The genesis of the Global Health Security (GHS) agenda was to address issues caused by: increased intercontinental travel; increased biological, pandemic, and other disease threats; and the need for increased international cooperation and communication. The GHS agenda elevates political attention, broadens participation, and focuses commitments, coordination, and collaboration. Past public health incidents of worldwide consequence entailed challenges in areas such as communication between nations, consistent public messaging, vaccine/anti-viral distribution, and surge management.
Prevention, Detection & Response
Keeping these challenges in the forefront, the GHS agenda is an effort between the U.S. government, 28 other countries, international organizations, and public and private stakeholders, to “accelerate progress toward a world safe and secure from infectious disease threats and to promote global health security as an international priority.” In addition, within the United States, the Department of Health and Human Services, Department of State, Department of Defense, Department of Agriculture, Centers for Disease Control and Prevention (CDC), and U.S. Agency for International Development will lead the effort to fulfill the U.S. government’s commitment to GHS.
The overall goal of the GHS agenda is to prevent avoidable catastrophes and epidemics, detect threats early, and respond to outbreaks as rapidly and effectively as possible, thus promoting security as an international priority. The GHS agenda will include programs to help countries develop national infectious disease laboratories, public health electronic reporting systems, and emergency operations centers. The specific objectives of the GHS agenda include:
- Prevent the emergence and spread of antimicrobial drug-resistant organisms and emerging zoonotic diseases, and strengthen international regulatory frameworks governing food safety;
- Promote national biosafety and biosecurity systems; and
- Reduce the number and magnitude of infectious disease outbreaks.
- Launch, strengthen, and link global networks for real-time biosurveillance;
- Strengthen the global norm of rapid, transparent reporting and sample sharing;
- Develop and deploy novel diagnostics and strengthen laboratory systems; and
- Train and deploy an effective biosurveillance workforce.
- Develop an interconnected global network of emergency operations centers and multisectoral response to biological incidents; and
- Improve global access to medical and nonmedical countermeasures during health emergencies.
Understanding Health Threats
A disease threat anywhere can mean a threat everywhere, including from: the emergence and spread of new microbes; globalization of travel and trade; rise of drug resistance; intentional or inadvertent release of dangerous pathogens; and terrorist acquisition, development, and use of biological agents. In today’s interconnected world, these threats emerge and spread faster than ever before and no single country can address them alone.
To that end, in 2005, the World Health Organization (WHO) promulgated core International Health Regulations (IHR), which specifically outline the need for countries to detect, assess, notify, and report events, and respond to public health risks and emergencies of national and international concern. Although all 194 WHO member states adopted the IHR, fewer than 20 percent of countries reported reaching full compliance with these regulations by 2012. In the global challenge described by the GHS agenda, “Vulnerabilities include geographic areas with limited disease surveillance systems, reluctance to share outbreak information or biological samples, emergence of new pathogens and development of drug-resistance, and the specter of intentional or accidental release of biological agents.”
When reviewing some of the recent disease threats that parts of the world have encountered – such as the severe acute respiratory syndrome (SARS), swine flu (H1N1), and even the more recent Middle East respiratory syndrome coronavirus (MERS-CoV) and avian influenza (H7N9) outbreaks – it is evident that a well-planned agenda with input from a wide variety of stakeholders is a priority. Every year, new infections, together with the emergence of drug-resistant pathogens, pose challenges to global health as well as political and economic stability. The speed at which the SARS virus spread across international borders in 2002-2003 to infect some 8,000 people and kill more than 700 worldwide remains a concern within the global public health community. The CDC estimated that the 2009 H1N1 influenza pandemic killed approximately 284,000 people globally in the first year alone.
