Public Health Emergency Response Research Articles

Examining public perceptions and concerns about the impact of heatwaves on health outcomes using Twitter data

BackgroundHeat is becoming a global public health concern. This paper presents a comprehensive Twitter data analysis (2011–2023) to gain insights into public perceptions of heatwaves and their health-related concerns. MethodsA number (N = 2,070,197) of filtered tweets were included for analysis after preprocessing. Utilizing the Extractor of Demographic Characteristics (EDC) module, we extracted demographic attributes, including user type, gender, and age, highlighting the diverse voices in the Twitter conversation. Sentiment and emotional analyses were conducted utilizing BERT models. An active learning content analysis approach was employed using the GPT-3 model to identify health outcomes and concerns related to heat waves. ResultsOur results show that joy and anger were the dominant emotions, reflecting positive and negative sentiments surrounding heat waves. Public sentiment varied, revealing concern and optimism in response to changing weather patterns.In terms of health outcomes, the paper categorizes and analyzes a wide range of concerns during heat waves, from heat-related illnesses to mental health issues. These findings provide valuable insights into how different health concerns are distributed across gender, user type, and age categories. An overview of the measures people took to control these issues was also given. ConclusionsThis study illustrates the evolving dynamics of public emotional responses to heat waves, offering a holistic view of the various health-related concerns raised by the public during these extreme weather events. Such insights are essential for informing public health strategies and emergency responses to mitigate the adverse effects of heat waves and protect vulnerable populations.

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

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

Information sharing across institutions: Practices and barriers during public health emergencies in Ethiopia

BackgroundRapid, integrated information exchange between stakeholders is critical for effective emergency preparedness and response. However, many low- and middle-income countries face barriers to seamless data sharing. While information accessibility is recognized as important for evidence-based decision-making and resource allocation in Ethiopia, factors influencing current health information sharing practices among stakeholders involved in public health emergency management programs are unclear. This study aims to examine multi-sectoral stakeholders' perspectives and experiences with health data sharing during emergencies in Ethiopia, to identify opportunities and challenges influencing practices to strengthen the national public health emergency response system. MethodsA mixed-methods study was conducted between June and August 2023, involving a survey of 169 stakeholders actively involved in PHEM programs in Ethiopia as well as 23 in-depth interviews with key informants in senior leadership or advisory roles. The data was analyzed using descriptive statistics in SPSS and thematic analysis of qualitative transcripts. ResultsDuring emergencies, it was observed that data sharing between different entities occurred. Quantitative findings showed the predominant types of health data shared between stakeholders during emergencies included hospital data (109, 64.5 %), clinical case information, and laboratory results. Challenges limiting effective coordination included issues like limited functionality of digital health systems (75, 44 %), incompatible data formats (13, 34 %), and financial constraints (83, 49 %) and and socio-cultural barriers constrain current practices in Ethiopia. Qualitative interviews identified five themes around risk communication and inclusive alert systems. Experts emphasized tailored, multichannel outreach but noted infrastructure gaps and digital divides currently limit poorer communities' engagement. ConclusionWhile collaborative health information exchange during emergencies is recognized as important, systemic, financial, and socio-cultural barriers constrain current practices in Ethiopia. Targeted strategies including capacity building, investment in integrated data infrastructure, economic optimization through innovative financing models, trust-based relationship development, and locally relevant communication channels informed by stakeholder perspectives can optimize information accessibility, coordination, quality, and equity of healthcare services during public health emergencies.

Exploring hospital resilience protective or risk factors: lessons for future disaster response efforts.

