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Rift Valley fever (RVF) is a devastating zoonotic mosquito-borne viral hemorrhagic fever disease that threats human and animal health and biodiversity in Africa, including in Rwanda. RVF is increasingly outbreaking in Africa, leading to devastating impacts on health, socioeconomic stability and growth, and food insecurity in the region, particularly among livestock-dependent communi-ties. This systematic review synthesizes existing evidence on RVF's epidemiology, transmission dynamics, and the prevention and control measures implemented in Rwanda. Our findings high-light the rapidly increasing prevalence of RVF and the expansion of its geographical distribution and host range in Rwanda. Furthermore, the review reveals gaps in local evidence, including the existence of competent vectors of RVFV and the risk factors associated with the emergence and spread of RVF in the country. This underscores the urgent need for prospective research to inform evidence-based health policymaking, strategic planning, and the development and implementation of cost-effective preventive and control measures, including diagnosis and surveillance for early detection and response. It also calls for the institutionalization of a cost-effective, multisectoral, and transdisciplinary One Health strategy for reducing the burden and risk of climate climate-sensitive and zoonotic diseases, including RVF, in the country. We recommend exploring cost-effective human and/or animal vaccination mechanisms for RVF, integrating AI-powered drones into dis-ease vectors surveillance and control, and the routine implementation of genomics-enhanced xenosurveillance to monitor changes in pathogens and vectors dynamics in order to inform poli-cymaking and guide the control interventions. [ABSTRACT FROM AUTHOR]

Objectives: Arboviruses pose a significant global health challenge. This study investigated the seroprevalence of major human arboviral infections, including yellow fever (YFV), dengue (DENV), Crimean-Congo hemorrhagic fever (CCHF), Rift Valley fever (RVF), West Nile virus (WNV), and chikungunya (CHIK), in Darfur region from September to December 2018. ELISA-IgM was used to detect antibodies. RT‒PCR was used to differentiate YFV infection from vaccine-immuno-response in IgM samples. Results: A total of 152 blood samples were collected, with 123 (80.9%) from males and 29 (19.1%) from females. The participants were grouped by age: 50 (32.9%) were under 20 years, 96 (63.2%) were aged 20–45 years, and 6 (3.9%) were over 45 years. The seroprevalence rates for YFV, DENV, and CHIKV were 68 (44.7%), 23 (15.1%), and 5 (3.3%), respectively. There were 11 molecularly-confirmed YFV cases (7.2%). Among these, 3/11 were positive for DENV-IgM, and 1/11 was positive for CHIKV-IgM. Among the 68 YFV-positive individuals, 15 (22.1%) had been exposed to DENV, and 2 (2.9%) had been exposed to CHIKV. Co-exposure to DENV and CHIKV was detected in 3 (1.9%) patients, while 2 (1.3%) patients had triple exposure to YFV, CHIKV, or DENV. No exposure to CCHF, RVFV, or WNV was detected. [ABSTRACT FROM AUTHOR]

Background: An explosion in a Chinese factory in 2016 caused a global shortage of essential broad-spectrum antibiotic piperacillin-tazobactam. Hitherto, no detailed, policy-relevant analysis has been conducted on this major shortage event. Thus, we aimed to (1) investigate causes; (2) describe supply chain challenges; and (3) uncover policy gaps to support possible mitigation actions. Methods: Applying an analytical framework for security of medical supply chains, we investigated the changing roles of Pfizer-led and Chinese API suppliers. We identified demand surge, capacity reduction and co-ordination failures. Triangulating between scientific literature, corporate, and regulatory documents, we analysed the impact of Western and Chinese policy contexts on supply chain resilience. Results: We uncovered 'red flags': geographically dispersed manufacturing failures due to complexity of sterile production; undetected supply chain concentration and interlinkages; and Chinese policy-led API supplier consolidation. We found these warning signals were ignored in the absence of a co-ordinated policy framework to identify and mitigate emerging global supply risks. Firstly, policy makers lacked visibility on growing 'volume dependency' in the chain. Secondly, national policy makers lacked a global view of supply risk. Thirdly, we show antibiotic API manufacturing economics were impacted by a number of non-pharmaceutical policy decisions (e.g. state aid, environmental standards, procurement rules) which contributed to supply chain vulnerability. Conclusions: Our findings suggest possible policy gaps in governance of supply chain resilience. Firstly, disclosure of API suppliers including degree of dependency may better pre-empt bottlenecks, facilitating priority setting for public investments in re-shoring where global API supply currently relies on few, or single plants; secondly, a whole-of-government approach may counter the potential impact of non-pharmaceutical policies on supply chain resilience. Our findings confirm suggestions from previous studies that international data sharing would be beneficial considering the global shortage effects which can emerge from a single point of failure. [ABSTRACT FROM AUTHOR]

