Bridging Knowledge Gaps in a Pandemic
When COVID-19 swept across Iran in early 2020, the country faced a dual challenge: combating an unprecedented health crisis while scrambling to understand a novel pathogen within its unique socio-political context. As one of the earliest and hardest-hit countries in the Middle East, Iran's scientific community embarked on an ambitious mission to identify critical knowledge gaps and establish research priorities that would guide their pandemic response.
The process of identifying knowledge gaps during a rapidly evolving pandemic represents a remarkable scientific endeavor combining urgent data collection with thoughtful analysis.
Iran's experience demonstrates how countries can leverage local expertise while addressing global health priorities, creating a blueprint for evidence-based decision-making during times of crisis 2 .
In public health emergencies, knowledge gaps represent critical questions that, when answered, can significantly improve disease control and mitigation efforts. These gaps exist when there is insufficient evidence to inform policy decisions or clinical practices, particularly in areas specific to a country's cultural, economic, or healthcare context.
The process of research prioritization involves systematically identifying and ranking these gaps to ensure limited resources are directed toward the most pressing questions 7 .
The World Health Organization emphasized that each country needed to adapt these frameworks to their local circumstances, creating both a challenge and an opportunity for Iranian researchers 7 .
Research priority-setting exercises serve two crucial functions: they increase the efficiency of research systems by reducing wasted resources, and they enhance equity by ensuring studies address the most urgent societal needs 7 .
In the early months of the pandemic, Iranian researchers undertook a comprehensive study to identify the nation's most critical COVID-19 research needs. This investigation employed a remarkable mixed-methods approach that combined multiple data sources to ensure both scientific rigor and practical relevance 7 .
Distributed to healthcare professionals, researchers, and policymakers, asking them to identify the five most pressing research questions and challenges in COVID-19 control and management. This survey garnered responses from 162 individuals, approximately 80% of whom were directly involved in pandemic response efforts 7 .
Conducted with key stakeholders including senior health policymakers, healthcare providers, executive managers, and faculty members. Using a purposive sampling approach across different provinces, researchers collected qualitative insights about management challenges and knowledge needs 7 .
Analysis of both government and independent news outlets along with social media platforms, tracking public concerns, questions, and challenges related to the pandemic between February and March 2020. This innovative approach helped capture the societal perspective often missing from traditional scientific prioritization exercises 7 .
The researchers then analyzed this vast dataset using manifest content analysis, categorizing identified needs into two broad areas: those aligning with international research priorities and those specific to health policy and systems research 7 .
The study revealed several critical insights about Iran's COVID-19 research needs. Unlike many Western countries, Iran's priorities emphasized practical implementation challenges alongside biomedical questions 7 .
| Rank | Research Domain | Example Topics |
|---|---|---|
| 1 | Epidemiology | Economic burden, regional variation in outcomes, mortality trends |
| 2 | Social Science & Public Health | Quarantine adherence, stigma reduction, intervention acceptance |
| 3 | Clinical Management | Non-COVID patient care, hospital preparedness, medical errors |
| 4 | Infection Control | PPE effectiveness, healthcare transmission risks |
| 5 | Health System Operations | Resource allocation, psychological support for staff |
What made these findings particularly notable was their practical orientation—rather than focusing on basic science or vaccine development (which were being addressed globally), Iranian researchers prioritized questions with immediate operational relevance to their specific context 7 .
Iranian researchers recognized early that understanding the epidemiological patterns of COVID-19 across their diverse population was essential for effective response planning. Specific priorities included comparing symptoms severity, hospitalization rates, ICU stays, and mortality rates across different time periods and regions 6 .
The economic impact of the pandemic emerged as another critical research area. Calculating the comprehensive economic burden of COVID-19 on Iran's healthcare system and society required innovative methodologies 6 .
Studies examining why people struggled to stay home during lockdowns, analyzing preferences for quarantine acceptance, and identifying optimal physical distancing methods were all deemed essential 6 .
Iran's primary healthcare (PHC) system, which had undergone significant development before the pandemic, played a crucial role in the COVID-19 response. Researchers identified the need to document how the existing network of community health centers (CHCs) was leveraged to manage mild cases and conduct contact tracing 3 .
| Strengths | Weaknesses | Recommended Improvements |
|---|---|---|
| Existing network of community health centers | Limited coordination between levels of care | Decentralized decision-making |
| Experience with public health campaigns | Insufficient funding for prevention | Revised financing mechanisms |
| Community health worker system | Vertical inequalities in access | Enhanced community engagement |
| Ability to adapt facilities for COVID care | Inadequate digital infrastructure | New family medicine models |
Conducting research during a public health emergency presented unique ethical dilemmas for Iranian scientists. A qualitative study identified ethical challenges across three domains: substantive ethical principles, the research environment, and research governance and management .
| Domain | Specific Challenges | Recommended Solutions |
|---|---|---|
| Substantive Ethical Principles | Balancing social value with individual risk, maintaining autonomy amid pressure | Crisis-specific ethical frameworks |
| Research Environment | Political interference, resource limitations, misinformation | Strengthened ethics infrastructure |
| Research Governance & Management | Streamlined reviews without compromising rigor, oversight difficulties | Enhanced training, transparent standards |
Conducting rigorous pandemic research required Iranian scientists to utilize a diverse array of methodological approaches and technical resources. The unique challenges of working during a public health emergency necessitated both innovation and adaptation of existing research tools.
This statistical method was employed to evaluate the impact of COVID-19 on various health services by comparing trends before and after specific pandemic-related interventions or events 5 .
Combining quantitative and qualitative approaches allowed researchers to both measure effects and understand contexts, as exemplified by the priority-setting study 7 .
Iran's existing health network provided crucial infrastructure for data collection 3 .
The Iranian Registry of Clinical Trials and other established systems provided mechanisms for tracking research activities .
Software like VOSviewer helped researchers analyze publication patterns and map research trends 9 .
Iran's experience identifying knowledge gaps and setting research priorities during the COVID-19 pandemic offers valuable insights for global health emergency preparedness. The country's systematic approach to identifying context-specific research needs while addressing universal scientific questions demonstrates how nations can leverage local expertise amidst global crises.
As the world continues to grapple with COVID-19 and prepares for future pandemics, Iran's experience underscores the vital importance of national research priority-setting exercises. By systematically identifying knowledge gaps and directing resources toward addressing them, countries can ensure their research efforts yield maximum impact for both policy and practice.