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Grabar-Kitarović K, Phumaphi J. A crisis of trust in pandemic prevention, preparedness, and response. Lancet 2023; 402:1730-1732. [PMID: 37918412 DOI: 10.1016/s0140-6736(23)02359-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Affiliation(s)
| | - Joy Phumaphi
- African Leaders Malaria Alliance, Dar es Salaam, Tanzania
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2
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Gostin LO. A Historic Moment in Global Health-"Futureproofing" the World Against Pandemics. JAMA HEALTH FORUM 2023; 4:e234804. [PMID: 37971774 DOI: 10.1001/jamahealthforum.2023.4804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
This JAMA Forum discusses the International Health Regulations of the World Health Organization, political declarations of the United Nations, and a pandemic agreement proposed by the World Health Assembly and suggests 5 reforms that could improve pandemic prevention, preparedness, and response.
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
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3
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Da'ar OB, Kalmey F. The level of countries' preparedness to health risks during Covid-19 and pre-pandemic: the differential response to health systems building blocks and socioeconomic indicators. HEALTH ECONOMICS REVIEW 2023; 13:16. [PMID: 36917372 PMCID: PMC10012285 DOI: 10.1186/s13561-023-00428-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
The global health security (GHS) Index assesses countries' level of preparedness to health risks. However, there is no evidence on how and whether the effects of health systems building blocks and socioeconomic indicators on the level of preparedness differ for low and high prepared countries. The aim of this study was to examine the contributions of health systems building blocks and socioeconomic indicators to show differences in the level of preparedness to health risks. The study also aimed to examine trends in the level of preparedness and the World Health Organization (WHO) regional differences before and during the Covid-19 pandemic. We used the 2021 GHS index report data and employed quantile regression, log-linear, double-logarithmic, and time-fixed effects models. As robustness checks, these functional form specifications corroborated with one another, and interval validity tests confirmed. The results show that increases in effective governance, supply chain capacity in terms of medicines and technologies, and health financing had positive effects on countries' level of preparedness to health risks. These effects were considerably larger for countries with higher levels of preparedness to health risks. The positive gradient trends signaled a sense of capacity on the part of countries with higher global health security. However, the health workforce including doctors, and health services including hospital beds, were not statistically significant in explaining variations in countries' level of preparedness. While economic factors had positive effects on the level of preparedness to health risks, their impacts across the distribution of countries' level of preparedness to health risks were mixed. The effects of Social Development Goals (SDGs) were greater for countries with higher levels of preparedness to health risks. The effect of the Human Development Index (HDI) was greatest for countries whose overall GHS index lies at the midpoint of the distribution of countries' level of preparedness. High-income levels were associated with a negative effect on the level of preparedness, especially if countries were in the lower quantiles across the distributions of preparedness. Relative to poor countries, middle- and high-income groups had lower levels of preparedness to health risks, an indication of a sense of complacency. We find the pandemic period (year 2021) was associated with a decrease in the level of preparedness to health risks in comparison to the pre-pandemic period. There were significant WHO regional differences. Apart from the Eastern Mediterranean, the rest of the regions were more prepared to health risks compared to Africa. There was a negative trend in the level of preparedness to health risks from 2019 to 2021 although regional differences in changes over time were not statistically significant. In conclusion, attempts to strengthen countries' level of preparedness to health shocks should be more focused on enhancing essentials such as supply chain capacity in terms of medicines and technologies; health financing, and communication infrastructure. Countries should also strengthen their already existing health workforce and health services. Together, strengthening these health systems essentials will be beneficial to less prepared countries where their impact we find to be weaker. Similarly, boosting SDGs, particularly health-related sub-scales, will be helpful to less prepared countries. Moreover, there is a need to curb complacency in preparedness to health risks during pandemics by high-income countries. The negative trend in the level of preparedness to health risks would suggest that there is a need for better preparedness during pandemics by conflating national health with global health risks. This will ensure the imperative of having a synergistic response to global health risks, which is understood by and communicated to all countries and regions.
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Affiliation(s)
- Omar B Da'ar
- Department of Health Systems Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- Institute for Cost Analysis and Research Evaluation, Minneapolis, MN, USA.
| | - Farah Kalmey
- Institute for Cost Analysis and Research Evaluation, Minneapolis, MN, USA
- College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Organizational Health and Wellbeing at the Division of Health Research, Lancaster University, Lancaster, UK
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4
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Elnaiem A, Mohamed-Ahmed O, Zumla A, Mecaskey J, Charron N, Abakar MF, Raji T, Bahalim A, Manikam L, Risk O, Okereke E, Squires N, Nkengasong J, Rüegg SR, Abdel Hamid MM, Osman AY, Kapata N, Alders R, Heymann DL, Kock R, Dar O. Global and regional governance of One Health and implications for global health security. Lancet 2023; 401:688-704. [PMID: 36682375 DOI: 10.1016/s0140-6736(22)01597-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
The apparent failure of global health security to prevent or prepare for the COVID-19 pandemic has highlighted the need for closer cooperation between human, animal (domestic and wildlife), and environmental health sectors. However, the many institutions, processes, regulatory frameworks, and legal instruments with direct and indirect roles in the global governance of One Health have led to a fragmented, global, multilateral health security architecture. We explore four challenges: first, the sectoral, professional, and institutional silos and tensions existing between human, animal, and environmental health; second, the challenge that the international legal system, state sovereignty, and existing legal instruments pose for the governance of One Health; third, the power dynamics and asymmetry in power between countries represented in multilateral institutions and their impact on priority setting; and finally, the current financing mechanisms that predominantly focus on response to crises, and the chronic underinvestment for epidemic and emergency prevention, mitigation, and preparedness activities. We illustrate the global and regional dimensions to these four challenges and how they relate to national needs and priorities through three case studies on compulsory licensing, the governance of water resources in the Lake Chad Basin, and the desert locust infestation in east Africa. Finally, we propose 12 recommendations for the global community to address these challenges. Despite its broad and holistic agenda, One Health continues to be dominated by human and domestic animal health experts. Substantial efforts should be made to address the social-ecological drivers of health emergencies including outbreaks of emerging, re-emerging, and endemic infectious diseases. These drivers include climate change, biodiversity loss, and land-use change, and therefore require effective and enforceable legislation, investment, capacity building, and integration of other sectors and professionals beyond health.
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Affiliation(s)
- Azza Elnaiem
- Royal Free London NHS Foundation Trust, London, UK
| | - Olaa Mohamed-Ahmed
- UK Health Security Agency, London, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Tajudeen Raji
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ammad Bahalim
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Logan Manikam
- Global Health Programme, Royal Institute of International Affairs, London, UK
| | - Omar Risk
- Department of Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | | | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Simon R Rüegg
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | | | - Nathan Kapata
- Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia
| | - Robyn Alders
- Global Health Programme, Royal Institute of International Affairs, London, UK; Development Policy Centre, Australian National University, Canberra, ACT, Australia
| | - David L Heymann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Kock
- Royal Veterinary College, University of London, London, UK
| | - Osman Dar
- Global Operations, London, UK; Global Health Programme, Royal Institute of International Affairs, London, UK
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5
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Kickbusch I, Liu A. Global health diplomacy-reconstructing power and governance. Lancet 2022; 399:2156-2166. [PMID: 35594877 PMCID: PMC9113726 DOI: 10.1016/s0140-6736(22)00583-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 01/13/2023]
Abstract
Over the past two decades, global health diplomacy, foreign policy for health, and global health policy have changed substantially. Diplomacy is a constitutive part of the system of global health governance. COVID-19 hit the world when multilateral cooperation was subject to major challenges, and global health has since become integral to geopolitics. The importance of global health diplomacy, especially at WHO, in keeping countries jointly committed to improving health for everyone, has once again been shown. Through a systematic review, this Series paper explores how international relations concepts and theories have been applied to better understand the role of power in shaping positions, negotiations, and outcomes in global health diplomacy. We apply an international relations perspective to reflect on the effect that those concepts and theories have had on global health diplomacy over the past two decades. This Series paper argues that a more central role of international relations concepts and theories in analysing global health diplomacy would help develop a more nuanced understanding of global health policy making. However, the world has changed to an extent that was not envisioned in academic discourse. This shift calls for new international relations concepts and theories to inform global health diplomacy.
