Country report, ECDC public health emergency preparedness assessment for Iceland, 2025 : under Article 8 of the Regulation (EU) 2022/2371.
Date: 2025-10-14
Institutions: European Centre for Disease Prevention and Control, Lindmark, Sandra, Menel-Lemos, Cinthia, Reyes-Urueña, Juliana, Silvestros, Valentinos, Taha, Zara
Subjects: EU reference laboratory, Iceland, antimicrobial resistance, crisis management, cross-border dimension, disease surveillance, emergency aid, emergency medical treatment, environmental risk prevention, hospital infection, report, zoonosis

ASSESSMENT

Country report: ECDC Public 
Health Emergency Preparedness 
Assessment for Iceland, 2025

Under Article 8 of the Regulation (EU) 2022/2371

ECDC ASSESSMENT 

Country report: ECDC Public Health 
Emergency Preparedness Assessment for 
Iceland, 2025 

Under Article 8 of the Regulation (EU) 2022/2371 

i 

Contributing authors 
Agoritsa Baka (ECDC), Bruno Ciancio (ECDC), Carmen Varela Santos (ECDC), Daniel Cauchi (ECDC), Jessica Beser 
(ECDC), Juliana Reyes-Urueña (ECDC), Pete Kinross (ECDC), Zara Taha (ECDC), Cinthia Menel-Lemos (DG SANTE, 
European Commission), Sebastiano Lustig (DG HERA, European Commission), Sandra Lindmark (WHO Regional 
Office for Europe) and Valentinos Silvestros (country expert, Ministry of Health, Cyprus) 

Acknowledgements 
The assessment team would like to thank Guðrún Aspelund (Chief Epidemiologist), Tryggvi Oddsson, Íris 
Kristinsdóttir and Guðlín Steinsdóttir for coordinating the Public Health Emergency Preparedness Assessment of 
Iceland at the national level, and all the country experts that participated in the discussion and supported the process. 

Suggested citation: European Centre for Disease Prevention and Control. Country report: ECDC Public Health 
Emergency Preparedness Assessment for Iceland, 2025. Stockholm: ECDC; 2025. 

Stockholm, October 2025 

ISBN 978-92-9498-825-6 
doi: 10.2900/1830261 
Catalogue number TQ-01-25-055-EN-N 

© European Centre for Disease Prevention and Control, 2025 

Reproduction is authorised, provided the source is acknowledged.  

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ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

Contents 
Contents ...................................................................................................................................................... iii 
Abbreviations ............................................................................................................................................... iv 
Executive summary ........................................................................................................................................ 1 
Introduction .................................................................................................................................................. 4 
Background and legal basis........................................................................................................................ 4 
Aim and objectives .................................................................................................................................... 4 
Assessment process .................................................................................................................................. 5 
Recommendations ................................................................................................................................ 5 
Findings and recommendations per capacity ............................................................................................... 6 
Capacities assessed in depth .................................................................................................................. 6 
Other capacities not assessed in-depth ................................................................................................. 14 
Conclusions ................................................................................................................................................. 22 
Annex 1. List of capacities included in the assessment ..................................................................................... 23 
Annex 2. Practical arrangements for the assessment process ........................................................................... 24 

Tables 
Table 1A. List of capacities included in the assessment .................................................................................... 23 

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Abbreviations 

EEA 

EC 

EU 

IHR 

European Economic Area 

European Commission 

European Union 

International Health Regulations (2005) 

SCBTH    

Serious Cross-Border Threats to Health  

SPAR 

State Party Self-Assessment Annual Report 

IHR NFP  

National IHR Focal Point 

PoE  

MAST 

MCM 

NIA 

NAATs 

IVDR 

WGS 

BSL 

ISAC 

SOP 

NRL 

Points of Entry 

Icelandic Food and Veterinary Authority 

Medical countermeasure 

National IHR Authority 

Nucleic Acid Amplification-based Tests 

Regulation on In Vitro Diagnostic medical devices 

Whole Genome Sequencing 

Biosafety Level 

Icelandic Service for Accreditation 

Standard Operating Procedure 

National Reference Laboratory 

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ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

Executive summary  

Introduction  
The aim of the Public Health Emergency Preparedness Assessment, as mandated in Article 8 of the Regulation (EU) 
2022/2371 on serious cross-border threats to health, is to improve prevention, preparedness and response planning 
in EU/EEA countries through the implementation of recommendations following individual country assessments. As 
specified in the Regulation, each EU/EEA country will undergo an assessment every three years, with the first cycle 
of these occurring between 2024 and 2026. 

This report presents the findings and recommendations of the first assessment conducted in Iceland. This 
involved a desk review of relevant documents, followed by a five-day country visit that took place between 2 
June and 6 June 2025. As per the assessment methodology, all of the 16 capacities included in Article 7 of the 
Implementing Regulation (EU) 2023/1808 self-assessment template were assessed, with five of them considered 
in depth: Health Emergency Management (Capacity 6); Laboratory (Capacity 3); Surveillance (Capacity 4); 
Antimicrobial resistance (AMR) and healthcare-associated infections (Capacity 12) and Zoonotic diseases and 
environmental threats (Capacity 10). 

Key findings  
Iceland’s health system is a state-centred, publicly funded system with universal health coverage. The main bodies 
responsible for health policy, financing, planning and regulation are Parliament (Althingi) and central government 
via the Ministry of Health (MoH) and the Ministry of Finance and Economic Affairs (MoF). The MoH has major 
policy-making and executive authority, while its agencies – including the Directorate of Health (DH), Iceland Health 
(Sjúkratryggingar Íslands), the Icelandic Medicines Agency (IMA) and the Icelandic Radiation Safety Authority 
(IRSA) – are responsible for executing health policy, administration, and supervision.  

The Health Services Act provides for the organisation of healthcare services, which are predominantly public. The 
Directorate of Health supervises healthcare services in Iceland, as per the Act on the Medical Director of Health 
and Public Health. The Chief Epidemiologist is responsible for disease control and preventive measures against 
epidemics, as required under the Act on Health Security and Communicable Diseases (Act (No 19/1997) and is 
accountable directly to the Minister of Health. Iceland is divided into seven healthcare regions for organisational 
purposes with a healthcare institution, which is responsible for providing healthcare within the region and separate 
funding to cover for certain administrative responsibilities. Landspítali University Hospital in Reykjavik is the 
country's largest university hospital, while Akureyri Hospital is the back-up hospital, as mandated in regulation no. 
1111/2020. This role is currently under revision.  

There is a strong collaborative culture within and across sectors, resulting in the rapid exchange of information and 
effective public health decision-making and action in response to various types of event. Such collaborations 
undergo frequent testing in response to natural events, which are common in Iceland. This has resulted in a strong 
and consolidated mechanism for preparing and responding to all-hazard incidents with an emphasis on natural 
disasters. The health sector collaborates closely with civil protection at all levels. Public health preparedness and 
surveillance are mostly coordinated at the national level, while response activities are carried out both regionally 
and nationally. These preparedness and response tasks and activities are less consistently executed within 
healthcare services, as they are not always perceived as part of the tasks of healthcare providers and regions do 
not have enough human resources to assign directly to public health tasks. Furthermore, some roles and 
responsibilities in the country’s public health infrastructure could be better defined and formalised to ensure clear 
accountabilities and avoid overlapping. Ways to improve the public health infrastructure of Iceland include:  

Integrate public health requirements in the routine healthcare provision process by involving district 
physicians more in meetings/seminars/simulation exercises, sharing of surveillance feedback, 
acknowledging the public health impact of their work, and planning of dedicated budget for their public 
health activities.  

Increase capacities for public health preparedness and response at the Chief Epidemiologist office, and the 
overall epidemiological workforce (e.g. by participating to EU training activities such as EPIET, EUPHEM, or 
MS-Track). 

Assess which of the ongoing informal collaborations require to be formalised in the pandemic preparedness 
plan to ensure business continuity, resilience, and timeliness across sectors.  

Ensure that roles and responsibilities for key public health functions at national and local level are 
formalised, including for surveillance, prevention, preparedness, response, quality assurance and evaluation. 

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Main recommendations for each capacity assessed in depth 

Health emergency management (Capacity 6) 
• 

Formalise the response process and communication among stakeholders (suggest checklist or standard 
operating procedures (SOPs)).  
Strengthen intersectoral collaboration for preparedness planning at national level by conducting a 
stakeholder mapping and formalising their involvement. 
Ensure that the upcoming legislation provides for regular reviews of preparedness plans at all levels based 
on an all-hazard all-country risk prioritisation exercise, and that it foresees cycles of simulation exercises. 
Develop or adopt/adapt a rapid risk assessment process/methodology in response to health-related events 
for effective communication of the risk with stakeholders (e.g. shared templates by other member states).  
Reinforce public health competence in the national operations centre and improve the situation awareness 
tools (e.g. bed capacity, ICU coverage, workforce, cases, deaths, tests performed etc). 
Develop tools to monitor supply and estimate demand of crisis-relevant MCM. The relevant tools should 
collect information for all relevant types of products that fall under the definition of crisis-relevant MCM. 
Develop a specific methodology to compile the list of items of crisis-relevant medical countermeasures to be 
included in a strategic stockpile.  
Develop a sustainable management plan for national strategic stockpiles of MCMs, including operational 
SOPs (deployment and reception of medical countermeasures).  
Continue the ongoing legislative work to support achievement of six-month supply of critical MCMs.  
Continue to participate in EU-level and global activities related to joint procurement or advance purchase 
agreements. 

Laboratory (Capacity 3) 
• 

The designation of the national reference laboratory (NRL) at Landspítali University Hospital should be 
supported by appropriate legislation and the necessary budget to fulfil its public health role in notifiable 
disease diagnostics and surveillance. 
Define the role of the NRL in the context of the national pandemic preparedness plan to ensure that the 
laboratory requirements are properly accounted for and ensure that a clear strategy for scaling up 
laboratory capacity in emergency situations is part of the plan. 
Create a national laboratory network through a formal cooperation framework in which the NRL shall 
oversee, coordinate, and support all regional public and private laboratories to ensure harmonised quality 
standards, reliable diagnostics, and efficient information exchange. Ensure sustainable funding for the 
national laboratory network to maintain and further develop laboratory capacity and capability, including 
training, tools, and infrastructure for next generation sequencing and bioinformatics. 
Prioritise the work of unifying the electronic laboratory systems, also connecting the regional laboratories. 
The same goes for the animal sector, where work needs to begin on developing and implementing an 
electronic reporting system that can eventually connect to the human side.  
Start the development of a national sequence database and mechanisms for sharing sequence data 
between the NRL and the Chief Epidemiologist, with flexibility to also expand to include all One Health 
sectors to allow for integrated surveillance and outbreak management. 

Surveillance (Capacity 4) 
• 

Develop standardised reporting procedures through the development of national reporting protocols aligned 
with EU surveillance requirements. These protocols should define disease-specific objectives, required data 
elements and formats, and the frequency of reporting. 
Develop a comprehensive data infrastructure and standardised process models to support interoperability, 
integration, and linkage between the updated clinical notification system and other key databases – for 
example laboratory information management systems (including the timely reports from the laboratory at 
Akureyri Hospital), vaccination registries, vital statistics, electronic medical records, and data needed for 
One Health analyses. 
A contact tracing platform should be developed and integrated into the surveillance system. 
Establish a primary healthcare-based sentinel surveillance system for acute respiratory infections, with 
integrated microbiological surveillance of influenza, RSV, and SARS-CoV-2 to help capture data on mild 
respiratory infections and enhance early detection of emerging pathogens.  
Continue monitoring the quality of surveillance data from ICD-10 codes, striving for representativeness by 
age and place, and conducting system evaluations when performance issues are noted. 
Reintroduce disease-specific thresholds and early warning indicators, particularly for respiratory viruses to 
enhance the system’s ability to respond promptly to emerging health threats. 

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Antimicrobial resistance and healthcare-associated infections 
(Capacity 12) 
• 

Secure sustainable multi-year funding and involvement of relevant Ministries to implement and monitor the 
One Health National Action Plan (NAP) for AMR, including the multi-sectoral programmes for ‘information 
dissemination, education and prevention’ (NAP Action 2). 

• 

• 

• 

• 

Strengthen and expand antimicrobial stewardship in all healthcare sectors, including:  
-  Promotion of accredited training programs for healthcare workers including pharmacists (NAP Action 1); 
-  Reinforcement and improvement of the Prescription Medicines Database and electronic feedback 

systems/dashboards for prescribers (NAP Action 1); and  

-  Stewardship interventions for hospitals and long-term care facilities (LTCFs), e.g. at EAAD/WAAW (NAP 

Action 2). 

Further develop national healthcare associated infection (HAI) prevention and control programmes and 
policies, including establishment of sustainable and comprehensive e-surveillance, for sample types 
including blood. 

Renew or establish activities to ensure infection prevention and control (IPC) capacity at all healthcare 
facilities, such as face-to-face workshops for local adaptation of the Landspítali guidance for hospital IPC. 

