Conducting in-action and after-action reviews of the public health response to COVID-19


Conducting in-action and after-action reviews of the public health response to COVID-19. Stockholm: ECDC; 2020.

The unprecedented events of the COVID-19 pandemic have placed enormous strain on the health and economic systems of countries worldwide. In roughly 20 EU/EEA countries, it appears that physical distancing measures have had an impact and that the initial wave of transmission has started to decline. Given that the COVID-19 pandemic is not expected to end for at least several more months, there is a need to assess what has happened so far, to identify strategic priorities, and to exchange lessons learned. This will help to optimise the response to the next phases of the COVID-19 pandemic, by providing an evidence-based approach to identifying and implementing new actions based on the lessons learned. It may also help identify appropriate de-escalation strategies. During later phases of the pandemic, countries will be advised to review their full response to COVID-19. Systematically identifying and acting upon lessons from the COVID-19 pandemic will be of the utmost importance to guide preparedness and response planning and strengthen health systems in the coming years.

Executive summary

This document aims to support the implementation of after-action reviews (AARs) and in-action reviews (IARs) focused on the public health response to COVID-19. After-action reviews are structured, qualitative reviews of the actions taken during the response to identify best practices, gaps and lessons learned. After-action reviews may address all dimensions of a public health response, or they may just focus on the detail of particular elements. Similar to AARs, IARs seek to identify best practice and lessons learned, but they seek to apply these insights in a tighter time-scale to improve the outcome of an ongoing response. In-action reviews may also include a ‘forward-look’ to assess strategic options in the upcoming phases of the pandemic.

This document is designed to complement existing ECDC and WHO documentation about AARs, and it draws on ECDC guidance documents related to emergency preparedness planning and response, in particular, documents published in the context of COVID-19. It is intended to support IARs and AARs by highlighting the basic planning and implementation stages. Following a brief overview of AAR and IARs, Part 1 reviews the main phases for planning and conducting AARs and IARS: designing, planning and implementing. Part 2 discusses specific considerations relating to IARs and AARs focused on COVID-19. This includes a comprehensive list of ‘trigger questions’ for COVID-19 (presented in Annex 3). These have been prepared to guide the design and facilitation of IARs/AARs focused on the public health response to COVID-19. The trigger questions are informed by multiple sources including ECDC Rapid Risk Assessments for COVID-19; ECDC Technical Guidance on COVID-19; WHO Guidance for After Action Review and its associated database of trigger questions; lessons learned from three European case studies of preparedness planning for MERS-CoV; options for public health response as identified and available during the outbreak; WHO’s Joint External Evaluation Tool; the joint ECDC/WHO Guide to revision of national pandemic influenza preparedness plans - lessons learned from the 2009 A(H1N1) pandemic and the WHO Interim Guidance on strengthening preparedness for COVID-19 in cities and other urban settings.