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Affiliation(s)
- Ilona Kickbusch
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland.
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7
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Ye Y, Zhang Q, Wei X, Cao Z, Yuan HY, Zeng DD. Equitable access to COVID-19 vaccines makes a life-saving difference to all countries. Nat Hum Behav 2022; 6:207-216. [PMID: 35102361 PMCID: PMC8873023 DOI: 10.1038/s41562-022-01289-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/05/2022] [Indexed: 12/17/2022]
Abstract
Despite broad agreement on the negative consequences of vaccine inequity, the distribution of COVID-19 vaccines is imbalanced. Access to vaccines in high-income countries (HICs) is far greater than in low- and middle-income countries (LMICs). As a result, there continue to be high rates of COVID-19 infections and deaths in LMICs. In addition, recent mutant COVID-19 outbreaks may counteract advances in epidemic control and economic recovery in HICs. To explore the consequences of vaccine (in)equity in the face of evolving COVID-19 strains, we examine vaccine allocation strategies using a multistrain metapopulation model. Our results show that vaccine inequity provides only limited and short-term benefits to HICs. Sharper disparities in vaccine allocation between HICs and LMICs lead to earlier and larger outbreaks of new waves. Equitable vaccine allocation strategies, in contrast, substantially curb the spread of new strains. For HICs, making immediate and generous vaccine donations to LMICs is a practical pathway to protect everyone.
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Affiliation(s)
- Yang Ye
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China.
| | - Xuan Wei
- Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
| | - Zhidong Cao
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Hsiang-Yu Yuan
- Department of Biomedical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
- Centre for Applied One Health Research and Policy Advice, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | - Daniel Dajun Zeng
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.
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8
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Guerrier C, McDonnell C, Magoc T, Fishe JN, Harle CA. Understanding Health Care Administrators’ Data and Information Needs for Decision Making during the COVID-19 Pandemic: A Qualitative Study at an Academic Health System. MDM Policy Pract 2022; 7:23814683221089844. [PMID: 35368410 PMCID: PMC8972941 DOI: 10.1177/23814683221089844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective. The COVID-19 pandemic created an unprecedented strain on the health care system, and administrators had to make many critical decisions to respond appropriately. This study sought to understand how health care administrators used data and information for decision making during the first 6 mo of the COVID-19 pandemic. Materials and Methods. We conducted semistructured interviews with administrators across University of Florida (UF) Health. We performed an inductive thematic analysis of the transcripts. Results. Four themes emerged from the interviews: 1) common types of health systems or hospital operations data; 2) public health and other external data sources; 3) data interaction, integration, and exchange; and 4) novelty and evolution in data, information, or tools used over time. Participants illustrated the organizational, public health, and regional information they considered essential (e.g., hospital census, community positivity rate, etc.). Participants named specific challenges they faced due to data quality and timeliness. Participants elaborated on the necessity of data integration, validation, and coordination across different boundaries (e.g., different hospital systems in the same metro areas, public health agencies at the local, state, and federal level, etc.). Participants indicated that even within the first 6 mo of the COVID-19 pandemic, the data and tools used for making critical decisions changed. Discussion. While existing medical informatics infrastructure can facilitate decision making in pandemic response, data may not always be readily available in a usable format. Interoperable infrastructure and data standardization across multiple health systems would help provide more reliable and timely information for decision making. Conclusion. Our findings contribute to future discussions of improving data infrastructure and developing harmonized data standards needed to facilitate critical decisions at multiple health care system levels.
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Affiliation(s)
- Christina Guerrier
- Center for Data Solutions, University of Florida Health Science Center, Jacksonville, Florida, USA
| | - Cara McDonnell
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Tanja Magoc
- Integrated Data Repository, University of Florida, Gainesville, Florida, USA
| | - Jennifer N. Fishe
- Center for Data Solutions, University of Florida Health Science Center, Jacksonville, Florida, USA
| | - Christopher A. Harle
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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9
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Singh B, Chattu VK. Prioritizing 'equity' in COVID-19 vaccine distribution through Global Health Diplomacy. Health Promot Perspect 2021; 11:281-287. [PMID: 34660222 PMCID: PMC8501485 DOI: 10.34172/hpp.2021.36] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/30/2021] [Indexed: 12/03/2022] Open
Abstract
With over 4 million deaths worldwide, the current coronavirus disease 2019 (COVID-19)pandemic is regarded as one of the worst pandemics in history. With its wider devastating consequences, even so-called affluent countries could not provide full coverage for COVID-19vaccines and medications to all of their citizens. Against this backdrop, the main aim of this article is to examine how Global Health Diplomacy (GHD) can play a role in prioritizing vaccine equity in the global health agenda in the fight against COVID-19. The majority of developed countries’ healthcare systems have been exposed and have reached a tipping point.After the completion of eighteen months of the pandemic, only five countries were able to produce vaccines for the treatment of COVID-19. This pandemic has divided the world into two blocs: those with vaccines, such as the United States, the United Kingdom, Russia, China, and India; and those without, such as the rest of the world. The greatest challenges are vaccine inequalities, inequities and distribution, which undermine the global economic recovery. Many poor countries are still waiting for the initial doses to be delivered to their citizens, while some rich nations are planning for booster doses. GHD plays a critical role in establishing successful global collaborations, funding mechanisms and ensuring international cooperation through the combined efforts of all stakeholders. Besides, global solidarity is necessary to lessen the wider gaps between the vaccination status of rich and poor nations. Therefore, through GHD, the vaccine gaps and inequities can be addressed to strengthen global health security and accelerate global economic recovery.
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Affiliation(s)
- Bawa Singh
- Department of South and Central Asian Studies, School of International Studies, Central University of Punjab, Bathinda, India
| | - Vijay Kumar Chattu
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada.,Institute of International Relations, The University of the West Indies, St. Augustine, Trinidad and Tobago.,Department of Public Health, Saveetha Medical College, SIMATS, Saveetha University, TN, Chennai, India
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10
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Ahmad R, Atun RA, Birgand G, Castro-Sánchez E, Charani E, Ferlie EB, Hussain I, Kambugu A, Labarca J, Hara GL, McKee M, Mendelson M, Singh S, Varma J, Zhu NJ, Zingg W, Holmes AH. Macro level influences on strategic responses to the COVID-19 pandemic - an international survey and tool for national assessments. J Glob Health 2021; 11:05011. [PMID: 34221358 PMCID: PMC8248749 DOI: 10.7189/jogh.11.05011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning. METHODS A cross-sectional electronic survey of health and non-health care professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains - Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks. RESULTS 928 respondents from 66 countries (57% health care professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains. CONCLUSIONS The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.
