Public health emergency response through field epidemiology training and rapid response teams – a scoping review

Abstract

Background

Public Health Emergency Workforce (PHEW) plays a significant role in the detection and rapid response to emerging diseases, thus helping countries manage global threats. In line with the International Health Regulations’ call for strengthening national capacities, field epidemiology training programs (FETPs) and rapid response teams (RRTs) have been developed to enhance countries’ preparedness and response capacities. This scoping review synthesizes the evidence on available FETPs and RRTs and on their effectiveness as well as the challenges they face.

Methods

A scoping review was conducted using EMBASE, Ovid Medline and Scopus databases in addition to the grey literature for studies published after year 2000, in the English language. Studies were selected by two independent reviewers and data were extracted into an excel sheet. Included manuscripts were analyzed through a narrative synthesis.

Results

Four thousand one hundred ten studies were identified from the three peer-reviewed databases and six articles from the grey literature. Finally, 67 studies were included in the review comprising 47 identified through our search and 20 sourced from the references. The studies on PHEW training included FETPs encompassing those with laboratory and veterinary focus, and training on rapid response. Enhancement in learning acquired, course satisfaction, application of skills in workplace and engagements in key emergency response activities were found. However, lack of funding and a standardized curriculum were still among the most common challenges facing FETPs and RRTs.

Conclusion

While PHEW training including FETPs and RRTs are essential for building resilience against health threats, financial challenges, lack of standardized curricula and operating procedures hinders their effectiveness. Integrating One Health and laboratory skills into FETPs are vital, as seen during the COVID-19 pandemic response. Governments should work towards increasing funding and incentivizing graduate retention. They should also collaborate with organizations such as the International Association of National Public Health Institutes (IANPHI) and the Global Field Epidemiology Partnership (GFEP) to establish standardized curricula for FETP and RRT.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-27361-w.

Introduction

Rationale

Infectious diseases transcend borders due to increased travel and trade, creating a pressing need for agile public health responses. Outbreaks such as Ebola, Yellow Fever, Zika, and most recently, the COVID-19 pandemic, have underscored the urgency to provide competency-based training to public health emergency workforce (PHEW) to enhance preparedness and effectively manage threats [1–6]. This is further stressed by the World Health Organization (WHO) positing that a trained PHEW is one of the key components to strengthen the architecture of the health emergency prevention, preparedness, response and resilience [7]. Field epidemiology training programs (FETPs) have long been considered the cornerstone of the PHEW training. FETPs are structured, competency-based training programs that build long-term capacity in applied epidemiology, typically delivered over one to two years [8]. FETPs bridge the gap between theoretical knowledge and practical application and equip PHEW with the competencies they need to support timely investigation of disease outbreaks [9]. Complementing FETPs, are rapid response teams (RRTs). RRTs are multidisciplinary teams trained through short induction, refresher courses and exercises for rapid emergency deployment [10]. Many RRT members are FETP graduates, and the programs work synergistically to strengthen national response systems and ensure rapid mobilization when outbreaks or emergencies occur [10, 11].

The Joint External Evaluation (JEE) states, regarding workforce development, that an ‘’optimal target for surveillance is one trained field epidemiologist (or equivalent) per 200,000 population. This workforce development target provides a measurable standard for IHR (2005) human resource compliance and preparedness by countries’’ [12]. Low-income countries especially suffer from a shortage in trained PHEW [13]. According to WHO data in 2006, Sub-Saharan Africa has slightly more than 10% of the world’s population, and bears 25% of the global burden of disease [14]. This is countered only by 3% of the world’s health resources and around 1% of the world’s trained health workers [14, 15]. On the other hand, while North America makes up around 14% of the global population and accounts for only 10% of the global disease burden, it possesses 42% of the world’s health workforce and accounts for about 50% of global health expenditure [15, 16]. This shows the inequitable distribution in trained global health workforce [14], exacerbated by ongoing challenges in educating and improving performance of PHEW [17, 18]. In a recent report by WHO/AFRO, it was estimated that “less than 10% of countries in the African Region have optimal and sustainable human resources to detect and respond to public health emergencies […], especially within Rapid Response Teams” [19]. Even globally, and while RRTs offer a comprehensive multidisciplinary approach required for successful outbreak response, the COVID-19 pandemic revealed that many RRT programs are not fully functional, largely due to understaffing, lack of infrastructure and financial constraints [20]. Despite the fact that both FETP graduates and RRTs had been deployed intensely during the Covid-19 pandemic, there is a limited understanding of the existing gaps, as well as the sustainability and scalability of this training beyond their immediate response. In terms of geographical distribution, there is also little evidence on the functionality and operational readiness of RRTs. Thus, evidence-based research analyzing FETPs and RRTs training, as well as identifying existing gaps is needed to inform best approaches for capability building of an integrated, multidisciplinary and multisectoral PHEW as a strategy to increase pandemic readiness.

