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How ready is the world for the next infectious disease outbreak? « Back to Blogs

The World Health Organization has set up a new process to assess countries’ ability “to prevent, detect and respond to public health threats such as infectious disease outbreaks”. (1)

It is called the Joint External Evaluation. Gupta and colleagues have recently published a paper analysing the results of the Joint External Evaluation.

Their findings are worrying.

They found that most countries do not have capacity to deal with infectious disease pandemics. They found particular weaknesses in the domains of antimicrobial resistance and biosecurity response. The problems related to antimicrobial resistance were weak antimicrobial stewardship and inadequate surveillance systems for highly resistant pathogens. Countries with the weakest capacity to respond were in Africa.

This is concerning for a number of different reasons.

Firstly, many of the countries where there are most likely to be further outbreaks are in Africa. The Ebola outbreak of 2014 affected West Africa and there are still ongoing infections in the Congo. These are the same countries with the weakest capacity to respond.

Secondly, the weaknesses in the public health systems are likely to affect a range of important responses and not just to infectious disease threats. These weaknesses could affect a country’s ability to react to any sudden and unexpected disaster.

Thirdly and lastly, the problems identified are basic and serious and will not be easy to fix. For example, it is fundamental to any health system that it has healthcare-associated infection (HCAI) prevention and control programs in place – one of the indicators that is looked for in the Joint External Evaluation. Another one that is not easy to fix is the lack of a “whole-of-government biosafety and biosecurity system in place for human, animal and agriculture facilities”. This joined up approach is often not fully functional in countries with well-developed health systems and so will be doubly difficult in poorer countries.

Building a healthcare workforce that can deliver

The indicators that were evaluated are a mixture of structural, process and outcome measures. However, a common thread that runs through many of them is the need to have a healthcare workforce that will be able to deliver the reforms that are needed.

Human resources for health will need to be strengthened before this can happen. This will mean providing undergraduate and postgraduate education to the workforce of tomorrow and continuing professional development to the workforce of today.

New technologies will be needed to deliver this education on the global scale that is required. At BMJ, we have growing experience of delivering this type of education – mainly through the provision of e-learning and clinal decision support. Our experience has helped us gain a great deal of knowledge of how a range of different types of healthcare professionals learn (2). Most healthcare professionals want continually updated content that will help them put evidence-based guidelines into practice for the benefit of their patients. This content could be provided in any format – but new technologies enable a vital outcome in this domain: they can be scaled to a global level.


  1. Gupta VKraemer JDKatz RJha AKKerry VBSane JOllgren JSalminen MO. Analysis of results from the Joint External Evaluation: examining its strength and assessing for trends among participating countries. J Glob Health.2018 Dec;8(2):020416.  
  2. Walsh K. Interprofessional education online: the BMJ learning experience. Journal of interprofessional care. 2007 Jan 1;21(6):691-3.

Competing interests

Kieran Walsh works for BMJ – which produces clinical decision support resources in infectious diseases.


The purpose of this document is to educate and to inform. The content of this document does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the authors. BMJ does not endorse any views or recommendations expressed in this document. Readers should also be aware that professionals in the field may have different opinions. Users of this document hereby agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

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