Public health is under pressure. In all health care systems around the world, funding is shrinking, exhausted professionals are leaving the field, and US state legislatures are rolling back the necessary authorities. At the same time, outbreaks of diseases such as measles and dengue are on the rise, making the work even more urgent. By 2025, these pressures will start a revolution in epidemiology, pushing the field to adopt new things to be more efficient and effective in managing outbreaks.
The Covid-19 pandemic has been incredibly challenging for public health workers, creating a historic pandemic response. The protracted crisis has left many vacancies for workers under great strain.
Unfortunately, this pandemic was not the first and will not be the last public health threat to overwhelm our defenses. Historically, major infectious disease threats have emerged about every two years on average. Even now, avian influenza A(H5N1) has been expanding its range and species for years. By one assessment, 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 vaccine platforms and home tests increase our arsenal against disease outbreaks, we cannot rely solely on these biomedical countermeasures.
The most important untapped source of innovation is in public health practice itself. The most promising development arising from these challenges is the adoption of high reliability principles as the new standard of operation. These principles are taken from industries that have zero tolerance for accidents and errors, such as space exploration and commercial aviation.
Public health, especially epidemiology, is beginning to move away from the observed methods of responding to outbreaks of processes towards more reliable industrial processes. A commitment to continuous improvement, data and metric-based performance monitoring, and the implementation of standard operating procedures are hallmarks of high reliability. These methods enable organizations to maintain safety and efficiency, even in the most complex and high-pressure times.
Although we are in the early days of this transition, the pressures of the past five years will accelerate the adoption of high reliability children in the coming year. Some early successes are already evident. For example, the CDC’s program for responding to foodborne illness outbreaks has taken a major step forward. They have leveraged whole-genome sequencing to identify the sources of outbreaks and develop a best practices model to support state and local officials in their investigations. This change has led to an increase in successful investigations, meaning that the sources of outbreaks are now more likely to be clearly identified. In contrast, before these changes, the origin of many disease outbreaks was not resolved.
Epidemiology is in crisis. Faced with dwindling resources, burnout, and increased disease outbreaks, the industry is being pushed to innovate. The adoption of more reliable principles, borrowed from industries where failure is not an option, appears as a promising solution. This change is already producing results, such as foodborne illness investigations. By adopting systematic and continuous processes and advanced technology, public health will improve its ability to identify and control disease outbreaks. This change promises a more efficient and effective way to protect public health in the face of emerging threats.