“Global Health Security” sounds like a very grand and important subject, but what does it mean for PHE (and the UK) and what do we actually do?
Global Health Security in this context covers the collective efforts of governments and non-government agencies to ensure a world safe from the global threat of infectious disease, whether natural or deliberate.
This work became a concern for many countries after the 9/11 attacks in New York in 2001 which caused us to reconsider our assessment of the risk from a bio-terrorist attack and the extent to which we were prepared to respond to such an event if it happened (however unlikely). It then came to prominence again following the Severe Acute Respiratory Syndrome (SARS) epidemic in 2002/2003 which had a very significant impact on the global economy as well as a major health impact. Health security thinking was also strongly influenced by the H1N1 pandemic in 2009 which demonstrated, once again, both the interdependence between countries in the context of an infectious disease emergency and the interdependence between health, security and economic stability and prosperity.
Much of the focus of the work is on how would we know if another threat such as SARS was emerging somewhere in the world, and what would we do about it? For PHE, this means that global health security work involves many parts of the organisation and depends on close collaboration between them: national surveillance, international and travel health, respiratory disease epidemiology, microbiology, emergency response as well as the global health team. PHE has an impressive array of experts and expertise, some of the best in the world, but we also have to look outwards to other people and organisations that might be able to help. This includes not just the obvious partners such as the World Health Organization (WHO) and European Centre for Disease Control (ECDC), but also national agencies like the Centers for Disease Control (CDC) in Atlanta, public health agencies in Asia and the Middle East and less obvious partners such as the police, military and intelligence sectors.
The International Health Regulations (IHRs), drawn up and revised by WHO after SARS, provide a framework for this work. The IHRs set out what each member state of WHO (there are over 190 of them covering most of the world) must be able to do in terms of disease surveillance and response and they effectively benchmark what a reasonable standard would be. Helping other countries to develop their systems to meet or exceed, the WHO standards is a key ambition of PHE. We also work with government agencies around the world to encourage the sharing of information rapidly to allow an accurate assessment of risks from new diseases and this helps build trust between countries and agencies.
We also work alongside those with an interest in reducing the global threat from chemical and biological weapons. We share common interests because many of the systems and the expertise that would deter an attack or alert us to a deliberate release of a harmful substance are the same as those we depend on for natural events. Meeting the IHR requirements is a good start so strengthening these systems has a dual benefit, as does the trust that is built up through our collaborations. Knowing that a deliberate release will be quickly detected and managed is one of the deterrents that reduce the threat from these weapons. This is one particular way in which PHE’s overseas work to help develop public health capacity in other countries benefits the UK: stronger public health systems means better protection for the UK from threats (natural and deliberate) that arise elsewhere.
Another area that the Global Health team are actively engaged in is sharing the knowledge and expertise on the planning and delivering of public health for mass gatherings, building on our experience from the London 2012 Games. This again focusses on helping countries build up their own public health capacity, starting with their mass gathering planning but continuing afterwards as a legacy. This has led to work with a number of countries, not just for the well-recognised events such as the World Cup and 2016 Olympics in Brazil but also with developing and emerging countries.
This included working with national health teams and WHO in Burma (Myanmar) last year to help their planning for the regional South East Asia Games which took place successfully in December 2013. This was an incredible opportunity to work closely with a country that is opening up and wanting to learn and improve their public health systems. We provided advice and assistance in their risk assessment, planning and delivery, particularly around the speed and thirst for information in the event of an incident. This involved training teams to rapidly respond and undertake investigations. This has left a legacy for the country of increased capability and capacity for any future public health incidents, as well as work to help support continuing improvements in their public health systems and response. Working with people in a quite challenging environment with limited resources who are enthusiastic to learn from others and develop both themselves and their country has proved to be a very rewarding aspect of global health work.
So, although PHE is a England-focused agency our work on global health security helps us sleep better at night knowing that we are able to detect and respond to things that might threaten us from abroad and that public health colleagues around the world are also better prepared. But it would be good, as always, to hear what you think: what are the big challenges from around the world? How can we make the biggest difference? Can we afford to ignore these risks or should we leave it to others to deal with them while we focus on the big public health issues we have in England?