Continue activities to ensure additional acute care capacity, including increasing inpatient bed capacity,  
to facilitate IPC, at both Landspítali and Akureyri hospitals. 

Zoonotic diseases and threats of environmental origin, including 
those due to the climate (Capacity 10)  
• 

Establish One Health governance to coordinate surveillance, prevention, and control of zoonotic and 
environmental threats by defining roles, communication, decision-making, and resource allocation across 
sectors and administrative levels.  
Enhance the Statutory Joint Committee for Epidemic Prevention (SSUS) to become more active and 
operational, involving additional sectors (e.g. the NRL for human, animal and food sector and the Icelandic 
Medicines Agency).  
Organise joint interdisciplinary training and exercises on surveillance, preparedness, risk assessment and 
risk management in response to zoonotic and environmental threats that involve public health, animal 
health and environment sectors, using lessons learned from real events and trainings organised by ECDC or 
other Agencies. 
Develop a comprehensive data infrastructure and standardised processes for the surveillance of food-, 
water-, vector-borne and zoonotic diseases that integrates data from the food and animal sectors, as well 
as vector data. This system should be built with consideration to interoperability with the public health 
surveillance system/databases and allowing for data-sharing among sectors.  
Integrate health related indicators and correlations to the Climate Atlas and assess the potential impact of 
extreme weather events in the provision of health services, proposing preventive measures for their 
continuity, while addressing special needs of certain population groups (e.g. migrants, elderly) in the next 
Icelandic Climate National Action Plan (NAP) and the next pandemic preparedness plan. 

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• 

Conclusions  

The update of the national legal framework, as well as the new EU Regulation on Cross-Border Threats to Health 
and the funding of the EU4Health programme represent opportunities that should be harnessed by Iceland public 
health authorities to formalise critical collaborations in the context of the national pandemic preparedness plan, to 
strengthen laboratory-based surveillance and the role of the National Reference Laboratory, to establish a 
dedicated representative surveillance system for respiratory infections integrated with laboratory data, to introduce 
a One Health governance guiding roles and processes, and to ensure sustainable funding for key public health 
priorities such as prevention of healthcare associated infections.  

Key factors in the maintenance of a robust public health system are the engagement of all stakeholders, including 
healthcare providers, in public health functions and tasks, and the strengthening of the epidemiological and 
microbiological workforce, both at national and regional levels.  

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Introduction  

The aim of the Public Health Emergency Preparedness Assessments, as mandated in Article 8 of the Regulation (EU) 
2022/2371 on serious cross-border threats to health, is to improve prevention, preparedness and response planning 
in EU/EEA countries through the implementation of recommendations following individual country assessments. As 
specified in the Regulation, each EU/EEA country will undergo an assessment every three years, with the first cycle 
of these occurring between 2024 and 2026. 

This report presents the findings and recommendations of the first assessment conducted in Iceland. This process 
involved a desk review of relevant documents, followed by a five-day country visit. 

Background and legal basis  
During the COVID-19 pandemic it was recognised that the legal framework for combatting serious cross-border 
threats to health, provided for in Decision No 1082/2013/EU, needed to be broadened and enhanced to ensure a 
more effective response across the European Union (EU) to deal with health-related emergencies. Hence, the 
European Commission developed and published on 23 November 2022 the Regulation (EU) 2022/2371 on serious 
cross-border threats to health1.  

Within this Regulation it is recognised that prevention, preparedness and response planning are essential elements 
for combatting serious cross-border threats to health. In addition to creating a Union prevention, preparedness and 
response plan (Article 5 of the Regulation), the Regulation also outlined the importance of updating and seeking 
coherence with Member States’ prevention, preparedness and response plans (Article 6 of the Regulation).  

To monitor the implementation of the plans, the Member States shall report to the European Commission regarding 
their prevention, preparedness and response planning at the national level every three years. For this purpose, a 
self-assessment template was developed under Article 7 of the Regulation2, complementary to the International 
Health Regulation (IHR) State Party Self-Assessment Annual Report (SPAR)3.  

In order to support the assessment of these plans, Article 8 of the Regulation indicates that ECDC has the 
responsibility – in coordination with relevant Union agencies and bodies – to conduct assessments of all 30 
European Union and European Economic Area (EU/EEA) countries every three years. The procedures, standards 
and criteria for the assessments of the state of implementation of national prevention, preparedness and response 
plans and their relationship with the Union prevention, preparedness and response plan are defined by the 
Commission Delegated Regulation (EU) 2024/1232, adopted in March 20244. 

ECDC has developed a methodology for Public Health Emergency Preparedness Assessment to implement Article 8 
of the Regulation (EU) 2022/2371. The assessment process addresses the 16 capacities included in the Article 7 
self-assessment template and is designed to maintain consistency within the EU/EEA countries throughout the 
three-year cycle, while allowing for adaptation of plans if the national circumstances require. 

Aim and objectives  
The aim of the ECDC Public Health Emergency Preparedness Assessment process, drawn from Article 8 of the 
Regulation on serious cross-border threats to health, is to improve prevention, preparedness and response 
planning in EU/EEA countries through the implementation of recommendations following individual country 
assessments. Countries are asked to provide an action plan addressing the proposed recommendations of the 
assessment within nine months of the receipt of the ECDC report. 

1 European Commission (EC). Regulation (EU) 2022/2371 of the European Parliament and of the Council of 23 November 2022 on 
serious cross-border threats to health and repealing Decision No 1082/2013/EU. Brussels: EC; 2022. Available at: https://eur-
lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32022R2371&from=EN  
2 European Commission (EC). Commission Implementing Regulation (EU) 2023/1808 of 21 September 2023 setting out the 
template for the provision of information on prevention, preparedness and response planning in relation to serious cross-border 
threats to health in accordance with Regulation (EU) 2022/2371 of the European Parliament and of the Council. Brussels: EC; 
2023. Available at: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32023R1808 
3 World Health Organization (WHO). IHR (2005) States Parties self-assessment annual reporting tool, 2nd ed. Geneva: WHO; 
2021. Available at: https://www.who.int/publications/i/item/9789240040120 
4 European Commission (EC). Supplementing Regulation (EU) 2022/2371 of the European Parliament and of the Council as 
regards assessments of the state of implementation of national prevention, preparedness and response plans and their relation 
with the Union prevention, preparedness and response plan. Brussels: EC; 2024. Available at: https://eur-lex.europa.eu/legal-
content/EN/TXT/?uri=OJ:L_202401232 

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The specific objectives of the assessment process are to:   
• 

Assess the countries’ self-assessments of preparedness in the 16 capacities covered by the outputs from 
the most recent International Health Regulation State Party Self-Assessment Annual Report and the 
Article 7 template. 
Collaborate with countries to identify good practice, challenges, bottlenecks, gaps or areas for improvement 
concerning the 16 capacities referred to in Article 7 (a list of the capacities assessed is available in Annex 1).  
Encourage the inclusion of key elements within the prevention, preparedness and response planning 
structure such as cross-sectorial and cross-border coordination, crisis management, response governance, 
communication, plan testing, evaluation and regular reviews, according to the lessons identified from the 
response to public health emergencies. 
Use the opportunity of a standardised approach to the assessment process to contribute to the 
improvement of EU/EEA prevention, preparedness and response capacities by promoting a common 
understanding of key elements and a coordinated approach. 
Provide support to countries in enhancing their national prevention, preparedness, and response capacities 
through recommendations based on the assessment, and provide targeted assistance upon request. 

• 

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Assessment process  
An ECDC-led team composed of eight ECDC experts and three experts from the European Commission (DG SANTE 
and DG HERA) and the World Health Organization Regional Office for Europe was assembled to conduct the 
assessment, in collaboration with the country focal points and a national public health expert from Cyprus. The 
assessment process consisted of a desk review phase and a country visit that took place between 2 June and 6 
June 2025.  

As per the established process, the team reviewed Iceland’s responses to the Article 7 self-assessment questions, 
with five of them considered in depth: Health Emergency Management (Capacity 6); Laboratory (Capacity 3); 
Surveillance (Capacity 4); Antimicrobial resistance (AMR) and healthcare-associated infections (Capacity 12) and 
Zoonotic diseases and threats of environmental origin, including those due to the climate (Capacity 10).  

The assessment mission was conducted with an open and transparent approach from the host country, including 
the prompt sharing of relevant documents, engaging in a productive, open discussion and providing clarifications or 
additional documentation as needed or requested.  

Further details regarding the practical aspects of the mission are available in Annex 2. 

Main findings and overarching recommendations 
There is a robust culture of collaboration both within and across sectors, which significantly enhances the timely 
exchange of information and supports effective public health decision-making and implementation in Iceland. This 
collaborative environment is a key strength in the national public health landscape. A well-established and 
integrated mechanism is in place for the preparation and response to all-hazard incidents, with a particular focus 
on natural disasters. This system reflects a high level of consolidation and readiness to manage a broad range of 
emergencies. However, some essential public health functions – such as preparedness, surveillance, and response 
– are not consistently executed within the healthcare delivery system. These inconsistencies may hinder the overall 
effectiveness of public health interventions. Furthermore, the current public health infrastructure in Iceland would 
benefit from clearer delineation of roles and responsibilities. Ambiguities in accountability and overlapping duties 
among institutions and stakeholders (such as the tasks of the various intersectoral committees, the roles of Points 
of Entry, the roles of district physicians, etc.) may reduce operational efficiency and responsiveness during public 
health events. 

Recommendations 

• 

• 

Integrate public health requirements in the routine healthcare provision process by involving more the 
district physicians in meetings/seminars/simulation exercises, sharing of surveillance feedback, 
acknowledging the public health impact of their work, and planning of dedicated budged for their public 
health activities.  

Increase capacities for public health preparedness and response at the Office of the Chief Epidemiologist, 
and the overall communicable disease workforce (e.g. by training in epidemiology of communicable 
diseases through participating in EU training activities such as the EPIET/EUPHEM programmes). 

•  Assess which of the ongoing informal collaborations require to be formalised in the pandemic 
preparedness plan to ensure business continuity, resilience, and timeliness across sectors.  

• 

Ensure that roles and responsibilities for key public health functions at national and local level are formalised, 
including for surveillance, prevention, preparedness, response, quality assurance and evaluation. 

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Findings and recommendations per capacity  
A list of the capacities that were included in the assessment is available in Annex 1. Annex 3 includes findings and 
recommendations that the country considered confidential and/or sensitive information that the country provided. 

Capacities assessed in depth 
Health emergency management (Capacity 6) 

Management of health emergency response  
Iceland shared multiple documents in the area of health emergency response, including legislation on the control 
of communicable diseases and civil protection, national plans (National Pandemic Plan, Chemical, Biological, 
Radiological, Nuclear, and Explosive (CBRNe) threats plan, National Mass Burn Incident Plan), and the review of the 
governmental crisis management during the COVID-19 pandemic.  

The generic pandemic and CBRNe plans are well structured, outlining the responsibilities of the various actors at 
the different administration levels: national, regional, and local, as well as the three alert levels: uncertainty, 
hazard/danger, and emergency. The Chief Epidemiologist and the National Commissioner of the Icelandic Police 
collaborate and mutually decide on the activation of plans. Municipalities and local healthcare facilities are 
responsible for developing their own preparedness plans and both a regulation on what the plans should 
address and a template for a healthcare contingency plan (2018) was also shared. Using such templates is a 
good practice to help local and regional levels develop their contingency plans. Both the Department of Civil 
Protection and Emergency Management and the Directorate of Health oversee these preparedness plans with a 
‘soft’ overview and monitoring mechanism, as there is no mandated/legislated timeline for updating or 
exercising these plans.  

The government’s policy on civil protection and security is defined by the Civil Protection and Security Council for a 
period of three years, and according to Civil Protection representatives the existing national plans cover the risks 
identified. However, risk prioritisation is largely not regularly updated to be subsequently reflected in all the 
contingency planning in the country.  

There is a strong response culture at all levels in the country, local regional and national, where all stakeholders 
know each other and have worked and responded to multiple incidents. The response system is the same in all 
incidents at all levels, and assisting in an emergency is embedded in Icelandic culture, so that even members of 
the public respond promptly in emergencies. Having one response system makes it easy to come together at the 
National Crisis and Coordination Centre (NCCC) for the coordination of the response in any type of crisis. This is 
hugely helped by the fact that human resources are limited in number, meaning a few specific people are involved 
at each level. The multiple all-hazard incidents occurring in the country (mostly natural disasters) have established 
and reinforced personal communication lines among the major players. However, these are rarely formalised (e.g. 
with SOPs, checklists or other tools), which makes it risky when new staff enter service or when the main response 
players are missing for any reason.  

The Civil Protection system has four response levels: Green, Yellow, Red, and Black in increasing severity and 
involvement of administration levels. In addition, it works in three alert phases – uncertainty, hazard/danger, and 
emergency. A manual on ‘Health Services and Civil Protection’ (2017) outlines how the two sectors work together 
in the different types of disaster and at different levels. Civil protection has a well-established incident management 
system for the response phase, which is currently under revision; follow up with training all the stakeholders and 
levels in the country is expected.  

