The research indicated that a national operational epidemiological modeling process should be structured around three distinct priorities:. Once the study team completed the literature review, the stakeholder workgroup convened in Arlington, VA, on August 11, , to determine the requirements of a national operational epidemiological modeling process.
Several events were held with stakeholders to gain direction and input as the NOEMP was being refined. The stakeholders provided substantive feedback leading to additional revisions.
Exercise players included workgroup members as well as external public health stakeholders with no previous knowledge of the NOEMP. OC are defined in this study as the staff responsible for coordinating the flow of information to and from policy decision makers and tactical capabilities within an agency or organization. The process recognizes the following types of models as providing information that is relevant across a broad spectrum of decision types and decision makers:.
To better establish regular and sustainable progress in disseminating model information products, a phased approach to incorporating the process should be considered.
The first phase should be limited to models that forecast the impacts of infectious disease outbreaks and of intervention strategies at a national level and, where data is made available, at state and local levels. The second phase should expand to include spread and intensity models. The models should not be exclusive to human models, but should also include models on diseases in animal populations and vegetation that potentially impact human health consistent with the One Health concept. The process should include a catalogue of relevant models in order to maintain awareness of national capabilities for operational epidemiological modeling, as well as to facilitate potential modeler and OC relationships.
The IOMAG should be led by and include representatives from the federal interagency, and have representation from state, local, county, and tribal governments, and private and academic sectors see Figure 1. This advisory body should be integrated into an existing strategic, federal interagency biosurveillance governance structure under the rules and regulations established by the Federal Advisory Committee Act FACA. The role of this advisory committee should be to provide guidance and recommendations to its affiliated inter-agency governance structure on strategic topics to:.
The administration and management of the NOEMP should be integrated into an existing management structure that can coordinate the human resource and financial needs of this process.
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Additionally, this management structure should be able to provide overarching quality assurance and quality control processes and will have pre-existing relationships and complimentary information products for supporting a common operating picture among the biosurveillance community. The creation of a program manager position for Model Integration and Dissemination may be required to ensure the functioning of a Model Integration and Dissemination Unit see below into the existing management structure.
The positions and general responsibilities are outlined in Table 1. Some models will need to be procured or may be submitted from external partners and may be run by the MIDU modeling technical analyst s. The MIDU analyst s must have an understanding of how the models operate and their associated limitations, so the models can be utilized to provide information during response operations.
External partners may be leveraged for the model development, data input, and model running processes as well; however, these external partners must be able to provide appropriate model outputs as requested by the NOEMP. After analyzing outputs the analysts will create information products for use by the OC. The activities performed would be distinguished between two types of operations: steady-state operations and response operations see Figure 2. The steady-state operational period is considered to be the time period when the MIDU is not activated by a federal agency.
The response operational period is the time period when the MIDU has been activated by a federal agency to provide epidemiological information. During steady-state operations the NOEMP should work with stakeholders to determine how information results will be produced and presented to the requester once the information provided by the model has been analyzed.
By engaging stakeholders early in the process, the NOEMP can then leverage these established relationships to conduct exercises and provide modeling support during small-scale incidents in order to refine the process that will be used during response operations of national significance. Stakeholders will then be able to provide guidance and insight into the validation and verification processes they currently use and assist in determining the minimum acceptable validation and verification standards for the NOEMP.
The NOEMP should also have the ability to operate as a referral service for those agencies having specific model requests that could not be fulfilled by the organization. This ability will be gained through the relationships established with model development organizations.
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During the steady state period the organization may provide support to communities to provide targeted infectious disease outbreak support. During the initial phases of the implementation of the NOEMP, research priorities will need to be established based on identified epidemiological modeling gaps and the MIDU should work to close those gaps by developing in-house models. As stated earlier, standards will be identified for the type and amount of data gathered for the model process, model run-time, and the levels of analysis to be conducted on the model outputs.
Decision makers and OC will have such a variety of information that it may not be possible for the NOEMP to close all identified gaps, therefore, some models may be submitted for use to the MIDU but will need to be executed by external organizations. Policies and procedures will need to be created for the submission of models by external agencies.
