Preparedness of public health laboratories for respiratory infectious diseases – EU/EEA country perspectives on lessons learned from the COVID-19 pandemic

During the COVID-19 pandemic, public health laboratories (PHLs) in EU/EEA countries faced intense pressure due to high levels of demand and limited capacity and resources. They faced challenges in staffing laboratories with sufficiently trained staff and implementing new digital infrastructure to support genomic surveillance. Supply chain and procurement issues led to shortages in key equipment, and laboratories struggled to keep up with demands in public health surveillance and supporting other types of laboratories. 

In response, PHLs increased capacity by hiring and training new staff, building new physical and digital infrastructure, and procured supplies through new procurement schemes and from new sources. PHL activities were supplemented by collaboration across sectors, including drawing on capacity from the military, animal health laboratories and the private sector.

The COVID-19 pandemic led to great advances in genomic surveillance, sequencing capacity, and other techniques such as wastewater surveillance. During the pandemic, PHLs implemented new techniques and methods, and needed to respond rapidly to emerging evidence, including information about variants. Guidelines and standard operating procedures were crucial in informing practice within PHLs and helped spread best practice and improved data quality.

PHLs struggled with data sharing, collaboration and coordination during the pandemic. Collaboration and networks were crucial in addressing some of these challenges. For example, regional networks within countries helped enable improved surveillance, and EU-level and WHO-facilitated collaborations helped improve capacity and communication during the pandemic.

There is an opportunity to learn from the experience of the COVID-19 pandemic to help improve the preparedness of PHLs for future health threats, including balancing the speed, accuracy and quantity of tests that laboratories need to deliver. Information about the types of PHL activities that are most effective to inform decision making at different points in pandemics can support this. 

To improve preparedness of PHLs for future respiratory health threats, countries should maintain sufficient PHL capacity during ‘peace time’ to detect threats and create plans for scaling up capacity during emergencies. They should create coordination mechanisms between PHLs and cross-sectoral stakeholders and address challenges that slow data sharing during emergencies, including enhancing digital infrastructure where needed. 

To improve preparedness for future health threats, PHLs will require:

• resources and capacity to support long-term preparedness, and continued support for coordination and data sharing during public health emergencies;
• evidence on ‘right-sizing’ surveillance activities such as sequencing and PCR testing to inform PHL priorities in future public health emergencies;
• support to maintain the advances made during the pandemic, including in sequencing, genomic surveillance, wastewater surveillance, and training staff in new laboratory techniques;
• enhanced preparedness planning, including how and when to scale up and scale down capacity to meet demands.

Participants from PHLs in EU/EEA countries highlighted EU-level support they thought would help improve preparedness for future respiratory infectious diseases:

• maintaining and, where needed, increasing resources provided to support long-term preparedness where there are gaps in countries;
• collating evidence around best practice related to PHL activities and identifying specific evidence gaps in responding to public health emergencies;
• funding research that fills gaps in understanding how to conduct surveillance that meets the needs of decision makers, and that makes the best use of available resources (e.g. evidence on ‘right-sizing’ surveillance activities);
• implementing EU-level actions to address supply chain issues, including stock piling and joint procurement;
• conducting EU-wide preparedness exercises to bring stakeholders involved in responding to public health emergencies together, which can help improve communication, coordination and agility during crises;
• clarifying the role that different EU-level actors play in supporting PHL preparedness;
• continuing to build and strengthen networks and collaborations amongst PHLs, other laboratories, and other stakeholders.