In this review, we investigated the genetic diversity and evolutionary dynamics of the Orthomarburgvirus marburgense species that includes both Marburg virus (MARV) and Ravn virus (RAVV). Using sequence data from natural reservoir hosts and human cases reported during outbreaks, we conducted comprehensive analyses to explore the genetic variability, constructing haplotype networks at both the genome and gene levels to elucidate the viral dynamics and evolutionary pathways. Our results revealed distinct evolutionary trajectories for MARV and RAVV, with MARV exhibiting higher adaptability across different ecological regions. MARV showed substantial genetic diversity and evidence of varied evolutionary pressures, suggesting an ability to adapt to diverse environments. In contrast, RAVV demonstrated limited genetic diversity, with no detected recombination events, suggesting evolutionary stability. These differences indicate that, while MARV continues to diversify and adapt across regions, RAVV may be constrained in its evolutionary potential, possibly reflecting differing roles within the viral ecology of the Orthomarburgvirus marburgense species. Our analysis explains the evolutionary mechanisms of these viruses, highlighting that MARV is going through evolutionary adaptation for human-to-human transmission, alarmingly underscoring the global concern about MARV causing the next pandemic. However, further transdisciplinary One Health research is warranted to answer some remaining questions including the host range and genetic susceptibility of domestic and wildlife species as well as the role of the biodiversity network in the disease's ecological dynamics. [ABSTRACT FROM AUTHOR]

Background/Objectives: As we commemorate 50 years of the Expanded Programme on Immunization (EPI), the global mission to eradicate polio stands at a critical juncture. While remarkable progress has been made over the past decades, ensuring a steady supply of polio vaccines remains a significant challenge that could undermine these achievements. This manuscript aims to address the complexities of polio vaccine security within the context of the Immunization Agenda 2030 (IA2030) and the Global Polio Eradication Strategy 2022–2029, proposing actionable strategies to strengthen the vaccine supply. Methods: This manuscript analyzes obstacles to vaccine security, including supply disruptions and market uncertainties. It presents the Polio Vaccine Security Framework as a key strategy for addressing these challenges. Data were gathered from Global Polio Eradication Initiative (GPEI) reports, consultations with key stakeholders, and analyses of past vaccine shortages. Results: The findings indicate that the primary risks to vaccine security include the lack of a coherent long-term policy framework on polio vaccination, the absence of a clear polio vaccine development roadmap, and insufficient long-term, predictable forecasting. Additionally, stronger coordination is needed between stakeholders involved in vaccine supply, polio containment, and research, as well as addressing challenges related to financing and access to resources. Conclusions: A robust, adaptable, and sustainable approach to vaccine security, proposed in the Polio Vaccine Security Framework, is critical to achieving and sustaining polio eradication. Collaboration among policymakers, manufacturers, and stakeholders to implement it is essential to ensure the uninterrupted supply of polio vaccines, protecting the progress made over the past half century, and preventing a resurgence of poliovirus in the future. [ABSTRACT FROM AUTHOR]

Objectives: Marburg virus disease (MVD) is on the WHO list for pandemic-prone pathogens. The current outbreak in Rwanda provides an opportunity to map outbreaks and generate information to inform policymaking, resource mobilization, and guide the implementation of cost-effective response strategies. Methods: We synthesized available information about MVD to build holistic, up-to-date evidence to inform policymakers, public health leaders, and healthcare and public health services providers in their development and implementation of cost-effective preparedness, prevention, and control measures. Results: We have identified 20 outbreaks of MVD that occurred in 14 countries between 1967 and 2024; these outbreaks led to 580 confirmed cases and 423 deaths in total. We summarize the available information about the main clinical signs, diagnostic tools, primary reservoir, transmission dynamics, and case management protocol. We also document the best practices in the prevention and control of MVD outbreaks, including the implementation of a multisectoral One Health strategy for preparedness, prevention, and response to MVD outbreaks that incorporates the strict implementation of WASH and infection prevention measures, contact tracing, and the isolation of infected and suspected humans and animals, and enhances the implementation of the International Health Regulations, particularly efficient cross-country coordination. Conclusions: In the absence of a licensed treatment or vaccine for MVD, the response strategy to MVD should focus on preventive measures, including community engagement to promote the reduction in contact between humans and reservoirs, the supportive care and isolation of patients, and proper waste management. High risk populations such as frontline responders, including healthcare providers and community health workers, should be prioritized so that they can access all currently available protection measures. [ABSTRACT FROM AUTHOR]

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]

