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Table 3 Core set of recommendations (149 recommendations)

From: Towards defining core principles of public health emergency preparedness: scoping review and Delphi consultation among European Union country experts

Governance

1. Emergency preparedness should be integrated in national health strategies, financing and plansd.

2. Multi-sectoral emergency risk management policies and legislation include public health treatsd

3. A national Public Health Emergency Preparedness Plan should be developed, kept updated or endorsed by e.g. National Competent Body.a

4. The national Public Health Emergency Preparedness Plan should be implemented.

5. Preparedness planning should include a self-assessment, involving identification of gaps and possible solutions, human resources capacity, relevant national stakeholders.

6. This self-assessment should be integrated into the existing strategic, planning and financial mechanism.

7. Preparedness planning should include assessing and strengthening existing capacities (structures/services, staff equipment, written plans for preparedness, standard operating procedures).

8. Preparedness planning should include development of appropriate national stockpiles.

9. Preparedness planning should include identification of suppliers for medical countermeasures, including delivery capacity and time.

10. Preparedness planning should include the capacity to support operations at the intermediate and community/primary response levels during a public health emergency.

11. Preparedness planning should include community preparedness to prepare for, resist, and recover from public health incidents.

12. Preparedness should include: the capacity to prevent, detect and manage outbreaks, during large sudden influxes of migrants.

13. Preparedness plans should be flexible and easy adaptable.

14. Preparedness planning should ensure cross-sectorial collaboration and clearly defined roles and responsibilities for all stakeholders.

15. Whole-of-government (i.e. formal and informal networks) biosafety and biosecurity system should be in place for human, animal, and agriculture facilities.

16. Multi-sectorial and multi-stakeholder coordination, command and control should be based on established infrastructure and should be continually strengthened during the planning process.

17. Priority public health risks and resources should be mapped and utilized.

18. Countries should have public health, medical, and mental/behavioural health systems that support recovery.

19. Preparedness plans for events of biological hazards should be in place jointly developed by the public health and non-health sectors such as civil protection, border control and customs.

20. A specific national framework should be in place for priority threats (such as pandemic Influenza) across all sectors.

21. Regarding pandemic preparedness, strong cross-government planning and coordination remains critical and should be led by the Department of Health.

22. The pandemic plans should be consistent with international (e.g. WHO and EU) available guidance.

23. Safety measures for the handling of pathogenic substances should be in place and known by health care workers.

24. Infection prevention and control standards should be established and functioning at national and hospital levels.

25. Antimicrobial stewardship (set of coordinated strategies to improve the use of antimicrobial medications) should be implemented.

26. Laboratory services should be available to test for priority health threats.

27. Laboratory biosafety and laboratory biosecurity (Biorisk management) practices should be in place and implemented.

28. Preparedness should involve national, regional and global networks.

29. Collaboration between countries should be in place to maintain high levels of preparedness.

30. The preparedness and response system for public health emergencies (including communicable diseases) should meet EU best practices.

31. National IHR Focal Points functions and operations should be in place as defined by the IHR (2005).

32. IHR obligations regarding Points of Entry should be fulfilled.

33. Preparedness should be independently evaluated, facilitated by the WHO.

34. Preparedness plans should include a capacity building strategy.

35. Availability of a competent public health workforce for a continuum of health services should be ensured.

36. Human resources should be available to implement IHR core capacity requirements.

37. For respondents that are assisting in a public health emergency abroad, a protocol should be in place for medical evacuation.a

38. Public Health authorities (i.e. decision-makers) should establish communication policies and procedures to develop, coordinate, and disseminate information related to an event of public health concern.

39. The communication strategy should ensure timely and effective communication before and during an event.

40. The communication strategy should include a scale-up approach.

41. Emergency communication plans should remain flexible and updated as needed.

42. Emergency communication plans should be pragmatic and straightforward to implement.

43. Emergency communications plans should be tested.

44. Emergency communication plans should cover the possibility that certain events receive increased media attention.

45. Emergency communication plans should cover the possibility that certain events lead to a higher demand from the public for information.

46. Information related to an event should be disseminated to the public, in order to explain the outbreak, to establish confidence and to minimize the risk of infection.

47. Communication to the public should be harmonized with other national and international organizations.

48. Public Health authorities should create key messages for public communication.

49. Information to the public should be meaningful, relevant and timely.

50. Information to the public should be open and transparent.

51. Information to the public should take into account risk perceptions of the public.a

52. Communication to the public should take into account characteristics of the population such as language, social, religious, cultural, political and/or economic aspects.

