Public Health Emergency Preparedness Research Articles

An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland.

Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021-2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35-49 (compared to 18-34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic.

Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response.

Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response.

Identifying and costing common gaps in Central and West Africa pharmaceutical regulation.

Regulatory systems strengthening is crucial for catalyzing access to safe and effective medical products and health technologies (MPHT) for all. Identifying and addressing common regulatory gaps through regional approaches could be instrumental for the newly incepted African Medicine Agency. This original study sheds light on common gaps among 10 national regulatory authorities (NRAs) and ways to address them regionally. The study used NRA self-assessment outcomes to identify common gaps in four critical regulatory pillars and estimate the cost of addressing them from regional perspectives that aimed at raising the maturity level of regulatory institutions. A cross-sectional study, using the WHO Global Benchmarking Tool (GBT), was conducted between 2020 and 2021 with five NRAs from ECCAS and ECOWAS member states that use French and Spanish as lingua franca. The 10 NRAs operated in a non-formal-to-reactive approach (ML1-2), which hinders their ability to ensure the quality of MPHT and respond appropriately to public health emergencies. Common gaps were identified in four critical regulatory pillars-good regulatory practices, preparedness for public health emergencies, quality management systems, and substandard and falsified medical products-with overall cost to address gaps estimated at US$3.3 million. We elaborated a reproducible method to strengthen regulatory systems at a regional level to improve equitable access to assured-quality MPHT. Our bottom-up approach could be utilized by RECs to address common gaps through common efforts.

Development of a workforce self-assessment tool for public health emergency preparedness.

In collaboration with six European public health agencies as part of the PANDEM-2 consortium, we have developed and validated a self-assessment tool that captures the workforce capacities and capabilities needed at the institutional level within National Public Health Institutes (NPHIs) to deal with public health emergencies. The work carried out in this study included (i) a review of existing tools for workforce assessment, (ii) focus group discussions and interviews to map the experiences and needs of NPHI's, (iii) the development of a tool for NPHI's to assess their workforce capacity and capabilities in public health emergency preparedness (PHEP) and (iv) refinement of the assessment tool via a Delphi study. Capacity markers were identified to assess the workforce required for PHEP functions and the availability of surge capacity during a public health emergency. The tool also enables NPHIs to analyze gaps in PHEP staff competencies. The assessment scores can assist NPHI pandemic preparedness by identifying and prioritizing training and recruitment needs. In line with EU Regulation 2022/2371 on serious cross-border threats to health, article 11 Training of healthcare staff and public health staff, Member States (MS) are tasked with assessing current workforce capacity and capability gaps. The PANDEM-2 workforce self-assessment tool aligns with this requirement and will support effective planning and development to strengthen the public health workforce capacity in EU MS.

Challenges in capacity building of national immunization programs and emergency or pandemic vaccination responses in the Global Health Security Agenda member countries.

The Immunization Action Package aims to increase the vaccination rate for vaccine-preventable diseases to save lives. To achieve this, member countries of the Global Health Security Agenda (GHSA) must have the capacity to implement sustainable national immunization programs (NIPs) and to respond to emergency vaccination scenarios. This article focuses on 4 major areas of NIP capacity, including in emergency situations: infrastructure capacity, sustainable financing capacity, vaccine access and equity, and vaccination hesitancy. Countries require resilient infrastructure to achieve high vaccination rates and develop preparedness for public health emergencies. Financial sustainability is crucial in achieving high vaccination coverage to best implement initiatives and national programs. Furthermore, challenges to NIPs include vaccine access and equity, as inequitable distribution and access to vaccines for coronavirus disease 2019 accelerated the impact of the pandemic. Lastly, the correlation between low acceptance and successful implementation of national initiatives suggests that vaccination hesitancy is another challenge to NIPs. In an attempt to overcome these challenges, the Expert Forum of the GHSA Seventh Ministerial Meeting was held to provide sessions allowing countries to share their national case studies and discuss strategies for capacity building of country-level NIPs, including for emergency responses.

