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RKI 2018-2025 Summary Research Agenda

A Crowd walking and microorganisms under a magnifying lens, showing "2025" Source: RKI

The Robert Koch Institute meets the challenge of changing demands

Changes in demographic structures, disease spectrum and risk factors, internationalisation and digitalisation of numerous spheres of life, as well as technologic upheaval and innovations put new demands on the Robert Koch Institute (RKI). At the same time, these changes open new avenues for its work. With this in mind, the current research agenda outlines the strategic orientation of RKI’s research in the coming five to eight years.

As a public health institute, RKI plays a central role in health protection in Germany. Its tasks are to recognise and evaluate health trends and risks for the population, as well as to support the government, health experts and several other stakeholders in public health office, by issuing practice-oriented recommendations and proposals for action. Another task is to face and overcome acute crises. RKI’s work prioritizes diseases of high epidemiologic relevance and those important for health policy.

This field of action continues to develop. On the one hand, demographic shifts, changes in behavioural patterns, changes in spheres of life and social inequality, globalisation, migration and climate change may lead to novel health problems. Chronic diseases such as cardiovascular diseases, diabetes and cancer, as well as mental disorders are gaining importance in the spectrum of diseases. At the same time, newly emerging and re-emerging infectious diseases, altered pathogens, increasing antimicrobial resistance and threats posed by biological agents lead to global risks that become difficult to assess.

On the other hand, medicine and health-related research are constantly subject to fundamental methodological changes. For example, contemporary high-throughput sequencing techniques enable the analysis of the molecular evolution of pathogens almost in real time. This is accompanied by the need to manage exponentially increasing volumes of data, to evaluate, maintain and link them, and make them available – a trend that is accelerated by vast quantities of data from many other areas, and which has led to the concept of digital epidemiology.

To meet these developmental changes, RKI must continuously advance its methodology by autonomous and application-oriented research, and adapt innovative approaches for its queries. It is also required to communicate the knowledge generated in a target group-specific and appropriate way, both to the general public and the professionals, by using digital technologies. Finally, the work profile of RKI is impacted particularly by the increasing international networking in health protection and cooperation with numerous research institutions and institutes.
This research agenda thematically defines three main areas:

  1. In a changing world, the complex and reciprocal factors influencing health and diseases must be investigated further (chapter 1: Determinants of health and disease)
  2. Recommendations and measures for health promotion, prevention and crisis management must be based on evidence and data, and must be target-group specific and proven in practice (chapter 2: Evidence base and evaluation of measures)
  3. The methodological foundations for health protection of tomorrow must be laid today (chapter 3: Further development of methodology)

Further information in german language including a downloadable version of the full agenda: www.rki.de/forschungsagenda

The complex factors influencing health and disease must be investigated further

One of the core tasks of RKI is the constant and continuous surveillance of health, health threats and diseases, by collecting, analysing and making reliable data and information accessible. Health and disease are linked to biological, mental and social influences, behavioural patterns and circumstances, income and educational resources, as well as health-related effects during the course of life which vary based on gender. In addition, regional and local variations result in noticeable differences in the life expectancy within Germany. The main tasks of RKI include the investigation of these determinants relevant to health, the identification of vulnerable groups, and the demonstration of approaches for targeted prevention and health promotion.

In light of demographic changes, the concept of "Healthy Ageing" is of particular interest for RKI. This does not mean aging without any diseases, but rather a process spanning the stages of life during which someone maintains their well-being, their self-determination and their capacity to do what is important to them. Healthy Ageing includes the most diverse dimensions of objective and subjective health, social inclusion and social security, on an individual and social level.

Of special importance are nosocomial infections and antibiotic resistance. An increasing number of geriatric inpatients and increasingly complex interventions in the elderly put a stronger focus on nosocomial infections, antibiotic consumption and problems associated with resistance. Not only is it important to determine the rates of resistant infections, but also to determine the way resistance develops and spreads, the underlying mechanisms and possible ways to prevent the spread of resistance.

The effect resistance has on the duration of hospital stay, medical costs or earning capacity of patients, and the way antibiotic-stewardship programmes could lead to a more rational and strategic use of antibiotics is of further interest.

Novel infection threats such as through zoonotic pathogens from virgin forest areas, are also of great interest and are already being looked into within cooperation projects with partners in African countries. The risk potential of emerging pathogens is affected by their molecular evolution as well as by ecological correlations such as human expansion into previously untouched areas. It is essential therefore, to continually assess the epidemiological status in Germany in the context of the international situation.

In general, over the past years one has come to realise and accept that there is a close connection between human and animal health and a healthy environment. This paradigm is termed "One Health". Examples of research questions are the connection between climate change and allergies, the spread of antibiotic resistance in different reservoirs, as well as the risk of transmission of novel influenza viruses as a result of the globally increased consumption of meat and the altered production of animals for slaughter. Thus it is possible for potentially highly pathogenic strains to spread within large animal fattening farms, showing different dispersal dynamics. The existing cooperation between RKI and the Friedrich-Loeffler-Institut (FLI) with regard to the molecular infection epidemiology of human and avian influenza viruses offers a cross-sector model for a One Health research strategy.

