International Health Security Research Articles

Increase in febrile illness among children in mainland China, winter 2023 - 2024

In late 2023, mainland China reportedly saw a rise in respiratory illnesses, primarily among children. Officials from the Chinese Center for Disease Control attributed this increase to the circulation of known pathogens, including influenza viruses, respiratory syncytial virus, SARS-CoV-2, and mycoplasma pneumoniae, to which the population had only limited exposure while strict “zero Covid” measures were enforced in recent years. However, outside observers raised concerns that a novel infectious agent could be circulating, and the World Health Organisation took the unusual step of publicizing a request for further information from Beijing. While no novel pathogen has been identified at the time of writing, this apprehension among the international press, and among some public health experts, is an instructive reminder of how unresolved issues relating to the outbreak of SARS-CoV-2 in late 2019 continue to impact international public health. Such reactions suggest that the political control of epidemiological data in the early stages of the COVID-19 pandemic has had a lasting impact on international collaboration, institutional trust and global health security. Resolving these issues is essential if the world is to be prepared for future infectious disease outbreaks of potential international concern.

International health security

The paper proposes the classification of health security as one of the non-military security dimensions of the second generation, determined more by globalization processes than by the end of the Cold War (first generation). The cognitive goal of the article is to identify and analyse the elements of the structure of international health security such as 1) the essence and specificity of securitization of threats to health security; 2) health security threats; 3) the referent object or whom it concerns; and 4) measures to ensure it. Specific to this dimension is the political motivation for its securitization. In the world of interrelated and global mobilities, what is significant for health security is the diversity of the development level, preferred values, and, consequently, the diversity of sensitivity and susceptibility of national healthcare systems to cross-border threats.

The identity China has shaped in the fight against COVID-19: A comparative discourse study

By conducting a comparative discourse analysis of the news reports in China Daily and news releases by the Ministry of Foreign Affairs (MFA) of China on COVID-19 prevention and control, this paper aims to reveal the identity China has shaped in the fight against COVID-19. Epidemic-related news materials were firstly collected on the official websites of China Daily and the MFA of China, and then the representative news items were selected as the research corpus according to the principles of relevance and representativeness. The methods of critical discourse analysis and comparative study were adopted to analyze the selected news items. It was found that the epidemic-related news reports in China Daily have constructed the national identity of a responsible power for China from the perspective of fighting the epidemic and maintaining domestic and international public health security, and this national identity is consistent with the one publicized to the international community through diplomatic channels.

The Health Security of Drinking Water in Sacred City: the Hydraulic and Zam Zam Projects in Mecca as Cases

As the first Islamic sacred city, the health security of drinking water in Mecca has been highly concerned since ancient time. As a unique potable water resource of Mecca, the health security of Bir Zam Zam has aroused the high attention of Muslims and related countries all over the world, which is closely related to the special status generated by the origin of the role in the sa’y ceremony of the hajj. Because of this, Zam Zam water is widely regarded as ‘sacred water’ and appears the phenomenon of religious alienation in its health function. In 2013, Saudi Arabia launched a new Bir Zam Zam project to improve water quality by more scientific and technological means. Relevant tests found that its water quality could meet the potable water standards of the World Health Organisation and the American Public Health Association, but there were also voices of doubt from abroad, and Saudi Arabia also responded to this. With the advent of the post-pandemic era and the resumption of the hajj for Muslims outside Saudi Arabia in 2022, the consumption of Bir Zam Zam by pilgrims and Muslims will rise to high levels, inevitably leading to an upward risk to international health security.

