Pandemic preparedness and response priorities in Latin America: A regional Delphi consensus

Abstract

Objective:

The Independent Panel for Pandemic Preparedness and Response issued a series of recommendations for future pandemic preparedness and response. Latin America’s COVID-19-related deaths represented 25 % of the global demises, despite harboring less than 8 % of the world’s population. As little data exists to support whether the Panel’s recommendations reflect public health professionals’ priorities in the region the study aimed to define these priorities utilizing a Delphi study.

Study design:

A consensus-building modified Delphi technique.

Methods:

For the first two rounds, participants were asked to rank a list of topics across seven domains on a 4-point Likert scale. Topics voted by at least 75 % of participants in either round as very important were included in the final round. Participants ranked the topics from each of the seven domains in numeric order to define top priorities.

Results:

A total of 115 responses were obtained across three rounds. Most respondents were involved in direct efforts against COVID-19 (75·0–86·%) and a considerable proportion had more than 16 years of public health experience (37·3–50·0 %). The top priority issues were zoonotic disease-pathogen surveillance systems (27·4 points), robust infection and prevention control programs (22·8 points), and indicator and event-based monitoring and reporting systems (22·1 points).

Conclusions:

Establishing priorities for future pandemics is critical to ensure better health outcomes. The region should strengthen collaboration and enhance its capacities while conducting country-level analysis and defining priorities for future arrangements.

1. Introduction

As of May 7th, 2023, more than 765 million COVID-19 cases and 6·9 million deaths had been reported across the globe according to the World Health Organization (WHO)¹ as the Public Health Emergency of International Concern ended.² Although the pandemic affected every country, the toll was unevenly distributed. Despite harboring 7·7 % of the world’s population, Latin American totaled 1·7 million COVID-19-attributed deaths, representing 25·1 % of the global reported deaths (6·9 million) by May 2023.³ Moreover, excess deaths in the region occupied second place (2·86 million excess deaths) out of seven world regions, surpassed only by South Asia (5·27 million excess deaths)⁴ [see Table 1]

Table 1.

Quality characteristics of the study.

Quality characteristic	Our study
Literature review conducted	Yes
Background information provided to respondents	Yes
Purpose is item generation or ranking or both	Yes
Number of respondents indicated	Yes
Number of respondents for round 1 indicated	Yes
Number of respondents for round 2 indicated	Yes
Number of respondents for round 3 indicated	Yes
Criteria used for respondents reproduciblea	Yes
Polling described	Yes
Private decisions collected (anonymity)	Yes
Formal feedback of group ratings	No
Number of rounds conducted 2 or more	Yes
Number of rounds to be performed stateda	Yes
Predetermined definition of consensus	Yes
Consensus forced	No
Were criteria used for dropping items cleara	Yes
Stopping criteria other than rounds specifieda	No

Quality items as outlined by Van Schalkwyk et al.¹⁴

^aIndicates quality items from Diamond et al.¹⁵.

As voiced strongly by the Independent Panel for Pandemic Preparedness & Response, actors from all sectors, such as governments, foundations, regional bodies, and civil society groups (ex. academia and non-governmental organizations) are essential to strengthen capacities for preparedness and response. Among the outlined recommendations, bottom-up regional empowerment and self-sufficiency have been championed by the panel.^5–7 In addition to this, the Panel has also identified priority areas for pandemic preparedness and response over the next five years across the globe.⁶ Thus, a regional consensus establishing priorities for Latin America is coherent and justifiable, given the panel’s recommendations. We conducted a literature review of the topic, resulting in 27 articles (Appendix A). Still, none outlined priorities for future pandemics specific to the region through a consensus, strengthening the case to address this research gap and unveil priorities as we prepare for the next pandemic.

This project emerged from the Network for Pan American Health to Support Laboratories, Ministries of Health, and Other Organizations (RESPALDO), an initiative funded by the University of California (UC) Global Health Institute⁸ and Latin America (LA) partners for strengthening pandemic preparedness and expanding health systems capacities. A Symposium with regional partners, facilitated by the Institute for Global Health Sciences from UC San Francisco, served as the point of encounter to launch the enterprise.^9,5,10,11

2. Methods

2.1. Study design and sample

A classical Delphi is characterized by surveying experts anonymously through a standardized questionnaire adaptable between rounds that are repeated, incorporating feedback and result in answers determined statistically. We employed a consensus type Delphi (type four), typified by establishing the highest possible degree of consensus among experts and participants through a quantitative approach).¹² The following section and Fig. 1 summarize the study’s steps and key.¹³

Fig. 1.

