Simulation and Modeling Applications in Global Health Security

The concept of global health security underpins the current framework for global preparedness and response to emerging infectious diseases. (1-5) The Global Health Security Agenda--a collaboration between governments--was launched in 2014, aiming to make our interconnected world safe from infectious disease threats. The governments involved in the Global Health Security Agenda focus on strengthening their countries' capacities for detection, response and prevention. (6) In the context of public health emergencies, the Agenda has received financial and political support from international organizations and almost 50 countries. (6) However, there is tension between the aims of global health security and governments' mandate to ensure national security. The 1994 United Nations Development Programme's Human Development Report first introduced the concept of human security, referring to security of citizens as individuals rather than that of the states in which they live. We posit that the use of the term global health security can have a negative unintended effect on the ultimate goal of improving health for all. There are three reasons why this term potentially privileges the security of the state rather than the security of individuals. First, global health security, in its current use, is largely focused on protecting high-income countries against public health threats coming from low- and middle-income countries. (8) Ebola virus, Marburg, Zika virus, dengue, chikungunya, Riff Valley and Lassa fevers, originated in low--and middle-income countries. If the Agenda is used to prioritize global health risk depending on the origin of infections, resource allocation may become even more skewed towards high-income settings. To ensure that a health security agenda is an integral part of national and foreign policy of each country, political attention and coordination between national ministries is needed as well as support from the national security budget. Second, global health security tends to emphasize disease containment to protect national security rather than the prevention of future local outbreaks. Disease containment is common practice in the control of emerging infectious diseases. A national security perspective often results in unilateral, neo-colonial and/or short-term solutions designed to protect national borders. For example, many countries and airline companies imposed travel restrictions during the 2013-2016 Ebola virus disease outbreak in western Africa, contrary to World Health Organization recommendations. (9) Third, we argue that respect for human rights and values such as equity and solidarity should underlie each national security agenda. Such values are consistent with the motives of many people who provide health services in public health emergencies. Health security agendas should aim to build resilience to future outbreaks of infectious diseases, and require a long-term systems approach based on surveillance and national health system strengthening. Protecting the world from infectious disease threats requires that national governments share the responsibility of serving those most in need, wherever they live. We believe that the concept of global health security should be expanded to include solidarity and sustainability. …

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.

Global Health Security Implementation: Expanding the Evidence Base.

This article was published in the BMC Infectious Diseases [© 2017 BMC Infectious Diseases] and the definite version is available at : https://doi.org/10.1136/bmjgh-2016-000217 . The Journal's website is at: http://gh.bmj.com/content/2/1/e000217

