No time to wait: A regional model for inter-epidemic vector-borne disease preparedness in the Caribbean.

Abstract

Vector-borne diseases continue to pose significant and evolving public health threats in the Caribbean. The compounded effects of human travel and migration, climate variability, ecological change, and structural vulnerabilities are intensifying transmission risks. However, preparedness efforts across the region remain largely reactive, with limited investment during the inter-epidemic periods, the interval between recognized outbreak waves when risk drivers persist but attention often declines, despite their potential as a strategic window for resilience-building. This Opinion and Analysis article, informed by deliberations during the 2025 Annual Meeting of the Caribbean Vector-Borne Disease Network, argues for a redefinition of the inter-epidemic phase as the operational core of vector-borne disease preparedness and resilience. Drawing on structured technical discussions within the Network's technical working groups and regional stakeholders, the article presents three strategic pillars: integrated surveillance that brings together epidemiological surveillance, integrated vector management, and innovations such as entomo-virological and wastewater monitoring; strong coalitions with sustained community engagement and stakeholder co-ownership of prevention and response; and the alignment of research with policy through a regionally developed research agenda. Each pillar is examined alongside implementation considerations, enabling conditions, and constraints relevant to small island health systems. The Caribbean Vector-Borne Disease Network is presented as a regional innovation platform whose transdisciplinary, multilingual, and equity-focused approach may offer transferable lessons for climate-vulnerable settings across the Americas, subject to contextual adaptation. Its outputs, including tools, protocols, and implementation resources, are being piloted and adapted across Member States through network-supported exchange and coordination. This framing supports a shift from episodic crisis response toward sustained inter-epidemic governance.