Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2020-046057 on 8 June 2021. Downloaded from Role of systems science in preventing and controlling emerging infectious diseases: protocol for a scoping review Mariam Abdulmonem Mansouri , Frank Kee, Leandro Garcia, Declan T Bradley To cite: Mansouri MA, Kee F, ABSTRACT Strengths and limitations of this study Garcia L, et al. Role of systems Introduction In recent history, many new infectious science in preventing and diseases have affected humans for the first time or have ► We explore the use of systems science approaches controlling emerging infectious appeared in previously unaffected areas of the world; diseases: protocol for a to the prevention and control of emerging infectious these diseases are known as emerging infectious diseases scoping review. BMJ Open diseases. (EIDs). Examples of EIDs include COVID-19, Middle East 2021;11:e046057. doi:10.1136/ ► This protocol uses well- recognised methodological respiratory syndrome and Ebola virus disease. EIDs are bmjopen-2020-046057 frameworks to guide a scoping review. known for their complexity. Multiple factors play a role ► The review uses a broad- based search strategy to ► Prepublication history for in their spread, including increases in human population, uncover and map relevant evidence, searching at this paper is available online. conflicts, urbanisation, air travel, global trade and To view these files, please visit least six databases and grey literature. inequalities in wealth distribution and access to healthcare. the journal online (http:// dx. doi. ► There will not be a language restriction to data In order to gain a better understanding of such complexity, org/ 10. 1136/ bmjopen- 2020- extraction. we aim to explore the role of systems science, which 046057). ► Because of the nature of scoping reviews, no quality allows us to view EIDs in the context of complex adaptive assessment of the reviewed data will be performed. Received 27 October 2020 systems rather than simple causes and effects. The Accepted 21 May 2021 objectives of this scoping review are to explore and map the theoretical concepts and key characteristics of studies that use systems methods in controlling EIDs, to identify outbreaks due to novel zoonotic infectious the gaps in knowledge and disseminate the results. diseases include COVID-19, MERS- CoV, Ebola Methods We will follow the Joanna Briggs Institute virus disease, Zika virus disease, SARS- CoV guidance for this scoping review, comprising the 3–5 and novel influenza viruses. Empirical http://bmjopen.bmj.com/ following stages: formulating the research question and subquestions, scanning the literature for available data, evidence suggests that many systemic societal selecting relevant publications, charting the data by two and social factors contribute to the appear- independent reviewers, aggregating the findings, reporting, ance of EIDs including urbanisation, climate summarising and disseminating the results. We will change, increasing travel and trade, human review peer- reviewed articles, preprints and grey literature population growth, human behaviour and available in all languages. the emergence of antimicrobial resistance.4 6 Discussion We intend that this scoping review will Even though EIDs are known to cause contribute to a better understanding of the use of systems a substantial threat to human life and can on September 25, 2021 by guest. Protected copyright. methods to inform policymakers about how to prevent and impose significant economic burden, Fauci control EIDs. and Morens6 argue that the behaviour of such Ethics and dissemination Research ethics approval 6 is not required for a scoping review because it is based diseases can be predicted and mitigated. on reviewing and collecting data from publicly available Public health history provides solid evidence sources. To disseminate the findings, results will be shared that public health measures, including clean through academic publications, seminars and conferences. water, sanitation, vaccinations and antibiotics, © Author(s) (or their have been effective in decreasing the burden employer(s)) 2021. Re- use of EIDs.6 In more recent history, many permitted under CC BY-NC. No BACKGROUND countries around the world have invested commercial re- use. See rights and permissions. Published by The WHO defines an emerging infec- in increasing national and international BMJ. tious disease (EID) as ‘one that either has communicable diseases control capacities and Centre for Public Health, appeared and affected a population for the resources in order to prepare and respond to 7 Queen’s University Belfast, first time, or has existed previously but is the next potential pandemic caused by EIDs. Belfast, UK rapidly spreading, either in terms of the However, due to the novelty of these diseases, number of people getting infected or to new there are considerable gaps in our knowledge Correspondence to 1 4 5 Dr Mariam Abdulmonem geographical areas’. Over 60% of EIDs are for the prevention and control of EIDs. Mansouri; zoonotic, having crossed over from animals to From its early origins in the middle of the mmansouri01@ qub. ac. uk humans by a process called spillover.2 Recent last century, systems science has evolved its own Mansouri MA, et al. BMJ Open 2021;11:e046057. doi:10.1136/bmjopen-2020-046057 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-046057 on 8 June 2021. Downloaded from distinguishable academic identity and a corpus of related There have been some previous attempts to use systems- scientific literature devoted to the subject. Since then, it oriented approaches in infectious disease research, has offered academics and practitioners from a variety including, for example, Ebola virus disease, HIV, tuber- of fields a number of different approaches and methods culosis, influenza and vaccine uptake.17 Systems science for helping better describe and solve ‘complex’ social, methods were also recommended by Shi et al, who used technological, ecological and organisational problems. examples of disease transmission prediction for influenza By ‘complex’ we mean having features of ‘complexity’ as A H1N1 in Hong Kong and malaria in Yunnan Province found in complex adaptive systems. Those features include in China, to provide policymakers with a better under- multiple interacting components, non- linear relationships standing of how to enhance surveillance and prepared- and feedback loops between them that might be moder- ness.18 Lee et al provided another example for using ated or synergistic with other system elements. In addition, systems science, mapping the elements that make up the interactions across multilayered contexts may induce emer- vaccine manufacturing and distribution system; there- gent outcomes at various levels that cannot be predicted after, they used multiple systems models to inform poli- from relationships observed at any single level.8 cymakers of the best ways to maximise the benefit and Those working in this field have appropriated a reduce wasted resources.19 Nevertheless, while interest number of methods and tools9 and while many of these has been growing, there has been no systematic attempt have roots in computer science, operational research to scope the charted and uncharted ground over which and simulation, others are alternatively branded as systems science methods and systems thinking can help ‘soft systems’ methods that invoke paradigmatic systems societies manage EIDs. thinking.8 This may often take us a long way towards a Before writing this protocol, a comprehensive search of solution by allowing us to see our problem as a feature databases for scoping or systematic reviews on the topic was of a complex adaptive system rather than focusing on a conducted. Resources used at this stage included Scopus, single cause and effect.8 It does so by helping us explore the Joanna Briggs Institute (JBI) Database of Systematic the purpose, behaviour and dynamics of the system’s Reviews and Implementation Reports, the Cochrane elements and what connects them.10 By mapping the Database of Systematic Reviews, PubMed, Evidence for patterns of behaviour within a system and what gener- Policy and Practice Information and Epistemonikos. ates them, the use of systems- oriented methods and To the best of our knowledge, no scoping or systematic tools can help us see the ‘bigger picture’ and better reviews exploring the role of systems approaches to the appreciate where the sweet spots for intervention might control of EIDs have been published (up to the time of lie to achieve desirable outcomes.8 9 writing). Systems thinking and the associated tools of systems Therefore, this review has the potential to inform dynamics have made inroads into healthcare manage- researchers and policymakers about innovative ways http://bmjopen.bmj.com/ ment.9 Since many of the big issues affecting public to prevent and control EIDs at global, national and health are easily seen among what are known as ‘wicked regional levels. It can provide evidence on how systems- problems’, systems thinking has begun to take root in oriented approaches can complement classical public public health.11 For example, Rutter and colleagues12 health approaches to the prevention and control of EIDs. advocated the use of systems science to inform policy Researchers can use this review as a precursor to a more debates and to help policymakers find more holistic systematic review on the topic. answers to public health problems.