Reviewed by: Unprepared: Global Health in a Time of Emergency by Andrew Lakoff Limor Samimian-Darash Andrew Lakoff. Unprepared: Global Health in a Time of Emergency. Oakland: University of California Press, 2017. 240 pp. $29.95. (978–0–52029–576–6). This book joins the recent literature that examines future intervention technologies and identifies a new modality of securing against “future threats” that goes beyond Foucauldian biopolitical security apparatuses. Preparedness within this framework involves multiple techniques emerging in response to the problem of potential uncertainty.1 One of the first works to present this approach was Andrew Lakoff and Stephen Collier’s edited volume on Biosecurity Interventions.2 In their introduction, the editors argued that preparedness combines elements of national security and population security and is directed toward reducing potential damage rather than preventing specific threats. Subsequent studies have also identified related governmental forms, variously termed “preparedness,”3 “anticipation,”4 “precaution,”5 “preemption,”6 “prudence,”7 “the politics of possibilities,”8 and “resilience.”9 The present book shows how a global health security assemblage consisting of diverse elements, experts, and technologies has established “preparedness” as its central governmental modality. It traces both the roots of preparedness from the end of the Cold War to the present and the emergence of this [End Page 723] assemblage, analyzing how relevant authorities—public health officials, national security experts, and life scientists—conceptualize and act on an encroaching future of disease emergence. Significantly, the book focuses not only on the changing mode of governing—the emergence of preparedness—but also on the diverse governmental technologies applied within this approach. If the problem has shifted from knowledge-dependent possibilities (accidents, risks), manageable by means of risk technology, to potential threats, what types of intervention technologies become possible? The book seeks neither to provide a manifesto for the importance of preparedness nor to criticize its failures. Instead, drawing on the perspective of historical ontology, it tracks the emergence of an unstable consolidation of global health security, posing the question: “How did the norm of preparedness come to structure expert thought and action concerning the future of infectious disease?” (p. 12). Each chapter draws on a different case study to explore how uncertain global health threats can be addressed and made into an object of present intervention, according to different and sometimes competitive rationalities, such as probability, and imaginative enactment, risk assessment, and preparedness. Chapter 1 presents the case of Hurricane Katrina (2005), focusing on how “contemporary authorities seek to manage potential future dangers . . . whose probability cannot be statistically calculated and whose potential consequences outstrip the capacities of existing prevention and mitigation measures (p. 8).” It distinguishes between two forms of thinking about and intervening on the dangerous future and its potential threats: as a regularly occurring event that can be calculated via probabilities (based on known historical patterns) and managed through risk distribution, or as an unprecedented, potentially catastrophic event whose consequences are to be managed through methods of imaginative enactment (enabling planners to mitigate vulnerabilities). Chapter 2 discusses the 1976 swine flu outbreak and the 2005 avian influenza threat in the United States, examining how techniques of emergency management migrated to and were implemented within U.S. public health. This “involved the composition of a new object of knowledge and intervention for public health: no longer, or not only, the population but also the infrastructure that underpins response to health emergencies” (p. 9). Chapter 3 discusses the controversy surrounding Indonesia’s refusal to provide the WHO with samples of a new strain of the H5N1 influenza virus. It examines how, from the early 2000s, public health preparedness was extended as a global strategy in relation to the threat of emerging disease, focusing on the development of the 2005 revised International Health Regulations that form part of the WHO’s strategy of “global public health security.” Here, an analytic distinction is made between two regimes for governing global health problems: global health security and humanitarian biomedicine. Chapter 4 examines the controversy over the WHO’s decision to declare a Public Health Emergency of International Concern over the 2009 swine flu (A\ H1N1) outbreak. It shows how decision instruments for guiding emergency interventions at the early stages...

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.

ABSTRACTIn recent years the framings of global health security have shifted while the structures governing global health have largely remained the same. One feature of the emerging re-ordering is the unresolved allocation of accountability between state and non-state actors. This brings to critical challenges to global health security to the fore. The first is that the consensus on the seeming shift from state to human security framing with regard to the global human right to health (security) risks losing its salience. Second, this conceptual challenge is mirrored on the operational level: if states and non-state actors do not assume responsibility for health security, who or what can guarantee health security? In order to address global health security against the backdrop of these twenty-first Century challenges, this article proceeds in three parts. First, it analyses the shortcomings of the current state-based World Health Organization (WHO) definition of health security. Second, taking into account the rising pressures posed to global health security and the inadequacy both of state-based and of ad hoc non-state responses, it proposes a new framing. Third, the article offers initial insights into the operational application of beyond state responses to (health) security challenges.