Iceland is in the process of revising their legislation on the control of communicable diseases, as well as on civil 
protection. According to the discussions, intersectoral collaboration on these pieces of legislation is occurring at the 
ministry level. 

Iceland has strong ties to the other Nordic countries in the Svalbard Group, the Nordic co-operation group on 
health preparedness. Specific agreements allow for cross-country assistance for rare or severe cases or in the 
event of a Burn Casualty Incident when Iceland’s surge capacity is exceeded. Under such circumstances, patients 
in need of highly specialised care can be transferred to other collaborating Nordic countries. The relevant plan was 
also shared with the experts and is well developed describing the activation and prioritisation processes.  

Public health measures are proposed by the office of the Chief Epidemiologist according to their mandate (Act on 
Communicable Diseases 19/1997) based on data available and scientific advice, and are negotiated/agreed with 
other sectors at the ministerial level rather than being co-developed at the technical level.  

As the National University Hospital in Reykjavik, Landspítali plays a central role both in preparing and responding to 
public health threats. Clinician specialists provide advice to the Office of Chief Epidemiologist and the NCCC and 
take part in public health activities (e.g. contact tracing) as needed. According to the discussions, the hospital is 
operating at very high capacity for a variety of reasons, and this would limit its capacity to respond in case of large 
events, e.g. mass casualties or another pandemic. The hospital coordinator has a daily overview of the bed 

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capacity and its coverage, however this is not reflected in the NCCC, although data can be requested. In addition, 
Landspítali lacks currently a High-Level Isolation Unit (HLIU), which limits the capacity of the country to manage 
potential patients with highly infectious diseases. The hospital is working on setting up a temporary HLI unit until 
the new hospital will be operational around 2030. 

Recommendations 
• 
• 

Formalise the response process and communication among stakeholders (suggest check list or SOPs).  

Strengthen intersectoral collaboration for preparedness planning at national level by conducting a 
stakeholder mapping and formalising their involvement when developing the plan.  

• 

• 

• 

• 

Ensure that the upcoming legislation provides for regular reviews of preparedness plans at all levels based 
on an all-hazard all-country risk prioritisation exercise, and that it foresees cycles of simulation exercises. 

Develop or adopt and adapt a rapid risk assessment process in response to health-related events for effective 
communication of the risk with stakeholders (e.g. discuss/adapt formats used by other countries).  

Reinforce public health competence in the NCCC and improve the situation awareness tools as regards the 
health sector capacities and operations in a crisis (e.g. bed capacity, ICU coverage, workforce, cases, 
deaths, tests performed, etc).  

Continue efforts to establish a temporary HLIU at Landspítali, until the new university hospital becomes 
operational. 

Emergency logistic and supply chain management 
Iceland has legal and regulatory frameworks in place for identifying the stockpile of critical medicines and 
delineating related responsibilities at the national level. The list of critical medicines is included in the Regulation on 
Infection Prevention Control Measures – No. 817/2012. A working group designated by the Ministry of Health is 
currently preparing a proposal for an updated list and legislative efforts are underway to establish regulations 
defining minimum stock levels for both institutions and wholesalers. Currently, wholesale authorisation holders are 
obliged to maintain sufficient stock of specific necessary medical products based on a list produced by the Icelandic 
Medicines Agency (IMA). 

The Chief Epidemiologist is responsible for maintaining a national stockpile of certain medications (as per the 
regulation), vaccines, and intravenous fluids. This stockpile is physical and primarily held by individual wholesalers. 
However, some medications are also stored at the Landspítali University Hospital. The size of the stockpile 
generally corresponds to one month’s supply. While institutions and wholesalers are expected to maintain a 
minimum quantity of stock, there are currently no specifications regarding required quantities.  

The Chief Epidemiologist is also responsible for a national stockpile of personal protective equipment (PPE). The 
stockpile is physical, and while its current contents are known, there is no clear definition of which types of PPE 
should be included nor of the quantities to be maintained. It was deployed during the COVID-19 pandemic and 
proved effective as there were no shortages of PPE during that period.  

Beyond medications and PPE, there are no stockpiles of other categories of medical equipment, and no 
corresponding obligations on institutions or wholesalers to maintain such products, except where specified in 
individual purchasing contracts.  

The emergency logistics and supply chain management mechanism in Iceland is developed and capable of 
providing adequate support during national health emergencies. Nevertheless, the reliance on a very limited 
number of pharmaceutical wholesalers represents a vulnerability for stockpiling security. 

Iceland currently monitors supply and estimates demand for crisis-relevant medical countermeasures (MCMs) on an 
ad hoc basis. For example, the monitoring system was activated during the COVID-19 pandemic and in response to 
volcanic eruptions. However, the country lacks a real-time monitoring platform for medicine availability and a 
formal inventory system for PPE. While IMA can request information from wholesalers, the data provided are 
limited to general product availability and does not include specific quantities except on wholesale level. In specific 
cases, the agency has requested information about quantities from pharmacies and hospitals. 

Furthermore, Iceland currently lacks a formal reception and distribution plan for MCMs during emergencies. 
Although informal procedures exist, there is no Standard Operating Procedure (SOP) outlining deployment logistics. 

Finally, the country has limited domestic pharmaceutical manufacturing capacity, with the exception of medical oxygen, 
which is produced in a factory on the Reykjanes peninsula. Most MCMs are imported. Icelandic authorities have 
participated in EU joint procurement initiatives and advance purchase agreements for influenza pandemic vaccines. 

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Recommendations 
• 

• 

• 

• 

• 

Develop tools to monitor supply and estimate demand of crisis-relevant MCM. The relevant tools should 
collect information for all relevant types of products that fall under the definition of crisis-relevant MCM. 
Develop a specific methodology to compile the list of items of crisis-relevant medical countermeasures to be 
included in a strategic stockpile.  
Develop a sustainable management plan for national strategic stockpiles of MCMs, including operational 
SOPs (deployment and reception of medical countermeasures).  
Continue the ongoing legislative work to support achievement of six-month supply of critical MCMs, most 
notably by introducing a provision in the Pharmaceuticals Act specifying the required stock levels of 
essential medicines to be maintained by wholesalers. 
Continue to participate in EU-level and global activities related to joint procurement or advance purchase 
agreements. 

Laboratory (Capacity 3) 

The microbiology laboratory capacity for emergency preparedness, response, and communicable disease 
surveillance in Iceland is primarily centralised at the Department of Clinical Microbiology at Landspítali Hospital, 
with a smaller contribution from the laboratory at Akureyri Hospital. In addition, several smaller regional 
laboratories – both public and private – provide primary diagnostic services within regional health districts. 
However, these smaller laboratories operate in the absence of formal oversight, highlighting the need for 
centralised coordination and a formalised laboratory network. 

The Department of Clinical Microbiology at Landspítali is designated as the national reference laboratory (NRL) for 
human samples. However, under the current legislation, it is not formally recognised as a national public health 
laboratory, with public health functions, which restricts its access to dedicated funding and limits its formal 
responsibilities in public health activities such as notifiable disease diagnostics and surveillance. Complementing the 
NRL on the human side, the Institute for Experimental Pathology at Keldur, University of Iceland, is designated as 
reference laboratory for animal samples. In addition, Matís – a government-owned, independent research institute 
– is designated as NRL for food and environmental samples. 

The molecular laboratory at Landspítali has expanded its capabilities and capacity through investments in advanced 
technologies, including next-generation sequencing. These developments have strengthened its ability to respond 
to emergency situations and support the surveillance of communicable diseases. The laboratory is able to 
implement new nucleic acid amplification tests (NAATs) within two to four weeks when needed. Following these 
investments made during and after the COVID-19 pandemic, it is now essential to secure sustainable funding. This 
support is critical to maintain and further develop current capabilities for the national laboratory network, including 
training, equipment, and infrastructure for next-generation sequencing and bioinformatics. 

A challenge in the capacity of implementing rapidly new diagnostic methods for a novel pathogen with pandemic 
potential is aligning with the EU regulation on in vitro diagnostic medical devices (IVDR, 2017/746). This EU regulation 
limits medical microbiology laboratories from performing in-house testing, due to demanding requirements. This is 
likely to significantly affect capacity, know-how and expertise in such laboratories in developing and validating new 
methods; this is a capacity that is crucial during a public health emergency with a novel pathogen. The ability for 
microbiological laboratories to retain the necessary expertise on NAATs to set up such in-house tests on short notice is 
crucial for ensuring a nationwide test capacity and making use of NAATs as a major countermeasure for effective 
control of emerging microbiological threats. The laboratory at Landspítali also operates its own media and substrate 
production facility, which could serve as a significant advantage during a pandemic situation; its continued operation 
will however also be affected by the requirements of the IVD regulation. 

In addition to the molecular capabilities at the Landspítali laboratory, both Keldur and Matís possess facilities for 
molecular diagnostics and whole genome sequencing (WGS). While there is strong and active – albeit informal – 
collaboration among the three sectors, particularly in response to foodborne outbreaks, data-sharing remains 
limited and lacks automated or standardised protocols. Formalising this collaboration could be further explored 
during preparedness planning to enhance the national laboratory capability and capacity. 

During the COVID-19 pandemic, the scale-up of laboratory testing was successful. This was achieved through 
investments in testing platforms, method development, facility reorganisation, staff reallocation and new hires, and 
collaboration with a private company. The main bottlenecks identified were shortages of sampling materials and 
reagents and the lack of stockpiling. However, no formal plan or organisation for scaling up testing in the event of a 
public health emergency has been established since. It is essential to clearly define the role of the NRL within the 
national pandemic preparedness plan to ensure that laboratory needs are adequately addressed. In addition, a clear 
strategy for scaling up and down laboratory capacity during emergency situations should be included in the plan. 

On the human side, Iceland has the capacity to report microbiological laboratory testing results for national 
surveillance through an electronic reporting system, although not all small regional laboratories currently have this 
capability. In contrast, the animal health sector still lacks such a system, underscoring the need to develop and 

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implement an electronic reporting system that can eventually be integrated with the human health system. In 
addition, the electronic laboratory information system at Landspítali needs to be updated, and efforts to unify 
electronic systems – including investigating the possibility to connect regional laboratories – should be prioritised. 
Beyond electronic reporting, there is also a need to establish a national sequencing database to facilitate the 
sharing of genomic data between the NRL and the office of the Chief Epidemiologist. This database should also 
support data exchange across sectors to enable integrated surveillance and effective outbreak response. 

The Ministry of Health is responsible for issuing licenses to laboratories that investigate diseases listed in 
Regulation 221/2012 on the reporting of infectious diseases. Accreditation is mandatory for laboratories 
conducting such analyses. The Icelandic Service for Accreditation (ISAC) is the national accreditation body. To 
support accreditation in areas where ISAC has not yet attained mutual recognition through the European co-
operation for Accreditation, a framework agreement is in place between ISAC and SWEDAC (Sweden). The 
Landspítali laboratory is accredited under this arrangement, and it is important to recognise the significant 
effort, resources, and compliance requirements involved in obtaining and maintaining this accreditation. Smaller 
regional laboratories conduct diagnostic tests such as urine and throat cultures, as well as antibiotic 
susceptibility testing, but only one is licensed. None of these laboratories are accredited, and in the absence of 
formal oversight, there is limited insight into their overall quality, testing capacity and the completeness of their 
reporting to national authorities.  

There is currently no standardised national system for transporting specimens, including official standard operating 
procedures (SOPs) for the packaging and shipping of referral samples. The NRL at Landspítali provides guidance on 
packaging and the information required for samples, which is accessible to other laboratories. However, the 
shipment of specimens – both within Iceland and internationally – could be more formalised through agreements 
with transportation companies, supported by national guidelines. 

Recommendations 
• 

• 

• 

• 

• 

The designation of the NRL at Landspítali should be supported by appropriate legislation and the necessary 
budget to fulfil their public health role in notifiable disease diagnostics and surveillance. 
Define the role of the NRL in the context of the national pandemic preparedness plan to ensure that the 
laboratory requirements are properly accounted for and ensure that a clear strategy for scaling up 
laboratory capacity in emergency situations is part of the plan. 
Create a national laboratory network through a formal cooperation framework in which the NRL shall 
oversee, coordinate, and support all regional public and private laboratories to ensure harmonised quality 
standards, reliable diagnostics, and efficient information exchange. Ensure sustainable funding for the 
national laboratory network to maintain and further develop laboratory capacity and capability, including 
training, tools, and infrastructure for next generation sequencing and bioinformatics. (Please also refer to 
recommendations under Surveillance (Capacity 4) and Zoonotic diseases and threats of environmental origin 
including those due to the climate (Capacity 10)). 
Prioritise the work of unifying the electronic laboratory systems connecting also the regional laboratories. 
The same goes for the animal sector, where work needs to begin on developing and implementing an 
electronic reporting system that can eventually be connected to the human side.  
Start the development of a national sequence database and mechanisms for sharing sequence data 
between the NRL and the Chief Epidemiologist, with built-in capability to expand to all One Health sectors to 
allow for integrated surveillance and outbreak management. 

