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Über dieses Buch

With our highly connected and interdependent world, the growing threat of infectious diseases and public health crisis has shed light on the requirement for global efforts to manage and combat highly pathogenic infectious diseases and other public health crisis on an unprecedented level. Such disease threats transcend borders. Reducing global threats posed by infectious disease outbreaks – whether naturally caused or resulting from a deliberate or accidental release – requires efforts that cross the disaster management pillars: mitigation, preparedness, response and recovery.

This book addresses the issues of global health security along 4 themes: Emerging Threats; Mitigation, Preparedness, Response and Recovery; Exploring the Technology Landscape for Solutions; Leadership and Partnership. The authors of this volume highlight many of the challenges that confront our global security environment today. These range from politically induced disasters, to food insecurity, to zoonosis and terrorism. More optimistically, the authors also present some advances in technology that can help us combat these threats. Understanding the challenges that confront us and the tools we have to overcome them will allow us to face our future with confidence.



Emerging Threats


Plagues, Epidemics and Pandemics

Pandemic always emerge as social constructions determined by the synergy of socioeconomic, cultural, religious, ecological and biological factors. Plagues have been on earth before mankind and in fact they emerge along with life on earth experiencing three and a half billions of years of evolution and adaptation. The encounter of civilizations has facilitated the exchange of microorganisms determining the emergence of plagues and pandemics that have decimated populations. One of the most striking social demonstrations were observed during the Processions of the Flagellants that took place in the Europe of the fourteenth century, in the times of the Black Plague. In the 1990s, a rampant expansion of the seventh cholera pandemic originated in the Celebs Islands, Indonesia arrived into the Pacific coasts of South America, similar social reactions were seen in the times of cholera when this plague arrived into the Americas. Parishioners of the port of Guayaquil, Ecuador participated in the Eastern Christ of Consolation Procession begging to God for a cessation of the epidemic. But also, the London of 1854 was also struck by cholera leading to the John Snow’s classic Soho study where water was found to be the vehicle of transmission. The reanalysis of Snow’s study brings to discussion the following questions: Did the consumption of not well-cooked fish or seafood have been another route of transmission as demonstrated in recent cholera outbreak investigations? Was the cholera epidemic controlled not only by John Snow’s clever interventions but also because of the development of protective natural immunity by the Londoners?
Ricardo Izurieta

Agricultural Emergencies: Factors and Impacts in the Spread of Transboundary Diseases in, and Adjacent to, Agriculture

The purpose of this chapter is to introduce agricultural emergencies and provide some case examples, specifically transboundary disease (TBD) events, that have threatened sustainable agriculture worldwide. Agricultural self-sufficiency, the ability of a country to meet its own food requirements domestically, is a new goal of the United Nations (UN) Sustainable Development Goals. Agricultural emergencies are hazardous conditions or events that threaten production, livelihoods, and economic stability within the agricultural sector. TBD outbreaks are socially, economically, and politically significant agricultural emergencies that offer a diverse array of impacts and challenges to the economy and trade of agriculture. This chapter explored the impacts and factors involved in the spread of multiple plant and animal TBDs in, and adjacent to, agricultural production. TBDs cost millions to billions of dollars in production and trade losses in endemic countries where they normally circulate, in addition to outbreaks in non-endemic countries. Outbreaks of TBDs are also capable of producing massive social fear and civil or political unrest. This research found that human activity, climate change and variability, and the agricultural-wildlife interface are important drivers in the occurrence and spread of these diseases, but the threat of a malicious attack using these pathogens is a continuing danger as well. The threats in the occurrence and spread of these diseases are not easily eliminated and the severity of impacts caused by TBDs warrants continuing research and monitoring.
Ashley Hydrick

The Threat Within: Mitigating the Risk of Medical Error

Threats to human health reside in the environment – for example, famine, war, pollution, poverty and disease – and in treatment. To secure further improvements in life expectancy, society must address both the threat without, and the threat within. Lives are in jeopardy not only from global diseases such as Ebola, H1N1 and H5N1, but also from medical error. One of the ironies of medicine is that sometimes the cure kills. Despite investing in patient safety initiatives, each year Britain’s National Health Service (NHS) records around 12,000 ‘avoidable deaths’ (a term coined by the NHS itself). In 2013–2014, NHS England received 174,872 written complaints from patients. In 2017, the NHS carried a contingent liability of over £26 billion for claims alleging medical error. In the United States, the three biggest killers are cancer, heart disease and medical error. The World Health Organisation is very concerned about the human and financial costs of medical error. The risk of medical error can be reduced first, by securing a second opinion, secondly, by actioning patient and employee suggestions and thirdly, by engaging in proactive risk management. The chapter elaborates the latter option, specifically, how a tool used to manage operational risk in commercial aviation could be adapted for use in healthcare.
Simon Bennett

