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A Revised Public Health Emergency Preparedness Logic Model Reflecting the European Experience in the COVID-19
Stefano Guicciardi1, Michael A Stoto1, Federico Toth1
1Stefano Guicciardi, MD, PhD, is a Medical Doctor, Health Directorate, Local Health Authority of Bologna, and a PhD Student, Department of Biomedical and Neuromotor Sciences, University of Bologna; both in Bologna, Italy. Michael A. Stoto, PhD, is a Professor Emeritus, Department of Health Management and Policy, Georgetown University, Washington, DC. Federico Toth, PhD, is a Professor, Department of Political and Social Sciences, University of Bologna, Bologna, Italy. Elena Savoia, MD, MPH, is Principle Scientist, Department of Biostatistics and Emergency Preparedness Research Evaluation and Practice Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, Boston, MA. Rachael Piltch-Loeb, PhD, MSPH, is an Assistant Professor, Department of Environmental Occupational and Geospatial Health Sciences, CUNY Graduate School of Public Health and Healthy Policy, New York, NY. Chiara Reno, MD, PhD, is a Medical Doctor, Health Services Research, Evaluation Research and Health Services Policy Unit, Local Health Authority of Romagna, Ravenna, Italy. Maria Pia Fantini, MD, is an Alma Mater Professor, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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In 2017, the European Centre for Disease Prevention and Control developed a public health emergency preparedness logic model for European Union, differentiating between capacities (resources and infrastructure) and response capabilities (actions during emergencies). Analysis of the COVID-19 experience suggests that the main features of this logic model, including the 5 high-level categories of capabilities, remain valid. Some changes are needed, however, in 3 areas. In the detection and assessment area, "laboratory analysis" was integrated with "testing" to better represent their combined role; additionally, "incident recognition," "epidemiological investigation," and "risk characterization" were included under the wider definition of "public health intelligence." In the health services area, "preventive medicine" was replaced with the more specific capability of "coordination of preventive, primary care and other outpatient services (population-based medicine)." In the emergency risk communication area, several capabilities were further clarified such as the use of infodemic management. In addition, the analyses identified 4 overarching issues that must also be consider in preparedness assessments: (1) the need to develop new strategies, approaches, and policies under pressure and to review and revise them as the pandemic evolved; (2) the challenges of implementing an emergency response in the context of a country's internal hierarchical structure of public health, healthcare, and related entities; (3) the need for coordination among the different sections of the healthcare system, particularly hospital and community-based levels; and (4) the challenges of scaling up a country's pandemic response.
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