Global Health Security

Global Health Security

To the Editor: Global health security is the protection of the health of persons and societies worldwide. It includes access to medicines, vaccines, and health care, as well as reductions in collective vulnerabilities to global public health events that have the potential to spread across borders. For example, transboundary zoonotic diseases such as avian influenza (H5N1) infections affect animals and humans, thereby threatening health security worldwide because of their high death rates (≈60% in humans) (1). During the past 15 years, fairly standardized responses to threats have been implemented around the globe. Some of these responses have been against severe acute respiratory syndrome and avian influenza (H5N1), which have been overseen by a well-resourced international health system (2). These global health threats have raised the highest levels of political and social concern. This concern has provoked governments and international agencies to address health threats through a security rationale, which emphasizes the themes of national security, biosecurity, and human security. This amalgamation of health issues and security concerns has produced a notion of health security, which is dominated by technical medical approaches and pharmaceutical interventions. These approaches and interventions have already begun to shape the way international health policy is formulated (3). A global vision of health security is very much part of contemporary rhetoric. However, this vision lacks the drive and speed needed to make proposals materialize and operationalize ideas in the geographic areas where they are most desperately needed. Small benefits accrue to members of vulnerable populations who in fact are those most likely to be affected by epidemic diseases. A public health security design that impinges on a global approach runs the risk of neglecting cultural, economic, ecologic, and social conditions on the ground. Regional approaches that address hazards and threats may be more inclusive of context-specific conditions (4). Global public health threats related to infectious pathogens of animal origin are expected to rise. To address these threats, several experts and strategists suggest the initiation of a worldwide early-alerting and -reporting mechanism. Aggregation of disease threats through an event-focused Web-based platform could enable this mechanism. This timely gathering of disease intelligence can inform policymakers about the nature of risks. Disease maps can display details needed to design tailored policies and control measures to tackle diseases according to their specifics (5). Leading scientists and researchers continue to try to understand the global temporal and spatial patterns of animal diseases. This understanding is gained through an array of instruments, ranging from the use of satellite images to cutting-edge molecular technologies. The momentum so far has created an open forum for decisionmakers to collaborate with the leading international agencies to advocate for surveillance, identification, and control of zoonotic diseases to uphold global public health security (6). However, global initiatives suffer from the free-rider problem and from moral hazards. Some low-income countries with weak governance have alerted the international community about their fragile health care systems to capture a nontrivial portion of funds that seldom reach their intended destinations. These resource allocations to developing countries foster aid dependence (7). The international technical agencies tasked with upholding animal and human health should remain at the forefront of identifying and addressing evolving threats. This process will demand continuous flexibility, agility, and a coordinated international effort. Attaining goals of mitigating threats and reducing risks posed by the emergence of zoonoses requires close collaborations with national health authorities and local governments. The large investments planned to improve foresight and prevention might or might not work. If they do not work, apportioning blame to countries or regions for disease flare-ups can result in social, political, cultural, and economic consequences that in the past have turned out to be unjustified, unfair, and ultimately detrimental (8). Clearly, global health threats can be reduced only by the concerted actions of national and international actors. In the years ahead, the international community will almost certainly be expected to bring its formidable technical knowledge, skills, and analytic capabilities to confront this expanded global health threat environment (9). It would be wrong, however, to forget the many insights that current advances in epidemiology and surveillance have delivered. In fact, should the impetus to finance a global health agenda encounter opposition or obstacles, it would seem easier and logical to strengthen already functional activities. Lastly, the realities and the prevalent policymaking environment have created a trap between a desire to prioritize global health by portraying aspects of it as an existential security issue and the fact that security ultimately might not be the most useful language for describing and institutionalizing the health threats and hazards confronted by societies around the world (10). Regardless of whether a trap has been created, action is urgently needed.

