PERSPECTIVES ON THE FUTURE CROSS-BORDER PANDEMIC MANAGEMENT

Abstract

Within this paper requirements and related gaps associated with cross-border pandemic management are analyzed. In order to systematically investigate the potential of solutions to close such gaps, trials can be executed and evaluated. Core elements of such trials are specific scenarios that frame the validation of the applicability of solutions. Stakeholders involved in pandemic 138 management specified a framing for such scenarios such as cross-border common operational picture and resource management, pandemic management during a refugee crisis and sharing of mobile infrastructure to detect pathogens. An insight in these scenarios is given and, finally, solutions having the potential to close at least partially gaps arising in the mentioned scenarios provided from projects such as STAMINA are presented.

Full text

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PERSPECTIVES ON THE FUTURE CROSS-BORDER
PANDEMIC MANAGEMENT
Georg Neubauer, Dražen Ignjatović, Gerald Schimak,
Johannes Peham, Bernhard Bürger
AIT Austrian Institute of Technology GmbH
georg.neubauer@ait.ac.at
Adam Widera, Michael Middelhoff
University Munster
adam.widera@wi.uni-muenster.de
Florian Gehre, Muna Affara
Bernhard Nocht Institute for Tropical Medicine,
gehre@bnitm.de
Helena Blažun Vošner, Jernej Završnik, Aleksander Jus
Community Healthcare Center Dr. Adolf Drolc Maribor,
helena.blazun@zd-mb.si
Karin Rainer, Alois Leidwein
AGES Austrian Agency for Health and Food Safety
karin.rainer@ages.at
Peter Kokol
Faculty of Electrical Engineering and Computer Science, University of Maribor
peter.kokol@um.si
DOI: 10-35011/IDIMT-2022-137
Keywords
Pandemic, disaster, cross-border pandemic management, COVID 19, STAMINA project
Abstract
Within this paper requirements and related gaps associated with cross-border pandemic
management are analyzed. In order to systematically investigate the potential of solutions to close
such gaps, trials can be executed and evaluated. Core elements of such trials are specific scenarios
that frame the validation of the applicability of solutions. Stakeholders involved in pandemic

138
management specified a framing for such scenarios such as cross-border common operational
picture and resource management, pandemic management during a refugee crisis and sharing of
mobile infrastructure to detect pathogens. An insight in these scenarios is given and, finally,
solutions having the potential to close at least partially gaps arising in the mentioned scenarios
provided from projects such as STAMINA are presented.
1. Introduction
Since the spread of COVID-19 in Europe in the beginning of 2020 the need for cross-border
pandemic management became more and more evident. Carrera (2020) points out that since 2007
the WHO declared six Public Health Emergencies of International Concern (PHEIC) such as
Influenza in 2009, Ebola in 2014 and 2020 or Zika in 2016. Moreover, a multitude of epidemics
affected European countries also on a cross-border level such as measles, West Nile Virus or
Dengue Fever. Furthermore, he proposed stronger cross-border collaboration, united coordinated
action and enhanced solidarity. The pandemic has considerable impact on border control. Eržen et
al. (2020) specified some lessons learned from the pandemic, encompassing enhanced cooperation
between guards, custom services and sanitary inspections, as well as the need for enhanced
digitalisation. Moreover, they point to the need of improved cooperation between neighboring
states regarding early warning and risk assessment. When considering asymptomatic persons, the
need of border crossing information exchange turns out to be imperative. Carrera (2020) describes
the challenge at the beginning of the pandemic, however huge efforts were made worldwide in the
meantime to manage the pandemic, it is therefore interesting to see how the situation is perceived
after about two years of dealing with COVID-19.
Mertens (2022) describes a type of “waterbed effect” that took place in the Netherlands, Belgium
and Germany. In summer 2021 the Netherlands had a lockdown during the summer vacation, but
due to missing harmonization of cross-border management neither Belgium nor Germany
implemented similar measures. People from the Netherlands moved therefore to the neighboring
countries for shopping and eating and drinking. Another example of lack of cross-border
cooperation is the recommendation of an authority in the Netherlands to not get a booster COVI-19
vaccine in neighboring countries. Such a recommendation is remarkable in the light of a common
European goal to have as many people as possible vaccinated. Mertens identified three major
roadblocks: lack of instruments to coordinate health risk management on a European level, lack of
coordination between neighboring countries due to the lack of bilateral agreements and finally
missing guidance of cross-border management by national or regional authorities. The author
concludes that the existing cross-border pandemic management is not robust enough. A similar
effect was observed in March 2021 in Vorarlberg in Austria: the decision to loosen access
limitations for the gastronomy (ORF 2021, Vorarlberg Tourismus 2021) due to regional low
incidences led to augmented afflux of guests not only from Vorarlberg, but also from neighboring
regions and states and consequently increased infection rates. (AGES 2022). This is also an
indicator for the population being tired of the pandemic interventions and regulations from
government side, that impacted the very core of the lives of people for a longer period. WHO
(2020) early identified this “pandemic fatigue” and its effects on the development of the pandemic
waves (Rypdal et al 2020); this phenomenon also evidently reflects in the compliance as well as in
the denial/countering of official recommendations and regulations.

