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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

The Future of the GHSA Matters for US Clinicians—Find Out Why

The Global Health Security Agenda (GHSA) is a pivotal international effort to ensure countries, regardless of wealth, have a strong public health and health security foundation. But, before we venture down the GHSA rabbit hole, it is important to truly understand its goal and origins.

The World Health Organization (WHO) has been working to strengthen global health and cooperation as far back as 1851 when the guidelines were called, the International Sanitary Regulations. We can further trace the history of this goal of international health collaboration and support through the International Health Regulations (IHR), which were legally binding regulations among member countries to improve health and fight infectious diseases. The goal of the IHR is to form a global collaborative effort to build national capacities to prevent, detect, and respond to public health events. If, as the saying goes, we are only as strong as the weakest country, then we need to start supporting and investing in that country’s public health infrastructure. The IHR has been revised many times, but the most recent iteration (in 2005) includes 196 States Parties, which work together to ensure global health security.

The IHR involves several components, which require states to notify the WHO of events that would be considered public health emergencies, as well as develop and maintain core public health capacities. According to WHO, “IHR also includes specific measures at ports, airports and ground crossings to limit the spread of health risks to neighboring countries, and to prevent unwarranted travel and trade restrictions so that traffic and trade disruption is kept to a minimum.”

Not surprisingly, you can see how this may pose a problem for states hoping to avoid the public fallout of a public health emergency (ie, consider the handling of the SARS outbreak by the Chinese government). The WHO coordinates the IHR and encourages countries to build their internal capacities; however, there are no enforcement mechanisms in place. Although the IHR is an international law and legally binding, if a country fails to meet the regulations, there is not a lot of fallout. WHO, instead, tends to rely on the outcomes of non-compliance as a means of encouraging compliance. Countries who fail to comply may increase the risk for morbidity/mortality within affected populations, and damage their public image and global relationships. Moreover, although the goal is to strengthen global health security, there has been a substantial struggle for many countries to truly increase their capabilities when their resources are already limited.

This is where the GHSA makes a timely entrance. Simply put, countries were failing to meet the IHR, and this was impacting global health security, so action was needed.
Launched in 2014, the GHSA works to increase core capabilities and capacities within countries to help them not only meet those IHR needs, but also to strengthen their response to biological threats, regardless of origin.

The GHSA involves 50 countries, international organizations, and non-government stakeholders, who all work together to help countries not only identify and truly assess their capacities, but also develop plans to build resilience. The focus within the GHSA is on 11 action packages within 3 categories (Prevent, Detect, and Respond). Action packages include: antimicrobial resistance, biosafety and biosecurity, national laboratory systems, immunization, reporting, workforce development, medical countermeasures, etc.

The GHSA utilizes an assessment process that is voluntary and collaborative, and built upon Joint External Evaluations (JEEs). According to the GHSA agenda, “these external evaluations assess the “country’s capacity under the IHR to prevent, detect, and rapidly respond to public health threats whether occurring naturally or due to deliberate or accidental events.” What makes the JEE so effective is the 2-stage process, which starts with a self-evaluation phase, followed by an external evaluation phase. After the JEE, countries are provided with priority actions in efforts to match gaps in current and prospective donors and partners, with resources.

Perhaps one of the best aspects of the GHSA and JEE is the use of a transparent, unbiased measurement tool. You can check out the JEEs from many different countries such as the United States, Pakistan, Finland, and Cambodia.

Overall, the GHSA is a holistic approach to health security and strengthening national core capacities for all countries, regardless of wealth or capabilities. It truly supports the notion that an outbreak anywhere is an outbreak everywhere.

The future of the GHSA is currently up in the air as President Trump’s administration has not officially endorsed or commented on extending it past the current endpoint of 2019. This has many health officials worried as the GHSA has been a vital part of global health security efforts. In an era of increased globalization, an outbreak can be as easy as an airplane flight away. To this end, the Nuclear Threat Initiative recently spoken out in support of extending the GHSA and urging the GHSA Steering Committee to act and address future steps at a meeting this week in Seoul, South Korea. Many members are highlighting the vital role the GHSA plays in promoting measurable markers for increasing national health security, as well as its role in encouraging and facilitating international health cooperation.

Talks on the future of the GHSA come at a pivotal time as the president’s proposed 2018 budget makes substantial cuts to public health and life sciences research which facilitate US health security and biodefense efforts. Fundamentally, the GHSA is a crucial component to ensuring a solid and reliable global foundation exists for responding to, detecting, and preventing public health crises. Whether you are a physician in an urgent care, a nurse in a major hospital, a public health epidemiologist, or working in national policy, the importance of the GHSA and its work is apparent and a future without it will only serve to weaken US and global health security. 
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HIV surveillance data is being used to populate an interactive map, capable of depicting the impact of HIV and mortality in the United States on national, state, and local levels.
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