PHWR Public Health Weekly Report

Since 2000, a series of outbreaks of novel and re-emerging infectious diseases—including coronavirus disease 2019 (COVID-19), Middle East respiratory syndrome, and avian influenza infections in humans—have underscored the critical importance of preparedness for and response to infectious disease threats. In response, systematic approaches for investigating, analyzing, and evaluating risk factors for infectious disease outbreaks, as well as for designing preparedness and response measures to prevent disease spread, have been developed [1-9]. It is now imperative to engage in sustained, systematic discourse on strategies for maintaining and strengthening existing infectious disease management capacities.

Infectious disease control may be broadly categorized into three phases: prevention prior to an outbreak, mitigation of transmission following an outbreak, and response during active spread. Each phase entails distinct vulnerabilities and requires tailored countermeasures. A systematic, phased approach is therefore essential to establish preventive and preparedness measures in advance and to enable rapid and effective response to infectious disease emergencies, thereby facilitating early resolution of crisis situations. Accordingly, numerous studies have examined preparedness and response strategies to infectious diseases across specific fields. During the COVID-19 pandemic in particular, research has focused on identifying factors and indicators influencing the emergence and subsequent spread of infectious diseases. Several studies have presented macroeconomic indicators that reflect the socioeconomic dimensions of the pandemic [1,2]. Other investigations have examined the status of local government personnel responsible for infectious disease response under the exceptional conditions of the COVID-19 crisis, with particular emphasis on the following: infectious disease response teams, personnel assigned to nationally notifiable infectious diseases, and workforce capacity for managing such diseases [3]. Moreover, foundational requirements for infectious disease management are essential for mounting effective initial responses during and after outbreaks. The COVID-19 pandemic has brought renewed attention to the necessity of robust preparedness and response systems, which continue to undergo refinement. Key efforts span multiple domains, including revision of legal frameworks to establish clear statutory authority; development of infectious disease information systems to support real-time surveillance, investigation, and analysis; implementation of epidemiological investigator systems to secure skilled response personnel; expansion of capacity-building training programs and response frameworks; strengthening governance mechanisms to enhance coordination between central and local governments; and advancing the development and supply of therapeutics and vaccines to prevent outbreaks and mitigate transmission.

Against this backdrop, the Capital Regional Center for Disease Control and Prevention initiated a study entitled “Development infectious disease copping strategy of capital area through hazard profiling” [4]. In this study, we aimed to identify ongoing management needs and areas for improvement in infectious disease response capacity within the metropolitan region, in anticipation of future outbreaks. Vulnerability to infectious diseases was assessed across the metropolitan area—comprising Seoul, Incheon, Gyeonggi, and Gangwon—as well as at the provincial, city, and county/district levels, with particular attention to vulnerability and response capabilities. Disparities in infectious disease response resources and capabilities were systematically analyzed, and the findings informed the development of tailored prevention and response strategies to serve as a foundation for policy formulation. This study presents the findings of a post–COVID-19 survey evaluating the infectious disease response capabilities of basic local governments within the metropolitan area.

It should also be noted that this paper was prepared based on a report [4] from the “Development infectious disease copping strategy of capital area through hazard profiling.”

1. Survey Overview and Content

To assess infectious disease response capabilities in the metropolitan area, this survey employed indicators reflecting transmission control and medical response capabilities applied during large-scale infectious disease emergencies, such as the COVID-19 pandemic. Infectious disease response capacity was evaluated across multiple domains, including the availability and competencies of response personnel, the effectiveness of interagency coordination within the affected area, and the adequacy of secured response resources, such as quarantine-related supplies. Based on these domains, a set of evaluation indicators was developed through expert advisory focus group interviews, and clear operational definitions were established for each indicator. Consequently, 10 categories covering areas such as infectious disease response personnel, epidemiological investigators, education and training, consultative bodies, response plan formulation, quarantine supplies, and migrant management were identified, encompassing 42 specific indicator items. Data collection was subsequently conducted using a structured questionnaire administered in an Excel-based survey format (Supplementary File; available online).