Hospital resilience is essential in responding to disasters, but current research focuses mainly on frameworks and models rather than the protection of resilience and analysis of risk factors during public health emergencies. This study aims to examine the development of resilience in Chinese frontline hospitals during the initial COVID-19 outbreak in 2020, providing insights for future disaster response efforts. We conducted interviews with 26 hospital staff members who were involved in the initial response to the COVID-19 outbreak in China. We used a semi-structured interview approach and employed purposive sampling and snowball sampling techniques. The interview outline was guided by the 'Action Framework' proposed by the World Health Organization (WHO) for responding to infectious disease emergencies. This framework includes dimensions such as command, surveillance, risk communication, medical response, and public health response. We analyzed the collected data using Colaizzi's seven-step data analysis method and the template analysis method. WHO's 'action framework' effectively highlights the factors that contribute to hospital resilience. While medical response, including the availability of materials and facilities, the use of information technology, and the capacity for infectious disease diagnosis and treatment, remains crucial, other important aspects include awareness and beliefs about infections, treatment experience, interdisciplinary collaboration, and more. Additionally, it is essential to establish an intelligent command system, foster trusting partnerships between teams, improve monitoring capabilities for infectious disease agents, enhance risk communication through information synchronization and transparency, strengthen infection control planning, and improve environmental disinfection capabilities for effective public health emergency response. These contradictions significantly impact the enhancement of hospital resilience in dealing with major infectious disease outbreaks. In responding to sudden major infectious diseases, hospitals play a vital role within the healthcare system. Enhancing hospital resilience involves more than just improving treatment capabilities. It also requires effective command coordination at the hospital level, infection control planning, and the deployment of intelligent equipment. Additionally, planning for effective communication and coordination between hospitals, communities, and the national healthcare system can further enhance hospital resilience.

Teamwork and Collaboration: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response.

The public health emergency response following the outbreak of COVID-19 necessitated greater internal public health agency teamwork and external collaboration. Building on previous research, this article is the third of 3 research briefs that highlight "bright spots" or valuable experiences and opportunities from the COVID-19 response. Using PH WINS 2021 data, we qualitatively examined responses to a question about pandemic workforce experiences. Teamwork and collaboration were emphasized as a critical component of employees' experiences. Across 260 responses, 7 subthemes emerged, generally commemorating the ways that the response effort and employees were supported by teamwork and collaboration. Findings highlight the value of ongoing cross-division teamwork within agencies, the role of leaders in teamwork, and that lessons from teamwork/collaboration experiences can inform organizational system improvements. Maintaining and expanding on improved external collaboration and partnerships should be prioritized for preparing for future emergency events and serving public health communities on a daily basis.

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...

Lessons Learned from COVID-19 Response in Correctional and Detention Facilities.

The COVID-19 pandemic disproportionately affected persons held in and working in correctional and detention facilities, causing facilities' traditional priorities to shift when healthcare and public health needs temporarily drove many aspects of operations. During July-August 2022, we interviewed members of health departments and criminal justice organizations to document lessons learned from the COVID-19 response in correctional settings. Participants valued enhanced partnerships, flexibility, and innovation, as well as real-time data and corrections-specific public health guidance. Challenges included cross-sector collaborations, population density, scarcity of equipment and supplies, and mental health. Most participants reported improved relationships between criminal justice and public health organizations during the pandemic. Lessons from COVID-19 can be applied to everyday public health preparedness and emergency response in correctional facilities by ensuring representation of correctional health in public health strategy and practice and providing timely, data-driven, and partner-informed guidance tailored to correctional environments when public health needs arise.

The Change of Public Health Emergency Policy in China: Course, Logic, and Prospect

With the frequent occurrence of various public health events, systematic analysis of public health emergency policies is urgently needed. Based on the historical institutional framework, it can be found that China's public health emergency policy has experienced four stages: slow start, rapid development, gradual adjustment and comprehensive improvement since the founding of the People's Republic of China. From the perspective of deep structure, economic level, social governance concept and scientific and technological development affect the evolution of public health emergency policy; From the perspective of path dependence, the policy is strengthened by increasing returns. From the perspective of dynamic mechanism, the interaction between key nodes and policy stakeholders promotes policy development. In the new era, the future development of China's public health emergency policy should grasp the key nodes of institutional change, enrich the policy system, improve the social participation mechanism, and encourage emergency technical innovation, and then realize the comprehensive improvement of China's public health emergency response capacity.

The role of the Field Epidemiology Training Program in the public health emergency response: Sudan armed conflict 2023.

