This Tool Could Be Key to Preventing the Next Pandemic

How countries can speed up their ability to detect and respond to disease outbreaks

Dr. Tom Frieden
3 min readApr 21, 2023
Health workers in Arua District, Uganda amid the Ebola outbreak in DRC. Photo Credit: Resolve to Save Lives

We discover a new microbial threat, on average, every year. And that’s in addition to the hundreds of viruses, bacteria, and fungi we already know about that can cause disease in humans, become increasingly resistant to antimicrobials, and spread to new areas or in new ways.

Our world is increasingly interconnected. A new infectious disease threat can spread across the globe in just 36 hours. Climate change and human intrusions into previously untouched wilderness areas heighten the risk of animal diseases infecting and spreading among humans. Once a disease takes hold in a population, it’s extremely hard to eradicate. Only two diseases — smallpox in humans and rinderpest in cattle — have been eradicated.

Given these factors, another pandemic threat is inevitable and could emerge anytime from anywhere. That may sound scary, but there are steps countries and communities around the world can take to reduce this risk and stop outbreaks from escalating. This isn’t theoretical — epidemics can and have been prevented.

One key? Improving how fast we detect and respond to outbreaks. Countries are coalescing around a new, galvanizing global target of “7–1–7” — aiming for every suspected and actual outbreak to be detected within 7 days, reported within 1 day, and have all essential control measures in place within the next 7 days. This gives countries a tool to use to assess and improve their efforts. Concrete goals for public health programs have worked well before, such as the 90–90–90 target (now 95–95–95 for 2030) which drove down AIDS deaths.

In a new study for Lancet Global Health, Resolve to Save Live’s Prevent Epidemics team and global colleagues applied the 7–1–7 approach to understand outbreak detection and control in 41 public health events in Brazil, Ethiopia, Liberia, Nigeria, and Uganda between 2018 and 2022.

The results are promising.

Researchers found that delays in detection, notification, and response directly affected the outcome of public health events, highlighting the importance of early action to contain and stop disease spread to save lives.

Of the 41 public health events, only 11 (27%) met the complete 7–1–7 target. Figuring out what went right and what can be improved is illuminating.

The most frequently observed bottleneck to detection was low levels of clinical suspicion by health workers, followed by delays in laboratory confirmation. In terms of reporting, the detecting entity in seven events didn’t communicate to the relevant authority; technological challenges for electronic surveillance or reporting systems also caused delays. Common bottlenecks to response were lack of resources for rapid response initiation, delayed laboratory confirmation, and limited availability or access to mitigation measures such as medication, vaccines and personal protective equipment. Applying the 7–1–7 approach exposed these bottlenecks and now health authorities can focus on where to accelerate and advocate, and hold themselves accountable for reducing time to detect, report and control the next outbreak.

It was further discovered that approximately half of the public health events met each target (54% of events met the target for detection, 71% notification, 49% early response). This demonstrates that these targets are achievable; the 7–1–7 approach provides a framework for both evaluation and prioritization.

A strength of the 7–1–7 target is that it complements existing preparedness measures — such as the World Health Organization’s (WHO) Joint External Evaluation (JEE), International Health Regulations (IHR), and After Action Reviews — to help identify bottlenecks, shape advocacy efforts, hold stakeholders accountable, and accelerate progress. A companion commentary in the Lancet by WHO highlights the role that the 7–1–7 target can play within existing preparedness frameworks by establishing more agile systems, particularly on the front lines, where outbreaks are often first detected. 7–1–7’s ability to promote agility and accountability in global health security will be crucial when — not if — we face the next pandemic.

The 7–1–7 Alliance, a new country-driven initiative, will provide technical assistance, financial support, and a growing global community of practice to help countries achieve the 7–1–7 target and be better prepared for health threats.

Recent outbreaks of Ebola, Marburg virus, and mpox in places where they haven’t occurred before demonstrate the urgency of strengthening preparedness and response systems everywhere. The microbial world is full of unknowns. Microbes might outnumber us — but we can outsmart them.



Dr. Tom Frieden

President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives.