Health, agriculture and environment authorities are simulating future outbreaks as a pressure test for the first major overhaul of the country’s infectious disease response in more than a decade.

QUEZON CITY — Nearly 11 years since its last revision, the Philippines’ national strategy to combat infectious disease threats is undergoing its most serious stress test yet. On November 6, 2025, the Ateneo Center for Research and Innovation (ACRI) in collaboration with the Department of Health (DOH) held a high-level simulation exercise to validate the newly updated Emerging and Re-Emerging Infectious Diseases (EREID) Operating Procedures Manual, the first comprehensive review since 2014. The exercise was conducted at Harold’s Hotel in Quezon City with hybrid participation from across the country, and the country’s outbreak response framework reflects the realities exposed by COVID-19, Mpox, and other recent public health emergencies.

First established in 2005, the EREID program was designed to detect and contain emerging disease threats early. But successive global crises have made one reality inevitable. That is, existing manuals can no longer keep up with the speed, complexity, and cross-disciplinary nature of modern trends. The simulation was therefore not a formality, but a deliberate attempt to find out where the new system might fail under pressure.

To do this, the agency faced two escalating outbreak scenarios. The first, NIPAH-25, involved a highly lethal respiratory virus associated with animal transmission. The second, “EE-25,” simulated a neurological disease of unknown origin. Participants included officials from the Department of Epidemiology, the Department of Quarantine, the Research Institute of Tropical Medicine (RITM), and the agriculture and environmental sectors, reflecting the interdependence that real-life epidemics now demand.

One of the lessons that emerged was structural rather than technical. If the sectors move in sequence instead of simultaneously, the reaction will be slower. In both scenarios, delays occurred because the animal and environmental investigations were treated as secondary steps rather than occurring in immediate parallel fashion. The revised manual addresses this issue by incorporating One Health coordination from the first alarm and formally linking human, animal, and environmental surveillance rather than relying on ad hoc coordination.

Laboratory capacity was another focus. Although RITM demonstrated strong diagnostic and sequencing capabilities, this exercise confirmed the hard fact that identifying entirely new pathogens may still be weeks away. To compensate, the updated manual places greater emphasis on infection-based response protocols, allowing front-line responders to respond to suspected modes of transmission (airborne, contact, or vector-borne transmission) before definitive laboratory confirmation is obtained.

Beyond science and logistics, the simulation also revealed persistent vulnerabilities in risk communication. Participants repeatedly pointed out how fragmented messages during past outbreaks fueled confusion and mistrust. As a result, the revised EREID manual strengthens provisions for a single authoritative DOH-led communication channel with coordinated messages from agricultural and environmental authorities to simultaneously address public health, food security, and livelihood concerns.

Another insight directly shaped by the COVID-19 experience was that there is no clear guidance on how the emergency will end. Officials emphasized the need for clear data-driven criteria for scaling back responses, arguing that uncertainty around de-escalation could be just as damaging as delays in escalation. One participant noted that knowing when to stop is “as important operationally as knowing when to start.”

With simulation feedback integrated and support from the World Health Organization, DOH plans to complete the revised EREID manual by January 2026. The final version will include clearer agency activation flowcharts, integration of the 7-1-7 outbreak detection and response framework, and a dedicated One Health chapter.

Rather than a procedural update, the revised EREID manual is positioned as a living national asset that prioritizes speed, coordination, and evidence over improvisation. In a world where the next infectious disease can occur without warning, this exercise made one message unmistakably clear: Preparation is no longer about responding well, but about being structurally prepared before the first case is confirmed.