Exploring integrated advice and avian influenza knowledge gaps by using a Highly Pathogenic Avian Influenza outbreak simulation

Background: Initial evaluations of the COVID-19 pandemic suggested that broad multidisciplinary expertise is needed for an all of society pandemic response. However, it is unclear whether balanced, multi-perspective scientific advising is secured in separate disciplinary advisory committees. Aim: Our aim was to explore the potential of integrated advising among biomedical, societal and economic experts into pandemic response, using a simulation of a highly pathogenic avian influenza (HPAI) outbreak. Additionally, we aimed to identify cross-cutting gaps in knowledge and expertise relevant for HPAI pandemic preparedness. Methods: We conducted two table-top simulation exercises (April/May 2024), based on a fictitious HPAI outbreak originating in the Netherlands and associated with severe disease among children. In total, 22 and 19 experts participated, representing biomedical, societal and economic sciences. Participants first drafted an outbreak management advice in separate biomedical and societal teams, followed by integrated deliberations and advice in mixed groups. Written notes of the deliberations and pre-simulation interviews was used for an inductive, reflexive thematic analysis. Results: Separate advisory processes differed in perceived urgency, situation assessment, and the drafted best- and worst-case scenarios. Mixed groups deliberations exposed disciplinary blind spots and fostered mutual understanding. In particular, school closure was discussed extensively due to conflicting perspectives. Cross-cutting knowledge and know-how gaps were identified in the alignment of (infra)structures and guidelines. Conclusions: Our simulation exercises suggest that an integrated advisory approach may have an added value in overcoming conflicting advice during pandemics. Further research is needed to explore whether this observed added value extends to an integrated advisory body.