PHWR Public Health Weekly Report

Based on experiences from the coronavirus disease 2019 (COVID-19) response, the Korea Disease Control and Prevention Agency (KDCA) developed and announced a mid- to long-term strategic plan to strengthen evidence-based policies and establish a safer society against emerging infectious diseases [1]. The objective of this plan is to systematically prepare for the prevention and response, anticipating the potential emergence of infectious diseases from various sources. One of its key components includes the establishment and implementation of a comprehensive, cross-ministerial training system to enhance the government’s coordinated response capacity during public health emergencies [2]. To ensure a timely crisis response, it is essential to review and continuously improve inter-ministerial collaboration mechanisms. Accordingly, an inter-ministerial training system was designed to enable joint responses to pandemics and other health crises. The training aims to establish coordinated inter-ministerial response mechanisms, assess the practicality of existing emergency manuals, and inform future policy and administrative improvements based on its outcomes [3].

For example, in 2016, the United Kingdom conducted a national emergency preparedness exercise to evaluate its pandemic influenza response capabilities, highlighting the need for cross-ministerial systems. This training has led to improvements in national planning and pandemic preparedness capacities [4]. The objective of the current study was to describe the goals, structure, and implementation plans of Republic of Korea (ROK)’s cross-ministerial training system for responding to emerging infectious diseases and to examine how this system can improve practical response capacities and preparedness for future pandemics.

The KDCA established a training system based on inter-ministerial tabletop exercises (TTX) to clarify ministerial roles and assess the effectiveness of existing crisis response manuals. This study describes the development process of the training system, including the formulation of scenarios, manual revisions, and the selection of participating ministries, based on an analysis of inter-agency response capacities for emerging infectious diseases.

To prepare for emerging infectious diseases, the KDCA conducts various training programs annually, including the “Emerging and re-emerging infectious disease response exercise,” the “Training program for medical responders to emerging and bioterrorism-related infectious diseases,” and the “Safe Korea exercise” (Table 1). These training programs primarily target local governments and healthcare personnel, focusing on early- and clinical-level response capacities. While these elements are crucial, they are limited in scope and cannot be considered as structured training for enhancing the central government’s response capability. Although the “Safe Korea exercise” has been implemented as a government-wide drill, in practice, it is primarily led by the KDCA, with only limited roles assigned to other ministries. Accordingly, there remains a lack of an integrated, multi-agency training system that can effectively address complex crises such as novel infectious disease outbreaks.

Table 1 Outcomes and implications of Republic of Korea’s emerging infectious disease response training

Category	Emerging and re-emerging infectious disease response exercise	Training program for medical responders to emerging and bioterrorism-related infectious diseases	Safe Korea exercise
Target	Local government	Healthcare workers	KDCA
Frequency	Annually	Annually	Annually
Outcomes	-. Scenarios adapted to local government conditions. -. Joint training involving basic local governments and related agencies (e.g., hospitals, fire departments).	-. Practical and simulation-based training in clinical settings. →. Enhances capabilities of medical responders. →. Enables rapid response to emerging disease outbreaks.	-. Participation by multiple relevant agencies. -. Full-process integrated training (field and head quarter) for infectious disease and bioterrorism response.
Key results	-. Over 480 institutions and 1,335 participants involved. -. Theoretical training on infectious diseases. -. Execution and tabletop (discussion-based) exercises. -. Personal protective equipment practice.	-. Over 200 healthcare workers participated. -. Theory and practice training on emerging infectious diseases.	-. Discussion and execution drills. -. Annual drills support continuous improvement and capacity building.
Implications	-. Training limited to initial infectious disease response. -. Continued training needed due to local staff turnover.	-. Training limited to healthcare settings.	-. Training led by KDCA (evaluated by Ministry of the Interior and Safety). -. Limited role of other ministries. -. Lack of training for strengthening inter-ministerial response capacity.

KDCA=Korea Disease Control and Prevention Agency..

Therefore, it is necessary to develop a joint inter-ministerial training system in which the KDCA, as the lead agency for infectious disease disasters, can collaborate with other central ministries (Figure 1). To enable early containment during the initial phase of an outbreak, a scenario-based training strategy was designed to simulate uncertainty, moving beyond conventional, rigid exercises to improve crisis response capabilities. This comprehensive inter-ministerial exercise is the first of its kind since the COVID-19 pandemic, distinguished by its focus on evaluating and improving the operational validity of each ministry’s crisis management manual. Led by the KDCA, this exercise is expected to strengthen national-level capabilities through integration with the existing training frameworks [5]. This training will provide an opportunity to review inter-ministerial policies and coordination mechanisms under crisis conditions while also contributing to enhancing national preparedness through a whole-of-government approach.

Figure 1. Framework for inter-ministerial training on emerging infectious diseases
KDCA=Korea Disease Control and Prevention Agency; EID=emerging infectious disease.