Surveillance (Capacity 4) 

Surveillance of communicable diseases in Iceland is a core public health function, legally grounded in the Icelandic 
Act on Health Security and Communicable Diseases. This Act authorises the Ministry of Health to determine which 
diseases require notification and mandates the Chief Epidemiologist to maintain a central infectious disease 
registry. Further provisions, including a list of reportable diseases, are set out in the Regulation on Infection Control 
Reporting. Guidelines based on Act No. 19/1997 and Regulation No. 221/2012 instruct physicians, hospitals, and 
laboratories on how to report. However, the list of notifiable diseases in the electronic medical records has not 
always been up to date. Although it covers a broad range of pathogens, it lacks specific surveillance objectives and 
case definitions. Furthermore, the data submission is not yet digital. 

The surveillance system is mainly based on daily updated laboratory results, but also ICD-10 codes submitted daily 
from the primary care and hospitals to the national register. ICD-10 codes reflect diagnoses at primary care visit or 
at discharge from hospital, but if a diagnosis is changed after the codes have been submitted to the national 
register the update is not captured and the initial code remains unchanged. 

A further challenge associated with ICD-10 coding is the potential for overreporting or misclassification. This can 
occur when clinicians fail to use sufficiently specific codes or apply incorrect ones, which can compromise the 
accuracy of the surveillance data. This issue is relevant to all surveillance systems based on ICD-10 codes. 
Although each patient has a unique identifier that could link surveillance data with electronic health records, 
vaccination registries, and mortality data, this integration was not often implemented until recently when the 

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permission process regarding linkage was facilitated. Data received by the Directorate of Health are anonymised, 
and re-identification requires authorisation. A strength of the system is the timely availability of laboratory data, 
which is key for effectively using these data for surveillance.  

When more detailed clinical information is needed, physicians are supposed to complete paper forms that are 
manually entered into a separate database. This process is expected to be replaced by an electronic system 
supported by an EU4Health grant, which also explores direct access to the national ICD-10 database, and builds on 
the vaccination registry to support future outbreak responses. 

Laboratory-based data are primarily received from Landspítali and Akureyri Hospitals, with daily submissions on 
notifiable and weekly Excel reports with additional aggregated information on non-notifiable respiratory viruses and 
number of tests performed. A semi-automated system, including manual validation steps, ensures code accuracy 
before submission to the National Communicable Disease Register. Around 90% of national testing is conducted in 
the laboratories at Landspítali and Akureyri hospitals, while the remaining 10% comes from smaller, often non-
reporting, private or regional labs whose diagnostic capacity is unclear. Differences in laboratory information 
systems – even within hospitals – complicate integration. For instance, the Landspítali uses the GLIMS system, 
managed by an external vendor in Belgium, leading to delayed updates and communication issues. Akureyri 
Hospital struggles to maintain regular reporting, even of mandatory notifiable diseases. A technical solution for the 
laboratory is needed to send lab results to the Chief Epidemiologist. Landspítali reviews admissions daily for 
respiratory infections and weekly for other conditions, submitting findings via Excel during influenza season.   

Paediatric clinical surveillance data are incomplete. Significant proportion of paediatric outpatient consultations 
occur at a private clinic not integrated with national systems. While severe cases are referred to Landspítali, mild-
to-moderate cases are underreported.  

There is no integrated sentinel surveillance for mild acute respiratory infections, resulting in limited sampling from 
primary care. This affects the representativeness of lab results and delays detection of emerging pathogens, while 
limiting availability of samples for characterising circulating influenza and SARS-CoV-2 strains. 

Centrally, automatic validation detects errors and flags duplicates, if multiple reports occur within a defined time 
window. 

Surveillance data are regularly shared with Landspítali. Weekly summaries – based on an interactive dashboard 
tracking notifiable respiratory diseases – are published in both Icelandic and English, interpreting key trends. The 
team also conducts weekly reviews of this dashboard and an internal report on additional respiratory infections not 
covered in the public platform. In recent years no specific thresholds have been used for respiratory virus activity in 
the community, however new thresholds for influenza activity are being calculated and will be introduced before 
the 2025/2026 season.  

The system's sensitivity and specificity are difficult to assess due to the lack of a gold standard and gaps in 
population coverage, such as among children and institutionalised elderly people. During a pandemic, shifting 
system objectives or changing clinician reporting habits could be difficult without a national coordination network 
or ongoing communication mechanisms. Although data extraction and reporting are timely, the lack of an 
overarching digital infrastructure prevents interoperability between key systems, such as lab databases, EHRs, 
vaccination records, vital statistics and veterinary surveillance. These structural issues reduce the overall efficiency 
of the surveillance system. 

The system demonstrated resilience, flexibility, and adaptability during the COVID-19 pandemic. Daily phone calls 
were made to COVID-19 patients by Landspítali Hospital, with the support of retired physicians and quarantined 
health workers. Testing capacity was rapidly expanded through primary care and a private laboratory. A digital 
platform managed test scheduling, result delivery and contact tracing. Contact tracing was supported by over 100 
temporary staff including nurses and police. However, after the COVID-19 pandemic, no contact tracing platform 
remained, and this should be considered for development and integration into the surveillance system. 

Surveillance during the pandemic included a digital passenger locator form and daily hospital reviews tracked 
deaths, ICU and ventilation needs. Telemedicine was also widely adopted. ICD-10 codes were also used to follow 
up real-time the effects of other threats, such as the volcanic eruption in Grindavík. 

Modelling capacity is not part of the surveillance capacities due to limited national resources. During the Covid 19 
pandemic Iceland relied on external models developed by universities and neighbouring countries to project case 
numbers, transmission, and hospital admissions, including in ICUs. While data specialists are in place, the 
Directorate lacks in-house statisticians, and no formal evaluation of the surveillance system is planned. 

Primary care contact tracing remains underfunded, with primary healthcare centres covering the costs without 
dedicated budgets. Testing is expected to be managed within existing resources. Hospitals typically detect clusters 
and report them to the Chief Epidemiologist. Primary care services and hospitals handle routine contact tracing, 
while the Chief Epidemiologist coordinates broader responses in serious cases. However, the Chief Epidemiologist 
does not have manpower or budget to conduct contact tracing activities unless an emergency/pandemic is declared 
– leaving frontline staff to carry them out.  

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ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

Recommendations 
• 

Develop standardised reporting procedures through the development of national reporting protocols aligned 
with EU surveillance requirements. These protocols should clearly define disease-specific objectives, 
required data elements and formats, and the frequency of reporting. 

• 

• 
• 

• 

• 

Develop a comprehensive data infrastructure and standardised process models to support interoperability, 
integration, and linkage between the updated clinical notification system and other key databases – for 
example laboratory information management systems (including the timely reports from the laboratory at 
Akureyri Hospital), vaccination registries, vital statistics, electronic medical records and contact tracing 
systems, other One Health data. (Please also refer to recommendations under Laboratory (Capacity 3) and 
Zoonotic diseases and threats of environmental origin including those due to the climate (Capacity 10)). 

A contact tracing platform should be developed and integrated into the surveillance system. 

Establish a primary healthcare-based sentinel surveillance system for acute respiratory infections, with 
integrated microbiological surveillance of influenza, RSV, and SARS-CoV-2 to help capture data on mild 
respiratory infections and enhance early detection of emerging pathogens.  

Continue monitoring the quality of surveillance data from ICD-10 codes, striving for representativeness by 
age and place, and conducting system evaluations when performance issues are noted. 

Reintroduce respiratory disease-specific thresholds and early warning indicators to enhance the system’s 
ability to respond promptly to emerging health threats. 

Antimicrobial resistance and healthcare-associated infections (Capacity 12)  

The One Health National Action Plan (NAP) on Antimicrobial Resistance (AMR), 2025–2029, was published in July 
2024, after completion of the Article 7 questionnaire. The political commitment for the NAP is exemplified by it being 
co-signed by the Minister of Health, the Minister of Food, Fisheries and Agriculture, and the Minister of Environment, 
Energy and Climate. Its detailed cost estimate identifies that 30.1% of the anticipated costs are funded through 
budget that is already being allocated to the relevant institutions. However, ‘additional funding’ will be needed for 
69.6% of the planned activities, through negotiated annual budgeting, and so the long-term sustainability of the NAP 
is uncertain. A cross-sectoral working group would be useful at least for the duration of the NAP (2025–2029) to 
monitor its implementation for its governance, and to support preparation of the subsequent NAP. The mechanism for 
relevant organisations to apply for NAP funding is not specified in the document.  

The NAP presents six ‘Actions’ for 10 national public sector stakeholders, in a One Health approach. The Actions 
are valid and proportionate for the AMR, healthcare-associated infections (HAIs) and infection prevention and 
control (IPC) challenges in Iceland. These are well described in the ‘Annual report of the infection control unit of 
the National Hospital, 2023’, and the ‘Annual report on antibiotic use and antimicrobial resistance in humans and 
animals in Iceland, 2023’. 

Each Action in the NAP is considered in detail, with sub-objectives that have output indicators and granular activities 
that aim to achieve benchmarks, and, where relevant, quantitative targets for 2029 compared to 2022. The 
quantitative targets note relevant EU activities, such as the Council Recommendation on stepping up EU actions to 
combat antimicrobial resistance in a One Health approach’ (2023/C 220/01), and match ambition with realism. 

The NAP information dissemination and education plan (Action 2) is exemplary. Like many countries, it includes a 
survey for healthcare workers and the public, matched with standard campaigns in legacy and social media and 
participation in international awareness campaigns during World Antibiotic Awareness Week. However, it also 
prescribes education for the public regarding the risk of infection during international travel, for parents with 
children in daycares and infant healthcare, for primary and secondary schools, and for tourists. This recognises the 
increasing risk and rate of importation of infections, including multidrug-resistant pathogens, from countries with 
higher rates of AMR than Iceland, and is likely to help prevent outbreaks and endemicity. 

The rate of antimicrobial consumption in Iceland exceeds that of its Nordic neighbours, and Iceland recognises the 
need for reinforced antimicrobial stewardship activities, including the community, hospitals, general and private 
practice, and long-term care facilities (LTCFs); within specialties such as dermatology; and among non-specialist 
clinicians. A ‘STRAMA’ working group, similar to the groups in Sweden, tackles this among other challenges, 
providing GPs with peer-comparison reports, holds regular meetings, and updates clinical guidelines. However, 
stewardship efforts in hospitals face challenges with limited representation in hospital governance, no formal 
accreditation for training, and sustainability challenges with, for example, hospital pharmacologists leaving the 
public sector. There is an electronic information system in place for primary care physicians, ‘Gagnasýn’ via the 
Saga medical record system, which can provide feedback on antibiotic prescribing practices to individual physicians, 
for each clinic and region. However, the Gagnasýn system has suboptimal support for technical maintenance or 
development and may become obsolete in the near future.  

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By contrast, there is currently no electronic system/dashboard in place for the hospital and LTCF sectors to provide 
feedback on antibiotic prescription practices to physicians at the individual, ward, institution or regional levels. The 
NAP for AMR (2025–2029) includes development of dashboards/data visualisation for antibiotic prescription 
feedback to doctors in all sectors, including hospitals and LTCFs; and further development of interactive statistics 
on antibiotic prescriptions at the Directorate of Health, for all sectors.  

Iceland has strong practices for the screening of admitted patients, based on risk assessment. The Chief 
Epidemiologist maintains a dashboard to track trends in diagnoses of MRSA and extended-spectrum beta lactamase 
(ESBL)/AMPC-containing organisms. The dashboard was felt to be not optimally accessible, requiring several 
manual steps to locate information online. In addition, Landspítali has real-time monitoring of diagnoses of 
Vancomycin resistant enterococci (VRE) and carbapenemase-producing bacteria. Iceland’s participation in the E-BSI 
project, for blood samples, highlighted the potential of electronic HAI surveillance in general and for efficiency 
savings that might enable additional focus on the prevention and control of ESBLs/AmpC and MRSA.  

Prior to the COVID-19 pandemic, healthcare facilities throughout Iceland directly shared practical experience on 
their IPC practices across a national network of health-care workers working in IPC in all health districts during 
meetings and face-to-face workshops. During and following the COVID-19 pandemic, IPC guidance was shared for 
local use and/or adaption, such as the IPC guidance for Landspítali hospital.  

IPC training opportunities for nurses and other healthcare professionals are scarce within Iceland, which was not 
unexpected considering the country’s population size. Some opportunities for such training exist within Nordic 
universities and via international societies. Looking forward, a two-year University training programme for nurses in 
Iceland that took place in 2021/2022 may be repeated in 2026/2027.  

The two largest acute care hospitals, the Landspítali and Akureyri hospitals have dedicated IPC staff, and 
participated in the ECDC point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care 
hospitals, 2022–2023 (ECDC PPS). Iceland also participated in the antimicrobial use in European long-term care 
facilities study 2023–2024 (ECDC HALT), and continues to actively engage in international activities relevant to 
prevention and control of AMR and HAIs, such as EU-JAMRAI 2. Iceland is building additional acute care capacity 
for IPC, through provision of a new Landspítali hospital, and by seeking to match the Landspítali IPC capacity at 
Akureyri hospital.  

