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Background The COVID-19 pandemic highlighted the critical importance of community engagement in managing disease outbreaks. In Ethiopia, efforts to control the pandemic were hampered by a limited understanding of the disease, especially in rural areas. While early studies provided some insights, there remains a significant gap in comprehensive data on community involvement throughout all phases of outbreak management. This study aimed to assess knowledge, attitudes, practices, and community participation in pandemic preparedness and response, emphasizing that informed and engaged communities are key to early detection, effective intervention, and overall outbreak control. Learning from the COVID-19 experience, it is essential to understand how communities can be better equipped to respond to future public health threats. Methods A cross-sectional study was carried out between October and December 2022 across eight rural districts in the Sidama region of Ethiopia. Using multistage sampling, a total of 593 community members were selected and interviewed with a semi-structured questionnaire. Data were entered into EpiData version 4.6 and analyzed in SPSS version 25 using descriptive statistics, bivariate analysis, and multivariable logistic regression to identify factors associated with knowledge, attitudes, practices (KAP), and community participation. Results The majority of participants, 76% (95% CI: 72.5–79.3), demonstrated sufficient knowledge about COVID-19 transmission and prevention, yet only 58% (95% CI: 54.0–61.9) showed positive attitudes, and 28% (95% CI: 24.5–31.7) reported practicing good preventive behaviors. Participation in emergency response activities, such as mask-wearing, handwashing, and symptom identification, was relatively low at 35% (95% CI: 31.2–39.0). Education level, marital status, and risk perception were significant predictors of KAP and participation levels. Individuals with primary (AOR = 5.06, 95% CI: 2.81–9.11) or secondary education (AOR = 4.84, 95% CI: 2.64–8.87) had greater odds of possessing adequate knowledge compared to those without education. Unmarried participants were less likely to exhibit positive attitudes (AOR = 0.58, 95% CI: 0.35–0.96), and perceiving low personal risk was associated with lower preventive practices (AOR = 0.32, 95% CI: 0.21–0.48) and participation in response activities (AOR = 0.19, 95% CI: 0.12–0.30). Conclusion While knowledge of COVID-19 was relatively high, attitudes were only moderate and preventive practices remained low. The finding that only 35% of the population actively participated in COVID-19 response efforts highlights a critical gap in community engagement during health crises. From an emergency management perspective, this calls for more effective strategies to translate awareness into proactive involvement. The Ministry of Health and WHO must focus on trust-building, communication, and empowering local leaders to mobilize communities. Tailored, community-driven models and culturally appropriate messaging are essential to ensure grassroots resilience and preparedness in future pandemics.

Emerging and re-emerging viruses continue to pose major threats to public health. Their ability to adapt, cross species barriers, and spread rapidly can trigger severe outbreaks or even pandemics. Strengthening preparedness with comprehensive and efficient strategies is therefore essential. Here, we explore the key components of viral outbreak preparedness, including surveillance systems, diagnostic capacity, prevention and control measures, non-pharmaceutical interventions, antiviral therapeutics, and research and development. We emphasize the increasing importance of genomic surveillance, wastewater-based surveillance, real-time data sharing, and the One Health approach to better anticipate zoonotic spillovers. Current challenges and future directions are also discussed. Effective preparedness requires transparent risk communication and equitable access to diagnostics, vaccines, and therapeutics. The COVID-19 pandemic highlighted both the promise of next-generation vaccine platforms and the necessity of maintaining diagnostic capacity, as early testing delays hindered containment efforts. Countries adopted various non-pharmaceutical interventions: risk communication and social distancing proved to be the most effective, while combined workplace infection-prevention measures outperformed single strategies. These experiences highlight the importance of early detection, rapid response, and multisectoral collaboration in mitigating the impact of viral outbreaks. By applying best practices and lessons learned from recent events, global health systems can strengthen resilience and improve readiness for future viral threats.

