Norwegian Experts Rank the Epidemic Questions That Matter Most

When the next pandemic arrives, decision-makers will once again face agonizing choices about closing schools, restricting travel, mandating masks, and asking citizens to change their daily lives. During the COVID-19 pandemic, many of those decisions were made under deep uncertainty, with limited evidence about which public health and social measures actually worked, for whom, and at what cost. A team at the Norwegian Institute of Public Health has now taken a systematic step toward fixing that problem for future epidemics. In a multi-method consensus study published in BMC Public Health, researchers led by Heather Menzies Munthe-Kaas and Andrew D. Oxman assembled a ranked list of sixteen research questions about the effects of public health and social measures, or PHSM, that they judge most important to answer for the Norwegian context.

The motivation for the project is straightforward: research priority setting determines which uncertainties get resolved before they matter. The authors argue that prioritizing research on epidemic measures can help ensure that studies address genuinely important questions rather than convenient ones, so that future decisions rest on better evidence. The work was carried out by the Centre for Epidemic Interventions Research, CEIR, a research centre embedded within the Norwegian Institute of Public Health that focuses on generating and synthesizing evidence about interventions used to control epidemics. Rather than letting individual researchers choose their own questions, the team built a structured process designed to capture the concerns of a broad range of Norwegian stakeholders and to apply transparent criteria for ranking what matters most.

The first methodological challenge was scope. Public health and social measures encompass a sprawling universe of interventions, from testing, isolation, contact tracing and quarantine to school closures, border restrictions, mask mandates, ventilation improvements and mass gathering limits. To map that landscape, the researchers conducted a literature review and solicited feedback from Norwegian stakeholders, ultimately assembling an exhaustive inventory of 173 distinct interventions. Because that list was far too large to interrogate question by question, they asked stakeholders to identify their top priorities, which narrowed the field to 22 interventions considered most relevant for the Norwegian setting. This filtering step anchored the entire exercise in what practitioners and decision-makers actually care about, rather than in what is easiest to study.

With the shortlist in hand, the team turned to established methods for surfacing research uncertainties. They drew on the nominal group technique, a structured facilitation method designed to elicit and rank ideas from participants in a way that limits the influence of dominant voices, and on approaches developed by the James Lind Alliance, a UK-based initiative known for bringing patients, clinicians and researchers together to agree on research priorities. Using these techniques with Norwegian stakeholders, the researchers collected raw proposals about what remains unknown or contested about the effects of the 22 priority interventions. The process generated 252 distinct questions, a volume that reflects how much legitimate uncertainty persists about measures that many governments deployed at enormous economic and social cost during the COVID-19 pandemic.

Turning 252 raw questions into a workable set required careful analytical work. The researchers applied thematic analysis, a qualitative method that groups similar items into overarching themes, combined with member checking, in which participants verify that the synthesized versions faithfully capture what they originally proposed. Through this process the 252 questions were consolidated into 76 research questions framed to capture the substance of the uncertainties stakeholders had raised. The consolidation was not merely editorial; each retained question needed to be answerable through research while preserving the intent of the people who raised it. The resulting list provides a systematic snapshot of where Norwegian stakeholders see the largest gaps between what is known about epidemic measures and what decision-makers need to know.

Prioritizing those 76 questions demanded explicit criteria rather than intuition. Drawing on a review of the literature and feedback from stakeholders, the team developed a set of twelve criteria against which each question could be judged, reflecting considerations such as the importance of the underlying decision, the size of the uncertainty, and the feasibility and likely impact of answering it. Thirteen members of the research team then independently applied these criteria to score and rank the questions. Using structured scoring by multiple assessors, rather than a single panel discussion, helps reduce the idiosyncrasies of individual judgment and makes the rationale for each ranking visible and auditable.

The scoring was not the final word. The team sought feedback from Norwegian stakeholders on the provisional priorities and incorporated that input into a consensus process within CEIR, which ultimately settled on a final list of sixteen prioritized research questions about the effects of public health and social measures. That iterative design, moving from broad stakeholder input to analytical consolidation to formal scoring and back to stakeholder consultation, reflects a core principle of evidence-informed priority setting: the people who will use or be affected by the research should have a genuine voice in what gets studied. It also mirrors lessons learned during COVID-19, when rapid evidence syntheses sometimes answered questions that were technically tractable but of limited practical value to policymakers.

A distinctive feature of the study is its attention to whether the priorities travel beyond Norway. The researchers presented the final list of sixteen questions to five external experts from Australia, Canada, Chile, the United States and the United Kingdom, using the TRANSFER framework, an approach developed for assessing the transferability of systematic review findings to different settings. This step acknowledges a persistent tension in pandemic research: measures such as school closures or contact tracing operate within specific health systems, legal frameworks and social contexts, so priorities identified in a high-capacity Nordic welfare state may differ from those in low- and middle-income countries. The external review offers an indication of how far the Norwegian list can serve as a starting point internationally, even though the questions were formulated for a national context.

The methodological machinery of the study, documented across nine appendices of supplementary material, is itself a contribution. By combining literature review, stakeholder consultation, nominal group technique, James Lind Alliance methods, thematic analysis, structured scoring against twelve criteria, and transferability assessment, the team produced a reproducible template that other national public health agencies could adapt. The study also navigated the ethical landscape of such work: because it did not constitute medical or health research under the Norwegian Health Research Act, it was exempt from review by the Regional Committees for Medical and Health Research Ethics, but the authors nevertheless followed established research ethics principles, including informed consent, anonymity and minimizing the burden of participation. The article is open access, published under a Creative Commons Attribution license, with no dedicated funding received for the work.

The implications reach well beyond Norway. The COVID-19 pandemic exposed how little rigorous evidence existed about the comparative effectiveness, unintended consequences and equity impacts of non-pharmaceutical interventions, and how quickly decisions must be made when evidence is thin. A pre-agreed list of priority questions can shape funding calls, trial designs, data collection infrastructure and rapid evidence synthesis efforts before the next crisis hits, so that answers are available when they are needed rather than years afterward. The sixteen prioritized questions will now guide the future work of the Centre for Epidemic Interventions Research, and the authors suggest the list may be useful to others in Norway and internationally as a starting point for setting their own research priorities. In effect, the study converts the scattered uncertainties of a global emergency into a disciplined research agenda, offering a concrete answer to a question that has haunted public health since 2020: when the next epidemic comes, what should we be studying right now?

Subject of Research: Research priority setting for public health and social measures to manage epidemics

Article Title: Research priorities for public health and social measures to manage epidemics: a multi-method consensus study in Norway

Article References: Munthe-Kaas, H. M., Elstrøm, P., Bruun, T., Bjørbaek, M., Elgersma, I. H., Flottorp, S., Fretheim, A., Gopinathan, U., Holst, C., Rosenbaum, S., Selstø, A., Solberg, R., & Oxman, A. D. (2026). Research priorities for public health and social measures to manage epidemics: a multi-method consensus study in Norway. BMC Public Health. https://doi.org/10.1186/s12889-026-29391-w

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29391-w

Keywords: public health and social measures, epidemic preparedness, pandemic preparedness, research priority setting, consensus methods, nominal group technique, James Lind Alliance, stakeholder engagement, non-pharmaceutical interventions, evidence-informed decision making, COVID-19, Norway