The outbreak of hantavirus disease caused by Andes virus aboard a cruise ship is a reminder of the challenges posed by emerging diseases in the modern era. While Andes virus-associated disease can be particularly severe, it is unlikely to spread extensively beyond the current number of cases or emerge as a large epidemic, especially if public health measures are followed. Nonetheless, the outbreak exemplifies the complexity of international outbreak response with differences in national preparedness frameworks and the rapid spread of mis-/disinformation.

In a recently published Lancet Viewpoint article, lead author Marion Koopmans, Scientific Director of the PDPC, co-author Anja Schreijer, Medical Director of the PDPC, and many colleagues from all over the world discuss this outbreak in the context of global epidemic and pandemic preparedness and emphasizes the importance of sustained, inclusive global collaborative One Health approaches – which considers the interconnected health of humans, animals, and the environment – to preparedness and response. They stress the urgent need for global coordination, discuss specific challenges, and provide recommendations for further strengthening of global preparedness.

Below are the authors’ recommendations to strengthen outbreak preparedness and response.

Recommendations – How to improve outbreak responses?

1. Invest in One Health early warning surveillance to provide essential information on potential epidemic threats before they evolve into outbreaks. Such surveillance can be targeted to areas with increased or increasing risk, and should increase understanding of pathogen diversity, reservoir hosts, their geographic range, and the infection dynamics in these hosts.
2. Strengthen sustained investment in epidemic preparedness and response infrastructure with core capacity for case finding, contact tracing, testing, and the swift deployment of standard public health interventions.
3. Expand integrated environmental surveillance approaches, including wastewater, air, and surface sampling, in high-risk international travel and transport settings such as cruise ships, airports, ports, and other major transportation hubs.
4. Strengthen development and access to field-deployable diagnostics, portable sequencing, real-time genomic analysis, and serology capable of supporting outbreak detection and characterization outside centralized laboratory systems.
5. Invest in building and sustain the specialist research infrastructure, high-containment laboratory capacity, and multidisciplinary scientific expertise necessary to investigate, characterise, and respond rapidly to emerging pathogens.
6. Support and strengthen the research base for development of scalable diagnostics, antivirals, vaccines, monoclonal antibodies, and adaptable platform technologies targeting pathogens with known epidemic potential.

Regarding international coordination, the recommendations are:

7. Develop and routinely implement multinational outbreak simulation exercises focused on rare but high-consequence pathogens, including diseases with prolonged incubation periods and complex international contact tracing requirements.
8. Continue strengthening of international preparedness frameworks, including broad participation in WHO-led coordination mechanisms and implementation and ratification of pandemic agreement frameworks.

Regarding the infodemic, the recommendations are: 

9. Prepare for the growing challenge of misinformation and disinformation during outbreak response.

All in all, whether future outbreaks remain manageable or become much larger crises will depend largely on what happens in-between outbreaks. Preparedness cannot remain a reactive exercise initiated only during crises. Strengthening rather than weakening international coordination mechanisms before crises occur will help reduce fragmentation, avoid inconsistent responses, ensure that public health decisions can be made rapidly across countries working under different legal, operational, and health-system contexts, and increase the chances of successful containment of outbreaks.

The Viewpoint article was first published on June 11, 2026 in The Lancet Regional Health–Europe:

Koopmans, M., Brechot, C., Bruzzone, R., Diagne, M. M., Drosten, C., Eckerle, I., … & Karlsson, E. A. (2026). Andes Virus on a Cruise Ship, what it Tells us About the Global Pandemic Preparedness Agenda. The Lancet Regional Health–Europe.

Read the full publication here.

Read also the (Dutch) Amazing Erasmus MC article about this publication!

About the authors

The authors of this paper are:

Marion Koopmans – Director Pandemic and Disaster Preparedness Research Center, and Viroscience Department, Erasmus MC, Rotterdam, the Netherlands

Christian Brechot – Department of Internal Medicine, University of South Florida, USA

Roberto Bruzzone – Center for Immunology & Infection, Hong Kong Science Park, Hong Kong Special Administrative Region, PR China; Institut Pasteur, Paris, France

Moussa Moïse Diagne – Virology Department, Institut Pasteur de Dakar, Senegal

Christian Drosten – Institute of Virology, Charité Universitätsmedizin Berlin, Germany

Isabella Eckerle– Geneva Centre for Emerging Viral Diseases, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland

Robert Gallo – Division of Infectious Diseases, University of South Florida, USF Health Institute for Translational Virology & Innovation, Tampa General Hospital Cancer Institute, USA

David T. S. Hayman – Molecular Epidemiology and Public Health Laboratory, Massey University, New Zealand

Peter Horby – Pandemic Sciences Institute, Oxford University, Oxford, UK

Peter Hotez – National School of Tropical Medicine, Baylor College of Medicine, USA

Menno de Jong – Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands

Florian Krammer – Ignaz Semmelweis Institute, Interuniversity Institute for Infection Research, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Science Outreach and Pandemic Preparedness at the Medical University of Vienna, Vienna, Austria; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA

Jean Claude Manuguerra –  Institut Pasteur, Université Paris Cité, Environment and Infectious Risks Unit, Laboratory for Urgent Response to Biological Threats (CIBU), French National Reference Centre for Hantaviruses, France

Gustavo Palacios – Global Health Emerging Pathogens Institute, Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, United States

Massimo Palmarini – Department of Viroscience, Erasmus Medical Centre, Rotterdam, the Netherlands; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK

Anja Schreijer – Pandemic and Disaster Preparedness Research Center, Erasmus MC, Rotterdam, the Netherlands

Nicole D. Tischler – Laboratorio de Virología Molecular, Centro Ciencia & Vida, Fundación Ciencia & Vida and Escuela de Bioquímica, Facultad de Ciencias, Universidad San Sebastián, Santiago, Chile

Tulio de Oliveira – Centre for Epidemic Response and Innovation (CERI), Stellenbosch University, Stellenbosch, South Africa

Bas B. Oude Munnink – Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands

Malik Peiris – School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, PR China

Emma Thomson – MRC-University of Glasgow Centre for Virus Research, Glasgow, UK

Olli Vapalahti – Departments of Virology and Veterinary Biosciences, University of Helsinki, and Helsinki University Hospital Diagnostic Center, Finland

Marietjie Venter – Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Jacqueline Weyer –  Center for Emerging and Zoonotic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa; Department of Virology, University of Witwatersrand, Johannesburg South Africa, and Department of Medical Virology, University of Pretoria, Pretoria, South Africa

Yazdan Yazdanpanah –  Infectious Disease Department at Bichat–Claude Bernard Hospital, Director ANRS Emerging Infectious Diseases, Paris, France

Erik A. Karlsson – Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia