Table.

Challenges, and opportunities for epidemic preparedness associated with characteristics of urban settings

	Challenges	Opportunities
High population density and high volume of public transportation	A larger population to be managed; ease of disease spread between humans in congested areas; difficulties in contact tracing, especially causal contact in public areas; inequalities resulting in poor housing environments that might hinder outbreak prevention and control efforts; closer encounters with wildlife via food markets or because of expansion into previously untouched ecosystems	Urban planners can consider epidemic preparedness in their designs and implementation; transport networks can be used to rapidly move supplies to outbreak epicentres; harnessing advancement in technologies for more effective contact tracing
Interface between animals and humans	Areas of poor sanitation with rodents and other animal vectors; live domestic and wild animal markets; animals raised in backyard farms or industrial agricultural facilities in close proximity to humans	Improved sanitation and rodent control around humans and animal communities; vaccination of domestic animals for common zoonotic infections; precautions at slaughter to prevent contact with blood; regulating live animal markets to phase out sale of live animals or to ensure that those for sale are raised on commercial farms and have been verified to be disease free
Governance by local authorities	Competing interests within a finite local budget; insufficient authority to institute response measures promptly; insufficient epidemic preparedness capabilities or capacities at a subnational and local level; difficulties in accessing national capacities	Leaders in cities would be better placed to develop and implement effective and contextually appropriate solutions; consolidated local surveillance data can improve sense-making at the national level; local leaders can be engaged to advocate for greater investments in local systems
Heterogeneous subpopulations	A wide range of cultural factors, including modes of social interactions and acceptable control measures; some subpopulations might be difficult to reach	Community leaders can be mobilised for targeted approaches to preparedness and response; innovative solutions can be shared and adapted across cultures
High connectivity to other urban centres (domestic and international)	High likelihood of multiple importation events; risk of rapid export of disease to other parts of the country or to other countries; fear might lead to restrictions on travel and trade	Evidence-based points of entry measures and exit screening measures can be implemented; trust can be built through strong diplomatic relations to allow for better collaboration
Centres of commerce	Greater disruption to economic activity, stability, and growth	Businesses and corporations can be engaged in business continuity plans that also prevent further spread, as part of a whole-of-society approach
Unconventional communications and interactions	Multiple information sources leading to misinformation; false information might spread quickly	Unconventional but reliable information channels and social media can be used for risk communication