Incorporating multisectoral collaboration in public health emergency preparedness and response: Lessons learned in Europe

Introduction Public health emergencies (PHE) continue to be a threat to society across the globe, as the recent COVID-19 pandemic (2020-2023) has shown. The existing international documents on public health emergency preparedness and response (PHEPR), such as the WHO’s International Health Regulations (2005) and the European Union’s (EU) Regulation (EU 2022/2371), advocate for a multisectoral approach to PHEPR. Yet, it remains unclear how multisectoral collaboration should be interpreted, what the extent of the collaboration should be, and how it should be implemented. Research aims and scope This thesis presents studies performed within the context of the EU Joint Action on Strengthening International Regulations and Preparedness in the EU (SHARP JA), with the aim of answering the following central research question, “What are the current practices and possibilities of improvement for the incorporation of multisectoral collaboration in national public health emergency preparedness and response?” Using an all-hazard and transdisciplinary approach, five individual studies were conducted to investigate three dimensions of multisectoral collaboration during PHEs. The main research question consisted of three parts. 1. The pre-COVID-19 public health emergency preparedness and response literature on multisectoral collaboration The following sub-research questions were investigated here: - Which sectors are mentioned in the peer-reviewed PHEPR literature published between 2005 and 2020? - How can the description of the involvement of different sectors be mapped across the seven PHEPR cycle domains? 2. The European experts’ understanding of multisectoral collaboration during the COVID-19 pandemic The following two sub-research questions were investigated here: - Which sectors should be involved in decision-making during public health emergency preparedness, response, and recovery, according to European PHEPR experts? - Which key factors played a role in the development of SARS-CoV-2 testing strategies in various European countries? 3. The European citizen’s perspective on multisectoral collaboration during the COVID-19 pandemic The following two sub-research questions were investigated here: - What is the Dutch citizen’s understanding and perception of the actors involved in the Dutch COVID-19 pandemic response? - What is the European citizen’s perception of its role in COVID-19 management? Synthesis This thesis identified that the pre-COVID-19 PHEPR literature focuses on four sectors, namely (1) governmental institutions, (2) human health, (3) experts, and (4) civil society. It identifies 13 sectors that should be involved in PHEPR decision-making, namely (1) agriculture, forestry, fishery, and the environment, (2) energy and water supply, sewerage, and waste management, (3) ICT service activities, (4) chemical industry (including pharmaceutical companies), (5) governmental institutions, (6) media and communication, (7) civil society, (8) experts, (9) (human) transportation and points of entry, (10) education and training, (11) human health industry, (12) veterinary activities, and (13) personal service-, administrative support and security and investigation activities. Furthermore, it provides ten recommendations on how to improve the incorporation of multisectoral collaboration in national PHEPR plans. Within this thesis, I suggest that the final recommendation should be the starting point for a strategy for increasing the integration of multisectoral collaboration in PHE. It reads, “National public health emergency preparedness and response plans should designate an actor responsible for the coordination of multisectoral collaboration”. Moreover, the thesis uses a previously developed framework for diagnostic preparedness to identify key factors that played an important role in the development of national SARS-CoV-2 strategies. Many of those factors are dependent on some form of collaboration. Lastly, this thesis shows that there is a diversity of various societal actors’ interpretations and expectations of the concept of multisectoral collaboration during PHEs. Interestingly, the citizens in the Dutch and multi-country studies, included in the thesis’ studies generally did not advocate for a seat at the PHEPR decision-making table.