Recommendations 
• 

Secure sustainable multi-year funding and involvement of relevant Ministries to implement and monitor the 
One Health NAP for AMR, including the multi-sectoral programmes for ‘information dissemination, education 
and prevention’ (NAP Action 2). 

• 

• 

• 

• 

Strengthen and expand antimicrobial stewardship in all healthcare sectors, including:  
- 
- 

Promotion of accredited training programs for HCWs including Pharmacists (NAP Action 1); 

Reinforcement and improvement of the Prescription Medicines Database and electronic feedback 
systems/dashboards for prescribers (NAP Action 1); and  

- 

Stewardship interventions for hospitals and LTCFs, e.g. at EAAD/WAAW (NAP Action 2). 

Further develop national HAI prevention and control programmes and policies, including establishment of 
sustainable and comprehensive e-surveillance, for sample types including blood. 

Renew or establish activities to ensure IPC capacity at all healthcare facilities, such as face-to-face 
workshops for local adaptation of the Landspítali guidance for hospital IPC. 

Continue activities to ensure additional acute care capacity, including increasing inpatient bed capacity,  
to facilitate IPC, at both Landspítali and Akureyri hospitals. 

Zoonotic diseases and threats of environmental origin, including those due to the 
climate (Capacity 10)  

In Iceland, several institutions contribute to surveillance, preparedness and response to zoonotic diseases. The 
ministries involved include the Ministry of Health, the Ministry of Industries (responsible for Food, Agriculture and 
Fisheries) and the Ministry of the Environment Energy and Climate. The main organisations involved are the Chief 
Epidemiologist at the Directorate of Health, the Icelandic Agency for Environment and Energy, the Icelandic Food 
and Veterinary Authority (MAST), Landspítali Hospital (National Reference Laboratory), Matís and Keldur Institute 
for Experimental Pathology (NRLs for food and animal health, respectively) and Health inspectorates at regional 
and local level. 

According to Article 11 of the Act on Communicable Diseases nr. 19/1997, the Chief Epidemiologist shall be notified 
by the animal, environmental and radiation authorities about any potential risk of infection or threat due to toxic 
chemicals or radio-nuclear substances to public health, as the Chief Epidemiologist is responsible for their 
management. In turn, the chief epidemiologist notifies to those authorities any events that may concern the 
animal, radio-nuclear or the environmental sector.  

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The Minister of Health has established a collaborative committee responsible for organising response for events from 
animals, food borne diseases, chemicals and radiation that can pose a serious threat to public health. This is the 
Statutory Joint Committee for Epidemic Prevention (abbreviated SSUS in Icelandic), chaired by the Chief 
Epidemiologist. The Food and Veterinary Authority is represented by two specialists, one in zoonotic diseases and one 
in food safety; the Environmental Agency brings two specialists in toxic chemicals and food safety; and the Radiation 
Authorities have one representative. This Committee meets on an ad hoc basis, often once or twice per year.  

Since the Act details the importance of cross-sectorial collaboration and how it should be arranged, a formal 
memorandum of understanding has not been established. However, the Chief Epidemiologist has published 
guidelines on the management of food- and waterborne disease outbreaks that clearly outline each stakeholder’s 
role in the investigation and management of foodborne outbreaks. Intersectoral foodborne outbreak investigation 
teams are formed and meet frequently, sharing files among sectors and producing joint reports. Notifications of 
cases of suspected foodborne diseases are usually shared through a joint online channel and discussed at monthly 
cross-sectoral online meetings. The most recent cross-sectoral simulation (table-top) exercises were held in 2022 
and 2024 with a scenario of a foodborne disease outbreak, to clarify roles and prompt discussions on how to 
improve the overall outbreak investigation process.  

Priority diseases in humans are listed in regulation 221/2012 about reporting on communicable diseases. Priority 
diseases in animals are listed in regulation 52/2014 about diseases in animals that are mandatory to register and 
report. A joint list of shared priority diseases in the human and animal/food sectors is not available.  

The analysis of animal health and zoonoses laboratory data is conducted manually, without a database or platform 
that allows data-sharing among sectors. Due to short communication pathways, most notifications between sectors 
on zoonotic events start with a phone call or an email and are usually followed up with a virtual meeting of 
relevant stakeholders. The Icelandic Food and Veterinary Authority has a general contingency plan for serious 
animal diseases, including zoonotic diseases. Several disease-specific operational plans and other supporting 
documents have also been published. The authority regularly holds exercises and training sessions, as well as 
after-action reviews. Other parties (e.g. practising veterinarians and the Environment and Energy Agency) are 
involved in the development of recommendations and training on how to work in case of a new zoonotic threat. 
The Icelandic Food and Veterinary Authority has also developed a draft contingency plan for avian influenza, which 
is not yet public. 

The country has not yet published a One Health Strategy for Zoonotic diseases, or a document that presents the 
governance and communication flow among relevant sectors at national or regional levels, or procedures to for 
joint emergency response in the case of emerging zoonotic diseases. However, the OH AMR National Action Plan 
shows the commitment to engage in the One Health approach. 

The intention is to update the preparedness and response plan for CBRNe events, considering the One Health 
approach, and therefore the necessary coordination and involvement of different sectors, complementing it with 
intersectoral disease specific operational plans.  

Iceland’s frequent geological events, such as volcanic eruptions, earthquakes, avalanches, may have heightened its 
awareness about the health impact of extreme weather and environmental threats. 

A Scientific Committee on Climate, led by the Ministry of Environment and Climate and involving all Ministries and 
the association of local health authorities, has produced a recent scientific report on climate effects on the country. 

Building on the National Adaptation Strategy 2021, a National Adaptation Plan for climate change is being drafted, 
which aims to increase the number of indicators related to public health, climate and environment, conducting 
health and impact assessments and increasing the knowledge and response capacity of the healthcare system.  

Early warning systems in place for natural disasters (e.g. volcano eruptions) and mechanisms for exchange of 
information through coordination groups are highly valuable in the communication to the population to help them 
prepare for the health impacts of such emergencies (e.g. volcanic gases). The Icelandic Meteorological Office, the 
Environment and Energy Agency, the Chief Epidemiologist, Landspítali Hospital, the Food and Veterinary Authority 
and the Civil Protection have worked very closely with local health authorities (via the Association of Public Health 
Authorities), raising awareness, and this has been crucial to reduce the health impact. The Chief Epidemiologist 
leads a cross sectorial group that monitors acute health hazards to the public from air pollution from volcanoes and 
issues guidance and advice. The group has produced collaborative publications and meets regularly when an 
eruption is ongoing. 

A Climate Atlas, based on scenarios, presents current environmental and meteorological data and projections; it 
covers the possible impact of climate change in the risk of importation of vectors or occurrence of vector-borne 
diseases. Iceland’s intense maritime tourism and relatively high number of ports implies a potential vulnerability.  

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Recommendations 
• 

Establish One Health governance to coordinate surveillance, prevention, and control of zoonotic and 
environmental threats by defining roles, communication, decision-making, and resource allocation across 
sectors and administrative levels.  
The SSUS could be enhanced to become more active and operational, producing guidance and procedures, 
developing and engaging in simulations, and involving additional organisations (e.g. the Icelandic Medicines 
Agency and the NRL for human and animal/food sectors).  
Organise joint interdisciplinary training on surveillance, preparedness, risk assessment and risk management 
in response to zoonosis and to environmental threats that involves the public health, animal health and 
environment sectors, using lessons learned from real events and trainings organised by ECDC or other 
Agencies. Organise cross-sectoral simulation exercises for priority zoonotic threats, using the experience 
from food and waterborne diseases as a model. 
Develop a comprehensive data infrastructure and standardised processes for the surveillance of food-, 
water- and vector-borne and zoonotic diseases that integrates food, animal and vector data, with 
consideration for interoperability with the public health surveillance system/databases allowing for data-
sharing among sectors. This could lead in the future to an annual Icelandic One Health zoonoses report. 
Environmental data could also be considered for certain diseases and analysis. (Please also refer to the 
recommendations under Laboratory (Capacity 3) and Surveillance (Capacity 4)). 
Assess the potential impact of extreme weather events in the provision of health services (e.g. disruption 
due to destruction or malfunction of health facilities, electricity, potable water, other), proposing measures 
for continuity and considering the lessons learned from COVID and other environmental crises (e.g. volcano 
eruptions) when addressing special needs of certain population groups (e.g. migrants, older people).  
The Climate Atlas should incorporate health related indicators and correlations, informing the Icelandic NAP 
for climate change, which should be cross-referenced with the next pandemic preparedness plan. 

• 

• 

• 

• 

• 

Other capacities not assessed in-depth  

Policy, legal and normative Instruments to implement the International Health 
Regulations 2005 (Capacity 1) 

The Act on Health Security and Communicable diseases (nr. 19/1997) allows the Minister of Health to implement 
the International Health Regulations (IHR 2005) at all levels and outlines the responsibilities of the Chief 
Epidemiologist as the designated National IHR Focal Point (NFP). Following the COVID-19 pandemic, the Act was 
reviewed and amended, most notably in 2021. A new bill aimed to further strengthening of the Act is in the works 
and has been announced to be presented to parliament this coming autumn. Additional amendments to the Act 
may however be considered following the finalisation of the ongoing review of the implementation of the 2024 
amendments to the IHR (2005), including Iceland’s designation of the National IHR Authority (NIA).  

The IHR NFP function of Iceland holds a generic email account and a telephone number. It is the Chief 
Epidemiologist who holds the main responsibility to uphold the 24hr/7d communication requirement under 
Article 4 of the IHR (2005). During traditional work hours, the Chief Epidemiologist is supported with managing 
this function by an alternative duty officer. This set up makes the system vulnerable through personal 
dependence, while also reflecting Iceland’s challenge of having limited human resources available. The office of 
the Chief Epidemiologist conducts internal surveillance meetings on a weekly basis where both national and 
international events are covered. Multisectoral meetings with other IHR implementing entities are held on ad 
hoc basis only.  

Multisectoral implementation of the IHR (2005) in Iceland from an all-hazards approach is largely based on 
informal communication, while the foundation for establishing multisectoral coordination and collaboration 
mechanisms are provided for in the Act on Health Security and Communicable diseases (nr. 19/1997). A list of 
focal points for technical areas under the IHR (2005) is available but not incorporating or reflecting all-hazard/all-
threats approach of the IHR (2005) and the SCBTH regulation. There is a need to assess available capacities at 
ports in Iceland and update the list of designated Points of entry (PoE) under the IHR (2005) (please also see 
recommendations in Points of Entry and border health (Capacity 9)).  

The presence of an IHR advocacy mechanism was not documented during the assessment meeting. Cross-sectoral 
collaboration between IHR implementing sectors is currently reactive rather than proactive.  

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Recommendations 
• 

• 

Develop a list of IHR implementing entities at national and regional level, including contact points and their 
contact details, for each core capacity area, to serve as the formal reference and basis for coordination and 
collaboration on IHR implementation.  
Utilise the list of IHR implementing entities to formalise a mechanism/process to ensure multisectoral 
involvement in the mandatory annual State Party Annual Reporting (SPAR) process under Article 54 of the 
IHR (2005), and the triennial Article 7 reporting under the SCBTH regulation.  

Financing (Capacity 2) 

Iceland has a highly centralised administrative and governance system that ensures high access to primary 
healthcare, regardless of ability to pay, thereby promoting equity and social solidarity. While the health budget is 
determined annually by the Ministry of Finance and Economic Affairs, the Ministry of Health (MoH) is responsible 
for managing it centrally and overseeing its allocation through regular coordination meetings. The budget has 
remained stable over the past four years and constitutes approximately 26% of the annual government budget. 

The Ministry of Health can seek increased budgetary appropriations to respond to unforeseen health emergencies 
through a Supplementary Budget Act procedure. The Ministry of Finance and Economic Affairs allocates these 
additional funds on an ad hoc basis, usually requiring strong justification. There is usually an opportunity to 
request supplementary budget allocations once a year, but there is some flexibility to this (e.g. during the COVID-
19 pandemic such requests were made more frequently, up to five times a year). While these procedures can be 
complex and challenging, and despite the lack of formal procedures, the Ministries in Iceland are approachable and 
respond quickly to budget requests during times of crisis.  

In case of a health emergency at the regional level, the affected region is expected to redistribute resources and 
reallocate funds internally to manage the emergency. If additional funding for unforeseen expenses because of the 
emergency is necessary, a special request is sent to the Ministry of Health to inform them about the situation and 
request official support – usually the Ministry is very understanding about such requests. There is a small amount 
of contingency funding available at the Ministry of Health level, but if this is insufficient, the ministry may engage 
in formal interministerial discussion with the Ministry of Finance to request additional funds through the 
supplementary budget act procedure.  

