BackgroundPandemic mortality rates in 1918 and in 2009 were highest among those with the lowest socioeconomic status (SES). Despite this, low SES groups are not included in the list of groups prioritized for pandemic vaccination, and the ambition to reduce social inequality in health does not feature in international and national pandemic preparedness plans. We describe plans for a systematic review and meta-analysis of the association between SES and pandemic outcomes during the last five pandemics.MethodThe planned review will cover studies of pandemic influenza that report associations between morbidity, hospitalization, or mortality with socioeconomic factors such as education and income. The review will include published studies in the English, Danish, Norwegian, and Swedish languages, regardless of geographical location. Relevant records were identified through systematic literature searches in MEDLINE, Embase, Cinahl, SocIndex, Scopus, and Web of Science. Reference lists of relevant known studies will be screened and experts in the field consulted in order to identify other additional sources. Two investigators will independently screen and select studies, and discrepancies will be resolved through discussion until consensus is reached. Covidence will be used. Results will be summarized narratively and using three meta-analytic strategies: coefficients expressing the difference between the highest and lowest socioeconomic groups reported will be pooled using (a) fixed and random effects meta-analysis where studies involve similar outcome and exposure measures and (b) meta-regression where studies involve similar outcome measures. In addition, we will attempt to use all reported estimates for SES differences in (c) a Bayesian meta-analysis to estimate the underlying SES gradient and how it differs by outcome and exposure measure.DiscussionThis study will provide the first systematic review of research on the relation between SES and pandemic outcomes. The findings will be relevant for health policy in helping to assess whether people of low socioeconomic status should be prioritized for vaccines in preparedness plans for pandemic influenza. The review will also contribute to the research literature by providing pooled estimates of effect sizes as inputs into power calculations of future studies.Systematic review registration PROSPERO 87922

Background The objective of this study is to document whether and to what extent there is an association between socioeconomic status (SES) and disease outcomes in the last five influenza pandemics. Methods/principle findings The review included studies published in English, Danish, Norwegian and Swedish. Records were identified through systematic literature searches in six databases. We summarized results narratively and through meta-analytic strategies. Only studies for the 1918 and 2009 pandemics were identified. Of 14 studies on the 2009 pandemic including data on both medical and social risk factors, after controlling for medical risk factors 8 demonstrated independent impact of SES. In the random effect analysis of 46 estimates from 35 studies we found a pooled mean odds ratio of 1.4 (95% CI: 1.2–1.7, p < 0.001), comparing the lowest to the highest SES, but with substantial effect heterogeneity across studies,–reflecting differences in outcome measures and definitions of case and control samples. Analyses by pandemic period (1918 or 2009) and by level of SES measure (individual or ecological) indicated no differences along these dimensions. Studies using healthy controls tended to document that low SES was associated with worse influenza outcome, and studies using infected controls find low SES associated with more severe outcomes. A few studies compared severe outcomes (ICU or death) to hospital admissions but these did not find significant SES associations in any direction. Studies with more unusual comparisons (e.g., pandemic vs seasonal influenza, seasonal influenza vs other patient groups) reported no or negative non-significant associations. Conclusions/significance We found that SES was significantly associated with pandemic influenza outcomes with people of lower SES having the highest disease burden in both 1918 and 2009. To prepare for future pandemics, we must consider social vulnerability. The protocol for this study has been registered in PROSPERO (ref. no 87922) and has been published Mamelund et al. (2019).

This special section addresses Responsible Research and Innovation (RRI) as an increasingly global concept that is translated and transformed in heterogenous national contexts. Based on seven national perspective articles from the RRI-Practice project, this introduction outlines a framework of transduction through which RRI becomes contextually negotiated and reconfigured. Read together, the national explorations of the special section make visible aspects of responsibility not readily apparent in abstract, European or global scale discussions of RRI. They not only point up important particularities of national contexts, but unexpected points of overlap in national contexts not often thought to have distinct commonalities.

Responsible research and innovation (RRI) has emerged in recent years, especially in Europe, as a science policy framework that (a) seeks to align technological innovation with broader social values and (b) supports institutional decisions concerning the goals and trajectories of research and innovation under conditions of uncertainty, ambiguity and ignorance. Rather than relying simply on consumer choice and market mechanisms on the one hand, or risk-based regulation on the other, RRI seeks to determine what constitute the goals, purposes and trajectories of (and alternatives to) technoscience and innovation, and thus the directions towards which these should be oriented, suggesting that these should be underpinned by shared public values. In addition to this overall philosophy of RRI, the European Commission has focused on five constituent policy keys (sometimes called pillars) of RRI that have their historical roots in the Science-in-Society programme; namely societal engagement, gender in research, open access, science education, and ethics. Action on these keys is seen as integral to an RRI approach and to Europe's ability to respond to societal challenges. A further issue in the European context concerns how to 'federate' the RRI community in the EU and promote institutional changes to foster RRI in research The original version of this chapter was revised: For detailed information please see Erratum.

Responsible research and innovation (RRI) has come to represent a change in the relationship between science, technology and society. With origins in the democratisation of science, and the inclusion of ethical and societal aspects in research and development activities, RRI offers a means of integrating society and the research and innovation communities. In this article, we frame RRI activities through the lens of layers of science and technology governance as a means of characterising the context in which the RRI activity is positioned and the goal of those actors promoting the RRI activities in shaping overall governance patterns. RRI began to emerge during a time of considerable deliberation about the societal and governance challenges around nanotechnology, in which stakeholders were looking for new ways of integrating notions of responsibility in nanotechnology research and development. For this reason, this article focuses on nanotechnology as the site for exploring the evolution and growth of RRI.