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2. Requirements arising in Cross Border Pandemic Management
In the past, several different attempts were made to describe requirements related to cross-border
pandemic management in a systematic way. In 2020, a questionnaire on the different challenges
related to the management of COVID 19 was distributed among 590 international stakeholders, 57
completed questionnaires were received (Neubauer et al, 2020). The main outcomes of this
investigation were related to communication and information exchange, health aspects such as
optimized testing procedures and resource management. The cross-border perspective was
explicitly mentioned multiple times. It was stressed, that non-centralized health management
systems and federal structures challenge pandemic management. The need for transnational data
assessment was high-lighted by stakeholders from several countries as well as the need for
transnational communication and sharing of resources. Moreover, the need for harmonized cross-
border strategies was mentioned. Several organizations as well as s projects identified gaps that are
implicitly or explicitly related to cross border pandemic management. An example is the
International Forum to Advance First Responder Innovation (IFAFRI, 2022). IFAFRI identified 10
common global capability gaps corresponding to the needs of the global first responders. These
gaps are not directly related to pandemic management, nevertheless they are in some cases quite
similar to the requests of stakeholders involved in pandemic management. Two examples of the ten
IFAFRI gaps are:
• The ability to incorporate information from multiple and non-traditional sources into
incident command operations
Incident commanders rely on several different information sources for decision support,
including sensor data, modelling data, media reports, social media etc. The same is true for
decision makers in time of pandemics, e.g., in case of evaluation of the impact of measures
such as lockdowns. This is also true for cross border pandemic management, when looking
at challenges as the one described by Mertens (2022) in the introduction section.
• The ability to obtain critical information remotely about the extent, perimeter, or interior of
the incident
The management of incidents of different dimensions such as wildfires or management of
events with large crowds need to obtain situational awareness on what is happening at as
well as around the incident site. Large number of people, smoke, extreme weather or other
parameters can negatively impact the ability to obtain situational awareness. When looking
at events like demonstrations against measures related to pandemic management such as
lockdowns or implementation of safety measures such as wearing of masks, the availability
of a shared common operational picture is relevant for police forces. The timely availability
of critical information may also be of relevance for health workers operating in the field,
being exposed by unexpected pathogens.
Other international organisations such as the Disaster Risk Management Knowledge Center
describe also strategic gaps, but there is no specific focus on pandemic management.
Within the project DRIVER+ the Gaps Explorer was developed as part of the Portfolio of Solutions
(Gaps Explorer, 2019). The Gaps Explorer includes strategic gaps on one hand from organisations
such as IFAFRI and from research projects such as STAMINA (2019) from the other. In this
project gaps specifically related to pandemic management were described. Several of these gaps are
also related to cross border pandemic management such as:
• Cross-agency decision support tools – assuring coherent and traceable decision making in
different, also cross-border operating organisations is imperative for a successful pandemic
management

