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Background: Pakistan's health system is expected to take a proactive position in the global health security arena amidst its own indigenous structural and systemic challenges. Henceforth, understanding the intricacies of this system is vital for creating effective strategies to prevent, detect, and respond to health emergencies, ensuring regional stability and overall global health security. Objectives: This study has ventured to understand the perspectives, hurdles, threats, and both international and national implications of Pakistan's current health system capacity and the requisites for meeting global health security commitments. Methods: This descriptive qualitative study, based on phenomenology theory, involved key informant interviews with 16 senior policy‑level experts and public health professionals from the public and private sectors, international non‑governmental organizations (NGOs), development partners, and United Nations (UN) bodies. Thematic analysis was employed to identify key themes related to Pakistan's health system and its role in global health security. Findings: The study uncovered significant insights into the strengths and weaknesses of Pakistan's health system, the impact of the coronavirus disease 2019 (COVID‑19) pandemic, and challenges such as funding constraints and fragmented healthcare delivery. It also highlighted threats like antimicrobial resistance and emphasized the importance of international collaboration. Areas needing special attention include multi‑drug resistance, food safety in emergencies, surge capacity of the frontline workforce, patient safety to reduce healthcare‑associated infections, and strengthening points of entry. Conclusion: The COVID‑19 pandemic has highlighted both the vulnerabilities and the potential within Pakistan's health system. To enhance its contribution to global health security, Pakistan needs a national policy stance, targeted health system reforms, improved resource allocation, workforce development, and strengthened partnerships with development agencies., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Pakistan's health system has a critical role to play in global health security, however, it faces numerous structural and systemic challenges while contributing to international health efforts. Understanding the dynamics of health system is essential for developing effective strategies to prevent, detect, and respond to health emergencies, ensuring regional stability, and the overall global health security This paper documents the strengths and weaknesses of Pakistan's health systems, the impact of the COVID-19 pandemic, challenges such as funding constraints and fragmented healthcare delivery, threats including antimicrobial resistance, and the importance of international collaboration. Anti-microbial particularly multi-drug resistance, food safety in emergencies, surge capacity of the frontline workforce, patient safety at the health care facilities to curtail healthcare associated infections, and strengthening the points of entry are still the areas that need special attention. To optimise the system's performance, governance and accountability mechanisms are necessary to be put in place under the auspices of national public health agency. Pakistan has the potential to transform its health system by addressing these critical areas and improve its preparedness and readiness for any future health emergency of this scale., (© 2024 John Wiley & Sons Ltd.)

The Africa Centers for Disease Control and Prevention declared mpox a Public Health Emergency of Continental Security (PHECS) in Africa. African public health systems have moved to mobilize a response against a backdrop of inherent significant challenges. With this commentary, we discuss how lessons from past public health emergencies, particularly COVID-19 and Ebola outbreaks, have prepared the region for improved disease surveillance, rapid response strategies, and effective public health communication and how these lessons can be applied to the mpox response, emphasizing the importance of strong healthcare infrastructure, effective data sharing, community engagement, targeted interventions, and robust contact tracing. Additionally, addressing misinformation and building public trust are crucial for controlling the spread of any disease. By leveraging these strategies, African countries can enhance their response to mpox. This includes improving diagnostic capabilities, strengthening cross-border collaborations, and prioritizing vaccination campaigns where needed. Ultimately, by applying the hard-earned lessons from the COVID-19 pandemic and Ebola outbreak, the East Africa region can better address the challenges posed by mpox and safeguard public health.

Background: The attainment of global health security goals and universal health coverage will remain a mirage unless African health systems are adequately funded to improve resilience to public health emergencies. The COVID-19 pandemic exposed the global inequity in accessing medical countermeasures, leaving African countries far behind. As we anticipate the next pandemic, improving investments in health systems to adequately finance pandemic prevention, preparedness, and response (PPPR) promptly, ensuring equity and access to medical countermeasures, is crucial. In this article, we analyze the African and global pandemic financing initiatives and put ways forward for policymakers and the global health community to consider., Methods: This article is based on a rapid literature review and desk review of various PPPR financing mechanisms in Africa and globally. Consultation of leaders and experts in the area and scrutinization of various related meeting reports and decisions have been carried out., Main Text: The African Union (AU) has demonstrated various innovative financing mechanisms to mitigate the impacts of public health emergencies in the continent. To improve equal access to the COVID-19 medical countermeasures, the AU launched Africa Medical Supplies Platform (AMSP) and Africa Vaccine Acquisition Trust (AVAT). These financing initiatives were instrumental in mitigating the impacts of COVID-19 and their lessons can be capitalized as we make efforts for PPPR. The COVID-19 Response Fund, subsequently converted into the African Epidemics Fund (AEF), is another innovative financing mechanism to ensure sustainable and self-reliant PPPR efforts. The global initiatives for financing PPPR include the Pandemic Emergency Financing Facility (PEF) and the Pandemic Fund. The PEF was criticized for its inadequacy in building resilient health systems, primarily because the fund ignored the prevention and preparedness items. The Pandemic Fund is also being criticized for its suboptimal emphasis on the response aspect of the pandemic and non-inclusive governance structure., Conclusions: To ensure optimal financing for PPPR, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR, make regional financing mechanisms central to global PPPR financing efforts, and ensure the inclusivity of international finance governance systems., (© 2024. The Author(s).)

