Global Health and the Future Role of the United States (2017) / Chapter Skim
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3 Infectious Diseases, Pandemic Influenza, and Antimicrobial Resistance: Global Health Security Is National Security
3 Infectious Diseases, Pandemic Influenza, and Antimicrobial Resistance: Global Health Security Is National Security
Pages 43-98
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, influenza A virus subtype H1N1, Middle East respiratory syndrome coronavirus (MERS-CoV) , Ebola, and Zika virus -- all of which presented serious risks to the health security of countries around the world.
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The chapter then presents the committee's vision of a new approach to global health security, focused on building preparedness capacity in the United States and abroad, ensuring sustainable funding for these efforts, and creating an environment for proactive research and development aimed at enhancing the nation's preparedness and response capacity. The final section presents a summary and recommendations.
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. More precise threats include zoonotic spillover or the emergence of new infectious diseases, pandemic influenza, and growing antimicrobial resistance.
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. Pandemic influenza A moderately severe influenza An influenza pandemic in the pandemica would result United States would result in annually in 700,000 deaths 89,000–207,000 deaths and an and a cost of $570 billion economic loss of $71.3–$166.5 (due to income loss and billion (Meltzer et al., 1999)
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government is currently conflict zones declared polio free in 2015, the largest donor to the Global conflict with Boko Haram in Polio Eradication Initiative its northern region prevented (GPEI) , with a commitment of the establishment of proper $228 million in fiscal year 2016.
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. Pandemic Influenza A persistent theme of the health security conversation is the threat of an influenza pandemic.
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Antimicrobial Resistance Antimicrobial resistance (AMR) refers to the phenomenon whereby pathogens stop responding to the drugs customarily used to combat them, making the drugs ineffective.
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, but also compromises the progress achieved in reducing the burden of critical infectious diseases, such as human immunodeficiency virus (HIV) , TB, and malaria (as BOX 3-2 Case Study: A "Nightmare" Bacterium in Nevada A female patient in her 70s in Washoe County, Nevada, arrived in the United States in early August 2016 after an extended visit to India.
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Public Health Infrastructure To prevent threats such as those described in the previous sections, the United States and the global community need to support appropriate public health measures, including access to clean water and sanitation, food safety, and robust immunizations campaigns. Given that not all health security events can be prevented, however, there is also a need for preparedness and response capacity in the event of an outbreak.
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. Recent memoranda on health security from the Johns Hopkins Center for Health Security to the new administration and Congress stress the importance of building sufficient surge capacity in the U.S.
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The Supply Chain System The current supply chain system that supports the deployment of medical products is not well matched to the demands that a health security threat would create -- a gap that represents a significant vulnerability. For everyday needs, the medical and public health sectors have come to rely on a just-in-time delivery system.
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Polio resurgence: WHO launched the Global Polio Eradication Initiative in 1988, with the goal of achieving eradication by 2000. By 2003, most of the 126 polio-endemic countries (the exceptions being Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan)
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2014 Ebola outbreak and personal protective equipment (PPE) : The need for highly robust PPE, the thousands of cases, and high levels of panic as every hospital tried to prepare for incoming patients caused the demand for adequate PPE to outpace the supply.
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According to Frederick Burkle of the Harvard Humanitarian Initiative, If one accepts that disasters keep us honest by defining the public health and exposing its vulnerabilities, the global community must emphasize prevention and preparedness and re-legitimize it under international law to ensure protective strategies that intercede in fragile states before they deteriorate to the point of no return. (Burkle, 2017, p.
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Finding: Wide-ranging threats to global health security influenced by resource scarcity, rapid urbanization, and inadequacies in stew ardship of medications are poised to exploit the vulnerability of all countries, including the United States. These threats range from infectious disease spillover to pandemic influenza, to antimicrobial resistance, and are exacerbated by such vulnerabilities as degrad ing public health infrastructure, weak medical supply chains, and fragile states.
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. The costs of infectious disease outbreaks are likely to rise, moreover, as such outbreaks become more frequent as a result of expanding travel and trade, as well as environmental changes (Pike et al., 2014)
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Finding: The committee believes that these threats will only be come more prevalent, due to global changes such as urbanization, resource scarcity, population growth, and environmental changes, resulting in high human and economic costs. THE CURRENT GLOBAL COMMITMENT Even as increasing globalization is making the world ever more vulnerable to infectious disease outbreaks -- whether due to natural, accidental, or intentional causes -- thereby threatening national and global security, methods of distributing global aid are changing.
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. 8 Executive Order 13747, Advancing the Global Health Security Agenda to Achieve a World Safe and Secure from Infectious Disease Threats, 3 C.F.R.
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strategies that provide for capacity building, technical assistance, and commodity support. Where the GHSA is novel, however, is in its coordination of these strategies and its elevation of global health security to senior-level attention (Holgate, 2014)
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BOX 3-5 Country Examples of Field Epidemiology Training Program (FETP) Deployment Since the Launch of the Global Health Security Agenda (GHSA)
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Global health security requires stable support systems for preparedness and response capacity in LMICs. Sustained funding by the global community is imperative to support this capacity and prevent the reversal of the progress that has been achieved.
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to provide advice and guidance for their work. While the PACCARB acknowledged that important steps have been taken to achieve the milestones outlined in the National Action Plan, its initial assessment identified overarching issues and generated recommendations for further improvement.
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Annex 3-2 provides additional detail on efforts to combat AMR and the National Action Plan. Finding: The growing threat of antimicrobial resistance resulting from poor stewardship, weak surveillance systems, and a lack of
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By virtue of their unpredictability and global effect, infectious diseases remain a perpetual challenge for the global community (Fauci and Morens, 2012)
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This same concept can be applied to investments in global health security through a lens of disaster risk reduction (see Box 3-6)
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. The committee believes that now more than ever, sustainable and adequate funding is needed to build readiness into public health and health care infrastructure, and that appropriate funding levels for this purpose are those that were in place in the initial years of the Public Health Security and Bioterrorism Response Act of 2002.