Monkeypox, now known as Mpox, has reemerged as a serious public health threat due to an increasing number of outbreaks outside its primary endemic regions. Although virologically similar to smallpox, smallpox therapy is not specifically approved for Mpox. The goal of this review is to assess the pharmacological progress and therapeutic efficacy of available and new therapies for Mpox. Structured literature review methodology was used based on peer-reviewed articles, clinical trials data and global health agency reports published from 2008 to 2025. Data was collected from ClinicalTrials.gov, Scopus and WHO databases with keywords on antiviral pharmacodynamics, resistance mechanism and clinical outcome. Prominent reviewed stewards include tecovirimat, brincidofovir, and cidofovir: drugs first developed for smallpox but repositioned for Mpox under expanded access programs. Tecovirimat seems most promising, however endangered by emerging resistance mutations. Innovative strategies, including mRNA vaccines, use of nanoparticles for drug delivery and host-directed treatments, are discussed that may improve treatment efficacy and preparedness for outbreaks. The results underscore that combination regimens will be required to counter resistance, there is a need for increased access in low- and middle-income countries, and global health cooperation should be bolstered. The review endorses increased clinical trial capacities, amended regulatory approaches development of new classes of therapeutics as part of global Mpox response efforts. By combining pharmacological breakthroughs with public health readiness, global health communities can be better equipped to respond to Mpox and other possible orthopox outbreaks of the future.

Background Despite considerable institutional experimentation at national and international levels in response to calls for global health security reform, there is little research on organisational models that address outbreak preparedness and response. Created in the aftermath of the 2013–16 West African Ebola epidemic, the United Kingdom’s Public Health Rapid Support Team (UK-PHRST) was designed to address critical gaps in outbreak response illuminated during the epidemic, while leveraging existing UK institutional strengths. The partnership between the government agency, Public Health England, and an academic consortium, led by the London School of Hygiene and Tropical Medicine, seeks to integrate outbreak response, operational research and capacity building. We explored the design, establishment and early experiences of the UK-PHRST as one of the first bodies of its kind globally, paying particular attention to governance decisions which enabled them to address their complex mission. Methods We conducted a qualitative case study using 19 in-depth interviews with individuals knowledgeable about the team’s design and implementation, review of organisational documents, and observations of meetings to analyse the UK-PHRST’s creation, establishment and initial 2 years of operations. Results According to key informants, adopting a triple mandate (response, research and capacity building) established the team as novel in the global epidemic response architecture. Key governance decisions recognised as vital to the model included: structuring the team as a government-academic collaboration which leveraged long-term and complementary UK investments in public health and the higher education sector; adopting a more complex, dual reporting and funding structure to maintain an ethos of institutional balance between lead organisations; supporting a multidisciplinary team of experts to respond early in outbreaks for optimal impact; prioritising and funding epidemic research to influence response policy and practice; and ensuring the team’s activities reinforced the existing global health architecture. Conclusion The UK-PHRST aims to enhance global outbreak response using an innovative and integrated model that capitalises on institutional strengths of the partnership. Insights suggest that despite adding complexity, integrating operational research through the government-academic collaboration contributed significant advantages. This promising model could be adopted and adapted by countries seeking to build similar outbreak response and research capacities.

Effective disease outbreak response has historically been a challenging accomplishment for the Nigerian health system due to an array of hurdles not unique to Nigeria but also found in other African nations which share its large size and complexity. However, the efficiency of the response mounted against the Ebola Virus Disease (EVD) outbreak of 2014 proved that indeed, though challenging, proactive and effective outbreak response is not impossible. With over 20 public health emergencies and infectious disease outbreaks between 2016 and 2018 alone, Nigeria is one of only five members of the World Health Organization (WHO) African Region to report five or more public health events per annum. There are many lessons that can be drawn from Nigeria's experience in handling outbreaks of infectious diseases. In this review, we discuss the history of emerging and re-emerging infectious disease outbreaks in Nigeria and explore the response strategies mounted towards each. We also highlight the significant successes and note-worthy limitations, which we have then utilized to proffer policy recommendations to strengthen the Nigerian public health emergency response systems.