Aim and objectives

The aim of this scoping review is to synthesize the evidence on the curricula, diversity, geographic distribution, involvement in emergency response, and challenges of FETPs and RRTs. We also summarize the evidence on their effectiveness including comparing FETP curricula to the needs highlighted by the COVID-19 pandemic, and identifying existing gaps and challenges that FETPs and RRTs face, which require attention to enhance pandemic readiness.

Methods

Eligibility criteria

The inclusion/exclusion criteria of the studies in this scoping review were based on the PCC (Population, Concept, Context) framework (See Table 1) [21].

Table 1.

Inclusion and exclusion criteria

Category	Inclusion criteria	Exclusion criteria
Population	Public health emergency workforce (PHEW). This refers to the multidisciplinary workforce responsible for delivering essential public health functions and supporting preparedness, response, and recovery during health emergencies [7, 22].	Healthcare workers (clinicians, nurses,..etc.)
Concept	Field Epidemiology training programs and initiatives, including those incorporated into academic programs, in addition to rapid response teams training. PHEW training in response to COVID-19. Also, any articles presenting gaps or challenges in these training programs	Any article not specifying the training programs of interest (generally talking about importance of educating public health workforce but not about FETP/RRT training in particular) Articles describing response efforts to an emergency without mentioning FETPS/RRT or PHEW academic training in response to COVID-19 Other public health academic training not related to FETP/RRT or not responding to COVID-19
Context	Health emergency settings globally	Non-emergency settings, non-communicable diseases
Study design	Reviews and observational studies including cross-sectional, and qualitative research. Analytical studies such as cohort, case–control, and analytical cross-sectional studies	Conference abstracts and commentaries
Language	English language studies	Language other than English
Dates	Publication date in or after 2000	Publication date prior to 2000

Information sources

This review was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines (Additional file 1) [23]. EMBASE, Ovid Medline and Scopus were searched from 2000 to 2022 to identify peer-reviewed articles, and google search engine was used to identify grey literature. The search was limited to English language literature.

Search

The research question included four concepts of search terms that were used for the search strategy (Public health workforce, emergency, training, programs). A comprehensive list of relevant synonyms and MeSH terms was used for each term. An additional file shows the final search strategy (see Additional file 2). A reference list of the studies that were selected was also reviewed to identify and include relevant references. The final search results were exported into excel sheet for screening and duplicates were removed. Mendeley was used for referencing.

Selection of sources of evidence

Six reviewers (DY, MB, JK, SJ, HA, EM) contributed to the screening process. Each article was independently screened by two reviewers during both title/abstract and full-text reviewing stages. The number of articles at each stage, along with the reasons for study exclusion is presented in the PRISMA flowchart (Fig. 1). Disagreements at any stage were first discussed between reviewers; if consensus could not be reached, disagreements were resolved by a third reviewer (CEB).

Fig. 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram

Data charting process/items

A data extraction tool was developed as an excel sheet (see Additional file 3). The following variables were extracted: Category, title of study, author, study aim, study design, study year, country, name of the training program/initiative, aim of the program, name of the organization/university/institute that developed the program, network, program/initiative description, curriculum modules or competencies or activities, suggested needs and methods, gaps/challenges, evaluation indicator, outcome of the program or evaluation, audiences, funding, criteria to recruit participants, and number of people trained.