Public Health Emergency Preparedness Cooperative Agreement (CDC)

Public Health Emergency Preparedness Cooperative Agreement (CDC)

Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response.

Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response.

The impact of policy and policy communication on COVID-19 vaccination inequalities among Venezuelan refugees and migrants in Colombia: a comparative cross-sectional interrupted time-series analysis

IntroductionEquitable access to vaccines for migrants and refugees is necessary to ensure their right to health and to achieve public health goals of reducing vaccine-preventable illness. Public health policies require...

Regional geographies and public health lessons of the COVID-19 pandemic in the Arctic.

This study examines the COVID-19 pandemic's spatiotemporal dynamics in 52 sub-regions in eight Arctic states. This study further investigates the potential impact of early vaccination coverage on subsequent COVID-19 outcomes within these regions, potentially revealing public health insights of global significance. We assessed the outcomes of the COVID-19 pandemic in Arctic sub-regions using three key epidemiological variables: confirmed cases, confirmed deaths, and case fatality ratio (CFR), along with vaccination rates to evaluate the effectiveness of the early vaccination campaign on the later dynamics of COVID-19 outcomes in these regions. From February 2020 to February 2023, the Arctic experienced five distinct waves of COVID-19 infections and fatalities. However, most Arctic regions consistently maintained Case Fatality Ratios (CFRs) below their respective national levels throughout these waves. Further, the regression analysis indicated that the impact of initial vaccination coverage on subsequent cumulative mortality rates and Case Fatality Ratio (CFR) was inverse and statistically significant. A common trend was the delayed onset of the pandemic in the Arctic due to its remoteness. A few regions, including Greenland, Iceland, the Faroe Islands, Northern Canada, Finland, and Norway, experienced isolated spikes in cases at the beginning of the pandemic with minimal or no fatalities. In contrast, Alaska, Northern Sweden, and Russia had generally high death rates, with surges in cases and fatalities. Analyzing COVID-19 data from 52 Arctic subregions shows significant spatial and temporal variations in the pandemic's severity. Greenland, Iceland, the Faroe Islands, Northern Canada, Finland, and Norway exemplify successful pandemic management models characterized by low cases and deaths. These outcomes can be attributed to successful vaccination campaigns, and proactive public health initiatives along the delayed onset of the pandemic, which reduced the impact of COVID-19, given structural and population vulnerabilities. Thus, the Arctic experience of COVID-19 informs preparedness for future pandemic-like public health emergencies in remote regions and marginalized communities worldwide that share similar contexts.

NACSD RECOMMENDATIONS FOR OLDER ADULT DISASTER PREPAREDNESS, RESPONSE, AND RECOVERY

Abstract This presentation shares the recommendations drafted by the National Advisory Committee on Seniors and Disasters (NACSD). This federal advisory committee provides advice and guidance to the Assistant Secretary for Preparedness and Response within the U.S. Department of Health and Human Services (HHS) and the HHS Secretary. The NACSD is comprised of seven non-federal members with expertise in geriatric disaster planning, preparedness, response, or recovery and ten federal (non-voting) members who are ex officio representatives from agencies within HHS and other Executive Branch departments. The voting members drafted recommendations intended to address the immediate and persistent challenges in public health emergency preparedness, response, and recovery affecting older adults in the United States. Numerous meetings with federal and non-federal subject matter experts from various disciplines were held to develop the recommendations. The NACSD was also tasked with evaluating issues and programs and providing findings, advice, and recommendations to the Secretary of Health and Human Services to support and enhance all-hazards public health and medical preparedness, response, and recovery activities related to meeting the unique needs of older adults and their families across the entire spectrum of their wellbeing. The NACSD evaluated and provided input concerning the medical and public health needs of older adults related to preparation for, response to, and recovery from all-hazards emergencies; and may provide advice and consultation with respect to State emergency preparedness and response activities relating to older adults.

Assessing health impact of COVID-19 and associated household socioeconomic factors in Papua New Guinea: evidence from the Comprehensive Health and Epidemiological Surveillance System

IntroductionThe COVID-19 pandemic had an unprecedented impact on the health and well-being of populations worldwide. Few studies have used household data to explore the health risks associated with COVID-19 in...

