A framework to support the integration of priority setting in the preparedness, alert, control and evaluation stages of a disease pandemic

Figures & data

Table 1. WHO recommended activities during the four phases of disease epidemics.

Pre-epidemic preparedness	Alert phase	Control phase	Evaluation phase
Establishment of a viral haemorrhagic fever surveillance system	Investigating suspected Ebola including evaluating available resources required	Ebola epidemic control strategy	Declare the end of the epidemic
Infection control precautions in health care settings	Obtaining laboratory results	Coordination and resource mobilisation	Resume social activities and address stigma
Health promotion program	Taking a decision on the basis of laboratory results and the outcome of the investigation	Coordination and resource mobilisation	Resume the activities of the pre-epidemic phase
Collaborate with health services and wildlife health services (Ebola)		Behavioural and social interventions Media	Produce the end of epidemic report
Pre-alert: What should be done if the specimen taken from animals tests positive for Ebola? Assessment of resources		Clinical case management Psychological management Research projects and ethical issues Logistics and safety Environmental management	Keep records on the epidemic Evaluate the management of the epidemic

World Health Organization, 2014.

Table 2. Integrating priority setting activities throughout the four phases of disease epidemics.

Phase	Priority setting activities
Pre-epidemic preparedness	• Identify possible priority setting and resource allocation decisions that need to be made during the outbreak; • Hold public consultations and dialogue with regards to priority setting criteria; • Identify key stakeholders to involve in the different priority setting processes; • Identify criteria and principles, including equity to guide the different priority setting decisions; • Establish explicit and fair priority setting processes for the different decisions • Use the identified criteria and principles to prioritise the known interventions that could be implemented within the context • Identify sources, and earmark resources for emergencies to ensure a swift, timely and effective response • Establish plans and resources for sustaining essential routine health programs • Establish cost-effectiveness modelling • Consider cross-program impact.
Alert phase	Validate the proposed plans developed in the pre-epidemic phase.
Control phase (Outbreak Response)	Implement Priority setting and resource allocation processes developed during the preparedness phase with regards to; • Allocating resources to the epidemic, the other health programs and other sectors, • Identifying and allocating resources between competing interventions in response to the specific epidemic, • Equitable rationing of the most cost-effective drugs/ vaccines (if available).
Evaluation phase (Post-epidemic)	Evaluate Priority setting and resource allocation processes at the different phases, and its impact on different populations – especially the vulnerable; other programs and sectors; and the effectiveness of the interventions that were implemented; and use the results to revise and improve the Priority setting processes for future epidemics.

World Health Organization. (2014). Ebola and Marburg virus disease epidemics : preparedness, alert, control, and evaluation. Who, (August), 1–107. https://www.who.int/csr/disease/ebola/manual_EVD/en/.

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