A one health indicator-based policy and implementation gap analysis of brucellosis control in Iran: A scoping review

Background Brucellosis remains endemic in Iran despite more than six decades of vaccination, surveillance, and test-and-slaughter activities. However, the national control program has not been systematically assessed against internationally recognized progressive-control frameworks. We conducted a descriptive and exploratory scoping review combined with an indicator-based policy and implementation gap analysis. The study was not designed to test a conventional epidemiological hypothesis or estimate causal effects. Methodology/Principal Findings We developed 45 measurable indicators by adapting the Food and Agriculture Organization Stepwise Approach for the Progressive Control of Brucellosis across five domains: governance, surveillance, laboratory capacity, prevention and control, and communication. The indicators were informed by nine international normative sources and reviewed by three subject-matter experts. We searched PubMed, Scopus, Web of Science, and Google Scholar for scientific literature published between January 2000 and March 2026 and manually screened relevant publicly accessible official documents, including earlier legal and regulatory sources. Seventy-one eligible documents were included. Two reviewers independently scored all indicators using predefined criteria. Exact agreement was 86.7% (39/45), and weighted Cohen's kappa calculated from the original independent pre-consensus scores was 0.84 (95% CI 0.72–0.93). The six disagreements were resolved by consensus. Overall stage classification was determined separately using a rule-based algorithm based on documented program prerequisites rather than aggregated indicator scores. Under the adapted framework, Iran met the minimum documented prerequisites associated with Stage 3. Major implementation or documentation gaps remained in animal identification and traceability, early warning, laboratory partnerships, wildlife and nomadic-population risk management, joint risk assessment, and public reporting. Six interdependent policy priorities were identified. Conclusions/Significance Iran has established important foundations for brucellosis control, but several integrated and elimination-oriented functions remain incomplete or undocumented. The Stage 3 classification is a framework-based interpretation of publicly available documentary evidence, not an official designation or an independently validated measure of national program performance. The framework may support systematic gap identification and program monitoring, but prospective and external validation is required before its broader application.