Abstract Objectives Disruptive public health risks and events, including infectious disease outbreaks, are inevitable, but their effects can be mitigated by investing in prevention and preparedness. We assessed the epidemic preparedness and response capacities of health systems in 186 countries from 2018 to 2022. Methods We utilized data from the International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submissions to assess health systems’ IHR capacities to (1) prevent, (2) detect, (3) respond, (4) enable resources and coordinate, and (5) ensure operational readiness from 2018 to 2022. We categorized the IHR capacities into five levels, with level 1 denoting the lowest level of national capacity and level 5 the highest. We calculated each index’s capacity level as the arithmetic mean of its related indicators and analyzed changes over time using the Mann–Kendall nonparametric trend test. Results SPAR reporting marginally improved from 92.9% (182 of 196 countries) in 2018 to 94.9% (186 of 196 countries) in 2022, with considerable improvement in all five capacity domains over this period: prevention (58.4 in 2018 to 66.5 in 2022), detection (74.7 to 78.3), response (56.5 to 67.8), enabling resources and coordination (63.0 to 68.3), and ensuring operational readiness (62.8 to 69.9). From the 2022 submissions, 116 (62%) countries reported functional (Level 4 or 5) prevention capacity, 162 (87%) had functional detection capacity, 118 (63%) had functional response capacity, 121 (65%) had functional enabling resources and coordination capacity, and 133 (72%) had functional operational readiness against public health events. Across all the indexes, the WHO African Region reported the fewest countries with functional capacity in these domains. Conclusions There was an overall increase in functional capacity across all five domains at both global and regional levels; and a high percentage of countries achieved functional capacity across all domains in 2022. However, a significant number of countries, particularly in the Global South, have yet to achieve functional competence in these capacities, leaving the world vulnerable to the persistent risk of epidemics and infectious biohazards. Strengthening IHR competencies through local, national, and global engagements must be urgently prioritized to achieve global health security against infectious diseases.

Objectives Infectious diseases present significant challenges to global health security in contemporary, interconnected global environments. This study aimed to evaluate and compare health security performance in Western Asia (WA), with a focus on income group-based disparities and region-specific insights. Methods This study utilized the Global Health Security Index (GHSI) to assess health security across 17 WA countries categorized by income level. Health security indicators for 2019 and 2021 were analyzed using the D-CRITIC method to determine the relative importance of each indicator (Global Health Security Index, 2021): https://ghsindex.org/report-model/). A combined D-CRITIC-CoCoSo framework was employed to rank the countries, followed by K-means clustering for grading. The study also investigated correlations between financial allocation’s indicators and health security outcomes using Spearman’s rank correlation. A comparative analysis elucidated regional disparities across income categories. Results This study highlights WA’s progress in health security by prioritizing foundational health systems, detection/reporting, rapid response, and risk management. From 2019 to 2021, priorities varied by income group, with high-income countries focusing on detection, upper-middle-income countries focusing on risk environments, and low-income countries focusing on prevention. While some nations demonstrated improvement, others, such as Armenia, experienced decline, revealing persistent vulnerabilities. This study revealed significant variability in health security capacity, with both progress and setbacks among countries in different clusters. High- and upper-middle-income countries, such as Qatar and Georgia, leverage investments and international partnerships to improve their rankings, while conflict-affected, low-resource countries, including Iraq, Yemen, and Syria, face stagnation or decline. Strong correlations were observed between financial resource allocation indicators and health performance. Higher investments in countries like Armenia and Georgia led to significantly improved health outcomes, while minimal spending in Syria and Yemen weakened their resilience to health threats. Conclusion Disparities in health resilience persist, underscoring the need for equitable resource allocation and regional cooperation to enhance public health security.

Objectives: Disruptive public health risks and events, including infectious disease outbreaks, are inevitable, but their effects can be mitigated by investing in prevention and preparedness. We assessed the epidemic preparedness and response capacities of health systems in 186 countries from 2018 to 2022. Methods: We utilized data from the International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submissions to assess health systems' IHR capacities to (1) prevent, (2) detect, (3) respond, (4) enable resources and coordinate, and (5) ensure operational readiness from 2018 to 2022. We categorized the IHR capacities into five levels, with level 1 denoting the lowest level of national capacity and level 5 the highest. We calculated each index's capacity level as the arithmetic mean of its related indicators and analyzed changes over time using the Mann–Kendall nonparametric trend test. Results: SPAR reporting marginally improved from 92.9% (182 of 196 countries) in 2018 to 94.9% (186 of 196 countries) in 2022, with considerable improvement in all five capacity domains over this period: prevention (58.4 in 2018 to 66.5 in 2022), detection (74.7 to 78.3), response (56.5 to 67.8), enabling resources and coordination (63.0 to 68.3), and ensuring operational readiness (62.8 to 69.9). From the 2022 submissions, 116 (62%) countries reported functional (Level 4 or 5) prevention capacity, 162 (87%) had functional detection capacity, 118 (63%) had functional response capacity, 121 (65%) had functional enabling resources and coordination capacity, and 133 (72%) had functional operational readiness against public health events. Across all the indexes, the WHO African Region reported the fewest countries with functional capacity in these domains. Conclusions: There was an overall increase in functional capacity across all five domains at both global and regional levels; and a high percentage of countries achieved functional capacity across all domains in 2022. However, a significant number of countries, particularly in the Global South, have yet to achieve functional competence in these capacities, leaving the world vulnerable to the persistent risk of epidemics and infectious biohazards. Strengthening IHR competencies through local, national, and global engagements must be urgently prioritized to achieve global health security against infectious diseases. [ABSTRACT FROM AUTHOR]

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response.