Impact at the State and Local Levels
All emergencies are local. Just as with nuclear, chemical, or even cybersecurity attacks, health threats have the potential to cause enormous damage in terms of lives lost, economic impact, and ability to recover. In reviewing just the element of economic impact, the SARS outbreak in 2002-2003 cost $30 billion in only four months and the anthrax attacks of 2001 cost more than $1 billion to clean up. It is also critical to remember that public health agencies typically are not in a position to handle severe health threats alone, and will need assistance from emergency management, response partners, healthcare sector, and others.
As Acting Deputy Defense Secretary Christine Fox noted on 13 February 2014 in a press release, “[The GHS agenda] establishes a roadmap for progress that ultimately depends on collaboration between the health and security communities.” State, local, tribal, and private sector partners can help advance the GHS agenda by continuing to enhance their capabilities and capacity to respond and manage health threats. The partnerships built during the state and local planning and collaboration efforts with key response agencies following the 2001 anthrax attacks and the 2004 Cities Readiness Initiative (CRI) can be leveraged. Additionally, the March 2011 Public Health Preparedness Capabilities and the January 2012 Healthcare Preparedness Capabilities include a wide range of planning, training, and operational elements that state and local jurisdictions should meet to improve their capabilities to respond and recover from incidents.
Simply participating in the planning and operationalization for these capabilities will be essential to successful early detection, response, recovery, and mitigation of various small- and large-scale public health emergencies. The capabilities focus on building capacity and capability across agencies and jurisdictions regardless of the type of hazard, such as emergency operations coordination, communication, fatality management, mass care, medical countermeasure dispensing, medical surge, non-pharmaceutical interventions, laboratory capabilities, and surveillance and epidemiological investigation.
The Future of Health Security
Over the next five years, the U.S. government has committed to advancing the GHS agenda by:
- Working with at least 30 partner countries to prevent, detect, and effectively respond to infectious disease threats, whether naturally occurring or caused by accidental or intentional release of dangerous pathogens;
- Working closely with global partners to build GHS capacities in areas such as surveillance, detection, and response in order to slow the spread of antimicrobial resistance, establish national biosecurity systems, reduce zoonotic disease transmission, increase routine immunization, establish and strengthen national infectious disease surveillance and laboratory systems, and develop public health electronic reporting systems and emergency operations centers;
- Holding numerous GHS partner events with the goal of developing additional commitments from other countries – for example, the White House will host an event in fall 2014 to highlight progress;
- The U.S. Department of Defense, Defense Threat Reduction Agency, and CDC devoting $40 million to fund GHS activities in up to 10 countries in fiscal year 2014;
- Continuing to build on best practices and successes in developing emergency operations centers like those already established in India, Uganda, and Vietnam, where the Ministries of Health and their partners can communicate and collaborate during an emergency response, such as a disease outbreak or natural disaster;
- Replicating the successes of the two GHS demonstration projects in 2013 – partnerships between CDC and Vietnam as well as CDC and Uganda helped develop real-time information systems for faster outbreak response and improved emergency operations procedures, including safe packaging and transport of potentially infectious samples; and
- Tracking and measuring progress using a series of metrics and inviting partner countries to use the metrics that are appropriate for their situations.
Raphael M. Barishansky, DrPH(c), is a consultant providing his unique perspective and multi-faceted public health and emergency medical services (EMS) expertise to various organizations. His most recent position was as the Deputy Secretary for Health Preparedness and Community Protection at the Pennsylvania Department of Health, a role he recently left after several years. He is also currently a doctoral candidate at the Fairbanks School of Public Health at Indiana University.
Audrey Mazurek, MS, has worked at all levels of government for nearly 20 years in public health and healthcare preparedness, emergency management, and homeland security. She was a program manager with the National Association of County and City Health Officials (NACCHO) Project Public Health Ready program. She supported the U.S. Department of Homeland Security in the development of an accreditation and certification program for private sector preparedness. She also served as a public health emergency preparedness planner for two local public health departments in Maryland, where she developed over 30 preparedness and response plans, trainings, and exercises. She is currently a director of public health preparedness with ICF, primarily supporting the U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response’s (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) program as the ICF program director.