Climate Change, Extreme Weather Events and Global Health Security a Lens into Vulnerabilities

Natural hazards have displaced over 26.4 million people per year since 2008 (Norwegian Refugee Council, Global estimates 2015: people displaced by disasters. Retrieved from http://​www.​internal-displacement.​org/​assets/​library/​Media/​201507-globalEstimates-2015/​20150713-global-estimates-2015-en-v1.​pdf, 2015). This number will only increase as climate change continues to exacerbate displacement due to monsoon-related flooding, coastal erosion, cyclones, and salinity intrusion (Barua P, Shahjahan M, Rahman M, Rahman S, Molla M. Forced Migr Rev 1(56), 88–91, 2017; Toufique K, Islam A, Int J Disaster Risk Reduction 10(Part A):236–249, 2014). Events such as Typhoon Haiyan, Hurricane Katrina, Hurricane Maria, Hurricane Irma and Michael represent examples of extreme weather events that had devastating effects on communities. Weick and Sutcliffe (Managing the unexpected: resilient performance in an age of uncertainty, 2nd edn. Wiley, San Francisco, 2007) argue that ‘Unexpected events often audit our resilience. Everything that was left unattended becomes a complex problem and every weakness comes rushing to the forefront.’ In the Chatham House report ‘Preparing for High Impact, Low Probability Events’, Lee et al. (Preparing for high-impact, low-probability events; lessons from Eyjafjallajökull. Chatham House Report, 2012:vii) ‘…found that governments and businesses remain unprepared for such events … the frequency of ‘high-impact, low-probability’ (HILP) events in the last decade signals the emergence of a new ‘normal’. Extreme weather and climate related events pose serious public health threats to vulnerable communities and has resulted in mass migrations and displacements; creating what some refer to as ‘climate refugees’. Threats and consequences stemming from climate related events are transboundary and transnational and thereby emerge as a global health security concern. Scenario planning provides a key ‘leverage point’ in managing (mitigation, preparedness, response and recovery) such disaster consequences by illuminating the space of possibilities regarding impact and vulnerabilities. To do so requires a framework to help characterize the challenges associated with the impact of climate related disasters.
This chapter examines climate related events and the health impacts it has on regional and global health security with specific attention on climate related migration. In so doing, the application of the Cynefin Framework and scenario planning are introduced as conceptual strategies for solution navigation.
Carson Bell, Anthony J. Masys

Global Health Biosecurity in a Vulnerable World – An Evaluation of Emerging Threats and Current Disaster Preparedness Strategies for the Future

Global health biosecurity faces many limitations with growing concern surrounding industrialization and urban development that is continuing across the globe, bringing with it the need to better understand the challenges this growth may have on our ability to maintain health sustainability, safety, and security. With the expansion of technologies and research comes both wonderous discoveries and great burden regarding the potential utilization of novel creations for harm instead of good. Biosecurity was developed not only for preparedness and protection from bioterrorism, but also to evaluate the interconnectedness of all aspects of safety and security of the planet, including areas of agricultural biosecurity, research biosecurity, human and animal health, pandemic threats, as well as threats from global warming and the recent increase in natural disasters. Global health biosecurity is attainable through effective collaborations between stakeholders at all levels from the ground up, which requires strong partnerships that extend past the imaginary boundaries of community, county, province, state, or country. Although there is no definitive amount of biosecurity preparedness that can eliminate all risks to human health, the current limitations that are present in global health biosecurity can be reduced through effective education and adequate partnering in disaster management, preparedness planning, and development of protection strategies. Strengthening global health partnerships can further ignite the ability to respond in the event of a biosecurity breach, whether intentional or accidental in nature, enabling an actionable plan which appropriately mitigates recovery creating security and resilience within the population. The history of infectious diseases has shown that the planet is ever changing with new challenges expected from unknown and remerging diseases that could affect human and animal health, as well as agricultural sustainability which may continue to make the earth and its inhabitants vulnerable to biological threats. Global health biosecurity has the ability to rise to these unknown challenges by utilizing the knowledge from the past, evaluating the research of today, strengthening global partnerships, and reinforcing biosecurity commitment through unified collaborations across borders.
Kristi Miley