Lessons From the COVID-19 Pandemic Response Implementation: A Case Study of South Sudan and Sierra Leone.

The COVID-19 pandemic caused havoc to health systems worldwide and in countries that already had weak health systems. There are lessons to be learned that could contribute to improved response preparedness to future public health emergencies, but there is little documentation on best practices in fragile countries. We describe lessons from South Sudan and Sierra Leone during the COVID-19 response implementation. We conducted a retrospective descriptive analysis of COVID-19 vaccination implementation at national and subnational levels between 2020 and 2022 in South Sudan and Sierra Leone to identify those practices that had a positive impact on public health. Several interventions were identified that not only improved the COVID-19 situation but also had a positive effect on routine immunizations. The development of a near-real-time vaccination dashboard gave stakeholders a quick look at vaccine implementation, allowing them to make decisions based on current data. The experience acquired from deploying the COVID-19 dashboard has since been applied to the development of a routine immunization dashboard in South Sudan. Surge vaccination was an effective approach to improving COVID-19 vaccination uptake. A measles reactive campaign was conducted during the initial stages of the pandemic when movement was restricted; experience gained from that effort was subsequently applied to COVID-19 mass vaccination initiatives and outbreak reactive campaigns. Additional vaccinators recruited for COVID-19 response also received comprehensive Immunization in Practice training, allowing them to provide routine childhood vaccinations alongside COVID-19 vaccination, contributing to the maintenance of routine vaccination services in both countries. Lessons were learned during the COVID-19 response implementation that have had a positive impact on routine health services. However, it is essential that these effects are maintained and further refined to strengthen the country's preparedness for future public health emergencies and better support the broader immunization service delivery.

Assessing US Small Animal Veterinary Clinic Adaptations and Their Impacts on Workforce COVID-19 Preparedness and Response.

Veterinary personnel are an essential yet often underappreciated workforce, critical for zoonotic disease prevention and response efforts that impact human health. During the early COVID-19 pandemic, the veterinary workforce supported emergency responses by promoting zoonotic disease risk communication, sharing animal health expertise, and boosting laboratory surge capacity against SARS-CoV-2 in animals and people. However, small animal veterinary workers (SAVWs), similar to healthcare workers, faced organizational challenges in providing clinical care to family pets, including those susceptible to SARS-CoV-2. We analyzed a cross-sectional survey of 1,204 SAVWs in the United States to assess veterinary clinic adaptations and their associations with SAVWs' self-perceived readiness, willingness, and ability to respond to the COVID-19 pandemic as a workforce. SAVWs who worked fewer hours than before the pandemic (ready, OR 0.59; willing, OR 0.66; able, OR 0.52) or used personal protective equipment less frequently for protection in the clinic (ready, OR 0.69; willing, OR 0.69; able, OR 0.64) felt less ready, willing, and able to respond to COVID-19. SAVWs working remotely felt less ready (OR 0.46) but not less willing or able to respond to COVID-19. Lastly, SAVWs with dependents felt less ready (OR 0.67) and able (OR 0.49) to respond to COVID-19 than SAVWs without dependents. Our findings highlight the importance of proactively managing work schedules, having access to personal protective equipment, and addressing caregiving concerns to enhance SAVW preparedness and response outcomes. SAVWs are knowledgeable, motivated personnel who should be integrated into local public health emergency preparedness and response plans, supporting a One Health framework that unites multidisciplinary teams to respond to future zoonotic disease threats.