Overview of Delphi steps from our study.

Step One. Identifying the problem:

A team of UC members and partners from LA engaged in a series of conversations to identify priority topics over six months, based on recommendations from the Independent Panel for Pandemic Preparedness and Response and the Global Health Security (GHS) Index as a reference for assessing country readiness against pandemics.^5,10

Step Two. Literature search:

In addition to topics taken from the previous, a complementary narrative review was conducted (Appendix A).

Step Three. Topic generation:

Based on the GHS Index, seven domains were selected: 1) prevention of the emergence or release of pathogens, 2) early detection and reporting systems, 3) rapid response, 4) health systems, 5) workforce development in epidemiology and rapid response, 6) laboratory workforce development and capacity building, and 7) policy and planning. Topics were grouped in each of these.

Step Four. Iterative rounds and data collection:

We conducted three rounds between October 2022 and July 2023. The first round took place during the Symposium (October 2022). Utilizing the QUALTRICS^XM Online Survey Software (Qualtrics, Seattle, Washington 2023), we invited all speakers and attendees (n = 196) to participate in the Delphi via email and live during the Symposium. The first survey (Appendix B) was emailed to all at the beginning of the event, followed by two email reminders. 34 responses were documented (response rate 17·4 %). Analysis of the first-round data by two researchers was followed by survey modifications, incorporating topics as answers as suggested by participant feedback. The modified survey (Appendix C) was sent out (June 2023), followed by three email reminders, totaling 46 responses (response rate 32·2 %) after 3 weeks. Topics voted in either the 1st or 2nd round as “very important” by at least 75 % of respondents were selected for the 3rd round. The final round (July 2023) consisted of a ranking exercise; participants were asked to rank in numeric order selected topics (Appendix D); 35 individuals responded (response rate 17.6 %) after three reminder emails. The survey was available in English and Spanish with access restricted by password. All responses were anonymous and untraceable.

Step Five. Feedback:

After each close-ended question, a second question asked participants to write missing topics not mentioned previously. Suggested topics were added to the second-round survey. During the final round, feedback was asked after the ranking exercise.

Step Six. Summary of findings:

All topics were described thematically (across all seven domains) and shared with colleagues and participants. A modified quality criteria for Delphi studies was used to characterize our study.¹⁴

2.2. Instruments

The first survey (Appendix B) consisted of two parts 1) demographics and 2) pandemic preparedness and response-specific topics. These were categorized across seven domains 1) prevention of the emergence or release of pathogens, 2) early detection and reporting systems, 3) rapid response, 4) health systems, 5) workforce development in epidemiology and rapid response, 6) laboratory workforce development and capacity building, and 7) policy and planning. A Likert scale was used to label the importance of topics as “not at all important”, “slightly important”, “fairly important” and “very important”. For each domain, a text box was available to write topics left out as thought by participants. For the second round, 29 topics were added across all domains (Appendix C). For the third-round survey (Appendix D), only topics voted as “very important” by at least 75 % of the participants in either round were included¹⁵ and ranked numerically. Fig. 1 summarizes our study.

2.3. Data analysis

For the first two surveys, descriptive statistics were obtained. For each open-ended questions, two researchers went through the responses and determined the topics were not repeated elsewhere in the survey. Those not included in survey were placed in the best-fitted domain and included in the second survey. The final ranking was carried out by calculating a weighted score for each topic across all domains. All analyses were conducted in Microsoft Excel (Version 16).

$$\begin{gathered} \mathit{Weighted}\mathit{score}=\left[\left(\text{number}\text{of}{1}^{\mathrm{s}\mathrm{t}}\text{place}\text{votes}\right)\times \left(1.0\right)\right] \\ +\left[\left(\text{number}\text{of}{2}^{\mathrm{n}\mathrm{d}}\text{place}\text{votes}\right)\times \left(0.5\right)\right] \\ +\left[\left(\text{number}\text{of}{3}^{\mathrm{r}\mathrm{d}}\text{place}\text{of}\text{votes}\right)\times \left(0.33\right)\right] \\ +\left[\left(\text{number}\text{of}{4}^{\text{th}}\text{place}\text{votes}\right)\times \left(0.25\right)\right] \\ +\left[\left(\text{number}\text{of}{5}^{\text{th}}\text{place}\text{votes}\right)\times \left(0.2\right)\right] \\ +\left[\left(\text{number}\text{of}{6}^{\text{th}}\text{place}\text{votes}\right)\times \left(0.16\right)\right] \\ +\left[\left(\text{number}\text{of}{7}^{\text{th}}\text{place}\text{votes}\right)\times \left(0.14\right)\right] \\ +\left[\left(\text{number}\text{of}{8}^{\text{th}}\text{place}\text{votes}\right)\times \left(0.12\right)\right] \\ +\left[\left(\text{number}\text{of}{9}^{\text{th}}\text{place}\text{votes}\right)\times \left(0.11\right)\right] \\ +\left[\left(\text{number}\text{of}{10}^{\text{th}}\text{place}\text{votes}\right)\times \left(0.1\right)\right] \end{gathered}$$

