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Research at the Ministry of Health

The COVID-19 Challenge Questions Initiative:
Research Areas and Challenge Questions

October 2021

Note: All analyses should include consideration of population sub-groups, for example: sex, gender, and sexual orientation; people with high risk clinical characteristics; people with physical and/or mental health disabilities; Indigenous peoples and communities; immigrants and refugees; ethno-racial communities; Francophone communities; linguistic communities; religious/faith communities; homeless people; people living on a low income; people receiving social assistance; people using drugs; and people living in rural/remote or inner urban areas.

  1. Vaccination Strategy
  2. Therapeutic Treatment Options and Outcomes
  3. Pandemic Waves
  4. Testing and Surveillance Strategies
  5. Population Level Prevention and Containment Strategies
  6. Health System Resourcing
  7. Health Equity and Vulnerable Populations

Research Area 1: Vaccination Strategy

(COVID-19 Research Priorities Framework theme – Public Health Measures)

The research area will focus on informing an optimal COVID-19 vaccination strategy, including determining factors critical to vaccine targeting, messaging, access, across the population to ensure efficient use of vaccine doses and minimized wastage.

All analyses should include consideration of population sub-groups, for example: sex, gender, and sexual orientation; people with high risk clinical characteristics; people with physical and/or mental health disabilities; Indigenous peoples and communities; immigrants and refugees; ethno-racial communities; Francophone communities; linguistic communities; religious/faith communities; homeless people; people living on a low income; people receiving social assistance; people using drugs; and people living in rural/remote or inner urban areas.

Key Challenge Questions:

  1. What are the key factors influencing vaccine uptake and coverage across the population?
    1. What are the drivers of vaccine hesitancy?
    2. How can we improve vaccine coverage?

  2. What are the factors influencing access to COVID-19 and influenza vaccination? Analysis should consider changes in how people access their primary care practitioner. How can we improve access to both COVID-19 and influenza vaccination?

  3. What is the relationship between COVID-19 vaccination status and broader health outcomes including COVID-19?
    1. What is the relationship between COVID-19 and influenza vaccination status, and broader health outcomes including COVID-19 and influenza?

  4. How effective is the COVID-19 vaccine and how long does the conferred immunity last at population level? Does COVID-19 vaccination improve the broader health impacts of COVID-19 at the population level? Analysis should consider the expected vaccine timing, type schedule, and supply.

  5. How does vaccination coverage, as well as the efficacy and safety profile of the vaccine, influence the need for ongoing surveillance testing?

Research Area 2: Therapeutic Treatment Options and Outcomes

(COVID-19 Research Priorities Framework theme – Disease Management)

This research area will focus on better understanding the relative efficacy and effectiveness of various therapeutic treatment options including drugs, and appropriate use of therapeutics to mitigate impact of the virus. Analysis should consider improving the supply chain for, and access to, various therapeutic treatment options.

All analyses should include consideration of population sub-groups for example: sex, gender, and sexual orientation; people with high risk clinical characteristics; people with physical and/or mental health disabilities; Indigenous peoples and communities; immigrants and refugees; ethno-racial communities; Francophone communities; linguistic communities; religious/faith communities; homeless people; people living on a low income; people receiving social assistance; people using drugs; and people living in rural/remote or inner urban areas.

Key Challenge Questions:

  1. What is the relative efficacy and effectiveness of various therapeutic treatment options including therapeutic drugs and other forms of treatment?
    1. What are the factors influencing the relative efficacy and effectiveness of various therapeutic treatment options at population level?
    2. How can we improve clinical decision making regarding appropriate use of therapeutic drugs?

  2. Can we predict the ideal mix of therapeutic drugs that will be needed for purpose of planning and resource allocation? Analysis should consider expected timing and supply of various therapeutics.

  3. What is the most cost-effective approach to the use of therapeutics to mitigate population level impacts of COVID-19?

Research Area 3: Pandemic Waves

(COVID-19 Research Priorities Framework themes – Data Analytics, Modelling and Measurement; Public Health Measures)

This research area will focus on improving our ability to predict the trajectory of COVID-19, understanding multiple COVID-19 waves, its interactions with influenza, and the relative impacts of various public health measures at the population level.

All analyses should include consideration of population sub-groups for example: sex, gender, and sexual orientation; people with high risk clinical characteristics; people with physical and/or mental health disabilities; Indigenous peoples and communities; immigrants and refugees; ethno-racial communities; Francophone communities; linguistic communities; religious/faith communities; homeless people; people living on a low income; people receiving social assistance; people using drugs; and people living in rural/remote or inner urban areas.

Key Challenge Questions:

  1. What are the drivers of future pandemic waves?

  2. What is the relative impact of various public health measures on COVID-19 pandemic waves over time?
    1. How does compliance with public health measures at the population level affect future pandemic waves?

  3. What is the potential impact of COVID-19 vaccination on future pandemic waves?

  4. What impact does restarting the health system have on future pandemic waves?

  5. Are there population characteristics or other risk factors that can predict where COVID-19 outbreaks are more likely to begin and expand quickly?

Research Area 4: Testing and Surveillance Strategies

(COVID-19 Research Priorities Framework themes – Case Testing and Surveillance; Data Analytics, Modelling and Measurement)

This research area will focus on better understanding the best mix of population level testing and surveillance strategies including symptomatic testing alongside passive, active, sentinel and syndromic surveillance approaches. Areas of interest include analysis of various types of tests, testing levels and targeting strategies.

All analyses should include consideration of population sub-groups for example: sex, gender, and sexual orientation; people with high risk clinical characteristics; people with physical and/or mental health disabilities; Indigenous peoples and communities; immigrants and refugees; ethno-racial communities; Francophone communities; linguistic communities; religious/faith communities; homeless people; people living on a low income; people receiving social assistance; people using drugs; and people living in rural/remote or inner urban areas.

