Global Health Security

How an action tank can catalyze issues and change the world

This blog post was written by Gabrielle Fitzgerald, the Founder and Chief Executive Officer at Panorama. Panorama’s mission is working to solve global problems through audacious thinking and bold action. They are a 2018 Global Health Council Member.

I launched Panorama in early 2017 with a new vision for how to solve complicated problems. We call ourselves an action tank because we engage deeply with our partners to develop and execute solutions together. This is a unique, entrepreneurial model that drives action on local and global social issues by influencing people and policy. We are now a team of more than 20 strategists, advocates, analysts, and storytellers, all with a passion for changing the world.

An action tank aligns the critical components we know are needed to make progress on any issue, whether it’s malaria or neglected tropical diseases or violence against children. These components include:

  • Insight that comes from systems thinking and analysis of an issue, leadership, or organization.
  • Influence enabled by the right combination of advocacy, stakeholder engagement, communications, and resource mobilization.
  • Incubation & Infrastructure through such services as fiscal sponsorship, grant making and management, organizational design, and fund management and administration.

Our fiscal sponsorship program, for example, is a way for Panorama to support other organizations pursuing charitable activities that are aligned with our mission. Current projects include TogetHER, a group fighting to end cervical cancer in developing countries.

One of the most exciting elements of an action tank is that we initiate projects when we see gaps that need filling, such as our menstrual health work to fight the stigma that can limit women and girls, or our collaboration with Rockefeller Foundation to unite the health and environment sectors around the emerging concept of Planetary Health.

A high priority for us is to rally decision makers around the need to prepare for the next global pandemic. I recently co-authored an article in the British Medical JournalGlobal epidemics: How well can we cope? We reviewed the many initiatives and organizations set up after the 2014-15 West Africa Ebola outbreak and concluded that serious gaps remain in terms of leadership, funding, and monitoring. Despite the rapid response and excellent work by WHO in recent outbreaks, I fear we are woefully unprepared for a global outbreak, especially one caused by an unknown virus.

To help push the conversation forward with key decision makers, we are co-hosting with the United Nations Foundation and PATH a panel alongside the UN General Assembly to celebrate the global community’s success in stemming recent outbreaks while highlighting what still needs to be done to ensure the world is prepared for a major outbreak.

Panorama works on a wide range of global health issues, but we think big and bring the energy, scope, and conviction of an action tank to every partnership we build.

Learn more about Panorama.

(Image courtesy of Panorama: Gabrielle Fitzgerald speaking with staff at the national 115 Call Center in Conakry, Guinea, during the Ebola outbreak in 2015)

Clade X: A Global Health Security Pandemic Simulation Highlights Need to Support Global Health Security Initiatives

This blog is a collaborative effort between Global Health Council, Nuclear Threat Initiative (NTI)|bio, the Johns Hopkins Center for Health Security, and PATH.

The U.S. government has been a leader and financier of international action to prevent, detect, and respond to infectious disease threats both prior to and following the 2014 launch of the Global Health Security Agenda (GHSA), a partnership of more than 60 countries, international organizations, and non-governmental stakeholders dedicated to global health security. Due to important progress made possible through the GHSA, the five-year partnership has been extended from 2019-2024.

The Johns Hopkins Center for Health Security, Global Health Council, NTI | bio, and PATH recently hosted Clade X: A Global Health Security Simulation for Congressional staff to demonstrate the need for continued support to prevent serious infectious disease threats. The simulation—an abridged, modified version of the original day-long Clade X pandemic exercise designed and hosted by the Center for Health Security—was conducted to highlight the necessity for effective preventive interventions and the importance of accountability of government agencies during global health crises. The exercise gave Congressional staff a window into the choices government leaders must make during a pandemic.

The exercise highlighted the need for the U.S. to play a leadership role in the global health security community and for countries to work together to develop a robust pipeline of countermeasures to mitigate the impacts of outbreaks; create transparent international action plans that measure progress; and support sustained global health security funding that advances health security preparedness in low- and middle-income counties. Overall, participants emphasized the need for the Administration and Congress to work together to develop and support a comprehensive U.S. strategy for pandemic preparedness.

During the simulation, Dr. Tom Inglesby, Director of the Center for Health Security, played the role of National Security Advisor to the President, with co-facilitation by Carolyn Reynolds, Vice President of Advocacy and Policy at PATH, and Dr. Beth Cameron, Vice President for Global Biological Policy and Programs at NTI. While the scenario was fictional, it gave participants a realistic perspective into what it is like to face multiple reports of disease outbreaks occurring simultaneously in Venezuela and Germany.