Abstract 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.

Abstract This study explored a Bayesian belief networks (BBNs) approach, developing two distinct models for prioritizing the seven indicators related to the “rapid response to and mitigation of the spread of an epidemic” category within the context of both the specific category and the Global Health Security Index (GHS index). Utilizing data from the 2021 GHS index, the methodology involves rigorous preprocessing, the application of the augmented naive Bayes algorithm for structural learning, and k-fold cross-validation. Key findings show unique perspectives in both BBN models. In the mutual value of information analysis, “linking public health and security authorities” emerged as the key predictor for the “rapid response to and mitigation of the spread of an epidemic” category, while “emergency preparedness and response planning” assumed precedence for the GHS index. Sensitivity analysis highlighted the critical role of “emergency preparedness and response planning” and “linking public health and security authorities” in extreme performance states, with “access to communications infrastructure” and “trade and travel restrictions” exhibiting varied significance. The BBN models exhibit high predictive accuracy, achieving 83.3% and 82.3% accuracy for extreme states in “rapid response to and mitigation of the spread of an epidemic” and the GHS index, respectively. This study contributes to the literature on GHS by modeling the dependencies among various indicators of the rapid response dimension of the GHS index and highlighting their relative importance based on the mutual value of information and sensitivity analyses.

Abstract Background The escalating threat of infectious disease outbreaks in Africa, particularly emerging and re-emerging diseases, necessitates urgent and comprehensive action. The frequency of these outbreaks demands a robust enhancement of notification and reporting systems to enable swift public health interventions. Main body of the abstract Tropical diseases such as malaria, COVID-19, typhoid fever, yellow fever, arboviruses, cholera, rabies, schistosomiasis, tuberculosis, black fungus, meningitis, evolving pathogens, and antimicrobial resistance pose significant health risks globally, especially in Sub-Saharan Africa. The region faces complexities in healthcare, including weak systems, inadequate surveillance, socioeconomic disparities, and other issues. Poor health literacy, traditional practices, and distrust hinder effective disease control and contribute to disease emergence in Sub-Saharan Africa. Continuous research and global collaboration are essential to address these public health concerns, especially given Africa's unique challenges. Disease surveillance emerges as a highly effective strategy, crucial in regions vulnerable to infectious diseases. Establishing and strengthening comprehensive surveillance and reporting systems at individual, regional, national, and international levels is crucial due to the unpredictable nature of borderless outbreaks and their significant impact on morbidity, mortality, and economic stability. National surveillance relies heavily on effective control mechanisms within local community areas, necessitating the active involvement of medical personnel. Successful systems depend on functional countries using collected data for timely warnings and localized interventions. Stakeholders, including governments, health authorities, and international organizations, must collaborate urgently to implement and sustain these vital systems, mitigating the devastating consequences of infectious disease outbreaks. Additionally, a holistic approach is crucial, involving prioritized local production of vaccines, medicines, and diagnostics through initiatives like the African Vaccine Producers Initiative. This approach emphasizes the need for domestic pharmaceutical production, intensified public awareness campaigns, and the training of the next generation of global health leaders, ensuring multidimensional strategies, political and diplomatic skills, and evidence-based assessments. Conclusion Collaboration among governments, international organizations, and educational institutions is essential for successful policy advocacy and implementation to strengthen health security and mitigate the continuous rise of infectious diseases on the continent.

Abstract 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.

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. [ABSTRACT FROM AUTHOR]

The need for strengthening national capacities for disease prevention, preparedness, and response is increasingly becoming urgent. Central to this is strengthening existing systems and workforce capacity for disease surveillance and disease outbreak response. This study aimed to evaluate the national capacity and needs of veterinary services in Vietnam in animal disease surveillance and outbreak investigation skills. A cross-sectional, convergent, mixed-methods study was conducted between November 2020 and April 2021. An online questionnaire was administered to government field veterinarians, followed by descriptive and multivariable analyses to understand field capacity, specifically levels of experience in outbreak investigation and animal health surveillance. Semi-structured interviews were conducted with various stakeholders in veterinary services and interview transcripts were coded and thematically analyzed. Qualitative results were used to contextualize quantitative findings from the survey. Overall, 178 field veterinary staff completed the online survey, and 25 stakeholders were interviewed. Eighty percent of respondents reported a high priority for further training in both animal disease surveillance and outbreak investigation. Training and competence were more limited at the district and commune levels, highlighting a gap in capacity at the subnational level. Reasons included a lack of in-depth training opportunities, limited access to resources and high staff turnover. Respondents who completed postgraduate qualifications in epidemiology or Field Epidemiology Training Programs were more likely to have higher levels of experience in animal health surveillance and outbreak investigation. This study identified gaps in knowledge and adoption of practices most often related to local-level or less experienced veterinary staff with limited training opportunities in epidemiology. Findings inform the prioritization of training and planning activities to further enhance the national capacity of veterinary services in Vietnam. Underlying explanations for existing gaps in capacity include inequities in skill development and training opportunities across levels of veterinary staff, gaps in the chain of command and unequal funding across provinces. [ABSTRACT FROM AUTHOR]