Background and Aim Mathematical modelling plays an important role in public health by enabling the prediction of disease outbreaks, assessment of transmission dynamics and evaluation of intervention strategies. Although widely applied in high‐resource settings, its use in underserved contexts remains underexplored. This review aimed to examine and synthesize current evidence on the application of mathematical modelling for predicting and controlling infectious diseases in underserved settings. Methods A comprehensive and reproducible search was conducted using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and population, intervention, comparison and outcome (PICO) frameworks across databases, including PubMed, Scopus, Medline, ScienceDirect and EBSCOhost. Keywords and Medical Subject Headings (MeSH) terms related to mathematical modelling and infectious disease control were applied. Two reviewers independently screened titles, s and full texts, with a third resolving discrepancies. Thematic analysis and meta‐analysis were used for synthesis. Results Out of 838 studies screened, 27 (3.2%) met inclusion criteria. Deterministic models were most used, followed by stochastic and agent‐based models. Diseases modelled included COVID‐19, malaria, tuberculosis (TB), Ebola, Zika, chikungunya, dengue, diphtheria, respiratory infections, visceral leishmaniasis (VL) and Mpox. Modelling predicted the impact of interventions on transmission, with pooled effect size (Ro) of 1.32 (θ = 1.3, p < 0.0001). However, challenges, such as data underreporting, gaps and inconsistencies, were common, potentially affecting model accuracy and real‐world applicability. Conclusion Mathematical modelling has demonstrated value in supporting infectious disease control in underserved settings. However, the predominance of deterministic models limits adaptability across diverse contexts. Poor data quality further constrains reliability. Future work should focus on expanding modelling approaches, strengthening data infrastructure and addressing a broader range of diseases. These findings can guide public health policy by supporting data‐driven decision‐making, improving resource allocation and integrating modelling into outbreak preparedness and response strategies in underserved settings.

Background The level of preparedness of the health care workers, the health facility and the entire health system determines the magnitude of the impact of an Ebola Virus Disease (EVD) outbreak as demonstrated by the West African Ebola outbreak. The objective of the study was to assess preparedness of the health care facilities and identify appropriate preparedness measures for Ebola outbreak response in Kasese and Rubirizi districts in western Uganda. Methods A cross sectional descriptive study was conducted by interviewing 189 health care workers using a structured questionnaire and visits to 22 health facilities to determine the level of health care system preparedness to EVD outbreak. District level infrastructure capabilities, existence of health facility logistics and supplies, and health care workers’ knowledge of EVD was assessed. EVD Preparedness was assessed on infrastructure and logistical capabilities and the level of knowledge of an individual health work about the etiology, control and prevention of EVD. Results Twelve out of the 22 of the health facilities, especially health center III’s and IV’s, did not have a line budget to respond to EVD when there was a threat of EVD in a nearby country. The majority ( n  = 13) of the facilities did not have the following: case definition books, rapid response teams and/or committees, burial teams, and simulation drills. There were no personal protective equipment that could be used within 8 h in case of an EVD outbreak in fourteen of the 22 health facilities. All facilities did not have Viral Hemorrhagic Fever (VHF) incident management centers, isolation units, guidelines for burial, and one-meter distance between a health care worker and a patient during triage. Overall, 54% ( n  = 102) of health care workers (HCWs) did not know the incubation period of EVD. HCWs who had tertiary education (aOR = 5.79; CI = 1.79–18.70; p  = 0.003), and were Christian (aOR = 10.47; CI = 1.94–56.4; p  = 0.006) were more likely to know about the biology, incubation period, causes and prevention of EVD. Conclusions Feedback on the level of preparedness for the rural districts helps inform strategies for building capacity of these health centers in terms of infrastructure, logistics and improving knowledge of health care workers.