Key Challenge Questions:

  1. What is the ideal testing strategy (including testing in people with and without symptoms and with and without known exposures) to mitigate and contain the pandemic, while minimizing unnecessary testing and inefficiencies?
    1. What is the relative efficacy and effectiveness of various testing approaches in relation to mitigating the spread of COVID-19?
    2. What is the relative cost effectiveness of various testing approaches?
    3. Given the level of vaccine uptake within the population at this time, how should testing strategies be adapted?

  2. What is the efficacy and effectiveness of testing outside of the context of known exposures (i.e., not in an outbreak and not for contacts of a case), considering test sensitivities, testing frequency, test turnaround time, and inter-laboratory variability?
    1. Where is the best yield for asymptomatic or surveillance testing in relation to mitigating spread? What is the best targeting strategy for asymptomatic testing and surveillance?
    2. What is the ideal frequency of testing outside of the context of known exposure to reduce the chance of outbreaks in high risk settings?

Research Area 5: Population Level Prevention and Containment Strategies

(COVID-19 Research Priorities Framework theme – Public Health Measures)

This research area will focus on informing the most efficient and effective prevention and containment, including closing and re-opening strategies, understanding the interactions between various strategies, and compliance with prevention containment strategies in different settings, and among different population groups. Analysis should consider the required conditions for various stages of closing and re-opening, the interdependencies, and the health and well-being impacts of closing and re-opening.

All analyses should include consideration of population sub-groups for example: sex, gender, and sexual orientation; people with high risk clinical characteristics; people with physical and/or mental health disabilities; Indigenous peoples and communities; immigrants and refugees; ethno-racial communities; Francophone communities; linguistic communities; religious/faith communities; homeless people; people living on a low income; people receiving social assistance; people using drugs; and people living in rural/remote or inner urban areas.

Key Challenge Questions:

  1. What are the unintended consequences of the COVID-19 prevention and containment measures in Ontario and their associated impact?

  2. What are the most effective prevention and containment strategies to maintain opening of various sectors (including daycares, various levels of school and various business sectors)?
    1. What is the ideal mix of prevention and containment strategies?
    2. What are the most cost-effective prevention and containment strategies?

  3. What are the factors to consider in determining whether to close or re-open various sectors (e.g., returning to Stage 1 or 2)?

  4. What are the key factors influencing compliance/adherence with prevention and containment strategies?
    1. Are there mitigating population characteristics that may inform compliance/adherence strategies, but also function to undermine them, that should be considered with any strategies?

  5. What are the most critical factors influencing COVID-19 transmission at schools or daycares? Does school classroom characteristics/size influence COVID-19 spread? If so, how?

  6. Is there an optimum number of case manager/contact tracers required to effectively trace and isolate all new COVID-19 cases and their close contacts? What is the number required for each position in relation to new cases each day?

Research Area 6: Health System Resourcing

(COVID-19 Research Priorities Framework themes – Frontline Workers; Supply Chain; Data Analytics, Modelling and Measurement; Disease Management)

This research area will focus on informing health system resourcing needed during surges and peaks, understanding of demands and impact on the broader health system and the related non-COVID-19 impacts.

All analyses should include consideration of population sub-groups for example: sex, gender, and sexual orientation; people with high risk clinical characteristics; people with physical and/or mental health disabilities; Indigenous peoples and communities; immigrants and refugees; ethno-racial communities; Francophone communities; linguistic communities; religious/faith communities; homeless people; people living on a low income; people receiving social assistance; people using drugs; and people living in rural/remote or inner urban areas.

Key Challenge Questions:

  1. What is the ideal level of health system resourcing to respond safely and effectively to surges / peaks in COVID-19 (i.e., PPE, HHR, ICU beds, ventilators, testing, non-ICU beds, drug supply, home monitoring requirements)? How can we best calibrate the response to specific neighborhoods experiencing outbreaks?

  2. What are the implications of COVID-19 response for non-COVID-19 health system resourcing needs?
    1. What are the implications for health and mental health demand, costs, and/or funding required?
    2. What are the implications for preventative care (e.g., cancer screening)?

  3. What do we understand of the medium and long-term health impact of COVID-19 (e.g., increased cardiac disease, neuropathies, mental health implications, testing and diagnosis, respiratory conditions requiring oxygen) and what will be the future pressures on the health system (e.g., rehab, home care, complex continuing care)?

Research Area 7: Health Equity and Vulnerable Populations

(COVID-19 Research Priorities Framework theme – Health Equity and Vulnerable Populations)

This research area will focus on identifying and mitigating disproportionate impacts on populations vulnerable to COVID-19. Vulnerable populations in the context of the COVID-19 pandemic include those with specific needs and accommodations before/during/after, include consideration of population sub-groups for example: sex, gender, and sexual orientation; people with high risk clinical characteristics; people with physical and/or mental health disabilities; Indigenous peoples and communities; immigrants and refugees; ethno-racial communities; Francophone communities; linguistic communities; religious/faith communities; homeless people; people living on a low income; people receiving social assistance; people using drugs; and people living in rural/remote or inner urban areas.

Key Challenge Questions:

  1. What are the specific, quantifiable impacts of COVID-19 on populations vulnerable to COVID-19?
    1. What are the specific impacts of COVID-19 on vulnerable populations?
    2. What are the non-COVID-19 impacts of COVID-19 for these populations (e.g., social determinants, broader health outcomes)?
    3. How has COVID-19 impacted access to care and treatment for conditions such as HIV or hepatitis C for vulnerable populations?

  2. How can we best mitigate disproportionate impacts of COVID-19 on vulnerable populations and promote health equity?

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