Introductory Chapter: Contemporary Considerations and Developments in Global Health Security

1. Introduction

The world has encountered a spectrum of global health threats, from several pandemics, bioterrorism, and antimicrobial resistance to natural disasters and, concurrently, changes in governance structures, policy frameworks, and legislation at both the national and international levels. The resulting loss of life, economic disruption, strain on healthcare systems, and social instability profoundly impacted countries’ health security and threatened progress. As demonstrated repeatedly over the past several decades, countries around the globe are generally unprepared and ill-equipped to tackle the potential threats of epidemics, pandemics, and other public health emergencies [1, 2]. The fallout from the coronavirus disease (COVID-19) exposed the various deficiencies and vulnerabilities of health systems around the world, even among the most medically advanced nations [3, 4]. To further compound the already challenging global status quo, health equity issues adversely affect underserved communities and low-income countries, thus further contributing to the breakdown in global health security, especially in the era of rapid climate change, widespread medical misinformation, and increasing armed conflicts [5, 6, 7, 8].

As we enter the post-pandemic era and reflect on the catastrophic impact and devastating rippling effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on communities and nations, the need for a more robust, strategic, and systematic approach to health security has become more evident than ever before [3]. Global health security (GHS), according to the United States Agency for International Development (USAID), can be defined as “…the existence of strong and resilient public health systems that can prevent, detect, and respond to emerging infectious disease threats wherever they occur in the world” [2, 9, 10, 11] (Figure 1). Dramatic changes associated with globalization, population expansion, environmental degradation, armed conflicts, and chemical usage have advanced the spread of diseases, especially infectious agents, endangering the health of people and posing a grave threat to public health across geographical regions and international borders [1, 5]. These undeniable consequences led to the formation of the Global Health Security Agenda (GHSA). A committee of 70 countries, academic institutions, the private sector, and non-governmental organizations [2, 12, 13, 14], working strategically and collaboratively, these partnerships aim to leverage and complement the strengths and resources of their partners to develop sustainable financing mechanisms, improve information sharing and accountability across member countries to remove the needs and gaps, allowing for timely detection, response, and prevention, in an effort to alleviate the increasing occurrence and severity of epidemics, pandemics, and other emerging infectious disease threats [14, 15, 16]. Additionally, recognizing that emerging diseases are two times more likely to be caused by zoonotic pathogens [17], the implication and influence of the ‘One Health Approach,’ a term coined during the 2003 severe acute respiratory disease (SARS) avian influenza H5N1 outbreak is vital in addressing global health security threats. This concept emphasizes the interconnectedness of animal, human, and environmental health [18]. Consequently, a robust GHS framework is essential for safeguarding population health, while investing in GHS is critical to promoting sustainable development (Figure 2).

Figure 1.

Word cloud representing key concepts in global health security.

Figure 2.

The global health security framework consists of four pillars of interconnected systems, procedures, and policies that aim to mitigate health risks, minimize exposure, and strengthen countries’ operations for sustainable health security.

With the evolving landscape of global health threats, above all, it is increasingly imperative to integrate efforts from various governments and non-governmental organizations, leveraging existing partnerships to address underlying determinants of health and misinformation during health emergencies to foster effective public health responses, achieve sustained investment and rapid response mechanisms that are critical to ensuring a timely and effective mitigating response to prevent future outbreaks or pandemics.

Thus, the GHSA member partners’ 2024 strategic framework and some of the core areas the Centers for Disease Control and Prevention (CDC) determined essential to reducing global health security risk’s themes focus on preparedness, leadership development, technical knowledge, and health data information, initiates to achieve universal health care, and collaborative foundation [18, 19, 20, 21, 22].

1.1 Preparedness and management

Preparedness is crucial to handling any emergency or emerging situation. Preparedness, as stipulated by the World Health Organization (WHO) and The United Nations, is a comprehensive approach that involves the acquisition of knowledge and the development of skills by governments, response and recovery organizations, communities, and individuals to effectively anticipate, respond to, and recover from the effects of foreseeable, imminent, or current disasters or threat [2, 23, 24]. A country’s ability to effectively identify and respond to health security threats depends on several factors, such as its surveillance systems, preparedness response, infrastructure, and established preventive measures [24, 25]. Consequently, a lack of preparedness cripples the country’s economy and causes a significant loss of human life. As such, preparedness is fundamental to any country’s health security and management. The average country’s Global Health Security Index (GHS) score in 2021 was 38.9 out of 100, with no country scoring within the top tier 5, suggesting weaknesses in the global healthcare systems and an urgent need for preparedness actions [2]. The growing importance of preparedness management is also underscored by the impact of climate change on global health security. Rising temperatures and altered habitats for disease vectors have been shown to increase the spread of infectious diseases like malaria, dengue fever, and cholera [26]. Extreme weather events, such as hurricanes and floods, have led to displacement, food shortages, and damage to health infrastructure, heightening vulnerability to disease outbreaks and emergencies [27].

Furthermore, climate change impacts agricultural productivity, compromising food security and nutrition [28]. As such, effective mitigation strategies requiring interdisciplinary collaboration, robust surveillance systems, adaptive healthcare infrastructure, and coordinated international efforts continue to grow in importance to address both direct and indirect health impacts. The present global landscape reflects a marked upsurge in political and security risks across most countries, with the countries that have fewer resources being the most vulnerable with the biggest gaps in preparedness [2, 16], resulting in significant health disparities.