Background: Heterogeneity in national SARS-CoV-2 infection surveillance capabilities may compromise global enumeration and tracking of COVID-19 cases and deaths and bias analyses of the pandemic's tolls. Taking account of heterogeneity in data completeness may thus help clarify analyses of the relationship between COVID-19 outcomes and standard preparedness measures., Methods: We examined country-level associations of pandemic preparedness capacities inventories, from the Global Health Security (GHS) Index and Joint External Evaluation (JEE), on SARS-CoV-2 infection and COVID-19 death data completion rates adjusted for income. Analyses were stratified by 100, 100-300, 300-500, and 500-700 days after the first reported case in each country. We subsequently reevaluated the relationship of pandemic preparedness on SARS-CoV-2 infection and age-standardized COVID-19 death rates adjusted for cross-country differentials in data completeness during the pre-vaccine era., Results: Every 10% increase in the GHS Index was associated with a 14.9% (95% confidence interval 8.34-21.8%) increase in SARS-CoV-2 infection completion rate and a 10.6% (5.91-15.4%) increase in the death completion rate during the entire observation period. Disease prevention (infections: β = 1.08 [1.05-1.10], deaths: β = 1.05 [1.04-1.07]), detection (infections: β = 1.04 [1.01-1.06], deaths: β = 1.03 [1.01-1.05]), response (infections: β = 1.06 [1.00-1.13], deaths: β = 1.05 [1.00-1.10]), health system (infections: β = 1.06 [1.03-1.10], deaths: β = 1.05 [1.03-1.07]), and risk environment (infections: β = 1.27 [1.15-1.41], deaths: β = 1.15 [1.08-1.23]) were associated with both data completeness outcomes. Effect sizes of GHS Index on infection completion (Low income: β = 1.18 [1.04-1.34], Lower Middle income: β = 1.41 [1.16-1.71]) and death completion rates (Low income: β = 1.19 [1.09-1.31], Lower Middle income: β = 1.25 [1.10-1.43]) were largest in LMICs. After adjustment for cross-country differences in data completeness, each 10% increase in the GHS Index was associated with a 13.5% (4.80-21.4%) decrease in SARS-CoV-2 infection rate at 100 days and a 9.10 (1.07-16.5%) decrease at 300 days. For age-standardized COVID-19 death rates, each 10% increase in the GHS Index was with a 15.7% (5.19-25.0%) decrease at 100 days and a 10.3% (- 0.00-19.5%) decrease at 300 days., Conclusions: Results support the pre-pandemic hypothesis that countries with greater pandemic preparedness capacities have larger SARS-CoV-2 infection and mortality data completeness rates and lower COVID-19 disease burdens. More high-quality data of COVID-19 impact based on direct measurement are needed., (© 2024. The Author(s).)

The crowded global health landscape has been joined by the European Union Health Emergency Preparedness and Response Authority (HERA). HERA will assume four broad areas of responsibility: horizon scanning for major health threats; research and development; support for capacity to manufacture drugs, vaccines, and equipment; and procuring and stockpiling key medical countermeasures. In this Health Reform Monitor article, we outline the reform process and describe HERA's structure and responsibilities, explore issues that arise from the creation of this new organisation, and suggest options for collaboration with existing bodies in Europe and beyond. The COVID-19 pandemic and other infectious disease outbreaks have shown the need to treat health as a cross-border issue, and there is now a broad consensus that greater direction and coordination at the European level is needed. This ambition has been matched with a considerable increase in EU funding to tackle cross-border health threats, and HERA can be used to deploy this funding in an effective manner. Yet this is contingent upon clearly defining its role and responsibilities vis-à-vis existing agencies to reduce redundancies., Competing Interests: Declaration of Competing Interest A grant from the World Health Organization Regional Office for Europe supported Dr Wouters. Dr McKee reports being Research Director of the European Observatory on Health Systems and Policies. No other disclosures were reported., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Several stakeholders assumed different responsibilities for global health security and safety during the COVID-19 pandemic. This study aims to highlight how the Tanzanian government, in collaboration with the international government, non-governmental organizations (NGOs), donor agencies, and stakeholders responded to the pandemic to improve health security and community well-being. This article analyzed secondary data sources from the World Health Organization's (WHO) country report and published reports from Tanzania's government to evaluate vaccine availability and health security. Findings from the data gathered indicate that the initial response from the Tanzanian government concerning the fight against the COVID-19 pandemic was rather abysmal due to the posture of the late President John Pombe Magufuli who at first downplayed the severity and seriousness of the COVID-19 pandemic. However, with the swearing-in of the new President, Samia Suluhu, there was a new approach and strategy instituted to deal with the pandemic which has resulted in the country making headway in containing the pandemic. Data gathered thus, indicate that, as of 11 th February 2022, the total number of fully vaccinated individuals in the country as of 12th April 2022 stood at 3,435,513 from the total number of 2,205,815 reported on 11 th February 2022. This study thus, concludes that there is a need for a strong stakeholder engagement with high-level political, community, and religious leaders and increased access to COVID-19 vaccination as well as a mass campaign to scale up vaccination activities with adequate resource mobilization and plan., (© 2023. The Author(s).)

