Frequently Asked Questions

Preparedness builds and sustains the capabilities needed to respond to an outbreak. Readiness ensures those capabilities can be mobilised quickly and effectively for a specific threat. Written plans alone cannot show whether people, resources and decisions will come together when needed.  [1,2]

A neighbouring country reports a new respiratory infection. Your country has a pandemic plan, trained teams and emergency stockpiles. But who will coordinate the response? How will surveillance detect the first cases? Who can release emergency funding?

These are readiness questions: can the foundations you have built deliver when they are needed?

From building capabilities to putting them into action

Preparedness requires sustained investment in people, systems and coordination. This includes building capabilities across the core pillars of outbreak response, including surveillance, testing, case management, infection prevention and control, logistics, risk communication and community engagement. [3] Chapter 38 of the CIDER book, Till the next pandemic: national preparedness, also emphasises leadership and building public trust as foundational to preparedness. [1]

Readiness builds on these foundations by ensuring all parts of the system can be activated effectively and efficiently when needed, with everyone clear about their roles. Timely action can save lives, while delays can allow an outbreak to spread and increase its health and societal impacts. [1,2]

Preparedness and readiness overlap within the broader emergency cycle. [4] Readiness is dependent on preparedness for effective activation of these capabilities.

Preparedness and readiness in practice

Response function	Preparedness: building capability	Readiness: enabling effective activation
Leadership and coordination	Establish leadership roles, responsibilities and coordination arrangements across agencies.	Confirm named leads and agency representatives are available, briefed and authorised to activate agreed arrangements.
Surveillance	Establish and strengthen surveillance systems, reporting pathways and a trained workforce.	Ensure teams know which signals to look for, reporting pathways function and personnel are available to investigate alerts.
Funding and supplies	Establish emergency financing mechanisms, stockpiles and supply arrangements.	Ensure funds can be accessed promptly, suitable supplies are available and delivery arrangements can be activated.
Communication and Community Engagement	Build public trust, communication channels and mechanisms for community participation.	Ensure spokespeople and community partners understand their roles, initial messages are prepared and channels are available to share information and hear concerns.

Would current plans and capacity work if an outbreak emerged tomorrow?

Simulation exercises conducted ahead of an outbreak help test whether plans and capabilities can work in practice. Ranging from tabletop discussions to practical exercises involving multiple agencies, they can explore different outbreak scenarios to assess how teams adapt the response and work together under pressure.

Real outbreaks provide crucial insights into how systems perform in practice, revealing strengths and weaknesses that simulations may not capture. During the recovery phase, an after-action review helps identify where preparedness and readiness need strengthening. These lessons need to be institutionalised into future plans and practice with each response strengthening the next.

Sustaining preparedness and readiness in a changing world

Preparedness and readiness both need to adapt as new threats emerge, health systems change and wider societal shifts alter the demands on a response. Ongoing review and investment help strengthen capabilities and the arrangements for activating them, drawing on past experience while anticipating future challenges.

References:

1. Thies DA, Navarro-Colorado C, Khan AS. Till the next pandemic: national preparedness. In: Fisher D, editor. Infectious Disease Emergencies: Preparedness and Response. Singapore: NUS Press; 2025. Chapter 38. Available from: https://doi.org/10.56159/emergencies-38.
2. World Health Organization. Strengthening readiness to respond to emergencies [Internet]. Geneva: WHO; [cited 2026 Oct 29]. Available from: https://www.who.int/activities/strengthening-readiness-to-respond-to-emergencies.
3. Fisher DA, Carson G; GOARN Steering Committee. Back to basics: the outbreak response pillars. Lancet. 2020;396(10251):598. doi: 1016/S0140-6736(20)31760-8.
4. Fisher D. Infectious disease emergencies: Introduction. In: Fisher D, editor. Infectious Disease Emergencies: Preparedness and Response. Singapore: NUS Press; 2025. Chapter 1. Available from: https://emergencies.pubpub.org/pub/infectious-disease-emergencies/release/3.

Not directly. Not directly. Getting wet does not cause an infection, but rain can change how you are exposed to the germs that do.

Rain has long been blamed for coughs, colds and fevers. The connection is worth exploring, but it has more to do with what rain changes around us than simply getting wet.

Colds and flu are caused by viruses, not rainwater. Taking shelter in a crowded indoor space may bring you closer to someone carrying a respiratory virus. Heavy rain and flooding can also increase your contact with harmful bacteria in soil and water, or allow sewage to contaminate drinking water.