(Left to Right): Dr. Tom Inglesby, Carolyn Reynolds, Dr. Beth Cameron, and Dr. Jennifer Nuzzo.

As part of the fictional scenario, Congressional staff were tasked with providing recommendations to the President about whether to, and how the U.S. should respond to the scenario. Among the most significant challenges were: requests for global aid amid an impending national crisis; requests for U.S. military and public health intervention in various geopolitical environments; and processing information about the severity and longevity of the outbreak in the context of a constrained national budget. An additional challenge throughout the exercise was the lack of timely and specific information, mimicking the lack of reliable data that exists to inform leaders during a real global health crisis.

As a result, participants grappled with providing timely resources to affected countries. Delays in aiding highlighted that if previous investments in disease detection and reporting systems had been made, more information would have been available to inform response decisions, and ultimately, fewer people would have died.

In the second half of the simulation, participants discussed the impact of a reported outbreak of Clade X in Niger, as well as a new outbreak in a small college town in the United States. During this session, the conversation focused on the impact of the outbreak on U.S. domestic and foreign policy. Thorny issues also arose regarding the need to protect Americans and military personnel abroad while at the same time contributing to an international response effort.

Following the simulation, the non-governmental sponsors led the group through a “hot wash” discussion about Congressional roles in preparing for and responding to outbreaks, including deployed public health personnel to help with disease  prevention; providing for robust disease-detection data; and identifying channels for coordination and communication across the executive and legislative branches.

The simulation painted a realistic picture of global health security risks in action—the lack of emergency preparedness and planning, absence of clear authorities, and poor communication with the public—and was a reminder that viruses know no borders. Today, more than two-thirds of countries are still not properly prepared to address pandemic threats. A severe infectious disease pandemic could cost more than 1 million U.S. lives and up to $6 trillion to contain*. Although a growing number of countries are taking steps to prepare for the increasing risks of emerging infectious diseases, sustained political commitment, financial support, technical assistance, and partnerships are needed to strengthen the capacity of every country to prevent, detect, and respond to global health threats.

Regarding the original Clade X, from the Johns Hopkins Center for Health Security website:

The original Clade X was a day-long pandemic tabletop exercise hosted by the Johns Hopkins Center for Health Security that simulated a series of National Security Council-convened meetings of 10 U.S. government leaders, played by individuals prominent in the fields of national security or epidemic response. The exercise illustrated high-level strategic decisions and policies needed to prevent a severe pandemic or diminish its consequences should prevention fail.

At the conclusion of the exercise on May 15, 2018, the Center for Health Security presented 6 strategic policy goals needing commitment from the United States to prevent or reduce the worst possible outcomes in future pandemics. Those recommendations are:

  1. Develop capability to produce new vaccines and drugs for novel pathogens within months not years.
  2. Pioneer a strong and sustainable global health security system.
  3. Build a robust, highly capable national public health system that can manage the challenges of pandemic response.
  4. Develop a national plan to effectively harness all US healthcare assets in a catastrophic pandemic.
  5. Implement an international strategy for addressing research that increases pandemic risks.
  6. Ensure the national security community is well prepared to prevent, detect, and respond to infectious disease emergencies.

To learn more about Clade X and access an extensive repository of materials from the exercise, please click here.

References:

*Gostin, L.O., Mundaca-Shah, C.C., & Kelley, P.W. (2016). Neglected Dimensions of Global Security: The Global Health Risk Framework Commission. JAMA, 315(14), 1451-1452

World Health Organization: Building a Healthier Future for Tomorrow

This post originally appeared on the Better World Campaign website, and was written by Kelli Meyer. The Better World Campaign (BWC) works to foster a strong, effective relationship between the United States and the United Nations to promote core American interests and build a more secure, prosperous, and healthy world. They are a 2018 Global Health Council member.

The United Nations system is comprised of the UN, which is headquartered in New York, and more than 30 affiliated organizations—known as programs, funds, and specialized agencies—with their own membership, leadership, and budget processes.In our “Meet the (UN) Family” series, we’re taking a look at the UN entities that might not always make the headlines but play an integral part of the UN’s mission to promote global peace and prosperity.

Up next: the World Health Organization.

As the global guardian of public health, the primary goal of the World Health Organization (WHO) is to build a better, healthier future for people all over the world. But don’t let the word “World” in the name fool you—WHO makes an enormous impact in the U.S., too.

So what is it that WHO does that is so important to Americans? Let us explain.

