Qualitative analysis of outbreak management by national public health institutes across the WHO Eastern Mediterranean Region

Abstract

Background: National public health institutes are science-driven agencies that lead surveillance, laboratory services, risk assessment, and emergency preparedness and response at country level. It is therefore essential to understand their role in the management of disease outbreaks. Aim: To examine the role of national public health institutes in disease outbreak management in the Eastern Mediterranean Region by comparing the detection, reporting and response across countries that had and did not have a national public health institute, and across crisis- and non-crisis-affected contexts. Methods: Using the framework method, we reviewed and analysed publicly available data reported during 2023–2024, in accordance with the standards for reporting qualitative research, describing disease outbreak detection, reporting and response in the Eastern Mediterranean Region, including the role of national public health institutes and other national institutions. Results: Outbreak surveillance and response were nationally led and structurally integrated in non-crisis countries/ territories that had a national public health institute, while in countries/territories that did not have a national public health institute they were led by the Ministry of Health through the central laboratories. In crisis-affected settings, regardless of whether they had a national public health institute or not, response was surge-oriented and carried out by multiple actors. National public health institute contribution was constrained by infrastructure destruction, insecurity and reliance on external support. Countries/territories with stronger national public health institutes documented outbreak events, while outbreaks were underreported in disrupted settings. Conclusion: National public health institutes were associated with stronger institutional capacities for outbreak detection, coordination and verification. Strengthening EMR epidemic preparedness requires investments in NPHIs, workforce and laboratory capacity, alongside the enabling conditions such as water sanitation and health, supply chain continuity and partner coordination to enable them to continue to deliver services during shocks.