Achieving Global Health Security
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In today’s interconnected world. an infectious disease outbreak that is not rapidly detected and controlled at its sources can become a costly global health threat, both in lives lost and economic turmoil. Every year, hundreds of outbreaks occur worldwide, many of which involve pathogens with pandemic potential.
Since 2009, the World Health Organization (WHO) has declared public health emergencies of international concern for outbreaks of influenza a (HINI) in 2009, Ebola in West Africa in 2014, Zika in the Americas in 2015 and COVID19 globally in 2020. Since the start of 21st century, infection disease outbreaks and epidemics have increased in both severity and frequency. The vast majority, approximately 75% of emerging infectious disease threats originate from animals, at a time when an increasing number of people around the world are living in closer proximity to animals due to deforestation, land use change, climate change and a variety of other factors. Around the world, millions of people had lost their lives and livelihood because the world lacked capacity to prevent, detect, and respond to COVID19 and still are threatened from the other emerging infectious disease threats(1).
With these global health emergencies being declared at a rapid pace than before, the health security of nations is now of critical importance than ever before. Global health security is now a matter of national security and no country can ignore it, especially, due to climate change and the human and economic costs brought by COVID19.
Health security encompasses the activities and responses of nations to public health threats, Access to health care, access to preventive medicine, vaccination programs and epidemic control are part of the deliberate health security strategies.
In 2007, the International Health Regulations 2005 (IHR 2005) had entered into force and all 196 state parties were legally bound to implement the core capacity require under the regulations. The IHR (2005) had a purpose and scope “to prevent, protect against, control and provide a public health response to the international spread of the disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade” (2). To accelerate progress towards IHR 2005 compliance, the Global Health Security Agenda (GHSA) was launched in 2014 by 29 countries, WHO, the Food and Agriculture Organization of the United Nations, And the World Organization for Animal Health.
Global Health Security (GHS) is defined as the activities required, both proactive and reactive, to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries. It is the “existence of strong and resilient public health systems that can prevent, detect and respond to emerging infectious disease threats wherever they occur in the world” (3).
The GHSA is a multisector partnership of more than 70 countries, international organizations, non—governmental stakeholders and private sector companies. All aim to achieve a vision of a word that is safe and secure from global health threats posed by infectious disease. This is aimed to be achieved by stimulating global support and commitments through surveillance systems that work quickly to catch outbreaks before they spread, laboratory networks that can accurately diagnose diseases and identify new pathogens, workforce development of frontline staff to identify, track and contain outbreaks at their source, and guide countries to enhance their capacities to prevent, detect and respond to potential outbreaks of infectious diseases and other public health threats. All stakeholders work simultaneously to finance health security, strengthen global health systems, and create early warning systems to prevent, detect and reponse to future biological threats (4).
The GHSA aims to close gaps in preparedness and accelerate progress towards this mission. It is built on three pillars:
GHSA Objectives (5)
Prevent: 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. Reduce the number and magnitude of infectious disease outbreaks
Detect: launch, strengthen and link global networks for real-time bio surveillance. Strengthen the global norm of rapid, transparent reporting and sample sharing. Develop an interconnected global network of Emergency Operations Centers and multi-sectoral response to biological incidents. Develop and deploy novel diagnostics and strengthen laboratory systems. Train and deploy an effective bio surveillance workforce.
Respond: Develop an interconnected global network of Emergency Operations Centers and multi-sectoral response to biological incidents. Improve global access to medical and non-medical countermeasures during health emergencies.
The GHSA objectives were developed to tackle the current top global health security risks that include:
potential for accidental release, theft or illicit use of dangerous pathogens.
ever increasing globalization of travel and trade enabling disease to spread.
emergence and spread of new infectious diseases.
rise of drug-resistant, disease causing pathogens.
Globally the relevant agencies including CDC strengthens capabilities in these four core areas to fight top global health security risks as under:
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Surveillance systems to quickly catch outbreaks before they spread.
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Laboratory networks to accurately diagnose diseases and identify new pathogens:
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Workforce development of frontline staff to identify, track, and contain outbreaks at their source.
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Emergency Management systems to coordinate response efforts when crises occur.
Health security is a national security issue. Not only does investment in global health security help prevent threats from reaching other countries’ shores, it also promotes economic and political stability in every country and around the world. From Avian Flu, to COVID-19, and drug-resistant bacteria, the world faces a host of dangerous pathogens and potential epidemics. New COVID-19 variants and novel influenza A (H1N2) variant virus, can emerge without warning and quickly spread. In present globally connected world, their effects have unprecedented reach.
Building global health security can’t be accomplished alone. Countries need to work together to accomplish GHSA goals. World-class experts from various countries must share knowledge and gain on-the-ground experience that better prepare the governments to handle health threats at home and around the world. Relevant agencies must promote mutual strategies, research, and policies to ensure that partner countries are well prepared to respond to disease threats, wherever they might begin. Attention to global health security governance is more important now than ever before. Scientists predict that in future a possible influenza pandemic could affect 1.5 billion people, cause up to 150 million deaths and leave US$3 trillion in economic damages. A public health emergency in one country is now looming dangerously from affecting many others (6).