WHO helps orchestrate international collaboration and develop solutions to confront global health risks, which help to protect and advance U.S. interests at home and abroad.

For example, after the 2014 Ebola epidemic in West Africa, a partnership was formed under the Global Health Security Agenda with participation from governments in the region, WHO and other UN agencies, plus the U.S. Centers for Disease Control and Prevention, the U.S. Agency for International Development, and other U.S. agencies.

This innovative partnership played a key role in stopping an outbreak of the disease from reaching the same devastation in 2016. It also helped rebuild fragile health systems decimated by Ebola, and spearheaded vaccination campaigns to protect kids who missed out on basic vaccines during these Ebola outbreaks. And with the current Ebola outbreak in the Democratic Republic of the Congo (DRC), WHO is on the frontlines of the response, facilitating the delivery of the new Ebola vaccine.

While this work might seem (literally) thousands of miles away from our shores, it protects Americans because it strengthens a country’s ability to stop to disease threats at their source, before they can spread regionally and globally. This in turn saves lives abroad, protects U.S. troops stationed far from home, and promotes economic and political stability in those areas.

WHO’s leadership has also driven forward global partnerships that impact our lives closer to home. The organization is a founding member of the Measles &Rubella Initiative (M&RI), which is helping protect Americans from a highly infectious disease that still causes outbreaks here in the U.S. Globally between 2000 and 2016, M&RI has driven an 84% reduction in measles deaths, saving 20.4 million lives.

WHO is also a founding member of the Global Polio Eradication Initiative (GPEI), founded in 1988. At its peak in the 1950s, polio caused over 15,000 cases of paralysis in the United States alone. Since 1988, GPEI and WHO have reduced global polio cases by 99.9%, from 350,000 cases to just 22 in 2017. These investments in polio eradication have in turn strengthened country health systems to better identify and respond to other disease threats before they become global risks.

Another area where WHO’s expertise comes into play is addressing environmental and public health issues, such as air quality, water and sanitation. For example, the Environmental Protection Agency (EPA) works with WHO to support reductions in air pollution generated in developing countries, which has the potential to travel across borders. Collaborations such as these means that U.S. agencies like the EPA can rely on the extensive networks and technical expertise of WHO to safeguard the health and security of Americans at home and abroad.

As we said earlier, don’t let the word “World” fool you; WHO works to make sure all people of all ages, no matter where they were born, can live healthy lives. Their work keeps us safe, healthy and protected from health threats here at home, and equips our public health officials with the tools, resources and partnerships they need to solve issues on U.S. soil.

To learn more about WHO, click here.

Local Participation is the Key to Success in Global Health Security

This guest post was originally published by Management Sciences for Health. The post is written by Ashley Arabasadi and is an overview of “Getting Local with Global Health Security,” a World Health Assembly side-event co-sponsored by partners under the Global Health Security Agenda Consortium including MSH, the Global Health Council, Resolve to Save Lives at Vital Strategies, Nuclear Threat Initiative, PATH, the Global Health Technologies Coalition, the Global Health Security Agenda Next Generation Network, and US Pharmacopeia. 

Loyce Pace of the Global Health Council moderates an expert panel at the WHA71 side event in Geneva, May 22, 2018. Panelists included Dr. Diane Gashumba, Rwanda’s Minister of Health; Catharina Boehme, CEO of the Foundation for Innovative New Diagnostics; and Rüdiger Krech, Director of Health Systems and Innovation at WHO. Photo credit: MSH

Is the world safer today from the threat of infectious diseases than it was a generation ago?

It is true that we have more tools at our disposal: better surveillance and diagnostic systems, stronger frameworks and regulations, such as the Global Health Security Agenda and Joint External Evaluations (JEE), and a deeper understanding of how diseases spread and what is needed to stop them. It is also true that climate change, deforestation, population growth, and our proximity to farm and wild animals are making the threat of epidemics greater than ever before. Although the challenge is great, we have the knowledge to solve it. So what do we need to do?

This is the question we set out to answer during a discussion on the sidelines of the 71st World Health Assembly in Geneva last week. Industry experts, including Dr. Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies; Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Dr. Diane Gashumba, Rwanda’s Minister of Health; Rüdiger Krech, Director of Health Systems and Innovation at the World Health Organization; and Catharina Boehme, CEO of the Foundation for Innovative New Diagnostics, engaged a room of more than 200 people on what they see are critical gaps—and how to fill them—in global health security.

