New pathogens continue to emerge, and the increased connectedness of populations across the globe through international travel and trade favors rapid dispersal of any new disease. The ability to respond to such events has increased but the question is what 'preparedness' means at the level of the clinician. Clinicians deal with patients with unexplained illness on a daily basis, and even with syndromes highly indicative of infectious diseases, the cause of illness is often not detected, unless extensive and costly diagnostic work-ups are done. This review discusses innovations in diagnostics and surveillance aimed at early detection of unusual disease. Risk based approaches are promising, but optimal preparedness planning requires multidisciplinary partnerships across domains, and a global translational research agenda to develop tools, systems, and evidence for interventions.