Cross-Country Synthesis: Advance Warning and Response

Climate change, rapid urbanization, and global population migration are increasing human exposure and vulnerability to pathogens. Robust, innovative advance warning and response (AW&R) systems can help countries detect disease outbreaks within and near their borders—and in some cases provide early warning of outbreaks before they happen. Earlier detection enables faster, more coordinated, cost-effective, and targeted responses, reducing the human and economic toll of epidemics, pandemics, and other pathogenic public health crises.

Exemplars in Global Health has identified four countries—Brazil, Kenya, South Africa, and Vietnam—that are developing and implementing AW&R systems tailored to local needs and capacities and aligned with existing governance structures and public health systems. These innovative systems enable more effective early warning and detection and more timely responses to disease outbreaks (Figure 1).

Figure 1: Advance Warning and Response Exemplar (AWARE) countries

AW&R systems have three key components:

• Early warning before infectious disease outbreaks occur.

• Early detection as infectious disease outbreaks emerge.

• Response mechanisms that aim to prevent, contain, or mitigate the spread of outbreaks.

Figure 2: Three key components of advance warning and response systems

Across all four countries, Exemplar researchers derived their findings primarily from interviews with in-country key informants. This report synthesizes those findings into five common themes that capture the core elements of implementing and sustaining AW&R systems: advance warning capabilities, data sharing and integration, governance and decision-making, financing and sustainability, and evaluating effectiveness (Figure 3).

Figure 3: Five common themes of sustained advance warning and response systems

• Advance warning capabilities: AW&R systems help countries identify and prepare for disease outbreaks weeks or even months before they occur. The Exemplar countries are moving beyond passive case detection by integrating climate, environmental, and community data into predictive tools that provide weeks to months of lead time for climate-sensitive infectious diseases such as dengue and malaria.

• Data sharing and integration: Connected surveillance systems ensure that countries and health systems can share health data across different sectors, agencies, and levels of government. In the Exemplar countries, cross-sector data exchange is expanding but still remains uneven. Where legal frameworks, One Health platforms, and digital tools exist, they unlock powerful, cross‑sectoral assessments of risk. views of risk. Where systems remain siloed, early warning signals often fail to translate into action.

• Governance and decision-making: Effective governance clearly defines roles and responsibilities, empowers the right stakeholders to act, and enables multi- and cross-sectoral cooperation and collaboration when health threats emerge. In the Exemplar countries, clear roles across national and subnational levels, plus formal One Health structures, are critical for turning warnings into coordinated responses.

• Financing and sustainability: Sustainable funding—whether from governments, donors, or both—is essential to build, maintain, improve, and scale AW&R systems. The Exemplar countries combine domestic and external financing: domestic budget lines are essential to sustain core surveillance, while donor funding has been crucial for innovation and pilot programming. However, project-based support without transition planning poses sustainability risks.

• Evaluating effectiveness: Regular monitoring, evaluation, and assessment of AW&R systems—using defined indicators and stakeholder feedback—shows what is working and highlights areas for improvement for countries, their peers, and international partners. In the Exemplar countries, evaluation tends to focus on detection and response timeliness, with much less systematic assessment of early warning performance (such as forecast lead time or predictive accuracy). Where multistakeholder evaluation is routinely embedded in AW&R systems, it has directly shaped system improvements.

This cross-country synthesis is a high-level overview of AW&R systems in Brazil, Kenya South Africa, and Vietnam, drawn from Exemplars in Global Health research led by Brown University Pandemic Center, the University of São Paulo, Washington State University Global Health–Kenya, the University of the Witwatersrand, and Oxford University Clinical Research Unit Vietnam. The following sections are organized by theme, each identifying and describing cross-cutting best practices observed in at least three of the four Exemplar countries. Together, these practices offer insights to inform policymaking, investment, and research in peer countries around the world.

To learn more, click through the thematic sections on this page to jump to the relevant part of the narrative.