PEARLES challenges and solutions to the implementation of clinical research responses to epidemics and pandemics: a scoping review.

Publication date: Jul 01, 2025

Conducting clinical research in response to infectious disease outbreaks presents unique challenges. In a previous review, we identified a range of political, economic, administrative, regulatory, logistical, ethical and social (PEARLES) challenges and proposed solutions to effective implementation of outbreak research responses. Following the COVID-19 pandemic, we conducted an update to explore if solutions recommended had been implemented, or new challenges identified. We searched seven databases (Ovid MEDLINE, Global Health, Embase, and PsycINFO, Scopus, Epistemonikos, Google Scholar) and grey literature from 01/06/2018 to 28/09/2023 for studies presenting PEARLES challenges/solutions to epi/pandemic research responses. Of 12,652 records, 191 were included. Our review identified many persisting challenges, particularly the lack of international research co-ordination, pre-planned research strategies, and limited research infrastructure in resource deprived settings. While some solutions were implemented, many remain recommendations e. g. pre-prepared regulatory guidelines and protocols, research infrastructure investment and international research coordination. Our data shows an urgent need to address challenges identified, implement and evaluate recommended solutions, to strengthen global health security to new and (re-) emerging epidemics and pandemics.

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Concepts Keywords
Conducting Challenges
Eclinicalmedicine Epidemics
Google Pandemics
Pandemic PEARLES
Preparedness
Priority diseases
Research response
Solutions

Semantics

Type Source Name
disease MESH infectious disease
pathway REACTOME Infectious disease
disease MESH COVID-19 pandemic
disease MESH Ebola Virus disease
disease MESH Lassa Fever
disease MESH emergency
drug DRUGBANK Coenzyme M
disease MESH morbidity
disease IDO production
pathway REACTOME Translation
drug DRUGBANK Isoxaflutole
disease IDO process
disease IDO country
drug DRUGBANK Spinosad
drug DRUGBANK Methionine
disease MESH Influenza
disease MESH rare diseases
disease MESH infection
disease MESH communication barriers
drug DRUGBANK Etoperidone
drug DRUGBANK Trihexyphenidyl
disease MESH privacy
disease MESH critically ill
disease MESH uncertainty
disease MESH complications
drug DRUGBANK Cysteamine
drug DRUGBANK Trestolone
disease MESH emerging infectious diseases
disease IDO facility
drug DRUGBANK Bisoprolol
drug DRUGBANK gamma-Aminobutyric acid
drug DRUGBANK Tropicamide
disease MESH viral diseases
drug DRUGBANK Gold
disease IDO site
drug DRUGBANK Nonoxynol-9
disease MESH chikungunya virus infections
disease MESH Pneumonia

Original Article

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