The Emerging Threat of Ebola

Ebola is one of the deadliest infectious disease of the modern era. Over 50% of those infected die. Prior to 1976, the disease was unknown. No one knows exactly where it came from, but it is postulated that a mutation in an animal virus allowed it to jump species and infect humans. In 1976 simultaneous outbreaks of Ebola occurred in what is now South Sudan and the Democratic Republic of the Congo (DRC). For 20 years, only sporadic cases were seen, but in 1995 a new outbreak occurred killing hundreds in the DRC. Since that time the frequency of these outbreaks has been increasing. It is uncertain why this is occurring, but many associate it with increasing human encroachment into forested areas bringing people and animals into more intimate contact and increased mobility of previously remote population. This chapter will navigate Ebola in the context of global health and security.
There are multiple objectives of this chapter. First is to provide a basic understanding of Ebola disease processes and outbreak patterns. Second, is to explore the interplay between social determinants of health and Ebola. The role of technology in spreading Ebola outbreaks will be explained as will Ebola’s potential as a bioweapon. Readers will gain understanding of the link between environmental degradation and Ebola outbreaks.
This chapter will be divided into five main sections. These are (1) a case study; (2) Ebola Disease process; (3) Social determinants of health and Ebola; (4) Ebola in the modern era, and (5) the link between Ebola and environmental degradation.
Michelle LaBrunda, Naushad Amin

Mitigation, Preparedness and Response and Recovery


Natural and Manmade Disasters: Vulnerable Populations

In recent decades, the influence of natural disasters such as hurricanes, earthquakes, heat waves, droughts, floods and epidemics, on Global Health Security have become more prominent. In addition, disaster events stemming from civil unrest or natural disasters create humanitarian and refugee crisis thereby contributing to local, regional and global health security challenge. These disaster events also highlight the social, physical, psychological and economic vulnerabilities among population groups. Vulnerable populations, including pregnant women, families with children, older adults, disabled and low-income individuals suffer disproportionate harm in disasters. Vulnerable populations are less likely to undertake self-protective actions before, during or after disasters. They are also at greater risk for poor physical and psychological health outcomes after a disaster. This chapter focuses on the impact of disasters on the following vulnerable population groups: pregnant women and families with children, and older adults. It highlights the complex and unique needs of women, children, and older adults which can lead to catastrophic consequences during and after a disaster. Case studies are included to demonstrate the vulnerabilities and ensuing consequences for women and children and older adults during or after disasters.
Jennifer Marshall, Jacqueline Wiltshire, Jennifer Delva, Temitope Bello, Anthony J. Masys

Global Sexual Violence

This chapter examines how sexual violence is defined, how it exists on a global scale and why it is a significant global health concern. It examines the various forms that sexual violence takes such as sexual harassment, stalking, rape, sexual assault and human trafficking. There is also an exploration and discussion of specific regions, countries and case studies where there are higher and lower rates of sexual violence and potential risk factors that may affect those rates. Following this is a discussion of the actions or lack of actions that have been taken globally to address sexual violence concerns and how the face of this issue has changed over time and future directions it may go. Adapted excerpts from interviews and individuals the author has encountered in France, India, Syria, Mali, Ghana, Tanzania and the United States from survivors of sexual violence are included to provide a better understanding of the lived experience of survivors.
Sara Spowart

Global Health Security and Weapons of Mass Destruction Chapter

The global proliferation of weapons of mass destruction (WMD) presents a clear and present danger to global health security. Unlike conventional weapons that confine themselves to a defined and targeted area, WMD’s cross international boundaries and borders. Moreover, the release of WMDs can be achieved using a low technology approach resulting in a transformation and redefinition of the mission of global health providers. This chapter will focus on the ease of access to WMDs, the impact biological weapons and bioterrorism plays on global health security, United States global policies on public health, and the role actors and non-state actors play in the global health landscape. In addition, this chapter will focus on global WMD proliferation prevention to include international efforts, treaties, and conventions. The chapter will conclude with a discussion of ongoing research initiatives, identification of emerging threats, and additional recommended readings.
Chris Reynolds

Antimicrobial Resistance in One Health

Antimicrobial resistance (AMR) is a slow but inexorable public health threat and a “wicked problem.” The UK Review on Antimicrobial Resistance projected that up to 10 million deaths could be attributable to AMR by 2050, whereas the World Bank estimated that AMR could independently result in global GDP falling by 1.1–3.8% by 2050 if current practices continue. AMR is, undeniably, a considerable global health security issue. In 2016, the United Nations General Assembly addressed the issue of AMR and announced a global commitment to action.
Acquired AMR occurs and spreads rapidly because of the excessive use of antibiotics in humans and food-producing industries, as well as via environmental pollution with antibiotics. Therefore, a One Health framework is necessary to understand the implications of AMR and to evaluate the impact of current and future interventions.
In this chapter, we attempt to improve the awareness and understanding of AMR as a threat to global health security, in the context of a One Health framework. We begin by defining antimicrobials and describing the emergence and transmission of AMR. We then describe the threats posed by AMR to global health security, in the context of healthcare-associated infections, malaria, HIV/AIDS, TB and fungal infections; to food security, in the context of the complex and controversial practice of industrial farming; and to economic security, in the context of the World Bank global GDP and poverty projections for 2050. We then present global initiatives that address the problem of AMR through a One Health lens, followed by future considerations for continued action against AMR and then conclude with a summary of the chapter.
Marie-jo Medina, Helena Legido-Quigley, Li Yang Hsu