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Adequate communication technology for crisis management – crisis communication
encompasses communication within an organization, cross-organisation, cross-border
communication as well as communication with the public. So far, no solid pandemic
communication methodologies were endorsed
• Secure cross-agency documentation, sharing and tracking – efficient and secure sharing of
information necessary for decision making has proven to be a key challenge in the
management of COVID-19, also on a cross border level
The gaps shown in this chapter are reflecting needs on a strategic level and are representative
examples. Such gaps often mirror a multitude of needs on a tactical as well as operational level. In
the next chapter selected scenarios of cross border pandemic management are described. These
scenarios reflect on one hand one or more strategic gaps and provide a context of application and
testing for pandemic management solutions (see also chapter 4) on the other.
3. Selected scenarios of cross-border pandemic management
In complex crises, such as the ongoing COVID-19 pandemic, it is evident that the exchange of
information between the actors involved is impaired by various types of communication barriers.
Obstacles such as different responsibilities, some of which are not clearly delineated, different legal
bases, (specialist) cultures and mandates and, as a result, only limited harmonized processes, as
well as semantic and other barriers, make cooperation difficult. An overarching requirement for
most of all pandemic management scenarios is the need to break down communication barriers and
to bridge silos of responsibility. Such barriers have both a technical as well as a sociological
dimension. Regarding the technical dimension solutions interoperability between different actors is
needed. From the sociological perspective mutual understanding of the involved actors is
imperative, encompassing overcoming of semantic barriers. Although it is frequently required that
only one definition is assigned to a particular term in a specific domain, it is evident that different
terminologies are used within a state, between different organizations and, in some cases, even
within an organization, and that different actors also have different understandings of the same
terms used. The challenge is that the actors involved have no or only superficial knowledge of other
vocabularies not used by them and, in the case of deployment, do not have the time or, in most
cases, the opportunity to gain insight into them to better understand their partners. Since the
interactants work in different, partly multicultural environments with specific (professional)
cultural imprinting (concerning language, behavior, cultural markers, taboos, etc.), this increases
the overall probability of misunderstandings and resulting wrong decisions or decisions not made.
3.1. Cross-border Register Systems and Resource Management
The free movement of labour is one of the four fundamental freedoms in the European Union's
internal market. Slovenia, like other European Union countries, is facing daily migration of people,
and which was a special challenge during the COVID-19 pandemic, for people as well as for
healthcare facilities such as Community Healthcare Center dr. Adolf Drolc Maribor (HCM).
HCM is one of the largest community healthcare centres in Slovenia and one of the 16 healthcare
facilities responsible for organizing COVID-19 entering point for 5 large geographical areas in
Northeastern Slovenia (middle and lower Podravje i.e., Maribor, Ptuj, Slovenska Bistrica, Lenart,
Ormož). In these COVID-19 entering points, in accordance with the appropriate indication and
compliance with the definition for the notification and monitoring of new coronavirus and
instructions for proper swab collection, swab collections were performed. It was necessary to
strongly adjust the organization of work in the institution to be able to carry out the implementation

