Creating the building blocks for global health security

SYDNEY — The 2019 Global Health Security conference, held in Sydney on June 18-20, brought together more than 800 members of the global health security community from 65 countries to share knowledge and engage in discussion on the science, policy, and practices that can improve global health security. In a video introduction to the conference, World Health Organization Director-General Tedros Adhanom Ghebreyesus said health security was a shared responsibility — and it was important for all countries to scale up and invest in prevention and preparedness. “WHO’s recent report to the global preparedness monitoring board underscored the urgency of all countries in scaling up and financing country health emergency preparedness and the implementation of the international health regulations,” he said. “Strong political leadership is essential. WHO calls on all countries to take ownership for national health security by investing in stronger systems that can prevent, detect, and respond rapidly to emergencies.” But this, he said, was a job not just of government but for a range of sectors and partners who needed to work together. As the first ever conference of its kind focusing on global health security, sectors were brought together representing academia, government, nongovernmental organizations, and the private sector. And while it identified many challenges and gaps that exist in making health security a priority for planning, policy, and budgeting for all governments, it also highlighted the work progressing and the willingness of actors to form new partnerships to deliver outcomes. Understanding the challenges In defining health security, the conference discussion focused on antimicrobial resistance the emergence of currently untreatable infections, deliberate use of a biological weapon, and the synthesis of eradicated or other novel pathogens — all that are threats with global consequences that require collective solutions. Osewe said there were limited resources for health security — including no new investments or major restructuring. Workforce development and capacity building was another critical barrier identified by John Nkengasong, director of the Africa Centres for Disease Control, explained that preparedness and response needs to lie with all countries to ensure global security is achieved. This was an issue echoed by Stephen Redd, deputy director of Public Health Service and Implementation Science with the Centers for Disease Control and Prevention, who said that global commitment to self-evaluation through national action plans wasn’t always converted into capacity building, calling on donors to work with low-income countries. Just as the global community is looking to the private sector to support climate change response, Osewe said, global health security should look to the private sector too. Identifying roles and responsibilities The conference demonstrated how various actors were already playing critical roles in the promotion and delivery of global health security. Advocacy, training, and empowerment were three key areas of focus identified for civil society, leveraging their engagement at the community level. Leena Martin, an independent researcher from India, said that CSOs had an important role to play in education — including basic knowledge of diet diversity and building community kitchens to get the foundations of healthy living down. And in supporting health issues such as epidemics, Ousmane Souare from RTI International, explained that by providing logistical support — including motorbikes, phones, computers, and internet hotspots — in Boffa, Guinea, community health workers were enabled to do their jobs better. Civil society could also provide information on the challenges on the ground that could create a risk of outbreaks. For the military Rear Admiral Louis Tripoli, command surgeon with the United States Pacific Command, said health security was linked to human security — and organizations such as the U.S. military — with an interest to promote security — had a supportive role to play. Building partnerships, supporting response for countries limited in capability, were all important roles for the military. Tripoli said work needed to be done to improve trust between the military and other sectors — something currently underway. Advocating for health security in political thinking was also an area Tripoli said the military could play a part in, by expanding upon existing research and spending on health security studies. The private sector was identified as important in a range of areas — including limiting the spread of risk and building capacity to respond and recover from health issues. Tourism, trade, pharmaceuticals, and technology companies were among the critical players, but not enough was being done to build their investment in responding to potential health security risks. In engaging with the private sector, Executive Director of The Global Fund to Fight Aids, Tuberculosis and Malaria Peter Sands explained that it was important to think about how business sees risk and engage with them on their terms. “Academia and civil society also have vested interests, not just the private sector,” said Adrian Thomas, vice president of Health with Johnson & Johnson. “Let’s all acknowledge these and then get to work.” Empowering action Participants said that global health security shouldn’t be seen as a funding competitor against other health issues including HIV/AIDS, TB, and malaria. “There is a pooled risk, so funding should not be competitive,” said Beth Cameron, vice president of biological policy and programs at NTI. Sustainable funding is needed to ensure this was not a “flavor of the month” health issue. There were calls for a number of financial solutions, including a global health security fund, which FIND CEO Catharina Boehme said should be allocated for low-income countries, while middle-income countries pay through taxes. There is a need to build accountability in systems to force action from government, said Executive Director of the Stop TB Partnership Dr. Lucica Ditiu. Progressing action The Sydney Statement released as part of the conference was a call to action for progress, signed by participants including Australian Minister for Health Greg Hunt. “Global health security is a state of freedom from the scourge of infectious disease, irrespective of origin or source,” the statement reads. “It is achieved through the policies, programmes, and activities taken to prevent, detect, respond to, and recover from biological threats.” In responding, signatories committed to seven principles — including the use of “Inclusive, equitable and data-driven” interventions; building base capability of disease prevention; detection and response for all countries; greater interaction with communities and a human rights-based approach to interventions; wider sectoral engagement to deliver health security; and a commitment to a sustainable and comprehensive funding mechanism. “Trying to change something is not easy,” explained Theobald Owusu-ansah, president of the Hepatitis Foundation of Ghana. “You have to push — and you also need a passion to bring change.”