Food Security: Microbiological and Chemical Risks

Food Security within a health security context relates to systems dealing with the prevention and control of not only acute but also sporadic and chronic foodborne diseases. The description of food security and safety systems in this chapter will hence include oversight of both microbiological and chemical hazards, which both can cause acute as well as chronic disease events.
The Chapter includes a description of existing national and international surveillance systems for foodborne diseases and regulatory systems enabling risk mitigation action for both chemical and microbiological hazards, with specific inclusion of the concerning increase in antimicrobial resistance (AMR) of foodborne microorganisms also related to the animal production systems.
The Chapter also includes descriptions of methodology for the quantitative assessment of sustainability of food production systems.
Joergen Schlundt, Moon Y. F. Tay, Hu Chengcheng, Chen Liwei

Exploring the Technology Landscape for Solutions


Gaussianization of Variational Bayesian Approximations with Correlated Non-nested Non-negligible Posterior Mean Random Effects Employing Non-negativity Constraint Analogs and Analytical Depossinization for Iteratively Fitting Capture Point, Aedes aegypti Habitat Non-zero Autocorrelated Prognosticators: A Case Study in Evidential Probabilities for Non-frequentistic Forecast Epi-entomological Time Series Modeling of Arboviral Infections

Unfortunately, currently there is no literature contribution describing the frequency and distribution of potential, seasonal, Aedes (Ae.) aegypti, superbreeder, capture point covariates and their effect on epidemics of emerging diseases in county abatements. Ae. aegypti is one of the most significant mosquito species as it is capable of transmitting dengue fever, chikungunya, Zika, and yellow fever viruses. Here we regress an empirical dataset of potential, superbreeder, multivariate, Ae. aegypti, habitat, estimators (e.g., container volume, temperature, and relative humidity) spatiotemporally associated with immature, abundance counts of geographically sampled (henceforth geosampled), county abatement, capture points, to simulate seasonal prolific habitats in a single eco-geographic foci in Hillsborough County Florida. We employ an inferential, hierarchical, Bayesian paradigm with a subjective, maximum, likelihood (ML) estimator to unbiasedly parameterize the epi-entomological, time series dataset of seasonal sampled, aquatic habitat, optimizable signature prognosticators. A probabilistic, framework for distinguishing chaotic, random, geometric uncertainties about covariance matrices is demonstrated in PROC MCMC. An inner-product for spaces of random matrices is motivated and constructed. The assumption was that the inner-product on this space could exploit second-order co-exchangeability and related specifications in order to optimally simulate potential, seasonal, superbreeder covariates from an eco-georeferenceable dataset of, county abatement, capture point, empirical, Ae. aegypti, aquatic, larval/pupal habitat regressors. We introduce the basic idea of the analytical depoissonization on an implicit solution to the epi-entomological, time series that is, the asymptotic analysis of a sequence of Cauchy integrals on the complex plane with saddle point-like estimates. We show that a Bayesian treatment to the constrained probabilistic matrix factorization outperform simple linear estimation for rendering non-normality (multicollinearity, leptokurotic distributions) from regressed geosampled, seasonal, inferential covariates associated to potential, superbreeder, eco-georeferenceable Ae. aegypti foci. We employ extensions to heteroskedastic precision introduced in the literature by Haight (Handbook of the Poisson distribution, Wiley, New York, 1967) for depoissonizing geosampled, potential, seasonal, ento-epidemiological, capture points in order to translate the results of the vector arthropod model into the original (i.e., Bernoulli) model. Herein a maximum a posteriori probability (MAP) estimate was equated to the mode of the posterior' distribution in the simulated, distribution, regression paradigm for unbiasedly deducing statistical significance in a dataset of heuristically optimizable parameterizble estimators spatiotemporally associated to an eco-georeferenceable, prolific, county abatement Ae . aegypti foci. The MAP obtained a real time, capture point, approximation analogous to maximum likelihood estimation, but with an alternative augmented optimization  which incorporated a prior distribution. We simulated datasets thereafter from a generalization of the Tukey-Lambda distribution employing the Ae. aegypti, capture point covariates which allowed us to control the levels of independence, kurtosis and skewness of the potential, prolific, habitat, parameterized estimators while simultaneously comparing the prognosticators by their Type I and Type II error rates. The model output revealed that the explanative habitat regressors were not invariant under re-parameterization and displayed a significant effect on abundance with a 95% confidence interval, with the covariate Container Volume having the strongest impact on the abundance of Ae. aegypti immatures.
Angelica Huertas, Nathanael Stanley, Samuel Alao, Toni Panaou, Benjamin G. Jacob, Thomas Unnasch