Lessons from the NHS for UHC and health security

To reduce the risk and effect of sudden incidents of public health that put people at risk across national and international boundaries, it is necessary to take both preventive and reactive measures. These measures are referred to as global health security. Discussions on health security in scientific gatherings have become more prevalent in recent years after the Covid pandemic. Health security is for the whole world, irrespective of age, race, gender, or financial stability. However, it has been noted that there are many different concepts of health security, that the whole purpose of this is to accommodate only the upper-class societies. The disturbed equilibrium of the microbial world due to rapid urbanization, population increase, environmental deterioration, and the improper use of antimicrobials makes people realize the importance of health security that requires a collaborative approach focused on preparedness for any future pandemics and equal access to health care products. 
 The covid-19 pandemic has had a great influence on people’s lives and their ability to think. Now the main race is not about defence systems; it has shifted towards more and better health security and the ability to deal with any future pandemics. The coronavirus outbreak was associated with severe acute respiratory syndrome, the Middle East respiratory syndrome coronavirus outbreak in 2012, the swine flu pandemic in 2009, and the West African Ebola virus disease epidemic in 2013–2016. All these epidemics are primarily caused by the significant travel of infected people across borders. This highlights the need for global health security, which helps coordinate surveillance and policymaking. This limits disease transmission and reduces the damage.
 While infectious diseases have no limits, inadequate health systems in poor nations make them worse and more out of control. Africa and other third-world states face many problems in securing global security. The spread of infectious diseases among susceptible areas is due to inadequate public healthcare fundings, vaccine coverage, poverty, armed conflict, and climate-related disasters, which damage developing countries. This only serves to increase susceptibility to the disease. The continuous transmission of polio and measles in different parts of Africa and Asia, as well as recent Ebola outbreaks in West Africa, highlights the need to overcome this in order to stop the spread of diseases to other areas. No nation can be completely protected from the spread of diseases due to a lack of social services and a strong health infrastructure; hence, global security demands global equality and progress towards health for everyone. 
 To advance global health security in all nations, there is a need for multi-stakeholders and governance, justifiable finance through the proposed pandemic funds, and common goods for health. Future outbreaks can be efficiently managed by funding basic healthcare and enhancing the response systems. Equity in pandemic preparedness and response measures depends on high-level political commitment and global leadership irrespective of colour and gender. False contradictions between countries can be dismissed by focused investments in strengthening health emergency infrastructure, particularly through primary healthcare, ensuring that the world is better prepared to handle complex public health emergencies.

Since the commencement of the International Health Regulations (IHR, 2005) in 2007, global public health security has been faced with numerous emerging and ongoing events. Moreover, the Joint External Evaluation (JEE) is a voluntary tool developed in compliance with the Global Health Security Agenda (GHSA) that represents a reaction by the international health community towards the increased incidence of emerging and re-emerging diseases. Against this background, between 29th May and 2nd June 2016, a team of WHO consultants arrived to the State of Qatar to assess, in collaboration with national experts, the country's capacity to prevent, detect, and rapidly respond to threats of public health aspect. They identified areas of strength, weakness, and recommendations for improving national health security of Qatar in anticipation of the 2022 World Cup event. Qatar has demonstrated a leading role in the region through its commitment to International Health Regulations (2005) and community. Similarly, the Qatar was the first Arab state and seventh volunteering country globally to undergo the JEE process. In this review, we highlighted Qatar's achievements and shortcomings of IHR core capacities to inform healthcare professionals and the scientific community about the country's contribution toward global health security.

Since the commencement of the International Health Regulations in 2007, global public health security has been faced with numerous emerging and ongoing events. Moreover, the Joint External Evaluation is a voluntary tool developed in compliance with the Global Health Security Agenda that represents the high responsibility of international health community towards the increased incidence of emerging and re-emerging diseases. Against this background, between 29th May and 2nd June 2016, a team of World Health Organization consultants arrived to the State of Qatar to assess, in collaboration with national experts, the country’s capacity to prevent, detect, and rapidly respond to threats of public health aspect. They identified areas of strength, weakness, and recommendations for improving national health security of Qatar in anticipation of the 2022 FIFA World Cup event. Qatar has demonstrated a leading role in the region through its commitment to International Health Regulations (2005) and population health. Similarly, the Qatar was the first Arab state and seventh volunteering country globally to undergo the Joint External evaluation process. In this review, we highlighted Qatar’s achievements and shortcomings of International Health Regulations’ core capacities to inform healthcare professionals and the scientific community about the country’s contribution toward global health security.

