To our knowledge, this national study is the first to define youth-developed recommendations on planning for future pandemics and public health emergencies in Canada. Youth achieved consensus on eleven recommendations in support of preparedness for the next pandemic or public health emergency. These recommendations focused on the provision of easily accessible, clear, and understandable information about pandemics; the efficient and equitable distribution of vaccines; awareness of accessible MHSU services in schools, workplaces and communities; investment in free or inexpensive MHSU services; pandemic-related policy decisions led by health professionals and scientists; clear pandemic policies available to the public; evidence-informed pandemic preparedness; implementation of financial aid programs; the provision of in-person and virtual MHSU service options to youth, families, and the community; prioritization of the health, safety, and wellbeing of students and workplaces; and the provision of paid sick- and mental health- days.
The recommendations generated in this study align with previously published pandemic preparedness responses. For example, the American College of Physicians(15) support similar recommendations, including an evidence-based comprehensive pandemic preparedness plan; clear communication on pandemic-related information; the promotion of physical and mental wellbeing among populations; universal access to paid sick leave and time off; and the efficient and equitable distribution of vaccines. Similar recommendations were drafted for the Quebec government to inform planning of the next pandemic (46). These recommendations included improving communication between the public and the government; strengthening the role of knowledge-based agencies in making decisions; supporting digital health strategies and telehealth; and establishing reliable health information systems that can be shared with the public.
Results of this study indicate that youth recommend clear and accessible information about the pandemic. In order to follow through on this recommendation, Canada needs to strengthen its public health system and handling of misinformation (47),(48). Indeed, one of the most pressing public health challenges experienced over the pandemic period was the extensive amount of misinformation circulated online about the pandemic, public health measures and policies (17, 49, 50, 51). This misinformation was particularly acute for youth (52, 53, 54), who may not have had the capacity to discern and filter reliable and accurate information from misinformation (51, 55). For example, a systematic review and secondary data analysis reported that the frequency and consumption of COVID-19 related news was adversely associated with youth mental health concerns (51, 53). To counter the spread of misinformation, clear, accurate, and transparent information about public health policies and measures must be shared and widely accessible. This information needs be delivered early on through communication methods tailored to youth and involve diverse youth in the co-design of messaging. A recent systematic review on communication interventions to combat COVID-19 vaccine misinformation (56) reported that the most effective strategies included adding misinformation warnings; using humour to convey messages; and highlighting that the evidence was generated through scientific consensus. In addition, a systematic review highlighted that information be developed by reliable and credible sources and tailored to different communities’ lived experiences, needs, and concerns (17, 49, 50).
Youth recommend that health professionals and scientists inform and lead pandemic and public health emergency related decisions. While all youth in this study agreed that science plays a critical role in public health preparedness, a qualitative study of COVID-19 policy advisors reported the challenges that scientific advisors experienced over the COVID-19 period.(57) These challenges included the inability to stay up-to-date on the evidence given the overwhelming, rapid generation of evolving and sometimes conflicting evidence; scientific uncertainty about different pandemic-related scenarios; the misinterpretation and misapplication of evidence; concerns about research integrity; and the lack of clarity on the integration of multi-sectoral evidence. At the same time, scientific advisors reported that they experienced a lack of transparency with governmental decision-makers on how pandemic-related decisions were made (57). Further, a qualitative study and repeated-measures cohort study reported that scientific and technical jargon can be alienating for the public, pointing to a need for better knowledge translation.(58, 59)
To overcome these challenges youth also recommended that scientists and health professionals lead pandemic-related decisions. This recommendation could be achieved by establishing a diverse, multidisciplinary, and integrated group of scientific experts, in collaboration with a youth advisory group. To inform and support these decisions, establishing and promoting tools based on open science principles and responsible data sharing, guided by Ownership, Control, Access and Possession (OCAP®) principles(60) and Engagement Governance, Access and Protection (EGAP) framework(61) is critical. Further, there is a need to establish a rigorous review system that ensures rapid access to clear and reliable evidence, as well as decision-support frameworks to support scientific integrity and transparency to communities (57).
A recommendation endorsed among subgroups of youth (e.g., Nonbinary and gender diverse, White, straight, and 14–16 years) identified a need for financial aid programs; specifically, the implementation of accessible financial aid programs in the context of public health emergencies and future pandemics. The COVID-19 pandemic period was associated with far-reaching negative economic consequences, including recession, unemployment, business closures, and followed by inflation and rising prices for consumers (62, 63, 64). Two previous reviews(64, 65) suggested that focusing on social protection measures, including promoting social welfare, targeted measures for vulnerable populations, and establishing a minimum standard of living (e.g., food, shelter, clothing, finances) could help buffer the shock of the next pandemic or public health emergency.
We would like to acknowledge some of the strengths and limitations of this study. Strengths include the authentic engagement of youth; recommendations that reflect youth’s lived experiences and needs; robust participation rates in each round; and recommendations that can inform public health planning for future pandemics and public health emergencies. Limitations are as follows: Fifty percent of the study sample identified as a girl/woman. The recommendations generated may not be representative of the perspectives of boys/men and nonbinary or gender diverse youth. Participants resided mainly in Central Canada (Ontario and Quebec) and may not represent youth perspectives from other provinces and territories. It is important to obtain these perspectives. Further, the Canadian health system is decentralized at the provincial/territorial level, therefore, implementation of these recommendations will vary by province and territory.
Recognizing that these recommendations reflect youth needs and priorities for the next pandemic or public health emergency, future work is needed to support the translation of these recommendations into policy action. The Youth Expert Advisory Committee in this study recommended that youth collaborate with scientists and health professionals to support decision-making. As part of a knowledge dissemination strategy, a prior literature review has highlighted the important role of training researchers about engaging policy-makers, learning about the policy-making process and how to convey evidence to policy-makers(66). Other strategies include the identification of knowledge brokers, or an individual who moves the knowledge from knowledge creators (e.g., youth and the research team) to knowledge users (e.g., policy- and decision-makers)(67, 68, 69, 70, 71); face-to-face contact; and communication through various media platforms(71).