1.2 Surveillance and metrics

Innovations, such as telemedicine, rapid diagnostic tests, and digital surveillance tools, are transforming and enhancing disease surveillance and countries’ response capabilities; however, the need for capacity building, partnerships, and finance at multiple levels while preserving sustainability, especially in the context of resource availability [29, 30, 31] has proven challenging. Point-of-care testing (POCT) and point-of-care imaging are among the most important modern tools to promote high-yield quality care while encouraging cost containment, portability, and sustainability [32, 33, 34, 35]. Point-of-care testing and point-of-care imaging are among the most important modern tools to promote high-yield quality care while encouraging cost containment, portability, and sustainability [32, 33, 34, 35]. However, as point-of-care strategies evolve, it’s evident that input from key stakeholders and strategically leveraging knowledge and skills in existing programs across regions, countries, and continents are of critical importance to the long-term success of point-of-care imaging and laboratory programs. Periodic gap analyses are mandatory to ensure that overall progress is being accurately measured and any emerging issues are promptly addressed [32, 36, 37].

One of the barriers to progress in GHS is the relative paucity of shared published evidence-based approaches, interventions, outcome measurements, and lessons learned among countries [38, 39, 40]. It is critical for every nation to assess its health systems (e.g., facilities, laboratories, and related critical infrastructure) and other security metrics and needs in order to guarantee that participating stakeholders and partners follow standard guidelines, accurate knowledge and skill dissemination, training and competency, and continuous data monitoring [41, 42, 43]. Correct identification, early detection of specific pathogens, real-time tracking, and the transfer of information at the local, regional, national, and international levels are approaches used to combat and control the spread of infectious agents and determine appropriate treatment plans [41, 42, 43]. Available research indicates that strengthening disease surveillance helps identify high-risk infectious diseases’ pathogens of national concern, detect emerging trends, and strengthen vector monitoring capacity [44, 45]. Also of great importance, pharmaceutical quality surveillance systems prevent antimicrobial resistance transmission in healthcare facilities [46, 47, 48]. Overall, this reinforces countries’ and partners’ relationships and inevitably enhances GHS optimally within a self-improving paradigm. The success of these systems typically requires scientific and expert partnerships, health ministries, and organizations working in concert at various levels (local and global) [49, 50].

1.3 Workforce development, finance and equity

Another fundamental theme and element in maintaining GHS is a country’s workforce. Workforce and capacity development requires the mobilization of multi-sectoral efforts, coordination of public health resources on lessons learned, and collaboration of governments at various levels to reinforce their health security infrastructure and train future and current workforce based on evidence-based resources [51, 52]. With billions of dollars in economic losses and increasing frequency of public and global health emergencies, workforce and capacity development are vital facets of health security [53, 54]. Central to sustainable global workforce development is the importance of the support and collaboration of various leaders and partners in health security, especially so in the context of diversity, equity, and inclusion [55, 56, 57]. Significant gaps and challenges regarding women’s leadership in GHS have been identified over the years and are increasingly and more effectively being addressed at this time [58, 59, 60]. As previously mentioned, one of the central premises of GHS is sustainability, and investments from various partners and stakeholders are crucial to facilitating GHSA’s strategic objectives. Often under-recognized, the contributions of sustainable financing tend to be overlooked as contributors to GHS. But the ability to provide adequate resources often equates to empowerment, manifesting over a number of critical domains, such as one’s independence, authority, status, agency, and living standards. This, in turn, directly and indirectly impacts population health and, inevitably, health security [61, 62, 63].

2. Synthesis and conclusion

In conclusion, the discourse on global health security underscores the urgent need for coordinated action to address the myriad challenges posed by infectious diseases, pandemics, natural disasters, and health inequities. The COVID-19 pandemic has starkly exposed the vulnerabilities of health systems worldwide, compelling a reevaluation of preparedness, response mechanisms, and the broader infrastructure supporting global health security. As we navigate the post-pandemic landscape, it is evident that a robust and strategic approach to health security is paramount. The Global Health Security Agenda (GHSA) exemplifies the collaborative efforts required to bolster health security across nations. Through partnerships and sustainable financing mechanisms, GHSA endeavors to strengthen disease surveillance, response capabilities, and workforce development, thereby enhancing the resilience of public health systems.

Key themes essential to advancing global health security include preparedness and management, surveillance, metrics, workforce development, and finance. Addressing these themes necessitates a multifaceted approach, encompassing the integration of evidence-based interventions, capacity-building initiatives, and equitable resource allocation. In essence, investing in global health security is not only a matter of safeguarding individual well-being but also a critical component of promoting sustainable development and fostering resilience in the face of future health threats. By embracing a collaborative, holistic approach, we can strive towards a safer, more equitable world for all.

Acronyms and abbreviations

CDC	Centers for Disease Control and Prevention
COVID-19	coronavirus disease of 19
GHS	global health security
GHSA	Global Health Security Agenda
POCT	point-of-care testing
SARS	severe acute respiratory disease
SARS-CoV-2	severe acute respiratory syndrome coronavirus 2
USAID	United States Agency for International Development
WHO	World Health Organization