On April 15, 2023, the armed conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) started in Khartoum state, Sudan. This conflict was complicated by the preexisting complicated epidemiological situation and fragile health system in Sudan. This study endeavors to illuminate the pivotal role essayed by the Sudan FETP (SFETP) in enhancing the nation's public health response, particularly amidst the tumultuous backdrop of armed conflicts that have left their indelible mark on the region. Employing a blend of quantitative and qualitative methodologies, we investigated the SFETP's contributions to the public health response during the initial 4 months of the conflict (April-July 2023). Sixty-four SFETP residents and graduates were invited to participate, and data were gathered through semi-structured questionnaires. A total of 44 (69%) SFETP residents and graduates were included in this study. Out of 38 SFETPs present in the states, 32 have considerably contributed to the crisis response at state and locality levels. Three-quarters of them have played key leadership, planning, and management roles. In essence, 38% (n = 12) of them have contributed to public health surveillance, particularly in data management, reports, Early Warning Alert and Response System (EWAR) establishment, and epidemic investigation. SFETPs have made special contributions to crisis response at the community level. The involved SFETPs supported WASH interventions (n = 4), and almost one-third of them strengthened risk communication and community engagement (n = 9). Despite their physical presence at the subnational level, 27% of graduates were not deployed to the crisis emergency response. Notably, throughout this time, half of the total SFETPs were formally retained during this response. The study highlighted the importance of FETP engagement and support during public health crises. SFETP residents and graduates played diverse roles in the various levels of public health emergency response to the crisis. However. Strategies to improve the deployment and retention of FETP residents are necessary to ensure their availability during crises. Overall, FETP has proven to be an asset in public health crisis management in Sudan.

Rethinking the World Health Organization's leadership of global health governance and the global health surveillance systems.

Global health governance is a strategic priority for the World Health Organization (WHO), and the public health surveillance system (PHSS) is a fundamental element of the global health governance structure to timely identify emerging diseases and guide global public health decisions and actions. This analysis explores the overall landscape of global health governance, with a specific focus on the PHSS to understand whether the existing governance landscape facilitates or undermines the WHO's ability to formulate and implement global health policies and initiatives. To achieve this, the existing evidence was reviewed, and synthesized with the experts' perspectives. It is reported that fragmentation is the main drawback of the global health governance landscape, necessitating reorganization and restructuring. The disintegration of PHSS at the global, regional and local levels is associated with a lack of leadership, misalignment with global health priorities, imbalance in coverage of surveillance systems, inadequate innovative technology and digitalization, and fragmented data and information systems. The fragmentation and disintegration of global health governance undermine the effectiveness of the WHO's global health strategic directions and programmes and hinder its ability to govern and guide the global, regional and national public health emergency response. Strategic rethinking of the WHO's governance is essential because strong governance and leadership lead to a robust, aligned and effective PHSS.

Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has emphasized the importance of multi-sectoral collaboration to respond effectively to public health emergencies. This study aims to generate evidence on the extent to which multi-sectoral collaborations have been employed in the macro-level responses to the COVID-19 pandemic in nine selected countries of the Eastern Mediterranean region (EMR).MethodsThe study employed in-depth analytical research design and was conducted in two phases. In the first phase, data were collected using a comprehensive documentation review. In the second phase, key informant interviews were conducted to validate findings from the first phase and gain additional insights into key barriers and facilitators. We analysed the macro-level pandemic responses across the following seven components of the analytical framework for multi-sectoral collaborations: (1) context and trigger; (2) leadership, institutional mechanisms and processes; (3) actors; (4) administration, funding and evaluation; (5) degree of multi-sectoral engagement; (6) impact; and (7) enabling factors.ResultsGovernments in the EMR have responded differently to the pandemic, with variations in reaction speed and strictness of implementation. While inter-ministerial committees were identified as the primary mechanism through which multi-sectoral action was established and implemented in the selected countries, there was a lack of clarity on how they functioned, particularly regarding the closeness of the cooperation and the working methods. Coordination structures lacked a clear mandate, joint costed action plan, sufficient resources and regular reporting on commitments. Furthermore, there was no evidence of robust communication planning both internally, focused on promoting internal consensual decision-making and managing power dynamics, and externally, concerning communication with the public. Across the selected countries, there was strong representation of different ministries in the pandemic response. Conversely, the contribution of non-state actors, including non-governmental organizations, civil society organizations, the private sector, the media and citizens, was relatively modest. Their involvement was more ad hoc, fragmented and largely self-initiated, particularly within the selected middle- and low income- countries of the EMR. Moreover, none of the countries incorporated explicit accountability framework or included anti-corruption and counter-fraud measures as integral components of their multi-sectoral plans and coordination mechanisms. Key enablers for the adoption of multi-sectoral collaborations have been identified, paving the way for more efficient responses in the future.DiscussionMirroring global efforts, this study demonstrates that the selected countries in the EMR are making efforts to integrate multi-sectoral action into their pandemic responses. Nevertheless, persistent challenges and gaps remain, presenting untapped opportunities that governments can leverage to enhance the efficiency of future public health emergency responses.