3. Results

3.1. Demographics

A total of 115 participants responded across all three rounds, representing 18 countries, including 15 from LA (Mexico, Ecuador, Honduras, Colombia, Guatemala, Nicaragua, Brazil, Peru, El Salvador, Paraguay, Argentina, Panama, Belize, and Bolivia) (Table 2). Most were 30 years or older (92·5–94·5 %). Participants with more than 16 years of public health experience were more common (37·3–50·0 %). Most reported involvement in pandemic response efforts against COVID-19 (75·0–86·3 %). The main areas of involvement were research (18·2–20·6 %), surveillance (12·6–14·9 %) and health systems strengthening (11·8–16·8 %). Most reported having pandemic experience; some (39·2–41·7 %) and a lot (37·7–44·4 %). Around a third of respondents identified their host institution as a university (33·8–35·7 %).

Table 2.

Demographic characteristics of participants.

Variable	Category	1st Round (n = 34)	2nd Round (n = 46)	3rd Round (n = 35)
Age	18–20 years	0 (0)	0 (0)	1 (2·8)
	21–29 years	2 (5·8)	3 (6·5)	1 (2·8)
	30–39 years	11 (32·3)	8 (17·3)	6 (17·1)
	40–49 years	7 (20·5)	14 (30·4)	13 (37·1)
	50–59 years	5 (14·7)	7 (15·2)	2 (5·7)
	60 years or older	9 (26.4)	14 (30·4)	12 (34·2)
Years of experience in public health	Less than 1 year	0 (0)	0 (0)	1 (2·8)
	1–5 years	4 (11·7)	5 (10·8)	4 (11·4)
	6–10 years	6 (17·6)	5 (10·8)	4 (11·4)
	11–15 years	15 (44·1)	9 (19·5)	8 (22·8)
	16 years or more	9 (26·4)	24 (52·1)	17 (48·5)
	I do not work in public health	0 (0)	3 (6·5)	1 (2·8)
Worked on pandemic response efforts	Yes	32 (94·1)	38 (82·6)	26 (74·2)
	No	2 (5·8)	8 (17·3)	9 (25·7)
Working area	Surveillance	18 (15·6)	21 (14·6)	16 (15·5)
	Operational guidelines	10 (8·6)	12 (8·3)	10 (9·7)
	Public policy development	11 (9·5)	14 (9·7)	7 (6·7)
	Research	19 (16·5)	25 (17·4)	22 (21·3)
	Health systems strengthening	12 (10·4)	19 (13·2)	17 (16·5)
	Vulnerable populations	5 (4·5)	7 (4·8)	5 (4·8)
	Direct patient care	6 (5·2)	4 (2·7)	1 (0·9)
	Contact tracing/case investigation	9 (7·8)	3 (2·0)	7 (6·7)
	Acquisition	3 (2·6)	4 (2·7)	2 (1·9)
	Laboratory	7 (6·0)	12 (8·3)	7 (6·7)
	Vaccine development	2 (1·7)	3 (2·0)	1 (0·9)
	Vaccine distribution, other supplies	6 (5·2)	9 (6·2)	8 (7·7)
	None	0 (0)	5 (3·4)	0 (0)
	Other	7 (6·0)	5 (3·4)	0 (0)
Experience in pandemic response efforts	A lot of experience	14 (41·1)	20 (43·4)	15 (42·8)
	Some experience	19 (55·8)	20 (43·4)	15 (42·8)
	A little experience	1 (2·9)	7 (15·2)	5 (14·2)
	No experience	0 (0)	4 (8·6)	0 (0)
Institution	Government health agency (national/district)	7 (16·6)	12 (20·0)	7 (17·0)
	International organization	9 (21·4)	9 (15·0)	8 (19·5)
	Research institute	5 (11·9)	11 (18·3)	8 (19·5)
	Civil society	2 (4·7)	2 (3·3)	1 (2·4)
	University	16 (3·8)	19 (31·6)	15 (36·5)
	Medical center/hospital	2 (4·7)	3 (5·0)	0 (0)
	Other	1 (2·3)	4 (6·6)	2 (4·8)

