A Review of Interministerial and Local Government Simulation Training on Zoonotic Diseases

Abstract

Objectives

This study aimed to identify limitations in interministerial role allocation and information sharing during the response to the 2025 Brucella canis outbreaks. It also sought to propose practical improvements for the One Health collaboration system through simulation exercises using the joint risk assessment (JRA) tool.

Methods

A tabletop exercise was conducted with 34 interministerial practitioners using scenarios based on actual B. canis cases and social issues in April and August 2025. The effectiveness of the exercise was evaluated using pre- and post-surveys (on a 5-point Likert scale) to assess changes in the participants’ understanding of risk assessment and perceptions of collaboration.

Results

Participants’ subjective understanding of risk assessment improved significantly, from an average score of 2.47 to 3.94 points. The “perception of the importance of interministerial collaboration” received the highest score (4.56 points). While participants gained experience in mediating conflicts between the social impact of pet-borne zoonoses and quarantine priorities, they reported a high cognitive burden during when formulating qualitative justifications for risk characterization.

Conclusions

An effective response to companion animal-derived zoonoses such as B. canis requires systems capable of reconciling interdepartmental differences in risk perception and supporting consensus-based decision-making. The findings suggest that the JRA tool, can serve as practical instruments for strengthening collaborative responses.

Key messages

① What is known previously?

Brucella canis is a zoonotic pathogen primarily associated with dogs, and human infections are likely underreported due to nonspecific clinical symptoms and low clinical awareness and its public health importance is increasing globally and in the Republic of Korea.

② What new information is presented?

A joint risk assessment (JRA) exercise based on canine brucellosis identified intersectoral differences in risk perception and limitations in collaboration, with inconsistencies observed in the timing of information sharing and response prioritization. Following the exercise, risk understanding and collaborative awareness improved.

③ What are the implications?

Applying JRA and strengthening multi-sectoral coordination are essential for managing companion animal zoonoses. Companion animal–specific guidelines and shared information systems are also needed.

Background

1. Occurrence of Brucella canis and the Necessity of a One Health Response

Brucella canis is a zoonotic pathogen for which dogs serve as the primary host. In humans, infection typically presents with non-specific clinical symptoms, and its prevalence has historically been reported as lower than that of other Brucella species [1]. However, according to the U.S. Centers for Disease Control and Prevention and recent studies, concerns are increasing that B. canis infections may be underdiagnosed due to the limited sensitivity of standard serological tests and low clinical suspicion [2]. In regions such as Europe, the risks of B. canis infection and the possibility of unrecognized human cases have been increasingly highlighted [3]. In the Republic of Korea (ROK), following confirmation of B. canis infection in the spouse of a dog breeding facility owner in April 2025, the Korea Disease Control and Prevention Agency (KDCA) and local quarantine departments initiated a joint epidemiological investigation. During this response—an unprecedented case involving pet-derived zoonosis—several practical challenges emerged, particularly in establishing optimal role allocation and ensuring efficient information-sharing mechanisms between departments. These limitations were largely attributable to the existing Joint Epidemiological Investigation Manual for Brucellosis, which was primarily designed for industrial animal quarantine systems (e.g., cattle and sheep) and does not adequately reflect the specific characteristics of pet-borne diseases involving close human contact. Further complications arose in August 2025, when 115 of approximately 300 dogs rescued from a breeding facility in Ganghwa-gun, Incheon, tested positive for B. canis. The incident caused significant social repercussions. While public concern escalated due to reports of animal abuse by 12 animal advocacy groups and intensive media coverage [4,5], interministerial discrepancies remained regarding the timing of information sharing and the prioritization of risk judgment. These experiences in actual response underscored the need for a multisectoral joint risk assessment (JRA) framework that integrates not only technical countermeasures but also social receptivity.

Accordingly, the KDCA reviewed the practical feasibility of the JRA operational tool—collectively developed by World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), and World Organisation for Animal Health (WOAH)—as an alternative to resolve interministerial perception gaps and strengthen practical cooperation measures.

Exercise Design

1. Application of the JRA Tool to Bridge Perception Gaps

JRA is a One Health-based decision-making tool developed jointly by the WHO, FAO, and WOAH. It provides a structured procedure for multisectoral experts to collaboratively analyze transmission pathways and qualitatively assess the likelihood and impact of infectious disease risks (Figure 1) [6].

Figure 1. The 10-step standard procedure of JRA and its four modules.

JRA=joint risk assessment.

To address limitations of the industrial animal-oriented response system and reconcile perception differences among ministries, the KDCA planned a JRA simulation exercise in October 2025. The exercise was based on the 2025 B. canis outbreak in the ROK and incorporated social dimensions such as animal cruelty issues and intensive media coverage to reproduce a decision-making environment similar to real-world situations. The exercise followed a two-stage group composition design. In the first stage, sector-specific group discussions were held to identify the risk perceptions and response priorities across ministries. During this process, distinct differences in perception between the public health and animal quarantine sectors were confirmed. In the second stage, multisectoral mixed groups were formed to jointly map transmission pathways and conduct risk assessments using standard JRA procedures. Through this process, participants experienced a One Health collaboration where they discussed socially sensitive policy options—such as the cancellation of stray dog festivals—based on scientific evidence and derived consensus-based decision results.