53. Public Health authorities should set up multiple risk communication channels (e.g. website, E-mail, subject-specific telephone lines).

54. Public Health authorities should provide timely information and guidance about an event to health and other professionals, so they can appropriately respond to the public.

55. Public Health authorities should prepare ad hoc information material for different stakeholders (e.g. simplified case definitions for community use).

56. Public Health institutions should address ethical issues and specific needs of vulnerable populations (e.g. children, pregnant women, elderly people, malnourished people, people who are ill or immunocompromised, and migrants and refugees) in their preparedness plan.a

57. Public Health organizations should counter misinformation and prevent stigma, even among educated hospital staff.

Capacity building & maintenance (Education, training & simulation exercise)

1. Skills and competences of public health personnel should be strengthened to sustain public health surveillance and response at all levels of the health system.

2. Education, training and exercises should be part of an organization’s preparedness planning activities.

3. Education, training and exercises should be supported at the strategic and operational level of an organization.

4. Public Health authorities should assess the level of preparedness through simulation exercises.

5. Relevant partner organizations should be involved in exercises to improve understanding of each other’s response plans.

6. Simulation exercises should be performed to test procedures for the management of an event (e.g. key roles and decision-making).

7. Exercises should be based on a scenario and tailored to the setting (e.g. local, regional, national, and international).

8. In order to carry out a successful simulation exercise, the planning group should be granted a clear mandate and the authority to plan, conduct and evaluate the exercise.

9. The purpose of a simulation exercise should be to identify areas for improvement.

10. Initial aims and objectives of education, training, and exercises should be evaluated and lessons learned documented in a report.

11. Public Health authorities should conduct exercises to test the actual functionality of IHR core capacities.a

Surveillance

1. Public Health authorities should have an indicator-based surveillance system in place (e.g. syndromic surveillance or mortality surveillance).

2. These indicators should be defined in protocols to enable timely follow-up.

3. Public Health authorities should have an event-based surveillance system in place (e.g. media surveillance).

4. These events should be defined in protocols, to enable timely follow-up.

5. Public Health authorities should participate in EU surveillance networks.

6. The surveillance system should meet EU & WHO standards with regard to epidemiological data on all diseases under EU surveillance, their case definitions, and reporting protocols.

7. The surveillance system should provide real-time reporting of surveillance data

8. The surveillance system should generate an early warning signal of a possible event of public health concern.

9. The surveillance system should be sensitive and flexible, to detect initial cases or events.

10. The surveillance system should obtain information from a broad range of different and reliable resources.a

11. The surveillance system should be able to provide the information necessary to inform and advice response.

12. The surveillance network should include information from veterinary surveillance systems.

13. The surveillance network should include information from entomological surveillance systems.

14. The surveillance network should include information from environmental surveillance systems.

15. The surveillance network should include information from meteorological surveillance systems.

16. The surveillance network should include information from microbiological surveillance systems.

17. All relevant surveillance systems should be integrated in a network that consistently exchanges information.

18. Surveillance data should be systematically and regularly reported to the relevant sectors and stakeholders.

19. Public Health authorities should have reporting networks and protocols in place.

Risk assessment

1. Alerts and early warnings should be assessed based on a joint analysis of the surveillance data.

2. A risk assessment team should be assembled to assess the risks of a (possible) event of Public Health concern.

3. The risk assessment team should include additional expertise (e.g. toxicology, animal health, food safety, etc.).

4. Risk assessment should be used to aid preparedness planning of response activities.

5. Clearly defined questions should be used as part of the risk assessment to help identify priority activities.

6. Risk assessment should be used to identify risk areas.

7. Risk assessment should be used to identify risk populations.

8. Risk assessment should be used to identify and engage operational partners.

9. Risk assessment should be used to identify and engage key policy partners.

10. The level of risk assigned to an event should be based on the suspected (or known) hazard.

11. The level of risk assigned to an event should be based on the possible exposure to the hazard.

12. The level of risk assigned to an event should be based on the context in which the event is occurring.

13. The level of risk assigned should be based on the disease characteristics (such as number of cases/deaths, proportion of severe disease in population, clinical groups most affected, etc.).