Diseasescape and immobility governance: COVID-19 and its aftermaths

COVID-19 upended both the existing world order and the research agenda of academics. In both cases, one crucial feature was a net shift from an expansive ‘hyper mobile’ world to a strong emphasis on the immobilization of people. With growing anxieties about the risks and dangers involved in human mobility, there was a turn in mobility studies: an ‘immobility turn’ agonized by a rapidly evolving diseasescape shaped at the intersection of a rapidly evolving virus and rapidly evolving human responses to it. This paper seeks to examine the dynamic dialectical relationship between this diseasescape and human (im)mobility that has resulted in the formation of a new mobility hierarchy that stresses ‘sanitized mobility’. This in turn heightens human inequality. The pandemic has also forced a competition in ‘immobility governance’—testing different models of governing health security within and beyond borders. The paper sheds new light on the emerging scholarship on ‘immobility and pandemic’ by examining the multifariousness in ‘immobility governance’ and interrogating the uneven state capacity in ensuring ‘sanitized mobility’ and practicing ‘immobility governance’ that will bring different outcomes in national and international health security in the post-COVID era.

International Health Cooperation in the Post-Pandemic Era: Possibilities for and Limitations of Middle Powers in International Cooperation

The COVID-19 pandemic has left international cooperation and liberalistic values in crisis. As liberalism’s downfall is widely discussed, international collaborations like the European Union are criticised for their inability to operate adequately during the pandemic. The four examples in this paper are middle power countries (South Korea, Japan, Taiwan, and Singapore) in terms of economic scale and influence. The purpose of this study was to uncover possibilities for and limitations of these middle powers within international cooperative efforts during and after the pandemic. The unknown factor is the path the post-pandemic world will follow. Will nations focus on independent survival? Or will international cooperation shape the new world? Globalisation already seems to have progressed too far for the national egoism of the great powers to prevail. Even if face-to-face is replaced by virtual and offline meetings move online, the social nature of humans remains unchanged, and international cooperation remains valid. The four middle power countries in Asia, which are included among the most economically successful countries, are important to international society based on their relatively excellent quarantine performance. What is important in the diplomacy of middle power countries is not traditional security and hard power but the soft power of international law, human rights, health security, and international cooperation.

Health-related research publications on religious mass gatherings of Muslims: a bibliometric analysis (1980\u20132020)

ObjectiveMass gatherings medicine is an emerging and important field at the national and international health security levels. The objective of the current study was to analyze research publications on religious mass gatherings of Muslims using bibliometric tools.MethodsKeywords related to religious mass gatherings of Muslims were used in Scopus database. The duration of the study was from January 01, 1980 to December 31, 2020. Examples of keywords used include hajj, Umrah, mass gatherings/Mecca or Makkah, mass gatherings/Karbala, pilgrim/Makkah or Mecca, and others. Bibliometric indicators and mapping were presented.ResultsIn total, 509 documents were retrieved. The average number of citations per article was 16.7 per document. Analysis of the retrieved documents indicated that (1) more than 90% of the retrieved documents were about the mass gatherings in Mecca/Makkah; (2) two-thirds of the retrieved documents were research articles; (3) a take-off phase in the number of publications was observed after 2008; (4) the retrieved documents were disseminated in a wide range of journals but specifically the ones in the fields of infectious diseases, public health, and travel medicine; (5) the retrieved documents were mainly published by scholars from Saudi Arabia with collaborative research ties with scholars in the US, France, the UK, and Australia; (6) Saudi Arabia contributed to more than half of the retrieved documents; and (7) four research themes were found: knowledge, attitude, and practices of pilgrims to Mecca/Makkah, vaccination, etiology of hospital admission among pilgrims, and epidemiology of various types of infectious diseases.ConclusionsResearch on mass gatherings, specifically the Hajj, is emerging. Researchers from the Saudi Arabia dominated the field. Research collaboration between scholars in Saudi Arabia and scholars in low- and middle-income countries is needed and must be encouraged since these countries have weaker health systems to screen, monitor, and control the spread of infectious diseases because of the Hajj season.

The Efficiency of Health Systems in Response to the Covid-19 Pandemic: Evidence from the EU Countries

The COVID-19 pandemic has revealed the insufficient capacities and capabilities of countries around the world to deal with global infectious diseases and stressed the need to improve the international health security framework. An efficient and comprehensive health system that is able to cope with public health emergencies is an essential prerequisite for strengthening health security. The paper analyzes the efficiency of health systems in the European Union (EU) countries and their responsiveness to the COVID-19 pandemic. The research covers 27 EU countries and it is based on the secondary data contained in the 2019 Global Health Security Index Report. The aim of the paper is to identify key determinants for improving the efficiency of health systems in the EU, as well as to examine the interdependence between health expenditures and the efficiency of health system in this sample of countries. The research is conducted through descriptive statistics and correlation and regression analysis. The conclusions can be useful for the EU policy makers in formulating a strategy to improve the efficiency of Member States’ health systems and preparedness for possible new pandemics.