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Affiliation(s)
- Raheelah Ahmad
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, Northampton Square, London, UK
- Institute of Business & Health Management, Dow University of Health Sciences, Karachi, Pakistan
| | - Rifat A Atun
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Gabriel Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
- Centre d’Appui à la Prévention des Infections Associées aux Soins (CPias), Pays de la Loire, Nantes University Hospital, Nantes, France
| | - Enrique Castro-Sánchez
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, Northampton Square, London, UK
- Division of Nursing, School of Health Sciences, City, University of London, Northampton Square, London, UK
| | - Esmita Charani
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Amrita Institute of Medical Sciences, Amrita University, Kerala, India
| | - Ewan B Ferlie
- King’s Business School, King’s College London, Bush House, London, UK
| | - Izhar Hussain
- Institute of Business & Health Management, Dow University of Health Sciences, Karachi, Pakistan
| | - Andrew Kambugu
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Jaime Labarca
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Levy Hara
- Unit of Infectious Diseases, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Martin McKee
- Department of Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sanjeev Singh
- Department of Medicine, Amrita Institute of Medical Sciences, Amrita University, Kerala, India
| | - Jay Varma
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Nina J Zhu
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
| | - Walter Zingg
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
| | - Alison H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
| | - the COMPASS (COntrol and Management of PAndemicS through Strategic analysis) study group
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, UK
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, Northampton Square, London, UK
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Centre d’Appui à la Prévention des Infections Associées aux Soins (CPias), Pays de la Loire, Nantes University Hospital, Nantes, France
- Division of Nursing, School of Health Sciences, City, University of London, Northampton Square, London, UK
- King’s Business School, King’s College London, Bush House, London, UK
- Institute of Business & Health Management, Dow University of Health Sciences, Karachi, Pakistan
- Infectious Disease Institute, Makerere University, Kampala, Uganda
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Unit of Infectious Diseases, Hospital Carlos G Durand, Buenos Aires, Argentina
- Department of Public Health, London School of Hygiene & Tropical Medicine, London, UK
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Amrita Institute of Medical Sciences, Amrita University, Kerala, India
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
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11
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Perillat L, Baigrie BS. COVID-19 and the generation of novel scientific knowledge: Evidence-based decisions and data sharing. J Eval Clin Pract 2021; 27:708-715. [PMID: 33580747 PMCID: PMC8013509 DOI: 10.1111/jep.13548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 12/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The COVID-19 pandemic has impacted every facet of society, including medical research. This paper is the second part of a series of articles that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of novel scientific knowledge during the COVID-19 pandemic. In the first part of this series, we demonstrated that, in the context of COVID-19, the scientific community has been faced with numerous challenges with respect to (1) finding and prioritizing relevant research questions and (2) choosing study designs that are appropriate for a time of emergency. METHODS During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peer-reviewed journals, pre-print servers and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. RESULTS This second paper demonstrates that a lack of research prioritization and methodological rigour resulted in the generation of fleeting and inconsistent evidence that complicated the development of public health guidelines. The reporting of scientific findings to the scientific community and general public highlighted the difficulty of finding a balance between accuracy and speed. CONCLUSIONS The COVID-19 pandemic presented challenges in terms of (3) evaluating evidence for the purpose of making evidence-based decisions and (4) sharing scientific findings with the rest of the scientific community. This second paper demonstrates that the four challenges outlined in the first and second papers have often compounded each other and have contributed to slowing down the creation of novel scientific knowledge during the COVID-19 pandemic.
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Affiliation(s)
- Lucie Perillat
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Brian S Baigrie
- Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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12
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Tanniru MR. Transforming public health using value lens and extended partner networks. Learn Health Syst 2021; 5:e10234. [PMID: 33490383 PMCID: PMC7805004 DOI: 10.1002/lrh2.10234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Organizational transformations have focused on creating and fulfilling value for customers, leveraging advanced technologies. Transforming public health (PH) faces an interesting challenge. The value created (preventive practices) to fulfill policy makers' desire to reduce healthcare costs is realized by several external partners with varying goals and is practiced by the public (value in use), which often places low priority on prevention. METHODS This paper uses value lens to argue that PH transformation strategy must align the goals of all stakeholders involved. This may include allowing partners and the public to contextualize the preventive practices to see the value in near term and as relevant. It also means extending the number of partners PH uses and helping them connect with the public to seek shared alignment in shared goals of value fulfillment and value-in-use. RESULTS Using lessons from Covid-19 and PH experience with partners in four different sectors: business, healthcare, public and community, the paper illustrates how PH transformation strategy can be implemented going forward. CONCLUSIONS We conclude the paper with five distinct directions for future research to create and sustain value using the framework of learning health systems.
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Maserat E, Jafari F, Mohammadzadeh Z, Alizadeh M, Torkamannia A. COVID-19 & an NGO and university developed interactive portal: a perspective from Iran. HEALTH AND TECHNOLOGY 2020; 10:1421-1426. [PMID: 32837811 PMCID: PMC7431114 DOI: 10.1007/s12553-020-00470-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022]
Abstract
On 19 February 2020, Iran reported the initial cases of novel coronavirus (2019-nCoV). As of 21 March 2020, Iran had reported 175,927 COVID-19 cases, including 8425 deaths. One of the best approaches for responding to COVID-19 is rapid detection, early isolation, and quick treatment of the disease. Studies have stated that information technology (IT) is a powerful tool for detecting, tracking, and responding to pandemic diseases. Despite the importance of IT, a lack of efficient use of information technology capacity was observed after the emergence of the new cases of COVID-19 in Iran. A web-portal can integrate different services and technologies and can support interaction between non-governmental organizations (NGO) and universities. NGOs can provide services for public health utilizing technology and its advancements. One of the important duties of these organizations is to inform and provide integrated services to the general public. An interactive portal is one of the advanced technologies that these organizations can use for health management. Medical sciences of universities play a vital surveillance role for enhancing the performance quality of NGOs. A web-portal can be a collaboration tool between health-related NGOs and medical sciences of universities. In this study, an interactive portal was developed by NGOs and a university. NGOs under the supervision and participation of Tabriz University of Medical Sciences’ Center for Social Factors Research in COVID-19 management division of this portal separated classified information into two sections, informatics and services. This portal is accessible to the general public, patients, service providers, and, importantly, policymakers and presents educational and medical research information to all users. For patients and the general public in high-risk environments, increasing information security, reducing confusion regarding finding needed information, and facilitating communication are only part of the portal’s benefit. It seems that web-portal capacity is needed to control COVID-19 in the digital age. The collaboration of academic and university bodies in the context of health portals can play key roles for coverage of the COVID-19 pandemic.
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Affiliation(s)
- Elham Maserat
- Department of Medical Informatics, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Fereshteh Jafari
- Biomedical & Environmental Health, Leicester School of Pharmacy, Health and Life Sciences Faculty, DMU, The Gateway, Leicester, LE1 9BH UK
| | - Zeinab Mohammadzadeh
- Health Information Technology Department, School of Management & Medical informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahasti Alizadeh
- Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Anna Torkamannia
- Student Research Committee, School of Management & Medical informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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14
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Kannampallil TG, Foraker RE, Lai AM, Woeltje KF, Payne PRO. When past is not a prologue: Adapting informatics practice during a pandemic. J Am Med Inform Assoc 2020; 27:1142-1146. [PMID: 32333757 PMCID: PMC7188126 DOI: 10.1093/jamia/ocaa073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022] Open
Abstract
Data and information technology are key to every aspect of our response to the current coronavirus disease 2019 (COVID-19) pandemic—including the diagnosis of patients and delivery of care, the development of predictive models of disease spread, and the management of personnel and equipment. The increasing engagement of informaticians at the forefront of these efforts has been a fundamental shift, from an academic to an operational role. However, the past history of informatics as a scientific domain and an area of applied practice provides little guidance or prologue for the incredible challenges that we are now tasked with performing. Building on our recent experiences, we present 4 critical lessons learned that have helped shape our scalable, data-driven response to COVID-19. We describe each of these lessons within the context of specific solutions and strategies we applied in addressing the challenges that we faced.
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Affiliation(s)
- Thomas G Kannampallil
- Institute for Informatics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Anesthesiology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randi E Foraker
- Institute for Informatics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, Missouri, USA
| | - Albert M Lai
- Institute for Informatics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, Missouri, USA
| | - Keith F Woeltje
- Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, Missouri, USA.,BJC HealthCare, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, Missouri, USA
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15
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Affiliation(s)
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
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16
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Reeves JJ, Hollandsworth HM, Torriani FJ, Taplitz R, Abeles S, Tai-Seale M, Millen M, Clay BJ, Longhurst CA. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc 2020; 27:853-859. [PMID: 32208481 PMCID: PMC7184393 DOI: 10.1093/jamia/ocaa037] [Citation(s) in RCA: 244] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. MATERIALS AND METHODS Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. RESULTS We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. DISCUSSION The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. CONCLUSION The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.
