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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.

Global Health Security Meets Infection Prevention

NOV 15, 2018 | SASKIA V. POPESCU
The 5th Ministerial Meeting of the Global Health Security Agenda (GHSA) was held last week in Bali, Indonesia, to address the current state of the GHSA, strategies to improve international and national readiness, and to launch the 2024 Framework which serves as a guideline for the next phase of the GHSA. I was fortunate to attend as a student ambassador with George Mason University’s Biodefense program and a joint partnership with the Next Generation Global Health Security Network.

The GHSA is an international effort created in 2014 to help strengthen global and national capacity to respond to and prevent infectious disease threats. It represents a multilateral and multisectoral strategy for improving biopreparedness in all corners of the world and includes government health organizations. It was launched under the notion that we are only as resilient as our weakest link when it comes to infectious diseases.

From Ebola virus disease to influenza and antimicrobial resistance, the GHSA seeks to address the vulnerabilities and gaps in health security and infection prevention found in countries that fail to meet the required International Health Regulations (IHR) set by the World Health Organization (WHO). In a nutshell, the GHSA is an effort to help countries combat infectious disease threats with the realization that the WHO is often limited by resources and red-tape, and that it often takes a multisectoral team to help bridge the gap. 

For those of us working in health care and infection control, there were several discussions at the meeting that were especially prudent.

Nick Adkin, deputy director of global health security within the department of health and social care in the United Kingdom, spoke about antimicrobial resistance (AMR), noted that the complexity of the problem of global health security makes it that much more challenging, but also it is within all our best interests to fix it. One particular challenge he highlighted was surveillance, as oftentimes laboratories in many countries are unable to perform the necessary tests. Funding for 24 countries to improve laboratory capabilities has been granted, but ultimately there is much more that needs to be done. Perhaps one of the biggest challenges in addition to funding these efforts is training. Many of the countries that most want to improve their global health security are simply too resource-strained and as such, Dr. Adkin stressed the need to contribute to their capacity building. The multiple sectors involved make this an issue that truly impacts everyone.

In terms of antimicrobial resistance, Dr. Askin stressed that one aspect that has often been neglected is the environment. There are efforts to change this and raise awareness, but there is still a considerable amount of work to be done. Dr. Adkin emphasized efforts such as the GHSA and the tripartite collaboration created between the WHO, the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE) that was established to combat antimicrobial resistance. The goal is to address antimicrobial resistance across OneHealth, and as Dr. Adkin noted, the GHSA action package that addresses resistance emphasizes important conversations between different sectors and identifying opportunities to keep antimicrobial resistance on the international political agenda. He emphasized that the United Kingdom, through the GHSA, will continue to encourage member states to not only include officials in public health, but also animal health and environmental safety, in these discussions. The antimicrobial resistance tripartite has also been expanded to include environmental experts and contributors to address this very issue.

Jennifer Nuzzo, DrPH, of the Johns Hopkins Center for Health Security spoke about strengthening health systems and their relation to health security, something we can all appreciate after the 2013-2016 Ebola outbreak and the 2002 Severe Acute Respiratory Syndrome (SARS) outbreak. Dr. Nuzzo pointed to the increased risks of health care workers (who are 21-32 times more likely to become infected!) during outbreaks such as these—especially Ebola—and the role that hospitals play in amplifying disease transmission. For many of us in infection prevention and control, this has been a lesson we have been working to promote, but it was particularly impactful to hear the message being publicized in front of hundreds of international health experts and leaders. 

Many of the challenges that come in working to strengthen capacities in global health security, such as antimicrobial stewardship, hospital infection control, or biosafety, at the national level come from developing incentives. Strengthening a laboratory goes beyond just testing capabilities; it also includes the biosafety and biosecurity aspects, which can be costly in terms of resources and personnel. For some institutions, this might mean investing in better facilities with more security or additional lab equipment; for others, it could mean a cultural shift to focus on safety during procedures. Investments in public health and infection prevention often have competing interests in resource-stressed countries, such as Liberia. Several national representatives emphasized this point during the meeting and noted that although they wanted to fill the gaps that were found in their Joint External Evaluations (JEE), fixing something like national laboratory capabilities can be costly. Per their JEE, they scored well on national vaccine delivery, but significantly struggled with antimicrobial resistance detection and surveillance.

Overall, the 5th Ministerial Meeting of the GHSA was a profound experience, not only for an infection prevention epidemiologist like myself, but as a person dedicated to public health and preventing the spread of infectious diseases. It was inspiring to see participants from private industry to government working to help facilitate capacity building from the ground up.  The GHSA is a particularly unique effort in that it brings together so many different people—from private companies to government health officials and even academia. In many ways, this is a perfect example of the diverse efforts needed to address health security vulnerabilities. In a single day, I was fortunate to chat with Swiss health officials on antimicrobial resistance and bioterrorism, university professors on hospital infection prevention as a preparedness tool, and GE healthcare on their efforts to fund health care capability building.

The 5th Ministerial Meeting of the GHSA is a great example of the dedicated community that exists across public health, health care, private industry, and government, to combat the threat of infectious diseases.
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