The concept of ‘health security’ has been increasingly apparent in recent years in both academic and policy discourses on transborder infectious disease threats. Yet it has been noted that there are a range of conceptualisations of ‘health security’ in circulation and that confusion over the concept is creating international tensions with some states (particularly from the Global South) fearing that ‘health security’ in reality means securing the West. This article examines these tensions but puts forward an alternative explanation for them. It begins by looking at the different ‘health securities' that characterise the contemporary global health discourse, arguing that there is in fact a good deal more consensus than we are often led to believe. In particular there is a high level of agreement evident over what the major threats to ‘health security’ are and what should be done about them. These are a particular set of health risks which are primarily seen as major threats by Western developed nations, and contemporary global responses – often couched in the language of global health security – have a tendency to focus on containment rather than prevention. The article makes the case that to resolve the tensions around (global) health security there is the need for a more explicit recognition of the primary beneficiaries of the current system, and of who is bearing the costs. Only following such a recognition can meaningful debates be carried out about the appropriate prioritisation of global health security in relation to other global health governance priorities.

Background Member States lack of compliance with 2005 IHR implementation led to the launched of the Global Health Security Agenda. This research will provide an understanding of how the Global Health Security Agenda Steering Group (GHSA SG) governance interventions impact health system performance and global health security. This will enhance the understanding of a Steering Group's governance interventions in complex Global Health initiatives. Research questions: To what extent have GHSA SG governance interventions contributed towards enabling health system performance of WHO Member States? To what extent have GHSA SG governance interventions contributed towards the implementation of global health security among WHO Member States? Methods Correlational analysis using Spearman's rho examined the relationship between governance, health system performance and global health security variables at one point in time. A convenience non-probability sample consisting of eight WHO Member States was used. SPSS Statistics generated the bivariate correlation analyzes. Results Governance and health system performance analysis indicated a statistically significant strong positive effect size in 11 out of 18 and moderate positive effect size in the remaining seven out of 18 health system performance indicators. Governance and global health security analysis concluded three of the governance indicators had strong and moderate positive coefficients. Global health security variables demonstrated weak effects in the remaining three governance indicators. Conclusions This study presents a case for health systems embedding in global health security. Health system performance is only as effective at protecting populations when countries achieve core capacities of preparedness and response to global health threats. The associations provide stakeholders information about key characteristics of governance that influence health system performance and global health security implementation. Key messages This study provides an argument for the continued support of the GHSA 2024 Framework with implementation of global health security capabilities and meeting 2005 IHR requirements. The GHSA SG governance role remains profoundly important in establishing sustainable efforts internationally towards achieving the objectives of the GHSA in support of the 2005 IHR standards.

Background: Global health security (GHS) and universal health coverage (UHC) are key global health agendas which aspire for a healthier and safer world. However, there are tensions between GHS and UHC strategy and implementation. The objective of this study was to assess the relationship between GHS and UHC using two recent quantitative indices. Methods: We conducted a macro-analysis to determine the presence of association between GHS index (GHSI) and UHC index (UHCI). We calculated Pearson’s correlation coefficient and the coefficient of determination. Analyses were performed using IBM SPSS Statistics Version 25 with a 95% level of confidence. Findings: There is a moderate and significant association between GHSI and UHCI (r=0.662) and individual indices of UHCI (maternal and child health and infectious diseases: r=0.623, 0.594, respectively). However, there is no association between GHSI and the non-communicable diseases (NCDs) index (r=0.063). The risk of GHS threats a significant and negative correlation with the capacity for GHS (r=-0.604) and the capacity for UHC (r=-0.792). Implications: The aspiration for GHS will not be realized without UHC; hence, the tension between these two global health agendas should be transformed into a synergistic solution. We argue that strengthening the health systems, in tandem with the principles of primary health care, and implementing a “One Health” approach will progressively enable countries to achieve both UHC and GHS towards a healthier and safer world that everyone aspires to live in. Funding Statement: School of Public Health, the University of Queensland. Declaration of Interests: The authors declare no competing interests.