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Affiliation(s)
- J Jeffery Reeves
- Department of Surgery, University of California, La Jolla, San Diego, California, USA
| | | | - Francesca J Torriani
- Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, California
| | - Randy Taplitz
- Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, California
| | - Shira Abeles
- Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, California
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, University of California, La Jolla, San Diego, California, USA
| | - Marlene Millen
- Department of Medicine, Division of Biomedical Informatics, University of California, La Jolla, San Diego, California, USA
| | - Brian J Clay
- Department of Medicine, Division of Biomedical Informatics, University of California, La Jolla, San Diego, California, USA
| | - Christopher A Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California, La Jolla, San Diego, California, USA
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17
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Fourth meeting of the Eastern Mediterranean Acute Respiratory Infection Surveillance (EMARIS) network and first scientific conference on acute respiratory infections in the Eastern Mediterranean Region, 11-14 December, 2017, Amman, Jordan. J Infect Public Health 2020; 13:451-456. [PMID: 32144017 PMCID: PMC7102739 DOI: 10.1016/j.jiph.2020.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/16/2022] Open
Abstract
Influenza causes significant morbidity and mortality worldwide. Owing to its ability to rapidly evolve and spread, the influenza virus is of global public health importance. Information on the burden, seasonality and risk factors of influenza in countries of the World Health Organization Eastern Mediterranean Region is emerging because of collaborative efforts between countries, WHO and its partners over the past 10 years. The fourth meeting of the Eastern Mediterranean Acute Respiratory Infection Surveillance network was held in Amman, Jordan on 11–14 December 2017. The meeting reviewed the progress and achievements reported by the countries in the areas of surveillance of and response to seasonal, zoonotic and pandemic influenza. The first scientific conference on acute respiratory infection in the Eastern Mediterranean Region was held at the same time and 38 abstracts from young researchers across the Region were presented on epidemiological and virological surveillance, outbreak detection and response, influenza at the animal-human interface, use and efficacy of new vaccines to control respiratory diseases and pandemic influenza threats. The meeting identified a number of challenges and ways to improve the quality of the surveillance system for influenza, sustain the system so as to address pandemic threats and use the data generated from the surveillance system to inform decision-making, policies and practices to reduce the burden of influenza-associated illnesses in the Region.
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18
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R&D for Emerging Infectious Diseases of Epidemic Potential: Sharing Risks and Benefits Through a New Coalition. INFECTIOUS DISEASES IN THE NEW MILLENNIUM 2020. [PMCID: PMC7226903 DOI: 10.1007/978-3-030-39819-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The lack of effective vaccines for emerging infectious diseases (EID) of limited market potential, such as Chikungunya and Zika, poses a serious threat to human life and prosperity. Research and development (R&D) for new vaccines for EIDs faces two major challenges. The first is R&D preparedness: that is, to advance EID vaccine candidates to the latest R&D stage possible during non-epidemic times, on the basis of any feasible safety or efficacy data. The second is R&D response: that is, to test the clinical efficacy of vaccine candidates rapidly once an outbreak erupts. To overcome these challenges, the Coalition for Epidemic Preparedness Innovations (CEPI) was established in August 2016. Here, we explore why the realisation of CEPI’s mission—preventing outbreaks of emerging infectious diseases from becoming humanitarian crises—is a global public good, and the crucial role R&D preparedness and R&D response play in providing this good. We next examine why providing this global public good requires incentivising involvement and sharing risks with the private sector. Finally, we explore the potential for CEPI to be an agent mobilising shared responsibilities, including key factors that must be addressed in order for CEPI to demonstrate to governments that collective action is the preferred strategy for preventing future epidemics and strengthening global health security.
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19
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Kain T, Fowler R. Preparing intensive care for the next pandemic influenza. Crit Care 2019; 23:337. [PMID: 31665057 PMCID: PMC6819413 DOI: 10.1186/s13054-019-2616-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023] Open
Abstract
Few viruses have shaped the course of human history more than influenza viruses. A century since the 1918-1919 Spanish influenza pandemic-the largest and deadliest influenza pandemic in recorded history-we have learned much about pandemic influenza and the origins of antigenic drift among influenza A viruses. Despite this knowledge, we remain largely underprepared for when the next major pandemic occurs.While emergency departments are likely to care for the first cases of pandemic influenza, intensive care units (ICUs) will certainly see the sickest and will likely have the most complex issues regarding resource allocation. Intensivists must therefore be prepared for the next pandemic influenza virus. Preparation requires multiple steps, including careful surveillance for new pandemics, a scalable response system to respond to surge capacity, vaccine production mechanisms, coordinated communication strategies, and stream-lined research plans for timely initiation during a pandemic. Conservative models of a large-scale influenza pandemic predict more than 170% utilization of ICU-level resources. When faced with pandemic influenza, ICUs must have a strategy for resource allocation as strain increases on the system.There are several current threats, including avian influenza A(H5N1) and A(H7N9) viruses. As humans continue to live in closer proximity to each other, travel more extensively, and interact with greater numbers of birds and livestock, the risk of emergence of the next pandemic influenza virus mounts. Now is the time to prepare and coordinate local, national, and global efforts.
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Affiliation(s)
- Taylor Kain
- Department of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Robert Fowler
- Department of Critical Care, University of Toronto, Toronto, ON, Canada.
- Sunnybrook Health Sciences Centre, Room D478, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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20
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Aubry S. The Future of Digital Sequence Information for Plant Genetic Resources for Food and Agriculture. FRONTIERS IN PLANT SCIENCE 2019; 10:1046. [PMID: 31543884 PMCID: PMC6728410 DOI: 10.3389/fpls.2019.01046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/29/2019] [Indexed: 05/27/2023]
Abstract
The recent debates on the legal status of "digital sequence information" (DSI) at the international level could have extensive consequences for the future of agriculture and food security. A large majority of recent advances in biology, medicine, or agriculture were achieved by sharing and mining of freely accessible sequencing data. It is most probably because of the tremendous success of modern genomics and advances of synthetic biology that concerns were raised about possible fair and equitable ways of sharing data. The DSI concept is relatively new, and all concerned parties agreed upon the need for a clear definition. For example, the extent to which DSI understanding is limited only to genetic sequence data has to be clarified. In this paper, I focus on a subset of DSI essential to humankind: the DSI originating from plant genetic resources for food and agriculture (PGRFA). Two international agreements shape the conservation and use of plant genetic resources: the Convention on Biodiversity and the International Treaty for Plant Genetic Resources for Food and Agriculture. In an attempt to mobilize DSI users and producers involved in research, breeding, and conservation, I describe here how the increasing amount of genomic data, information, and studies interact with the existing legal framework at the global level. Using possible scenarios, I will emphasize the complexity of the issues surrounding DSI for PGRFA and propose potential ways forward for developing an inclusive governance and fair use of these genetic resources.
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Affiliation(s)
- Sylvain Aubry
- Department of Plant and Microbial Science, University of Zurich, Zurich, Switzerland
- Section Genetic Resources and Technology, Swiss Federal Office for Agriculture, Bern, Switzerland
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21
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ROURKE MICHELLEF. Access by Design, Benefits if Convenient: A Closer Look at the Pandemic Influenza Preparedness Framework's Standard Material Transfer Agreements. Milbank Q 2019; 97:91-112. [PMID: 30637812 PMCID: PMC6422609 DOI: 10.1111/1468-0009.12364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points Securing access to pathogen samples for research purposes is crucial for pandemic preparedness and responding to infectious disease outbreaks. The Pandemic Influenza Preparedness Framework (PIP Framework) is the only pathogen-specific international access and benefit-sharing (ABS) instrument. This analysis reveals that during an influenza pandemic, the PIP Framework will safeguard access to virus samples but may not be as effective in delivering the associated benefits, like vaccines and antivirals, to countries in need. The PIP Framework's deficiencies must be addressed before an influenza pandemic and before this ABS model is extended to other human pathogens. CONTEXT The World Health Organization (WHO) adopted the Pandemic Influenza Preparedness Framework (PIP Framework) after being forced to grapple with the demands of developing countries for the fairer distribution of vaccines and antivirals created using influenza viruses isolated from within their territories. Though adopted as a nonbinding resolution, the PIP Framework has been praised for its novel legal approach to access and benefit-sharing (ABS), using Standard Material Transfer Agreements (SMTAs) to create binding terms and conditions on both providers and users of PIP biological materials. The PIP Framework's SMTA1 regulates the movement of influenza viruses with human pandemic potential through the WHO's Global Influenza Surveillance and Response System (GISRS) as it operates to monitor the spread of seasonal influenza and detect the emergence of pandemic strains. Member States give consent to the WHO to transfer their materials to third parties under the terms of a negotiated SMTA2. The SMTA2 details benefits such as vaccines and antivirals to be made available to the WHO for distribution in the event of an influenza pandemic. METHODS I analyzed the PIP Framework, its SMTAs, and secondary sources to determine whether the PIP Framework will effectively function as an ABS instrument during an influenza pandemic. FINDINGS The SMTAs do not create any direct or binding agreements between Member States and third-party recipients of influenza viruses. In the lead-up to and during a pandemic, the SMTA1 secures access to influenza viruses for the WHO, and the SMTA2 secures access for commercial users of virus samples, but the SMTA2 may be ineffective in securing tangible benefits for the sovereign providers of those materials. CONCLUSIONS As the international community starts to consider how to best regulate access to nonpandemic influenza pathogen samples, it is imperative that we first address the shortcomings of the only pathogen-specific international ABS instrument available, and we should do so before it is put to the ultimate test.