Knowledge is King

“Three years ago, we were flying blind,” said Dr. Frieden, reflecting on the progress the world has made in strengthening our capacity to prevent, detect, and respond to infectious disease threats. “There was no information about which countries were ready, what they were ready for, or what needed to be done.” While we’ve made important progress in understanding where the gaps are and how to address them, says Frieden, we’re far from filling those gaps.

To date, more than 76 countries have completed the JEE process, and a few dozen of them are developing national action plans for health security. However, virtually none have costed these plans, identified necessary resources to implement programs, or established sustainable systems to close gaps and stop outbreaks at the source.

Frieden signaled where the gap is greatest: “Countries in Africa have the furthest to go and require the greatest partnership, following the leadership of countries like Rwanda, which are in front of implementing effective programs.”

The better we understand the gaps in a country’s capacity to prevent, identify, and fight infectious disease outbreaks, the better positioned we are to implement the right interventions to strengthen health systems in support of health security. But we need to move from awareness into action.

Money Motivates

“The number of infectious disease outbreaks is going up,” Peter Sands said. “This is not a problem that is going away as mankind gets bigger and richer. This is a problem that seems to be increasing in magnitude.”

“Although we appear to be getting better in controlling the mortality impact of such outbreaks because of the advances in medical science, we actually appear to be getting more vulnerable to the economic impact,” Sands continued. Fear of an outbreak travels fast, and the behavioral consequences of that fear are extremely powerful and can disrupt economies, even in countries where the disease never appeared.

The challenge is to recognize the cost of epidemics and prepare locally in advance. We must invest now in prevention and preparedness or pay later in lost lives, closed businesses, and disrupted economies.

Prepare Locally

Poor planning and preparation leaves populations vulnerable to illness and undercuts efforts to treat patients and curb new infections. Each country needs to understand its weaknesses so they can start addressing them right away.

Rwanda, for example, recently finished its JEE.  “Each country has to adapt global health security work to its own specific situation,” said Dr. Gashumba, reflecting on the process. “Sometimes it is very difficult to make priorities, especially when you have lot of health and social issues . . . the strategy we adopted is to focus everything on the ground because the issues are on the ground, but also the solutions are on the ground.”

If we are to get local with global health security, we must get local in context and recognize that the threats facing communities today may be endemic diseases, like malaria, tuberculosis, and HIV. Active prevention and constant readiness must break down silos and follow an integrated and holistic approach to health.

Better Diagnostics

The ability to quickly and accurately diagnose an infectious disease where it starts, at the community level, can make or break an epidemic. According to Catharina Boehme, diagnostics is a “blindspot” in global health security. “Effective, affordable diagnostics is critical to every country’s surveillance and response system . . . and diagnostics is one of the pieces that is absent in many of the countries that would be most in need to have early response and preparedness mechanisms.”

She continued: “For six of the nine blueprint pathogens, we have no diagnostics available at all, and even when diagnostics exist, health systems are rarely equipped to deploy them when needed.”

Early response, aided by efficient diagnostics, could save countless lives and billions of dollars every year. According to Boehme, only one laboratory in all of Africa (Senegal) today can confirm yellow fever. For Ebola, she says, despite progress, it took three months in 2014 to diagnose it. “Now in the current Ebola outbreak in DRC, we’re faced with a situation where there’s again a major access problem to diagnostics.”

This is an area where the world clearly hasn’t made enough progress over the years compared with vaccines, says Boehme. “There’s no manufacturing capacity in place to scale up diagnostic manufacturing when needed.” Local partnerships, sample sharing, clinical trial capacity in countries, and local R&D are also lagging far behind. Speaking about the progress made by global vaccine initiatives, she says, “it wouldn’t take much money to leverage these same mechanisms towards some diagnostics.”

A Political Choice

Epidemic preparedness is within any country’s reach, said Rüdiger Krech. But in the end, it’s a matter of political choice. “By and large we know what to do. It’s not that we can’t afford it. We can afford it. That is why it’s a political choice.”

“There will be outbreaks and epidemics if you have weak health systems,” Krech said. “For quite some time, we’ve tried to address the low-hanging fruit, which is disease-specific programs, and we’ve always thought that this was done on the basis of well-functioning health systems, but as we’ve seen, that is not the case.” To make real progress, he says “ We need to much better align the JEE and the Global Health Security Agenda with what’s actually going on in health systems.”

No matter where you live in the world, the risk is universal. To stop outbreaks at the source and prevent threats from becoming epidemics, local preparedness is key. We know that bridging the gap between awareness and action requires us to engage citizens, communities, frontline health workers, and those working with animal populations in the direct reporting of suspected outbreaks. It also requires having in place the tools and skills needed for an effective and efficient response that ensures essential services remain in place when battling an outbreak. The challenge now is to persuade government leaders that preparedness is worth the price tag.

