Public health depends on acting before illness becomes widespread. Vaccination, surveillance, early detection, environmental control, and effective communication succeed because their benefits are often realized before disease occurs. Yet in 2026, public health is moving in opposing directions: biological, environmental, and social threats are becoming more complex and interconnected, even as institutions and preventive systems face increasing pressure. The result may be a widening public health resilience gap, in which threats evolve faster than our collective capacity—or willingness—to prevent and respond to them.
A recent shift in United States childhood vaccination policy illustrates this tension. On August 10, 2026, a presidential executive order established a framework recommending immunization against 11 diseases for all children, compared with 18 diseases in the 2024 Centers for Disease Control and Prevention (CDC) schedule; several other vaccines were assigned to risk-based or shared clinical decision-making categories [
1]. The administration has characterized the change as an effort to align United States recommendations with those of peer countries and expand parental choice; medical and public health experts have raised concerns about its implications for evidence-based immunization policy [
2,
3].
The central issue is not simply whether a national schedule universally recommends protection against 18 diseases or 11. Vaccination rests on a broader infrastructure of scientific review, surveillance, financing, delivery systems, professional guidance, and public confidence. Changes to any component can have consequences well beyond a single vaccine.
The Republic of Korea’s measles experience offers an instructive counterpoint. After the nationwide epidemic of 2000–2001, the Republic of Korea implemented a 5-year elimination strategy combining a school-based catch-up campaign, high 2-dose coverage, vaccination verification at school entry, strengthened epidemiological and virological surveillance, and rapid outbreak response [
4]. The Republic of Korea also drew on United States measles-elimination experience, with assistance from the World Health Organization (WHO), United Nations Children’s Fund, and the United States CDC [
4].
The Republic of Korea declared measles elimination in 2006 and received formal verification from the WHO Western Pacific Region in 2014. This achievement went beyond successful vaccination by strengthening national immunization and surveillance infrastructure [
4]. There is therefore a troubling historical irony in seeing elements of an evidence-based prevention system that the United States helped the Republic of Korea build more than 2 decades ago now face uncertainty in the United States itself. Public health achievements are reversible: vaccination can achieve elimination, but institutions sustain it.
Several papers in this issue of Osong Public Health and Research Perspectives reinforce this point. A commentary on influenza A(H3N2) subclade K shows how viral evolution continually challenges vaccine policy and underscores the need for genomic and antigenic surveillance, vaccine-effectiveness monitoring, timely vaccine-strain selection, and international data sharing. A Perspective on dengue vaccination similarly emphasizes that vaccination should complement, not replace, vector control. Resilience depends on maintaining multiple layers of prevention.
Emerging and re-emerging infections also test these systems. The mpox review describes changing transmission and new diagnostic and prevention challenges, while the national analysis of Lassa fever surveillance in Nigeria demonstrates the importance of sustained surveillance and climatic influences on disease activity. Together, these studies support adaptable One Health surveillance rather than isolated disease-specific systems.
Recent events make this need clear. The 2026 outbreak of Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda highlighted a less-studied human-pathogenic orthoebolavirus; genomic analysis identified a new variant, while a recent review emphasized gaps between scientific innovation and operational preparedness [
5,
6]. An Andes virus outbreak aboard an international cruise ship likewise demonstrated the challenges of managing person-to-person transmission in a highly mobile, multinational population [
7–
9]. Despite their different epidemiology and pandemic potential, both expose weaknesses in surveillance, laboratory capacity, infection control, research pipelines, and cross-border coordination. The investigation of
Kudoa septempunctata foodborne outbreaks in the Republic of Korea illustrates the same fundamentals: rapid detection, appropriate specimen collection, source identification, and prompt intervention.
Environmental and climate-related hazards further expand the scope of public health protection. The 2025
Lancet Countdown highlighted the health burden associated with extreme heat and wildfire smoke [
10], and a multicountry European study suggested that conventional methods may substantially underestimate wildfire-attributable mortality [
11]. In the Republic of Korea, extreme heat and the devastating 2025 wildfires in Uiseong, Andong, and neighboring areas have highlighted health effects extending beyond the immediate disaster. Investigations following these wildfires underscored the need for long-term, cohort-based follow-up of affected communities [
12]. Studies in this issue on ambient temperature and blood pressure in Indonesia and climatic patterns of Lassa fever in Nigeria illustrate why environmental information should be integrated into surveillance of infectious and chronic diseases.
Other papers broaden resilience beyond outbreaks and environmental hazards. Studies of mental disorders in Vietnam, postpartum depression in Indonesia, and lifestyle-related inflammation and quality of life in the Republic of Korea show how social, behavioral, psychological, and biological vulnerabilities intersect. A resilient public health system must identify what threatens health, who is most vulnerable, and how multiple risks interact.
Three priorities follow. First, proven foundations—including vaccination, surveillance, independent scientific review, laboratory networks, and public financing—must be sustained, evaluated, and strengthened. The Republic of Korea’s measles-elimination experience shows that prevention depends on durable institutions and international learning, not isolated interventions.
Second, public health systems must detect change and adapt to it. As pathogens evolve, vectors shift, environmental exposures intensify, and population vulnerability changes, surveillance should link epidemiological, genomic, environmental, and population-health information. One Health should function as an operational principle rather than merely an aspiration.
Third, public health protection must encompass infectious diseases, environmental hazards, chronic disease risks, mental and maternal health, behavioral risk, and social vulnerability—particularly when these threats occur simultaneously.
The defining challenge may be a widening resilience gap: biological, environmental, and social risks are changing faster than the institutions designed to anticipate, prevent, and respond to them. Retreating from prevention as new threats emerge would move public health in precisely the wrong direction. The task is not only to prepare for the next outbreak, but also to preserve, connect, and strengthen the institutions capable of protecting populations from multiple threats at once.
Article information
Ethics Approval
Not applicable.
Conflicts of Interest
Jong-Koo Lee has been the editor-in-chief of Osong Public Health and Research Perspectives since October 2021.
References
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