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Affiliation(s)
- MICHELLE F. ROURKE
- Griffith Law SchoolGriffith University and Australian Defence Force Malaria and Infectious Disease Institute
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22
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Boyce AM, Garibaldi BT. Genomics and High-Consequence Infectious Diseases: A Scoping Review of Emerging Science and Potential Ethical Issues. Health Secur 2019; 17:62-68. [PMID: 30724614 DOI: 10.1089/hs.2018.0108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Host genomic research on high-consequence infectious diseases is a growing area, but the ethical, legal, and social implications of such findings related to potential applications of the research have not yet been identified. While there is a robust ethical debate about the ethical, legal, and social implications of research during an emergency, there has been less consideration of issues facing research conducted outside of the scope of emergency response. Addressing the implications of research at an early stage (anticipatory ethics) helps define the issue space, facilitates preparedness, and promotes ethically and socially responsible practices. To lay the groundwork for more comprehensive anticipatory ethics work, this article provides a preliminary assessment of the state of the field with a scoping review of host genomic research on a subset of high-consequence infectious diseases of relevance to high-level isolation units, focusing on its ethically relevant features and identifying several ethical, legal, and social implications raised by the literature. We discuss the challenges of genomic studies of low-frequency, high-risk events and applications of the science, including identifying targets to guide the development of new therapeutics, improving vaccine development, finding biomarkers to predict disease outcome, and guiding decisions about repurposing existing drugs and genetic screening. Some ethical, legal, and social implications identified in the literature included the rise of systems biology and paradigm shifts in medical countermeasure development; controversies over repurposing of existing drugs; genetic privacy and discrimination; and benefit-sharing and global inequity as part of the broader ecosystem surrounding high-level isolation units. Future anticipatory ethics work should forecast the science and its applications; identify a more comprehensive list of ethical, legal, and social implications; and facilitate evaluation by multiple stakeholders to inform the integration of ethical concerns into high-level isolation unit policy and practice.
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Affiliation(s)
- Angie M Boyce
- Angie M. Boyce, PhD, is Research Scholar and Associate Faculty, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Director, Johns Hopkins Biocontainment Unit, and Associate Professor, Medicine and Physiology, Johns Hopkins University School of Medicine, Baltimore, MD
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23
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Fourth meeting of the Eastern Mediterranean Acute Respiratory Infection Surveillance (EMARIS) network and first scientific conference on acute respiratory infections in the Eastern Mediterranean Region, 11-14 December, 2017, Amman, Jordan. J Infect Public Health 2019; 12:534-539. [PMID: 30733047 PMCID: PMC7102791 DOI: 10.1016/j.jiph.2019.01.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/15/2022] Open
Abstract
Influenza causes significant morbidity and mortality worldwide. Owing to its ability to rapidly evolve and spread, the influenza virus is of global public health importance. Information on the burden, seasonality and risk factors of influenza in countries of the World Health Organization Eastern Mediterranean Region is emerging because of collaborative efforts between countries, WHO and its partners over the past 10 years. The fourth meeting of the Eastern Mediterranean Acute Respiratory Infection Surveillance network was held in Amman, Jordan on 11–14 December 2017. The meeting reviewed the progress and achievements reported by the countries in the areas of surveillance of and response to seasonal, zoonotic and pandemic influenza. The first scientific conference on acute respiratory infection in the Eastern Mediterranean Region was held at the same time and 38 abstracts from young researchers across the Region were presented on epidemiological and virological surveillance, outbreak detection and response, influenza at the animal-human interface, use and efficacy of new vaccines to control respiratory diseases and pandemic influenza threats. The meeting identified a number of challenges and ways to improve the quality of the surveillance system for influenza, sustain the system so as to address pandemic threats and use the data generated from the surveillance system to inform decision-making, policies and practices to reduce the burden of influenza-associated illnesses in the Region.
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24
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Rampling T, Page M, Horby P. International Biological Reference Preparations for Epidemic Infectious Diseases. Emerg Infect Dis 2019; 25:205-211. [PMID: 30666925 PMCID: PMC6346470 DOI: 10.3201/eid2502.180798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Recent years have seen unprecedented investment in research and development for countermeasures for high-threat pathogens, including specific and ambitious objectives for development of diagnostics, therapeutics, and vaccines. The inadequate availability of biological reference materials for these pathogens poses a genuine obstacle in pursuit of these objectives, and the lack of a comprehensive and equitable framework for developing reference materials is a weakness. We outline the need for internationally standardized biological materials for high-threat pathogens as a core element of global health security. We also outline the key components of a framework for addressing this deficiency.
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25
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Metagenomic analysis of viruses in toilet waste from long distance flights-A new procedure for global infectious disease surveillance. PLoS One 2019; 14:e0210368. [PMID: 30640944 PMCID: PMC6331095 DOI: 10.1371/journal.pone.0210368] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/20/2018] [Indexed: 01/01/2023] Open
Abstract
Human viral pathogens are a major public health threat. Reliable information that accurately describes and characterizes the global occurrence and transmission of human viruses is essential to support national and global priority setting, public health actions, and treatment decisions. However, large areas of the globe are currently without surveillance due to limited health care infrastructure and lack of international cooperation. We propose a novel surveillance strategy, using metagenomic analysis of toilet material from international air flights as a method for worldwide viral disease surveillance. The aim of this study was to design, implement, and evaluate a method for viral analysis of airplane toilet waste enabling simultaneous detection and quantification of a wide range of human viral pathogens. Toilet waste from 19 international airplanes was analyzed for viral content, using viral capture probes followed by high-throughput sequencing. Numerous human pathogens were detected including enteric and respiratory viruses. Several geographic trends were observed with samples originating from South Asia having significantly higher viral species richness as well as higher abundances of salivirus A, aichivirus A and enterovirus B, compared to samples originating from North Asia and North America. In addition, certain city specific trends were observed, including high numbers of rotaviruses in airplanes departing from Islamabad. Based on this study we believe that central sampling and analysis at international airports could be a useful supplement for global viral surveillance, valuable for outbreak detection and for guiding public health resources.
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26
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Griffiths E, Dooley D, Graham M, Van Domselaar G, Brinkman FSL, Hsiao WWL. Context Is Everything: Harmonization of Critical Food Microbiology Descriptors and Metadata for Improved Food Safety and Surveillance. Front Microbiol 2017; 8:1068. [PMID: 28694792 PMCID: PMC5483436 DOI: 10.3389/fmicb.2017.01068] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/29/2017] [Indexed: 11/18/2022] Open
Abstract
Globalization of food networks increases opportunities for the spread of foodborne pathogens beyond borders and jurisdictions. High resolution whole-genome sequencing (WGS) subtyping of pathogens promises to vastly improve our ability to track and control foodborne disease, but to do so it must be combined with epidemiological, clinical, laboratory and other health care data (called “contextual data”) to be meaningfully interpreted for regulatory and health interventions, outbreak investigation, and risk assessment. However, current multi-jurisdictional pathogen surveillance and investigation efforts are complicated by time-consuming data re-entry, curation and integration of contextual information owing to a lack of interoperable standards and inconsistent reporting. A solution to these challenges is the use of ‘ontologies’ - hierarchies of well-defined and standardized vocabularies interconnected by logical relationships. Terms are specified by universal IDs enabling integration into highly regulated areas and multi-sector sharing (e.g., food and water microbiology with the veterinary sector). Institution-specific terms can be mapped to a given standard at different levels of granularity, maximizing comparability of contextual information according to jurisdictional policies. Fit-for-purpose ontologies provide contextual information with the auditability required for food safety laboratory accreditation. Our research efforts include the development of a Genomic Epidemiology Ontology (GenEpiO), and Food Ontology (FoodOn) that harmonize important laboratory, clinical and epidemiological data fields, as well as existing food resources. These efforts are supported by a global consortium of researchers and stakeholders worldwide. Since foodborne diseases do not respect international borders, uptake of such vocabularies will be crucial for multi-jurisdictional interpretation of WGS results and data sharing.
