Health research versus the virus: strengthening systems, saving lives.

For this Commentary, we selected papers from those in this journal's Thematic Series on health research systems' pandemic response. The calling notice for papers suggested possible use of a WHO framework for analysing health research systems (HRSs). Whilst it was not widely used in the reported studies, it did provide the basis for the two main, overlapping, topics for analysis in this Commentary. These, in turn, informed the selection criteria for papers. First, we selected papers that described the contributions made towards meeting the needs for pandemic-related research in at least one area we could classify as being one of the nine components of a HRS, and did so in at least one jurisdiction. Second, we identified papers that could contribute to an analysis of how comprehensive HRSs facilitated progress in meeting the needs for pandemic-related research.Using the selection criteria, we included 13 papers in the Commentary covering research in 22 named countries, and many others unnamed. For the first topic, we found that for each of the nine components, we could identify at least two of the included papers, usually more, as having in some ways analysed the contributions made towards meeting the needs for pandemic-related research. Examples included, for coordination, the first HRS component, a paper describing a pandemic preparedness program in Australia. For other HRS components, some papers analysed prioritization systems in the United Kingdom and Iran, and another, research ethics governance across Central American countries. For the finance component, a US paper covered Operation Warp Speed's substantial funding. Papers showed existing capacity for conducting trials contributed to rapid progress on new drugs and vaccines in Brazil, the United Kingdom and the United States. Included papers showed how capacity was mobilized for knowledge production and how evidence, often locally produced, was used in many countries across the income range. Papers cited studies showing pandemic research had saved millions of lives through vaccines and repurposed drugs. For the second topic, evidence suggested that where there was a comprehensive HRS, especially with an overall strategy, considerable progress was made.The Commentary's added value lies in it extracting, collating and organizing data from the 13 papers to facilitate analysis of HRSs. Collectively, the papers provide evidence about the benefits of strengthening HRSs, and challenges (including resource waste) when HRSs were not well developed. This can justify a recommendation to give serious consideration to WHO's call in 2013 for a comprehensive approach to developing health research systems as fully as possible, in as many countries as possible. This could be particularly important before any future pandemics.