{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T08:43:49Z","timestamp":1793263429043,"version":"4.5.0"},"reference-count":61,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The emergence of high-threat pathogens\u2014such as Ebola, Lassa fever, and most recently SARS-CoV-2\u2014has highlighted critical weaknesses in global surveillance systems, particularly in resource-limited settings where many zoonotic spillovers originate. Despite the World Health Organization\u2019s (WHO) prioritization of these diseases for research and development (R&amp;D), the current surveillance infrastructures in these regions remain under-resourced, fragmented, and often reactive rather than anticipatory. This narrative review explored the literature and structured relevant findings in three key dimensions: (i) the structural and operational limitations of existing surveillance systems for the WHO priority diseases in resource-limited settings including challenges in data integration, laboratory capacity, workforce, and community engagement; (ii) how these surveillance gaps could delay detection and hinder the response to future emerging threats, particularly a hypothetical but inevitable Disease X; and (iii) innovative and context-adapted strategies to strengthen epidemic intelligence including integrated One Health surveillance, digital and genomic tools, participatory approaches, and regional data-sharing mechanisms. We argue that building agile, equity-centered, and decentralized surveillance systems is not only essential for managing known threats, but also foundational to the early detection and rapid containment of the next public health emergency in resource-limited settings. This review uniquely frames surveillance limitations in resource-limited settings as a global security concern and outlines context-adapted, equity-centered innovations to strengthen epidemic intelligence in preparation for Disease X.<\/jats:p>","DOI":"10.3390\/microorganisms13112615","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T09:58:42Z","timestamp":1763459922000},"page":"2615","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["One Health, Many Gaps: Rethinking Epidemic Intelligence in Resource-Limited Settings to Prepare for the Global Threat of Disease X"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-2450","authenticated-orcid":false,"given":"Blondy","family":"Kayembe-Mulumba","sequence":"first","affiliation":[{"name":"Bordeaux Population Health Research Center, BPH, INSERM, U1219, University of Bordeaux, F-33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anderson Kouabenan","family":"N\u2019gattia","sequence":"additional","affiliation":[{"name":"National Institute of Public Hygiene, Ministry of Health, Abidjan 01 BPV 14, C\u00f4te d\u2019Ivoire"},{"name":"World Health Organization, Country Office of the Central African Republic, Bangui BP 1416, Central African Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3771-7841","authenticated-orcid":false,"given":"Marie Roseline Darnycka","family":"Belizaire","sequence":"additional","affiliation":[{"name":"World Health Organization, Country Office of the Central African Republic, Bangui BP 1416, Central African Republic"},{"name":"School of Medicine, University of Alcal\u00e1, 28871 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1038\/nature06536","article-title":"Global Trends in Emerging Infectious Diseases","volume":"451","author":"Jones","year":"2008","journal-title":"Nature"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/2049-9957-3-29","article-title":"Need of Surveillance Response Systems to Combat Ebola Outbreaks and Other Emerging Infectious Diseases in African Countries","volume":"3","author":"Tambo","year":"2014","journal-title":"Infect. 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