Literature review: Best practices in ranking emerging infectious disease threats
The threat of serious, cross-border infectious disease outbreaks in Europe is a significant challenge in terms of emergency preparedness. In order to effectively target the use of resources to manage the risks of outbreak, it is necessary to formulate rankings or prioritisation of human and/or animal pathogens. This literature review aims to identify the range of methods used to prioritise communicable disease threats for the purposes of emergency preparedness planning.
The threat of serious, cross-border infectious disease outbreaks in Europe is a significant challenge in terms of emergency preparedness. Types of threats and the pathogens involved shift in response to changing factors such as climate change, global travel, immigration patterns, environmental degradation, and social inequalities. In order to effectively target the use of resources to manage the risks of outbreak, it is necessary to formulate rankings or prioritisation of human and/or animal pathogens.
A literature review was conducted to identify the range of methods used to prioritise communicable disease threats for the purposes of emergency preparedness planning, and an evaluation undertaken to identify which are the most robust methodologies. Searches were undertaken across various biomedical and grey literature databases, supplemented by search techniques including reference harvesting and citation tracking. Studies were selected using transparent inclusion criteria and underwent quality appraisal by means of a bespoke checklist based on the AGREE II criteria. Due to the diversity of ranking methods identified, a narrative synthesis was performed, with studies clustered by methodology.
Seventeen studies were selected for inclusion in the review. The included studies used one of five methodologies to prioritise communicable disease risks: bibliometric index, the Delphi technique, multi-criteria decision analysis (MCDA), qualitative algorithms, and questionnaires. The analysis includes an assessment of the individual studies (clustered by methodology), a discussion of the strengths and limitations of the individual methodologies, and a comparison of all of the methodologies. We also derived suggestions for good practice in risk-ranking exercises. Most of the studies included in this review followed a broadly similar approach to risk ranking: identifying diseases for ranking, identifying assessment criteria, weighting criteria, scoring diseases against criteria, and producing a ranked list of diseases. The studies that used a different approach were early-stage risk assessments, which aimed to narrow down a long list of diseases into a shorter list for use in further prioritisation exercises such as resource allocation.
The choice of methodology should reflect the objectives of the exercise. Instead of recommending a single definitive approach to risk ranking of communicable diseases for the purpose of preparedness planning, this review provides an evaluation of the strengths and limitations of the available methods, with a framework of best practice suggestions specific to individual methodologies and general points. This approach is intended to help inform decision-makers’ choice of an appropriate risk-ranking method and ensure that these methods are carried out according to best practice.