This study explored a Bayesian belief networks (BBNs) approach, developing two distinct models for prioritizing the seven indicators related to the "rapid response to and mitigation of the spread of an epidemic" category within the context of both the specific category and the Global Health Security Index (GHS index). Utilizing data from the 2021 GHS index, the methodology involves rigorous preprocessing, the application of the augmented naive Bayes algorithm for structural learning, and k-fold cross-validation. Key findings show unique perspectives in both BBN models. In the mutual value of information analysis, "linking public health and security authorities" emerged as the key predictor for the "rapid response to and mitigation of the spread of an epidemic" category, while "emergency preparedness and response planning" assumed precedence for the GHS index. Sensitivity analysis highlighted the critical role of "emergency preparedness and response planning" and "linking public health and security authorities" in extreme performance states, with "access to communications infrastructure" and "trade and travel restrictions" exhibiting varied significance. The BBN models exhibit high predictive accuracy, achieving 83.3% and 82.3% accuracy for extreme states in "rapid response to and mitigation of the spread of an epidemic" and the GHS index, respectively. This study contributes to the literature on GHS by modeling the dependencies among various indicators of the rapid response dimension of the GHS index and highlighting their relative importance based on the mutual value of information and sensitivity analyses. [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]

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. [ABSTRACT FROM AUTHOR]

Background: The escalating threat of infectious disease outbreaks in Africa, particularly emerging and re-emerging diseases, necessitates urgent and comprehensive action. The frequency of these outbreaks demands a robust enhancement of notification and reporting systems to enable swift public health interventions. Tropical diseases such as malaria, COVID-19, typhoid fever, yellow fever, arboviruses, cholera, rabies, schistosomiasis, tuberculosis, black fungus, meningitis, evolving pathogens, and antimicrobial resistance pose significant health risks globally, especially in Sub-Saharan Africa. The region faces complexities in healthcare, including weak systems, inadequate surveillance, socioeconomic disparities, and other issues. Poor health literacy, traditional practices, and distrust hinder effective disease control and contribute to disease emergence in Sub-Saharan Africa. Continuous research and global collaboration are essential to address these public health concerns, especially given Africa's unique challenges. Disease surveillance emerges as a highly effective strategy, crucial in regions vulnerable to infectious diseases. Establishing and strengthening comprehensive surveillance and reporting systems at individual, regional, national, and international levels is crucial due to the unpredictable nature of borderless outbreaks and their significant impact on morbidity, mortality, and economic stability. National surveillance relies heavily on effective control mechanisms within local community areas, necessitating the active involvement of medical personnel. Successful systems depend on functional countries using collected data for timely warnings and localized interventions. Stakeholders, including governments, health authorities, and international organizations, must collaborate urgently to implement and sustain these vital systems, mitigating the devastating consequences of infectious disease outbreaks. Additionally, a holistic approach is crucial, involving prioritized local production of vaccines, medicines, and diagnostics through initiatives like the African Vaccine Producers Initiative. This approach emphasizes the need for domestic pharmaceutical production, intensified public awareness campaigns, and the training of the next generation of global health leaders, ensuring multidimensional strategies, political and diplomatic skills, and evidence-based assessments. Conclusion: Collaboration among governments, international organizations, and educational institutions is essential for successful policy advocacy and implementation to strengthen health security and mitigate the continuous rise of infectious diseases on the continent. [ABSTRACT FROM AUTHOR]

In the face of global challenges, ensuring robust health security is paramount for safeguarding populations against emerging threats. Using country-level data on the Global Health Security (GHS) index covering 195 countries, this study employs Bayesian Belief Networks (BBNs) to explore probabilistic dependencies among various indicators that can influence health security outcomes. The findings reveal distinct probabilities of low performance for certain components within main indicators such as ‘prevention’, ‘early detection and reporting’, and ‘sufficient and robust health sector’, significantly shaping overall health security outcomes. Particularly noteworthy is the identification of ‘early detection and reporting’ as the most critical indicator, showing an 87% probability improvement, followed closely by ‘prevention’ at 81%. The latter part of the study delves into the sub-indicators associated with ‘early detection and reporting’. This analysis uncovers varying probabilities of extreme performance states, with ‘laboratory supply chains’ emerging as the most crucial sub-indicator, presenting an 84% probability improvement. Conversely, the ‘epidemiology workforce’ is deemed less influential in impacting overall health security outcomes. Assessing the mutual value of information sheds light on the informative nature of ‘prevention’ and ‘sufficient and robust health sector’ within the main indicators, while in sub-indicators, ‘surveillance data accessibility and transparency’ take precedence.