This paper evaluates global health responses to the COVID-19 pandemic through the 'two regimes of global health' framework. This framework juxtaposes global health security, which contains the threat of emerging diseases to wealthy states, with humanitarian biomedicine, which emphasises neglected diseases and equitable access to treatments. To what extent did the security/access divide characterise the response to COVID-19? Did global health frames evolve during the pandemic?Analysis focused on public statements from the World Health Organization (WHO), the humanitarian nonprofit Médecins Sans Frontières (MSF), and the American Centers for Disease Control and Prevention (CDC). Following a content analysis of 486 documents released in the first two years of the pandemic, the research yielded three findings. First, the CDC and MSF affirmed the framework; they exemplified the security/access divide, with the CDC containing threats to Americans and MSF addressing the plight of vulnerable populations. Second, surprisingly, despite its reputation as a central actor in global health security, the WHO articulated both regime priorities and, third, after the initial outbreak, it began to favour humanitarianism. For the WHO, security remained, but was reconfigured: instead of traditional security, global human health security was emphasised - collective wellbeing was rooted in access and equity.

Kenya's Ministry of Health (MOH) and the US Centers for Disease Control and Prevention in Kenya (CDC Kenya) have maintained a 40-year partnership during which measures were implemented to prevent, detect, and respond to disease threats. During the COVID-19 pandemic, the MOH and CDC Kenya rapidly responded to mitigate disease impact on Kenya's 52 million residents. We describe activities undertaken jointly by the MOH and CDC Kenya that lessened the effects of COVID-19 during 5 epidemic waves from March through December 2021. Activities included establishing national and county-level emergency operations centers and implementing workforce development and deployment, infection prevention and control training, laboratory diagnostic advancement, enhanced surveillance, and information management. The COVID-19 pandemic provided fresh impetus for the government of Kenya to establish a national public health institute, launched in January 2022, to consolidate its public health activities and counter COVID-19 and future infectious, vaccine-preventable, and emerging zoonotic diseases.

We documented the contributions of Field Epidemiology Training Program (FETP) trainees and graduates to global COVID-19 preparedness and response efforts. During February-July 2021, we conducted surveys designed in accordance with the World Health Organization's COVID-19 Strategic Preparedness and Response Plan. We quantified trainee and graduate engagement in responses and identified themes through qualitative analysis of activity descriptions. Thirty-two programs with 2,300 trainees and 7,372 graduates reported near-universal engagement across response activities, particularly those aligned with the FETP curriculum. Graduates were more frequently engaged than were trainees in pandemic response activities. Common themes in the activity descriptions were epidemiology and surveillance, leading risk communication, monitoring and assessment, managing logistics and operations, training and capacity building, and developing guidelines and protocols. We describe continued FETP contributions to the response. Findings indicate the wide-ranging utility of FETPs to strengthen countries' emergency response capacity, furthering global health security.

Noncommunicable diseases (NCDs) are the leading cause of death in the world, and 80% of all NCD deaths occur in low- and middle-income countries (LMICs). The COVID-19 pandemic has demonstrated that patients with NCDs are at increased risk of becoming severely ill from the virus. Disproportionate investment in vertical health programs can result in health systems vulnerable to collapse when resources are strained, such as during pandemics. Although NCDs are largely preventable, globally there is underinvestment in efforts to address them. Integrating health systems to collectively address NCDs and infectious diseases through a wide range of services in a comprehensive manner reduces the economic burden of healthcare and strengthens the healthcare system. Health system resiliency is essential for health security. In this article, we provide an economically sound approach to incorporating NCDs into routine healthcare services in LMICs through improved alignment of institutions that support prevention and control of both NCDs and infectious diseases. Examples from Zambia's multisector interventions to develop and support a national NCD action plan can inform and encourage LMIC countries to invest in systems integration to reduce the social and economic burden of NCDs and infectious diseases.

The International Health Regulations 2005 (IHR) set standards for countries to detect and respond to public health threats such as COVID-19. The US Department of Defense engages with partner nations to build IHR-related health security capacities. In this article, we compare 2 elements of the IHR Monitoring and Evaluation Framework to determine if they align in a useful way. The version of the State Party Self-Assessment Annual Reporting (SPAR) tool used for this study is a self-assessment of 13 capacities, while the Joint External Evaluation (JEE) requires collaboration with international subject matter experts to evaluate 19 capacities. The SPAR indicators are scored separately from 0% to 100%, whereas the JEE uses a rank-ordered scale from 1 to 5 for variable numbers of indicators in each capacity. Using 2018-2019 data from the World Health Organization, we quantitatively and qualitatively evaluated the alignment of the SPAR and JEE scoring systems, using paired t tests for related capacities and 3 approaches to matching the scales. Whether using a simple, evenly divided scale for the SPAR or downscaling the SPAR scores to match with lower JEE scores, the paired t tests indicate that the JEE and SPAR scoring systems are not aligned. Many of the capacities in the JEE and SPAR are defined differently, pointing to one of the reasons for the discordance. We discuss implications for revision of the JEE and SPAR assessment tools along with ways in which the scores might be used for planning global health engagement capacity-building activities.