Public Health Emergency Preparedness and Response to Natural Disaster in Sierra Leone: The Milestone in a Decade

Public Health Emergency Preparedness and Response to Natural Disaster in Sierra Leone: The Milestone in a Decade

Decision-making, training and support:Lessons from public health response to COVID-19 in Ireland

Abstract Background The COVID-19 pandemic exposed the critical need for a rapid and effective public health emergency response to such crises. This study investigates the public health response to COVID-19 in Ireland, focusing on decision-making, recruitment, training, and specialised support for emergency responders. Methods Using a mixed-methods approach, we analysed data from surveys of volunteer contact tracers recruited in the early days of the pandemic, from government reports, and from the Health Service Executive (HSE) COVID-19 Contact Management Programme work instructions that evolved over the course of the pandemic response. Results Our findings reveal that the public health response in Ireland was moderately rapid and decisive with innovative recruitment strategies, targeted training programmes and the development of specialised support for frontline responders. While volunteer contact tracers were quickly upskilled, they required ongoing expert support on an evolving IT system and for effective clinical and public health responses. We highlight key lessons learned, including the need for interdisciplinary collaboration, ongoing training and support, and effective communication strategies. Conclusions Our study has important policy implications for public health emergency preparedness and response, which include the need for greater investment in training and support for public health professionals, the development of effective communication channels, and the establishment of a coordinated national response system. By implementing these recommendations policymakers can better prepare for, and respond to, future public health emergencies ultimately improving the health and wellbeing of the population. The key lessons presented from this analysis point to the importance of forward planning for early intervention, rather than reactive responses in times of crises. Key messages • Improving emergency preparedness by investing in training for public health professionals, developing effective communication channels, and establishing a coordinated national response system. • The key lessons presented from this analysis point to the importance of forward planning for early intervention, rather than reactive responses in times of crises.

What are the research priorities for strengthening public health emergency preparedness and response in Africa?

BackgroundResearch evidence is needed to strengthen capacities in emergency preparedness and response (EPR). However, the absence of a clear research agenda limits the optimal use of research evidence. This paper reports on the prioritization of research questions and topics that could contribute to evidence-informed strengthening of EPR capacities in the African region.MethodsThe priority-setting consisted of desk review and stakeholder consultation workshop. Twenty-nine people participated in the workshop, including representatives from WHO regional office and EPR focal points in Africa, representatives of research institutions, and partners from Science for Africa Foundation, United Nations Children's Fund and Africa Center for Disease Control. Modified Delphi technique was used to systematically arrive at specific and cross-cutting research priorities in the three broad areas of the EPR, which are program Implementation, Clinical and Epidemiology. The research questions/topics were ranked on five-point Likert scale (1 = very low to 5 = very high) based on seven agreed-on criteria. Research priority score was calculated for each question as the mean of the criteria scores.ResultsA total of 123 research questions comprising, 29 on Epidemiology, 22 on Clinical, 23 on program Implementation, and 49 on cross-cutting issues were ranked. The top ten research priorities were: knowledge and skills of healthcare workers in detecting and responding effectively to disease outbreaks; quality of data (accuracy, timeliness, completeness) for epidemic prone diseases; determinants of vaccine hesitancy; determinants of infection transmission among health care workers during PHE; effective measures for protecting health workers from highly infectious pathogens in PHE; strategies to improve the effectiveness of contact tracing for epidemic prone diseases; effectiveness of current case definitions as screening tools for epidemic and pandemic prone diseases; measures to strengthen national and sub-national laboratory capacity for timely disease confirmation within the Integrated Diseases Surveillance and Response framework; factors affecting prompt data sharing on epidemic-prone diseases; and effective strategies for appropriate community participation in EPR.ConclusionsThe collaborative multi-stakeholder workshop produced a starting list of priority research questions and topics for strengthening EPR capacities in Africa. Action needs to be taken to continuously update the research agenda and support member States to contextualize the research priorities and commission research for timely generation and uptake of evidence.

