Abstract
CONTEXT: The COVID-19 emergency warrants reflection on how to improve future infectious disease pandemic preparedness and response (PPR). U.S. States took diverse approaches to COVID-19, with Florida's approach characterized by fewer restrictions on businesses and individuals. Despite the profound effects of the pandemic, there is a dearth of stakeholder-informed recommendations for PPR at the state level. This study aims to empirically examine stakeholder perspectives on PPR in Florida. METHODS: 25 semi-structured interviews were conducted with former and current leaders from government, academia, and the private sector in Florida. Participants were asked about challenges encountered during COVID-19 and considerations for what should be done for future pandemics. Interview transcripts and notes were analyzed using qualitative content analysis (QCA). FINDINGS: Results were organized into four main categories (recommendations for future actions, challenges in PPR, successes and failures during the COVID-19 response), across which six sub-categories were identified: public health systems capacities; mitigation of disease transmission; roles and relationships; messaging and information dissemination; minimizing other adverse effects of a pandemic; and public health culture. Considering the neglect of existing pandemic plans and jurisdictional tensions around decision-making during COVID-19, participants proposed implementing a pandemic playbook that delineates the responsibilities of relevant agencies and processes of waiving standard procedures. While many suggested closures and restrictions to avoid the spread of disease, others questioned the extent to which such strategies should be implemented. CONCLUSIONS: This study corresponds with the need for consensus-building across ideological divisions, revealing tensions among federal, state, and county-level entities, as well as across state-level agencies. Participants defined successful pandemic response as not only comprising the mitigation of disease transmission, but also the minimization of adverse social and economic effects. Participants discussed strategies for a unified, well-coordinated approach to future pandemics that balances health and economic concerns.