Background: Health systems responsiveness is the key to addressing infectious disease threats such as pandemics. The paper outlines an assessment of health systems resilience by exploring the association of health systems and Global Health Security (GHS) parameters with case load and mortality resulting from COVID-19 across 203 countries using an ecological design., Methodology: Correlation analysis was performed to assess the relationship of each of the indicators with COVID 19 cases and deaths per million population. Stepwise multiple regression models were developed to determine the predictors of COVID-19 cumulative cases and deaths per million population separately., Results: Global health security indicators seemed to have a strong association when analyzed individually but those did not necessarily translate into less burden of cases or deaths in the multivariable analysis. The predictors of cumulative deaths per million population included general government expenditure on health as a proportion of general government expenditure, responsiveness of the system to prevent the emergence and release of pathogens and governance related voice and accountability., Conclusion: To conclude, health financing parameters and preventive activities with regard to emergence of pathogens were better predictors of cumulative COVID-19 cases and deaths per million population compared to other health systems and global health security indicators., (© 2022. The Author(s).)

The COVID-19 pandemic has demonstrated the devastating impact of infectious disease outbreaks and the threat of emerging and re-emerging dangerous pathogens, independent of their origin. Natural, accidental, and deliberate disease outbreaks all need systems in place for an effective public health response. The best known international instrument in the field of public health is the WHO International Health Regulations (2005). Although the International Health Regulations are mainly focused on natural disease outbreaks, the actions to take to comply with them also contribute to biosecurity and non-proliferation. This paper examines in case of full implementation of the International Health Regulations, what other actions states should take to comply with international biosecurity instruments, including the Biological and Toxin Weapons Convention and United Nations Security Council Resolution 1540, to effectively prevent and defend against intentional biological threats. An overview of international instruments from different disciplines regarding biosecurity is presented. Furthermore, this paper clarifies the similarities between the international biosecurity instruments and addresses the additional requirements that instruments stipulate. From a detailed comparison between the instruments it can be concluded that, to adhere to all legally-binding international biosecurity instruments, specific non-proliferation and export control measures are necessary in addition to full implementation of the International Health Regulations. Additionally, an overview of non-legally binding instruments in the field of biosecurity is presented and practical implementation examples are highlighted. Compliance with legally binding instruments can be improved by precise guidance provided by non-legally binding instruments that are clear and attuned to the situation on the ground. To improve understanding of the existing international instruments, this paper aims to provide an overview of the international legal biosecurity framework to biosecurity experts, policymakers, civil servants, and practitioners. It offers possible practical applications for the politico-legal context and accommodates the enhancement of full employment of biosecurity resources for an improved multidisciplinary capacity to prevent, detect, and respond to infectious disease outbreaks., Competing Interests: MB was employed by ENCO Consulting. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Vennis, Boskovic, Bleijs and Rutjes.)

Background: The shift in the global burden of disease from communicable to noncommunicable was a factor in mobilizing support for a broader post-Millennium Development Goals (MDGs) health agenda. To curb these and other global health problems, 193 Member States of the United Nations (UN) became signatories of the Sustainable Development Goals (SDGs) and committed to achieving universal health coverage (UHC) by 2030. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the importance of health systems governance (HSG) is felt now more than ever for addressing the pandemic and continuing to provide essential health services. However, little is known about the successes and challenges of HSG with respect to UHC and health security. This study, therefore, aims to synthesize the evidence and identify successes and challenges of HSG towards UHC and health security., Methods: We conducted a structured narrative review of studies published through 28 July 2021. We searched the existing literature using three databases: PubMed, Scopus and Web of Science. Search terms included three themes: HSG, UHC and health security. We synthesized the findings using the five core functions of HSG: policy formulation and strategic plans; intelligence; regulation; collaboration and coalition; and accountability., Results: A total of 58 articles were included in the final review. We identified that context-specific health policy and health financing modalities helped to speed up the progress towards UHC and health security. Robust health intelligence, intersectoral collaboration and coalition were also essential to combat the pandemic and ensure the delivery of essential health services. On the contrary, execution of a one-size-fits-all HSG approach, lack of healthcare funding, corruption, inadequate health workforce, and weak regulatory and health government policies were major challenges to achieving UHC and health security., Conclusions: Countries, individually and collectively, need strong HSG to speed up the progress towards UHC and health security. Decentralization of health services to grass root levels, support of stakeholders, fair contribution and distribution of resources are essential to support the implementation of programmes towards UHC and health security. It is also vital to ensure independent regulatory accreditation of organizations in the health system and to integrate quality- and equity-related health service indicators into the national social protection monitoring and evaluation system; these will speed up the progress towards UHC and health security., (© 2022. The Author(s).)

Public health emergencies can arise from a wide range of causes, one of which includes outbreaks of contagion. The world has continued to be threatened by various infectious outbreaks of different types that have global consequences. While all pandemics are unique in their level of transmission and breadth of impact, the 2019 coronavirus disease (COVID-19) pandemic is the deepest global crisis of the 21st century, which has affected nearly every country globally. Yet, going forward, there will be a continued need for global health security resources to protect people around the world against increasing infectious disease outbreaks frequency and intensity. Pandemic response policies and processes all need to be trusted for effective and ethical pandemic response. As the world can learn during the past few years about frequent infectious disease outbreaks, (these) diseases respect no borders, and, therefore, our spirit of solidarity must respect no borders in our efforts to stop the ongoing COVID-19 pandemic and be better prepared to respond effectively to a health crisis in the future.