Uganda has been implementing the Global Health Security Agenda (GHSA) since 2015 to build its capacity according to World Health Organization (WHO) Benchmarks on International Health Regulations Capacities. The country remains prone to outbreaks, with more than 20 disease outbreaks reported in the past five years, including Ebola virus disease, Crimean-Congo haemorrhagic fever, Marburg haemorrhagic fever, measles, yellow fever, coronavirus disease 2019 (COVID-19), and cholera. Antimicrobial resistance (AMR) is an ongoing challenge. Uganda scored capacity level 3 on infection prevention and control (IPC) and antimicrobial stewardship (AMS) in the 2017 Joint External Evaluation (JEE) assessment. Identified gaps were being addressed after a self-assessment in 2021. This paper describes the technical assistance approaches provided to Uganda by the Medicines, Technologies, and Pharmaceutical Services Program, funded by the United States (U.S.) Agency for International Development, and implemented by Management Sciences for Health. The program, through a One Health approach, supported systematic capacity strengthening based on the JEE’s capacity advancement framework for global health security, specifically relating to AMR. The program’s interventions impacted 32 WHO benchmark actions (7 for AMR multisectoral coordination, 16 for IPC, and 9 for AMS), contributing to Uganda’s strengthened GHSA capacity. Leveraging success built on the AMR platform, the program trained 745 health workers in IPC for the Ebola virus and provided support for simulation exercises by eight district IPC teams. The program also worked with the Ministry of Health to coordinate IPC for the COVID-19 response in five health regions, covering 45 districts and reaching 5,452 health workers at 858 health facilities.

Objectives: Marburg virus disease (MVD) is on the WHO list for pandemic-prone pathogens. The current outbreak in Rwanda provides an opportunity to map outbreaks and generate information to inform policymaking, resource mobilization, and guide the implementation of cost-effective response strategies. Methods: We synthesized available information about MVD to build holistic, up-to-date evidence to inform policymakers, public health leaders, and healthcare and public health services providers in their development and implementation of cost-effective preparedness, prevention, and control measures. Results: We have identified 20 outbreaks of MVD that occurred in 14 countries between 1967 and 2024; these outbreaks led to 580 confirmed cases and 423 deaths in total. We summarize the available information about the main clinical signs, diagnostic tools, primary reservoir, transmission dynamics, and case management protocol. We also document the best practices in the prevention and control of MVD outbreaks, including the implementation of a multisectoral One Health strategy for preparedness, prevention, and response to MVD outbreaks that incorporates the strict implementation of WASH and infection prevention measures, contact tracing, and the isolation of infected and suspected humans and animals, and enhances the implementation of the International Health Regulations, particularly efficient cross-country coordination. Conclusions: In the absence of a licensed treatment or vaccine for MVD, the response strategy to MVD should focus on preventive measures, including community engagement to promote the reduction in contact between humans and reservoirs, the supportive care and isolation of patients, and proper waste management. High risk populations such as frontline responders, including healthcare providers and community health workers, should be prioritized so that they can access all currently available protection measures.

In this review, we investigated the genetic diversity and evolutionary dynamics of the Orthomarburgvirus marburgense species that includes both Marburg virus (MARV) and Ravn virus (RAVV). Using sequence data from natural reservoir hosts and human cases reported during outbreaks, we conducted comprehensive analyses to explore the genetic variability, constructing haplotype networks at both the genome and gene levels to elucidate the viral dynamics and evolutionary pathways. Our results revealed distinct evolutionary trajectories for MARV and RAVV, with MARV exhibiting higher adaptability across different ecological regions. MARV showed substantial genetic diversity and evidence of varied evolutionary pressures, suggesting an ability to adapt to diverse environments. In contrast, RAVV demonstrated limited genetic diversity, with no detected recombination events, suggesting evolutionary stability. These differences indicate that, while MARV continues to diversify and adapt across regions, RAVV may be constrained in its evolutionary potential, possibly reflecting differing roles within the viral ecology of the Orthomarburgvirus marburgense species. Our analysis explains the evolutionary mechanisms of these viruses, highlighting that MARV is going through evolutionary adaptation for human-to-human transmission, alarmingly underscoring the global concern about MARV causing the next pandemic. However, further transdisciplinary One Health research is warranted to answer some remaining questions including the host range and genetic susceptibility of domestic and wildlife species as well as the role of the biodiversity network in the disease’s ecological dynamics.

The 24th Annual General Meeting of the Developing Countries Vaccine Manufacturers’ Network (DCVMN), held in Cape Town, South Africa and co-hosted by Biovac, convened over 400 delegates and featured more than 100 distinguished speakers across three days. This gathering served as a vital platform for vaccine manufacturers from developing nations to share insights, challenges, and achievements, underscoring their pivotal role in global vaccine research, development, and distribution to promote vaccine equity. The conference theme centered on partnerships in various forms and their instrumental role in assisting local manufacturers in achieving their and global health objectives. Speakers provided comprehensive reviews of the vaccine industry’s current landscape, covering aspects such as development, manufacturing, quality control, technology transfer, and gender-related immunization, with a focus on the perspectives of DCVMs. This paper focuses on these interconnected areas, examining their present status through the perspectives of our member manufacturers and prominent global health organizations.

