Implementation of 7-1-7 for improving timeliness in outbreak detection and response in Thailand: A mixed-methods study on challenges in application and achievement of targets in 2024-25.

BACKGROUND: Infectious disease outbreaks result in unfavourable outcomes when swift actions fail. The 7-1-7 target (detect within 7 days, notify within 1 day, respond within 7 days) was proposed to improve timeliness. Thailand piloted 7-1-7 in 2024 and scaled it up nationwide in 2025. This study aimed to quantify the 7-1-7 target achievement, identify bottlenecks and enablers, and describe challenges and solutions for applying the 7-1-7 metrics. METHODS: A mixed-methods study was conducted with quantitative assessment of all events meeting the national health threat criteria during January 2024 and June 2025 for timeliness, bottlenecks and enablers for meeting the 7-1-7 target. A qualitative descriptive study with in-depth interviews of key stakeholders explored challenges and solutions for applying the 7-1-7 framework. RESULTS: Of the 1,435 events assessed, 15% were dangerous communicable diseases and 3% occurred in hotels. Among all the events, 50% achieved the 7-1-7 target; 85%, 73%, and 83% were detected, notified and responded to in a timely manner, respectively. The median (interquartile range) duration for detection, notification and response were 0 (0-5) days, 0 (0-2) days and 2 (0-5) days, respectively. Among events that occurred in hotels, none met the 7-1-7 target. Dangerous communicable diseases had the highest notification (95%) and response performance (99%), despite lower timely detection (71%). Key bottlenecks included delayed care-seeking and weak coordination. Key stakeholders felt that the 7-1-7 metrics was useful, but the lack of standardised data sources, disease-specific guidelines and centralised data extraction made implementation difficult. Proposed solutions focused on streamlining and decentralizing the application of 7-1-7. CONCLUSION: It is appreciable that Thailand was able to apply the 7-1-7 framework and half of the events met the 7-1-7 target. However, to better the application of 7-1-7, future work should focus on strengthening data integration and formulating disease specific guidelines.