1. Exercise Objectives

The training program was designed with two primary objectives: The first objective is to strengthen inter-ministerial collaboration in the event of an emerging infectious disease crisis. To achieve this goal, the training aims to establish an efficient division of labor and a systematic coordination framework across ministries, enhancing mutual understanding of roles and facilitating timely and accurate decision-making. Rapid and effective decision-making is essential for ministries to fulfill their respective roles and cooperate effectively during a crisis. The second objective is to assess the operational validity of the inter-ministerial infectious disease disaster response manuals and identify areas for improvement. The findings and improvement points from the exercise will be reviewed in stages and integrated into practical response manuals of individual ministries, with continuous refinement through regular training cycles (Figure 2). It is essential to assess whether manuals can be effectively implemented during an actual crisis and whether personnel can sufficiently understand the guidance, followed by incorporating these insights into manual revisions [6]. The core purpose of the training is to clarify the role of individual ministries during a crisis and establish concrete strategies for cross-ministerial coordination. Ultimately, the training aims to lay the foundation for effective inter-ministerial cooperation during future infectious disease outbreaks.

Figure 2. Process for revising the infectious disease response manual based on inter-ministerial exercise results
KDCA=Korea Disease Control and Prevention Agency.

2. Scenario

The training will be based on a structured competency framework and involve the development of various crisis scenarios, which will inform the creation of training manuals and the establishment of an operational system, including training schedules, frequencies, and methods. For instance, scenarios will simulate the large-scale spread of highly transmissible and fatal respiratory viruses (e.g., COVID-19 variants) or the domestic introduction of viral hemorrhagic fevers (e.g., Ebola). These scenarios will aid in assessing each institution’s role across the full spectrum of response phases. Moreover, these scenarios will specify ministry-specific responsibilities during the rapid spread of infectious diseases and examine compliance with existing infectious disease disaster response manuals. The training will focus on diseases with sustained human-to-human transmission, using these scenarios to evaluate and refine ministry-specific response manuals and strategies. To simulate inter-ministerial role execution, the exercise will adopt a TTX format, featuring real-time discussions and decision-making simulations to enhance crisis management capabilities. The participants will engage in diverse scenarios to develop problem-solving skills applicable to real-world crises. Such training enhances preparedness to respond effectively to diverse infectious disease emergencies that may occur in the future.

3. Participating Ministries

According to the 2024 policy research project (Research for Inter-Ministerial Comprehensive Training for Emerging Infectious Diseases, Seoul National University) [7], the response capabilities required by the central government for emerging infectious diseases can be categorized by functional areas such as response systems, prevention, and diagnostics. The framework was developed by reviewing the relevant literature and consulting subject matter experts to define the capability domains and indicators for infectious disease responses. Each domain was prioritized, and the required capabilities were identified accordingly [7]. Based on this, the response capabilities were structured across different response phases (e.g., preparedness and response), categorized into five key domains and 15 sub-components, and analyzed (Table 2). This analysis clarified the roles and responsibilities of each ministry and underscored the importance of inter-ministerial collaboration. It also informed discussions on how cooperative frameworks between ministries could be improved across different functional areas. These findings were used to identify and structure institutions appropriate for participation in the training. Given that all ministries play a role during public health crises, a mapping exercise between ministry functions and response domains revealed that the Ministry of Health and Welfare, Ministry of Food and Drug Safety, Ministry of Environment, and Ministry of the Interior and Safety should be prioritized for participation based on their strong alignment with the training domains. In addition, the Ministry of Education, the Ministry of National Defense, the Ministry of Agriculture, Food, and Rural Affairs, and the Ministry of Foreign Affairs were identified as relevant stakeholders for joint training, depending on specific issues [7]. This systematic approach is pivotal for establishing a foundation to ensure timely and coordinated inter-ministerial responses during emerging infectious disease outbreaks. The structured analysis used to select the participating agencies is expected to strengthen institutional linkages and enable more effective coordination during future public health emergencies.

Table 2 Core areas and components of emerging infectious disease response capacity

Emergency preparedness and command	Surveillance and analysis	Prevention and control	Patient and contact management	Risk communication
Infectious disease emergency preparedness and capacity building. Operation of command system for emergency response. Response strategy & risk assessment.	Surveillance. Epidemiological investigation. Quarantine. Diagnostic testing.	Vaccines & treatments. Non-pharmaceutical interventions (e.g., social distancing). Resource logistics (staff, equipment).	Patient care. Contact tracing & quarantine. Healthcare system readiness.	Risk communication. Information sharing.