Lifestyle-based health awareness using digital gadgets and online interactive platforms

With the transforming world, awareness of lifestyle-based variation is necessary. The availability of the locally available network and smart devices like wearable health devices (WHDs) based on artificial intelligence (AI) technology prompted us to learn about the disease, its causes, spreads, and precautions. Socioeconomic, environmental and behavioural factors, international travel and migration foster and increase the spread of communicable diseases. Vaccine-preventable, foodborne, zoonotic, healthcare-related and communicable diseases pose significant threats to human health and may sometimes threaten international health security. On the other hand, non-communicable diseases, also known as chronic diseases, are more prolonged. It could be the cause of different factors like genetic, environmental, behavioural or physiological disturbances. Smart wearables help to keep these diseases in check through different sensors installed in them. They can check for the difference in body function, but they can also help the needy consult the physician or practitioner. The data collected from these devices can also check the current health status when compiled with data collected practically. Organizations viz., World Health Organization (WHO), Food and Drug Administration (FDA) work collaboratively, leading global efforts to expand health coverage. WHO keeps the nation safe through connecting its people on the health and awareness interactive platforms, and FDA promotes public health through supervision and control, defending its role in human health and services.

Taiwan’s Participation in the World Organisation for Animal Health (oie): Modalities, Utility, and Challenges

Abstract This article explores the utility of membership in international organisations for states with specific status within the international community, focusing on Taiwan’s surprisingly neglected involvement in the World Organisation for Animal Health or oie (Office International des Épizooties). The paper shows that in addition to its contribution to the legitimisation of Taiwan’s identities, such participation has also enabled Taiwan to shape international norms in the field of animal health, increase international cooperation opportunities, strengthen domestic and global health security, and facilitate the trade of animal health-related products. Additionally, it has contributed to the domestic implementation of international animal health norms and helped increase the accountability of Taiwanese authorities in the domain of animal health management. Despite tremendous challenges, Taiwan still has plenty of opportunities to enhance its participation in global health governance through its membership in oie.

National Biosafety Management System: A Combined Framework Approach Based on 15 Key Elements.

The pervasive nature of infections causing major outbreaks have elevated biosafety and biosecurity as a fundamental component for resilient national laboratory systems. In response to international health security demands, the Global Health Security Agenda emphasizes biosafety as one of the prerequisites to respond effectively to infectious disease threats. However, biosafety management systems (BMS) in low-medium income countries (LMIC) remain weak due to fragmented implementation strategies. In addition, inefficiencies in implementation have been due to limited resources, inadequate technical expertise, high equipment costs, and insufficient political will. Here we propose an approach to developing a strong, self-sustaining BMS based on extensive experience in LMICs. A conceptual framework incorporating 15 key components to guide implementers, national laboratory leaders, global health security experts in building a BMS is presented. This conceptual framework provides a holistic and logical approach to the development of a BMS with all critical elements. It includes a flexible planning matrix with timelines easily adaptable to different country contexts as examples, as well as resources that are critical for developing sustainable technical expertise.

COVID-19 as an International Security Threat

After the Cold War a transition occurred in the international relations paradigm, where it was necessary to redefine which was considered as a threat to international security. As a result, human security doctrine was established which suggested that the international security agenda should focus on people and their needs, rather than states. In the globalized and interrelated world, we live nowadays, infectious diseases spread rapidly, and their consequences can be catastrophic. Hence, pandemics should be considered an international security threat. This paper aims to examine the COVID-19 pandemic as such. We discuss the development from international security towards human security, health security as a theoretical framework, the evolution of the pandemic in context of modern international security paradigm and international health security enforcement, and the securitization of the pandemic. In conclusion, based on the evidence presented, it is clear that the COVID-19 has severe effect on the international community, both in human lives and global economic, and has been securitized.