With regards to private sector involvement in responding to health emergencies, the MoH can outsource services 
to the private sector or academic institutions through agreements. Iceland Health (Sjúkratryggingar Íslands) has 
the authority to negotiate agreements and contracts with the private sector within the terms of reference and 
budgetary constraints set out by the Ministry of Health. The agency administers health insurance and handles 
negotiations and payments for healthcare services (e.g. surge capacity for certain services or ‘quarantine hotels’ 
during the COVID-19 pandemic) as required. 

Financing for IHR implementation is included in the annual budget of the Ministry of Health. No issues are foreseen 
for allocating additional funds to satisfy the requirements of the 2024 amendments to the IHR (2005) (e.g. 
establishment of a National IHR Authority).  

Recommendations 
• 

Formalise the procedure for re-prioritising and/or requesting additional financial resources in the national 
and regional preparedness plans. 

Human resources (Capacity 5) 

Although Iceland has good capacity in terms of human resources for health and public health, several challenges 
exist. Specialised medical services are provided mostly in the capital, and each Healthcare District and specialised 
hospital assesses its capacity to deliver healthcare services based on the volume of visitors within its jurisdiction. 
The country faces shortages of registered nurses and licensed practical nurses and recruitment and retention of 
medical staff in rural areas remains challenging with no straightforward solutions to address this issue. A limited 
number of public health professionals shoulder multiple critical roles; the Chief Epidemiologist, for example, plays 
central role across infection prevention and control, toxic chemicals and radiation health threats. District physicians, 
as well, absorb public health responsibilities alongside their clinical duties. The reliance on few experts covering 
several roles makes the system highly dependent on individuals and structurally vulnerable. 

While there is a legal requirement for each institution to maintain a preparedness plan, several were updated after 
the COVID-19 pandemic. Most plans reference ‘business continuity’ without offering concrete guidance on how to 
manage it in practice, and existing plans are largely mass-causality focused. Human resource monitoring 
framework exists but requires technical improvements and funding to achieve near real-time oversight, which is 
essential for effective staff management and continuity of care during crises.  

The importance of providing continuous professional training to experts that work in Iceland is acknowledged and 
mechanisms are established by law. The National Commissioner of Police leads training on civil protection, 

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including field and operational management as well as training Red Cross representatives within the Civil Protection 
and Coordination Centre, while Icelandic Red Cross trains its own field units. In healthcare, a master's programme 
on crisis management at Bifröst University commenced in 2021 in response to the growing need for structured 
crisis prevention and preparedness, response and rehabilitation. However frontline training in risk assessment and 
health emergency risk management is limited.  

The recommendations related to this capacity are presented jointly under the area Health Service Provision 
(Capacity 7) below.  

Health service provision (Capacity 7)  

Iceland has a strong culture for resilience for emergencies, both institutionally and among the public. However, 
healthcare services can be strained during a significant event due to limited surge capacity. A map showing 
healthcare bed availability is manually and irregularly updated. The declining number of acute care beds per capita 
was stated to be a concern for Iceland, especially given the aging and increasing population and large number of 
tourists visiting the country – many with age-related health issues – often travelling to relatively remote areas with 
healthcare capacities that are adapted to their permanent resident population. In addition, Landspítali hospital is 
operating regularly around and sometimes over 100% capacity. 

Collaboration between national, regional and local levels was reported to be generally good, although there are 
commonly very few people at each organisational layer, which implies fragility and imposes a need for flexibility 
and adaptability. District physicians, similar to clinical laboratories, absorb public health activities, such as contact 
tracing, within their routine healthcare work. This was reported to make it difficult for them to prioritise public 
health tasks, because their standard duties often had to pause. 

According to the Organisation for Economic Co-operation and Development (OECD) in 2021 Iceland had 15 nurses 
(registered nurses and licensed practical nurses) per 1 000 population, above the EU average of 8.5 nurses per 
1 000 population, and 15 doctors per 1 000 population, which was the third highest rate (after Finland and 
Norway).5, Nevertheless, Iceland faces a significant shortage of licensed practical nurses, which impacts the day-
to-day care, e.g. Landspítali hospital was short of approximately 400 licensed practical nurses last year.6 The 
proportion of GPs was 12.9%, far below the EU average (20.4%). During the assessment, Iceland noted that 
nursing staff retention is an ongoing challenge – particularly as many leave for other sectors and the Ministry of 
Health has identified a need to improve nurse recruitment and retention.  

In recent years, the recruitment of foreign-trained nurses – particularly from the Philippines – has increased 
significantly. Although no formal Icelandic language requirements are in place for licensing by the licensing body, 
proficiency in Icelandic is seen to be essential for safe and effective nursing practice in Iceland. To support this 
transition, Landspítali has implemented a two-year professional development program for international nurses 
working in Landspítali. This includes integration into the Icelandic healthcare system, Icelandic language training, 
and professional support. After completing the program, nurses enter Landspítali’s continuing education system for 
nurses, which provides 40 hours of annual training. Landspítali is also developing a similar continuing education 
program for licensed practical nurses.  

Iceland also relies on overseas healthcare transfers (through the Nordic Cooperation) for less common procedures 
and rare disease management, as well as surge capacity for severely burned patients but that capacity is very 
limited. According to the OECD, in 2023 there remained a backlog of cataract, knee replacement and hip 
replacement surgeries.5 

During the response to the COVID-19 pandemic, surge capacity was provided by recently retired professionals, 
those with reduced clinical duties, students, and, particularly for contact tracing by quarantined healthcare workers. 
The ‘Bakvarðasveitin’ register tracked the available healthcare workforce during the pandemic but is not operational 
anymore. Barriers to maintaining such a system for preparedness purposes include the challenges with maintaining 
its accuracy and data protection issues. While aspects of the Civil Protection law can be activated to recruit 
Icelandic citizens, voluntary healthcare worker recruitment was considered sufficient for healthcare emergencies. 

To strengthen future preparedness, Iceland could consider establishing a national surge capacity framework by 
institutionalising the ‘Bakvarðasveitin’ initiative as a legally anchored, regularly updated registry. This framework 
should extend beyond hospital care to encompass essential public health functions. A phased implementation could 
begin by piloting the integration of data from relevant sources (e.g. licensing authorities, insurance agencies, and 
professional associations) to create a real-time dashboard that maps health professionals by specialty and 
geographic location, enabling rapid and targeted deployment during public health emergencies. 

5 ‘State of Health in the EU Iceland Country Health Profile 2023’; OECD and World Health Organization (acting as the host 
organisation for, and secretariat of, the European Observatory on Health Systems and Policies) 2023. Available at: 
https://eurohealthobservatory.who.int/publications/m/iceland-country-health-profile-2023  
6 https://www.ruv.is/frettir/innlent/2025-07-03-vantar-morg-hundrud-sjukralida-447580  

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The act on Civil Protection No. 08/2008 and regulation No 323/2010 (Iceland Department of Justice) require 
agencies to create their own preparedness plans for business continuity and response to serious events, aligned 
with an overarching national plan, using a standardised format. Several such plans were presented, although there 
appeared to be no recent plan for business continuity and continuity of care in primary care.  

Training and continuous professional development (CPD) programs for emergency preparedness and response 
remain uneven across regions and healthcare roles. Our assessment supports the findings of a number of studies, 
for example, a 2023 study in rural Iceland found that over 40% of healthcare workers had never participated in 
mass casualty exercises, and 43% lacked disaster preparedness training. Establishing a mandatory, comprehensive 
training framework; including practical simulation exercises, role-specific SOPs, and prioritisation protocols, would 
strengthen preparedness and ensure that all personnel can effectively respond to public health crises.  

Recommendations for Human resources (Capacity 5) and Health Service provision (Capacity 7)  
• 

Enhance engagement of district physicians with public health activities through measures such as financial 
incentives or leave compensation. 

• 

• 

• 

Develop long-term strategies to increase and retain an adequate nursing and HCW workforce, including in 
rural areas. Expand access to training abroad, improve the recruitment and integration of foreign-trained 
healthcare workers, particularly nurses, and address attrition among trained staff. 

Develop the system for managing national surge capacity for HCWs and other critical sectors within the 
national preparedness and response plan to be able to re-create a list of eligible HCWs that can be called in 
an emergency (e.g. Bakvarðasveitin during COVID-19). 

Establish plans to ensure continued delivery of primary healthcare and non-urgent medical procedures during 
emergencies of varying duration. This may be facilitated by updating the hospital preparedness plan template. 

Risk communication and community engagement (Capacity 8) 
Iceland’s capacity in Risk Communication and Community Engagement (RCCE) including Infodemic Management 
(IM) is based on a strong inter-agency collaboration, a pragmatic culture of transparency, and a population with 
high levels of institutional trust. The country benefits from its small size and close interpersonal communication 
channels within the administration, which allows for rapid information flow and coordination during emergencies.  

There is no standalone Risk Communication Plan in Iceland; instead, risk communication is generally included as a 
chapter within broader preparedness plans, and each sector holds the primary responsibility for communication 
within its remit. During officially declared public health emergencies, coordination of communication is centralised 
through the National Crisis and Coordination Centre (NCCC), with regional police chiefs, health institutions, and 
municipal actors ensuring harmonised messaging and strategic alignment across sectors. National risk 
communication has been effective, with tailored and transparent messaging via traditional and social media, 
healthcare providers, press briefings, and a 24/7 national hotline operated by the Icelandic Red Cross. During the 
COVID-19 pandemic, this hotline also served as a channel for public feedback, allowing authorities to identify 
common concerns and adjust messaging accordingly. 

A key strength of the country’s RCCE approach lies in high public trust gained through demonstrated commitment 
to transparency and empathy in crisis communication, which has been sustained during the pandemic through 
consistent and explicit communication and updates including addressing scientific uncertainty. Service Centres 
jointly operated by Civil Protection and the Red Cross are set up and opened temporarily after a disaster. They 
serve as one-stop-shops for residents, offering access to social and psychological support as well as other practical 
and necessary support, such as insurance and general information. 

Iceland has made efforts to ensure inclusive communication with vulnerable groups. For people with special needs, 
authorities engaged directly with organisations such as the Disability Association and the Deaf Association to help 
ensure no one is left behind. To reach migrant and immigrant communities, who often live in clusters, have limited 
access to mainstream Icelandic media, and face integration barriers, COVID-19 response efforts included 
engagement with foreign employers and the use of the Multicultural Information Centre. For individuals 
experiencing substance abuse, mobile outreach teams were deployed. However, in the absence of a national RCCE 
strategy, these efforts remain ad hoc. In addition, the engagement of high-profile community leaders for many 
hard-to-reach communities, was notably lacking. 

In addition, Iceland's preparedness planning should account for the substantial seasonal influx of tourists and 
integrate tourism-specific RCCE considerations, particularly in municipalities where cruise ship arrivals may double 
or even triple the local population. This dynamic presents unique communication and coordination challenges that 
require the involvement of local tourism authorities, municipal governments, and port health services. 

Social listening is conducted through traditional means such as monitoring media reports, collecting feedback from 
Red Cross hotlines, and analysing public opinion polls. There is increasing awareness of the need for more 
structured infodemic management approaches and a National Infodemic Management strategy, which include 
strengthening partnerships with academia and involving social and behaviour scientists in risk assessments and 
RCCE efforts. During the pandemic, universities played an active role in countering misinformation through 

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scientific publications. Several master level theses have examined lessons learned from the COVID-19 
communication response. However, this body of evidence has not yet been formally synthesised or institutionalised 
into public health emergency preparedness frameworks. 

A critical capacity gap exists due to the lack of dedicated RCCE-IM staff within institutions. RCCE responsibilities are 
integrated into broader administrative or operational roles, restricting the ability to scale up during emergencies 
and hampering sustained, coordinated community engagement during peacetime. 

Recommendations 
• 

Formalise RCCE-IM strategy at both national and regional levels, with clearly defined roles, responsibilities, and 
intersectoral coordination mechanisms, including SOPs to guide RCCE in both routine and emergency contexts. 

• 

• 

Strengthen human resource capacity by appointing permanent RCCE-IM focal points for RCCE-IM functions 
in the Directorate of Health, Civil Protection, and other relevant bodies. And provide ongoing training in RCCE-
IM methods including on Infodemic Management 

Improve  outreach  to  vulnerable  groups  by  jointly  developing  a  stakeholder  engagement  plan,  led  by  the 
Directorate of Health and Civil Protection, with active involvement of community and religious leaders. 

Points of Entry and border health (Capacity 9) 

Iceland has four airports which are designated Points of Entry (PoE) under the IHR (2005), and 30 seaports, of 
which some meet the requirements as designated PoE under the IHR (2005). Since Iceland is an island, the 
country has no ground crossings. Keflavík International Airport is the main aviation hub that receives the majority 
of international passengers. Of the 30 maritime PoE, 24 are authorised to issue ship sanitation control exemption 
certificates, in accordance with the provisions of the IHR (2005) while only five are authorised to issue quarantine 
certificates and conduct inspections for vector borne diseases in vessels. Regional health committees, in 
consultation with the Icelandic Transport Authority, are responsible for health surveillance on vessels. Each 
committee can issue quarantine exemption certificates for several ports within their respective region. It was 
unclear how many of the 30 ports are able to implement routine core capacities with an all-hazard contingency 
plan, including vector surveillance. Multisectoral approach integrated into the national surveillance system, and 
training for inspectors at the district level is sporadic. In addition, there seems to be a discrepancy between the 
PoE reported in the SPAR and those listed in the relevant legislation, which further sheds light on the need for a 
review of these ports and their availability of core capacities as outlined in Annex 1 of the IHR (2005).  