4. Exercise Evaluation

Training evaluation is a critical process that assesses how effectively the training can be applied in a real-world emergency response. The KDCA conducts post-training evaluations in collaboration with external experts and participating institutions using pre- and post-training surveys, discussion transcript analyses, and other methodologies. This evaluation process verifies whether the training objectives were met, assesses the performance of participants, and determines the effectiveness of the training manuals. Key evaluation indicators include the establishment of a rapid and structured infectious disease response system, effectiveness of inter-agency cooperation, and enhancement of practitioner competencies. This allows the identification of potential operational challenges during actual emergencies and facilitates the development of practical inter-ministerial coordination strategies. The evaluation also examines the quality of inter-ministerial communication and improvements in response efficiency, which can inform future training enhancements. Through this process, the effectiveness of training can be demonstrated, and directions for future refinement can be clearly established.

5. Major Expectations

The outcomes of the training are expected to contribute not only to the refinement of response manuals but also to the assessment of practical inter-ministerial collaboration. The institutional limitations and functional overlaps identified during training will inform policy reforms, facilitating qualitative improvements in the infectious disease response system. Moreover, repeated training for participants through crisis simulations will enhance their operational competence in real-world emergencies by fostering mutual understanding and communication between ministries, which is expected to strengthen the foundation for an effective inter-ministerial crisis response.

The importance of an inter-ministerial response system has been clearly demonstrated during the COVID-19 pandemic. In the face of an unprecedented global crisis, all ministries are required to act swiftly and make timely decisions. Although some positive outcomes were achieved, the response had several shortcomings and inefficiencies. Considering the unpredictable nature of emerging infectious diseases, it is crucial to implement flexible training approaches that are not constrained by conventional frameworks. The proposed training, based on a TTX format, offers a multidimensional opportunity to enhance the capacity to respond to emerging infectious diseases. Moreover, the training aims to improve the efficiency of inter-ministerial cooperation and revise response manuals to ensure better alignment with real-world scenarios.

Unlike operation-based training, which emphasizes real-time, spontaneous decision-making, TTX facilitates slower-paced, in-depth discussions and decision-making on critical issues in both real and simulated emergencies. Therefore, it is particularly suitable for inter-ministerial training, as it enables the assessment of problem-solving, information sharing, and coordination between agencies [8]. In contrast, operation-based exercises are typically employed to examine one or more functional capabilities, predominantly focusing on staff training at coordination centers such as national disaster response headquarters. Although conducted in real-time environments, these exercises encounter challenges in terms of sustainability and depth, particularly owing to frequent personnel changes. With adequate budgetary support, developing hybrid training models that integrate TTX with field-based components may be feasible.

Globally, agencies like the US Centers for Disease Control and Prevention and the World Health Organization have demonstrated the effectiveness of simulation-based training in enhancing real-world preparedness and response capabilities. Despite the introduction of similar training programs in ROK, lessons from the pandemic have led to a shift toward more pragmatic and macro-level training designs that account for actual institutional capacity. Such approaches are expected to foster more integrated and effective inter-agency collaborations during future outbreaks of infectious diseases.

There are several limitations associated with the current training approach. While TTX are effective in facilitating policy-level decision-making and inter-agency coordination, they are inherently limited in simulating the real-time operational actions and implementation capacities required during actual outbreaks. Moreover, inadequate coordination across ministries, limited scenario sharing, and inconsistent participation could undermine the training’s intended outcomes, reducing it to a mere formality. Frequent staff turnover also presents a challenge for retaining institutional knowledge and experience.

The planned inter-ministerial training program for emerging infectious diseases led by the KDCA is the first of its kind to be introduced post-COVID-19 in 2025, marking a significant departure from previous training formats. The 2025 training will adopt a hybrid model, combining scenario-based workshops with policy discussions involving key ministries. By simulating near-real crisis situations, this initiative aims to enhance national preparedness and promote sustained development of an integrated response capacity. Such training is expected to play a pivotal role in reinforcing national crisis management capabilities and establishing a more resilient posture against future pandemics.

The KDCA plans to implement a comprehensive inter-ministerial training program for emerging infectious disease responses starting in 2025, based on structured response capacities and tailored training scenarios. Based on this training, the response manuals of each ministry will be updated, and the overall response system will be reinforced to enable effective coordination and collaboration among ministries. The insights and lessons acquired through this training will be incorporated to improve the preparedness for future infectious disease emergencies, thereby establishing a solid foundation for rapid and effective national responses. The training program will continue to evolve and expand, further enhancing its capacity to respond to diverse crises. Ultimately, this initiative will strengthen the whole-of-government response framework and serve as a foundation for more efficient responses to future pandemics than those during the COVID-19 pandemic.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: YMK, IHK, SGY. Methodology: YMK, IHK. Project administration: YMK, IHK. Supervision: SGY. Validation: IHK. Visualization: YMK, EMP, HJH. Writing – original draft: YMK. Writing – review & editing: EMP, HJH, IHK, SGY.