Public Health Emergency Management and Preparedness in Mongolia: COVID-19 as a Stress Test Assessed Through the 2017 and 2023 Joint External Evaluations

Mongolia completed Joint External Evaluations (JEEs) of its International Health Regulations capacities in 2017 and 2023, providing assessments before and after the acute coronavirus disease 2019 (COVID-19) emergency. We conducted a comparative document analysis of the two mission reports and selected contextual sources. Because the assessments used different editions of the JEE tool, we interpreted scores alongside narrative findings and priority actions rather than as directly comparable measurements. Immunization was rated at demonstrated capacity in both rounds, and selected laboratory functions received similarly favorable ratings. The 2023 report documented pandemic-period expansion of molecular testing, vaccine deployment, and use of existing respiratory surveillance systems. Antimicrobial resistance and biosafety and biosecurity repeatedly included limited-capacity ratings, while the 2023 assessment identified constraints in workforce capacity, routine financing, and multisectoral coordination. The documentary design and different assessment instruments prevent direct measurement of change or causal attribution to COVID-19. The 2023 JEE prioritizes formalized multisectoral coordination, coherent One Health implementation, and a costed, adequately resourced national action plan. Longitudinal implementation evidence is needed to determine whether pandemic-period mobilization resulted in sustained capacity in practice.