14. The level of risk assigned should be based on the service capacity (e.g. number of patience presented at primary care services/admitted to hospital and intensive care specialist treatment).

15. Risk characterization should incorporate information from quantitative model, if available and accessible, and on the expert opinion.

16. Based on the disease characteristics, the risk assessment team should decide how frequently the risk assessment should be updated.

Risk and crisis management

1. Specific procedures should be in place for activation and deactivation (‘stand-down’) of the health emergency response.d

2. An emergency operational program should be in place involving an Emergency Operations Centre, Operating Procedures and Plans, and the capacity to activate emergency operations.

3. Countries should have a tested command and control structure with clear roles and responsibilities.

4. Procedures for coordination of multi-sectorial activities between the ministries and sectors should be established.

5. Coordination, command and control should be based on established infrastructure.

6. Coordination, command and control should be continually strengthened.

7. Procedures to coordinate all relevant partners of the health system should be established e.g. public health, medical, and mental/behavioural health services.

8. Coordination should involve population-based care, resource mobilization, activation of support networks, advisory groups, partner networks and communication.

9. Multidisciplinary and multisectorial Rapid Response Teams (RRT) should be established and available 24 h a day, 7 days a week.

10. Public health system should be supported by crisis management teams on all levels.

11. Case management procedures are implemented for IHR relevant hazards.

12. Response decisions should take into account the following principles: precaution, proportionality and flexibility.

13. Procedures for medical countermeasures, including implementation and dispensing, should be in place.

14. Procedures should be in place for sending and receiving medical countermeasures during a public health emergency.

15. Procedures for responding to foodborne disease and food contamination should be established and functional.

16. Procedures for responding to zoonosis and potential zoonosis should be established and functional.

17. In areas receptive for arbovirus transmission, standard operation procedures for field investigations and rapid vector control measures should be developed.

18. Effective Public Health Response at Points of Entry, according to IHR, should be established.

19. Public Health authorities should reinforce health monitoring systems.

20. During the event, Public Health authorities should frequently evaluate health monitoring data related to the event.

21. Health monitoring systems should monitor the evolving event (e.g. geographical and/or temporal distribution).

22. Health monitoring systems should monitor the functioning of essential services.

23. Health monitoring systems should be linked to laboratories and health facilities.

24. Based on the gathered data, the effectiveness of response activities should be frequently evaluated.

25. Response activities should constantly be adapted to the new situation.

26. Information of the evolving event should be communicated to the relevant stakeholders and the public.

27. Public Health authorities should identify, map and monitor critical communication networks.

28. Public Health authorities should develop a comprehensive communication strategy to engage with all relevant stakeholders such as public health professionals, media and public, non-health sectors, etc.

29. Chains of responsibility should be clearly identified to ensure effective communications within the national and international level.

30. All relevant stakeholders should be engaged and well informed in advance, throughout and after an event.

31. During an event, core messages given out by the different authorities need to be coordinated and standardized.

32. During an event, consistent messages should be disseminated by a trusted authority.

33. Information related to an event should be disseminated between all relevant stakeholders within the health sector.

34. Information related to an event should be disseminated between all relevant stakeholders within non-health sectors.

35. The expected behavioural response (e.g. levels of concern experienced by the population) should be taken into account in the decision process of the risk management. c

Post-event evaluation

1. Public Health authorities should assess the level of preparedness by evaluating events of public health concern.

2. Post-event evaluations should be part of an organization’s preparedness planning activities.

3. The post-event evaluation should be conducted as soon as possible after the event.

4. The post-event evaluation should be of qualitative nature.

5. Post-event evaluations should consist of an internal audit, involving all national stakeholders responsible for essential public health functions.

6. Lessons learned from all relevant sectors should be systematically recorded in a post-event report.

Implementation of lessons learned

1. Experiences and lessons learned, coming forth from post-event evaluation or exercises, should be reviewed across all relevant sectors.

2. Experiences and lessons learned, coming forth from post-event evaluation or exercises, should be shared with the international community.

3. Experiences and lessons learned, coming forth from post-event evaluation or exercises, should be used to improve preparedness and response activities.

4. Experiences and lessons learned, coming forth from post-event evaluation or exercises, should be used to improve policies and practice.

5. Nations are encouraged to write executive summary of evaluation report in English.b

  1. aThe recommendation was textually adjusted by the experts
  2. bAdded by the experts
  3. cMoved from other domain
  4. dThe recommendation was added by the researchers