1) Operational definitions

(1) Infectious disease response personnel

The term “(number of) infectious disease response personnel” refers to all regular and non-regular employees actively engaged in infectious disease-related duties at city, county, or district offices and public health centers, including branch offices and health clinics. Regular employees comprise public officials, including both general and specialized term-based positions. Non-regular employees include part-time and temporary public officials, public service and fixed-term workers, participants in public work programs, short-term workers, and public health doctors. Health institution personnel encompassed within this definition include directors of public health centers, branch offices, and clinics; physicians; dentists; doctors of Korean medicine; pharmacists; nurses; nutritionists; health educators; medical technicians; nursing assistants; administrative staff; public health officers; and skilled workers. The infectious disease response department is used as an umbrella term encompassing the Infectious Disease Response Center, Infectious Disease Response Division, and Infectious Disease Response Team. The scope of infectious disease response work includes the management of nationally notifiable infectious diseases, as well as preparedness and response activities related to infectious disease emergencies. Personnel who occasionally perform duties unrelated to infectious disease control were excluded from the category of personnel dedicated to infectious disease response. A minimum service requirement of 2 years was applied by summing the duration of current and previous infectious disease response assignments in cases where personnel had transferred between departments. This requirement applied to physicians, dentists, and doctors of Korean medicine.

(2) Epidemiological investigator

The term “epidemiological investigator” refers to both certified and probationary individuals formally appointed to the role of epidemiological investigator. The classification of regular and non-regular employees follows the same definitions applied to infectious disease response personnel. Epidemiological investigator mentoring denotes a structured one-on-one system in which certified epidemiological investigators or more experienced senior investigators are paired with trainees or junior investigators to supervise their work and support the development of professional competencies. The survey assessed whether opportunities to strengthen the capacities of epidemiological investigators were provided on a regular and continuous basis through education, mentoring, consultation, and advisory activities during epidemiological investigations. In particular, it examined whether trainees and certified investigators, or senior and junior investigators, jointly participated in field site assessments and practical training activities, such as data analysis, to enhance their investigative skills. The term “epidemiological investigator mentoring for infectious disease response personnel” refers to the arrangement in which at least one epidemiological investigator from the infectious disease response department provides education, guidance, mentoring, and consultation, as needed, to other infectious disease response personnel. This support aims to enable personnel to acquire the knowledge and skills required for effective infectious disease response. Emphasis was placed on the capacity of epidemiological investigators—by virtue of their specialized expertise and experience exceeding that of other response personnel—to provide appropriate intervention or assistance upon request in their respective areas of specialization. The term “statistical analysis and academic support for epidemiological investigators” refers to whether the organization allocates funds from its own budget to procure statistical software and to support academic activities, including expenses related to English-language editing and publication fees, necessary for statistical analysis, report preparation, and scholarly output by epidemiological investigators. Notably, even if such support is currently not provided in practice, the item was marked as “Yes” if the relevant allocation is reflected in the organizational budget.

(3) Education, consultative bodies, and related components

In the education-related survey items, the term “completion” refers to the successful conclusion of training courses designated for each rank and position by the Korea Disease Control and Prevention Agency. The number of training sessions for infectious disease response personnel assigned to infectious disease response departments at infection-vulnerable facilities denotes the frequency, within the past year, of infectious disease response-related training provided to infection control personnel at facilities vulnerable to disease transmission, including nursing homes, long-term care hospitals, mental health promotion facilities, facilities for persons with disabilities, and other similar institutions. Disease information monitor registration and annual training refer to both the registration of disease information monitors at infection-risk facilities, such as hospitals, clinics, schools, industrial facilities, cafeterias, social welfare facilities, kindergartens, and daycare centers, and the provision of at least one training session per year. Training may be delivered in person, remotely, or through recorded video lectures and guideline-based instruction. Training content includes dissemination of infectious disease prevention and management guidelines, reporting procedures following the diagnosis of infectious disease cases, and reporting of infectious disease occurrence and prevalence status. Only training sessions conducted through in-person live instruction, live remote (video-based) instruction, or recorded video training and guidance were included.

For items related to consultative bodies, cases corresponding to any one of the four defined types of city/county/district–level infectious disease response local government–medical consultative bodies were marked as “Yes.” These four types comprise the following: (1) the basic model (city/county/district government and local medical association, composed of the director responsible for infectious disease response and the local medical association); (2) the expert advisory model (city/county/district government, local medical association, and advisory group, utilizing networks including regional infectious disease management support teams); (3) the emergency and medical response model (city/county/district government, local medical association, and emergency center, including emergency transport systems involving emergency centers and fire headquarters); and (4) the integrated model (city/county/district government, local medical association, advisory group, and emergency center, reflecting integrated participation at both local and regional levels). The consultative body for infection-vulnerable facilities refers to a forum in which infectious disease response personnel responsible for managing infections at facilities vulnerable to disease transmission, such as long-term care facilities, long-term care hospitals, mental health promotion facilities, and facilities for persons with disabilities, participate to discuss infection prevention and control. Exceptional cases in which an infectious disease response local government–medical advisory body had already been established, and in which infectious disease response personnel engaged in infection control at infection-vulnerable facilities participated jointly, were also recognized as consultative bodies for infection-vulnerable facilities. However, it was stipulated that infection control officers from major infection-vulnerable facilities within the relevant city or province must participate and that key facility-related infection control issues be addressed.