National preparedness plans for public health incidents are in place for both maritime and aviation PoE, supported 
by relevant legislation. The two national plans define the organisational crisis structure that is activated during 
relevant health emergencies. They contain operational checklists, standard operating procedures and lines of 
communication for the relevant stakeholders involved and are complemented by operational health emergency 
contingency plans specific to each PoE. Stakeholder communication within and between the regional and national 
levels is efficient and straightforward; standard operating protocols are in place and routinely followed. 
Preparedness at PoE is occasionally tested through actual events, including natural disasters, however the revision 
and updating of the preparedness plans – to integrate lessons learned since their publication – has been 
challenging and can benefit from more regular simulation exercises. 

The Ministry of Health is responsible for decision-making around travel-related public health measures. These are 
based on recommendations from the Chief Epidemiologist, who also represents Iceland in the EU Health Security 
Committee (HSC). The HSC would be informed of such planned border measures, but currently there is no 
dedicated step to formally consult with the HSC prior to their implementation as per Article 21 in Regulation 
2022/2371 on serious cross-border threats to health. Requirements to notify WHO on measures which may 
interfere with public travel and trade as per Article 43 of the IHR (2005) is acknowledged in Article 13 in the Act on 
Health Security and Communicable Diseases (No 19/1997).  

Recommendations 
• 

Map out the available core and routine capacities available at PoE and update the list of ports designated 
under the IHR (2005). 

Revise and update preparedness plans for PoE at ports and airports based on the experience from past 
events, including the pandemic. 

Conduct simulation exercises to test all-hazard preparedness and contingency plans at PoE, including for 
CBRNe threats and mass gathering events (e.g. cruise ships anchoring in small municipalities). 

Enhance national and regional competence (training) to ensure that designated PoE have the required core 
and emergency IHR capacities, including for ship sanitation inspections for vector-borne disease agents. 

• 

• 

• 

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Chemical events (Capacity 11) 

Several documents were provided to the expert team on the mechanism of response to chemical events in Iceland. 
Both the Act on Communicable Diseases and the National CBRNe Plan (2019), describe the involvement of different 
stakeholders at the local and national levels and the health sector in the response to chemical incidents. The 
response follows the general preparedness structure as with any other large-scale emergency. In addition, a 
CBRNe handbook (2019) was shared with the expert team, that is used for the training of first responders who 
may come in contact with CBRNe events.  

In principle, smaller events (e.g. small spills, etc) are handled at the local level by local first responders, while 
district physicians may be required to provide guidance to the public. However, the role of district physicians in 
those events is often unclear to first responders. Larger chemical events would trigger the activation of the CBRNe 
plan and potentially a civil protection emergency situation. Coordination will be from the National Crisis and 
Coordination Centre as well as regional emergency operation centres, involving multiple stakeholders e.g. the 
national police, the Capital Area Fire Brigade and the Coastguard.  

Decontamination facilities and capabilities are provided by three hospitals in the country (Landspítali, Akureyri and 
Suðurnes hospitals), while in addition, the Capital Area Fire Brigade and some other fire brigades have mobile 
decontamination equipment. A field exercise simulating the release of a chemical agent was conducted in 2023 
ahead of the Reykjavik Summit of the Council of Europe meeting hosted by Iceland, which was perceived useful by 
the participants.  

Landspítali also hosts the National Poison Information Centre (Eitrunarmiðstöð), which is led by one clinical 
toxicologist and staffed by trained clinical pharmacists and emergency medicine physicians and residents. The 
National Poison Information Centre is considered a source of scientific advice and has managed to provide services 
24/7 despite resources being scarce. It has close ties to the poison centres of the other Nordic and Baltic countries 
and there are unofficial routes of consultation among the toxicologists in that network, which are considered helpful. 

No systematic syndromic surveillance for the exposure to chemical substances is implemented, as is the case in 
most EU countries. However, due to the size of the country and the fact that a limited number of staff are working 
in the poison centre, they have had success with identifying contaminants and other exposures from connecting 
the information from clinicians and the telephone calls to the poison centre help line. 

Roughly 20 sites in Iceland fall under the Regulation on the Prevention of Major Accidents Involving Dangerous 
Substances, which transposes EU Directive 2012/18 (the Seveso Directive) into Icelandic law. These sites are 
primarily fuel storage facilities, as there is little chemical production in Iceland that falls within the scope of this 
regulation. Operators of such sites are required to report to the Administration of Occupational Safety and Health, 
which is under the Ministry of Social Affairs and Housing in collaboration with the Ministry of Environment and 
Natural Resources. The Administration is responsible for supervising, inspecting, and monitoring the facilities’ 
emergency plans, which must be submitted every five years. At present, there is no formal obligation to inform 
district physicians about these sites, and the national Civil Protection authorities, including the National Crisis and 
Coordination Centre, do not have direct oversight of them or their emergency response plans – although some 
staff members are aware of them through their participation in the Committee on the Prevention of Major 
Accidents in Industry (Samráðsnefnd um stórslysavarnir í iðnaði). 

Recommendations 
• 

Develop a National CBRNe strategy, including the update of the CBRNe plan in a multisector collaboration 
with the involved sectors and stakeholders, outlining the corresponding processes and roles 
for multisectoral response, the cycle of exercises, and stockpiling of critical medicines and other equipment.  

• 

• 

Enhance training in healthcare and public health staff in relation to CBRNe event recognition and 
management by taking advantage of European and international events (e.g. participation in simulation 
exercises, train with other Nordic countries, etc). 

Support the National Poison Centre to fulfil its role as a trusted source of advice for clinicians and the public 
by strengthening its human resources and formalising consultation processes with other Nordic countries 
(e.g. through collaboration agreements, etc).  

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Union level coordination and support functions (Capacity 13) 

The Chief Epidemiologist Office is responsible for ensuring coordination with the EU level across the various public 
health functions. This role covers the interactions with the European Commission, ECDC, and other relevant EU 
institutions. The Chief Epidemiologist is member of the senior-level HSC taking responsibility for the 
implementation of possible recommendations from the HSC and is the director and coordinator of the ECDC 
competent bodies from Iceland. Iceland participated to HSC working group on early warning and response, 
preparedness, AMR, civil and military collaboration when the implications of the SCBTH on surveillance, early 
warning and response and preparedness were discussed. Due to limited resources, it is challenging for Iceland to 
participate to all EU initiatives and to dedicate resources for national or EU simulation exercises. Nonetheless, 
Iceland has been very active in reporting and contributing to discussions in EWRS and EpiPulse. 

The new Act on Communicable Diseases under preparation will entail the operationalisation and integration of the 
Union Prevention, Preparedness and Response Plan (under development by EC) with the national preparedness 
plan as well as the alignment to the EU Regulation on SCBTH (2022/2371/EU).  

The possibilities of the EU Health Task Force and the Union Civil Protection Mechanism (UCPM) for providing 
assistance and technical support to the country were discussed during the meeting.  

Recommendations 
• 

Prioritise and finalise the alignment of Iceland’s national preparedness plans with the Regulation on SCBTH 
2022/2371 (SCBTH) with prioritisation on activities related to cross-border and intersectoral collaboration 
and coordination with the EC and the HSC, in line with Article 21. 

• 

Plan resources for participating in EU exercises and relevant preparedness training events.   

Research development and evaluations to inform and accelerate emergency 
preparedness (Capacity 14) 

Research is currently not formally included in Iceland's national preparedness and response plan, but the chapter 
on pandemic monitoring and epidemic analysis acknowledges the importance of studying the clinical features, 
spread, or burden of disease, when dealing with an emerging pathogen. The assessment of the effectiveness of 
medical countermeasures, or the impact of public health and social measures are proposed in the plan. 

During the COVID-19 pandemic, collaboration with the University of Iceland supported modelling and statistical 
analysis, where epidemiologists provided the data. Given the limited capacity within the epidemiology team to 
incorporate research effectively, the Directorate of Health maintains a contract with the Department of Public 
Health Sciences at the university to support statistical analysis. This partial agreement between the government 
and academic institutions, when activated, can help bridge capacity gaps  

Data ownership resides with the Directorate of Health, and data are primarily pulled from the national health 
registries. There are no major concerns about the use of data, especially when used for public health purposes. 
Linking data from different registries is possible with permission from the Data Protection Authority, specifically for 
public health research. However, researchers at the university must apply for access to health data. Applications 
are reviewed by a dedicated committee and, when approved, data are provided in anonymised form. Data access 
is also subject to ethics committee approval and university review processes. 

Iceland actively participates in Nordic countries research through NordForsk, an organisation under the Nordic 
Council of Ministers that provides funding and facilitates research cooperation, sharing data and contributing to 
projects on public health and social measures, and modelling. While Iceland does not lead any project due to 
limited capacity, it is committed to participating in such collaborations. 

Iceland also contributes data to surveillance projects led by ECDC and WHO, when opportunities arise. In the event 
of cross-border health emergencies, the rapid risk assessments provided by ECDC are considered valuable, as well 
as the access to guidance or joint study protocols. 

Recommendations 
• 

Include research in emergency preparedness and response as a core capacity in the preparedness and 
response plan. This could involve updating collaboration processes with university/-ies and exploring the 
possibility of incorporating university-based human resources to enhance research capacity. Besides 
epidemiological operational research that addresses public health assessment and response needs, 
behavioural science studies and modelling to develop preparedness scenarios could be considered. 
Maintain the existing collaboration within the Nordic Research Preparedness Strategy group of countries, a 
strong partnership where Iceland can play a key role and benefit from the joint drafting of study protocols 
or data-sharing agreements.  

• 

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Recovery elements (Capacity 15) and Actions taken to improve gaps found in the 
implementation of prevention, preparedness, and response plans (Capacity 16) 

Iceland has participated in several EU-level and European multi-country simulation exercises, including the annual 
WHO EURO Joint Assessment and Detection of Events (JADE) exercise. A national plan dedicated to recovering 
from public health emergencies is not available, but several municipalities have a recovery plan in place to rebuild 
their services after a health emergency. The Civil Protection Act (2008) provides a legal basis for the establishment 
of temporary Service Centres at the municipal level in situations where contingency plans have been activated. 
These are 'one-stop shops' that provide information and services to the public, thereby facilitating the recovery 
process in the affected communities. 

The national preparedness and response plan and other plans refer to a process of evaluation that identifies 
lessons from public health emergencies. The legal basis for this process (Articles 28 and 29 of the Civil Protection 
Act, 2008) is currently being revised and strengthened. However, not all health emergencies undergo a review 
process, in part due to human resource limitations and competing priorities. The board of the National Crisis and 
Coordination Centre can request that an after-action review (AAR) is carried out in case of emergencies where the 
National Civil Protection Plan has been activated. For other events, an AAR can be carried out at the prerogative of 
the Steering Committee established to manage that event. The Ministry of Justice can also commission an external 
review following a health emergency. According to the Civil Protection Act 2008, the National Commissioner of 
Police is responsible for ensuring that recommendations from AARs are implemented and that preparedness and 
response plans are improved, although no timeframe for implementation is specified.  

An SOP for evaluation of events that have required the involvement of the Civil Protection Department is in place 
and has been used multiple times. This usually takes the format of a two-hour meeting where invited stakeholders 
discuss what went well and what could be improved. However, a relevant methodology for health emergencies is 
not employed. More comprehensive AARs have also been carried out (e.g. on the response to the volcanic activity 
in Grindavík, and the review of the governmental crisis management during the COVID-19 pandemic), whereas 
AARs can also be done on an ad hoc basis for localised regional events. 

Recommendations 
• 

Ensure alignment between relevant legislation and provisions in future national and regional preparedness 
plans to regularly conduct AARs and implement any recommendations with a relevant action plan.  

• 

• 

Develop trigger criteria and procedures for conducting internal AARs following public health emergencies 
coordinated by the Centre for Health Security and Communicable Disease Control.  

Enhance national competence and human resources to conduct AARs by training a pool of experts in AAR 
methodology. Experts from other sectors or academia can assist in organising such events to decrease the 
burden on the government staff. 

21 

 
 
ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

ECDC ASSESSMENT 

Conclusions  

During the assessment, and in light of the documentation provided, the relevant authorities in Iceland 
demonstrated strong abilities to react to public health emergencies promptly, collaboratively and effectively. 
Significant strengths are the resilience of the national response structure, the timely availability of data on disease 
cases by near real-time reporting of laboratory results, and the significant financial resources dedicated to health. 
The response system, including the public health system and the capacities and capabilities of national hospitals 
and laboratories, are often stressed by the occurrence of natural or weather-related events.   