If the Ebola tragedy of West Africa has taught us anything, it should be that the 2005 International Health Regulations (IHR) Treaty, which gave unprecedented authority to the World Health Organization (WHO) to provide global public health security during public health emergencies of international concern, has fallen severely short of its original goal. After encouraging successes with the 2003 severe acute respiratory syndrome (SARS) pandemic, the intent of the legally binding Treaty to improve the capacity of all countries to detect, assess, notify, and respond to public health threats has shamefully lapsed. Despite the granting of 2-year extensions in 2012 to countries to meet core surveillance and response requirements, less than 20% of countries have complied. Today it is not realistic to expect that these gaps will be solved or narrowed in the foreseeable future by the IHR or the WHO alone under current provisions. The unfortunate failures that culminated in an inadequate response to the Ebola epidemic in West Africa are multifactorial, including funding, staffing, and poor leadership decisions, but all are reversible. A rush by the Global Health Security Agenda partners to fill critical gaps in administrative and operational areas has been crucial in the short term, but questions remain as to the real priorities of the G20 as time elapses and critical gaps in public health protections and infrastructure take precedence over the economic and security needs of the developed world. The response from the Global Outbreak Alert and Response Network and foreign medical teams to Ebola proved indispensable to global health security, but both deserve stronger strategic capacity support and institutional status under the WHO leadership granted by the IHR Treaty. Treaties are the most successful means the world has in preventing, preparing for, and controlling epidemics in an increasingly globalized world. Other options are not sustainable. Given the gravity of ongoing failed treaty management, the slow and incomplete process of reform, the magnitude and complexity of infectious disease outbreaks, and the rising severity of public health emergencies, a recommitment must be made to complete and restore the original mandates as a collaborative and coordinated global network responsibility, not one left to the actions of individual countries. The bottom line is that the global community can no longer tolerate an ineffectual and passive international response system. As such, this Treaty has the potential to become one of the most effective treaties for crisis response and risk reduction worldwide. Practitioners and health decision-makers worldwide must break their silence and advocate for a stronger Treaty and a return of WHO authority.

BackgroundSince the 2014–2016 West Africa Ebola epidemic, the concept of measuring health security capacity has become increasingly important within the broader context of health systems-strengthening, enhancing responses to public health emergencies, and reducing global catastrophic biological risks. Efforts to regularly and sustainably track the evolution of health security capabilities and capacities over time – while also accounting for political, social, and environmental risks – could help countries progress toward eliminating sources of health insecurity. We sought to aggregate evidence-based principles that capture a country’s baseline public health and healthcare capabilities, its health security system performance before and during infectious disease crises, and its broader social, political, security, and ecological risk environments.MethodsWe conducted a scoping review of English-language scholarly and gray literature to identify evidence- and practice-based indicators and proxies for measuring health security at the country level over time. We then used a qualitative coding framework to identify recurrent themes in the literature and synthesize foundational principles for measuring global health security. Documents reviewed included English-language literature published after 2001 until the end of the research period—September 2017—to ensure relevance to the current global health security landscape; literature examining acute infectious disease threats with potential for transnational spread; and literature addressing global health security efforts at the country level.ResultsWe synthesized four foundational principles for measuring global health security: measurement requires assessment of existing capacities, as well as efforts to build core public health, healthcare, and biosecurity capabilities; assessments of national programs and efforts to mitigate a critical subset of priority threats could inform efforts to generate useful metrics for global health security; there are measurable enabling factors facilitating health security-strengthening efforts; and finally, measurement requires consideration of social, political, and ecological risk environments.ConclusionThe themes identified in this review could inform efforts to systematically assess the impacts and effectiveness of activities undertaken to strengthen global health security.

The study examines the role of international organizations, specifically the World Health Organization (WHO), in managing global health security in Africa. It evaluates WHO’s effectiveness, the impact of systemic inequality in resource allocation, and the consequences of delays in decision-making and operational inefficiencies. The research is anchored in regime theory, which explains how international organizations govern global health security through established norms and cooperative frameworks (Krasner, 1983). A qualitative research design was employed, utilizing data from WHO reports, global health indices, and case studies of past health crises, such as Ebola (2014–2016) and COVID-19 (2020–2024). Data were collected from WHO publications, African CDC reports, peer-reviewed journals, and government health statistics. Findings reveal that WHO plays a pivotal role in disease surveillance, emergency response coordination, and health policy implementation. However, systemic inequalities in funding and material distribution have limited Africa’s ability to respond effectively to health crises. Delays in WHO’s decision-making processes have further exacerbated the impact of pandemics on the continent. Despite these challenges, WHO remains a key institution for strengthening health security, provided that operational inefficiencies are addressed, resource distribution becomes more equitable, and decision-making processes are restructured. The study recommends decentralizing WHO’s regional offices in Africa, improving health equity in resource allocation, and reducing bureaucratic inefficiencies to enhance rapid emergency response. These findings contribute to ongoing policy discussions on global health governance and sustainable health security strategies for Africa.