Background During the early stages of the COVID-19 pandemic, there was considerable uncertainty surrounding epidemiological and clinical aspects of SARS-CoV-2. Governments around the world, starting from varying levels of pandemic preparedness, needed to make decisions about how to respond to SARS-CoV-2 with only limited information about transmission rates, disease severity and the likely effectiveness of public health interventions. In the face of such uncertainties, formal approaches to quantifying the value of information can help decision makers to prioritise research efforts. Methods In this study we use Value of Information (VoI) analysis to quantify the likely benefit associated with reducing three key uncertainties present in the early stages of the COVID-19 pandemic: the basic reproduction number ( R 0 ), case severity ( CS ), and the relative infectiousness of children compared to adults ( CI ). The specific decision problem we consider is the optimal level of investment in intensive care unit (ICU) beds. Our analysis incorporates mathematical models of disease transmission and clinical pathways in order to estimate ICU demand and disease outcomes across a range of scenarios. Results We found that VoI analysis enabled us to estimate the relative benefit of resolving different uncertainties about epidemiological and clinical aspects of SARS-CoV-2. Given the initial beliefs of an expert, obtaining more information about case severity had the highest parameter value of information, followed by the basic reproduction number R 0 . Resolving uncertainty about the relative infectiousness of children did not affect the decision about the number of ICU beds to be purchased for any COVID-19 outbreak scenarios defined by these three parameters. Conclusion For the scenarios where the value of information was high enough to justify monitoring, if CS and R 0 are known, management actions will not change when we learn about child infectiousness. VoI is an important tool for understanding the importance of each disease factor during outbreak preparedness and can help to prioritise the allocation of resources for relevant information.

Filoviruses, including Ebola, Marburg, and Sudan viruses, cause severe hemorrhagic fevers with high mortality rates and outbreaks. While recent vaccine developments such as the rVSV-ZEBOV vaccine for Ebola have marked important progress and is now licensed by the FDA and the EMA, they remain virus-specific and limited in scope. The urgent need for a broad, cross-protective pan-filovirus vaccine is clear, especially considering recurring outbreaks and the potential for global spread. This paper reviews the current landscape of filovirus vaccine research, highlighting promising platforms, challenges in achieving cross-species protection, and lessons learned from past public health responses. It also emphasizes the scientific and logistical hurdles, such as antigenic diversity and the sporadic nature of outbreaks, which complicate vaccine development. Recommendations include sustained investment, collaborative research, and flexible trial designs. Ultimately, a pan-filovirus vaccine would be a vital tool in global health preparedness and reaching that goal will require long-term vision and commitment from the international community.

Respiratory failure due to SARS-CoV-2 has caused widespread mortality, creating an urgent need for effective treatments and a long-term need for antivirals for future emergent coronaviruses. Pharmacotherapy for respiratory viruses has largely been unsuccessful with the exception of early treatment of influenza viruses, which shortens symptom duration and prevents infection in close contacts. Under the rapidly evolving circumstances of the COVID-19 pandemic, most clinical trials of experimental treatments in the United States have focused on later stages of the disease process. Worldwide, the clinical studies of the most impactful drugs, remdesivir and dexamethasone in ACTT-1, RECOVERY, and Solidarity, have studied hospitalized patients. Less than half of clinical trials in the U.S. have investigated oral agents, and the majority have taken place in hospitals at a disease stage where the viral load is already decreasing. The limited success of treatments for respiratory viruses and the viral dynamics of COVID-19 suggest that an antiviral therapy with the greatest impact against pandemic coronaviruses would be orally administered, well-tolerated, target a highly conserved viral protein or host-coronavirus interaction and could be used effectively throughout the world, including resource-poor settings. We examine the treatment of respiratory viral infections and current clinical trials for COVID-19 to provide a framework for effective antiviral therapy and prevention of future emergent coronaviruses and call attention to the need for continued preclinical drug discovery.