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Affiliation(s)
- Emma Griffiths
- Department of Molecular Biology and Biochemistry, Simon Fraser University, VancouverBC, Canada
| | - Damion Dooley
- Department of Pathology and Laboratory Medicine, University of British Columbia, VancouverBC, Canada
| | - Morag Graham
- National Microbiology Laboratory, Public Health Agency of Canada, WinnipegMB, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, WinnipegMB, Canada
| | - Gary Van Domselaar
- National Microbiology Laboratory, Public Health Agency of Canada, WinnipegMB, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, WinnipegMB, Canada
| | - Fiona S L Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, VancouverBC, Canada
| | - William W L Hsiao
- Department of Pathology and Laboratory Medicine, University of British Columbia, VancouverBC, Canada.,British Columbia Centre for Disease Control Public Health Laboratory, VancouverBC, Canada
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27
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Gostin LO, Katz R. The International Health Regulations: The Governing Framework for Global Health Security. Milbank Q 2016; 94:264-313. [PMID: 27166578 PMCID: PMC4911720 DOI: 10.1111/1468-0009.12186] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center
| | - Rebecca Katz
- Milken Institute School of Public Health, George Washington University
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28
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Lai S, Qin Y, Cowling BJ, Ren X, Wardrop NA, Gilbert M, Tsang TK, Wu P, Feng L, Jiang H, Peng Z, Zheng J, Liao Q, Li S, Horby PW, Farrar JJ, Gao GF, Tatem AJ, Yu H. Global epidemiology of avian influenza A H5N1 virus infection in humans, 1997-2015: a systematic review of individual case data. THE LANCET. INFECTIOUS DISEASES 2016; 16:e108-e118. [PMID: 27211899 PMCID: PMC4933299 DOI: 10.1016/s1473-3099(16)00153-5] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 01/30/2016] [Accepted: 03/08/2016] [Indexed: 12/13/2022]
Abstract
Avian influenza viruses A(H5N1) have caused a large number of typically severe human infections since the first human case was reported in 1997. However, there is a lack of comprehensive epidemiological analysis of global human cases of H5N1 from 1997-2015. Moreover, few studies have examined in detail the changing epidemiology of human H5N1 cases in Egypt, especially given the most recent outbreaks since November 2014 which have the highest number of cases ever reported globally over a similar period. Data on individual cases were collated from different sources using a systematic approach to describe the global epidemiology of 907 human H5N1 cases between May 1997 and April 2015. The number of affected countries rose between 2003 and 2008, with expansion from East and Southeast Asia, then to West Asia and Africa. Most cases (67.2%) occurred from December to March, and the overall case fatality risk was 53.5% (483/903) which varied across geographical regions. Although the incidence in Egypt has increased dramatically since November 2014, compared to the cases beforehand there were no significant differences in the fatality risk , history of exposure to poultry, history of human case contact, and time from onset to hospitalization in the recent cases.
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Affiliation(s)
- Shengjie Lai
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; Department of Geography and Environment, University of Southampton, Southampton, UK; Flowminder Foundation, Stockholm, Sweden
| | - Ying Qin
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiang Ren
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Nicola A Wardrop
- Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Marius Gilbert
- Biological Control and Spatial Ecology, Université Libre de Bruxelles, Brussels, Belgium; Fonds National de la Recherche Scientifique, Brussels, Belgium
| | - Tim K Tsang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Luzhao Feng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Jiang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhibin Peng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiandong Zheng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiaohong Liao
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sa Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peter W Horby
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Singapore Infectious Disease Initiative, Singapore
| | - Jeremy J Farrar
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Singapore Infectious Disease Initiative, Singapore; International Severe Acute Respiratory and Emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - George F Gao
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China; Chinese Center for Disease Control and Prevention, Beijing, China
| | - Andrew J Tatem
- Department of Geography and Environment, University of Southampton, Southampton, UK; Flowminder Foundation, Stockholm, Sweden; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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He F, Leyrer S, Kwang J. Strategies towards universal pandemic influenza vaccines. Expert Rev Vaccines 2015; 15:215-25. [DOI: 10.1586/14760584.2016.1115352] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fang He
- Animal Health Biotechnology, Temasek Life Sciences Laboratory, Singapore, Singapore
| | - Sonja Leyrer
- Emergent Product Development Germany GmbH, Munich, Germany
| | - Jimmy Kwang
- Animal Health Biotechnology, Temasek Life Sciences Laboratory, Singapore, Singapore
- Department of Microbiology, Faculty of Medicine, National University of Singapore, Singapore, Singapore
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Moon S, Sridhar D, Pate MA, Jha AK, Clinton C, Delaunay S, Edwin V, Fallah M, Fidler DP, Garrett L, Goosby E, Gostin LO, Heymann DL, Lee K, Leung GM, Morrison JS, Saavedra J, Tanner M, Leigh JA, Hawkins B, Woskie LR, Piot P. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. Lancet 2015; 386:2204-21. [PMID: 26615326 PMCID: PMC7137174 DOI: 10.1016/s0140-6736(15)00946-0] [Citation(s) in RCA: 257] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Suerie Moon
- Harvard Global Health Institute, Harvard University, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Kennedy School, Harvard University, Boston, MA, USA.
| | - Devi Sridhar
- University of Edinburgh Medical School, Edinburgh
| | | | - Ashish K Jha
- Harvard Global Health Institute, Harvard University, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Chelsea Clinton
- Bill, Hillary & Chelsea Clinton Foundation, New York, NY, USA
| | | | - Valnora Edwin
- Campaign for Good Governance, Freetown, Sierra Leone
| | - Mosoka Fallah
- Action Contre La Faim International, Monrovia, Liberia
| | - David P Fidler
- Indiana University Maurer School of Law, Bloomington, IN, USA
| | | | - Eric Goosby
- University of California, San Francisco, CA, USA
| | | | | | - Kelley Lee
- Simon Fraser University, Burnaby, BC, Canada
| | - Gabriel M Leung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | | | - Marcel Tanner
- Swiss Tropical & Public Health Institute, Basel, Switzerland
| | - Jennifer A Leigh
- Harvard Global Health Institute, Harvard University, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Liana R Woskie
- Harvard Global Health Institute, Harvard University, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK
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Heymann DL, Chen L, Takemi K, Fidler DP, Tappero JW, Thomas MJ, Kenyon TA, Frieden TR, Yach D, Nishtar S, Kalache A, Olliaro PL, Horby P, Torreele E, Gostin LO, Ndomondo-Sigonda M, Carpenter D, Rushton S, Lillywhite L, Devkota B, Koser K, Yates R, Dhillon RS, Rannan-Eliya RP. Global health security: the wider lessons from the west African Ebola virus disease epidemic. Lancet 2015; 385:1884-901. [PMID: 25987157 PMCID: PMC5856330 DOI: 10.1016/s0140-6736(15)60858-3] [Citation(s) in RCA: 264] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.
