Table 3.

Bottlenecks to detection, notification, and response

	Detection (n=41)	Notification (n=32)	Response (n=56)	Total (n=129)
Laboratory confirmation	4 (10%)	2 (6%)	7 (13%)	13 (10%)
Low awareness or clinical suspicion by health workers	12 (29%)	0	0	12 (9%)
Availability of resources for response initiation or rapid resource mobilisation	0	1 (3%)	9 (16%)	10 (8%)
Reporting failure	1 (2%)	7 (22%)	1 (2%)	9 (7%)
Access issues (event occurred in remote, fragile, or conflict settings)	2 (5%)	1 (3%)	5 (9%)	8 (6%)
Competing priorities (including COVID-19)	3 (7%)	0	5 (9%)	8 (6%)
Human resources gaps for public health	1 (2%)	3 (9%)	3 (5%)	7 (5%)
Limited availability of countermeasures or personal protective equipment	0	0	7 (13%)	7 (5%)
Multi-agency coordination	0	2 (6%)	4 (7%)	6 (5%)
Technological challenge for electronic surveillance or reporting systems (eg, network coverage)	1 (2%)	4 (13%)	0	5 (4%)
Clinical surveillance focal point or capacity	1 (2%)	2 (6%)	1 (2%)	4 (3%)
Delayed specimen collection	3 (7%)	1 (3%)	0	4 (3%)
Low community knowledge or trust	2 (5%)	0	2 (4%)	4 (3%)
One health information sharing or collaboration (eg, between human health and animal health)	2 (5%)	1 (3%)	1 (2%)	4 (3%)
Specimen transportation	0	1 (3%)	3 (5%)	4 (3%)
Weak response coordination, including incident management and rapid response team capacity	0	1 (3%)	3 (5%)	4 (3%)
Data entry delay	2 (5%)	1 (3%)	0	3 (2%)
Failure to conduct early risk assessment or event verification	1 (2%)	2 (6%)	0	3 (2%)
New or unexpected pathogen	1 (2%)	2 (6%)	0	3 (2%)
Sensitivity of community detection	3 (7%)	0	0	3 (2%)
Delay in care seeking by patients	2 (5%)	0	0	2 (2%)
Insufficient clinical case management capacity	0	0	2 (4%)	2 (2%)
Inadequate risk assessments or preparedness plans	0	0	1 (2%)	1 (1%)
Scarcity of diagnostic commodities (laboratory reagents, rapid diagnostic tests, or specimen collection kits)	0	1 (3%)	0	1 (1%)
Logistics and shipment delays	0	0	1 (2%)	1 (1%)
Risk communications or community engagement	0	0	1 (2%)	1 (1%)

Data are n (%).