The Practice of the Socialist Outlook on Human Rights with Chinese Characteristics in the Face of Coronavirus Pandemic

The Socialist Outlook on Human Rights with Chinese Characteristics is a scientific theory developed and summarized in the development and practice of China’s human rights cause, and “taking people as the foremost” is its most basic characteristic. During this year’s pandemic and the current post-pandemic period, the Communist Party of China (CPC) has always adhered to the people-centered mission, respected every individual life, followed a realistic and pragmatic approach to fight against the pandemic, actively maintained international public health security, and practiced the concept of a community with a shared future for mankind. This is the best interpretation of the Socialist Outlook on Human Rights with Chinese Characteristics in this new coronavirus pandemic, and a vivid practice of safeguarding human rights.

2020 als Stresstest für die Europäische Union: Herausforderungen in Zeiten der COVID-19-Pandemie

The COVID-19 pandemic has deeply shaken the European Union (EU) and exacerbated existing prob- lems. How can the EU gain more autonomy in an ever-changing world order, especially when it comes to international supply chains and health security? To what extent can EU member states reconcile their aspiration to build European sovereignty with their efforts to forge multilateralism? What does European resilience mean and what specific actions does the EU need to take in order to strengthen it? How can the EU’s green goals be achieved in times of the COVID-19 pandemic? In this paper, the authors examine the crisis year 2020 in order to present approaches and solutions to tackle these challenges from the perspective of Germany as well as the Nordic and Baltic states.

Developing a National Public Health Laboratories Policy and Strategy

Abstract With the support of the European Union, the National Laboratory for Public Health and partners did an analysis of the primary healthcare and hospital laboratories in health facilities and identified strengths and weaknesses of the national network of public health laboratories. With that knowledge the LNSP developed in a participatory way a new national Laboratory Policy and thereafter a Strategic Plan 2019 - 2024 that guides the country in strengthening the labs at all levels. This is very much needed as Haiti still suffers of high levels of malaria, tuberculosis, HIV and other infectious diseases. The policy fits in the international Health Security Agenda. Most important lesson learned: by a systematic step by step process of analysis, policy formation and action planning, a research institute can - with support of stakeholders - make an impact on policies and practices.

Rapid validation of disease outbreak intelligence by small independent verification teams

ABSTRACTThe requirement for rapid ground-truth verification is a major rate-limiting step in the early warning of global outbreaks of serious infectious disease. Until this problem is solved, the current and future systems for global disease surveillance will not be optimally functional. One solution is to create a well-funded team of military specialists capable of conducting a rapid on-site inspection and verification of any infectious disease outbreak posing a possible threat to international health security. There are multiple scenarios for the deployment of this team, including their entry into conflict areas to garner medical intelligence. This concept is not without precedent.

What's new in Academic International Medicine? International health security agenda – Expanded and re-defined

What's new in Academic International Medicine? International health security agenda – Expanded and re-defined

COVID-19 blind spots: A consensus statement on the importance of competent political leadership and the need for public health cognizance

As the COVID-19 pandemic continues, important discoveries and considerations emerge regarding the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pathogen; its biological and epidemiological characteristics; and the corresponding psychological, societal, and public health (PH) impacts. During the past year, the global community underwent a massive transformation, including the implementation of numerous nonpharmacological interventions; critical diversions or modifications across various spheres of our economic and public domains; and a transition from consumption-driven to conservation-based behaviors. Providing essential necessities such as food, water, health care, financial, and other services has become a formidable challenge, with significant threats to the existing supply chains and the shortage or reduction of workforce across many sectors of the global economy. Food and pharmaceutical supply chains constitute uniquely vulnerable and critically important areas that require high levels of safety and compliance. Many regional health-care systems faced at least one wave of overwhelming COVID-19 case surges, and still face the possibility of a new wave of infections on the horizon, potentially in combination with other endemic diseases such as influenza, dengue, tuberculosis, and malaria. In this context, the need for an effective and scientifically informed leadership to sustain and improve global capacity to ensure international health security is starkly apparent. Public health “blind spotting,” promulgation of pseudoscience, and academic dishonesty emerged as significant threats to population health and stability during the pandemic. The goal of this consensus statement is to provide a focused summary of such “blind spots” identified during an expert group intense analysis of “missed opportunities” during the initial wave of the pandemic.