Infectious disease crisis management countermeasures were considered to be established only if all of the following components were included: clearly defined roles of responding agencies during an infectious disease disaster; the structure of the decision-making system, mobilization mechanisms and an inventory of facilities and personnel; measures for securing medical and quarantine supplies; training plans tailored to different disaster and crisis scenarios; and measures to protect populations vulnerable to infection.

The establishment of communication channels for immigrants refers to the development and operational use of networks involving human resources, foreign resident support centers, or private organizations capable of facilitating communication with immigrants from various countries. This includes securing a registry of foreign resident support centers or private organizations that can provide communication support through bilingual personnel and foreign residents of diverse nationalities, and the ability to mobilize these resources when needed. The number of languages used for foreign-language notices refers to the number of languages in which infectious disease-related notices, educational materials, and other documents are prepared and disseminated, corresponding to the principal nationalities of foreign residents within the local government’s jurisdiction.

2. Participants, Methods, and Survey Period

Official survey request letters were distributed to all 95 local governments within the Seoul metropolitan region—comprising Seoul (n=25), Gyeonggi Province (n=42), Incheon (n=10), and Gangwon Province (n=18)—including the public health centers of each city, county, and district. The survey was administered by the designated responsible official in each jurisdiction and targeted infectious disease response personnel working within infectious disease response departments (centers, divisions, and teams). Respondents included individuals holding key roles such as center directors, branch directors, department heads, section chiefs, team leaders, and operational staff. Each local government compiled its responses and submitted the finalized survey results. The online survey was conducted over a 3-week period, from September 26 to October 14, 2024. Responses were received from all targeted local governments, yielding a response rate of 100% across the Seoul metropolitan region.

3. Statistical Analysis

Relative evaluation indicators are expressed as mean values for each city, county, and district within the Seoul metropolitan region and subsequently grouped by metropolitan city or province (Seoul, Incheon, Gyeonggi, and Gangwon). The coefficient of variation was calculated both at the metropolitan city/province level and for individual cities, counties, and districts within each jurisdiction to assess variability. For personnel-related indicators, values were standardized as the number of personnel per 10,000 registered residents, calculated as: (number of personnel [persons]×10,000)/(registered population [persons] of respective local government). For absolute evaluation indicators, predefined benchmark criteria were established. The number of local governments meeting each criterion within a given region was then calculated and expressed as a percentage of the total number of local governments in that region. Compliance with each criterion was coded dichotomously (1=criterion met; 0=criterion not met).

1. Personnel

During the survey period (September 26 to October 14, 2024), the mean number of public health center personnel per 10,000 population across the Seoul metropolitan region was 11.5. By region, the corresponding figures were 26.1, 18.5, 7.0, and 6.2 for Gangwon Province, Incheon, Seoul, and Gyeonggi Province, respectively (Table 1) [4]. Because infectious disease outbreaks often require rapid activation of emergency protocols, particularly during the initial response phase, the efficiency of response operations is strongly influenced by the availability of regular or dedicated personnel. Accordingly, the survey assessed the proportion of regular and dedicated staff within the infectious disease response departments (centers, divisions, and teams) of public health centers and local governments. Incheon recorded the highest proportion of regular public officials among infectious disease response personnel in public health centers, at 81.7%. Among personnel working in infectious disease response departments at the city, county, and district government levels, the proportion of staff dedicated exclusively to infectious disease response was highest in Seoul (69.5%) and lowest in Gangwon (52.4%). Within the Seoul metropolitan region, Seoul also exhibited higher proportions of personnel with over 2 years of experience in infectious disease-related work (15.2%), fixed-term or specialized civil servants (16.2%), and physicians (7.4%) compared with other regions. In contrast, Gangwon Province had relatively higher numbers of dedicated pest control personnel and temporary staff at the city, county, and district levels, with both categories recorded at 0.6 personnel per 10,000 residents.