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Affiliation(s)
- David L Heymann
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre on Global Health Security, London, UK.
| | | | | | - David P Fidler
- Indiana University Maurer School of Law, Bloomington, IN, USA
| | | | | | | | | | - Derek Yach
- Vitality Institute, New York, NY, USA; World Economic Forum Global Agenda Council on Ageing, Geneva, Switzerland
| | | | - Alex Kalache
- International Longevity Centre (ILC) Global Alliance and ILC-Brazil, Rio de Janeiro, Brazil; New York Academy of Medicine, NY, USA; HelpAge International, London, UK
| | - Piero L Olliaro
- UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Els Torreele
- Public Health Program, Open Society Foundations, New York, NY, USA
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | | | - Daniel Carpenter
- Department of Government, Harvard University, Cambridge, MA, USA
| | - Simon Rushton
- Chatham House, Royal Institute of International Affairs, London, UK; Department of Politics, University of Sheffield, Sheffield, UK
| | - Louis Lillywhite
- Chatham House, Royal Institute of International Affairs, London, UK
| | - Bhimsen Devkota
- Chatham House, Royal Institute of International Affairs, London, UK; Tribhuvan University, Kathmandu, Nepal
| | | | - Rob Yates
- Chatham House, Royal Institute of International Affairs, London, UK
| | - Ranu S Dhillon
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Cambridge, MA, USA; Earth Institute, Columbia University, New York, NY, USA
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So AD, Shah TA, Roach S, Ling Chee Y, Nachman KE. An Integrated Systems Approach is Needed to Ensure the Sustainability of Antibiotic Effectiveness for Both Humans and Animals. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43 Suppl 3:38-45. [PMID: 26243242 DOI: 10.1111/jlme.12273] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The growing demand for animal products and the widespread use of antibiotics in bringing food animals to market have heightened concerns over cross-species transmission of drug resistance. Both the biology and emerging epidemiology strongly support the need for global coordination in stemming the generation and propagation of resistance, and the patchwork of global and country-level regulations still leaves significant gaps. More importantly, discussing such a framework opens the door to taking modular steps towards solving these challenges - for example, beginning among targeted parties rather than all countries, tying accountability to financial and technical support, or taxing antibiotic use in animals to deter low-value usage of these drugs. An international agreement would allow integrating surveillance data collection, monitoring and enforcement, research into antibiotic alternatives and more sustainable approaches to agriculture, technical assistance and capacity building, and financing under the umbrella of a One Health approach.
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Affiliation(s)
- Anthony D So
- Professor of the Practice of Public Policy and Global Health and Director of the Program on Global Health and Technology Access at the Sanford School of Public Policy at Duke University and Duke Global Health Institute in Durham, NC
| | - Tejen A Shah
- Associate in Research at the Program on Global Health and Technology Access at the Sanford School of Public Policy at Duke University and Duke Global Health Institute in Durham, NC
| | - Steven Roach
- Food Safety Program Director at Food Animal Concerns Trust in Chicago, IL
| | - Yoke Ling Chee
- Director of Programmes at the Third World Network in Penang, Malaysia
| | - Keeve E Nachman
- Assistant Professor, Departments of Environmental Health Sciences and Health Policy and Management at Johns Hopkins Bloomberg School of Public Health, and a Program Director at the Johns Hopkins Center for a Livable Future at Johns Hopkins University in Baltimore, MD
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Timpka T, Spreco A, Eriksson O, Dahlström Ö, Gursky EA, Strömgren M, Holm E, Ekberg J, Hinkula J, Nyce JM, Eriksson H. Predictive performance of telenursing complaints in influenza surveillance: a prospective cohort study in Sweden. ACTA ACUST UNITED AC 2014; 19. [PMID: 25425514 DOI: 10.2807/1560-7917.es2014.19.46.20966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Syndromic data sources have been sought to improve the timely detection of increased influenza transmission. This study set out to examine the prospective performance of telenursing chief complaints in predicting influenza activity. Data from two influenza seasons (2007/08 and 2008/09) were collected in a Swedish county (population 427,000) to retrospectively determine which grouping of telenursing chief complaints had the largest correlation with influenza case rates. This grouping was prospectively evaluated in the three subsequent seasons. The best performing telenursing complaint grouping in the retrospective algorithm calibration was fever (child, adult) and syncope (r=0.66; p<0.001). In the prospective evaluation, the performance of 14-day predictions was acceptable for the part of the evaluation period including the 2009 influenza pandemic (area under the curve (AUC)=0.84; positive predictive value (PPV)=0.58), while it was strong (AUC=0.89; PPV=0.93) for the remaining evaluation period including only influenza winter seasons. We recommend the use of telenursing complaints for predicting winter influenza seasons. The method requires adjustments when used during pandemics.
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Affiliation(s)
- T Timpka
- Department of Public Health, ostergotland County Council, Linkoping, Sweden
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van Panhuis WG, Paul P, Emerson C, Grefenstette J, Wilder R, Herbst AJ, Heymann D, Burke DS. A systematic review of barriers to data sharing in public health. BMC Public Health 2014; 14:1144. [PMID: 25377061 PMCID: PMC4239377 DOI: 10.1186/1471-2458-14-1144] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022] Open
Abstract
Background In the current information age, the use of data has become essential for decision making in public health at the local, national, and global level. Despite a global commitment to the use and sharing of public health data, this can be challenging in reality. No systematic framework or global operational guidelines have been created for data sharing in public health. Barriers at different levels have limited data sharing but have only been anecdotally discussed or in the context of specific case studies. Incomplete systematic evidence on the scope and variety of these barriers has limited opportunities to maximize the value and use of public health data for science and policy. Methods We conducted a systematic literature review of potential barriers to public health data sharing. Documents that described barriers to sharing of routinely collected public health data were eligible for inclusion and reviewed independently by a team of experts. We grouped identified barriers in a taxonomy for a focused international dialogue on solutions. Results Twenty potential barriers were identified and classified in six categories: technical, motivational, economic, political, legal and ethical. The first three categories are deeply rooted in well-known challenges of health information systems for which structural solutions have yet to be found; the last three have solutions that lie in an international dialogue aimed at generating consensus on policies and instruments for data sharing. Conclusions The simultaneous effect of multiple interacting barriers ranging from technical to intangible issues has greatly complicated advances in public health data sharing. A systematic framework of barriers to data sharing in public health will be essential to accelerate the use of valuable information for the global good. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1144) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Willem G van Panhuis
- University of Pittsburgh Graduate School of Public Health, DeSoto street 130, 703 Parran Hall, Pittsburgh, PA 15261, USA.
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Affiliation(s)
- Lawrence O Gostin
- From the O'Neill Institute for National and Global Health Law, Georgetown University Law Center, and the World Health Organization (WHO) Collaborating Center on Public Health Law and Human Rights, Washington, DC (L.O.G.); and the WHO Collaborating Centre for Population Health Research and Training, University of Edinburgh, Edinburgh, and the Blavatnik School of Government, University of Oxford, Oxford - both in the United Kingdom (D.S.)
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36
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Donis RO. Antigenic analyses of highly pathogenic avian influenza a viruses. Curr Top Microbiol Immunol 2014; 385:403-40. [PMID: 25190014 DOI: 10.1007/82_2014_422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
In response to the ongoing threat to animal and human health posed by HPAI endemic in poultry, Asia (H5N1) and North America (H7N3) have revived efforts to reduce pandemic risk by disease control at the source and improved pandemic vaccines. Discovery of conserved neutralization epitopes in the HA, which mediate broad protection within and across HA subtypes have changed the paradigm of "broadly reactive" or "universal" vaccine design. Development of such vaccines would benefit from comparative antigenic analysis of viruses with increasing divergence within (and between) HA subtypes. A review of recent work to define the antigenic properties of HPAI viruses revealed data generated through an array of experimental approaches. This information has supported diagnostics and vaccine development for animal and human health. Further harmonization of analytical methods is needed to determine the antigenic relationships among multiple lineages of rapidly evolving HPAI viruses.
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Affiliation(s)
- Ruben O Donis
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE Mailstop A20, Atlanta, GA, 30333, USA,
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37
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Mackenzie JS, Kelso A, Hampson AW. Influenza. MICROBIOLOGY AUSTRALIA 2014. [DOI: 10.1071/ma14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kickbusch I, Kökény M. Global health diplomacy: five years on. Bull World Health Organ 2013; 91:159-159A. [PMID: 23476084 DOI: 10.2471/blt.13.118596] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
The concept of immunization was started in Japan in 1849 when Jenner's cowpox vaccine seed was introduced, and the current immunization law was stipulated in 1948. There have been two turning points for amendments to the immunization law: the compensation remedy for vaccine-associated adverse events in 1976, and the concept of private vaccination in 1994. In 1992, the regional Court of Tokyo, not the Supreme Court, decided the governmental responsibility on vaccine-associated adverse events, which caused the stagnation of vaccine development. In 2010, many universal vaccines became available as the recommended vaccines, but several vaccines, including mumps, zoster, hepatitis B, and rota vaccines, are still voluntary vaccines, not universal routine applications. In this report, immunization strategies and vaccine development are reviewed for each vaccine item and future vaccine concerns are discussed.