Synthesis of results

Included articles were analyzed using narrative synthesis. We grouped and summarized the results according to the types of training (either field epidemiology training or RRTs training). Then we presented the evidence on effectiveness of each type of training and the existing gaps.

Results

Study selection

Initially, 4110 peer-reviewed studies and six grey literature articles were identified. Figure 1 presents the PRISMA flow diagram for the studies included in this review. In total, 47 studies meeting eligibility were selected to be included. In addition, 20 eligible references were identified through reference harvesting. Therefore, a total of 67 studies were included in this review.

Characteristics of sources of evidence

Study characteristics such as title, author, year, aims and objectives for each study are represented in Additional file 3. Evidence on FETPs and RRTs came from almost all regions of the world and covered training types, effectiveness, and curricula gaps and challenges.

Types of PHEW training

Four types of PHEW training programs were identified in this scoping review: A) Field Epidemiology Training Programs (FETPs) —competency-based programs aimed at training the PHEW in field epidemiology and other public health competencies [8, 24]. —, B) Field Epidemiology Laboratory Training Programs (FELTPs) —train epidemiologists alongside laboratorians so both can gain mutual understanding of each other’s disciplines [25]. —, C) Field Epidemiology Training Programs for Veterinarians (FETPVs) —public and animal health professionals are trained and cooperate to respond to any zoonotic outbreaks [8]. —, and D) Rapid Response Teams (RRT) Training —multidisciplinary public health experts trained and ready to rapidly mobilize when there is a public health emergency [10]. These training programs are often hosted by ministries of health (MoH) in collaboration with public health institutes, academic institutions, and regional and international organizations such as the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET).

Field Epidemiology Training Programs (FETPs)

FETPs are mostly structured along three levels: basic or frontline (3 months) to strengthen epidemiologic capacity at the district level [26], intermediate (9 months) to train the middle level of public health professionals [27], and advanced courses (2 years). Some countries offer all three levels, while others only offer one or two depending on the context, local needs and available resources. [8] We found that most frontline FETPs were implemented in Sub-Saharan Africa, including 24 countries [28–31], mostly as a result of the 2013–2015 Ebola epidemic in West Africa [32]. Differently from other FETPs, the FETP of Papua New Guinea has a different structure consisting of five training phases over 8 months which was preferred over a traditional 2-year program in order to rapidly address capacity needs [33]. Further details about other FETPs [34–39] are available in Additional file 3.

Some FETPs were incorporated into university degrees, fellowships or a residency to build sustainable programs, such as in Jordan [40], Zimbabwe [41], Australia [42], Uganda [43], India [44], Spain [45], and the fellowship program provided by the European Center for Disease prevention and Control [46].

Regionally, a three-levels FETP was identified in five Mesoamerican countries: Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and the Dominican Republic [47]. The fellows not only responded to outbreaks, but also to natural disasters. Another regional program is the 2-year FETP of the Indian Ocean Commission countries (FETP- OI) which are Comoros, Madagascar, Mauritius, Reunion (France) and Seychelles [48].

Field Epidemiology and Laboratory Training Programs (FELTPs)

Field Epidemiology and Laboratory Training Programs (FELTPs) incorporate laboratory training as part of their core training curricula. FELTPs were identified mainly in Sub-Saharan Africa [49–53]. The Nigeria FELTP program is an example that aims to enhance collaboration among epidemiologists and laboratorians in the context of One Health [54, 55]. It also allows clinicians to train with veterinarians during field assignments [55]. Another example is the Namibia Field Epidemiology and Laboratory Training Program that resulted in an effective response to disease outbreaks such as Crimean-Congo hemorrhagic fever and Anthrax among hippopotamus in Bwabwata National Park, Namibia [56]. An additional file shows more details about other FELTPs and programs achievements (see Additional file 3).

Field Epidemiology Training Programs for Veterinarians (FETPVs)

In our review, Southeast Asia is the only identified region currently offering a regional training program for veterinary epidemiology in Bangladesh, Bhutan, Cambodia, China, Indonesia, Lao People's Democratic Republic, Malaysia, Myanmar, Nepal, Philippines, Thailand, and Viet Nam [57]. The most recently implemented FETPV was in Bangladesh in 2020 [58].