As the world looks forward to turning a corner in the face of the COVID-19 pandemic, it becomes increasingly evident that international research cooperation and dialogue is necessary to end this global catastrophe. Last year, we initiated a research topic: "Infectious Disease Surveillance: Cooperative Research in Response to Recent Outbreaks, Including COVID-19," which aimed at featuring manuscripts focused on the essential link between surveillance and cooperative research for emerging and endemic diseases, and highlighting scientific partnerships in countries under-represented in the scientific literature. Here we recognize the body of work published from our manuscript call that resulted in over 50 published papers. This current analysis describes articles and authors from a variety of funded and unfunded international sources. The work exemplifies successful research and publications which are frequently cooperative, and may serve as a basis to model further global scientific engagements., Competing Interests: FP was employed by the company EpiPointe, LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Parekh, Hay, Tabynov, Hewson, Fair, Essbauer and Yeh.)

The current COVID-19 pandemic demonstrates the need for urgent and on-demand solutions to provide diagnostics, treatment and preventative measures for infectious disease outbreaks. Once solutions are developed, meeting capacities depends on the ability to mitigate technical, logistical and production issues. While it is difficult to predict the next outbreak, augmenting investments in preparedness, such as infectious disease surveillance, is far more effective than mustering last-minute response funds. Bringing research outputs into practice sooner rather than later is part of an agile approach to pivot and deliver solutions. Cooperative multi- country research programs, especially those funded by global biosecurity programs, develop capacity that can be applied to infectious disease surveillance and research that enhances detection, identification, and response to emerging and re-emerging pathogens with epidemic or pandemic potential. Moreover, these programs enhance trust building among partners, which is essential because setting expectation and commitment are required for successful research and training. Measuring research outputs, evaluating outcomes and justifying continual investments are essential but not straightforward. Lessons learned include those related to reducing biological threats and maturing capabilities for national laboratory diagnostics strategy and related health systems. Challenges, such as growing networks, promoting scientific transparency, data and material sharing, sustaining funds and developing research strategies remain to be fully resolved. Here, experiences from several programs highlight successful partnerships that provide ways forward to address the next outbreak., Competing Interests: FP was employed by the company EpiPointe, LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Yeh, Parekh, Tabynov, Tabynov, Hewson, Fair, Essbauer and Hay.)

The world is confronted by the current pandemic of Corona Virus Disease (COVID-19), which is a wake-up call for all nations irrespective of their development status or geographical location. Since the start of the century we have seen five big infectious outbreaks which proved that epidemics are no more regarded as historic and geographically confined threats. The Canadian government underlined that these infectious disease outbreaks are threats to global health security and disrupt societal wellbeing and development. In this context, the Public Health Agency of Canada is proactive and has shown its preparedness for outbreaks of emerging and epidemic-prone diseases, and in dealing with these pathogens. Even before the declaration of pandemic, Canada has proved its global health leadership by ensuring collective action and multisectoral coordination which still remains a serious challenge especially for low and middle- income countries with existing poor health systems. In this article we discuss how Canada is addressing the global challenges posed by the COVID-19 pandemic through its leadership and practice of global health diplomacy., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Examining the impact of the coronavirus pandemic on armed forces development, this article compares and contrasts the employment of six European armed forces in their efforts to provide emergency assistance to their respective governments between the first wave of COVID-19 infections from February 2020 and the fifth wave during the winter of 2021-2022. We present a comparative analysis and classification of the tasks undertaken by French, Austrian, Italian, British, German, and Swiss soldiers in health, logistics, and security. We find that a pandemic did not figure prominently in codified security policy and military doctrine before 2020. Additionally, we illustrate that the armed forces were used as a flexible go-to resource while containing COVID-19. Their employment meant a decrease in operational readiness leading to a withdrawal of soldiers in ongoing operations as well as the cancellation of exercises. [ABSTRACT FROM AUTHOR]

This study investigates the link between tourist flows to and from China and the COVID-19 death rate. This includes the moderating influence of the quality of health security in the underlying relationship. Bilateral tourist flows data to and from China to 152 countries are used for the empirical analysis. The results show that tourist flows to and from China are associated with a higher COVID-19 death rate. This suggests that international tourism flow is one of the major conduits for the transmission of COVID-19 across borders, especially at the initial stage of the pandemic. Furthermore, the results show that countries with stronger health security capabilities are better at reducing COVID-19 death rates even when they attract a higher number of tourist inflows from China or when they register a higher number of tourist flows to China. Governments, especially in countries that are more globally connected through international tourism, should consider using some share of the economic stimulus funds to enhance health capabilities to deal with the COVID-19 pandemic as well as potential future pandemics. [ABSTRACT FROM AUTHOR]

"Global Commissions of Inquiry" have usually been associated with the multilateral initiatives of governments and international organizations. However, various styles of "global commission" have emerged over time. During the COVID-19 pandemic, global commissions have been a key aspect of the COVID-19 international policy landscape, quickly emerging, in 2020 and 2021, to corral knowledge and evidence. These include "formal" commissions, such as the Independent Panel for Pandemic Preparedness and Response and the Global Commission for Post-Pandemic Policy, and "informal" commissions, including the Reform for Resilience and The Lancet Covid Commissions. This paper considers whether these Commissions have been engines for new ideas and global policy knowledge or whether this "chorus" of COVID Commissions represented a "clutter" of ideas at a time when global policy focus was needed. Global Commissions, in general, deserve greater scholarly attention to their design and the construction of their legitimate authority as hybrid and private commissions enter global policy making alongside official commissions. [ABSTRACT FROM AUTHOR]

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.