3.2. Domain one: prevention of the emergence or release of pathogens

Three of the five first round topics were voted as very important. Two topics were added to the second-round survey, of which one was selected by the majority in the second round. Ranking of the four topics (Appendix E) revealed the following order: Zoonotic disease and pathogen surveillance systems (27·4 points), Surveillance, detection, and reporting of antimicrobial resistance (15·6 points), International notification of animal disease outbreaks (14·3 points) and Operative research (13·4 points). The list of topics from every domain voted as very important in either round is available in the supplementary files (Appendix F).

3.3. Domain two: early detection and reporting

Out of six first-round topics, three were voted as very important. Only one feedback topic, Community-based surveillance, including remote places, was selected as very important in the second round. Ranking four topics resulted in the following order: Indicator and event-based monitoring and reporting systems (22·1 points), Community-based surveillance (22·0 points), Interoperable and interconnected real-time electronic information systems (17·0 points), and Transparency of surveillance data and Operative research (11·8 points).

3.4. Domain three: rapid response

Five of nine first round topics were categorized as very important in both rounds. No additional topics emerged from feedback. Ranking disclosed the following order: Public health and safety authorities’ linkage for rapid response (20·2 points), Activation of response plans (17·4 points), and Laboratory capacity to detect priority diseases (15·7 points).

3.5. Domain four: health systems

One of two first round topics was chosen as very important, Developing a user-friendly information system with alert information for front-line workers. Three topics were added to the second-round survey, of which Robust infections and prevention control programs, and Updated and real-time health information systems were voted as very important. Ranking of topics resulted in the following: Robust infections and prevention control programs (22·8 points) first, Updated and real-time health information systems (20·1 points) and developing user-friendly information systems with alert information for front-line workers (19·3 points).

3.6. Domain five: workforce development in epidemiology and rapid response

Five of fifteen first-round topics were labeled as very important. Five topics were added after feedback of which one was selected as very important. Ranking of topics showed the following three priority issues: Applied epidemiology training programs (19·4 points), Establishing collaborations among universities, research institutes and governments for capacity building and field training (18·8 points), and Expanding epidemiology workforce capacity (14·1 points).

3.7. Domain six: laboratory workforce and capacity building

Four of six first round topics were elected as very important. Eleven topics were added to the second-round survey of which six were selected as very important. Ranking of ten topics showed that the top three priority issues were better integration of animal and human lab-based surveillance (one health) (18·7 points), International-regional cooperation and partnerships (13·3 points), and Oversight of research (11·7 points).

3.8. Domain seven: policy and planning

One of three first round topics was chosen as very important, Revising national strategic plans for emerging and re-emerging pathogens. Eight topics were added to the second-round survey and all were voted as very important. Ranking resulted in the following top three order: Revising or improving national strategic plans (21·5 points), Increasing financial resources (13·3 points), and Legal frameworks for coordinating and responding against public health emergencies (13·0 points). Table 3 showcases the top ten ranked topics across all seven domains. Ranking of all topics from each domain is available in the supplementary files (Appendix E).

Table 3.

Top ten ranked policy priorities for pandemic preparedness and response in Latin America.

Domain	Topic	Weighted score
Prevention of the emergence or release of pathogens	Zoonotic disease-pathogen surveillance systems	27·4
Sufficient and robust health systems	Robust infection and prevention control programs	22·8
Early detection and reporting	Indicator and event-based monitoring and reporting systems	22·1
Early detection and reporting	Community-based surveillance	22·0
Policy and planning	Revising or improving national strategic plans for emerging and re-emerging pathogens	21·5
Rapid response	Public health and safety authorities linkage for rapid response during a biological event	20·2
Sufficient and robust health systems	Updated and real-time health information systems	20·1
Workforce development in epidemiology and rapid response	Applied epidemiology training programs	19·4
Workforce development in epidemiology and rapid response	Develop a user-friendly information system with alerts for physicians and front-line workers	19·3
Workforce development in epidemiology and rapid response	Collaborations among universities, research institutes and governments for capacity building and field training	18·8

4. Discussion

With engagement and input from senior public health experts from the LA region with substantial expertise in pandemic efforts, the Delphi yielded priorities for strengthening PPR against future threats. Moreover, it demonstrated remarkable concordance across the first two rounds. However, important topics were added in the second round, with 29 new issues across all seven domains. Furthermore, this is the first Delphi establishing PPR priorities for the region, and as such, can inform intersectoral public health policies at both country and regional levels. The first section focuses on the five priority issues for the region and describes some examples found in the literature. The second section underscores the importance of this work and provides further insight into other issues outside the top five.