Rapid Response Teams (RRTs)

After the West-African Ebola outbreak in 2014/15, RRTs experienced a surge in attention as well as financial support, not only in LMICs, but also in many high-income countries like the United States, the United Kingdom (UK), Canada, and Germany [59–61]. In regions such as Africa, Asia, and the Middle East, public health organizations, e.g. the West African Health Organization, Eastern Mediterranean Public Health Network (EMPHNET), and WHO, played a significant role in facilitating the creation and training of RRTs as part of pandemic preparedness programs [62–64]. RRTs were also trained to respond to public health emergencies and conducted field investigations during the H1N1 pandemic in 2009 [65]. National RRTs operated within individual countries, coordinating emergency responses, allocating resources, and collaborating with international partners [66, 67]. Specifically during and after the West-African Ebola outbreak, RRTs received extensive training based on the WHO Ebola Virus Disease Consolidated Preparedness Checklist [68]. RRTs have also been involved in responding to other disease outbreaks such as the investigation of suspected Lassa fever cases in an Ebola-affected region in Liberia [69].

PHEW training and Covid-19

The importance of FETPVs training was highlighted by the COVID-19 pandemic. In March 2020, it was agreed that a new strategic plan for the Southeast Asia FETPV needed to be developed in order to improve the epidemiological capacity of the national veterinary services [57]. Since contact tracing was crucial during COVID-19, many initiatives were established. For instance, in the USA, Butler County General Health District contracted Miami University to improve capacity building in contact tracing [70]. The Penn State College of Medicine [71] and University of California also implemented contact tracing initiatives [72]. Similarly, the Robert Koch Institute (RKI) in Germany created the Containment Scout Initiative to tackle the need for contact tracing. [73] Contact tracing also became one major surveillance activity that often actively made use of FETP graduates, such as in Yemen FETP [74]. Other FETPs contributed in the response to COVID-19 [42, 74–77].

So far there is limited evidence regarding the role and impact of RRTs during the COVID-19 pandemic. In one paper, operational challenges during Covid-19 were reported to have limited the availability and reduced the safety of RRT members during deployment [78]. Another Covid-19 specific challenge was around travel during lockdowns, resulting in delays [61]. Our review identified one paper that talked about the provincial RRT training in Papua New Guinea during Covid-19 [79].

Effectiveness of the training programs

Many of the studies included in the review evaluated the effectiveness of FETPs/RRTS using the Kirkpatrick model for training evaluation [80], however, none of these studies followed specific criteria to evaluate FELTPs. These evaluations were based on the four levels of the model, in addition to one extra outcome found. These are learning acquired, behavior, reaction, results of training and impact on career or educational level.

Effectiveness of the FETP training

The learning acquired (knowledge, skills, or competencies)

Many evaluation studies observed improvements in competency scores [29, 31, 81–85] and in self-perceived abilities [86–88], besides increase in awareness of COVID-19 symptoms [89]. This type of evaluation helps countries to identify areas of improvement in curricula [85, 90].

Behavior (Application of learned skills in workplace)

Participants in many FETP training reported that skills learnt in practices positively affected their worksites [30, 82, 87] and allowed them to conduct most field epidemiology activities [91].

Reaction (course satisfaction)

The graduates of one FETP training reported course quantity as rather short or fair, while fieldwork duration was evaluated as right among the majority of participants. [85].

Results of training (in terms of targeted outcomes and engagement in key activities)

Based on FETP training, graduates were found to engage in key activities such as surveillance activities [29, 81, 84], emergency response activities [29], outbreak investigations [74, 81, 82, 85, 91, 92], risk communication efforts [74], data analysis and epidemiologic report writing [82].

Impact on career or educational level

FETPs were seen as beneficial towards future career advancements [82, 85, 87]. However, in some cases, the participants’ jobs are filled after they start the training, sometimes leaving fellows in lower-ranking positions after graduation [82]. This highlights the necessity to monitor career progression and recognizing FETPs as a requirement for hiring and promotion decisions.