Simulation and Modeling Applications in Global Health Security

Global health security (GHS) is dependent upon having an adequate and prepared health security workforce. There are currently numerous challenges in establishing and maintaining a health security workforce. The frequency and magnitude of disasters have increased significantly over the past 30 years. Current and future GHS threats, both manmade and natural, require a prepared and flexible healthcare provider workforce ready to respond to current or emerging GHS threats. Developing and maintaining GHS -specific skills in the healthcare workforce is a tremendous logistical challenge. Innovative education technologies, including simulation and digital learning, can be leveraged to achieve preparedness for GHS threats.
This chapter focuses on the application of modeling and simulation to support Global Health Security planning, preparedness and operations.
Arthur J. French

The Growing Role of Social Media in International Health Security: The Good, the Bad, and the Ugly

Social media (SM) has revolutionized how people interact and communicate, effectively turning our planet into a true “global village”. At the same time, new and unexpected challenges emerged in conjunction with SM, including phenomena of “fake news” and cyber-bullying. As with most technological advancements, international health security (IHS) stands to benefit hugely from the advent of SM. At the same time, some real and potential dangers associated with both intentional and unintentional misuse of SM exist. The chapter will outline how SM can be used to fight disease more effectively (e.g., by information sharing/case identification during outbreaks) but also cause confusion and unauthorized transfer of sensitive information (e.g., premature or erroneous notification of a public health emergency). Finally, public health panics and other forms of harm can potentially be orchestrated with malevolent use of SM involving vulnerable populations (e.g., misinformation campaigns, encouraging deleterious behaviors). In each of the above situations, and especially the latter, SM can be viewed as an asymmetric influencer, with low investment cost(s) leading to disproportionate population effect(s).
Stanislaw P. Stawicki, Michael S. Firstenberg, Thomas J. Papadimos

Leadership and Partnerships


Effecting Collective Impact Through Collective Leadership on a Foundation of Generative Relationships

Leadership Lessons Learned from Global Health Threat Response: Ebola in 2014: As Seen Through the Eyes of a Former Virginia State Health Commissioner
Global health threats challenge leaders to forge a path forward in vague, uncertain, complex and ambiguous situations. Using the Ebola threat of 2014, this chapter identifies key leadership insights from the work done in Virginia to mitigate that health concern. Foundational to the competence required to manage such events is the appreciation by leaders of the value that arises from developing and maintaining positive, generative relationships across scale, space and time. The author, with insights from the leadership literature, shares the experiences and approaches in Virginia during the Ebola concern with an emphasis on the pre-event work done to build such relationships and the resulting public health emergency capabilities that developed. A novel statewide approach to the Ebola threat was implemented and, upon review, was considered instrumental in the effective response that was mounted. It is likely such an approach will inform public health emergency planning and response efforts for some time to come.
Marissa J. Levine

Global Health Security Innovation

Heyman et al. (Global health security: the wider lessons from the west African Ebola virus disease epidemic, vol 385. May 9, 2015 www.​thelancet.​com, 2015:1888) argues that, “the world is ill-prepared” to handle any “sustained and threatening public-health emergency”. Disease outbreaks such as Ebola SARS, and H1N1 challenged national and global response mechanisms. The emergence of these disease outbreaks and their influence globally has sparked a renewed attention to global health security. In the Chatham House report ‘Preparing for High Impact, Low Probability Events’, Lee et al. (Preparing for high-impact, low-probability events: lessons from Eyjafjallajökull. Chatham House Report, January 2012:vii) ‘…found that governments and businesses remain unprepared for such events … the frequency of ‘high-impact, low-probability’ (HILP) events in the last decade signals the emergence of a new ‘normal’. This calls for innovation on an unprecedented level to manage such global health threats as they represent a global health security challenge.
This chapter explores the foundations of the innovation space as it applies to global health security. The wicked nature of global health security points to how innovation and complexity framing go hand in hand in dealing with such global issues.
James Stikeleather, Anthony J. Masys


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