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Finding: Funding for preparedness has decreased dramatically since the Public Health Security and Bioterrorism Response Act was enacted in 2002. In fiscal year 2016, funding for the Public Health Emergency Preparedness program decreased from its initial level of $1.03 billion to $660 million, and funding for the Hospital Pre paredness Program decreased from an initial level of $515 million to $255 million.
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Echoing this need for highlevel coordination, other experts have recommended a dedicated leadership position and office to lead health security efforts (Watson and Watson, 2017)
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Yet given the breadth of expertise needed during a complex health emergency and the difficulties of coordinating so many agencies, the committee believes a strong coordinating body is needed for health emergencies that has appropriate authority, logistics, and subject matter expertise, as well as a dedicated budget. Finding: Although multiple agencies bring unique expertise to a U.S.
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14 According to the PCAST letter, "There is a Public Health Emergency Fund that was a uthorized in 1983 and placed at the disposal of HHS, but it has not been replenished since 1993, despite repeated national level infectious disease emergencies. In addition to being moribund, it is specific to HHS and therefore more narrow than what we propose here.
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. Creation of this entity would further encourage information sharing related to research priorities and areas of synergy for agencies involved in the devel opment of medical countermeasures.
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While funding from the National Institutes of Health (NIH) and DoD is critical for research on the basic science of emerging infectious diseases, Biomedical Advanced Research and Development Authority (BARDA)
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Food and Drug Administration; FIC = John E Fogarty International Center for Advanced Study in the Health Sciences; NIAID = National Institute of Allergy and Infectious Diseases; NIH = National Institutes of Health.
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Meeting this need will require the combined efforts and capabilities of research funding organizations, professional societies, NGOs, ministries of health, and governments. Regardless of whether injuries are caused by traffic crashes, earthquakes, or terrorist attacks, there are low-cost opportunities for increasing emergency response capacity to all hazards.
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Accordingly, a 2016 National Academies report was commissioned to advise the United States on how better to integrate the expertise and evidence from DoD into HHS and civilian hospitals. The authoring committee of that report found that prehospital military trauma care is often more advanced than what U.S.
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The lessons learned from the battlefield about injury assessment, triage, and emergency care can be used to dramatically improve trauma care in LMICs. Building this capacity in U.S.
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Funding for preparedness has decreased dramatically since the Public Health Security and Bioterrorism Response Act was enacted in 2002. In fiscal year 2016, funding for the Public Health Emergency Preparedness program decreased from an initial level of $1.03 billion in 2003 to $660 million (Levi et al., 2015b; Segal et al., 2016)
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citizens requires strong capabilities to detect the potential for a pandemic, ensure the availability of needed medical products, and provide the necessary capacity in the nation's hospitals and health departments. Conclusion: The current system for addressing health security threats described in this report is inadequate.
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. Recommendation 1: Improve International Emergency Response Coordination The administration should create a coordinating body for inter national public health emergency response that is accountable for international and domestic actions and oversee preparedness for and responses to global health security threats.
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Conclusion: It is essential to remain engaged and coordinated with domestic and international stakeholders, including the World Health Organization, the United Nations Secretary-General's Com mittee on Antimicrobial Resistance, and the Global Health Security Agenda. Recommendation 2: Combat Antimicrobial Resistance The U.S.
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While modern infrastructure often is not feasible in these countries because of high costs, smallerscale steps entailing process innovation can be taken in communities to improve their ability to respond to disasters. Whether responding to more slowly evolving public health emergencies such as disease outbreaks or more immediate injury events such as road traffic accidents, earthquakes, or terror attacks, having a properly trained workforce in accordance with the principles of disaster risk reduction can lead to safer and more resilient communities.
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84 GLOBAL HEALTH AND THE FUTURE ROLE OF THE UNITED STATES low- and middle-income countries to respond to both public health emergencies and acute mass casualty disasters. This training and information exchange should encompass core capacities such as surveillance, epidemiology, and disaster and injury care response, as well as enhanced capabilities to improve communication and information pathways for the dissemination of innovative findings.
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However, the 1918–1919 pandemic also heavily affected those aged 20–40, an age group in which half of the deaths during the pandemic occurred. Although 675,000 Americans were among the dead, the legacy of the 1918–1919 influenza pandemic has receded from memory in the United States, such that historians call it "America's forgotten pandemic" (Garrett, 2007)
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to develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines, and other interventions. WHO called on Member States to develop national action plans aligned with these global plan objectives within 2 years of the plan's endorsement by the WHA in May 2015.
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As required by executive order, the Task Force for Combating Antibiotic-Resistant Bacteria submitted a report (PACCARB, 2016) assessing the progress made toward the proposed milestones for each of the National Action Plan goals after the first 180 days of the plan's release.
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government worked closely with international partners to support implementation of WHO's Global Action Plan on AMR through its work with the Global Health Security Agenda (GHSA) AMR Action Package.
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Health Security 13(3)
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2016c. Global Health Security Agenda: Action packages.
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. In Global Security Forum 2016: The Global Health Security Agenda–Its First Years and the Way Forward.
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In The Launch of the Global Health Security Agenda. Center for Strategic and International Studies.
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Emerging Infectious Diseases 5(5)
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In The Launch of the Global Health Security Agenda. Washington, DC: Center for Strategic and International Studies.
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Rice on the executive order on advancing the global health security agenda. The White House.
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public health prepardness and response operations. Health Security 15(1)
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2017a. Antimicrobial resistance: Library of national action plans.
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