Indicator-Based Review Assesses Policy Gaps in Iran’s Brucellosis Control Program

A descriptive and exploratory scoping review of brucellosis control in Iran has found that the country met the minimum documented prerequisites associated with Stage 3 under an adapted international progressive-control framework, according to researchers Maryam Dadar and Zahra Baradaran-Seyed. The investigation paired the comprehensive literature review with an indicator-based policy and implementation gap analysis to systematically benchmark the national control program against established global guidelines. Crucially, the authors explicitly clarified that the investigation was not designed to evaluate a conventional epidemiological hypothesis or estimate causal effects, but rather to document program status and operational gaps across institutional sectors.

The persistent presence of brucellosis represents an ongoing challenge in Iran, where the zoonotic infection remains endemic despite more than six decades of continuous national interventions. Over this sixty-year period, Iranian authorities have implemented recurring vaccination campaigns, disease surveillance systems, and test-and-slaughter activities. Nevertheless, the nationwide program had never previously been evaluated in a systematic manner against internationally recognized progressive-control frameworks. To resolve this evaluation gap, the research team adapted the Stepwise Approach for the Progressive Control of Brucellosis formulated by the Food and Agriculture Organization, creating an indicator framework structured to assess baseline governance and operational capacity.

To build the evaluation instrument, the investigators developed 45 measurable indicators structured across five primary domains: governance, surveillance, laboratory capacity, prevention and control, and communication. The drafting of these indicators was informed by nine international normative sources and underwent formal review by three subject-matter experts. For data collection, the authors conducted comprehensive literature searches across four major electronic databases—PubMed, Scopus, Web of Science, and Google Scholar—focusing on scientific publications released between January 2000 and March 2026. In addition to peer-reviewed studies, the authors manually screened relevant, publicly accessible official documents, incorporating earlier legal statutes and national regulatory instruments, which yielded a final corpus of 71 eligible documents for detailed review.

The evaluation process relied on two independent reviewers who evaluated and scored all 45 indicators using predefined scoring criteria. The independent evaluation yielded an exact agreement rate of 86.7 percent, corresponding to matching initial determinations on 39 out of the 45 indicators. Statistical analysis of the original independent pre-consensus evaluations demonstrated a weighted Cohen’s kappa of 0.84, with a 95 percent confidence interval spanning from 0.72 to 0.93. The six remaining scoring disagreements between the reviewers were subsequently resolved through consensus discussions. Rather than calculating overall stage progression through aggregated indicator scoring, the authors determined the national stage classification through a separate rule-based algorithm centered strictly on documented program prerequisites.

Applying this rule-based algorithm, the authors determined that Iran satisfied the minimum documented prerequisites associated with Stage 3. Even though Iran has established critical institutional foundations for disease containment, the analysis highlighted major implementation and documentation gaps across the national infrastructure. Specific deficiencies were documented in animal identification and traceability, early warning capabilities, laboratory partnerships, risk management among wildlife and nomadic populations, joint risk assessments, and public reporting mechanisms. To guide future interventions, the authors identified six interdependent policy priorities, noting that elimination-oriented and integrated One Health functions remain largely incomplete or undocumented. The authors cautioned that the Stage 3 classification constitutes a framework-based interpretation derived exclusively from publicly available documents, rather than an official designation or an independently validated measure of national performance, stressing that prospective and external validation will be essential before the tool is applied more broadly.

Subject of Research: Brucellosis control policy and implementation gaps in Iran

Article Title: A one health indicator-based policy and implementation gap analysis of brucellosis control in Iran: A scoping review

Article References: Dadar, M., & Baradaran-Seyed, Z. (2026). A one health indicator-based policy and implementation gap analysis of brucellosis control in Iran: A scoping review. PLOS Neglected Tropical Diseases, 20(11), e0014690. https://doi.org/10.1371/journal.pntd.0014690

Image Credits: AI Generated

DOI: 10.1371/journal.pntd.0014690

Keywords: brucellosis, Iran, disease surveillance, scoping review, health policy, animal health, zoonosis control, progressive control, health, indicator-based, policy, implementation