Lessons learned from the experiences and perspectives of frontline healthcare workers on the COVID-19 response: a qualitative descriptive study

BackgroundDuring the COVID-19 pandemic, healthcare systems and healthcare workers (HCWs) faced significant demands and unique challenges. In this qualitative study, we explore the effects of the COVID-19 public health policies on British Columbia’s frontline HCWs, describe what worked in the management of the pandemic, and elucidate the lessons learned that could be applied to future pandemic preparedness, recovery and response.MethodsThis qualitative descriptive study is part of a larger, national multi-case study on pandemic policy communication and uptake. Semi-structured interviews were conducted from November 2020- June 2021 with fourteen HCWs working in long-term care (LTC), acute care and public health settings. Data were inductively coded, and analyzed following a resilience framework for public health emergency preparedness, which emphasizes the essential elements of a public health system, vital to all phases of health emergency management, readiness, response and recovery.ResultsHCWs experienced confusion, frustration, uncertainty, anxiety, fatigue and stress, during the pandemic and detailed challenges that affected policy implementation. This included communication and coordination inconsistencies between the province and regional health authorities; lack of involvement of frontline staff in pandemic planning; inadequate training and support; inadequate personal protective equipment resource capacity and mobilization; and staffing shortages. HCWs recommended increased collaboration between frontline staff and policy makers, investment in preparing and practicing pandemic plans, and the need for training in emergency management and infection prevention and control.ConclusionsPandemic planning, response and recovery should include inputs from actors/key stakeholders at the provincial, regional and local levels, to facilitate better coordination, communication and outcomes. Also, given the critical roles of frontline HCWs in policy implementation, they should be adequately supported and consideration must be given to how they interpret and act on policies. Bi-directional communication channels should be incorporated between policymakers and frontline HCWs to verify the appropriate adoption of policies, reflective learning, and to ensure policy limitations are being communicated and acted upon by policy makers.

[Challenges and prospects in public health emergency preparedness and response based on the COVID-19 experience in Japan: A report by the Monitoring Report Committee of the Japanese Society of Public Health].

[Challenges and prospects in public health emergency preparedness and response based on the COVID-19 experience in Japan: A report by the Monitoring Report Committee of the Japanese Society of Public Health].

Prioritization of zoonoses for multisectoral, One Health collaboration in Somalia, 2023

BackgroundThe human population of Somalia is vulnerable to zoonoses due to a high reliance on animal husbandry. This disease risk is exacerbated by relatively low income (poverty) and weak state capacity for health service delivery in the country as well as climate extremes and geopolitical instability in the region. To address this threat to public health efficiently and effectively, it is essential that all sectors have a common understanding of the priority zoonotic diseases of greatest concern to the country. MethodsRepresentatives from human, animal (domestic and wildlife), agriculture, and environmental health sectors undertook a multisectoral prioritization exercise using the One Health Zoonotic Disease Prioritization (OHZDP) tool developed by the United States CDC. The process involved: reviewing available literature and creating a longlist of zoonotic diseases for potential inclusion; developing and weighting criteria for establishing the importance of each zoonoses; formulating categorical questions (indicators) for each criteria; scoring each disease according to the criteria; and finally ranking the diseases based on the final score. Participants then brainstormed and suggested strategic action plans to prevent, and control prioritized zoonotic diseases. ResultsThirty-three zoonoses were initially considered for prioritization. Final criteria for ranking included: 1) socioeconomic impact (including sensitivity) in Somalia; 2) burden of disease in humans in Somalia); 3) availability of intervention in Somalia; 4) environmental factors/determinants; and 5) burden of disease in animals in Somalia. Following scoring of each zoonotic disease against these criteria, and further discussion of the OHZDP tool outputs, seven priority zoonoses were identified for Somalia: Rift Valley fever, Middle East respiratory syndrome, anthrax, trypanosomiasis, brucellosis, zoonotic enteric parasites (including Giardia and Cryptosporidium), and zoonotic influenza viruses. ConclusionsThe final list of seven priority zoonotic diseases will serve as a foundation for strengthening One Health approaches for disease prevention and control in Somalia. It will be used to: shape improved multisectoral linkages for integrated surveillance systems and laboratory networks for improved human, animal, and environmental health; establish multisectoral public health emergency preparedness and response plans using One Health approaches; and enhance workforce capacity to prevent, control and respond to priority zoonotic diseases.

El Niño-Southern Oscillation: a call to action for public health emergency preparedness and response

El Niño-Southern Oscillation: a call to action for public health emergency preparedness and response