Strengthening the Response: A Framework for High-Consequence Infectious Disease Preparedness
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As global health threats continue to evolve, so must our strategies for managing high-consequence infectious diseases (HCIDs). Preparedness and Response Considerations for High-Consequence Infectious Disease, a new open-access perspective in Emerging Infectious Diseases—authored by experts and collaborators from NETEC’s Special Pathogens Research Network (SPRN) —offers a critical roadmap for readiness and response, grounded in the lived experiences of healthcare systems and public health partners nationwide.
Defining the Threat: What Makes an HCID?
HCIDs are acute, severe infections with high illness and death rates, a few or limited treatment or preventive options, and potential to spread in communities and healthcare settings. Ebola, Marburg, and Nipah viruses are among the most recognized, but the list of concern continues to grow and shift with changing epidemiology and new spillover events. The manuscript underscores the importance of consistent terminology—using “special pathogen” to describe the agent, and “HCID” for the resulting disease—to improve communication and resource allocation during emergencies.
Key Components of a Strong Response System
The manuscript outlines essential elements for healthcare system preparedness, including:
- High-Level Isolation Units (HLIUs): Purpose-built spaces with enhanced engineering controls and trained multidisciplinary teams are essential for safely caring for patients with HCIDs. While capacity is limited, these units offer value beyond outbreaks—supporting training, research, and surge flexibility.
- Clinical Lab Readiness: Safe specimen handling, use of containment equipment, and risk-based protocols are vital. Facilities without full containment labs may need point-of-care testing alternatives.
- Medical Countermeasures: Many HCIDs lack approved vaccines or treatments. Expanding access to investigational therapies, as seen during the mpox outbreak, and investing in pre-outbreak clinical trial frameworks are critical to accelerating response timelines.
- Management of Contaminated Materials and Waste: From daily disinfection to Category A waste handling, safe protocols must be practiced and regulated to prevent secondary exposures.
- Workforce Safety, Care of Special Populations, and Health Equity: Protocols for occupational health, care of vulnerable populations (e.g., children, pregnant persons), and equitable regional access to care must be embedded in planning efforts.
The Role of Systems and Communication
Coordinated systems of care, such as the US National Special Pathogen System (NSPS), play a vital role in triaging patients to appropriate settings and facilitating consistent standards across regions. The authors call for enhanced integration between frontline facilities, public health, and specialized treatment centers—reinforcing that preparedness must extend well beyond high-profile containment units.
Public communication is also highlighted as a core component of outbreak response. From risk mitigation messaging to public assurance, transparent and coordinated information-sharing—often through a joint information system—is essential to build and maintain trust.
Looking Ahead: Research and Investment Priorities
The paper identifies urgent needs for new diagnostics, vaccines, and therapeutics tailored to HCIDs, and for global strategies that prioritize early detection and surge-ready research protocols. Strategic, sustained investment—especially in high-risk or endemic regions—is not just humanitarian; it’s a national security imperative.
The authors noted that while pandemic-scale investment isn’t necessary for every emerging threat—there is demonstrated value in proactive funding for preparedness infrastructure and medical countermeasures. By preparing research infrastructure and countermeasure trials before outbreaks occur, we reduce response delays and protect more lives.
Read the full article in Emerging Infectious Diseases: https://doi.org/10.3201/eid3108.250313
About the Experts
The following members of the Special Pathogen Research Network contribute to this blog post:
Dr. Justin Chan, MD, MPH, serves as Director of Infection Prevention and Control at NYC Health + Hospitals/Bellevue, and as the Enterprise Chief Healthcare Epidemiologist at NYC Health + Hospitals. He is an associate professor of medicine in the Division of Infectious Disease & Immunology at the NYU Grossman School of Medicine in New York, NY, USA. Dr. Chan’s research interests include understanding the epidemiology, prevention, and control of high-consequence infectious disease outbreaks.
Jared D. Evans, PhD, is a senior staff scientist whose expertise in virology includes over twenty years of experience in basic and applied research. He currently focuses on applications and response to investigate high-priority pathogens, including dengue and influenza viruses, with an emphasis on single-cell assays, genomics, and novel molecular tools. His responsibilities include leading projects in virology, molecular biology, and genomics and coordinating with partners to reach technical goals. Dr. Evans is also an assistant professor in the Department of Emergency Medicine in the Johns Hopkins School of Medicine. Additional areas of expertise include microfluidics and molecular/synthetic biology.
Lauren M. Sauer, PhD, MSc, is an Associate Professor in the College of Public Health, Department of Environmental, Agricultural, and Occupational Health, at the University of Nebraska Medical Center and both the Interim Associate Director of Research and a Scholar of the UNMC Global Center for Health Security. She is an Adjunct Associate Professor of Emergency Medicine in the Johns Hopkins School of Medicine, with a joint appointment in the Johns Hopkins Bloomberg School of Public Health, department of International Health. She is also an adjunct faculty member of the Boston University Center for Emerging Infectious Diseases Policy and Research.
Dr. Sauer is the Director of the Special Pathogens Research Network, the research arm of NETEC, and is an alumnus of the Emerging Leaders in Biosecurity program at the Johns Hopkins Center for Health Security, where she is a contributing scholar.
Dr. Sauer’s research focuses on human subjects research in bio-emergencies and disasters, in particular, ethical implementation of research and navigating the regulatory environment. The goal of her research is to provide health care facilities with the tools needed to conduct a clinical and operational research response in emergencies.