4.5: Global Public Health Security
By the end of this section, you should be able to:
- Define global health security.
- Describe interventions used to promote public health security.
- Discuss the interconnectedness of population health across borders.
- Describe the nurse’s role in public health security.
Infectious diseases are a threat everywhere in the world. Global health security refers to public health systems that work to prevent, detect, and respond to these threats. In the United States, the CDC works to protect the American people’s health, safety, and security and fight global health threats worldwide. The prevalent global health security risks include the following (CDC, 2022c):
- Emergence and spread of new infectious diseases
- Ability of diseases to spread related to the increased globalization of travel and trade
- Increasing drug-resistant, disease-causing pathogens
- Risk of accidental release, theft, or unlawful use of dangerous pathogens
The Global Health Security Agenda (GHSA) is an effort of more than 70 countries to protect the world from infectious disease threats (CDC, 2022f). The CDC works to strengthen the public health programs of other countries to reduce the risk of infectious disease outbreaks. It has invested in 19 partner countries to strengthen their public health readiness to contain infectious disease outbreaks at their source. The CDC is invested in the GHSA to promote the safety of the United States and the world, as there are more opportunities for disease to spread due to global travel. Closing gaps in preparedness is a role of the CDC that protects the world’s health and economic and political stability (CDC, 2021d, 2022d).
Global Public Health Security Interventions
The CDC’s efforts to promote public health security are focused on four interventions: surveillance systems, laboratory systems, emergency management, and workforce development. The CDC also works with other government agencies within the United States, such as the Office of Global Affairs (OGA), as well as ministries of health and international organizations to meet global health security goals (CDC, 2021d).
Surveillance Systems
Surveillance systems allow countries to identify risks and quickly detect and stop outbreaks of infectious diseases. In the United States, the National Notifiable Diseases Surveillance System (NNDSS) enables all levels of public health to report notifiable infectious, and some noninfectious, diseases. The data obtained by the NNDSS are used within the United States and can also be shared internationally. Limitations of surveillance systems include variations in reporting practices, both nationally and globally, and missing data from individuals who do not seek medical care. Resources, such as the availability of diagnostic testing facilities or the ability to test for new disease entities, also affect the validity and usefulness of case reports (CDC, 2022g). Pandemics and Infectious Disease Outbreaks discusses disease surveillance in more detail.
Laboratory Systems
Laboratory systems are an important component of public health security, as they allow for the detection of pathogens that cause disease, outbreaks, and death. Reducing the spread of disease and death is possible when a pathogen is identified quickly, as confirmation allows health care workers to respond with the appropriate treatment and prevention methods efficiently. As with surveillance systems, limitations of laboratory systems include factors such as the availability of diagnostic testing facilities and the ability to test for new disease entities. At the beginning of the COVID-19 pandemic in 2020, for example, the capacity for SARS-CoV-2 testing was limited, and the CDC advised a priority-based approach based on factors such as age, occupation, and morbidity. Another concern with COVID-19 testing was that limited data were available on the accuracy of the rapidly developed tests. These limitations, in turn, affected the validity of data obtained through surveillance systems (Goldstein & Burstyn, 2020). The WHO is reviewing the health emergency preparedness, response, and resilience (HEPR) process in light of the knowledge gained during the COVID-19 pandemic (WHO, 2022f).
Emergency Management and Response
Emergency management and efficient response to infectious disease threats are important public health security interventions. Countries must have knowledge and resources, such as emergency operations centers, to mount rapid, coordinated responses to infectious disease outbreaks. The United States and 19 partner countries have a Public Health Emergency Operations Center (PHEOC) that coordinates the response to an emergency or public health threat. Additionally, most of those 19 countries have personnel trained by the CDC’s Public Health Emergency Management (PHEM) Fellowship course. Coordinated efforts within and between countries are important in reducing the potential for a local outbreak to become a pandemic (CDC, 2021c, 2021d; WHO, 2022e). Principles of Disaster Management discusses the nurse’s role in emergency response in more detail.
Workforce Development
Global health security requires each country to have well-trained, highly skilled teams to investigate potential outbreaks and intervene quickly. The CDC has established the Field Epidemiology Training Program (FETP) to train what it refers to as “disease detectives” in more than 80 countries around the globe (CDC, 2023b). Many of these countries have expanded their programs since partnering with the CDC. The CDC also has between 350 and 400 experts who can be deployed in response to a public health emergency within 72 hours of the crisis, anywhere in the world (Knight, 2020).
This video features the CDC’s disease detectives as they investigate an outbreak of leptospirosis.
Watch the video, and then respond to the following questions.
- How do the disease detectives conduct an investigation?
