Bonds, bounds, and burdens at the borders
Authors:   , de Rooij Doret 
Published: January 2024

In recent decades, the scale and speed at which humans move around the world has increased dramatically. Countries and their respective points of entry (POE) increasingly need each other to cooperatively fight disease spread along with humans and goods. This thesis aimed to find out how to best train and prepare the POE workforce, including largely from non-health backgrounds, to meet internationally formulated conditions to deal with internationally spreading diseases. Chapter 2–4 were executed in this period.
In Chapter 2, we performed a training needs assessment among representatives of European airports, ports and ground-crossings to assess the priorities and needs of public health professionals involved in the infectious disease control. These results clearly showed that core capacities for PHEP&R were considered important where they covered human health and infectious diseases. In Chapter 3, we translated the requirements on organizational level (capabilities and capacities) to the personal level. We used the RAND-modified Delphi method to design a competency profile for the PH tasks, and restricted our method to airports. Performing infectious disease control in the POE setting requires much more than (public) health knowledge alone, and it is a complex task requiring intense collaboration and communication with POE partners. In Chapter 4, we mapped the available evidence for effective education, training and exercise methods on infectious disease preparedness and response from a public health perspective. We had particular interest in methodologies used in cross-border settings and with a wide geographic reach. The wide-reach methodologies such as online training, combined with practice, showed effective results.
We used the COVID-19 pandemic to learn from the response practice at POE during that crisis period. Chapter 5–7 were executed during the course of this pandemic.
In Chapter 5, we presented the results of interviews held with POE professionals involved in the COVID-19 response in order to develop a guided transition from generic preparedness to specific response situations. Applying a model from crisis response in military practice to public health at POE, we learned how this run-up phase is an important distinct phase to tailor generic preparations to the specific response at hand. In March 2021, we performed two intra-action reviews (IARs) in the Dutch port and airport setting, and evaluated its outcomes, as shown in Chapter 6. The IARs were highly valued by participants, even amidst the challenging time of a turbulent crisis. An important lesson for the organizing team has been that the IAR method needs to be prepared in interpandemic times. One of the main lessons from the discussed studies is how multi-sectoral PH response at POE are. In Chapter 7, we took a public administrative perspective and studied effectiveness of response of the multi-sectoral network. Although airports stated pre-defined plans according to which response situations needed to be handled, the information burden following from the involvement of a wide variety of parties remained extremely complex.
Synthesizing from this thesis’ different studies on different levels, we outlined the multiple dimensions of what capability entails. Furthermore, we have shown that within public health, capability is primarily used as a prescriptive concept, but is not sufficient to ensure good execution of response as well. In the future, it is important to better link preparedness with response. A first step could be to acknowledge operationalization as a separate phase, requiring its preparation and timing.