Table 1 Status of infectious disease response capabilities by city, county, and district in the metropolitan area in 2024 (infectious disease response personnel)

Division	Indicator	Relative evaluation index												Absolute evaluation index
		Average						Coefficient of variation						Requirements	Satisfaction ratio (%)
		All	Seoul	Incheon	Gyeonggi	Gangwon		All	Seoul	Incheon	Gyeonggi	Gangwon			All	Seoul	Incheon	Gyeonggi	Gangwon
Total infectious disease response personnel in cities, countries, and districts	Public health center personnela)	11.5	7.0	18.5	6.2	26.1		1.28	0.50	1.66	1.01	0.51		-	-	-	-	-	-
	Percentage of full-time servants among public health center personnel (%)	57.3	65.9	59.3	53.2	54.1		0.21	0.28	0.18	0.18	0.19		-	-	-	-	-	-
	Whether an infectious disease response center or infectious disease response department has in public health center (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	41	48	30	17	7
	Percentage of the infectious disease response staff in the infectious disease response center or infectious disease response department (%)	8.6	9.4	2.9	9.9	7.9		1.40	1.19	2.00	1.31	1.61		-	-	-	-	-	-
	Percentage of full-time servants in the public health center’s infectious disease response center or infectious disease response department (%)	30.7	38.4	24.6	26.9	32.3		1.14	0.98	1.55	1.13	1.17		-	-	-	-	-	-
	Percentage of personnel in infectious disease response divisions (centers, departments, teams) among the total public health center staff (%)	11.4	7.8	10.1	14.4	9.9		0.58	0.48	0.65	0.52	0.37		-	-	-	-	-	-
	Percentage of full-time servants in infectious disease response divisions (centers, departments, teams) among the public health center’s infectious disease response personnel (%)	66.8	68.7	81.7	60.9	69.6		0.33	0.39	0.23	0.32	0.23		-	-	-	-	-	-
	Percentage of personnel dedicated to infectious diseases in infectious disease response divisions (centers, departments, teams) within the city, county, or district (%)	62.0	69.5	53.2	63.8	52.4		0.50	0.48	0.54	0.45	0.59		-	-	-	-	-	-
	Percentage of infectious disease response personnel affiliated with at least two years of service in infectious disease response divisions (centers, departments, teams) with municipalities and counties (%)	10.8	15.2	4.9	9.2	11.6		1.76	1.55	2.15	1.71	1.63		-	-	-	-	-	-
	Percentage of fixed-term or professional servants in infectious disease response divisions (centers, departments, teams) affiliated with municipalities and counties (%)	9.7	16.2	9.4	10.0	0.4		1.24	0.78	1.18	1.18	4.12		-	-	-	-	-	-
	Percentage of physicians in infectious disease response personnel (centers, departments, teams) affiliated with municipalities and counties (%)	3.6	7.4	2.2	3.0	0.4		2.52	1.56	1.70	3.11	4.12		-	-	-	-	-	-
	Epidemiological investigation team members within public health centersa)	8.9	12.1	11.3	7.5	6.6		0.51	0.57	0.23	0.59	0.66		More than 10	53	68	90	36	50
	Contract-based quarantine personnela)	0.2	0.1	0.1	0.2	0.6		1.96	0.78	1.75	1.21	1.44		-	-	-	-	-	-
	Contract-based quarantine personnela)	0.2	0.1	0.1	0.2	0.6		1.85	0.93	1.70	1.03	1.28		-	-	-	-	-	-

^a)(The number of personnel described indicator in each local government×10,000)/resident registration population in each local government. Reused from the report of Korea Disease Control and Prevention Agency (2024) [4]..

2. Epidemiological Investigator

The survey assessing the status of epidemiological investigators across cities, counties, and districts, as well as public health centers, within the Seoul metropolitan region, revealed substantial interjurisdictional disparities across key indicators (Table 2) [4]. The number of epidemiological investigators per 10,000 population was highest among personnel assigned to health centers in Gangwon Province (0.32) and lowest in Incheon (0.03).