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of health care as much as possible within all services and adapt it to the current urgent needs of
patients. The services provided by the HCM were swabbing for PCR testing and rapid antigen tests,
examinations of COVID-19 suspected patients and implementation of vaccination campaigns for
over 300,000 inhabitants, various occupational groups etc. In March 2020 Austria closed 51 small
border crossings with Slovenia to limit the spread of coronavirus. Traffic remains unchanged at
major border crossings, like the border crossing Šentilj, where daily approx. 14,000 migrate
workers in both ways. In accordance with the tightened measures of the Austrian government, the
HCM had to carry out swabbing for PCR and rapid antigen tests almost overnight for all workers
who crossed the border. Health and other workers from HCM faced many challenges, on this basis
we identified measures that would support an effective cross-border pandemic management, such
as:
• Joint central register system - uniform notification of COVID test results - with regard to
cross-border cooperation, it would be very sensible to link at least data on PCR swabs and
Digital COVID-19 certificate of recovery, due to problems in the past with migrant workers
working in Austria. Due to the lack of harmonized data management between countries for
example the Austrian PCR was not registered in the Slovenian system. It was therefore
necessary to send patients tested in Austria again for testing in Slovenia to obtain a digital
COVID-19 certificate of recovery. Similar problems were faced by Slovenian citizens
working in Austria.
• Joint central register system for bed management - it would be sensible to interface the
systems monitoring the availability of beds in case of overcapacity in Slovenia, because
Austria is very close and quickly accessible, at least in the Štajerska region.
• Joint monitoring the availability of free capacities of individual hospitals and the
availability or utilization of vehicles for secondary or interhospital transport.
3.2. Shared testing capacities in future pandemic scenarios
Similar to the abovementioned Slovenian case, many European countries experienced border
closures due to COVID-19, affecting commuter populations and cross-border trade. In the early
pandemic phases this was mainly due to a lack of diagnostic capacity at border points to rapidly
issue negative PCR tests. Similar scenarios are to be expected in future epidemics of known and
unknown pathogens. A successful solution to close the diagnostic gap for efficient cross-border
epidemic management was shown in East Africa. The East African Community, as an
intergovernmental body for Burundi, Uganda, Rwanda, Tanzania, Kenya and South Sudan, together
with the six Ministries of Health, rapidly deployed a fleet of nine mobile laboratories to strategic
highways, or directly at border posts. This solution allowed countries to conduct SARS-CoV-2
PCR diagnostics, even in the remotest regions of the South Sudanese-Ugandan border. Together
with a rapidly developed, regionally recognized, electrically readable COVID-19 certificate
(enabling law enforcement and immigration officers to query the health status of truck drivers and
commuters), these mobile laboratories maintained internal trade of goods, food and medical
supplies in the region – in particular important for landlocked countries. Building on the African
experience, new mobile laboratories of highest biosafety levels, together with AI-based mobile
laboratory fleet management systems, are currently being developed in Europe, where new
emerging (hemorrhagic) fever viruses are finding their way into the continent.
3.3. Other potential Cross Border Pandemic Management scenarios
Several other potential cross-border pandemic management scenarios were discussed in the frame
of the STAMINA project encompassing the management of the refugee crisis on the border to a

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country neighboring the Ukraine combined with an epidemic outbreak of a pathogen such as
measles or influenza affecting international volunteer teams supporting the refugees in camps.
Another border-crossing scenario deals with the impact of the closure of international airports as
protective measure in times of pandemics and the potential support for the decision makers of other
airports due to the provision of data from a closed airport and the impact of the closure on the
pathogen distribution among the working personnel. In general terms, travelling across borders
maybe hampered due to the reduction of the security staff during the pandemic not only because of
non-availability of sick staff, but also because of people who left their jobs in order to pursue
different careers. A scenario partially aligned with the one described in chapter 3.1 deals with the
border crossing management and data sharing of a factory or business located in a border region,
e.g., a coal mine, where workers from both countries are employed. In such cases the sharing of
information on the vaccination as well as the infection and health status in a border crossing is of
outstanding importance.
4. Solutions having the potential to close scenario related gaps
The innovation potential of solutions in closing related gaps has to be assessed in relevant and
realistic scenarios applying rigorous methods. STAMINA therefore adopts the Trial Guidance
Methodology (TGM) (Fonio, Widera, 2020) for pandemic management in form of the Stamina
Demonstration Methodology, STADEM (Neubauer et al, 2021). It is an iterative co-creative design
approach with the practitioner needs in its focus covering the design, execution, and evaluation of
so-called trials. A trial brings together end-users and solution developers in realistic scenarios to
assess the impact on crisis management. The data collected during a trial is used to answer research
requestions in addressing the identified gaps and to guide future solution developments. A trial is
thereby capable to not only demonstrate a solution, but to achieve a deeper understanding of its use
in practice.
To fill the specific gaps mentioned above, STAMINA offers different solutions to be trialed in
different scenarios in 11 national trials across Europe and one specific cross-border trial. For the
handling of a cross-border trial (e.g., as mentioned in chapter 3.1) it is obvious that in all cases an
information platform is needed that has access to or can be used by different services to exchange
information/data on the availably of resources (e.g., hospitals, intensive care units, ambulances,
etc.). Also, with regards to this challenge, a monitoring service and visualisation application is
needed. Solutions that STAMINA could provide for this could be the data exchange platform,
named Early Warning System (EWS) which interconnects different services such as CrisisHub to
report on resources and current event situations with the e.g., EMT (Emergency Maps Tool), but
also to issue warnings or alarms about resources shortages, which in turn could also be visualised
on EMT. The same solutions can be applied specifically, to support pathogen addressed in chapter
3.2. Apart from that, STAMINA offers a portable solution called SHERLOCK/DETECTR for the
rapid detection of SARS-CoV-2 and E. coli (ESBL) which provides a new approach for novel
genetic markers enabling rapid detection of SARS-CoV-2 and Enterobacterales in human and
environmental samples. LAMP (qcLAMP), another STAMINA solution, also enables real-time
colorimetric primers and rapid detection of viruses, in most cases achieving higher sensitivity
compared to standard real-time PCR. This includes rapid detection of viral nucleic acids from
Measles and West Nile Virus in human samples and SARS-Cov-2 in environmental. Among the
available solutions for the scenarios mentioned in chapter 3.3, the most important point is the
timely and accurate exchange of information and the possibility of access to a common platform for
data exchange (e.g., vaccination status, infection and health status). This becomes especially
important when thinking about the airport scenario discussed above. As mentioned above, EWS,
CrisisHub or EMT can be seen as well-suited candidates to address these challenges. However,