An additional file shows further details of the indicators assessed and the evaluation outcomes (see Additional file 4).

Effectiveness of RRTs deployments

In the Eastern Mediterranean Region (EMR), effectiveness of RRT training in increasing skills and competency scores had been shown as well as great satisfaction with the training [62]. These RRT training have addressed issues related to the composition of an outbreak team, intersectoral coordination, surveillance systems, outbreak investigation and control measures, risk assessment, risk communication, role of the laboratory in outbreak investigation, biosafety and biosecurity, data management and report writing, and soft skills [62]. In Angola, RRTs reported using the skills and knowledge learned in a comprehensive functional exercise in Pambala [67]. The training was evaluated as valuable and that it increased the knowledge and self-perceived abilities among participants [67]. The evaluation of RRT training in Papua New Guinea during the COVID-19 pandemic showed that most participants agreed that the RRT outbreak manual was useful, and that the content was relevant to their work [79].

Gaps and challenges

Gaps and challenges in FETPs/FELTPs/FETPVs

Challenges in curricula

Gaps related to the curriculum such as lack of health economics [91] and laboratory modules were found in EMR FETPs, with Pakistan being reported to be the only country in the EMR that included the laboratory component to FETP [88]. Also, a lack of standardized curriculum for laboratory training was found among FELTPs programs [25]. One study emphasized the importance of collaboration between laboratory scientists, geneticists, economic experts and informaticians in the field of molecular epidemiology [93]. Inadequate data analysis and computer skills training were observed in Guinea [29], Zambia [39] and India [85] FETPs. Global surveys among epidemiologists also reported lack of communication and cultural skills [94, 95]. These surveys found training gaps in emergency response surveillance, specifically in community-based and syndromic surveillance, as well as in leadership and management capacities [94] and lack of standardized curriculum for public health emergency response training [96]. Further gaps that were identified are summarized in additional file 3.

Job placement of graduates

Challenges of job placements and retention of graduates were reported in EMR FETP [91], Democratic Republic of the Congo (DRC) FETP [82], Yemen FETP [97] and Nigeria FELTP [54]. In some countries, for example South Africa, policies do not support paid leave, which forces professionals to either resign from their posts to enroll into the program, or decline the training offer [51]. Also, there are no clear career pathways for FELTP graduates within the departments of health, leading to many joining private organizations later on. Such situations compromise the FELTP goal of strengthening human resource capacity within the public health system [51].

Funding

Since funding of FELPTs in LMICs mainly depends on donors, with little or no government financial support, FELTPs in Kenya [53] and Nigeria [54], Yemen FETP [97], and the Uganda Public Health Fellowship Program [43] face budget restrictions and financial challenges [25]. Similarly, some FELTPs were stopped due to lack of funding, e.g. in Gambia, Mauritania, and Cote d’Ivoire [50]. Before revitalization of Indonesia’s FETP, weak linkages with universities and health departments compromised the financial sustainability of programs. However, revitalization of the program by incorporating it within government structures for workforce planning and budgeting are shown to be critical for building a sustainable high-quality program and maintain funding [90].

Gaps and Challenges of RRTs

Organizational challenges

Main challenges that were reported regarding establishing and managing RRTs include challenges in developing and maintaining a functional RRT roster in addition to lack of a standardized competency-based training. These challenges can lead to critical delays in outbreak response [98]. Further challenges that were reported include the composition and size of teams, development and adherence to standard operating procedures for training and deployments, ensuring rapid response times, ensuring the safety of team members in high-risk areas, addressing geographical barriers, and securing adequate funding for missions [98].

Infrastructure challenges

The lack of logistics hubs and adequate infrastructure within the African region was reported to be a big challenge that limits the availability of emergency supplies and stockpiles and also exacerbates response time [98]. Instead of the foreseen rapid response time of 24 to 48 h, it can take up to 20 days before countries receive much needed supplies [19].