Lessons Learned From Adolescent COVID-19 Vaccine Administration in Medically Underserved Communities.

In May 2021, the Health Resources and Services Administration Health Center COVID-19 Vaccine Program (HCCVP) began supporting the national adolescent vaccination rollout for a safe return to in-person learning for children and adolescents from medically underserved communities. To understand the initial implementation of adolescent vaccinations, we estimated the number of vaccines administered through the HCCVP at the national and state level to adolescents aged 12-17 years, and we examined challenges and solutions in vaccine deployment. We analyzed data on vaccine administration, challenges, and solutions from the Health Center COVID-19 Survey during May 14-August 27, 2021, and we analyzed data on patients served from the 2019 Uniform Data System. National adolescent COVID-19 vaccination and population data came from CDC's COVID Data Tracker and the US Census Bureau's 2019 Current Population Survey. HCCVP health centers administered >485 000 COVID-19 vaccine doses to adolescents during the study period, with variations across states. Health centers in 13 states and territories (Arizona, California, Colorado, Connecticut, Delaware, Maine, Massachusetts, Missouri, Nebraska, Nevada, Oregon, Virginia, and Puerto Rico) vaccinated more adolescents than their share of prepandemic adolescent patients. The most frequently reported challenges in vaccine administration were vaccine confidence and staffing availability. This assessment of the initial months of COVID-19 vaccine administration among adolescent health center patients suggests rapid response by health centers in several states, reaching beyond their adolescent patient population to support state-level pandemic response. Future research could examine processes to optimize strategic activation of health centers in public health emergency responses.

Asymptomatic norovirus infection during outbreaks in China: A systematic review and meta-analysis.

Acute gastroenteritis outbreaks may be caused by the excretion of norovirus (NoV) from asymptomatic individuals. Despite numerous studies involving asymptomatic NoV infection during outbreaks in China, a comprehensive assessment of its role has not been conducted, which is critical for emergency management. Our objective was to assess the prevalence of asymptomatic NoV infection during outbreaks in China. We conducted a comprehensive search of multiple databases, including PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Wanfang, and China Weipu, between January 1, 1997 and June 19, 2023. The retrieved articles and their references underwent screening, which utilized polymerase chain reaction-based assays for the detection of NoV in asymptomatic individuals during outbreaks that occurred in China. The primary summary data were the prevalence of asymptomatic NoV infection in outbreaks. We generated pooled estimates of asymptomatic prevalence in the population as a whole and in subgroups by using random-effect models. Of the 97 articles included, the pooled asymptomatic prevalence of NoV among 5117 individuals in outbreaks was 17.6% (95% confidence interval [CI]: 14.1-21.3). The asymptomatic prevalence of NoV GII (17.1%, 95% CI: 12.9-21.5) was similar to that of NoV GI (22.0%, 95% CI: 12.8-32.4). However, the proportion of asymptomatic individuals involved in NoV GII (57.44%) was significantly higher than that of NoV GI (5.12%), and NoV GII (75.26%) was reported much more frequently than NoV GI (14.43%) in the included articles. Meta-regression analysis of 11 possible influencing factors (geographic region, setting, season, sample type, genotype, transmission route, occupation, age, per capita income, study quality, and cases definition) showed that the source of heterogeneity might be related to the outbreak settings, per capita income, and study quality (p = 0.037, 0.058, and 0.026, respectively). Of particular note was the asymptomatic prevalence peaked in preschoolers (27.8%), afterward, it fell into trough in elementary and junior school children (10.5%), before the second peak located in adults (17.8%), and the elderly (25.2%). Prevalent genotypes reported include GII.4, followed by GII.17, GII.2, GII.3, GII.6, and so forth. The estimated asymptomatic prevalence of NoV during outbreaks in China was as high as 17.6%, with NoV GII dominating. In addition, genetic subtypes of NoV in outbreaks should be detected whenever possible. The role of asymptomatic individuals in NoV outbreaks cannot be ignored. This knowledge will help governments develop public health policies and emergency response strategies for outbreaks, assess the burden, and develop vaccines.

GOARN training: supporting field epidemiology trainees to upskill for public health emergency response.

GOARN training: supporting field epidemiology trainees to upskill for public health emergency response.

