Literature review on disease ranking tools, their characterisation, and recommendations for the method to be used by EFSA

The EU‐Commission is setting up a coordinated surveillance system under the One Health approach for cross‐border pathogens that threaten the Union, for which EFSA is assessing the prioritization of pathogens to be targeted by surveillance. To support in prioritizing pathogens, this report reviews the literature on existing frameworks, describes the criteria to be considered for prioritization and compares approaches used in the reviewed studies (from year 2000 onwards). The search was undertaken across various biomedical and scientific literature databases and were selected using inclusion criteria to filter references presenting prioritization criteria/tool/methods applicable to transmissible and zoonotic diseases. A data standardised model was used to extract key information to characterise disease prioritization frameworks. One‐thousand one‐hundred and thirty‐eight studies were selected for inclusion in this review, which were reduced to 80 items once the inclusion and exclusion criteria had been applied, for which, statistics are presented. Most of these studies used one of six methodologies to prioritise disease risks: bibliometric index, the Delphi technique, multi‐criteria decision analysis (MCDA), qualitative algorithms, questionnaires, and multi‐dimensional matrix. Overall, the review of referenced papers indicated that, regardless of the selected method, (i) it is essential that when using experts the criteria reflects the aims of the risk‐ranking exercise, (ii) a large and multi‐disciplinary panel can further mitigate subjectivity and professional bias, (iii) all relevant stakeholders should be included in the process, (iv) weighing of criteria to rank pathogens should ideally be done at a separate time or by a separate group to reduce bias, and (v) it should be evaluated from the very beginning if the project team has the necessary expertise or if outsourcing is required for a given method. Indications are given for the methods to prioritise pathogens, remarking that, for a comprehensive risk ranking including novel, emerging and established infections, ECDC recommends MCDA or Delphi methods (which are here descriptively compared), which are comprehensive methods for risk ranking. We recommend a further detailed evaluation (as recommended by ECDC) of listed references based on their validity and reliability and including grey literature.