This study reviews current resources and limitations and suggests future directions for integrating diverse communities into related strategies. It documents research and interventions, including promising models and practices that address preparedness for minorities. However, findings reveal a general lack of focus on diversity and suggest that future preparedness efforts need to fully integrate factors related to race, culture, and language into risk communication, public health training, measurement, coordination, and policy at all levels.
The authors examined 27 published population-based instruments for planning or evaluating preparedness that were mostly unavailable in the peer-reviewed literature. Using the Essential Public Health Services framework, the instruments were evaluated for (i) clarity of measurement parameters, (ii) balance between structural and process measures, (iii) evidence of effectiveness, and (iv) specification of an accountable entity.
The declaration in 2009 that the H1N1 pandemic constituted a public health emergency of international concern (PHEIC) was the first such declaration under the revised International Health Regulations that were adopted in 2005. Since then, PHEICs have been declared in relation to polio, Ebola, and Zika. This article evaluates initiatives that have been introduced globally, within the Asia-Pacific region, and within Australia, to strengthen preparedness for public health emergencies. Through analysis of evolving conceptualizations of risk, surveillance, and capacity development, the article argues that the global community has failed to make the necessary investments in health system strengthening.
The World Health Organization’s determination of the Ebola virus disease outbreak as a public health event of international concern prompted nonaffected countries to implement measures to prevent, detect, and manage the introduction of the virus in their territories. This article describes a public health framework implemented in Latin America and Caribbean countries encompassing preparatory self-assessments, in-country visits, and follow-up suggests that the region should increase efforts to consolidate and sustain progress on core capacities and health system preparedness to face public health events with national or international repercussions.
In this article, Fineberg focuses on lessons from the global response to the 2009 H1N1 pandemic. Key successes and shortcomings in the global response are identified, on the basis of the findings and conclusions of a review committee. The article concludes by pointing to steps that can improve global readiness to deal with future pandemics.
Public health care practitioners and organizations are a part of community readiness for, response to, and recovery from emergencies and disasters of all kinds. Although response to health threats, particularly communicable disease outbreaks, have long been a part of public health practice, 2 advancements in preparedness, including the integration of public health into the broader community emergency response system and the clarification of exactly what knowledge, skills, and attitudes a public health professional brings to the response, have been made since 2001. This article presents the newly affirmed core competencies to be attained and maintained by the majority of the public health workforce and discusses some of the many ways in which these competencies influence practice, research, and education.
Four global commissions reviewing the recent Ebola virus disease epidemic response consistently recommended strengthening national health systems, consolidating and strengthening World Health Organization (WHO) emergency and outbreak response activities, and enhancing research and development. This article focuses on three major reform dimensions—national health systems, global governance, and research and development—and offers a set of priorities drawing on the findings of all four commissions.
The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. This article presents reflections of respected global health practitioners on lessons to be learned from the epidemic and offers suggestions for next steps.
The terrorist attacks on Sept 11, 2001 (9/11) uncovered weaknesses in the US national public health infrastructure. This article discusses the progress that has been made since that time, as well as issues to be addressed in public health preparedness within the next decade.
As more low- and middle-income countries (LMICs) commit to universal health coverage, there is a growing need for rational priority setting using health technology assessment and other policy tools. These authors describe an approach for rapidly mapping LMICs’ capacity and needs for rational priority setting, aimed at identifying candidate countries where technical assistance would be most viable, and present their findings from applying this approach to three continents.
Emerging infectious diseases are an important public health threat and infections with pandemic potential are a major global risk. Although much has been learned from previous events the evidence for mitigating actions is not definitive and pandemic preparedness remains a political and scientific challenge. This article discusses the need to develop trust and effective, meaningful collaboration between countries to help with rapid detection of potential pandemic infections and initiate public health actions.
Crisis management logic suggests that planning and preparing for crisis should be a vital part of institutional and policy toolkits. This paper explores the difficulties in translating this ideal into practice. It focuses on four key difficulties. First, crises and disasters are low probability events but they place large demands on resources and have to compete against front‐line service provision. Second, contingency planning requires ordering and coherence of possible threats, yet crisis is not amenable to being packaged in such a predictable way. Third, planning for crisis requires integration and synergy across institutional networks, yet the modern world is characterized by fragmentation across public, private and voluntary sectors. Fourth, robust planning requires active preparation through training and exercises, but such costly activities often produced a level of symbolic readiness which does not reflect operational realities.