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.

Community Assessment for Public Health Emergency Response (CASPER) following Hurricane Michael: Gadsden, Calhoun, and Jackson Counties, Florida, 2020.

To assess community preparedness and ongoing recovery efforts in the rural counties most severely impacted by Hurricane Michael, including structural and economic losses, injury and illness, healthcare access, and suicide risk and ideation. The Florida Department of Health conducted a Community Assessment for Public Health Emergency Response (CASPER) in January 2020, 15 months after Hurricane Michael made landfall in October 2018. A total of 30 clusters were randomly selected from three rural counties in the Panhandle of Florida, including Jackson (15 clusters), Gadsden (11), and Calhoun (four) counties. A total of 185 face-to-face and two phone interviews were conducted with residents 18 years of age or older. Hurricane preparedness, structural and economic losses, access to care, and physical and mental health. Around 43 percent of respondents evacuated as a result of Hurricane Michael, and at least two-thirds of all respondents reported having an emergency supply kit and enough nonperishable food, water, and medication. Structural damage was extensive with 63 percent reporting home damage, averaging over $32,000. Few injuries or illnesses were reported post-landfall (9 percent), with the most common being minor injuries and bacterial infections. Most respondents reported continued access to healthcare if needed. The most common stress-related issues reported were difficulty sleeping (19 percent) and agitated behaviors (10 percent). Seven percent of respondents reported being at moderate to high risk for suicide. Rural areas may lack resources, such as healthcare facilities, skilled workers, and supplies, that hinder their ability to recover from storms when compared to more urban counties. Many residents reported that 15 months after the storm, their homes were still not fully repaired. A majority of residents were prepared with adequate supplies, had minimal disruption in employment or healthcare access, and had few illnesses or injuries during the storm or the recovery efforts.

Examining the role of community resilience and social capital on mental health in public health emergency and disaster response: a scoping review

The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital?A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering both community resilience and social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria.The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method for measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities.Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring both community resilience and social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

Monitoring and reporting the US COVID-19 vaccination effort

Immunizations are an important tool to reduce the burden of vaccine preventable diseases and improve population health.1 High-quality immunization data is essential to inform clinical and public health interventions and respond to outbreaks of vaccine-preventable diseases. To track COVID-19 vaccines and vaccinations, CDC established an integrated network that included vaccination provider systems, health information exchange systems, immunization information systems, pharmacy and dialysis systems, vaccine ordering systems, electronic health records, and tools to support mass vaccination clinics. All these systems reported data to CDC’s COVID-19 response system (either directly or indirectly) where it was processed, analyzed, and disseminated. This unprecedented vaccine tracking effort provided essential information for public health officials that was used to monitor the COVID-19 response and guide decisions. This paper will describe systems, processes, and policies that enabled monitoring and reporting of COVID-19 vaccination efforts and share challenges and lessons learned for future public health emergency responses.

Examining the militarised hierarchy of Sierra Leone’s Ebola response and implications for decision making during public health emergencies

BackgroundIn September, 2014, Médecins Sans Frontières (MSF) called for militarised assistance in response to the rapidly escalating West Africa Ebola Epidemic. Soon after, the United Kingdom deployed its military to Sierra Leone, which (among other contributions) helped to support the establishment of novel and military-led Ebola Virus Disease (Ebola) response centres throughout the country. To examine these civil-military structures and their effects, 110 semi-structured interviews with civilian and military Ebola Response Workers (ERWs) were conducted and analysed using neo-Durkheimian theory.ResultsThe hierarchical Ebola response centres were found to be spaces of ‘conflict attenuation’ for their use of ‘rule-bound niches’, ‘neutral zones’, ‘co-dependence’, and ‘hybridity’, thereby not only easing civil-military relationships (CMRel), but also increasing the efficiency of their application to Ebola response interventions. Furthermore, the hierarchical response centres were also found to be inclusive spaces that further increased efficiency through the decentralisation and localisation of these interventions and daily decision making, albeit for mostly privileged groups and in limited ways.ConclusionsThis demonstrates how hierarchy and localisation can (and perhaps should) go hand-in-hand during future public health emergency responses as a strategy for more robustly including typically marginalised local actors, while also improving necessary efficiency—in other words, an ‘inclusive hierarchical coordination’ that is both operationally viable and an ethical imperative.