Our study brings insight into highly valuable elements of PPR for the region. Across seven domains, the top five priority issues were: 1) Zoonotic disease-pathogen surveillance systems (27·4 points) 2) Robust infection and prevention control programs (22·8 points) 3) Indicator and event-based monitoring and reporting systems (22·1 points) 4) Community-based surveillance, including remote places 5) Revising or improving national strategic plans for emerging and re-emerging pathogens (21·5 points). Table 3 showcases the top ten priorities. These coincide with elements outlined in the GHS Index and reinforce the need to strengthen them.⁴ It also highlights the importance of utilizing both instruments as the region and countries address PPR efforts. The following section outlines the top five priority issues for the region identified in the Delphi and related policy aspects.

4.1. Policy Priority One: Strengthening Zoonotic disease-pathogen surveillance systems

Although enormous efforts were made across America’s region to expand genomic surveillance for SARS-CoV-2,¹⁶ an example can be made of limited testing capacity country-level, such as Mexico.¹⁷ As most pathogens with pandemic potential arise in animals, surveillance should go beyond clinical syndromes and specific diseases. A One Health approach that considers the complex interactions between humans, animals, and the environment offers the best opportunity for improving global health security. Besides collaboration among networks, and disciplines, genomics and data infrastructure offer a novel and indispensable way to strengthen current systems.^18,19 Countries should revise surveillance systems to meet key strategic objectives for post-pandemic COVID-19 surveillance²⁰ and include as many possible sectors of society.

4.2. Policy Priority Two: robust infection and prevention control programs

Despite the disruption caused by COVID-19, the pandemic has provided opportunities to retake programs that aim to control and/or eliminate communicable diseases. An ambitious agenda set by the Pan-American Health Organization was proposed to eliminate 35 diseases and related conditions,²¹ based on their public health, societal and economic impact, as well as their feasibility. A key to this is engaging in multi-disease elimination approaches, leveraging regional experience, infrastructure, and incorporating local and community capacities.²¹ Another area of opportunity requiring substantial efforts is antimicrobial stewardship programs; the alarming increase in regional resistance highlights the need to invest in public health infrastructure, as many countries provide public services to a considerable proportion of their populations.²² Ensuring adequate surveillance for decision-making from regional to local levels and making effective antibiotics accessible to all countries should be fundamental components.

4.3. Policy Priority Three: indicator and event-based monitoring and reporting systems

A robust strategy of surveillance for monitoring threats involves both indicator-based surveillance (IBS) and event-based surveillance (EBS). EBS also has the potential to expand beyond traditional approaches, such as detecting unstructured textual online information (eg. social media), data from animal health, occupational health, community reports, geospatial data, and wearables.^23,24 An evaluation of various countries’ EBS systems disclosed considerable variation in performance, including systems from six LA countries.²⁵ Henceforth, an in-depth evaluation of EBS systems in the LA region should take place shortly to establish a baseline of performance metrics to establish country goals. In addition to this, efforts should also focus on expanding epidemic intelligence from open sources, as to date only three countries from LA have implemented this initiative.²⁶

4.4. Policy Priority Four: community-based surveillance, including remote places

Defined as “the systematic detection and reporting of events of public health significance within a community by community members” community-based surveillance (CBS) is a strategy that has been backed by the WHO Regional Offices and utilized in various disease eradication programs such as smallpox, guinea worm, polio, Ebola,²⁷ and more recently during COVID-19.²⁸ In the Americas region, until 2017, CBS had been documented in six countries, of which Brazil had the highest number of programs (n = 5). This assessment revealed that fourteen countries in the region had no CBS systems in place.²⁹ The Delphi results reinforce the need to implement and extend CBS coverage in the region.

4.5. Policy Priority Five: revising-improving national strategic plans for emerging and re-emerging pathogens

The need to revise or improve national strategic plans must be analyzed through different lenses and should consider critical elements of PPR such as trust in governments, interpersonal trust, and government corruption.²⁸ More undoubtedly, countries that lack national strategic plans will need to urgently work on one.³⁰ Findings regarding the value of GHS and other tools that have assessed country-level outcomes are mixed,^31–33 although a case can be made out of countries governed by populist leaders that were considered to be prepared but performed badly during the pandemic³⁴ such as Brazil and Mexico. Both had the highest regional GHS scores but registered very high excess mortality rates, suffering of risk minimization, displacement of councils, and disregard for institutions with technical expertise.^34,35 In this sense, countries need to plan and rethink how strategic plans can be consolidated so that political interference can be minimized to facilitate their execution.