Read more about this event from Global Health NOW: https://www.globalhealthnow.org/2018-05/local-path-global-health-security

 

“Two Sides of the Same Coin”: Can a health systems lens inform health security efforts?

This guest post was written by Taylor Williamson of RTI InternationalRTI International is an independent, nonprofit research institute dedicated to improving the human condition. They are a 2018 Global Health Council member.

The discussions at the 71st World Health Assembly (WHA) have been wide-ranging, from non-communicable diseases (NCDs) and youth engagement to citizen participation and Universal Health Coverage. With the 2018 Ebola outbreak in the Democratic Republic of Congo (DRC), health security, and its link to strong health systems, is at the forefront of the discussion as one of the three strategic priorities in the General Programme of Work. In fact, Dr. Tedros, the Director-General of WHO, has taken to saying that “health security and health systems are two sides of the same coin.” However, it is not yet not clear to me how Dr. Tedros, WHO, or the wider global health community think a health systems lens could add value to the health security discussions.

RTI International’s Dr. Boni Ngoyi takes a canoe to Muma, DRC to investigate an Ebola outbreak in June 2017.

Sessions on health security have so far focused on metrics and measurement, as 76 countries have conducted Joint External Evaluations (JEEs) to evaluate their own health security capacity. Speakers recognize that these evaluations are necessary, but not sufficient, to ensuring that countries focus their efforts on key health security priorities. To complement the JEEs, a team from Hopkins, the Economist Intelligence Unit, and the Nuclear Threat Initiative is developing a Global Health Security Index to provide regular updates on preparedness efforts. The index should be ready by mid-2019. Additionally, about 25 countries have developed health security action plans, based on the gaps found in the JEEs. Regardless, countries are not seeing the political commitment, at either global or national levels, to ensure that these action plans are adequately funded, implemented, and monitored.

Nonetheless, efforts to advocate for these commitments exist. For example, Resolve to Save Lives, under the direction of former CDC Director Dr. Tom Frieden, has consolidated JEE findings to spur global action on the highest priority areas. During the JEE process, several health systems challenges have emerged, including analyzing surveillance data, training epidemiologists, and coordinating across sectors. Building on the JEE findings, I see three systems approaches that could add value to the health security discussion: contextualization, use of complexity science, and adaptation of existing tools.

First, we know from our experience in health systems and governance that solutions must be contextualized to specific environments.  In the health systems space, we are beginning to use more political economy thinking and adaptive management techniques to inform programmatic design and technical assistance packages.  Health security, through the JEE process, takes a much more normative approach by evaluating the existence of set policies, standards, and processes. Contextualization could include using a political economy lens to understand incentives and motivations for prioritization and/or tailoring action plans to endemic disease patterns, geographic differences, and cultural practices when developing health security action plans.

Second, I wonder to what extent the health security community has embraced the knowledge on complexity science, which seeks to describe systems that have multiple, interconnected elements. In the sessions I have attended, health security is described as a complicated system of widgets (simulation sessions, laboratory diagnostics, reporting procedures, etc) where the effects can be predicted and replicated. We know, however, that systems with interpersonal relationships and various stakeholders are inherently complex.  Understanding and strengthening the complex systems that prevent, detect, and respond to pandemics requires knowledge of the relationships between actors, responding to their interests and motivations, and iterating effective, if not always perfect, solutions.

Third, the health systems community has developed several relevant tools and approaches that could be applied to health security issues. As Ministries of Health seek to finance and implement health security action plans, investment cases, as with those for NCDs or HIV, can influence Ministries of Finance to invest in health security. The Health Systems Assessment Approach takes advantage of the wealth of qualitative data and experience at national and sub-national level. While costing models, such as the OneHealth tool, provide powerful, low-cost ways to collect and analyze country-level data.

So how can we, as a global health community, make use of these systems approaches? The most obvious use is to inform the ongoing development of the Global Health Security Agenda 2024 that will outline how international, multilateral, and country programs can improve health security efforts. Using a health systems lens can also strengthen data use and political analysis that drive resource allocation decisions.

Preventing, detecting, and responding to pandemic threats is at the heart of public health.  When John Snow first removed the handle from the Broad Street pump in 1854, he was responding to an outbreak of cholera.  Though our profession has moved beyond wrenches and bolts, outbreaks of Ebola, measles, yellow fever, and H1N1 keep calling us back to our roots. We should use all the tools at our disposal to create a truly secure and healthy future.