Table 2 Status of infectious disease response capabilities by city, county, and district in the metropolitan area in 2024 (relating to epidemiological investigators among personnel)

Division	Indicator	Relative evaluation index												Absolute evaluation index
		Average						Coefficient of variation						Requirements	Satisfaction ratio (%)
		All	Seoul	Incheon	Gyeonggi	Gangwon		All	Seoul	Incheon	Gyeonggi	Gangwon			All	Seoul	Incheon	Gyeonggi	Gangwon
Epidemi-ological investigator staffing by cities, countries, and districts	Total (training+completed) epidemiological investigators in infectious disease response divisions (centers, departments, teams) affiliated with public health centersa)	0.11	0.06	0.03	0.07	0.32		0.87	0.78	0.90	1.04	0.77		More than 1	89	100	70	37	89
	Epidemiological investigators who completed the general course in infectious disease response divisions (centers, departments, teams) affiliated with public health centersa)	0.04	0.03	0.02	0.04	0.04		1.21	0.77	0.99	1.02	2.08		More than 1	64	80	60	71	28
	Percentage of full-time servants among epidemiological investigators in infectious disease response divisions (centers, departments, teams) affiliated with public health centers (%)	58.8	61.3	50.0	54.9	69.4		0.77	0.73	0.89	0.83	0.64		-	-	-	-	-	-
	Percentage of epidemiological investigators dedicated to epidemiological investigation in infectious disease response divisions (centers, departments, teams) affiliated with municipalities and counties (%)	51.6	70.0	38.3	58.9	16.7		1.14	0.71	1.13	0.72	2.00		More than 1	62	76	50	74	22
	Percentage of epidemiological investigators with 2+ years of service in epidemiological investigators in infectious disease response divisions (centers, departments, teams) affiliated within municipalities and counties, dedicated to epidemiological investigation (%)	55.8	80.7	41.7	57.1	25.9		0.85	0.35	1.06	0.77	1.20		More than 1	69	96	50	69	44
	Mentoring among epidemiological investigators (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	20	24	10	29	0
	Mentoring of epidemiological investigators with infectious disease response personnel (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	33	40	40	38	6
	Statistical analysis/academic support for epidemiological investigators (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	8	16	0	10	0

^a)(The number of personnel described indicator in each local government×10,000)/resident registration population in each local government. Reused from the report of Korea Disease Control and Prevention Agency (2024) [4]..

At the city, county, and district government levels, Gangwon recorded the lowest proportion of personnel dedicated exclusively to epidemiological investigation (16.7%) and the lowest proportion of investigators with ≥2 years of service (25.9%). In contrast, the proportions were highest in Seoul, at 70.0% and 80.7%, respectively. These findings suggest that Gangwon relies heavily on investigators who have been recently appointed as regular employees, whereas Seoul maintains a workforce characterized by a higher concentration of dedicated epidemiological investigators with longer service duration.

Overall, the establishment of mentoring systems and the allocation of budgets for academic support to strengthen the competencies of epidemiological investigators were limited across local governments within the Seoul metropolitan region. Although Seoul and Gyeonggi Province demonstrated comparatively higher levels of mentoring system implementation and academic support, Gangwon Province showed marked deficiencies in both epidemiological investigator mentoring and the provision of budgetary resources for scholarly activities.

3. Education, Consultative Bodies, and Related Components

Across cities, counties, and districts within the Seoul metropolitan region, training-related indicators for infectious disease response personnel generally demonstrated low completion rates, with the notable exception of the field epidemiology training program (FETP) completion rate among public health center team leaders responsible for infectious diseases (Table 3) [4]. The FETP showed a comparatively higher completion rate than other training measures, with a regional average of 37.3%. In contrast, completion rates were low for training indicators targeting public health center directors; center, division, and section chiefs at grade 5 or higher with infectious disease-related responsibilities; infectious disease response personnel in public health center infectious disease response departments (FETP); and reserve disease control personnel among all public health center staff, at 13.5%, 14.0%, and 4.0%, respectively.

Table 3 Status of infectious disease response capabilities by city, county, and district in the metropolitan area in 2024 (related to education, consultative bodies, etc.)