Other challenges

Ongoing regional conflicts in outbreak affected areas (e.g. Ebola in North Kivu (DRC)), emergence of co-infections and outbreaks of other infectious diseases were also reported to hamper the impact of RRT response activities [99]. Further, RRTs have been reported to face challenges regarding cultural sensitivity, effective communication, as well as gaining trust of the communities [98].

Discussion

Summary of evidence

This review summarized the evidence on PHEW training including field epidemiology and RRTs and their curricula. It also reported on training evaluations and highlighted the existing gaps. Overall, 67 studies met the eligibility criteria and were included in the review. While both FETPs and RRTs contribute to epidemiological capacity and outbreak response, they serve distinct purposes. FETPs are comprehensive training programs aimed at building long-term epidemiological capacity, whereas RRTs are specialized teams activated for rapid response during emergencies. The most common field epidemiology training found were FETPs, while more FELTPs were found in Sub-Saharan Africa [25, 49, 50]. The deployment of FETP trainees and alumni in public health emergencies, such as the Ebola outbreak in Liberia [92] and the COVID-19 response in Yemen, Uganda, India, and Australia [42, 74–77] highlights the strength of FETPs’ experiential, on-the-job training model, which equips participants to actively contribute to both national and international response efforts. The example of Jordan FETP engagement in gathering data on refugees indicates that not only disease outbreaks but also humanitarian crises make use of FETPs fellows [85]. FETPs of the Mesoamerican countries are another good example showing the importance of FETPs fellows in responding to other crises such as natural disasters [47]. The review also found an increase in the RRTs training in both low- and high-income countries especially after the Ebola outbreak in west-Africa.

While most of the studies evaluating the training showed improvements in skills and reported high course satisfaction, some training’s gaps were identified in this review. The findings of the review emphasize the need for more laboratory training, as some countries had discontinued their FELTP programs, mainly due to financial restrictions and lack of a standardized curriculum [25, 50, 88]. This aligns with the results that only one country in the EMR, Pakistan, reported training in laboratory skills [88]. Among the included studies, few curricula included veterinary epidemiology modules. Also, only one region offering a veterinary epidemiology training program was captured in this review [57]. This reflects the need for increasing the capacity in veterinary epidemiology since previous studies have shown its benefits in response to COVID-19 [100].

Despite the importance of contact tracing and IPC skills in response to the COVID-19 pandemic, a lack of training on these topics within FETPs curricula were identified in this review [88]. This underlines the need to incorporate contact tracing training through FETPs since a previous systematic review has shown its effectiveness in reducing infectious disease cases [101]. It also highlights the need to conduct more research on the capacity of contact tracing training and whether their curricula are standardized or not. Moreover, this review showed that funding is a main challenge for all PHEW training sustainability. Although FETPs/FELTPs are prestigious training, there are still gaps in graduates’ retention in their positions after the training, leading to inadequate applicability of learned skills in their countries [54, 82, 97].

Rapid response teams are at the forefront of public health emergencies and outbreak response. However, before the West-African Ebola epidemic and more recently the Covid-19 pandemic, RRTs on the national level were often improvised, non-formalized and tended to disappear after the interventions ended [20].

Recommendations

Given the limited representation of veterinary epidemiology training identified in this review, it is recommended that animal health perspectives be more systematically integrated into FETPs and FELTPs. Strengthening this component would support a more comprehensive approach to zoonotic disease detection, investigation, and preparedness within the broader One Health framework. To support this, the UN Food and Agriculture Organization has developed core competencies and guidelines to facilitate the developments of such training [102, 103]. Laboratory skills such as genomic sequencing and surveillance were crucial during the COVID-19 response to monitor the emergence of new variants [104, 105]. Thus, FETPs training should consider incorporating a genomic component to help epidemiologists interpret and apply genomic results. WHO has developed a “Global genomic surveillance strategy 2022–2032” [106]. One of its main objectives is rolling-out training packages in genomics and bioinformatics to improve competencies and strengthen programs for workforce development.

