Public health is under pressure. Across health care systems around the world, funding is declining, exhausted professionals are leaving the field, and in the US state legislatures are pulling back needed legal authorities. At the same time, outbreaks of diseases such as measles and dengue are increasing, adding more urgency and responsibility to the work. In 2025, these pressures will initiate a transformation in epidemiology, pushing the field to adopt innovations to become more efficient and effective in controlling outbreaks.
The Covid-19 pandemic was extraordinarily challenging for the public health workforce, which mounted a historic pandemic response. The long-lasting crisis revealed numerous gaps in a workforce under immense strain.
Unfortunately, the pandemic was neither the first nor will it be the last public health threat to overwhelm our defenses. Historically, major infectious disease threats have emerged about every two years on average. Even now, avian influenza A(H5N1) has been expanding its geographic footprint and host species for years. By some assessments, the world is closer now to a flu pandemic than at any time in recent memory.
With these pressures, public health has no choice but to adapt. Although new technologies like mRNA vaccine platforms and at-home testing are expanding our arsenal against outbreaks, we cannot rely solely on these biomedical countermeasures.
The most significant untapped source of innovation lies in public health practice itself. The most promising development emerging from these challenges is the adoption of higher reliability principles as a new operational standard. These principles are derived from industries with zero tolerance for accidents and errors, such as space exploration and commercial aviation.
Public health, specifically epidemiology, is beginning to reorient away from bespoke approaches to outbreak response towards the structured processes characteristic of high-reliability industries. A commitment to continuous improvement, data- and metric-based monitoring of performance, and the implementation of standardized operating procedures are hallmarks of high reliability. These practices enable organizations to maintain safety and effectiveness, even during complex and high-stakes environments.
Although we are in the early days of this transformation, the pressures of the last five years will accelerate high reliability’s adoption in the year ahead. Some early successes are already evident. For instance, the program at CDC responsible for responding to foodborne illness outbreaks has made significant strides. They’ve aggressively implemented whole genome sequencing to identify the sources of outbreaks and developed a range of model best practices to support state and local officials in their investigations. This transformation has led to an increase in successful investigations, meaning that the sources of outbreaks are now more likely to be definitively identified. In contrast, prior to these changes, the origins of many outbreaks remained unresolved.
Epidemiology is at a critical juncture. Faced with declining resources, staff burnout, and increasing disease outbreaks, the field is being pushed to innovate. The adoption of high-reliability principles, borrowed from industries where failure is not an option, is emerging as a promising solution. This shift is already yielding results, as with the investigation of foodborne illnesses. By embracing structured and continuously improving processes and cutting-edge technologies, public health will enhance its ability to identify and control disease outbreaks. This transformation promises a more efficient and effective approach to safeguarding public health in the face of evolving threats.