The upcoming update of the national legal framework, as well as the new EU Regulation on SCBTH (2022/2371) 
and the funding of the EU4Health programme, represent opportunities that should be harnessed by Iceland to 
formalise critical collaborations in the context of the national pandemic preparedness plan, to strengthen 
laboratory-based surveillance and the role of the National Reference Laboratory, to establish a dedicated 
representative surveillance system for respiratory infections integrated with laboratory data, to introduce a One 
Health governance guiding roles and processes, and to ensure sustainable funding for key public health priorities 
such as prevention of healthcare associated infections.  

Key factors in the maintenance of a robust public health system are the engagement of all stakeholders, including 
healthcare providers, in public health functions and tasks, and the strengthening of the epidemiological and 
microbiological workforce, at national, regional and local levels.  

22 

 
 
ECDC ASSESSMENT 

ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

Annex 1. List of capacities included in the 
assessment 

Table 1A. List of capacities included in the assessment 

Capacity no. 

Capacity name 

Capacity 1. 

International Health Regulation (IHR) implementation and coordination 

Capacity 2. 

Financing 

Capacity 3. 

Laboratory 

Capacity 4. 

Surveillance 

Capacity 5. 

Human resources 

Capacity 6. 

Health emergency management 

Capacity 7. 

Health service provision 

Capacity 8. 

Risk communications and community engagement (RCCE) 

Capacity 9. 

Points of Entry (PoEs) and border health 

Capacity 10. 

Zoonotic diseases and threats of environmental origin, including those due to the climate 

Capacity 11. 

Chemical events 

Capacity 12. 

Antimicrobial resistance (AMR) and healthcare-associated infections 

Capacity 13. 

Union level coordination and support functions  

Capacity 14. 

Research development and evaluations to inform and accelerate emergency preparedness  

Capacity 15. 

Recovery elements  

Capacity 16. 

Actions taken to improve gaps found in the implementation of prevention, preparedness and response plans  

The five capacities that were assessed in-depth are: 

1. 
2. 
3. 
4. 
5. 

Capacity 3. Laboratory 
Capacity 4. Surveillance 
Capacity 6. Health Emergency Management 
Capacity 12. Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) 
Capacity 10. Zoonotic diseases and threats of environmental origin, including those due to the climate. 

*The fifth capacity has been chosen by the country and agreed with ECDC. 

23 

 
 
 
 
ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

ECDC ASSESSMENT 

Annex 2. Practical arrangements for the 
assessment process  

This annex outlines the main practical arrangements for the Public Health Emergency Preparedness Assessment 
(PHEPA) in Iceland, conducted under Article 8 of Regulation (EU) 2022/2371 on serious cross-border threats to 
health. The country visit took place from 2 to 6 June 2025 at the Directorate of Health and Harpa Hall in Reykjavik. 
This section aims to identify the experts who were members of the assessment team, the national focal point and 
the national experts who participated in the assessment and provides the agenda for the mission. 

The assessment team 

Members of the assessment team 

Name 

Institution 
(ECDC/other agencies 
…)   

Role in the team 
(team 
leader/expert) 

Capacities assessed 

Bruno Ciancio 

ECDC 

Team Lead 

Pete Kinross 

Jessica Beser  

Juliana Reyes 

ECDC 

ECDC 

ECDC 

Daniel Cauchi 

ECDC 

Carmen Varela 
Santos 

ECDC 

Agoritsa Baka  

ECDC 

Zara Taha 

ECDC 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Cinthia Menel-
Lemos 

DG-SANTE 

Expert 

Surveillance, IHR, Union level coordination and 
support functions  

ARHAI, Laboratory, Health Service Provision 

Laboratory, ARHAI, Zoonotic diseases 

Surveillance, Laboratory, Financing, 

Financing, PoEs, Zoonotic diseases, Recovery 
elements, Actions taken to improve gaps in the 
implementation of PPR plans   

Zoonotic diseases, Research, RCCE, Chemical 
Events 

Health Emergency Management, Human 
Resources, Chemical Events 

Human resources, RCCE, Health Emergency 
management, PoEs 
Union level Coordination, IHR, Health 
Emergency management, Health Service 
Provision, Actions taken to improve gaps in the 
implementation of PPR plans 

Sebastiano Lustig 

 DG-HERA 

Expert 

Health Emergency Management (MCM) 

Valentinos 
Silvestros 

Country Expert (CY) 

Country Expert 
(Cyprus) 

Sandra Lindmark 

WHO-EURO 

Expert 

Health Emergency management, Health service 
Provision, PoEs, Recovery elements, Actions 
taken to improve gaps in the implementation of 
PPR plans 

IHR, RCCE, Health Emergency Management, 
Recovery Elements 

The country focal points 

Country focal point(s) and experts involved in the document sharing process 

Name 

Email address 

Organisation 

Guðrún Aspelund – Landl 

gudrun.aspelund@landlaeknir.is 

Directorate of Health 

Tryggvi Oddsson 

Íris Kristinsdóttir 

tryggvi.h.oddsson@landlaeknir.is 

Directorate of Health 

Iris.kristinsdottir@landlaeknir.is 

Directorate of Health 

Guðlín Steinsdóttir 

gudlin.steinsdottir@hrn.is 

Ministry of Health 

24 

 
 
 
 
 
 
 
ECDC ASSESSMENT 

ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

The national experts 

National experts participating in the assessment process  

Name  

National institution   

Role in the 
assessment 
(Coordinator, Expert)  

Main capacity to assess  

Aðalheiður Jónsdóttir 

The Icelandic Red Cross 

Expert 

RCCE 

Andrea Klara Hauksdóttir 

Suðurnes Hospital and Health Center 

Expert 

Health Emergency Management 

Anna Margrét 
Guðmundsdóttir 

Directorate of Health 

Coordinator 

Surveillance 

Anna Margrét Halldórsdóttir 

Directorate of Health 

Coordinator 

Laboratory, Zoonotic Diseases and 
threats of environmental origin, ARHAI 

Ástþóra Kristinsdóttir 

Development Centre for Primary 
Healthcare in Iceland 

Expert 

Human Resources 

Bjarni Sigurðsson 

Ministry of Health 

Coordinator 

Health Emergency Management 

David Dominic Lynch 

Department for Civil Protection 

Elísabet Eik Guðmundsdóttir  Matís 

Erla Björnsdóttir 

Akureyri Hospital 

Expert 

Expert 

Expert 

Ester Petra Gunnarsdóttir 

Ministry of Health 

Coordinator 

Eyjólfur Þorkelsson 

The Health Institute of East Iceland 
– Regional Physician 

Expert 

Health Emergency Management 

Laboratory 

Human Resources 

Human Resources 

PoE 

Fjölnir Freyr Guðmundsson 

Suðurnes Hospital and Health Center 

Expert 

Health Emergency Management, PoE 

Friðfinnur Freyr 
Guðmundsson 

ISAVIA – National Airport and Air 
Service Provider in Iceland 

Gígja Gunnarsdóttir 

Directorate of Health 

Gísli Rafn Ólafsson 

The Icelandic Red Cross 

Expert 

Expert 

Expert 

PoE 

Zoonotic Diseases and Threats of 
Environmental Origin 

RCCE 

Guðjón Hauksson 

The Health Institute of East Iceland 

Expert 

Health Service Provision 

Guðlaug Rakel Guðjónsdóttir 

Suðurnes Hospital and Health Center 

Expert 

Health Emergency Management, PoE 

Guðrún Lísbet Níelsdóttir 

Landspítali Hospital 

Guðrún Svanborg 
Hauksdóttir 

Landspítali Hospital – Department of 
Clinical Microbiology 

Expert 

Expert 

Health Emergency Management, PoE 

Laboratory, Surveillance 

Harpa Ingólfsdóttir Gígja 

Ministry of Health 

Coordinator 

Financing 

Helena Líndal 

Landspítali Hospital 

Expert 

Chemical Events 

Helga Harðardóttir 

Ministry of Health 

Coordinator 

Health Service Provision 

Helga Kristín Jónsdóttir 

Akureyri Hospital  

Helgi Þór Leifsson 

Akureyri Hospital 

Hildigunnur Anna Hall 

Directorate of Health 

Hildur Helgadóttir 

Landspítali Hospital 

Hrólfur Sigurðsson 

Matís 

Hulda Ringsted 

Akureyri Hospital 

Inga Stella Pétursdóttir 

Akureyri Hospital 

Ingibjörg Jónsdóttir 

Ingunn Steingrímsdóttir 

Icelandic Food and Veterinary 
Authority 

Landspítali Hospital – Department of 
Infection Control 

Jón Brynjar Birgisson 

The Icelandic Red Cross 

Jón Steinar Jónsson 

Development Centre for Primary 
Healthcare in Iceland 

Júlíana Jóna Héðinsdóttir 

Directorate of Health 

Kamilla Sigríður Jósefsdóttir 

Directorate of Health 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Human Resources 

Health Service Provision 

Surveillance 

Health Emergency Management 

Laboratory, Zoonotic Diseases and 
threats of environmental origin 

Health Service Provision 

Laboratory 

Laboratory 

Surveillance, ARHAI 

RCCE, 

Human Resources 

25 

 
 
ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

ECDC ASSESSMENT 

National experts participating in the assessment process  

Name  

National institution   

Role in the 
assessment 
(Coordinator, Expert)  

Main capacity to assess  

Karen Ósk Lárusdóttir 

Department for Civil Protection 

Expert 

Health Emergency Management, PoE 

Katarina Tina Nicolic 

Katrín Guðjónsdóttir 

Ministry of Food, Agriculture and 
Fisheries 
Icelandic Food and Veterinary 
Authority 

Kjartan Hreinn Njálsson 

Directorate of Health 

Kristján Orri Helgason 

Landspitali Hospital – Department of 
Clinical Microbiology 

Már Kristjánsson 

Landspítali Hospital 

Maríanna Þórðardóttir 

Directorate of Health 

Nanna Sigríður Kristinsdóttir 

The Health Care Centre of the 
Capital Area 

Ólafur Guðbjörn Skúlasón 

Landspítali Hospital 

Ólafur Guðlaugsson 

Landspítali Hospital – Department of 
Infection Control 

Ólöf Elsa Björnsdóttir 

Landspítali Hospital 

Ólöf Sigurðardóttir 

Akureyri Hospital 

Ólöf Þórhallsdóttir 

Icelandic Medicines Agency  

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Óskar Ísfeld 

Health Inspectorate of Reykjavík  

Expert 

Rafn Benediktsson 

Landspítali Hospital 

Ragnheiður Halldórsdóttir 

Akureyri Hospital 

Ragnheiður Ósk 
Erlendsdóttir 

Rögnvaldur Ólafsson 

Rut Guðbrandsdóttir 

Sigríður Dóra Magnúsdóttir 

Sigríður Magnúsdóttir 

Primary Health Care of the Capital 
area 

National Commissioner of the 
Icelandic Police 
Akureyri Hospital – Infection Control 
Nurse 
Primary Health Care of the Capital 
area 

Icelandic Environment and Energy 
Agency 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Sigrún Guðmundsdóttir 

Health Inspectorate of South Iceland 

Expert 

Sigurborg Daðadóttir 

Ministry of Food, Agriculture and 
Fisheries 

Þórgunnur Hjaltadóttir 

Directorate of Health 

Þórunn Rafnar 
Þorsteinsdóttir 

Keldur, Institute for Experimental 
Pathology 

Tinna Rán Ægisdóttir 

Landspítali Hospital 

Tómas Þór Ágústsson 

Landspítali Hospital 

Vigdís Tryggvadóttir 

Vilhjálmur Svansson 

Icelandic Food and Veterinary 
Authority 

Keldur, Institute for Experimental 
Pathology 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

Expert 

26 

Zoonotic Diseases and Threats of 
Environmental Origin 
Zoonotic Diseases and Threats of 
Environmental Origin 

RCCE, 

ARHAI 

Health Emergency Management 

Laboratory, Surveillance 

Surveillance 

Human Resources 

Surveillance, ARHAI 

Health Service Provision 

Laboratory  

Health Emergency Management 

Zoonotic Diseases and Threats of 
Environmental Origin 

Health Service Provision 

ARHAI 

Health Service Provision 

Chemical Events 

Surveillance, ARHAI 

Health Service Provision 

Zoonotic Diseases and Threats of 
Environmental Origin, Chemical 
Events, ARHAI 
Zoonotic Diseases and Threats of 
Environmental Origin 
Zoonotic Diseases and Threats of 
Environmental Origin 

Human Resources 

ARHAI 

Health Emergency Management, 

Health Service Provision 

ARHAI, Zoonotic Diseases and threats 
of environmental origin 

Laboratory, Zoonotic Diseases and 
threats of environmental origin 

 
 
 
ECDC ASSESSMENT                                                                                                                                                                       ECDC Public Health Emergency Preparedness Assessment for Iceland, 2025 

The mission agenda 

27 

European Centre for Disease 
Prevention and Control (ECDC)

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Tel. +46 858 60 10 00
ECDC.info@ecdc.europa.eu

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