Division	Indicator	Relative evaluation index												Absolute evaluation index
		Average						Coefficient of variation						Requirements	Satisfaction ratio (%)
		All	Seoul	Incheon	Gyeonggi	Gangwon		All	Seoul	Incheon	Gyeonggi	Gangwon			All	Seoul	Incheon	Gyeonggi	Gangwon
Training for infectious disease response personnel in cities, countries, and districts	Health center directors completion of (quarantine officer and infectious disease manager training course) (yes/no)	-	-	-	-	-		-	-	-	-	-		More than 1	25	28	20	29	17
	Public health center directors/directors/managers/section heads, etc., level 5 or higher, completion rate of (quarantine officer and infectious disease manager training course)	13.8	10.0	5.0	19.2	11.1		2.21	2.83	3.00	1.71	2.83		-	-	-	-	-	-
	FETP training completion rate for infectious disease team leaders in public health centers (%)	37.3	40.0	32.5	31.6	49.5		0.94	1.00	0.89	0.93	0.81		-	-	-	-	-	-
	FETP training completion rate for infectious disease response personnel in public health centers’ infectious disease response departments (%)	14.0	15.9	16.6	8.7	22.4		1.22	1.38	0.69	1.07	0.97		-	-	-	-	-	-
	Completion rate of reserve quarantine personnel training completion rate among all public health centers (%)	4.0	3.5	7.3	2.1	7.1		0.86	0.55	0.34	1.02	0.59		-	-	-	-	-	-
Training for external infectious disease manage-ment personnel	Number of trainings on infectious disease vulnerable facilities for infectious disease response personnel in public health departments (times)	12.9	15.1	3.1	18.8	1.5		1.26	1.50	0.77	1.59	1.16		More than 1	83	88	90	86	67
	Registration of disease information monitoring agents and training at least once a year (yes/no)	-	-	-	-	-		-	-	-	-	-		More than 1	46	16	40	62	56
Local government-Medical council for infectious disease response	Establishment of local government-medical council for infectious disease response in public health centers (yes/no)	-	-	-	-	-		-	-	-	-	-		More than 1	71	48	100	71	83
	Establishment of local government-medical council for infectious disease response in public health centers (yes/no); type (basic/expert advisory/emergency medical response/integrated)	Not shown												More than 1	71	48	100	71	83
	Number of meetings of the local government-medical council for infectious disease response in the city/county/district	1.6	1.1	1.5	1.8	1.9		1.36	1.99	1.09	1.41	0.96		More than 1	55	32	70	57	72
Council for response to infection-prone facilities	Whether a council for infection-prone facilities in the city/county/district is formed (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	28	44	30	17	33
Council for transporting infected patients
	Number of meetings of the council for infection-prone facilities in the city/county/district	0.3	0.5	0.6	0.2	0.1		2.86	2.25	2.49	3.88	2.83		More than 1	14	20	20	10	11
	Whether a council for infection-prone facilities in the city/county/district is formed (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	9	4	10	12	11
	Number of meetings of the council for infection-prone facilities in the city/county/district	0.07	0.00	0.10	0.12	0.06		3.09	0.00	3.00	5.25	4.12		More than 1	4	0	10	5	6
Establish-ment and activities of infectious disease crisis manage-ment measures	Infectious disease crisis management plan (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	84	92	100	76	83
Manage-ment and use of quarantine supplies	Check and manage the quantity and expiration date of quarantine supplies (Masks, PPE, etc.) at least once a year (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	100	100	100	100	100
	Storage of quarantine supplies (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	96	96	100	93	100
	Training of new employees (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	75	72	90	76	67
Infection control for immigrants	Securing communication channels for immigrants (presence/absence)	-	-	-	-	-		-	-	-	-	-		More than 1	15	8	20	19	11
	Number of foreign language announcements used (types)	0.6	0.2	0.6	1.1	0.0		3.47	2.44	1.70	2.78	0.00		-	-	-	-	-	-

FETP=field epidemiology training program; PPE=personal protective equipment. Reused from the report of Korea Disease Control and Prevention Agency (2024) [4]..

Regarding the establishment and operation of regional consultative bodies for infectious disease response in cities, counties, and districts within the Seoul metropolitan region, Incheon achieved full compliance (100%) in the formation of local government–medical consultative bodies. Seoul demonstrated relatively higher compliance in the establishment of consultative bodies for infection-vulnerable facilities (44%), while Gyeonggi Province showed comparatively higher compliance in the formation of patient transport consultative bodies (12%). Incheon also satisfied all six requirements specified in the indicators for the establishment and operationalization of infectious disease crisis management countermeasures. Regarding management and utilization of quarantine supplies, the indicator for assessing the monitoring and management of quantities and expiration dates was the only measure to achieve a 100% compliance rate across all regions. However, improvements were identified in storage-related indicators, particularly those concerning adherence to guidelines for appropriate storage locations and recommended temperature and humidity conditions. With regard to infection control measures for migrants, Incheon recorded a 20% compliance rate in the establishment of communication channels for migrant populations. With respect to the availability of multilingual guidance materials, Seoul demonstrated the lowest level of utilization, with an average of 0.2 foreign languages used.

