Usher Institute

New sleeper frameworks to help better prepare for future pandemics

'Sleeper frameworks' developed for rapid pandemic response, improving surveillance, risk assessment, and intervention monitoring.

Researchers from The University of Edinburgh and Nuffield Department of Primary Care Health Sciences, University of Oxford, have developed a set of ‘sleeper frameworks’ – strategic plans designed for rapid deployment to significantly enhance disease surveillance and response capabilities – for use during future epidemics and pandemics.

Featured in The Lancet Infectious Diseases, these frameworks build on lessons learnt from the UK’s response to recent swine flu (H1N1) and COVID-19 pandemics. They aim to address key needs, including improving surveillance of pathogens that cause outbreaks, using evolving data to rapidly identify those at risk of death and other severe outcomes, and implementing real-time monitoring of vaccine uptake, safety and effectiveness. 

The next pandemic is inevitable and rapid access to curated, linked data will be essential for timely responses. Our frameworks provide a roadmap for quickly obtaining approvals and creating systems to track key outcomes. By enabling nimble, data-driven responses when new threats emerge, we aim to provide stronger protection against global health threats.

Sir Aziz SheikhProfessor of Primary Care Research and Development, Usher Institute and co-lead author of the study

The researchers developed three frameworks for different stages of an outbreak. Each provides a broad approach which can be quickly enacted and adapted depending on the characteristics of the pathogen causing the outbreak. 

Enhanced testing

  • Outlines the initial steps needed to move from routine background pathogen surveillance to enhanced surge testing to help identify an outbreak.
  • Includes thresholds to help guide decisions at this stage. 
  • Stresses the importance of sufficient personal protective equipment, testing kits and lab capacity.

Dynamic risk stratification

  • A system for assessing the potential scope of the impact an outbreak might have to ensure guidance is addressing the current risk.
  • Uses dynamic stratified risk testing to continually reassess and adjust the risk levels based on changing factors such as differing natural immunity and the changing transmissibility and impact of different variants.
  • Advocates for strong linkages between pathogen sequencing and health care processes and outcomes. 


  • A process for additional monitoring of the uptake, safety and effectiveness of healthcare interventions, like vaccines, anti-virals, monoclonals and long-acting antibodies, depending on the outbreak. 

Our recent experiences with pandemics underscore an urgent need for readiness. There is an ethical imperative to learn from recent pandemics so we are better prepared for the next one. The hibernated systems proposed after swine flu were helpful for COVID-19, but proved insufficient. Our sleeper frameworks are improved ready-to-go systems that can pivot rapidly to new pathogens when needed, that will substantially improve our surveillance and response times.

Simon de LusignanProfessor of Primary Care and Clinical Informatics, Nuffield Department of Primary Care Health Sciences and co-lead author of the study

The frameworks are being made internationally available and the researchers are eager to collaborate with partners from across the globe to further refine and test these strategies. 

Cite as

de Lusignan, S., Shi, T., Fowler, T., Andrews, N., Todkill, D., Gu, X., Meza-Torres, B., Robertson, C., Sheikh, A. Sleeper frameworks for Pathogen X: surveillance, risk stratification, and the effectiveness and safety of therapeutic interventions. The Lancet Infectious Diseases (2024)

Further information

Read the full paper 'Sleeper frameworks for Pathogen X: surveillance, risk stratification, and the effectiveness and safety of therapeutic interventions' in The Lancet Infectious Diseases

Read the Nuffield Department of Primary Care Health Sciences, University of Oxford news item