Universal Health Coverage (UHC) and Global Health Security (GHS) are two high-priority global health agendas that seek to foster health system resilience against health emergencies. Many countries have had to prioritize one agenda over the other due to scarce resources and political pressures. To aid policymakers' decision-making, this study investigated the individual and synergistic effects of countries' UHC and GHS capacities in safeguarding essential health service delivery during the COVID-19 pandemic. We used a quasi-experimental difference-in-difference methodology to quantify the relationship between 192 countries' progress towards UHC and GHS and those countries' abilities to provide 12 essential childhood immunization services between 2015 and 2021. We used the 2019 UHC Service Coverage Index (SCI) to divide countries into a "high UHC group" (UHC SCI≥75) and the rest (UHC SCI 75), and similarly used the 2019 GHS Index (GHSI) to divide countries into a "high GHS group" (GHSI≥65) and the rest (GHSI<65). All analyses were adjusted for potential confounders. Countries with high UHC scores prevented a 1.14% (95% CI: 0.39%, 1.90%) reduction in immunization coverage across 2020 and 2021 whereas countries with high GHSI scores prevented a 1.10% (95% CI: 0.57%, 1.63%) reduction in immunization coverage over the same time period. The stratified DiD models showed that across both years, high UHC capacity needed to be augmented with high GHS capacity to prevent a decline in immunization coverage while high GHS alone was able to safeguard immunization coverage. This study found that greater progress towards both UHC and GHS capacities safeguarded essential health service delivery during the pandemic but only progress towards GHS capacity was both a necessary and likely sufficient element for yielding this protective effect. Our results call for strategic investments into both health agendas and future research into possible synergistic effects of the two health agendas.

Global health security is concerned with the response to infectious disease outbreaks across international borders. However, its precise nature and scope are contested because of lack of agreement about its focus and beneficiaries. Informed by qualitative interviews with thirty-eight professionals working in the field, this article explores views on how the scope and boundaries of global health security should be understood. The findings illustrate the ways in which those working in global health security operate in a complex moral landscape, with a wide variety of definitional boundaries about what global health security means. Our thematic analysis of this contested area suggests that views on global health security can be helpfully understood in terms of four models, each with different conceptual and moral priorities. We label these four moral models as follows: threat model, collective model, reframing model, and humanitarian model. Understanding the field of global health security in terms of these four sometimes competing models provides a helpful way of mapping out and understanding the complex range of agreements and disagreements that arise in relation to epidemics and other global health security events.

Blockchain technology has an enormous scope to revamp the healthcare system in many ways as it improves the quality of healthcare by data sharing among all the participants, selective privacy and ensuring data safety. This paper explores the basics of blockchain, its applications, quality of experience and advantages in disease surveillance over the other widely used real-time and machine learning techniques. The other real-time surveillance systems lack scalability, security, interoperability, thus making blockchain as a choice for surveillance. Blockchain offers the capability of enhancing global health security and also can ensure the anonymity of patient data thereby aiding in healthcare research. The recent epidemics of re-emerging infections such as Ebola and Zika have raised many concerns regarding health security which resulted in strengthening the surveillance systems. We also discuss how blockchains can help in identifying the threats early and reporting them to health authorities for taking early preventive measures. Since the Global Health Security Agenda addresses global public health threats (both infectious and NCDs); strengthen the workforce and the systems; detect and respond rapidly and effectively to the disease threats; and elevate global health security as a priority. The blockchain has enormous potential to disrupt many current practices in traditional disease surveillance and health care research.

Ebola's legacy: UK deficits and their global lessons

Practitioners of global health security have long warned of the risks ushered in by rapid urbanization, global interconnectivity, and increasing manipulation of environmental and ecological systems. The COVID-19 pandemic has concretized the often-abstract relationship among global and local phenomena, rendering it an objective and irrefutable physical reality. Despite the stark realization that the globe is only as safe and healthy as its least safe and healthy population, global cooperation is breaking down, power among multilateral institutions is waning, and emerging risks within the digital realm are reshaping global health security. This chapter explores how the shifting dynamics of globalization are impacting the scope and governance of global health security. It is intended to provide researchers, policy-makers, and practitioners of global health security with a primer on perennial issues within global health security, as well as an introduction to novel risks. In particular, this brief overview describes the opportunities and risks of a new class of digital technologies and how they will intersect with global health security. Attention to this shifting landscape of risk will be critical for ensuring global stability in a post-COVID-19 world.

