Public health under pressure. Across health care system around the world, the fund is decreasing, tired professionals who leave the field, and the US state legislatures revoked the necessary legal authorities. At the same time, outbreaks of diseases such as measles and dengue are increasing, increasing the urgency and responsibility of the work. In 2025, these pressures will start a change in epidemiology, pushing the field to adopt innovations to be more efficient and effective in controlling outbreaks.

The Covid-19 pandemic unique challenge for public health workers, who have mounted a historic response to the pandemic. The protracted crisis revealed many gaps in a workforce under great strain.

Unfortunately, the pandemic is not the first nor will it be the last public health threat to overcome our defenses. Historically, major infectious disease threats have emerged about every two years on average. Even now, avian influenza A(H5N1) has expanded its geographic footprint and host species over the years. Through some assessments, the world is now closer to a flu pandemic than at any time in recent memory.

With these pressures, public health has no choice but to adapt. Although new technologies such as mRNA vaccine platforms and home testing have expanded our arsenal against epidemics, we cannot rely solely on these biomedical countermeasures.

The most important untapped source of innovation is in public health practice itself. The most promising development emerging from these challenges is the adoption of higher reliability principles as a new standard of operation. These principles are derived from industries that do not tolerate accidents and errors, such as space exploration and commercial aviation.

Public health, especially epidemiology, is beginning to reorient away from deliberate methods of outbreak response to the structured processes characteristic of industries with reliability. A commitment to continuous improvement, data- and metric-based monitoring of performance, and the implementation of standardized operating procedures are signs of high reliability. These practices enable organizations to maintain safety and effectiveness, even during complex and high-stakes environments.

Although we are in the early days of this change, the pressures of the last five years will accelerate the adoption of high reliability in the coming year. Some early successes are already evident. For example, the CDC program responsible for responding to outbreaks of foodborne illness made significant strides. They are aggressively implementing whole genome sequencing to identify the sources of outbreaks and developing a variety of model best practices to support state and local officials in their investigations. This change has led to an increase in successful investigations, which means that the sources of outbreaks are now more likely to be identified completely. In contrast, before these changes, the origin of many outbreaks remained unresolved.

Epidemiology is at a critical stage. Faced with dwindling resources, staff burnout, and increasing disease outbreaks, the field is driven to change. Adopting high reliability principles, borrowed from industries where failure is not an option, emerged as a promising solution. This shift is already yielding results, such as the investigation of foodborne illnesses. By adopting structured and continuous improvement processes and cutting-edge technologies, public health can improve its ability to detect and control disease outbreaks. This change promises a more efficient and effective approach to protect public health in the face of evolving threats.