One of the first things you learn in medical school (or at least the oldest thing I remember from that time) is that the next flu pandemic can happen any time, now! You can’t argue with it, and it holds for all pathogens with pandemic potential. Pandemics (or what could become one) are threatening (think of Ebola and SARS) and usually give rise to many questions, such as what is the optimal diagnostic approach, treatment and prevention strategy. Research plans emerge, but before the studies can start, the pandemic is over, and hardly anything has been learned. That, now, should end.
The Platform for European Preparedness Against (Re-)emerging Epidemics (PREPARE) is a ”EU funded network for harmonized large-scale clinical research studies on infectious diseases (IDs), prepared to rapidly respond to any severe ID outbreak, providing real-time evidence for clinical management of patients and for informing public health responses.” The trick for better preparedness is to have ongoing large-scale studies in many different EU regions, that can capture a pandemic whenever it starts. Based on the type of pandemic, study protocols should be rapidly adapted to answer relevant questions. PREPARE has 3 of them:
The Multi-centre EuRopean study of MAjor Infectious Disease Syndromes (MERMAIDS); comprises 3 observational studies for Acute respiratory infections (MERMAIDS-ARI) in adults, for Sepsis-like syndrome in infants and ARI in children (MERMAIDS-PEDS) and for Arboviral compatible febrile illness (MERMAIDS-ARBO). Each aims to enroll 1000-2000 patients.
The ‘Antivirals for influenza Like Illness? An rCt of Clinical and Cost effectiveness in primary CarE’ (ALIC4E, although it may take some minutes to understand: count the C’s). This is “an individually randomised, open clinical trial (in an adaptive design) comparing the clinical and cost effectiveness of oseltamivir with usual care on duration and control of symptoms in patients presenting to primary care with influenza-like illness. The aim is to enroll 4500 patients.
A Randomized, Embedded, Multifactorial, Adaptive Platform trial for Community-Acquired Pneumonia (REMAP-CAP). This is a perpetual European adaptive RCT evaluating the effectiveness of several interventions (antibiotics, corticosteroids) in improving outcome in adults admitted to ICU with severe CAP. The aim is to enroll 4000 patients.
Here, you’ll find short videos explaining each study.
Yesterday the study teams were in Brussels, where they were confronted with a hypothetical pandemic, and with the question to – immediately – adapt their study and implement new research questions, such as for instance “how effective is fluX, a novel treatment”. At the end of the day, we realized that the international trials allow a “rapid” scientific response, when needed. Yet, we also identified many devils in many details. These will now all be addressed, and solved, hopefully before the next pandemic hits the fan.