Our insights into COVID-19 rapid research
By: Simon Pickard
Tags: Humanitarian Research, Public Health, Covid 19, Humanitarian, Research

Within weeks of WHO declaring a global pandemic, we launched a rapid research funding call to support the COVID-19 response in humanitarian settings. Based on priorities identified in WHO’s Research and Development Blueprint, the call exposed a huge demand for research and evidence to help combat the spread of the virus. Activities are already underway with the studies chosen for funding and we’re excited to see how they will have rapid and direct impact to support some of the world’s most vulnerable people during this crisis.

Exposed: a global appetite for evidence

We believe that people have a right to quality humanitarian response that is informed by robust evidence. The pandemic will impact in countless different ways on communities already affected by humanitarian events and the health systems that serve them. The emergency response needs to adapt to these additional challenges, using evidence of what is working in real time.

Our funding call received 465 applications, an unprecedented demand. Research proposals were received from over 60 countries, exposing a huge global interest in the role research can play in tackling COVID-19. The level of demand highlights the urgency, as well as the limited funding opportunities for research in humanitarian settings. Other resources continue to be made available for research, some with a broader scope across all low and middle income countries than our humanitarian-focused call allowed. Examples include the UK NIHR global health research call, whilst Grand Challenges Canada has a helpful summary of opportunities, many focused on the role of innovation to combat the virus.

Funding must continue to be made available to support on-going efforts to generate rigorous evidence as the pandemic develops.

Funding studies, finding answers

Our work exists to have a direct real-world impact, to improve the lives of those affected by crises by answering the questions that humanitarian responders are asking.

We saw large numbers of proposals seeking to investigate knowledge and awareness of COVID-19 amongst refugees/IDPs, and to use this to develop more effective public health messaging. This aligned with the priority identified in the WHO’s R&D Blueprint to integrate social sciences in the outbreak response. Nine of the studies selected for funding fall into this broad social science theme investigating behaviours and messaging.

We were particularly interested in studies which sought to investigate and counter misinformation, such as this study which will seek to adapt radio station broadcasts to counter misinformation amongst IDP populations in Burkina Faso. The importance of these approaches has been seen in other work we’ve funded in response to Ebola outbreaks: the Anthropology Platform created a space for sharing information in real time to support the West African outbreak and has been further developed as an established response platform, including for COVID-19. In the 2018–20 Ebola outbreak in eastern DRC, regular surveying work was adapted to understand people’s perceptions of various measures such as vaccination, and interviews with survivors and families helped make treatment centres more humane.

Reporting in Ouaga. Photo from University of Sheffield’s study ‘Internally displaced persons, radio and COVID-related misinformation in Burkina Faso’. Credit: Kalidou Sy — Fondation Hirondelle

Many of the funded studies have responded to specific concerns in relation to the pandemic, such as the need to consider older people who are more at-risk from the virus, and strengthening of hand-washing practices as a key activity to reduce its spread. These build on Elrha’s established work on these important issues through our Humanitarian Innovation Fund.

The greatest successes we’ve seen with our previously funded rapid research is where studies have generated evidence that feeds into response in real time. A key feature of all funded studies chosen for this COVID-19 call is their ability to generate evidence to quickly feed into response activities over the next few months. Some are short studies seeking to generate information in the next month or so for immediate use by decision-makers, such as a study working with UNRWA in Gaza to identify the barriers and enablers for public health measures in refugee camps. Others will take place over a 6–12 month period to build understanding of how the pandemic develops over time, such as a study investigating Venezuelan refugees and the Colombian host population, that will generate interim findings for practitioners during August-October.

Man holding a banknote. Credit: Chaucharanje

Some of the successful proposals have added COVID-19 data collection to existing survey mechanisms or on-going research. For example, IDinsight have added questions on the inter-relation between cash transfers and a household’s ability to follow guidance, such as social distancing, to an existing Randomised Controlled Trial on cash transfers.

By contrast, many unsuccessful proposals were considered by our Funding Committee to be opportunistic: simply adding questions to existing studies without sufficiently relating these to the needs of those responding to the pandemic.

As with all the research we fund, multi-partner teams are crucial. By requiring involvement of agencies who are leading COVID-19 response programmes, direct links are made for the use of findings.

Examples include the close involvement with UN-OCHA in a study on the impact of COVID-19 on multi-sectoral humanitarian needs at a global level, and UNRWA involvement in a study on Palestinian refugees in Lebanon and Gaza. A study investigating the use of Inter-Agency Standing Committee GBV guidelines and tools includes the multi-agency team developing global guidance on GBV risk mitigation.

At a national level, a Makerere University-led study includes the Ugandan Ministry of Health in the study team, whilst FMOS Bamako has strong connections with both the Mali Government and the West Africa pandemic response network. It’s the strength of pre-existing partnerships with operational organisations that enables research to be undertaken in affected communities , despite the difficulties in accessing people when lockdown measures are in place. Methodological adaptations to counter movement restrictions or potential spread of the virus are included across the studies, including remote interviews or data-gathering using phones, such as the Community Perception Tracker.

The studies we’ve funded reflect what we’ve learnt through our work over time: addressing important and often neglected themes, working with multiple partners to deliver timely findings and deliver real world impact.

Mind the gaps: still more to do

Our work is informed by the needs and priorities expressed by the humanitarian sector, and seeks to complement funding made available for clinical research, vaccines, and diagnostics. It’s driven by the guidance and experience of our Advisory Group, Funding Committee and donors. However, we acknowledge that gaps still remain.

Our studies were selected on their individual merits, not as a portfolio to cover all major humanitarian settings or all themes highlighted in our funding call guidance. We had hoped to see more focus on innovative solutions, for example to adapt PPE, ventilators, or supply chains. We had also anticipated greater interest in investigating co-morbidities, and on the pandemic’s impact on the availability of routine health services, and innovative solutions to address both of these. Whilst one study will investigate surveillance systems none are modelling the outbreak, in part as modelling studies have been funded elsewhere and because of concerns about the quality of data.

Not surprisingly, more of our research is taking place in countries with long-term displaced populations that are easier to operate in, such as Uganda and Lebanon, than in more challenging countries (Yemen, CAR, Syria). And only one of the funded studies is operating in Cox’s Bazar, although there are long-standing fears that the crowded camp conditions and poor sanitation could lead to a significant outbreak. Despite this, we hope the studies will generate evidence that can be applied beyond their immediate setting.

Multi-country studies such as one led by Michigan State University and another by Busara Center for Behavioural Economics seek to make comparisons across multiple settings, whilst others are supporting humanitarian coordination at a global level.

As the course of the pandemic becomes clearer, and the consequences of social and economic impacts of lockdowns develop, further research might be required to help inform the next phase of the response. The impacts on health systems, reduced availability of food, worsening mental health, and increased GBV are already being witnessed around the world, and will have a particularly acute impact in already under-resourced humanitarian settings.

We recognise that the studies we are funding are only one small contribution to the overall body of research studies, being tracked through a UKCDR COVID-19 tool. More research will be needed to help overcome this pandemic.

Looking ahead

Research is critical if the COVID-19 pandemic is to be brought under control. We hope the 15 studies we’ve funded will play a small but significant contribution to increasing the body of evidence needed to support COVID-19 response efforts in humanitarian settings. They build on what we’ve seen has successfully supported humanitarian response in recent Ebola Virus Disease outbreaks. The studies are underway and interim findings will be available via our website and newsletters so watch this space, or get in touch. As findings are made available we’ll share them in digestible formats to ensure that they are accessible to different audiences More funding for research will be needed as the impacts of the pandemic are realised.