The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confidence, and prevent future disasters? To address this question, the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine jointly launched the Independent Panel on the Global Response to Ebola. Panel members from academia, think tanks, and civil society have collectively reviewed the worldwide response to the Ebola outbreak. After difficult and lengthy deliberation, the authors concluded that major reforms are both warranted and feasible.
Recent high-profile infectious disease outbreaks, such as those caused by the Ebola and Zika viruses, serve as a reminder of the importance of preventing, promptly detecting, and effectively limiting outbreaks, no matter where or when they emerge. This report provides an assessment of potential future disease hot spots—those countries that might be especially vulnerable to infectious disease outbreaks. The report builds on a proof of concept that RAND Corporation researchers published previously and represents a more robust approach toward vulnerability assessment in four ways: a more comprehensive evidence base, a more robust set of factors potentially contributing to outbreak vulnerability and associated proxy measures, the use of adjustable weights for these parameters, and an examination of all countries worldwide. The report also describes a user-friendly tool that can help the U.S. Department of Defense, the U.S. Department of Health and Human Services and other U.S. government agencies, and international partners set priorities for technical and funding support to countries that may be most vulnerable to disease outbreaks with transnational potential.
Policymakers are increasingly seeking to determine whether the federal government’s recent investments in public health preparedness have left the public health system better prepared to respond to large-scale public health emergencies. Yet, there remain questions about how to define “public health emergency preparedness,” how much preparedness is enough, and how preparedness can be measured and assessed. This chapter identifies the key challenges associated with measuring public health preparedness and reviews approaches currently in use. The authors also identify several emerging measurement techniques that might help address some of these challenges.
In this perspective piece, Osterholm discusses the compelling need to prepare for a pandemic. Using influenza-like illness as a case study, he discusses the need to increase research and development of vaccines, develop more robust public health plans, creating business continuity plans, and creating an international approach to public funding. He ultimately calls for bold and timely leadership at the highest levels of the governments in the developed world and asks these leaders to recognize the economic, security, and health threats posed by pandemics.
Since the terrorist attacks of 11 September 2001, governments worldwide have invested considerable resources in developing emergency response plans. Particularly in the United States, the federal government has created new homeland security organizations and urged state and local governments to draw up plans. This emphasis on the written plan tends to draw attention away from the process of planning itself and the original objective of achieving community emergency preparedness. This paper reviews the concepts of community preparedness and emergency planning, and their relationships with training, exercises and the written plan. A series of 10 planning process guidelines are presented that draw upon the preparedness literature for natural and technological disasters, and can be applied to any environmental threat.
Increasing volumes of data and computational capacity afford unprecedented opportunities to scale up infectious disease (ID) mapping for public health uses. Whilst a large number of IDs show global spatial variation, comprehensive knowledge of these geographic patterns is poor. These authors present an objective, quantitative method to prioritize mapping efforts to begin to address the large deficit in global disease maps currently available.
Ebola virus disease epidemic in West Africa was the largest ever reported. In 2014, and in accordance with the 2005 International Health Regulations (IHR), the World Health Organization (WHO) declared the epidemic a public health emergency of international concern. Although the likelihood of Ebola virus disease introduction in South-East Asia was considered low, in 2015, nine of the 11 countries from the region agreed to a joint assessment by WHO and ministries of health of their preparedness and operational readiness for Ebola virus disease. This report summarizes the findings of the country reviews in Bangladesh, Bhutan, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.
Influenza pandemics are unpredictable but recurring events that can have severe consequences on human health and economic well being worldwide. Advance planning and preparedness are critical to help mitigate the impact of a global pandemic. This WHO Guidance document Pandemic influenza preparedness and response significantly updates and replaces WHO guidance thatt was published in 2005
The purpose of this document is to assist social and political leaders at all levels who influence policy decisions about the incorporation of ethical considerations into national influenza pandemic preparedness plans. The document focuses on priority setting and equitable access to resources, restriction of individuals’ movements as a result of non-pharmaceutical interventions, the respective obligations of health-care workers and their employers and governments, and the obligations of countries vis-à-vis each other. Key ethical principles emphasized include equity, utility/efficiency, liberty, reciprocity, and solidarity. The document also addresses the need for transparent and timely sharing of information to improve evidence-based policy design and facilitate public engagement in the decision-making process.
These guidelines aim to assist public health professionals at national level in the process of prioritization of communicable diseases/health events for public health surveillance. They represent a prototype for prioritization of communicable diseases, and describe the different steps in a prioritization exercise using a consensus methodology based on the Delphi method. They may need to be adapted depending on the organization of surveillance within a country, or for use in international collaborative settings where disease priorities may differ from those at national level.
