# Prioritisation and risk ranking of epidemic-prone diseases for emergency preparedness and response in Eastern Africa using a multi-criteria decision analysis framework, 2023

## TL;DR

This study ranks epidemic-prone diseases in Eastern Africa to guide emergency preparedness and resource allocation.

## Contribution

A novel multi-criteria decision analysis framework was used to prioritize diseases in Eastern Africa.

## Key findings

- Ebola virus disease, Marburg virus disease, and cholera were ranked as the highest risk.
- Unknown diseases and zoonoses showed the lowest preparedness ratings.
- The findings highlight priority diseases and capacity gaps for emergency response in Eastern Africa.

## Abstract

Resources to respond to emerging and re-emerging infectious disease emergencies are limited.

To support preparedness planning and resource allocation, a prioritisation methodology was applied to rank epidemic-prone diseases in Eastern Africa.

The study took place in the eastern region of Africa representing 14 member states.

A multi-criteria decision analysis (MCDA) combined with a modified Delphi approach, adapted from the Africa Centres for Disease Control and Prevention (CDC’s) continental prioritisation framework was employed. A planning team of epidemiologists and infectious disease experts designed the exercise, implemented through a three-day workshop in Comoros from 9 May 2023 to 11 May 2023. The workshop convened 43 experts from Eastern Africa member states and partner organisations to rank diseases. Participants assessed each disease against 19 predefined criteria, grouped into four overarching domains: risk trajectory, epidemic potential, disease severity, and preparedness and medical countermeasures. Overall risk was calculated as the product of risk trajectory, epidemic potential, and disease severity.

Twenty-eight experts (88%, 28 of the eligible participants, n = 32) prioritised 22 potential epidemic-prone diseases. The top 10 were Ebola virus disease (risk = 12.7), Marburg virus disease (11.8), cholera (11.1), coronavirus disease 2019 (COVID-19) (9.9), influenza (8.9), measles (8.6), yellow fever (8.5), Crimean-Congo haemorrhagic fever (8.2), malaria (8.0) and Rift Valley fever (7.9). The unknown disease, defined as one caused by a hypothetical novel pathogen (often referred to as ‘Disease X’), Crimean-Congo haemorrhagic fever, Rift Valley fever and mpox received the lowest preparedness rating.

Ebola virus disease (EVD), Marburg virus disease (MVD) and cholera ranked highest in risk, while unknown disease and zoonoses showed the lowest preparedness.

Amid current funding constraints, these findings provide evidence to guide Africa CDC and partners in strengthening emergency preparedness and response in Eastern Africa, highlighting priority diseases while underscoring the need for further analysis of capacity gaps.