AbstractThere has been an increase in emerging infections and serious epidemics in recent years. Investment has been in downstream capabilities in diagnostics, drugs and vaccines, but epidemic prevention and mitigation can be enhanced further by investment in upstream prevention and mitigation. If drugs and vaccines are available, they are important tools for epidemic control but come into play when an epidemic is established. Equally important are the ability to prevent epidemics altogether, to identify epidemics early, to ensure excellent triage and hospital infection control, surge capacity of space, as well as resources and personnel within health systems. Failures in any of these could cause health system failure and blow out of epidemics. Recognising the genesis of epidemics and all points where prevention or mitigation can be achieved is critical.