A Global Emergency Operations Centre Exercise (GEOCX) was conducted 4-6 December 2018. GEOCX was a simulated interactive 'functional' exercise that focused on the management of acute public health events. It has provided practical information about the efficiency of procedures, discovered gaps in planning and operational responses, helped build on strengths and identify opportunities for improving plans and procedures. Evaluators from Asia, North America, Europe, and Africa watched how the participating EOCs performed in real time, measuring performance against what was expected from existing procedures. The exercise offered participants a way to test their plans and capabilities in a realistic environment to gain an in-depth experience that could best be achieved by practice.