Getting ready to act: theorising a stepwise transition into crisis response at points of entry based on interviews with COVID-19 responders and a military preparedness framework

Abstract

IntroductionPoints of entry (POE) have an important role in timely national response to infectious diseases threats. However, a guiding framework is lacking for the transition from generic preparedness into optimally specified response for an imminent infectious disease threat, a step called ‘operational readiness’.ObjectiveWe aim to contribute to the conceptual closure of this preparedness–response gap for infectious disease control at POE by providing content to the operational readiness concept.DesignWe first explored the NATO Combat Readiness (NCR) concept for its applicability on infectious disease control at POE, as the military discipline faces the same need of being flexible in preparing for unknown threats. Concepts of the NCR that support the transition into response to a specific threat were integrated into the operational readiness concept. To explore the added value of the concept in practice, we conducted and analysed semistructured interviews of professionals at European POE (n=24) responsible for the early COVID-19 response.ResultsBased on the NCR, operational readiness builds on the fact that activating the response capabilities and capacities to a specific threat requires time. For professionals at POE, the transition from generic preparedness into the COVID-19 response led to challenges in specifying response plans, dealing with an overload of information, while experiencing shortages of public health staff. These challenges could be covered within operational readiness by defining the time and the specific staging needed to upgrade response capabilities and capacities.DiscussionWe conclude that a guiding framework for operational readiness seems appropriate in relation to the many activities and challenges POE have had to face during the COVID-19 response. Operational readiness is mainly defined by the time dimension required to deploy the response to a specific threat. However, integrating this conceptual framework into practice requires structural and sustainable investments in outbreak preparedness.

Adaptive organizational network response in a crisis: The case of five European airports during the COVID‐19 pandemic

“…Also the identified complex trans‐sectoral task allocation supports the idea that the use of ex ante coordination through crisis‐ and response plans appears to be difficult, as is described in both recent ON and public health literature (Kenis & Raab, 2020; De Rooij et al, 2022; Kenis et al, 2019). Instead, we need a governance layer during the response that is able to adapt the task division and allocation during the response.…”

“…An illustrative example is how airports occasionally say to use the dedicated radio system in place for aircraft emergencies just to stand out amidst the blur of information exchange. The dense information flow during response scenarios is clearly necessary but challenging to manage, as has also been recognized in previous research on COVID-19 response at points of entry (De Rooij et al, 2022).…”

“…The COVID-19 pandemic clearly showed that despite the fact that airport preparedness has been high on the international public health agenda, new response situations can occur that do not fit the experience of the past, which requires a unique approach by the airport partners of all sectors (De Rooij et al, 2022). Ansell et al (2021) recently drew a likewise conclusion regarding the COVID-19 response in general.…”

“…In these—often—new crisis situations, previous studies have shown several practical challenges. The communication to airport partners and the public amidst many uncertainties on this crisis' essence, the cooperation among new partners across sectors and working levels, and the volatile demands in trained public health staff and staff in the air travel sector are just a few of many examples of these practical challenges (De Rooij et al, 2022; Kleine‐Kampmann et al, 2021). A particularly illustrative case of how challenging COVID‐19 response at airports remained, was experienced at Schiphol Airport in the Netherlands in November 2021.…”