To measure countries’ progress towards meeting GHSA goals, the countries have developed the Joint External Evaluation external icon (JEE). The JEE is a voluntary evaluation process that gives countries a starting point for improving their health security by identifying their strengths and pointing out the most urgent needs within their health systems. This transparent, external evaluation process encourages countries to share vital information with each other and work together towards a safer, healthier world.[8]
To achieve strong, resilient health systems that reach both global health security and universal health coverage goals, a unified approach is required to understand how to work across the system. Following 3 key overarching approaches may be adopted to achieve the GHSA goals:
Strengthen comprehensive district planning in the light of World Health Organization’s definition of the district health system 1986 (i.e., to be successful, district planners must understand how various public health programs come together within their communities, the range of stakeholders who have a role to play in health efforts, and how public and private funding and information systems can be leveraged at the local level to achieve their objectives) (7).
Support flexibility of district health systems to break the silos of vertical programs and take on new roles as circumstances warrant.
Use the successfully implemented COVID-19 interventions as an opportunity to address management, coordination, and integration challenges at the district level.
Global health security relies on International Health Regulations 2005 (IHR 2005). Although much has been accomplished through the first few years of GHSA implementation, JEEs around the world has highlighted numerous prevent, detect, and respond capabilities that still need strengthening.
There is also a lack of evidence base of the most effective, timely, and cost-effective approaches to building national capacities for GHSA compliance. As countries and partners continue their work to build health security capabilities, there will be useful opportunities to evaluate different implementation strategies and to document the impact of newly acquired capacities. Continuing this work and thereby sustaining this momentum toward GHSA compliance is critical for protecting communities worldwide.
The GHSA’s reports analysis allows to understand the evolution, etiology and eventualities of the global health security regime, which is essential for national and international health policymakers, practitioners and academics to know where and how to act effectively in preparation for tomorrow’s challenges. Urgent support is needed at the subnational level of Low- and middle-income countries (LMICs) to integrate isolated programs and to facilitate the appropriate distribution of resources to ensure better integration of Health System Strengthening (HSS) for Global Health Security and health security to advance progress toward Universal Health Care (UHC). A system analysis-based approach should be adopted to increase resilience and improve GHS programs. Increased investment in improved technical and management capabilities will also be needed at the subnational level to address persistent problems and to ensure optimal functioning of the health system. Implementation of these recommendations should include a research agenda aimed at understanding how to integrate parallel activities into one sustainable community-based health system that addresses key priorities and ensures that new directions are flexible and capable of responding to change. Implementation might also focus on how the various stakeholders might be drawn together to advise policy makers on the optimal strategies to be used to address current GHS and HSS needs at the subnational level.
References and Articles used for this post:
Global health security. United States Agency for International Development. Updated March 8, 2021. Accessed April 13, 2022.
Heymann DL, Chen L, Takemi K, Fidler DP, Tappero JW, Thomas MJ, et al. Global health security: the wider lessons from the West African Ebola virus disease epidemic, National Library of Medicines
Gostin LO, Katz R. The International Health Regulations: the governing framework for global health security. Milbank Q. 2016;94:264–313.
Frieden TR, Tappero JW, Dowell SF, Hien NT, Guillaume FD, Aceng JR. Safer countries through global health security. Lancet. 2014;383:764–6.
Global health security, United States Agency for International Development. Updated March 8, 2021. Accessed April 13, 2022.
Tappero JW, Cassell CH, Bunnell BE, Angulo FJ, Craig A, Pesik N, et al.; Global Health Security Science Group. US Centers for Disease Control and Prevention and its partners’ contributions to global health security. Emerging Infectious Diseases, 2017;23 (Suppl):S5–14.
Bell E, Tappero JW, Ijaz K, Bartee M, Fernandez J, Burris H, et al. Joint External Evaluation development and scale-up of a global multisectoral health capacity evaluation process. Emerg Infect Dis. 2017;23(Suppl):S33–9.
Rao CY, Goryoka GW, Henao OL, Clarke KR, Salyer SJ, Montgomery JM, Global disease detection, Achievements in applied public health research, capacity building, and public health diplomacy, 2001–2016. Emerging Infectious Diseases, 2017;23(Suppl):S138–146.
Dr. Tom Frieden. Dr. Tom Frieden: Protecting the World from the Next Pandemic, GE Reports, 10/29/2015. Page accessed 5/12/2017.
WHO. IHR (2005) Monitoring and Evaluation framework Joint External Evaluation tool (JEE tool), Page accessed 5/12/2017.
Janovsky K; World Health Organization (WHO). Division of Strengthening of Health Systems, The Challenge of Implementation: District Health Systems for Primary Health Care. WHO; 1988. Accessed April 13, 2022.