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This report analyses experiences of five EU countries - Croatia, Finland, Germany, Italy and Spain, from the beginning of the pandemic up until COVID-19 vaccines became available at the end of 2020. The report focuses on testing and surveillance, healthcare sector coordination, and emergency risk communication and identifies specific challenges that were experienced in these areas, as well as successful responses to them. Implications for measuring preparedness are identified to inform outbreak preparedness efforts in the EU Member States in the future.

The analysis identifies the following overarching issues with existing measurement systems for preparedness:

• The COVID-19 pandemic required EU Member States to develop new strategies, approaches and policies related to their PHEP systems and structures under pressure. These also had to be reviewed and revised as the pandemic evolved. The extent of revision and innovation required was not contemplated in existing measurement tools for preparedness.
• Existing measurement tools for preparedness are generally not consistent with a country’s internal hierarchical structure of public health, healthcare, and other entities that influence emergency responses.
• Existing measurement tools for preparedness generally do not reflect the required coordination among different sections of the healthcare system, particularly at the hospital and community-based levels.
• Existing measurement tools for preparedness generally do not allow for adequate flexibility and resilience required to address the challenges of scaling up a country’s pandemic response.