Towards future-ready public health surveillance: A RE-AIM framework analysis for scalable pandemic preparedness

Background: The COVID-19 pandemic exposed important gaps between the technical capacity of public health surveillance systems and their implementation under routine conditions, particularly in low- and middle-income countries (LMICs). Surveillance platforms and reporting protocols did not consistently translate into timely case detection, complete data, coordinated response, equitable population coverage, or sustained system performance. Objectives: To examine implementation challenges and lessons arising from COVID-19 surveillance and use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify scalable and context-sensitive strategies for strengthening public health surveillance in resource-constrained settings. Methods: We conducted a narrative review of peer-reviewed and selected grey literature. A focused PubMed search covering January 2019 through July 2026 was supplemented by targeted Google Scholar searches, citation chaining, authoritative public health websites, and eligible publications identified during peer review. Sources addressing surveillance implementation, data quality, digital and community-based surveillance, interoperability, governance, financing, equity, or sustainability were considered. Seventy-six publications were retained for narrative synthesis and organized using the RE-AIM framework. Results: Across the reviewed literature, commonly reported implementation challenges included limited reach of case-finding systems, incomplete and delayed data, fragmented surveillance platforms, limited adoption of digital surveillance tools, weak cross-sectoral coordination, privacy concerns, variable implementation fidelity, and fragile financing. Many of these problems increased in magnitude after emergency support declined. Commonly recommended strategies included community-engaged surveillance, phased digital integration, simplified reporting standards, routine data-quality feedback, clear governance arrangements, and explicit sustainability planning. Together, these strategies can support more scalable, equitable, and sustainable surveillance strengthening. Conclusions: The review suggests that future-ready surveillance systems need implementation strategies that are feasible, equity-oriented, and embedded in routine health-system functions. Incremental improvements, supported by governance, feedback loops, community trust, and recurring financing, may be more sustainable than technology-heavy reforms that exceed local capacity.