This policy research project assessed the infectious disease response capabilities of all local governments within the Seoul metropolitan region. The organizational structures for infectious disease response varied across jurisdictions. At the metropolitan city and provincial levels, infectious disease-related functions were generally organized at the “division” level within health- and welfare-related bureaus. In contrast, at the city, county, and district levels, infectious disease prevention, response, and management activities were primarily implemented at the “division” and “team” levels, largely reflecting the organizational structures of public health centers. In Gangwon Province, only 7% of local governments met the prerequisite of establishing either an infectious disease response “center” or “division” within their public health centers. With respect to human resources, more than 50% of infectious disease response personnel at the local government level, including epidemiological investigators, were regular or dedicated staff. Although the number of regular term-based or specialized public officials, particularly epidemiological investigators, appeared insufficient at the city, county, and district (public health center) levels, this shortfall was partially mitigated through support and coordination at the metropolitan city level. These findings underscore the need for a comprehensive review and careful interpretation of policy research results. Overall, the results suggest that infectious disease response systems have undergone organizational restructuring accompanied by qualitative improvements in response capacity. However, the focus of this study was exclusively on infectious disease response capabilities at the city, county, district, and public health center levels and did not present results from surveys conducted at the metropolitan city or provincial levels.

During this research project, a comprehensive set of indicators was developed to measure infectious disease response capacity, drawing on field conditions and existing data sources. Using these indicators, the status of infectious disease response capacity at both the provincial and city/county/district levels—the front lines of infectious disease control—was assessed, and the relative strengths and weaknesses of individual local governments were identified. Nonetheless, substantial standard variability was observed not only across indicators and regions but also among cities, counties, and districts within the same region, limiting the generalizability of the findings. This heterogeneity may be attributable to intra-regional differences, including geographic characteristics, population density, administrative capacity, and operational practices. In addition, infectious disease response departments within public health centers encompass infectious disease response centers, divisions, and teams; however, most are organized at the team level. Accordingly, the results should be interpreted with caution. Given the diversity and complexity of infectious disease-related tasks and classifications, further caution is also warranted when interpreting survey results related to “infectious disease response departments” and “infectious disease response personnel” [3].

Due to space constraints, only a subset of the findings from this policy research project could be presented in this study. Nonetheless, the project is remarkable as it identified metropolitan-level indicators associated with infectious disease response capacity in the post–COVID-19 context and provided systematic, region-wide survey results. Despite some limitations related to data generation, statistical methods, and the consistency of notation, the findings offer valuable baseline data that can inform efforts to strengthen regional public health systems. Future research is expected to further refine crisis response indicators that incorporate considerations of governance and sustainability, thereby enhancing preparedness for emerging and re-emerging infectious disease threats.

Ethics Statement: Not application.

Funding Source: This research is supported Korea Disease Control and Prevention Agency (1790387-202400087).

Acknowledgments: This paper is a reconfiguration of the Study on Development infectious disease copping strategy of capital area through hazard profiling by Policy Research Services. We thank the members of the Division of Infectious Disease Control and Response, Capital Regional Center for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Seoul, Korea; Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Jae-Min Kim; Department of Preventive Medicine, University of Ulsan College of Medicine, Ulsan University, Eunjeong Noh; Department of Health Administration, Inje University, Su-Yeun Seo; Department of Interdisciplinary Program in Biomedical Engineering, Pusan National University, Myung-Jae Lee.

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

Author Contributions: Conceptualization: Jae-Hyun Park. Data curation: Jae-Hyun Park, Jong-Ho Park. Formal analysis: Jae-Hyun Park, Jong-Ho Park. Funding acquisition: Jae-Hyun Park. Investigation: Jae-Hyun Park, Jong-Ho Park. Methodology: Jae-Hyun Park, Jong-Ho Park. Project administration: Jae-Hyun Park. Software: Jae-Hyun Park, Jong-Ho Park. Supervision: Jae-Hyun Park. Validation: Jae-Hyun Park, Jong-Ho Park. Writing – original draft: JSS, SNK, KWH. Writing – review & editing: JSS, Jae-Hyun Park, SNK, KWH.

Supplementary data are available online.