Strengthening India's pandemic preparedness with the four zonal institutes of virology: stakeholder consultations for outbreak response and collaborative research priorities

Abstract Background The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) scheme, supported by the World Bank, is establishing four zonal National Institutes of Virology (NIVs) in India. It is essential to identify the zonal disease and research priorities so as to focus research at zonal levels. This study reports a zonal viral disease prioritisation exercise to support outbreak response and collaborative research. It describes zonal-prioritised viral diseases, assesses concordance and differences in zonal priority lists and, and identifies cross‑cutting research themes and preparedness gaps using an multicriteria decision analysis (MCDA)‑based consensus process. Methods We conducted a cross-sectional, multi-stakeholder consultative study across four geographical zones of India in March 2024. The zonal-level consultative workshops employed a systematic consensus-building approach using the modified One Health Zoonotic Disease Prioritisation (OHZDP) tool, adapted for emerging viral diseases and applied via MCDA. We identified zonal-level stakeholders, listed 40 viral diseases and categorised them into three groups: common occurrence (Group A), limited occurrence (Group B), and rare occurrences with a chance of emergence, evolution or importation (Group C). The stakeholders from state health departments, medical colleges, research institutes and the Virus Research and Diagnostic Laboratory (VRDL) network ranked the viral diseases and research themes in each zone. Spearman rank correlation was used to assess concordance of priority rankings between zones. Results A total of 186 participants (42–48 per zone) contributed to the four zonal workshops including collaborators from VRDL laboratories (26%), public health stakeholders from Integrated Disease Surveillance programme(IDSP) (28%), invited experts (21%), organisers (19%) and Indian Council of Medical Research (ICMR) representatives (6%). The key outcomes included the zone-specific lists of priority viral diseases in Groups A, B and C. There were zonal variations in viral disease prioritisation, reflecting local epidemiological patterns. Spearman rank correlation analysis showed moderate positive correlation between the Central and East zones (rho = 0.697, P = 0.031), whereas other pairwise comparisons were not statistically significant, which indicated both shared and distinct priority patterns within the zones. The top five priority viral diseases across zones included dengue, influenza, measles, Japanese encephalitis and hepatitis A. The research themes and subthemes were then decided for collaborative research. Conclusions These multistakeholder consultations provided a novel, replicable template for prioritising viral diseases to develop strategies for mitigating the impact of future outbreaks through collaborative research. These zonal priorities may guide similar exercises at national, regional and global levels in future.