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ENGAGE is also capable of supporting communication about resources and resource management
(e.g., hospital beds).
It is important to mention that STAMINA offers a wide portfolio of solutions that allow modelling
of pandemic-related situations (e.g., solutions such as FACS, CHARM, ENGAGE) to model and
support the management of resources that could be deployed in upcoming and future cross-border
scenarios (for more details on the STAMINA solutions see PoS, 2019).
5. Conclusion and Outlook
In this paper examples of cross-border gaps related to the management of pandemics are given, but
one has to be aware that gaps vary from country to country as well as versus time and the examples
shown here do neither reflect the multitude nor diversity of all cross-border gaps. Some gaps from
the beginning of COVID-19 such as the availability of a vaccine have been closed, others such as
provision of methods on how to deal with misinformation and fake news in times of pandemics are
still not finally solved yet. There are several approaches available on how to identify new gaps such
as interviews or questionnaires provided to stakeholders, or knowledge earned in projects such as
STAMINA. An insight in strategic gaps identified in STAMINA is available in the Gap Explorer,
but a systematic overview on all pandemic management related gaps is not known to us. To identify
if existing methods or solutions have the potential to close pandemic management gaps the
STADEM methodology was developed in the H2020 project STAMINA (Neubauer et al, 2021).
Currently 12 national and one cross-border trial on pandemic management are planned and
executed in the frame of the project. The requirements of the STAMINA stakeholders involved in
the management of COVID-19 are the basis for the trials, outcomes will show to what degree the
tested solutions are able to improve the pandemic management compared to the baseline. Scenarios
similar to those described in chapter 3 are central elements for the design of trials.
A central learning from the way COVID-19 was managed so far is that a worldwide crisis cannot
be handled successfully by national or regional solo attempts, without global coordination and
cooperation (Anschober, 2022). A pre-requirement of a successful border crossing pandemic
management is to break down or at least to reduce various types of communication barriers and
potential misunderstandings. Moreover, for the management of future pandemics, it can be
recommended to handle pandemics as complex events also related to other challenges such as
natural catastrophes like floodings, droughts and the climate crisis in more general terms. Avoiding
or at least mitigating the impact of future pandemics means to reconsider multiple facets such as
land loss and the way urban areas are structured, loss of habitats of species, or travel habits just to
name a few. Finally, the willingness of border – crossing cooperation on strategic and political
levels is imperative. As long as insular political or organisational targets have higher priorities
compared to large scaled, border crossing strategies, successful border crossing pandemic
management will always be hampered resulting in adverse effects on the well-being of the affected
societies.
6. Acknowledgment
The research leading to these results has received funding from the European Union`s Horizon
2020 research and innovation programme under Grant Agreement n°883441.

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