Public health is under pressure. In healthcare systems around the world, funding is declining, burned-out professionals are leaving the field, and in the US state legislatures They are withdrawing 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 job. By 2025, these pressures will initiate a transformation in epidemiology, pushing the field to adopt innovations to be more efficient and effective in controlling outbreaks.
The Covid-19 pandemic was extraordinarily challenging for public health staff, who mounted a historic pandemic response. The prolonged crisis revealed numerous gaps in a workforce under immense pressure.
Unfortunately, the pandemic was neither the first nor will it be the last threat to public health that overwhelmed our defenses. Historically, major infectious disease threats have emerged on average every two years. Even now, avian flu A(H5N1) has been expanding its geographic footprint and host species for years. According to some assessments, The world is now closer to a flu pandemic. than at any other time in recent history.
Faced with these pressures, public health has no choice but to adapt. Although new technologies such as mRNA vaccine platforms and at-home testing are expanding our arsenal against outbreaks, we cannot rely solely on these biomedical countermeasures.
The most important untapped source of innovation lies in the practice of public health itself. The most promising development emerging from these challenges is the adoption of higher reliability principles as a new operating standard. These principles are derived from industries with zero tolerance for accidents and errors, such as space exploration and commercial aviation.
Public health, specifically epidemiology, is beginning to reorient itself from tailored approaches to outbreak response toward structured processes characteristic of high-reliability industries. Commitment to continuous improvement, performance monitoring based on data and metrics, and implementation of standardized operating procedures are characteristics of high reliability. These practices enable organizations to maintain security and effectiveness, even in complex, high-risk environments.
Although we are in the early days of this transformation, the pressures of the last five years will accelerate the adoption of high reliability in the coming year. Some of the early successes are already evident. For example, the CDC program responsible for responding to Outbreaks of foodborne illnesses. has made significant progress. They have aggressively implemented whole genome sequencing to identify the sources of outbreaks and developed a variety of model best practices to support state and local officials in their investigations. This transformation has led to an increase in successful investigations, meaning that the sources of outbreaks are now more likely to be definitively identified. In contrast, before these changes, the origins of many outbreaks remained unresolved.
Epidemiology is at a critical moment. Faced with dwindling resources, staff burnout, and increasing disease outbreaks, the field is forced 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 paying off, as is research into foodborne illnesses. By adopting structured and continuously improving processes and cutting-edge technologies, public health will improve 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.