A transformative approach that bridges scientific knowledge with community engagement for resilient health systems
In the aftermath of the COVID-19 pandemic that swept across the globe, a critical lesson emerged—the most sophisticated medical interventions often faltered when they failed to consider the people they aimed to serve. Despite unprecedented scientific advancements that delivered vaccines in record time, the human element of pandemic response remained the weakest link in many countries. This revelation has sparked a paradigm shift in how public health experts approach epidemic preparedness, moving from purely top-down, technical solutions to people-centered frameworks that prioritize community engagement, equity, and local context 4 .
The staggering numbers behind COVID-19 tell only part of the story—while over 700 million documented infections occurred globally, perhaps more devastating has been the persistent shadow of Long COVID, affecting an estimated 7-30% of those infected, with higher rates in lower- and middle-income countries 2 .
This lasting impact, combined with the socioeconomic disruption that disproportionately affected vulnerable populations, has made clear that future preparedness must extend beyond medical interventions to address the complex tapestry of human needs, behaviors, and systems that determine how communities weather health emergencies. This article explores the emerging science of people-centered epidemic preparedness and response—a transformative approach that bridges the gap between knowledge and action to build more resilient communities for future health threats.
People-centered epidemic preparedness represents a fundamental reimagining of how we approach health emergencies—shifting from a solely pathogen-focused model to one that places human needs, behaviors, and contexts at the core of response strategies. This approach recognizes that technological solutions alone, no matter how advanced, cannot effectively combat epidemics without addressing the social, economic, and cultural dimensions of health 4 .
The World Health Organization has increasingly emphasized this approach through initiatives like Community Protection, which places communities at the centre of pandemic preparedness and response through risk communication, community engagement, infodemic management, and multisectoral engagement 5 .
This represents a significant evolution from traditional command-and-control models of public health emergencies toward more adaptive, responsive systems that recognize the unique needs and strengths of different communities.
The critical importance of community trust became painfully evident during COVID-19, when mistrust in authorities and institutions significantly hampered response efforts in many regions. Effective people-centered responses prioritize authentic engagement with communities through their existing structures and leaders.
The WHO's HIVE platform exemplifies this approach—creating a safe digital space that brings together community members to share knowledge, co-create solutions, and collaborate on health emergency preparedness 5 . Such initiatives recognize that communities themselves are often the first line of defense against epidemics when equipped with appropriate knowledge, resources, and support 3 .
Perhaps the most glaring lesson from recent epidemics has been the disproportionate impact on already marginalized populations. The COVID-19 pandemic exposed significant gaps in healthcare systems worldwide, with risk communication methods often lacking cultural sensitivity and failing to account for linguistic diversity 8 .
Traditional public health data systems often fail to capture the nuanced disparities that drive unequal outcomes during epidemics. People-centered approaches require disaggregated data that can reveal inequalities related to race, ethnicity, gender identity, socioeconomic status, and other social determinants of health 8 .
| Data Characteristic | Purpose | Example from COVID-19 |
|---|---|---|
| Demographically disaggregated | Reveal disparities affecting vulnerable groups | Identifying higher mortality rates in certain racial/ethnic groups |
| Collectively owned | Ensure communities benefit from data about themselves | Indigenous data sovereignty initiatives |
| Timely | Enable rapid response to emerging disparities | Real-time tracking of vaccine access in underserved neighborhoods |
| Contextualized | Capture social determinants, not just health outcomes | Linking housing density to transmission rates |
One of the most significant scientific advancements in understanding Long COVID has come from the Systematic Protein Expression and Residual Analysis (SPEAR) study, a multinational research initiative that investigated the role of persistent SARS-CoV-2 spike protein in driving chronic symptoms.
This rigorous investigation synthesized evidence from 76 studies published through August 2025, using stringent inclusion criteria to ensure research quality 2 .
