ABSTRACT
Background: In order to improve preparedness and response capacities in the European Union, a good overview of capacities at both country and union level is needed. The International Health Regulations (2005) Monitoring and Evaluation framework aims to assess capacities in countries. It includes semi-quantitative tools such as the State Parties Annual Report (SPAR) and the Joint External Evaluation (JEE). After Action Reviews (AAR) and Simulation Exercises (SimEx) were included to identify weaknesses in the functionality of capacities which are not addressed by SPAR and JEE. This study presents an analysis of the use of these tools on a regional level, in Europe. It aims to identify their added value by comparing them to standardised monitoring tools and lessons learned from COVID-19, and considers ways to improve their use in assessing capacities in the EU.Methods: We included 17 SimEx and 2 AAR organized by the European Commission between 2005 and 2018. We categorized a total of 357 recommendations according to the IHR (2005) core capacities they addressed and their target audience. We analysed data using language analysis software. Recommendations to countries were compared to SPAR and JEE indicators. Recommendations to EU agencies were compared to the current mandates of the EU agencies, and to lessons learnt during COVID-19.Results: Of all the extracted recommendations, 59% targeted EU agencies, 18% targeted countries, and 16% targeted both. Recommendations mainly addressed areas of IHR coordination (C2), heath emergency management (C7) and risk communication (C10), and not low scoring areas. Recommendations complement SPAR indicators by identifying gaps in functionality. Eight out of ten early lessons learnt during the Covid-19 pandemic had been raised earlier as recommendations from exercises. Exercise reports assessed did not include or result in action plans for implementation, but COVID-19 has accelerated implementation of some recommendations.Conclusion: SimEx/AAR provide valuable insight into public health preparedness at EU level, as they assess functionality of response mechanisms, point out gaps, and provide training and awareness for participants, who often have key roles in public health emergencies. Better follow-up and implementation of recommendations can improve the regional preparedness for international public health incidents.