Research as a part of public health emergency response.

In the past decade, a succession of public health emergencies has challenged preparedness and response capacities of government agencies, hospitals and clinics, public health agencies, and academic researchers, in the United States and abroad. The epidemic of the severe acute respiratory syndrome (SARS), the 9/11 terrorist attacks, and the anthrax mailings stand out as signal examples in the early years of the decade. In addition to natural disasters such as the 2010 earthquake in Haiti and the 2012 Superstorm Sandy, other recent events — including the 2009 influenza A (H1N1) pandemic, the Deepwater Horizon oil spill, and the Fukushima Daiichi nuclear reactor emergency in Japan — illustrate the diverse and complex forms that threats to public health can assume. Figure 1 displays some examples over the past decade or so and highlights the diversity and frequency of events that can be expected to occur in the foreseeable future. Each of these emergencies has yielded important information and data that are essential to what is, by design and necessity, an ongoing effort to improve preparedness and response. But each has also underscored a persistent need to be better prepared to resolve important research questions in the context of a public health emergency. The knowledge that is generated through well-designed, effectively executed research in anticipation of, in the midst of, and after an emergency is critical to our future capacity to better achieve the overarching goals of preparedness and response: preventing injury, illness, disability, and death and supporting recovery. We review challenges to the conduct of research in recent public health emergencies to identify critical elements of an effective research response.