Examples of these policies and procedures may be the amount of time it takes for a model to create outputs, on-going model maintenance, and type of information being analyzed. The stakeholders will need to be involved in this process in order to ensure that information products are accepted by their agencies.
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The established triggers may be based on population size, proximity to borders, or the MIDU may provide information based on direct orders from federal officials. These triggers for transition to response operations should be distinct from decision making for outbreak support and exercise participation during steady-state operations. It is also understood that other variables beyond triggers will also influence level of effort by MIDU. The information should be gathered by running models within the organizations or by reaching out to modeling organizations and requesting specific model outputs.
This data will be integrated into information products that will be provided to external OC. Information product development will be based on the collaboration with OC during the steady-state operational period. The NOEMP should maintain its role as a referral agency if information requests were made that could not be fulfilled with cataloged models or if the organization was unable to develop the appropriate model within the operational time period.
The stakeholder relationships established during the steady-state operational period will be critical during the response period. Those that have interacted with the organization prior to a response situation will be educated on the processes and will be familiar with the information products produced by the MIDU. The timeframe for making decisions is variable, so is the time required for running models. This will narrow the scope of models that can be run to those that can produce usable outputs in less than twenty-four hours, and will target decisions that can be informed by daily updates of information.
As the NOEMP is developed further and the understanding of health and medical decision making and the field of operational epidemiological modeling matures, the frequency and types of reporting may be expanded with a long term goal of being able to accommodate four to six hour decision cycles for events of national significance. Critics of both these approaches note that there is still a fundamental disconnect between knowledge generation and policy implementation.
The existing system is highly inefficient and the time lag caused by tiers of consensus building at conferences makes many policies obsolete by the time they are ready to be implemented. Important initiatives can be stymied for long periods by a few veto players. To address these problems, we propose a nimble governance model offering meritocratic leadership that respects state sovereignty but also empowers expertise through a quasi-democratic process of accountability and enforcement authority. While academics and practitioners have identified a range of deficiencies and inefficiencies in the global governance framework, our model foregrounds, and responds to, four of these features:.
Notwithstanding international treaties and normative instruments which address the rights of indigenous peoples, minority, ethnic and religious groups, women, and others, many still remain excluded or marginalized in domestic structures of governance and in global institutions and deliberations.
Further, while civil society organizations and the private sector are increasingly viewed as stakeholders in global governance initiatives, they need to be empowered as drivers of change and providers of solutions, and more formally and robustly incorporated into the architecture of global governance. Cognitive deficiencies. The framing of state and international organization policies and programs in terms of short-term benefits and political expediency inhibits efforts to tackle persistent problems.
A realistic, not idealist, global sometimes labeled planetary or cosmopolitan mindset needs to be cultivated. In the post-Cold War era, concepts such as human security and sustainable development, despite their shortcomings, exhibit new ways of thinking that should compel policymakers to shift focus to longer-term solutions to persistent problems.
Additionally, consensus on the definition, nature, and scope of global issues and problems remains largely assumed—and primarily Western or Northern in orientation. Deficiencies in leadership and implementation. Problems too often languish without receiving adequate attention from the international community. While concluding international conventions and cultivating normative consensus remain primary in global governing, too often they mask weak political wills to comply with, and enforce, agreements.
Resource deficiencies. Resource deficiencies, inefficiencies, and inequalities have resulted in environmental damage, corruption, poverty, and short-term profits taking priority over long-term sustainable growth. Too few resources are devoted towards sustainable development, including addressing global problems such as climate change, environmental degradation, and poverty. In sum, while economies are efficient in generating profits, they are inefficient in satisfying human needs, and resources are inequitably distributed.
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The current wave of global populism can be seen at least in part as a response to these problems. Our model builds upon a phenomenon within the UN system in which states usually middle powers adopt, fund, and nurture specific projects. Along these lines, one HLC would maintain global momentum to ameliorate climate change and environmental degradation, for example, while another would focus on problems of population growth. Those active in multinational diplomacy around these issues know each other and know who the most motivated, engaged, and effective contributors to solutions are.
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We envision that a broad group of such actors in each issue area would come together, forming an HLA to select an HLC that will lead global collaborative efforts that area. The logic of this approach is that some participants such as middle-power states would provide political leadership and diplomatic impetus; others e. All could contribute relevant expertise.