Public health is under pressure. Across health systems around the world, funding is declining, exhausted professionals are leaving the field, and in the United States, state legislatures are withdrawing necessary legal powers. At the same time, outbreaks of diseases such as measles and dengue fever are increasing, adding to the urgency and responsibility of the work. In 2025, these pressures will begin to transform epidemiology, requiring the field to adopt innovations to control infectious disease outbreaks more efficiently and effectively.
The COVID-19 pandemic has been extremely challenging for public health workers who have embarked on a historic pandemic response. The prolonged crisis has exposed many gaps in a highly strained workforce.
Unfortunately, the pandemic is not the first public health threat to defeat our defenses, and it will not be the last. Historically, major infectious disease threats have emerged on average approximately every two years. Even now, avian influenza A(H5N1) has expanded its geographic distribution and host species over the years. By some estimates, the world is now closer to an influenza pandemic than at any time in recent memory.
Public health has no choice but to adapt to these pressures. New technologies such as mRNA vaccine platforms and at-home testing are expanding our arsenal against outbreaks, but we cannot rely solely on these biomedical countermeasures.
The most important untapped source of innovation lies in public health practice itself. The most promising development to emerge from these challenges is the adoption of higher reliability principles as the new operational standard. These principles are derived from industries such as space exploration and civil aviation, where there is no tolerance for accidents or errors.
Public health, and epidemiology in particular, is beginning to pivot from a bespoke approach to outbreak response to a highly reliable, industry-specific, structured process. A commitment to continuous improvement, monitoring performance based on data and metrics, and implementing standardized operating procedures are hallmarks of high reliability. These practices enable organizations to remain safe and effective in complex, high-risk environments.
Although we are in the early stages of this transformation, the pressures of the past five years will accelerate the adoption of high reliability over the next year. Some early successes are already evident. For example, the CDC’s programs responsible for responding to foodborne illness outbreaks have made significant progress. They have aggressively deployed whole-genome sequencing to determine the origin of outbreaks and developed best practices for a variety of models to support state and local authorities’ investigations. This change led to an increase in successful investigations. This means the source is now more likely to be identified. In contrast, before these changes, the causes of many epidemics remained unresolved.
Epidemiology is at a critical crossroads. Faced with dwindling resources, staff burnout, and rising disease outbreaks, the sector is being forced to innovate. Adopting high reliability principles borrowed from industries where failures are not an option is emerging as a promising solution. As with food poisoning research, this change is already paying off. By employing structured, continuously improving processes and cutting-edge technology, public health strengthens its ability to identify and control disease outbreaks. This transformation promises a more efficient and effective approach to protecting public health in the face of evolving threats.