Is there any truth in catching a chill?

Respiratory infections follow seasonal patterns, but these vary by virus and location. Some peak during colder months in temperate regions, while rainy-season peaks occur in some tropical settings. Temperature and humidity can affect how long viruses remain infectious outside the body, as well as our respiratory defences. These effects differ between viruses, so wetter weather does not consistently favour transmission. [1]

Rain may encourage people to gather indoors, creating opportunities for respiratory viruses to spread. This may partly explain rainy-season infections, but other factors also contribute.

Researchers have also explored how cooling affects the body’s defences against respiratory viruses. Laboratory research using human nasal cells and tissue found that lower temperatures impaired some local antiviral defences. This offers a possible mechanism linking cold exposure and susceptibility to infection, but does not establish that getting soaked in the rain increases your chance of catching a cold. [2]

Infections linked to heavy rain and flooding

Heavy rain and flooding can increase exposure to pathogens in soil and water. Leptospirosis can follow contact with soil or water contaminated by infected animals’ urine. Flooding can also overwhelm sanitation systems, allowing sewage to contaminate drinking water and increasing the risk of cholera where the bacterium is circulating. [3,5]

Melioidosis presents an intriguing example of how heavy rain can increase the risk of infection. Caused by Burkholderia pseudomallei, a bacterium found in soil and water in tropical and subtropical regions. [4] A 30-year prospective study in tropical northern Australia recorded more than 1,100 cases of melioidosis, with 80% occurring during the wet season. [6]

The bacteria can enter the body through broken skin, by inhalation or by swallowing contaminated water. Heavy rain and strong winds may increase exposure, including by carrying bacteria into the air in tiny droplets or particles. Although the association with rainfall is well established, the route of infection often remains uncertain in individual cases. [4]

Melioidosis can cause a wide range of illness, from localised skin infections and abscesses to pneumonia and life-threatening sepsis. Treatment is challenging because the bacterium is intrinsically resistant to many commonly used antibiotics. In regions where melioidosis occurs, considering the diagnosis, particularly after heavy rainfall, and collecting appropriate samples for culture help identify the bacterium and guide timely, effective treatment. [4,6]

Climate change is intensifying heavy rainfall

Climate change is expected to make heavy rainfall more frequent and intense in many regions, potentially increasing exposure to pathogens in soil and water. Whether this translates into more illness depends on where pathogens are present, how people encounter them and the protection offered by water and sanitation infrastructure, health systems and public health measures. [7]

This interplay between pathogens, people and their environment is central to understanding why outbreaks occur, as explored in Chapter 2 of the CIDER book. [8] The connection between rain and illness is a reminder that our health is closely tied to the environments in which we live.

References:

1. 1. Moriyama M, Hugentobler WJ, Iwasaki A. Seasonality of respiratory viral infections. Annu Rev Virol. 2020;7(1):83–101.
   2. Huang D, Taha MS, Nocera AL, Workman AD, Amiji MM, Bleier BS. Cold exposure impairs extracellular vesicle swarm-mediated nasal antiviral immunity. J Allergy Clin Immunol. 2023;151(2):509–525.e8.
   3. Ko AI, Goarant C, Picardeau M. Leptospira: the dawn of the molecular genetics era for an emerging zoonotic pathogen. Nat Rev Microbiol. 2009;7(10):736–747.
   4. Meumann EM, Limmathurotsakul D, Dunachie SJ, Wiersinga WJ, Currie BJ. Burkholderia pseudomallei and melioidosis. Nat Rev Microbiol. 2024;22(3):155–169.
   5. Chowdhury F, Ross AG, Islam MT, McMillan NAJ, Qadri F. Diagnosis, management, and future control of cholera. Clin Microbiol Rev. 2022;35(3):e00211-21.
   6. Currie BJ, Mayo M, Ward LM, Kaestli M, Meumann EM, Webb JR, et al. The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation. Lancet Infect Dis. 2021;21(12):1737–1746.
   7. Dennis S, Fisher D. Climate change and infectious diseases: the next 50 years. Ann Acad Med Singap. 2018;47(10):401–404.
   8. Soo J, Moore C, Gao G, Heymann D. What causes outbreaks? In: Fisher D, editor. Infectious Disease Emergencies: Preparedness and Response. Singapore: NUS Press; 2025. Chapter 2.