Recommendations and measures must be evidence-based and proven in practice

RKI develops relevant recommendations and proposals for action covering diverse aspects of health protection, based on available scientific findings. However, it is necessary to continuously refine the processes related to the development of such recommendations, and to make them transparent, to expand the data sources used, and also to review the efficacy of the prevention proposals in practice. At the same time, with limited resources in future, it will be a matter of exemplarily calculating the burden of disease and the potential for prevention of different diseases.

Examples include modelling of the epidemiological and health economic effects of novel vaccination strategies or screening methods. The effects of vaccines that are already being used may be evaluated epidemiologically by RKI’s surveillance of diseases and pathogens. In turn, the results from surveillance, outbreak investigations and monitoring of vaccination coverage rates can be taken into consideration in continually updated vaccination recommendations or in communication activities. Novel data-based recommendations must also be developed for specific individual issues, such as food consumption of immune-compromised persons.

Acutely occurring outbreaks require the continuous development of methods, conceptions and recommendations. For example, RKI plans to visualise transmission events, in particular those of resistant pathogens in hospitals, but also outbreaks of food-borne pathogens, by using transponder-aided analyses of networks, molecular surveillance and risk factor analyses. In this way new prospects may be opened up. In this context RKI will also strengthen the management of outbreaks and crises. Accordingly, RKI’s field teams are professionalized further, and the situation assessment as well as the subsequent evaluation of infection events will be increasingly performed based on data in order to continuously improve crisis management in a structured process.

Depending on the cause and the extent of a health crisis, RKI’s research focuses on diverse measures such as vaccination, measures of sanitation, equipment for infection protection, quarantine measures or dietary recommendations. Experience has shown that close networking between public health stakeholders plays a key role.
Lastly, and importantly, RKI will increasingly take part in the development of evidence-based health information for the public. In diverse parts of the population this will contribute to higher "health literacy" – i.e. the ability to find, assess and apply health information.

The foundations of health protection of tomorrow have to be laid today

In order to efficiently fulfil its tasks as a public health institute under changing conditions, RKI has to enhance its tools and methods continuously. For example, RKI’s long-term surveys of the health of children, adolescents and adults provide a system that is exemplary on an international level for federal health monitoring. At the same time, parts of the population which are hard-to-reach must clearly be better included in epidemiologic investigations in future. Consequently, the diversity of our society with regard to gender, age, sexual orientation, functional capabilities, cultural background and origin must be taken into account.

The plan includes, inter alia, to create new access routes to vulnerable groups through participatory approaches, and to cooperate, for example, with drug counselling centres or to utilise internet forums used by specific target groups. The range of health surveys will also be increased by applying innovative survey methods such as "respondent-driven sampling" – a modified snowball procedure – in which participants in the survey recruit other persons from their circle of acquaintances

National diabetes surveillance is already being developed, which – in addition to the survey data from RKI’s health monitoring – incorporates so-called secondary data such as those from health insurance funds or hospitals, in order to better depict the burden of disease and the quality of care. This project serves as a prototype for the concept of a comprehensive information system regarding chronic diseases.

Digitalisation and advancing information technology offer new opportunities to use large volumes of data more and more efficiently and to enhance existing surveillance systems for the early detection of outbreaks and health threats by further components.

Complementing the existing reporting system, RKI is establishing the German electronic reporting and information system for infection control (DEMIS) for infectious diseases, which will facilitate a faster and easier consistent electronic data processing covering all stages of reporting. In addition, the genome-based subtyping (molecular surveillance) of important pathogens, including EHEC, salmonella, tuberculosis bacteria, antibiotic-resistant pathogens, HIV and influenza and measles viruses, is standardised and extended.

Relevant infectious agents will be investigated using the new possibilities of molecular analysis and cell culture models, in order to study their potential threat and tendency to spread. For this purpose, RKI is expanding its methods of pathogen diagnostics and for studying disease mechanisms. Examples of this are highly sensitive procedures for the detection of pathogens and toxins as well as innovative infection models.

In the course of these projects, innovative approaches of digital epidemiology must be developed or adapted in order to be able to gather data from diverse sources and types, to make databases readily accessible and compatible, and to further evaluate unstructured bulk data ("Big Data").

Moreover, another focus is on statistical and bioinformatics methodology, as well as adaptive algorithms that permit multimodal pathogen analyses, by using data from genomics, electron-microscopy, spectroscopy and epidemiology. These methods also help identify unknown routes and networks of transmission by comparing similarities in the genomes of pathogens. In addition, computer-aided outbreak simulations will increasingly serve to prognostically estimate the spatial spread of pathogens.

Date: 26.04.2019