- How does the CDC work with HHS during an investigation?
Interconnectedness of Population Health across Boundaries
Everyone is vulnerable to threats from infectious disease, which can spread nearly everywhere on Earth in as few as 36 hours (CDC, 2022d).The most significant risk from infectious disease occurs when novel diseases appear or when familiar diseases appear in novel geographic locations. COVID-19, for example, is a novel coronavirus. Illnesses that were eventually determined to be COVID-19 were first identified in Wuhan, China, in December 2019. COVID-19 spread rapidly, and the WHO declared it a global pandemic on March 11, 2020 (WHO, 2022f). From a public health standpoint, it is essential to understand the impact of emerging disease threats and outbreaks of familiar diseases on world health (CDC, 2022d).
Ebola
Ebola virus disease (EVD), or Ebola, is a rare form of hemorrhagic fever with a fatality rate that varies from 25 to 90 percent (Patel & Su, 2023). Ebola is transmitted by infected animals, the body fluids of infected persons, or items from infected persons that are contaminated with body fluids, such as clothing. It enters the body through human-to-human transmission via contact through the eyes, nose, or mouth or an opening in the skin. There are five identified strains of the Ebola virus species; four of them may cause the virus in humans (Patel & Su, 2023). Health care workers can become infected with Ebola if infection control precautions are not strictly followed. An effective vaccine is available only for the Zaire type of Ebola, and the treatment is supportive care and the use of antibodies (CDC, 2022c, 2023e; WHO, 2023e).
The first outbreak of Ebola occurred in 1976 in the Democratic Republic of the Congo (DRC, formerly Zaire) in a village near the Ebola River. There have now been more than 20 outbreaks of Ebola in 18 different countries, including the United States. In 2019–2020, the DRC experienced the second-largest recorded outbreak of Ebola (Patel & Su, 2023). Global health security interventions are imperative with a disease such as Ebola to contain the virus since transmission can occur even after the death of an individual, during burial practices (WHO, 2023e).
Tuberculosis
Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis bacteria. TB affects all age groups and occurs in every country in the world. In 2021, 10.6 million new cases of TB were diagnosed, resulting in more than 1.6 million deaths. TB is the second leading infectious cause of death worldwide, and although more than two-thirds of the new cases of TB in 2022 were in Bangladesh, China, the DRC, India, Indonesia, Nigeria, Pakistan, and the Philippines, it affects every country throughout the world. Multidrug-resistant TB (MDR-TB) is a public health threat because it is resistant to many drugs and is easily transmitted from person to person. Ending the TB epidemic by 2030 is among the health targets of the UN SDGs. The WHO is providing global leadership to end TB and setting strategic priorities, including monitoring and reporting on the current global, regional, and country-level epidemic progress (WHO, 2023f).
Human Immunodeficiency Virus
Human immunodeficiency virus (HIV) is an infection that affects the body’s immune response. Acquired immunodeficiency syndrome (AIDS) is an advanced form of the disease. The first published report of what would be identified as HIV and AIDS was in 1981 (CDC, 2001), and more than 40 years later it remains a major global public health issue. There is ongoing transmission of HIV globally, compounded by the concerning trend of increasing transmission reported by some countries. In 2021, 1.5 million people were diagnosed with HIV, and 650,000 people died from HIV-related causes. Approximately 40 million people were living with HIV at the end of 2022, with two-thirds residing in the WHO African region. In 2022, 630,000 peopled died from HIV-related causes, and 1.3 million people acquired HIV. WHO global HIV strategies align with the SDG target of ending the HIV epidemic by 2030. Contracting both HIV and TB is significant, as nearly all HIV-positive people with TB will die (WHO, 2023d).
The Nurse’s Role in Public Health Security
The role of the nurse in public health security is significant, and active participation is critical. Writing, updating, reviewing, and exercising emergency response plans are key, along with collaborating with other community entities in the event of an actual emergency.
The nurse must be knowledgeable about their agency’s security plan and chain of command. For example, when a biological agent has manifested, the nurse can provide the public with fact sheets to disseminate valid health information. This also includes responding to health consequences of biological agents.
A suspected bioterrorist event may require the nurse to dispense vaccines, antimicrobials, and antitoxins or obtain other resources from HHS’s Strategic National Stockpile (Administration for Strategic Preparedness and Response, n.d.). Nurses may also assist in shelters, schools, or places with vulnerable populations. Additionally, psychological support by the nurse may be required to care for the victims, the public, and the workers who are responding to and working with the bioterrorism event (Rowney & Barton, 2005). Both Pandemics and Infectious Disease Outbreaks and Principles of Disaster Management discuss bioterrorism in more detail.