Emerging infectious diseases have had a significant impact on the Asia-Pacific region in recent years, including a severe acute respiratory syndrome outbreak that occurred in 2002-2003, which had a substantial impact on several Asia-Pacific economies, the outbreak of highly pathogenic Asian avian influenza A (H5N1) that followed in 2006, strains of H1N1, and Middle East respiratory syndrome (MERS). There is an increasing frequency and impact of emerging infectious diseases (EID), as demonstrated by the current global outbreak of COVID-19 (coronavirus disease 2019). The Asia-Pacific region is particularly vulnerable to the spread of EID across national borders. In collaboration with the Ministry of Health of the Republic of Indonesia, the Asia Pacific Economic Cooperation (APEC) Health Working Group conducted an International Workshop on Managing Emerging Infectious Diseases (MEID) in Jakarta, Indonesia, on 12–16 September 2022. The workshop focused on a lesson-learning approach and aimed to strengthen global and domestic preparedness for the next pandemic. Four key lessons can be drawn from the APEC region's COVID-19 pandemic. First, zoonotic outbreaks threaten health security, making One Health an urgent necessity. Secondly, collaboration and partnership are essential to combating the pandemic. Thirdly, decisive leadership is essential at all global and local levels. Finally, risk communication builds trust and acknowledges uncertainty during a crisis. These lessons could strengthen the evidence base for regional policy responses and better responses to future threats.

Abstract On May 21, 2020, the Harvard Program in Global Surgery and Social Change (PGSSC) hosted a webinar as part of the Harvard Medical School Department of Global Health and Social Medicine’s COVID-19 webinar series. The goal of PGSSC’s virtual webinar was to share the experiences of surgical, anesthesia, and obstetric (SAO) providers on the frontlines of the COVID pandemic, from both high-income countries (HICs), such as the United States and the United Kingdom, as well as low- and middle-income countries (LMICs). Providers shared not only their experiences delivering SAO care during this global pandemic, but also solutions and innovations they and their colleagues developed to address these new challenges. Additionally, the seminar explored the relationship between surgery and health system strengthening and pandemic preparedness, and outlined the way forward, including a roadmap for prioritization and investment in surgical system strengthening. Throughout the discussion, other themes emerged as well, such as the definition of elective surgery and its implications during a persistent global pandemic, the safe and ethical reintroduction of surgical services, and the social inequities exposed by the stress placed on health systems by COVID-19. These proceedings document the perspectives shared by participants through their invited lectures as well as through the panel discussion at the end of the seminar.

During health emergencies, neglect of gender experiences and needs can compromise the outbreak response. Ebola in West Africa and Zika in Latin America had gendered effects that were evident during the crises, yet governments and international organizations failed to prioritize a gender-inclusive response. There is the same risk that gender-inclusive responses and knowledge will continue to be neglected during the COVID-19 pandemic. In this article, we examine the drivers of gender exclusion in health emergency response. We ask: where can we locate institutional responsibility for taking gender seriously to inform and improve sustainable disease control? The article addresses this question by turning to feminist institutional theory to explain why gender inclusion in decision-making processes is vital for effective response and post-crisis recovery. We argue that the institutional responsibility to recognize gender within the global health emergency regime lies with the World Health Organization (WHO). WHO has neglected to mainstream gender in the policies and practices that it promotes for the prevention and detection of, and response to, infectious disease outbreaks. WHO is in a position to support gender-inclusive practices, but this requires the technical agency to recognize the value of having a gender-inclusive framework to inform outbreak response, financial models, and recovery. [ABSTRACT FROM AUTHOR]

The costs of responding and mitigating the COVID-19 pandemic is a critical example of the need for continual investment for global health security (GHS) preparedness in today’s inter-connected world as exemplified earlier with Ebola, Zika, and H1N1. Microbial diversity including endemic and emerging infectious diseases unique to Latin America are well known. When combined with geopolitical, socioeconomic, and environmental factors, especially climate change and human migration, which are expanding the range of disease vectors and pathogens, the risk for infectious disease outbreaks greatly increases. Enhancing GHS requires a greater awareness and cooperation within the region as well as more effective infectious disease surveillance systems. Frameworks such as the International Health Regulations and Global Health Security Agenda underpin policies to strengthen health systems. Greater international cooperation aimed to effectively enhance infectious disease surveillance are pivotal to increasing trust among partner countries and strengthen health security systems and best practices to respond and mitigate infectious disease outbreaks. Here we discuss infectious disease threats and risks associated with the current socioeconomic and political climate that influence GHS in order to demonstrate the need for further investment.