The need for strengthening national capacities for disease prevention, preparedness, and response is increasingly becoming urgent. Central to this is strengthening existing systems and workforce capacity for disease surveillance and disease outbreak response. This study aimed to evaluate the national capacity and needs of veterinary services in Vietnam in animal disease surveillance and outbreak investigation skills. A cross-sectional, convergent, mixed-methods study was conducted between November 2020 and April 2021. An online questionnaire was administered to government field veterinarians, followed by descriptive and multivariable analyses to understand field capacity, specifically levels of experience in outbreak investigation and animal health surveillance. Semi-structured interviews were conducted with various stakeholders in veterinary services and interview transcripts were coded and thematically analyzed. Qualitative results were used to contextualize quantitative findings from the survey. Overall, 178 field veterinary staff completed the online survey, and 25 stakeholders were interviewed. Eighty percent of respondents reported a high priority for further training in both animal disease surveillance and outbreak investigation. Training and competence were more limited at the district and commune levels, highlighting a gap in capacity at the subnational level. Reasons included a lack of in-depth training opportunities, limited access to resources and high staff turnover. Respondents who completed postgraduate qualifications in epidemiology or Field Epidemiology Training Programs were more likely to have higher levels of experience in animal health surveillance and outbreak investigation. This study identified gaps in knowledge and adoption of practices most often related to local-level or less experienced veterinary staff with limited training opportunities in epidemiology. Findings inform the prioritization of training and planning activities to further enhance the national capacity of veterinary services in Vietnam. Underlying explanations for existing gaps in capacity include inequities in skill development and training opportunities across levels of veterinary staff, gaps in the chain of command and unequal funding across provinces.

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.

Claire J Standley,1,2,* Alanna S Fogarty,1 Lauren N Miller,1 Erin M Sorrell3,* 1Center for Global Health Science and Security, Georgetown University, Washington, DC, USA; 2Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany; 3Center for Health Security, Johns Hopkins University; Department of Environmental Health and Engineering, Bloomberg School of Public Health & Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA*These authors contributed equally to this workCorrespondence: Claire J Standley, Center for Global Health Science and Security, Georgetown University, 3900 Reservoir RoadNW, Washington, DC, 20007, USA, Tel +1 202 290 0451, Fax + 1 202-687-1800, Email Claire.standley@georgetown.eduAbstract: One Health is increasingly recognized as an important approach for health systems, particularly with respect to strengthening prevention, detection and response to zoonotic and other emerging disease threats. While many global health security frameworks reference the importance of One Health, there are fewer existing methodologies, tools, and resources for supporting countries and other regional or sub-national authorities in systematically assessing their One Health capabilities. We describe here two methodologies, One Health Systems Assessment for Priority Zoonoses (OHSAPZ) and One Health Transboundary Assessment for Priority Zoonoses (OHTAPZ), which have been developed to assist with creating consensus lists of priority zoonotic diseases for cross-sectoral consideration; identification of current strengths and gaps in One Health communication and coordination between sectors (and, in the case of OHTAPZ, between countries); and the development and dissemination of prioritized recommendations for future capacity strengthening. Implemented to date in seven diverse countries in Africa and the Eastern Mediterranean regions, these tools provide a modular, flexible and easily adaptable approach to One Health systems assessment that can support national capacity strengthening, regional epidemic preparedness, and compliance with international frameworks.Keywords: intersectoral coordination, capabilities mapping, information sharing and risk communication, epidemic preparedness and response, transboundary zoonotic diseases, global health security

IntroductionHealth systems including mental health (MH) systems are resilient if they protect human life and produce better health outcomes for all during disease outbreaks or epidemics like Ebola disease and their aftermaths. We explored the resilience of MH services amidst Ebola disease outbreaks in Africa; specifically, to (i) describe the pre-, during-, and post-Ebola disease outbreak MH systems in African countries that have experienced Ebola disease outbreaks, (ii) determine the prevalence of three high burden MH disorders and how those prevalences interact with Ebola disease outbreaks, and, (iii) describe the resilience of MH systems in the context of these outbreaks.MethodsThis was a scoping review employing an adapted PRISMA statement. We conducted a five-step Boolean strategy with both free text and Medical Subject Headings (MeSH) to search 9 electronic databases and also searched WHO MINDbank and MH Atlas.ResultsThe literature search yielded 1,230 publications. Twenty-five studies were included involving 13,449 participants. By 2023, 13 African nations had encountered a total of 35 Ebola outbreak events. None of these countries had a metric recorded in MH Atlas to assess the inclusion of MH in emergency plans. The three highest-burden outbreak-associated MH disorders under the MH and Psychosocial Support (MHPSS) framework were depression, post-traumatic stress disorder (PTSD), and anxiety with prevalence ranges of 1.4–7%, 2–90%, and 1.3–88%, respectively. Furthermore, our analysis revealed a concerning lack of resilience within the MH systems, as evidenced by the absence of pre-existing metrics to gauge MH preparedness in emergency plans. Additionally, none of the studies evaluated the resilience of MH services for individuals with pre-existing needs or examined potential post-outbreak degradation in core MH services.DiscussionOur findings revealed an insufficiency of resilience, with no evaluation of services for individuals with pre-existing needs or post-outbreak degradation in core MH services. Strengthening MH resilience guided by evidence-based frameworks must be a priority to mitigate the long-term impacts of epidemics on mental well-being.

