Abstract
Background: Emerging infectious diseases (EIDs) continue to pose disproportionate threats to populations in low- and middle-income countries (LMICs), where health systems remain fragmented, surveillance capacities are limited, and community trust in public institutions is often eroded. Disparities in preparedness and response capacity are consistently amplified by structural inequities in health financing, workforce distribution, and governance frameworks. This study provides an empirical examination of how equitable public health infrastructure, integrated disease surveillance, preventive programming, and community-centred engagement collectively determine the effectiveness and sustainability of health policy responses to EIDs.
Methods: A mixed-methods cross-national study was conducted across 18 countries (n = 9,420 participants) from January 2022 to December 2024. Quantitative data were collected through structured surveys administered to health policymakers, frontline health workers, and community members. Qualitative data were gathered through 64 key informant interviews and 24 focus group discussions. Integrated surveillance datasets from national health ministries were analysed using multilevel regression, thematic coding, and spatial epidemiological mapping. The Global Health Equity Index (GHEI) was adapted and applied as the primary composite scoring instrument.
Results: Countries with higher GHEI scores demonstrated significantly faster outbreak detection (mean: 4.2 vs. 11.7 days; p < 0.001), lower case fatality rates (CFR 1.3% vs. 4.9%; p < 0.001), and greater vaccination coverage (87.4% vs. 54.2%; p < 0.001). Community engagement programmes were associated with a 43% improvement in health-seeking behaviour (OR = 2.18, 95% CI: 1.74–2.73). Multilevel regression identified health financing adequacy (β = 0.47), surveillance system completeness (β = 0.39), and community trust (β = 0.31) as the strongest predictors of sustainable outbreak response. Spatial analysis revealed stark geographic clustering of response deficits in sub-Saharan Africa and South Asia.
Conclusions: Equitable investment in public health infrastructure and community engagement is both a moral imperative and a strategic necessity for sustainable EID response. Policymakers must prioritise equity-centred reforms, strengthen integrated surveillance systems, and foster meaningful community participation to achieve durable improvements in health security outcomes globally