During the COVID-19 pandemic, trade measures are popular to countries to secure and strengthen the health care system's capacity. Subsidies are one of the trade measures to boost the production of medical products and build up the domestic supply chain. The article explores the legality of a subsidy responding pandemics under the framework of the Agreement on Subsidies and Countervailing Measures (hereinafter "SCM Agreement"). The analyses reveal that the uncertainty inherent to pandemic responses does not automatically exempt governments' financial contributions from the governance of the SCM Agreement. Two solutions are proposed to reserve policy space for public health subsidies. One is to reconsider the relevance of the precautionary principle in interpretation of the SCM Agreement; another is to reflect the balancing policy in the SCM Agreement. A point central to the two solutions is harmonizing the international trade governance and global health governance in response to pandemics. Besides, the article highlights the role of regional governance in managing the emergency supply-demand imbalance caused by public health threats and exploring new subsidy rules. [ABSTRACT FROM AUTHOR]

Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Although the World Health Organization (WHO) has required all states parties to strengthen core capacities to respond to public health emergencies under the International Health Regulations (2005), the actions of most countries to combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This cross-sectional study aimed to examine the health system resilience of selected countries and analyze their strategies and measures in response to the COVID-19 pandemic. Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K., and the U.S., based on the severity of the national epidemic, the geographical location, and the development level. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure the severity of the impact of the pandemic in each country; WHO State Parties Self-Assessment Annual Reporting (SPAR) Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience; and research articles and press materials were summarized to identify the strategies and measures adopted by countries during response to COVID-19. This study applied the resilient health systems framework to analyze health system resilience in the selected countries from five dimensions, including awareness, diversity, self-regulation, integration and adaptation. Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and the U.S. were above the global and regional averages; the SPAR Scores of Iran were above the global average while the GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. invested more health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategy of extensive testing and identification of suspected patients. In terms of specific measures, all the five countries adopted measures such as restrictions on entry and international travel, closure of schools and industries, lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied across countries, based on the response strategies. Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparedness and response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries still do not build resilient health systems in response to public health emergencies. Health system strengthening and health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach to developing resilient health systems.

The importance of global health security on pandemic prevention, preparedness and response, adopted within the World Health Organization, was emphasized. The need for an international agreement between the countries to combat pandemics was presented. The agreement will set out the objectives and basic principles for structuring the necessary collective action to combat pandemics. The need for close cooperation between all countries to achieve global health security goals was emphasized. [ABSTRACT FROM AUTHOR]

The costs of responding and mitigating the COVID-19 pandemic is a critical example of the need for continual investment for global health security (GHS) preparedness in today's inter-connected world as exemplified earlier with Ebola, Zika, and H1N1. Microbial diversity including endemic and emerging infectious diseases unique to Latin America are well known. When combined with geopolitical, socioeconomic, and environmental factors, especially climate change and human migration, which are expanding the range of disease vectors and pathogens, the risk for infectious disease outbreaks greatly increases. Enhancing GHS requires a greater awareness and cooperation within the region as well as more effective infectious disease surveillance systems. Frameworks such as the International Health Regulations and Global Health Security Agenda underpin policies to strengthen health systems. Greater international cooperation aimed to effectively enhance infectious disease surveillance are pivotal to increasing trust among partner countries and strengthen health security systems and best practices to respond and mitigate infectious disease outbreaks. Here we discuss infectious disease threats and risks associated with the current socioeconomic and political climate that influence GHS in order to demonstrate the need for further investment. [ABSTRACT FROM AUTHOR]

SARS-CoV-2, a betacoronavirus of likely zoonotic origin, was first reported in December 2019. Its rapid worldwide spread precipitated a range of interventions, including by veterinarians, due to impacts on human health and well-being as well as animal health and welfare. We conducted 36 key informant interviews to explore the responses of Australian veterinarians, their engagement in One Health collaboration and cooperation, and their existing and developed insights to the COVID-19 pandemic. Responses were analysed using thematic analysis. Australian veterinarians provided valuable contributions to the national COVID-19 response by protecting animal welfare, maintaining local food security, providing essential veterinary services while mitigating human health risks in clinical settings and providing both key skills and surge capacity to the human health response. This was all guided by skills in scientific literacy and evidence-based communication. Informants identified a clear and urgent need for greater One Health coordination during pandemic prevention, preparedness, and response, even in the case of a disease which largely only affects humans.

