Enhancing cross-border contact tracing in Europe: Lessons learned from COVID-19 and future directions

Abstract Introduction Health systems in the EU operate at the national level, granting Member States autonomy for outbreak preparedness and response within their territories whilst coordinating at EU level to combat serious cross-border threats. The EU’s Early Warning and Response System (EWRS) provides the platform to exchange personal data for contact tracing across 30/EEA countries and was extensively utilized during COVID-19. This study examines insights from EU/EEA countries and assesses the feasibility of integrating national digital systems with EWRS to increase its effectiveness. Methods A comparative case study surveyed representatives from 24 countries and interviewed nine, analyzing contact tracing processes, actors, digital technologies, and challenges/facilitators during COVID-19. Thematic analysis was complemented by two webinars engaging EU/EEA countries to validate findings and gather additional perspectives. Results EWRS was valued for safety and efficiency but faced challenges during peak pandemic periods due to the heavy manual workload. Integrating national digital systems with EWRS could enhance data quality, timeliness, and coordination between countries. However, countries have varied and incompatible digital contact tracing systems, limiting the feasibility of their integration with EWRS. Moreover, most countries organize contact tracing at the subnational level, with regional entities developing and managing their own digital technologies under national guidance. Smaller countries excluded, subnational contact tracing case management systems were often not integrated with each other to exchange personal data in an automated way at a national level. Conclusions While integrating national digital systems with EWRS could bolster efficiency of contact tracing across EU/EEA, the presence of diverse technologies and decentralized governance poses feasibility challenges. Other improvements are needed to enhance cross-border contact tracing during outbreaks. Key messages • Integrating national digital systems with EWRS promises enhanced efficiency for contact tracing across EU/EEA in line with Regulation (EU) 2022/2371 on serious cross-border threats to health. • Diverse technologies and decentralized governance pose feasibility challenges, underscoring the need for further enhancements in cross-border contact tracing in EU/EEA during large outbreaks.