisal and the potential good versus harm to be accrued at various decision points. This could serve the dual functions of arriving at thoughtful decisions and explaining reassuring messages to gain public acceptance
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