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On May 21, 2020, the Harvard Program in Global Surgery and Social Change (PGSSC) hosted a webinar as part of the Harvard Medical School Department of Global Health and Social Medicine's COVID-19 webinar series. The goal of PGSSC's virtual webinar was to share the experiences of surgical, anesthesia, and obstetric (SAO) providers on the frontlines of the COVID pandemic, from both high-income countries (HICs), such as the United States and the United Kingdom, as well as low- and middle-income countries (LMICs). Providers shared not only their experiences delivering SAO care during this global pandemic, but also solutions and innovations they and their colleagues developed to address these new challenges. Additionally, the seminar explored the relationship between surgery and health system strengthening and pandemic preparedness, and outlined the way forward, including a roadmap for prioritization and investment in surgical system strengthening. Throughout the discussion, other themes emerged as well, such as the definition of elective surgery and its implications during a persistent global pandemic, the safe and ethical reintroduction of surgical services, and the social inequities exposed by the stress placed on health systems by COVID-19. These proceedings document the perspectives shared by participants through their invited lectures as well as through the panel discussion at the end of the seminar. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been shaped by preexisting political, social, and economic relations and governance structures, and will remold these structures going forward. This review essay considers three books on global health politics written by Simon Rushton, Clare Wenham, and Jeremy Youde. Here, I explore what these books collectively and individually can tell us about these preexisting dynamics, the events of the first eighteen months of the COVID-19 pandemic, and possible future directions in the politics of global health. I argue that they provide a firm basis for understanding the inequitable burdens of the pandemic, while juxtaposing these inequities against the narratives of shared vulnerability that sit at the heart of the global health security regime. They also help us make sense of the surveillance, detection, containment, and response mechanisms we have seen during the pandemic; the failures to address the systemic dynamics that drive disease outbreaks; and the national and international politics that have shaped the pandemic response. However, COVID-19 has also vividly and brutally demonstrated how global health hierarchies, racism, border politics, and neoliberal forms of knowledge production have led to a stratified burden of the pandemic. These areas are less apparent in the three books, but ought to be situated front and center in future critical scholarship on global health security. [ABSTRACT FROM AUTHOR]

Cyber-attacks against hospitals, medical devices, and healthcare entities are becoming increasingly common; simultaneously, physical attacks against hospitals and healthcare entities are increasing. The purpose of this article is to explore the threat to healthcare from cyber-attacks. We undertake qualitative analysis of current and past cyber-attacks on healthcare system and look at these in the context of the increase in non-traditional threats. We conclude that there is a current and systemic threat to the healthcare sector from cyber-attacks by nation state and criminal groups, which is not currently being addressed in a systematic manner. Finally, we conclude that further discussion on key issues such as legislation and regulatory frameworks needs to take place at both a policy and practitioner level.

The COVID-19 pandemic is not just a health crisis – it is a full-blown economic and social crisis that is impacting the lives and livelihoods of billions of people. This commentary examines the mutually dependent relationship between health security and universal health coverage (UHC), and how the longstanding underinvestment in both renders us all vulnerable. It also discusses the vulnerability of services for sexual and reproductive health and rights (SRHR) in times of crisis, which is compounded when these services are not included and well integrated into national UHC packages. It concludes with a call for stronger political leadership for UHC and SRHR as the global community strives to “build back better” after COVID-19.

Cyber-attacks against hospitals, medical devices, and healthcare entities are becoming increasingly common; simultaneously, physical attacks against hospitals and healthcare entities are increasing. The purpose of this article is to explore the threat to healthcare from cyber-attacks. We undertake qualitative analysis of current and past cyber-attacks on healthcare system and look at these in the context of the increase in non-traditional threats. We conclude that there is a current and systemic threat to the healthcare sector from cyber-attacks by nation state and criminal groups, which is not currently being addressed in a systematic manner. Finally, we conclude that further discussion on key issues such as legislation and regulatory frameworks needs to take place at both a policy and practitioner level. [ABSTRACT FROM AUTHOR]

The response to COVID-19 demonstrates an inclusive and dispersed form of global health security that is less reliant on the UN Security Council or the World Health Organization (WHO). While WHO remains central to fighting the pandemic, the dispersed global health security addressing the crisis is inclusive of the wider UN system, civil society, and epistemic communities in global health. As part of the special issue on "The United Nations at Seventy-Five: Looking Back to Look Forward," this essay argues that instead of facing crisis or criticism like WHO, this inclusive and dispersed form of global health security provides mechanisms of resilience and support to the UN at the height of global political tensions surrounding COVID-19. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease 2019 (COVID-19) pandemic has rapidly wrought havoc on the world, exposing the gaps in public health systems of countries that were previously considered most prepared for infectious disease outbreaks. Notably, despite being ranked highest on the Global Health Security Index, the United States has been severely hit with nearly two million confirmed cases and one hundred thousand deaths by the end of May 2020. In addition to the public health fragmentation from the federal to the state level and lagging regulations, early reports highlight substantial socioeconomic disparities and health system barriers contributing to the spread and impact of the pandemic in the United States. In this review, we explore the impact of COVID-19 on public health systems by assessing systems through the lens of the Centers for Disease Control and Prevention's Ten Essential Public Health Services. Building on prepandemic and COVID-19 observations and lessons, we propose recommendations moving forward to prepare for future waves and other disease outbreaks. [ABSTRACT FROM AUTHOR]

It is often said that "diseases know no borders," but COVID-19 has once again shown that policy responses certainly do. Governments have implemented bordering practices in a variety of ways to ensure that their own citizens are protected, even when in direct contravention to the International Health Regulations (IHR) of 2005. The IHR and the World Health Organization (WHO) have a strong preference for borders to remain open. Yet, we argue here, non-compliance by WHO member states is not the only problem with the IHR's treatment of borders. Bringing insights from critical border studies and exploring the varied ways in which the response to the COVID-19 crisis has been "bordered," we argue that a much broader understanding of "borders" is required in the IHR and by the WHO, given that much of the exclusionary bordering we find takes place away from physical points of entry. [ABSTRACT FROM AUTHOR]

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