Policies and practices of infectious disease control in European border regions: a scoping review

The COVID-19 pandemic exposed critical vulnerabilities in cross-border cooperation for infectious disease control, particularly in European border regions where fragmented public health systems complicate coordinated response. Despite longstanding collaborations in some regions, preventive strategies and structural alignment remain under-examined in the available evidence. This scoping review explores the available evidence on cross-border infectious disease threats, challenges of addressing those, as well as re recommendations to improve cross-border cooperation. Following JBI methodology, comprehensive searches were conducted in PubMed, Web of Science, Embase, the Cochrane database of systematic reviews, and grey literature sources. Studies published since 1994 were included. Two independent reviewers conducted study selection and data extraction, resolving discrepancies through discussion. Findings were reported following PRISMA-ScR guidelines. Forty-five studies were included, covering various study designs and cross-border regions. Most studies focused on outbreak investigations and surveillance of respiratory infections, while vector-borne and other emerging infections were scarcely represented. Twelve challenges were identified, including fragmented surveillance, inconsistent data sharing, and differences in national laws and procedures. Eleven public health recommendations were extracted, addressing areas like institutional collaboration, harmonised surveillance systems, and improved data integration. The findings highlight a concentration of research in specific border regions and limited evaluation of cross-border interventions. The underrepresentation of Southern and Eastern European areas indicates gaps in geographical coverage. EU project funding was frequently reported, particularly in the Netherlands-German-Belgium border region, while post-project continuation was rarely evaluated. The finding points to the need for institutional and financial arrangements, and for embedding cross-border collaboration in routine public health governance to strengthen preparedness for future infectious disease threats. Not applicable.