There is still time to anticipate the next global pandemic

Public health is under pressure. Across health care systems worldwide, funding is declining, exhausted professionals are leaving the field, and in the US state legislatures withdraw the necessary legal authorities. At the same time, outbreaks of diseases such as measles and dengue are increasing, adding more urgency and responsibility to the work. In 2025, these pressures will initiate a transformation in epidemiology, pushing the field to adopt innovations to become more efficient and effective in controlling outbreaks.

The Covid-19 pandemic it was extraordinarily challenging for the public health workforce, which mounted a historic pandemic response. The long-running crisis has revealed numerous gaps in a workforce under immense strain.

Unfortunately, the pandemic was neither the first nor will it be the last public health threat to overcome our defenses. Historically, major infectious disease threats have emerged approximately every two years on average. Even now, avian influenza A (H5N1) has been expanding its geographic footprint and host species for years. From some assessments, the world is now closer to a flu pandemic than at any time in recent memory.

With these pressures, public health has no choice but to adapt. Although new technologies such as mRNA vaccination platforms and at-home tests expand our arsenal against outbreaks, we cannot rely solely on these biomedical countermeasures.

The most significant source of untapped innovation is found in public health practice itself. The most promising development emerging from these challenges is the adoption of higher reliability principles as a new operational standard. These principles are derived from industries with zero tolerance for accidents and errors, such as space exploration and commercial aviation.

Public health, especially epidemiology, is beginning to reorient from personalized approaches to epidemic response toward the structured processes characteristic of high-reliability industries. A commitment to continuous improvement, data-based monitoring and performance metrics, and the implementation of standardized operating procedures are hallmarks of high reliability. These practices allow organizations to maintain security and effectiveness, even in complex and high-altitude environments.

Although we are in the early stages of this transformation, the pressures of the last five years will accelerate the adoption of high reliability in the coming year. Some early successes are already evident. For example, the program in CDC responsible for responding foodborne disease outbreaks has made significant strides. They have aggressively implemented whole genome sequencing to identify the sources of outbreaks and developed a range of best practice models to support state and local officials in their investigations. This transformation has led to an increase in successful investigations, which means that fire sources are now more likely to be definitively identified. In contrast, before these changes, the origins of many fires have not been resolved.

Epidemiology is at a critical point. Faced with a decrease in resources, staff burnout and an increase in disease outbreaks, the field is driven to innovate. The adoption of high reliability principles, borrowed from industries where failure is not an option, is emerging as a promising solution. This change is already showing results, as with the investigation of food diseases. By embracing structured processes and continuous improvement and cutting-edge technology, public health will increase its ability to identify and control disease outbreaks. This transformation promises a more efficient and effective approach to safeguarding public health in the face of evolving threats.