"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]

The aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

In the wake of the COVID-19 pandemic, the 'One Health approach' has ambivalently become a key policy instrument for dealing with global health risks, which raises some key questions. What problems does the One Health approach really address? And what is problematic about One Health? This article traces the development of the One health concept and deconstructs its implementation in policy and practice. While the original One Health approach has gradually embraced a broader outlook, it has ended up being implemented through the narrow focus on global health security gaining increased traction. Capitalism, according to Marx, creates a 'Metabolic Rift' between human and natural systems, undermining the conditions for human and nonhuman flourishing. For over 25 years, this rift concept has been extensively discussed in environmental sociology and political ecology, but it has sadly not found its way into interdisciplinary One Health scholarship and practice. Practically, and at its core, the One Health approach remains mainly hooked to biomedical, risk adaptation and risk mitigation strategies when it comes to existing and future pathogens emerging in the interactions between human, animals and the ecological environment. As such, One Health risks to maintain and confirm a status quo, hence deprived of any transformative potential. [ABSTRACT FROM AUTHOR]

Abstract Background The One Health approach is key in implementing International Health Regulations (IHR, 2005) and the Global Health Security Agenda (GHSA). Uganda is signatory to the IHR 2005 and in 2017, the country conducted a Joint External Evaluation (JEE) that guided development of the National Action Plan for Health Security (NAPHS) 2019–2023. Aim This study assessed the contribution of the One Health approach to strengthening health security in Uganda. Methods A process evaluation between 25th September and 5th October 2020, using a mixed–methods case study. Participants were Subject Matter Experts (SMEs) from government ministries, departments, agencies and implementing partners. Focus group discussions were conducted for five technical areas (workforce development, real-time surveillance, zoonotic diseases, national laboratory systems and emergency response operations), spanning 18 indicators and 96 activities. Funding and implementation status from the NAPHS launch in August 2019 to October 2020 was assessed with a One Health lens. Results Full funding was available for 36.5% of activities while 40.6% were partially funded and 22.9% were not funded at all. Majority (65%) of the activities were still in progress, whereas 8.6% were fully implemented and14.2% were not yet done. In workforce development, several multisectoral trainings were conducted including the frontline public health fellowship program, the One Health fellowship and residency program, advanced field epidemiology training program, in-service veterinary trainings and 21 district One Health teams’ trainings. Real Time Surveillance was achieved through incorporating animal health events reporting in the electronic integrated disease surveillance and response platform. The national and ten regional veterinary laboratories were assessed for capacity to conduct zoonotic disease diagnostics, two of which were integrated into the national specimen referral and transportation network. Multisectoral planning for emergency response and the actual response to prioritized zoonotic disease outbreaks was done jointly. Conclusions This study demonstrates the contribution of ‘One Health’ implementation in strengthening Uganda’s health security. Investment in the funding gaps will reinforce Uganda’s health security to achieve the IHR 2005. Future studies could examine the impacts and cost-effectiveness of One Health in curbing prioritized zoonotic disease outbreaks.

Abstract Sudan faces inter-sectional health risks posed by escalating violent conflict, natural hazards and epidemics. Epidemics are frequent and overlapping, particularly resurgent seasonal outbreaks of diseases such as malaria, cholera. To improve response, the Sudanese Ministry of Health manages multiple disease surveillance systems, however, these systems are fragmented, under resourced, and disconnected from epidemic response efforts. Inversely, civic and informal community-led systems have often organically led outbreak responses, despite having limited access to data and resources from formal outbreak detection and response systems. Leveraging a communal sense of moral obligation, such informal epidemic responses can play an important role in reaching affected populations. While effective, localised, and organised—they cannot currently access national surveillance data, or formal outbreak prevention and response technical and financial resources. This paper calls for urgent and coordinated recognition and support of community-led outbreak responses, to strengthen, diversify, and scale up epidemic surveillance for both national epidemic preparedness and regional health security.

The World Health Organization established International Health Regulations (IHRs) to give nations a legal framework for preventing, identifying, and responding to public health threats of international concern. On the other hand, One Health advocates for integrated approaches to health risks, acknowledging the interdependence of human, animal, and ecosystem health. By integrating these frameworks, stakeholders can leverage their respective strengths to enhance surveillance, early detection, and response mechanisms, as well as promote sustainable development and resilience against emerging health threats. This article explores the shared objectives, interconnectedness of health systems, collaborative mechanisms, and capacity-building initiatives that indicate the synergistic effects of IHRs and One Health in safeguarding global health security.