Since PHEW training differ between countries worldwide in terms of their curricula, governments in collaboration with organizations such as the International Association of National Public Health Institutes (IANPHI) [107] and the Global Field Epidemiology Partnership (GFEP) [108], may work toward establishing standardized curricula for FETPs and RRTs. To ensure workforce retention, MOHs may consider not only financial incentives but also broader strategies such as providing clear career pathways, more opportunities for continued training and professional development and integration of FETPs/FELTPs graduates into permeant public health roles. Since many FELTPs in low- and middle-income countries face financial challenges due to heavy reliance on external donor funding, it is recommended that governments explore more stable domestic funding mechanisms. Also, incorporating FELTPs within key MOH’s department structures for workforce and financial planning may also enhance long-term sustainability. Strengthening collaborations with universities and international partners may also help diversify funding sources. While countries may consider financial intermediary funds that support pandemic preparedness, and response, the primary focus should remain on building resilient and locally supported systems to reduce dependency on external funding sources [109].

Countries should also establish a well-functioning RRT roster and enhance the infrastructure to improve RRT management. The US Centers for Disease Control and Prevention (CDC) recommends establishing formal Rapid Response Teams (RRTs) at both national and subnational levels, integrated within public health systems. This includes defining roles, developing standard procedures, maintaining trained personnel rosters, and conducting regular training and simulations. The guidance also stresses the need for clear leadership and strong links to emergency coordination systems to ensure timely outbreak response [10].

Strengths and limitations

To the best of our knowledge, this review is the first to synthesize the evidence on FETPs and RRTs globally. The review followed a systematic search strategy to comprehensively map the available evidence. However, as our search was limited to the English language, we could have missed topic-relevant literature published in other languages. Although a more detailed search of the grey literature was not feasible due to time restrictions, most of the grey literature found reported similar types of programs as those identified from peer-reviewed databases. Further, study selection was conducted by five independent reviewers, while other reviewer helped in resolving disagreements to decrease risk of bias in study selection. The included studies ranged in publication dates from 2000 to 2022, and more recent papers may include new PHEWs training being implemented such as contact tracing training and FETVPs.

Conclusion

Competency-based training for the PHEW is essential in strengthening national capacity for the prevention, preparedness, response to health emergencies. Evidence from this review indicates that FETPs and RRTs improve technical knowledge, facilitate practical application of skills, and increase engagement in key outbreak response activities, highlighting their vital role in pandemic control. However, standardizing training programs, securing funding, ensuring workforce retention, integrating veterinary and laboratory components, and enhancing infrastructure are all needed to scale up these training programs. Addressing these gaps will strengthen PHEW capacity to respond to future zoonotic and infectious disease threats.

Abbreviations

PHEW

Public Health Emergency Workforce

FETPs

Field Epidemiology Training Programs

RRTs

Rapid Response Teams

JEE

Joint External Evaluation

IHR

International Health Regulations

WHO

World Health Organization

PCC

Population, Concept, Context

PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

FELTPs

Field Epidemiology Laboratory Training Programs

FETPVs

Field Epidemiology Training Programs for Veterinarians

EMPHNET

Eastern Mediterranean Public Health Network

TEPHINET

Training Programs in Epidemiology and Public Health Interventions Network

MoH

Ministries of Health

FETP- OI

Indian Ocean Field Epidemiology Training Program

UK

United Kingdom

CDC

Centers for Disease Control and Prevention

DRC

Democratic Republic of the Congo

IPC

Infection Prevention and Control

EMR

Eastern Mediterranean Region

IANPHI

International Association of National Public Health Institutes

GFEP

Global Field Epidemiology Partnership

Authors’ contributions

DY was the lead literature reviewer and developed the study protocol. Six reviewers (DY, MB, JK, SJ, HA, EM) contributed to the screening process. Each article was independently screened by two reviewers during both title/abstract and full-text reviewing stages. Disagreements at any stage were first discussed between reviewers; if consensus could not be reached, disagreements were resolved by a third reviewer (CEB).. All authors contributed to the drafting of the manuscript, interpretation and communication of the results. CEB supervised the research project.

Funding

Open Access funding enabled and organized by Projekt DEAL. This project was funded through a grant from the German Federal Ministry of Health. The funder had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.