The SPEAR study findings revolutionized our understanding of Long COVID pathophysiology. Researchers discovered that persistent spike protein could be detected in tissues—including the skull-meninges-brain axis—for up to four years post-infection 2 .
| Tissue Type | Detection Method | Maximum Observed Persistence | Clinical Correlations |
|---|---|---|---|
| Plasma | Immunoassay | 12 months | Fatigue, cardiovascular symptoms |
| Monocytes | Flow cytometry | 18 months | Cognitive impairment, brain fog |
| Skull-meninges-brain axis | Immunohistochemistry | 4 years | Anxiety, neuropsychiatric symptoms |
| Bone marrow | Biopsy with PCR | 3 years | Immunological dysfunction |
The SPEAR study's findings directly informed the development of targeted therapeutic approaches for Long COVID. By understanding the mechanisms of spike protein persistence, researchers could identify potential interventions 2 :
Studying complex phenomena like people-centered epidemic response and spike protein persistence requires specialized reagents and methodologies. The following toolkit highlights essential resources that have advanced this field:
| Reagent/Technology | Function | Application in People-Centered Research |
|---|---|---|
| Spike-specific monoclonal antibodies | Neutralize and detect persistent spike protein | Understanding Long COVID mechanisms; developing targeted therapies |
| TLR4 signaling inhibitors | Block inflammatory pathways activated by spike protein | Reducing chronic inflammation in Long COVID |
| Autophagy enhancers (e.g., spermidine) | Enhance cellular clearance of viral remnants | Accelerating recovery from persistent infection |
| Cytokine panel assays | Measure inflammatory markers | Correlating inflammation with symptom severity |
| Community engagement platforms (e.g., WHO HIVE) | Facilitate community co-creation of solutions | Designing contextually appropriate interventions |
| Equity assessment frameworks | Identify disparities in impact and access | Ensuring equitable distribution of resources |
These tools enable researchers to bridge the gap between laboratory science and community impact, recognizing that effective epidemic response requires both biological insights and social engagement. The integration of molecular research with community-centered approaches represents the future of epidemic preparedness—one that acknowledges the complex interplay between pathogens, human biology, and social systems.
Translating the principles of people-centered preparedness into concrete action requires structural changes to how we design health systems, allocate resources, and engage communities. Several key strategies have emerged as particularly effective:
The COVID-19 pandemic revealed critical gaps in community health infrastructure worldwide. According to a 2022 study by World Physiotherapy, 64% of countries reported that physiotherapy services were not included in any health emergency preparedness components, despite the crucial role rehabilitation plays in recovery from respiratory illnesses 9 .
The modern information landscape has introduced a new challenge to epidemic response—the infodemic, or overabundance of information, both accurate and inaccurate. WHO has developed global training packages on infodemic management, social listening, and risk communications that have been adapted by regional offices to build cadres of trained professionals who can strengthen national and regional capacities to combat mis- and disinformation 5 .
The Disaster Law in public health emergencies program recognizes that legal frameworks play a crucial role in enabling effective responses 3 . The COVID-19 pandemic highlighted how regulations could either facilitate or hinder equitable access to medical countermeasures, with intellectual property laws and export restrictions sometimes preventing timely access to vaccines and treatments in low-income countries.
As we reflect on the hard lessons from COVID-19 and prepare for future health emergencies, the evidence increasingly points to one undeniable conclusion: technical solutions alone are insufficient. The most advanced vaccines, therapeutics, and diagnostics cannot overcome the barriers of distrust, disparity, and disconnection that characterize many health systems.
"Understanding emergence is not solely a scientific endeavour, it is a moral and ethical imperative." - Dr. Marietjie Venter, Chair of WHO's Scientific Advisory Group for the Origins of Novel Pathogens 7
The journey from knowledge to action requires us to bridge worlds that have traditionally remained separate—virology and sociology, immunology and anthropology, clinical medicine and community health. It demands that we value qualitative insights about community trust as highly as quantitative data about viral load, and that we consider equity as fundamental to efficacy in intervention design.
The future of epidemic preparedness isn't just about developing better technologies—it's about building better relationships between health systems and the communities they serve. It's about creating structures that are not only technically proficient but also emotionally intelligent, culturally responsive, and relentlessly equitable. In short, the future of epidemic preparedness must be people-shaped, people-led, and people-centered.