Downloaded from http://journals.lww.com/co-infectiousdiseases by a7HA/QEXevgdd3F/aBovD532w8qXUo/7m4KpD+460ozKZzj8DJdMwz/4NDwAY+agA68RD8azcBm0GvA2pUkwxchH/GQa3t8BBmrMWAW+vsGtxUvekP6Y0tkI7COD0S9Z on 06/29/2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Planning for large epidemics and pandemics: challenges from a policy perspective Vageesh Jain a,b , Adriano Duse c , and Daniel G. Bausch d Purpose of review Less than two decades into the 21st century, the world has already witnessed numerous large epidemics or pandemics. These events have highlighted inadequacies in both national and international capacity for outbreak prevention, detection, and response. Here, we review some of the major challenges from a policy perspective. Recent findings The most important challenges facing policymakers include financing outbreak preparedness and response in a complex political environment with limited resources, coordinating response efforts among a growing and diverse range of national and international actors, accurately assessing national outbreak preparedness, addressing the shortfall in the global biomedical workforce, building surge capacity of both human and material resources, balancing investments in public health and curative services, building capacity for outbreak-related research and development, and reinforcing measures for infection prevention and control. Summary In recent years, numerous epidemics and pandemics have caused not only considerable loss of life but also billions of dollars of economic loss. Although the events have served as a wake-up call and led to the implementation of relevant policies and counter-measures, such as the Global Health Security Agenda, many questions remain and much work to be done. Wise policies and approaches for outbreak control exist, but will require the political will to implement them. Keywords epidemics, outbreaks, pandemics, policy, preparedness, response INTRODUCTION Although global health goals are realigning to match the growing burden of noncommunicable disease, the perennial threat posed by large infectious disease epidemics and pandemics remains. Less than two decades into the 21st century, the world has already witnessed numerous large epidemics or pandemics, three of which the World Health Organization (WHO) declared Public Health Emergencies of Inter- national Concern (PHEIC; Table 1). The PHEIC dec- laration means that WHO will help coordinate an immediate response with the affected country and with other countries around the world, and is an important designation in terms of mobilizing human, material and financial resources. Population growth, globalization, climate change and growing antibiotic resistance are among the factors that increase the risk of disease outbreaks. The frequency of large outbreaks and epidemics, and the effectiveness of the response to them, is largely reliant on emergency preparedness. Being adequately prepared for large epidemics and pan- demics requires a combination of political will, financial investment and public health expertise. Unfortunately, recent events, most notably the epi- demics of Ebola virus disease (EVD) in West Africa in a School of Medicine, University of Leicester, Leicester, b Kettering Gen- eral Hospital NHS Trust, Kettering, United Kingdom, c Clinical Microbiol- ogy and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa and d Faculty of Infectious and Tropical Diseases, Department of Disease Control, UK Public Health Rapid Support Team, Public Health England/ London School of Hygiene and Tropical Medicine, London, United Kingdom Correspondence to Daniel G. Bausch, MD, MPH & TM, Director, UK Public Health Rapid Support Team (UK-PHRST), Public Health England/ London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Department of Disease Control, Keppel Street, London UK WC1E 7HT, United Kingdom. Tel: +44 78 10057096; e-mail: Daniel.Bausch@lshtm.ac.uk Curr Opin Infect Dis 2018, 31:316–324 DOI:10.1097/QCO.0000000000000462 www.co-infectiousdiseases.com Volume 31  Number 4  August 2018 REVIEW