Preparedness in practice: An outbreak science approach to studying public health emergency response

Outbreak response, as a technical and specialized field of practice, is struggling to keep pace with the evolving dynamics of modern public health emergencies. Extensive scholarship across disciplines and epidemics has highlighted the importance of early action, the costs associated with delayed mobilization, the necessity of effective preparedness plans for complex crises, and the growing need for response to operate in spite of both uncertain information and social disruptions. Here, we present and analyze a new dataset of 235 different multisectoral activities that comprise outbreak preparedness and response. We explore the conditions under which these activities are applicable, including different phases of response, different operating circumstances, and different disease etiologies, and find that the core activities required for outbreak response largely apply across etiology and scale, but are more substantial during the early phases of response. To validate this framework with real-world examples, we then examine 279 reports from the WHO Disease Outbreak News (DON), a narrative record of outbreak history through time, and examine which of our activities are reported or implied in these narratives. We find that the core components of response are applicable across the vast majority of biological events, especially as they relate to basic epidemiology, infection prevention, and governance, and that many different kinds of real-world outbreaks require the same core set of responses. These findings point to a nearly-universal set of outbreak response activities that could be directly incorporated into national and international response plans, significantly reducing the risk and impact of infectious disease outbreaks.