Analysis of Key Achievements and Practical Receptivity

The effectiveness of the exercise was evaluated through pre- and post-surveys using a 5-point Likert scale to assess changes in participants’ understanding of risk assessment and perceptions of collaboration. Following the exercise, the average score for the participants’ understanding of risk assessment significantly improved from 2.47 to 3.94 points (n=34) (Tables 1, 2). These findings indicate that One Health-based JRA simulation exercises can serve as a “common language for decision-making” across heterogeneous ministries [6].

Table 1. General characteristics of exercise participants (n=34).

Category	Item	n (%)
Sex	Male	12 (35.3)
	Female	22 (64.7)
Affiliation	Central government	16 (47.1)
	Local government	18 (52.9)
Professional field	Public health/nursing	18 (52.9)
	Animal quarantine	13 (38.2)
	Environment, administration, etc.	3 (8.8)

표 2. 영역별 효과성 평가 및 긍정 응답률(n=34) .

평가영역	긍정 응답률(%)	비고
부처 간 협력 및 의사소통 중요성 체감	97.1	최고 응답률
훈련운영 및 진행 만족도	94.1	전문가 퍼실리테이션 효과
위험평가 이해도 향상	91.2	이해도 2.47점→3.94점으로 향상
타 부처 관점 수용 및 인식 개선	91.2	협업 인식 개선

긍정 응답은 5점 척도 중 ‘그렇다’ 이상 응답 비율로 정의함.

Notably, the “perception of the importance of interministerial collaboration and communication” received the highest rating, with an average score of 4.56 points, indicating a crucial shift in practitioners’ willingness to accept and integrate differing perspectives. Furthermore, higher satisfaction levels were reported in sessions facilitated by experts, confirming the importance of professional guidance in qualitative risk assessment (Tables 2).

Table 2. Comparison of satisfaction by program session and operation (n=34).

Evaluation area	Positive response rate (%)	Remarks
Perception of the importance of interministerial collaboration and communication	97.1	Highest response rate
Satisfaction with exercise operation and progression	94.1	Effect of professional facilitation
Effect of professional facilitation	91.2	Score improved from 2.47 to 3.94
Acceptance of other ministries’ perspectives and improvement in perception	91.2	Enhanced recognition of collaboration

Positive responses were defined as responses of “agree” or higher on a 5-point Likert scale.

Discussion and Policy Implications

The most significant challenge identified during the exercise was the “cognitive burden” experienced by practitioners. Although participants noted that the scenarios—reflecting social repercussions such as reactions from animal advocacy groups and impacts on the local economy—enhanced realism, they expressed considerable difficulty in logically describing the justifications for their judgments during Step 8 of the JRA process, “Risk Characterization.” In particular, when epidemiological investigators acted as facilitators and reframed arguments into scientifically ground questions to guide qualitative judgments, some practitioners described the experience as akin to a “stress interview.” This suggests that practitioners experience substantial burden in writing logical justifications for scientific judgments, suggesting that practical support systems must be reinforced to assist them in the future.

Based on these experiences, the following policy directions are proposed. First, “Joint Response Guidelines Specialized for Companion Animals” should be developed. Existing manuals for joint epidemiological investigations, which focus on industrial animals, must be supplemented with guidelines and risk assessment indicators that reflect the distribution characteristics and social sensitivity of pet dogs.

Second, a “Core Knowledge Base (Fact Sheet) for Each Disease” should be developed for multisectoral use. Despite being provided with standard JRA templates during this exercise, practitioners continued to struggled with qualitative justification. This is analyzed as stemming not merely from issues of narrative style but also from discrepancies in knowledge levels and incomplete prior information regarding the target disease among different departments. During discussions, sectoral differences in perception were revealed. For instance, the public health sector tended to emphasize human-to-human transmission despite clear evidence, whereas the animal quarantine sector underestimated the infection risks associated with intensive breeding environments. These conflicting perceptions act as obstacles to rapid and objective risk level determination. Therefore, to enhance the effectiveness of JRA, the prior sharing of a “One Health Standard Fact Sheet” to reduce interdepartmental perspective gaps is essential, alongside the distribution of templates.

Third, the “Training of Multidisciplinary Professional Facilitators” should be institutionalized. As the assistance of experts was confirmed to be a key driver determining the satisfaction of the discussions, it is necessary to establish a permanent pool of experts managed by the KDCA.

Conclusion

The 2025 B. canis outbreak highlighted the critical importance of addressing perception gaps among government ministries. This exercise demonstrated that the JRA is more than just an assessment tool; it serves as an effective platform for enabling diverse sectors to understand differing perspectives through a shared denominator of scientific data and derive consensus-based risk assessment results. These findings are consistent with previous studies [6-8], suggesting that multisectoral, collaboration-based training plays a significant role in capacity building. The continued accumulation of such practical experience will serve as a valuable national asset in responding to complex emerging zoonotic threats in the future.