Closing the preparedness-response gap in time: Operational readiness at points of entry in Europe

Abstract

Abstract Background As points of entry (POE) - ports, airports and ground-crossings - are important structures for international travel and trade, their timely activated capacity to respond to infectious disease threats is of utmost importance. How can POE timely adjust their capacity from generic preparedness to specific response? Methods We developed a conceptual framework for public health response at POE, based on a military used model, leading to a step-wise approach from preparedness to response. Subsequently, our framework has been used to analyze interview data of professionals working at European ports (n = 12), airports (n = 15) and ground-crossings (n = 4) in 11 European countries in June - August 2020 covering the activation of the response to COVID-19. Results By integrating the military model, we learned that in preparedness frameworks the pre-defined time expected to activate required capacity is missing. While combining time with capacity creates the possibility of defining a readiness range for different capacity requirements. E.g. information provision to passengers is arranged within hours, while entry-screening may take up to days to be operational. We hypothesized that this readiness range provides the opportunity to split strategic thinking from operational readiness, and may support proactive thinking. The interviews confirmed a very implicit and non-formalized reference to the time needed to activate the response. POE differed highly as regards proactive or reactive response strategies. A much stated problem was fast and often changing strategies on measures, leading to extreme required flexibility and workload in operations. Conclusions Explicitly acknowledging the time needed to activate appropriate capacity during the transition from preparedness to response can contribute to a better definition of the operational consequences of readiness. These findings may also be of added value in other public health area than POE.