Evaluating the 7-1-7 Outbreak Response Metric: Modelling and Implementation Insights for Ebola, Measles, and Anthrax in Central and Eastern Uganda, 2025

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Introduction Uganda’s recent progress in public health emergency preparedness, as reflected in the 2023 Joint External Evaluation, underscores the relevance of the 7-1-7 framework. Although the WHO recommends detecting outbreaks within 7 days, notifying within 1 day, and responding within 7 days, evidence on the incremental benefits of meeting these targets remains limited, particularly in resource-constrained settings. This study modelled the number of cases averted and the cost-effectiveness of achieving 7-1-7 timelines for Ebola, anthrax, and measles in Uganda. Methods We conducted a cross-sectional analysis in three districts with recent outbreaks, effective as of 13 th December 2024, applying stochastic Susceptible-Exposed-Infectious-Recovered-Death/Susceptible-Exposed-Infectious-Recovered models to compare observed response timelines with hypothetical scenarios meeting 7-1-7 targets. Surveillance data from Uganda’s recent Ebola, measles, and anthrax outbreaks informed the models. Cost-effectiveness was assessed using Disability-Adjusted Life Years (DALYs) averted and Incremental Cost-Effectiveness Ratios (ICERs). Simulations and sensitivity analyses were conducted in R (version 4.2.1). Results Achieving 7-1-7 timelines averted an estimated 133 Ebola cases (47 deaths) and 1,408.7 DALYs, with an ICER of –17.46 USD/DALY, indicating cost savings. For measles, 81 cases and one death were averted, with an ICER of 83 USD/DALY. For anthrax, the framework prevented three human cases (one death) and 50 animal cases (45 animal deaths), averting 734 DALYs, though requiring a 651,811 USD investment for livestock vaccination and carcass disposal. All ICERs fell below Uganda’s 1,300 USD/DALY willingness-to-pay threshold, confirming cost-effectiveness. Sensitivity analysis for measles showed no deaths under low R 0 (8), 90% vaccination coverage, and 90% contact tracing. Conclusion Overall, the 7-1-7 framework substantially reduced cases, deaths, and costs for all three diseases, with notable animal-health gains for anthrax. Measles and anthrax require additional resources for maximal impact. Strengthening rapid detection, contact tracing, vaccination, referral systems, and sustainable multi-sector financing is essential for resilient outbreak response in Uganda and similar settings.

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