Background: Infectious disease outbreaks require decision makers to make rapid decisions under time pressure and situations of scientific uncertainty, and yet the role of evidence usage in these contexts is poorly understood.<br />Aims and objectives: To define and contextualise the role of scientific evidence in the governance of infectious disease outbreaks and to identify recommendations for overcoming common barriers to evidence-informed decision making.<br />Methods: A scoping review and an expert workshop to provide additional input into recommendations on enhancing evidence uptake during infectious disease outbreaks taking place in European settings.<br />Findings: Forty-nine records reporting on multiple decision-making processes during infectious disease outbreaks of the past ten years were included in the study. Decision makers prioritise expert advice, epidemiological data and mathematical modelling data for risk characterisation and management, but tend to be challenged by scientific uncertainties, which allow for conflicting interpretations of evidence and for public criticism and contestation of decision-making processes. There are concrete opportunities for optimising evidence usage to improve public health policy and practice through investment in decision-making competencies, relationship building, and promoting transparent decision-making processes.<br />Discussion: It is not necessarily a disregard of evidence that puts a strain on decision making in health crises, but rather competing interests and the lack of clear, unambiguous and rapidly available evidence for risk characterisation and effectiveness of response measures.<br />Conclusion: The relationship between science and public health decision making is relatively understudied but is deserving of greater attention, so as to ensure that the pursuit of evidence for decision making does not challenge timely and effective crisis management.<br /><br />Key messages<br /><ol><li>Challenges to evidence-informed decision making during infectious disease outbreaks are numerous but understudied</li><br /><li>Scientific uncertainty often challenges decision making and facilitates the contestation of expertise</li><br /><li>Political, economic and media pressure impact technical decision making during outbreaks</li><br /><li>Knowledge transfer can be enhanced by collaborative risk governance networks and processes</li><br /></ol>