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. 2025 Dec;18(1):2491199.
doi: 10.1080/16549716.2025.2491199. Epub 2025 May 29.

Public health system response to emerging infectious respiratory outbreaks in Iran

Zahra Afshar Hosseinabadi  1 , Nasrin Shaarbafchizadeh  2 , Mostafa Amini-Rarani  3
Affiliations

Public health system response to emerging infectious respiratory outbreaks in Iran

Zahra Afshar Hosseinabadi et al. Glob Health Action. 2025 Dec.

Abstract

Background: Emerging infectious respiratory diseases present significant challenges to public health systems worldwide. The recent COVID-19 pandemic has revealed critical weaknesses in Iran's healthcare infrastructure, particularly regarding surveillance and testing capabilities. During the pandemic, Iran faced severe consequences, including a high death toll and overwhelming demands on its healthcare system. This situation highlights the urgent need for a stronger public health system in the country.

Objective: This study identifies interventions implemented in Iran's public health system during respiratory disease pandemics, their context, mechanisms and outcome.

Methods: A qualitative realist study was conducted using semi-structured interviews with 21 public health experts across various sectors. Data were analyzed through content-directed analysis using the CIMO (Context-Intervention-Mechanism-Outcome) approach and the SPRP (Strategic Preparedness and Response Plan) framework. Data collection occurred from March to June 2024.

Results: Analysis revealed that factors such as individual behaviors, social capital, institutional settings, and political pressures significantly influenced intervention outcomes. Key interventions included enhanced risk communication strategies and the establishment of specialized respiratory disease centers. However, bureaucratic inefficiencies and resource limitations hindered effective responses. Additionally, continued investment in local diagnostic production is essential for maintaining national laboratory and vaccination capabilities.

Conclusions: The findings underscore the necessity for systemic reforms in Iran's public health framework to enhance preparedness for future pandemics. The realist approach provided insights into the complexities of intervention effectiveness, emphasizing the importance of context in shaping health outcomes. Strengthening primary healthcare and fostering inter-sectoral collaboration are essential for building a more resilient public health system capable of addressing emerging respiratory diseases effectively.

Keywords: Intervention; Pandemic; public health; qualitative; realist study.

Plain language summary

Main finding: The study has revealed some crucial insights regarding Iran’s public healthcare interventions during the pandemic of emerging respiratory diseases. Additionally, the research highlights the pivotal role played by context and mechanisms in shaping the effectiveness of these interventions.Added knowledge: It has been found that a comprehensive understanding of context and the functioning of these interventions in different contexts is essential for improving public healthcare interventions and neglecting these factors can undermine the effectiveness of health initiatives, particularly during health crises such as emerging respiratory diseases.Global health impact for policy and action: These findings are important for policymakers as they can assist in developing policies that can help strengthen the public health system during the pandemic of emerging respiratory diseases.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
CIMO (context, intervention, mechanism, outcomes) configuration.
Figure 2.
Figure 2.
Configuration of CIMO framework based on the findings.
See this image and copyright information in PMC

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