**4. Discussion**

This is one of the first studies showing that SORT IT provides skillsets and core competencies that can be used transversally in building health system resilience at the time of a pandemic. Encouragingly, about seven in every ten individuals involved with COVID-19 reported applying their SORT IT acquired skills in 60 countries, including both LMICs and HICs.

These findings show that SORT IT has equipped front-line health workers not only with research skills, but also with a skill-set needed to respond to the unprecedented COVID-19 pandemic [7]. This proves the down-stream benefits of investing in operational research capacity building. The wide geographic coverage with no dichotomy between LMICS and HICs shows that such skills are universally applicable and likely to enhance global solidarity in tackling future outbreaks and pandemics.

There might have been a perception by some donors that investing in research capacity building is a luxury that is divorced from public health action. Much funding for research training also lies with academic institutions and is not accessible to implementers from disease control programmes [3,8,9]. It is time for a *volte-face.*

The strengths of this study are that SORT IT alumni in 93 countries were contacted and specific efforts were made to validate invalid e-mails, thereby limiting non-responders. As the SORT IT programme has a robust built-in monitoring and evaluation system, we were able to make use of this existing system to gather both quantitative and qualitative information. Study limitations include a response rate of 73%, which under the circumstances is still acceptable to good, the self-reported nature of the response, the potential social desirability bias and, considering the continued expansion of the COVID-19 pandemic, possible underestimation in our figures.

There are a few other salient observations. First, skills are being applied beyond research to all the vital pillars of the outbreak response. While SORT IT teaches multiple and practical skills for activities such as generating and utilizing data, conducting operational research and using evidence to influence policy and/or practice, several transversal skills are acquired at the same time [1]. For example, skills are developed in fostering stakeholder engagement, performing situation analysis in programme settings, prioritizing health issues, ensuring quality-assured data capture and analysis, critically reviewing the scientific literature, scientific writing to the standards of a medical journal and managing knowledge. It is therefore not surprising that those who were trained through the SORT IT programme acquired a "tool-kit" of skills that can then be applied to several areas of the outbreak response.

Second, the three areas where acquired skills were particularly used were data generation, situation analysis and setting up surveillance systems. The generation of high quality, timely and disaggregated data is essential for ensuring that countries tackling COVID-19 become "data rich, information rich and action rich"—a fundamental goal of the SORT IT programme [2]. Conducting a sound situation analysis and setting up robust surveillance systems are crucial in any outbreak: these help to feel and monitor the pulse of an outbreak and prevent responders from thinking and acting blindly.

Third, with the lock-down and restricted movements imposed by COVID-19, individuals with chronic diseases such as tuberculosis, HIV/AIDS and non-communicable diseases will understandably face hurdles in accessing diagnostic and treatment facilities and adhering to follow-up schedules [10]. It is encouraging that SORT IT alumni were using their skills in o ffsetting these negative health system e ffects.

Finally, following the 2014/2015 Ebola outbreak, WHO spearheaded global efforts to avert epidemics by making Research and Development (R&D) "outbreak-ready" [7]. While this will accelerate R&D on vaccines, drugs, and diagnostics, finding out "how to deliver" these innovations in an equitable manner is imperative [8]. SORT IT could play an important role in such operational research.

In conclusion, the results of this study demonstrate the value of investing in people and in research training ahead of public health emergencies. Clearly, building upstream operational research capacity has generated downstream dividends in strengthening health system resilience for tackling pandemics. In addition, it strengthens human resources for health (HRH) and the integration of research within health systems. In summary, it allows the health system to have the right people in the right place at the right time.

**Author Contributions:** All authors were involved with the conception and design, R.Z., S.D.B., P.T., M.K. were involved with data collection, analysis and interpretation while K.D., A.M.V.K., S.S., F.M., G.A., A.A., A.D.H. and J.C.R. were involved with interpretation. R.Z. wrote the first draft of the manuscript, which was revised by all and all authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no specific external funding.

**Acknowledgments:** TDR and partners can conduct their work thanks to the commitment and support from a variety of funders. These include our long-term core contributors from national governments and international institutions, as well as designated funding for specific projects within our current priorities. A full list of TDR donors is available on our website at: https://www.who.int/tdr/about/funding/en/. We are grateful to all these donors and particularly those who have supported research training activities, which allow health workers to save lives on the frontlines of the COVID-19 public health emergency. We are also grateful to all the SORT IT alumni who have responded to this survey despite their tight schedules and for their invaluable work in tackling COVID-19.

**Conflicts of Interest:** We have no conflict of interest to declare.

**Data Availability Statement:** De-identified study data are available on reasonable request from the corresponding author (zachariahr@who.int). A justification for its further use should be provided.
