21 Epidemiologic Research in the Setting of Outbreak Response

The highest priority during the response to an outbreak or epidemic is to limit morbidity and mortality by preventing new cases and improving outcomes in those who are affected. Epidemiologic research is an essential component of such a response. Well-designed and rapidly executed observational epidemiologic studies, often done in conjunction with laboratory and environmental investigations and informed by relevant behavioral and social sciences knowledge, can help guide the development and implementation of interventions that ameliorate the current outbreak, as well as contribute to more effective and earlier responses to future outbreaks. While generic, “off the shelf” protocols for studies of some recurring, outbreak-prone infectious diseases (e.g., cholera and influenza) may help expedite such studies, they are no substitute for well-trained, experienced epidemiologists who are available for rapid deployment wherever and whenever they are needed to plan and carry out such studies. Experience with recent epidemics and pandemics caused by a wide range of infectious disease agents (e.g., Ebola, Zika, severe acute respiratory syndrome [SARS or SARS-1], influenza, and coronavirus disease 2019 [COVID-19]) illustrates the central contribution of observational epidemiologic studies to enhanced understanding of and improved response to both new and old infectious disease threats. Following the COVID-19 pandemic, there will be considerable investment, at least in the short term, in accelerating outbreak response research, including its epidemiologic dimensions. Assuring that such research is thoughtfully designed and carefully implemented is a high priority.