Global Health Security: Opportunities and Challenges Claire Standley & Erin Casey

1. Global Health Security: Opportunities and Challenges Claire Standley & Erin Casey Biosecurity Engagement Program U.S. Department of State 5th annual AFENET Conference, Addis Ababa, November 2013

2. Roadmap for Discussion Claire Standley: • Historical perspective of Global Health Security • Modern GHS landscape • Examples from outside Africa Erin Casey • Linking veterinary education with epidemiology • One Health and GHS • Examples from within Africa

3. What is Health Security? Chronic disease Emergingdisease Dual use technologies Bioterrorism “The activities required…to minimize vulnerability to acute public health events that endanger the collective health of populations living across…international boundaries”. (WHO) Focus on health problems that transcend national borders Focus on elimination or dismantlement of biological weapons infrastructure BEP

4. BEP: Shared priorities BEP GOALS: • Institutionalize biorisk management • Promote compliance with international frameworks • Decrease opportunity for misuse of pathogens FOCUS EFFORTS HERE SUSTAINABILITY

5. Lessons From History • Tularemia used as weapon by Hittites in 1300s • “Black Death” in Europe (Yersinia pestis) caused socio-economic chaos • Smallpox introduced into Americas by early European colonists destroyed whole societies. • Better understanding of transmission in 19th century

6. More recent examples • First UN Security Council Resolution on health adopted in 2000, recognizing the destabilization threat of HIV/AIDS. • Anthrax attacks in U.S. in 2001 – threat of biological agents in hands of non-state actors. • Global pandemics: SARS, H1N1

7. The Modern Health Security Landscape • Greater global connectivity than ever before “An outbreak in Indonesia can reach Indiana within days, and public health crises abroad can cause widespread suffering, conflict, and economic contraction….” -President Obama, May 2009

8. The Modern Health Security Landscape • Greater global connectivity than ever before • Internet as a resource for responsible research but also nefarious purposes

9. The Modern Health Security Landscape • Greater global connectivity than ever before • Internet as a resource for responsible research but also nefarious purposes • Mobile, capable, and organized trans-national terrorist groups around the world

10. The Modern Health Security Landscape • Greater global connectivity than ever before • Internet as a resource for responsible research but also nefarious purposes • Mobile, capable, and organized trans-national terrorist groups around the world • Emerging infectious diseases and diffusion of advanced biotechnologies

11. Emerging Infections: The last 30 years MERS CoV ?? H1N1 Source: Nature 430, 242-249(8 July 2004)

12. “We must come together to prevent, and detect, and fight every kind of biological danger—whether it’s a pandemic like H1N1, or a terrorist threat, or a treatable disease.” President Obama, United Nations General Assembly Address, September 22, 2011

13. International Frameworks Related to Health Security • Biological Weapons Convention (1972) • Recent emphasis on responsible conduct/dual-use • International Health Regulations (2005) • Lots of national policies and guidelines States report meeting all core capacity requirements States report meeting all core capacity requirements OR OR Adopted by 194 States Parties Entered into force Request extension Request 2nd extension 2005 2007 2009 2012 2014 Plan/implement capacity building States assess core capacities

14. Examples from outside Africa • Support for national bodies that promote health security • Iraq National Biorisk Management Committee • Multisectoral coordination for outbreak response • Training of MoH first responders and law enforcement in Middle East to respond to CBW event

15. Global Health Security And One Health Africa Erin Casey, MS, DVM Program Officer Biosecurity Engagement ProgramCooperative Threat Reduction 5th annual AFENET Conference, Addis Ababa, November 2013

16. Epidemiology and Veterinary Medicine • Education curriculum • Global issue • Importance of partnering the fields • Better understanding of disease • Maximize training http://trialx.com www.phrei.org

17. Veterinary Medicine and Epidemiology / Environment and Human Medicine One Health Synergistic Effect www.onehealthinitiative.com

18. http://bio-risk.org/html/biosecurity.html Definitions • Biorisk: risk associated with biological materials • Biosafety: containment principles, technologies, and practices implemented to prevent unintentional exposure to pathogens and toxins, or their unintentional release • Biosecurity: measures designed to prevent the loss, theft, misuse, diversion, or intentional release of pathogens and toxins cvm.msu.edu

19. Health Security:From collection to containment FOCUS EFFORTS HERE • Sample collection • Sample transport • Laboratory analysis • Communication •  security MULTI-SECTORAL APPROACH

20. International Health Regulations • Development and history • Management plan in the event of an outbreak • Success stories

21. Integrated Disease Surveillance and Response • Adopted in 1998 • Framework for strengthening national public health surveillance and response systems http://www.who.int/csr/labepidemiology/projects/surveillance/en/ http://stacks.cdc.gov/view/cdc/11943

22. Case study • Ebola Virus (Uganda)July – August 2012 • Quick, organized response • Contained outbreak • Minimized impact • National and international partnerships • Veterinary / One Health www.brettrussell.com

23. Continued Success Stories in Africa • Field epidemiology capacity development • Public health laboratory capacity development • Public health disease surveillance and effective response • Networking and collaboration

24. Health Security:An integrated approach FOCUS EFFORTS HERE www.healthypeople.gov

25. Thank you! Erin Casey, MS, DVM Program Officer Biosecurity Engagement Program US Department of State CaseyED@state.gov Claire Standley, PhD Program Officer Biosecurity Engagement Program US Department of State StandleyCJ@state.gov