Accelerating Action in Global Health Security: Global Biosecurity Dialogue as a Model for Advancing the Global Health Security Agenda.

Biosecurity and biosafety measures are designed to mitigate intentional and accidental biological risks that pose potentially catastrophic consequences to a country's health system, security, and political and economic stability. Unfortunately, biosecurity and biosafety are often under-prioritized nationally, regionally, and globally. Security leaders often deemphasize accidental and deliberate biological threats relative to other challenges to peace and security. Given emerging biological risks, including those associated with rapid technological advances and terrorist and state interest in weapons of mass destruction, biosecurity deserves stronger emphasis in health and security fora. The Global Biosecurity Dialogue (GBD) was initiated to align national and regional donor initiatives toward a common set of measurable targets. The GBD was launched by the Nuclear Threat Initiative (NTI), with support from Global Affairs Canada's Weapons Threat Reduction Program and the Open Philanthropy Project, and in coordination with the government of The Netherlands as the 2018-19 Chair of the Global Health Security Agenda (GHSA) Action Package Prevent-3 (APP3) on Biosafety and Biosecurity. The GBD provides a multisectoral forum for sharing models, enabling new actions to achieve biosecurity-related targets, and promoting biosecurity as an integral component of health security. The GBD has contributed to new national and continent-wide actions, including the African Union and Africa Centres for Disease Control and Prevention's new regional Initiative to Strengthen Biosafety and Biosecurity in Africa. Here we present the GBD as a model for catalyzing action within APP3. We describe how the benefits of this approach could expand to other GHSA Action Packages and international health security initiatives.

Detection of Crimean-Congo Haemorrhagic Fever cases in a severe undifferentiated febrile illness outbreak in the Federal Republic of Sudan: A retrospective epidemiological and diagnostic cohort study.

BackgroundUndifferentiated febrile illness (UFI) is one of the most common reasons for people seeking healthcare in low-income countries. While illness and death due to specific infections such as malaria are often well-quantified, others are frequently uncounted and their impact underappreciated. A number of high consequence infectious diseases, including Ebola virus, are endemic or epidemic in the Federal Republic of Sudan which has experienced at least 12 UFI outbreaks, frequently associated with haemorrhage and high case fatality rates (CFR), since 2012. One of these occurred in Darfur in 2015/2016 with 594 cases and 108 deaths (CFR 18.2%). The aetiology of these outbreaks remains unknown.Methodology/Principal findingsWe report a retrospective cohort study of the 2015/2016 Darfur outbreak, using a subset of 65 of 263 outbreak samples received by the National Public Health Laboratory which met selection criteria of sufficient sample volume and epidemiological data. Clinical features included fever (95.8%), bleeding (95.7%), headache (51.6%) and arthralgia (42.2%). No epidemiological patterns indicative of person-to-person transmission or health-worker cases were reported. Samples were tested at the Public Health England Rare and Imported Pathogens Laboratory using a bespoke panel of likely pathogens including haemorrhagic fever viruses, arboviruses and Rickettsia, Leptospira and Borrelia spp. Seven (11%) were positive for Crimean-Congo haemorrhagic fever virus (CCHFV) by real-time reverse transcription PCR. The remaining samples tested negative on all assays.Conclusions/SignificanceCCHFV is an important cause of fever and haemorrhage in Darfur, but not the sole major source of UFI outbreaks in Sudan. Prospective studies are needed to explore other aetiologies, including novel pathogens. The presence of CCHFV has critical infection, prevention and control as well as clinical implications for future response. Our study reinforces the need to boost surveillance, lab and investigative capacity to underpin effective response, and for local and international health security.