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Affiliation(s)
- Tetsuo Nakayama
- Laboratory of Viral Infection I, Kitasato Institute for Life Sciences, Shirokane 5-9-1, Minato-ku, 108-8641, Tokyo,
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Krishnamurthy M, Herder M. Justice in Global Pandemic Influenza Preparedness: An Analysis Based on the Values of Contribution, Ownership and Reciprocity. Public Health Ethics 2013. [DOI: 10.1093/phe/pht027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Treating influenza with statins and other immunomodulatory agents. Antiviral Res 2013; 99:417-35. [PMID: 23831494 DOI: 10.1016/j.antiviral.2013.06.018] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/19/2013] [Accepted: 06/25/2013] [Indexed: 12/28/2022]
Abstract
Statins not only reduce levels of LDL-cholesterol, they counteract the inflammatory changes associated with acute coronary syndrome and improve survival. Similarly, in patients hospitalized with laboratory-confirmed seasonal influenza, statin treatment is associated with a 41% reduction in 30-day mortality. Most patients of any age who are at increased risk of influenza mortality have chronic low-grade inflammation characteristic of metabolic syndrome. Moreover, differences in the immune responses of children and adults seem responsible for the low mortality in children and high mortality in adults seen in the 1918 influenza pandemic and in other acute infectious and non-infectious conditions. These differences probably reflect human evolutionary development. Thus the host response to influenza seems to be the major determinant of outcome. Outpatient statins are associated with reductions in hospitalizations and deaths due to sepsis and pneumonia. Inpatient statins are also associated with reductions in short-term pneumonia mortality. Other immunomodulatory agents--ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), PPARγ and PPARα agonists (glitazones and fibrates) and AMPK agonists (metformin)--also reduce mortality in patients with pneumonia (ACEIs, ARBs) or in mouse models of influenza (PPAR and AMPK agonists). In experimental studies, treatment has not increased virus replication. Thus effective management of influenza may not always require targeting the virus with vaccines or antiviral agents. Clinical investigators, not systems biologists, have been the first to suggest that immunomodulatory agents might be used to treat influenza patients, but randomized controlled trials will be needed to provide convincing evidence that they work. To guide the choice of which agent(s) to study, we need new types of laboratory research in animal models and clinical and epidemiological research in patients with critical illness. These studies will have crucial implications for global public health. During the 2009 H1N1 influenza pandemic, timely and affordable supplies of vaccines and antiviral agents were unavailable to more than 90% of the world's people. In contrast, statins and other immunomodulatory agents are currently produced as inexpensive generics, global supplies are huge, and they would be available to treat patients in any country with a basic health care system on the first pandemic day. Treatment with statins and other immunomodulatory agents represents a new approach to reducing mortality caused by seasonal and pandemic influenza.
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Humphries-Waa K, Drake T, Huszar A, Liverani M, Borin K, Touch S, Srey T, Coker R. Human H5N1 influenza infections in Cambodia 2005-2011: case series and cost-of-illness. BMC Public Health 2013; 13:549. [PMID: 23738818 PMCID: PMC3700884 DOI: 10.1186/1471-2458-13-549] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 05/29/2013] [Indexed: 01/08/2023] Open
Abstract
Background Southeast Asia has been identified as a potential epicentre of emerging diseases with pandemic capacity, including highly pathogenic influenza. Cambodia in particular has the potential for high rates of avoidable deaths from pandemic influenza due to large gaps in health system resources. This study seeks to better understand the course and cost-of-illness for cases of highly pathogenic avian influenza in Cambodia. Methods We studied the 18 laboratory-confirmed cases of avian influenza subtype H5N1 identified in Cambodia between January 2005 and August 2011. Medical records for all patients were reviewed to extract information on patient characteristics, travel to hospital, time to admission, diagnostic testing, treatment and disease outcomes. Further data related to costs was collected through interviews with key informants at district and provincial hospitals, the Ministry of Health and non-governmental organisations. An ingredient-based approach was used to estimate the total economic cost for each study patient. Costing was conducted from a societal perspective and included both financial and opportunity costs to the patient or carer. Sensitivity analysis was undertaken to evaluate potential change or variation in the cost-of-illness. Results Of the 18 patients studied, 11 (61%) were under the age of 18 years. The majority of patients (16, 89%) died, eight (44%) within 24 hours of hospital admission. There was an average delay of seven days between symptom onset and hospitalisation with patients travelling an average of 148 kilometres (8-476 km) to the admitting hospital. Five patients were treated with oseltamivir of whom two received the recommended dose. For the 16 patients who received all their treatment in Cambodia the average per patient cost of H5N1 influenza illness was US$300 of which 85.0% comprised direct medical provider costs, including diagnostic testing (41.2%), pharmaceuticals (28.4%), hospitalisation (10.4%), oxygen (4.4%) and outpatient consultations (0.6%). Patient or family costs were US$45 per patient (15.0%) of total economic cost. Conclusion Cases of avian influenza in Cambodia were characterised by delays in hospitalisation, deficiencies in some aspects of treatment and a high fatality rate. The costs associated with medical care, particularly diagnostic testing and pharmaceutical therapy, were major contributors to the relatively high cost-of-illness.
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Affiliation(s)
- Karen Humphries-Waa
- Communicable Disease Policy Research Group, London School of Hygiene & Tropical Medicine, Faculty of Public Health, 9th Fl, Satharanasukwisit Building, 420/1 Rajvithi Road, Bangkok 10400 Thailand.
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Mackey TK, Liang BA. Response to comments on “A United Nations Global Health Panel for Global Health Governance”. Soc Sci Med 2013. [DOI: 10.1016/j.socscimed.2012.09.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Promoting global health: utilizing WHO to integrate public health, innovation and intellectual property. Drug Discov Today 2012; 17:1254-7. [PMID: 22728776 DOI: 10.1016/j.drudis.2012.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/31/2012] [Accepted: 06/15/2012] [Indexed: 11/30/2022]
Abstract
The appropriate role of innovation and intellectual property (IP) in global public health is a controversial issue. Discussion is one-sided, with potential benefits advocated by industry in stark contrast to condemnation by certain civil society players. WHO's Public Health, Innovation and Intellectual Property Department (PHI) was established to address healthcare resource need for developing countries, assess impact of innovation and IP on access to medicines, explore innovative funding mechanisms for R&D and provide evidence-based policy-making recommendations in response to the changing global health landscape. Importantly, PHI could represent a potential forum to bridge shared, yet often diverse, interests and opportunities between various public and private stakeholders, a crucial issue for ensuring the future viability of WHO.
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Tuvim MJ, Gilbert BE, Dickey BF, Evans SE. Synergistic TLR2/6 and TLR9 activation protects mice against lethal influenza pneumonia. PLoS One 2012; 7:e30596. [PMID: 22299046 PMCID: PMC3267724 DOI: 10.1371/journal.pone.0030596] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/23/2011] [Indexed: 12/22/2022] Open
Abstract
Lower respiratory tract infections caused by influenza A continue to exact unacceptable worldwide mortality, and recent epidemics have emphasized the importance of preventative and containment strategies. We have previously reported that induction of the lungs' intrinsic defenses by aerosolized treatments can protect mice against otherwise lethal challenges with influenza A virus. More recently, we identified a combination of Toll like receptor (TLR) agonists that can be aerosolized to protect mice against bacterial pneumonia. Here, we tested whether this combination of synthetic TLR agonists could enhance the survival of mice infected with influenza A/HK/8/68 (H3N2) or A/California/04/2009 (H1N1) influenza A viruses. We report that the TLR treatment enhanced survival whether given before or after the infectious challenge, and that protection tended to correlate with reductions in viral titer 4 d after infection. Surprisingly, protection was not associated with induction of interferon gene expression. Together, these studies suggest that synergistic TLR interactions can protect against influenza virus infections by mechanisms that may provide the basis for novel therapeutics.
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Affiliation(s)
- Michael J. Tuvim
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, Texas, United States of America
| | - Brian E. Gilbert
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Burton F. Dickey
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, Texas, United States of America
| | - Scott E. Evans
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, Texas, United States of America
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