Health security has gained significant attention at the national and global levels, "security" is not a simple term; instead, it is "essentially contested" - that is, it induces debates about what it means and how to use it. This study aimed to define three terms frequently used in health security discussions. These terms are national health security, Global Health Security, and public health. The research method was a scoping review performed in three stages. The first stage was electronic searching based on selection criteria among multiple sources at various time points during the year 2023. These sources included online literature searches, websites of non-governmental organizations (NGOs), and other governmental health agencies. The second stage involved determining the relevance of the selected papers to the study's objectives; the selected papers had moderate to high relevance to the study's objectives. The third stage was to evaluate the methodological quality of a study; we selected peer-reviewed published papers and websitesrecognized as trustworthy sources of information.The search yielded 143 articles; five met the inclusion criteria and were subjected to the definition of health security. Despite proposed definitions, agreement has yet to be reached on the content and scope of health security. Another main finding is that health security requires more state and international collaboration efforts to reach Global Health Security. To the best of our knowledge, no known government body or organization is responsible for governing health security in Saudi Arabia. However, the current study presents a definition of health security and differentiates it from the public health approach, in addition to emphasizing the importance of governing the related health sectors within each country in order to improve health security and have a positive impact on overall Global Health Security.

Universal health coverage (UHC) and global health security (GHS) should be pursued synergistically to strengthen health systems. However, existing studies found that the efforts toward the two agendas were divergent worldwide. We reviewed the synergy status between UHC and GHS in the Western Pacific Region (WPR) to provide evidence for decision-makers to promote synergy. We collected the UHC service coverage index (UHC SCI) and the GHS index (GHSI) scores. We created a four-quadrant diagram to discover the gap in UHC and GHS capacities within WPR and divide WPR countries into four groups based on the global mean scores. Further, we adopted global spatial autocorrelation analysis to discover spatial aggregations of high and low scores by calculating Moran's I. In addition, we conducted a correlation analysis to assess the synergy level in WPR and reveal the gap between Pacific Island countries or territories (PICTs) and non-PICTs. We conducted key informant interviews to uncover actual scenarios and address gaps in the quantitative evidence. Compared to the global mean UHC SCI and GHSI scores, nine out of 13 non-PICTs had higher scores, while all 14 of the PICTs had lower scores for both indexes. The Moran's I for WPR countries' UHC SCI and GHSI scores in 2021 were 0.20 and 0.23, respectively (Z-score >2.58; P < 0.01). The correlation coefficients between the two index scores were 0.722 (P < 0.001) at the global level and 0.869 (P < 0.001) at WPR. Within the WPR, the correlation coefficients were 0.859 (P < 0.001) in the non-PICTs and -0.026 (P > 0.05) in the PICTs. The synergy level between UHC and GHS was high in the WPR, but this mainly came from the synergy in the non-PICTs. The two agendas have barely synergised the PICTs. To build a safer and healthier WPR, it is important to pay more attention to the countries that have weaker health capacities in the region and narrow the gap.

Chapter 2 - Ethics and global health security

Facing Global Environmental Change

Given the increased demand for anesthesia and surgical services during the COVID-19 pandemic, it has become clear that surgery is acritical part of health capacity. There is an urgent need to markedly scale up surgical services within health systems strengtheningefforts, particularly in LMIC’s. We organized a panel titled “Surgery: Suturing the Gaps in Global Health Security” within th e larger series“From Pandemic to Progress: Building Capacity Through Global Surgical, Obstetric, Trauma, and Anaesthesia” during the 75th UnitedNations General Assembly (UNGA). The event was co-sponsored by the G4 Alliance and the Program in Global Surgery and SocialChange (PGSSC) at Harvard Medical School. Given the COVID-19 pandemic, the panel, along with the remainder of the UNGA this year,was virtually, greatly increasing the attendance of physicians, trainees, and policymakers worldwide. Additionally, the panel wasrecorded and made freely accessible online to allow for viewing by individuals after the session. The panelists highlighted three keythemes. Affordable and timely surgical care is critical for global health equity and investing in surgical capacity strengthe ns pandemicreadiness. Key stakeholders such as international and nongovernmental health organizations, philanthropic funders, and particularlynational and local governments must be engaged in order to promote cross-sector support. The economic impact of investing insurgical care must be emphasized. Future initiatives will build on these themes in order to improve health care access and security.