This work addresses a research gap identified in the literature as well as an essential element of preparedness and response stated by the Independent Panel for Pandemic Preparedness and Response, by encouraging regional and horizontal collaborations that can strengthen capacities and foster resiliency.^5–7 Literature on country-level responses and international consensus on how to make it the last pandemic exists,^16,36–38 however, there is no record of guidance that addresses priorities for LA considering the severe losses during COVID-19. As countries from the region recover, it is imperative to plan and prepare objectively and learn from the experiences countries went through. No tool alone can predict how nations will respond, and these should be seen as pieces of the broader picture. Reassessing and strengthening the core capacities of PPR is of utmost importance. Follow-up to country-specific and regional actions should take place to enhance accountability. However, decision-makers should also consider addressing contributors to detrimental outcomes during the pandemic such as high pre-existing levels of socioeconomic inequalities, weak health systems and high levels of non-communicable diseases.^39–53 An example of the aforementioned can be made for health spending; compulsory health expenditure as a proportion of the Gross Domestic Product among LA countries was dramatically low in some, as seen with Brazil (4·5 %), Peru (4·3 %), and Mexico (3·2 %), well below the OECD average (7·4 %). In addition to allocating more resources, these should be destined to strengthen key areas such as preparing for disaster and risk and disease control programs and epidemiological surveillance, among others.⁵⁴ Recognizing the importance of the latter should drive interventions for future threats. As concerns grow amidst negotiations on the new treaty for pandemic preparedness, countries from the Americas should make the most of the delicate situation by making the most of regional collaborations (South-South cooperation).^55,56

Panel. Top five policy priorities for pandemic preparedness and response in Latin America.

Policy Priority One: Strengthening Zoonotic disease-pathogen surveillance systems.

- Domain: Prevention of the emergence or release of pathogens

Policy Priority Two: Robust infection and prevention control programs.

- Domain: Sufficient and robust health systems

Policy Priority Three: Indicator and event-based monitoring and reporting systems.

- Domain: Early detection and reporting

Policy Priority Four: Community-based surveillance, including remote places.

- Domain: Early detection and reporting

Policy Priority Five: Revising-improving national strategic plans for emerging and re-emerging pathogens.

- Domain: Policy and planning

4.6. Strengths and limitations

As the first Delphi specific to LA by experienced professionals from the region, our work should serve as a reference for regional needs for pandemic preparedness and response as countries remerge from COVID-19. It also showcases the need to conduct country-level analysis and define priorities for future arrangements and reinforces the need to address common aspects in the region outlined by the Independent Panel and the GHS index. Moreover, it allowed for independent and decentralized input. Regarding the study’s limitations, participants may have been different across rounds, although most characteristics were distributed similarly throughout the three rounds. Additionally, the results of the Delphi may have been biased towards specific areas of expertise and workplace settings of participants, as a considerable proportion of participants were from governmental agencies and academic institutions. Also, the process outcomes were strongly shaped by those more engaged, as such we acknowledge that there may be critical knowledge gaps and biases towards certain topics, reflecting insufficient input from stakeholders of varied disciplines and contexts. Future research should strive for a more diverse pool of participants and a broader representation of actors from the region.

4.7. Conclusion

This study underscores priorities for pandemic preparedness and response in Latin America. To the best of our knowledge, it is the first regional consensus carried out by a multidisciplinary group of stakeholders from different backgrounds, including governments, research centers, non-governmental organizations, and international agencies. As countries restructure and plan for future pandemics, decision-makers can consider the expressed priorities as a source of reference. Ultimately, the challenge for the region lies in policy adoption, implementation, and articulation of cohesive preparedness and response strategies. The study also stresses the need to conduct an in-depth analysis of the outlined priorities in the region and countries to better assess specific needs.

Supplementary Material

Appendix. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.puhe.2025.01.003.

Data availability

Data is available at Mendeley Data: Mendez, Cesar (2024), “Pandemic Preparedness and Response Priorities In Latin America: A Regional Delphi Consensus”, Mendeley Data, V1, https://doi.org/10.17632/xh34wdmbcc.1.