Infectious diseases, including novel pathogens and resistance to antimicrobials, are major and growing global public health threats. Resilient health systems depend on the timely and accurate detection of emerging and re‑emerging diseases to control outbreaks at national and international level and to reduce the impact of public health emergencies on healthcare systems, as well as having a sufficient capacity to provide critical care when needed.
Public health preparedness requires adequate capacity of microbiology laboratories to: 1) ensure rapid infection diagnostics to guide treatment, detect and control epidemics; 2) characterise infectious agents for designing effective vaccines and control measures; and 3) monitor the impact of prevention of infections and containment of antimicrobial resistance (AMR). Since 2013, the ECDC is operating the EULabCap (European Laboratory Capability Monitoring System) to assess whether laboratory systems in EU/EEA countries possess key public health microbiology service capacities for EU surveillance and epidemic preparedness for communicable diseases and antimicrobial resistance (ECDC, 2023[1]).
In 2021, the EULabCap Index average for EU countries was 7.9 on a maximum scale of 10, a 5% improvement from the 2018 score (7.5). Of the 29 EU/EEA countries surveyed, 17 demonstrated high performance in public health laboratory capacity (score > 8.0), while 11 demonstrated intermediate performance (score 6.0‑7.9) and one country (Malta) had a low performance (Figure 8.3). The average EU score was graded high across the three dimensions of primary diagnostic testing (8.0), national reference laboratory services (8.0), and laboratory surveillance and outbreak response support (8.3). These results indicate that the EU has strong public health microbiology services that largely meet communicable disease surveillance and response requirements (ECDC, 2023[1]).
The average EU/EEA index score indicated high performance across 10 out of 12 target areas, with intermediate performance in diagnostic test utilisation and antimicrobial resistance monitoring. The increase in the EULabCap Index and narrowing score range between countries indicate convergence towards more harmonised laboratory capacities across EU/EEA countries. However, some gaps and inefficiencies remain on developing clinical guidance for adequate utilisation of diagnostic tests, upgrading surveillance programmes to integrate genomic surveillance and improving connectivity with public health monitoring systems.
The emergence of novel pathogens or threats from chemical, nuclear or biological hazards also poses a substantial risk to health services, in particular hospitalisations in intensive care units (ICU). The COVID‑19 pandemic in 2020/21 severely tested, and at times exceeded, the capacity of hospital systems to absorb and scale up ICU bed capacity while maintaining essential medical and surgical care. In response to the pandemic, most EU countries increased critical care capacity through temporary facilities and surge capacity. However, the initial response was hampered by capacity constraints in equipment and, more critically, in trained ICU workforce (OECD, 2023[2]).
In 2022, there remained wide variation between countries in the availability of ICU beds, with a near ten‑fold difference between Czechia (44.9 beds per 100 000 population) and Sweden (4.5 beds) (Figure 8.4). On average across EU countries with available data, ICU bed capacity only increased marginally from 18.2 beds per 100 000 population in 2019 to 18.4 per 100 000 population in 2022. Notable exceptions were Latvia, where ICU bed capacity doubled from 11.1 to 24.0 beds per 100 000 population, and Spain, where capacity increased from 10.4 to 18.8 ICU beds per 100 000 population. While physical capacity is important, resilient health systems must have the flexibility to meet critical care demand by ensuring that sufficient trained staff are available to match the number of available ICU beds.
