Rebecca Katz

Defining Health Diplomacy: Changing Demands in the Era of Globalization

CONTEXT Accelerated globalization has produced obvious changes in diplomatic purposes and practices. Health issues have become increasingly preeminent in the evolving global diplomacy agenda. More leaders in academia and policy are thinking about how to structure and utilize diplomacy in pursuit of global health goals. METHODS In this article, we describe the context, practice, and components of global health diplomacy, as applied operationally. We examine the foundations of various approaches to global health diplomacy, along with their implications for the policies shaping the international public health and foreign policy environments. Based on these observations, we propose a taxonomy for the subdiscipline. FINDINGS Expanding demands on global health diplomacy require a delicate combination of technical expertise, legal knowledge, and diplomatic skills that have not been systematically cultivated among either foreign service or global health professionals. Nonetheless, high expectations that global health initiatives will achieve development and diplomatic goals beyond the immediate technical objectives may be thwarted by this gap. CONCLUSIONS The deepening links between health and foreign policy require both the diplomatic and global health communities to reexamine the skills, comprehension, and resources necessary to achieve their mutual objectives.

IDSR as a Platform for Implementing IHR in African Countries

Of the 46 countries in the World Health Organization (WHO) African region (AFRO), 43 are implementing Integrated Disease Surveillance and Response (IDSR) guidelines to improve their abilities to detect, confirm, and respond to high-priority communicable and noncommunicable diseases. IDSR provides a framework for strengthening the surveillance, response, and laboratory core capacities required by the revised International Health Regulations [IHR (2005)]. In turn, IHR obligations can serve as a driving force to sustain national commitments to IDSR strategies. The ability to report potential public health events of international concern according to IHR (2005) relies on early warning systems founded in national surveillance capacities. Public health events reported through IDSR to the WHO Emergency Management System in Africa illustrate the growing capacities in African countries to detect, assess, and report infectious and noninfectious threats to public health. The IHR (2005) provide an opportunity to continue strengthening national IDSR systems so they can characterize outbreaks and respond to public health events in the region.

Use of revised international health regulations during influenza a (h1n1) epidemic, 2009

All nations should implement these regulations and cooperate in disease surveillance and data sharing.

Redefining syndromic surveillance

Abstract With growing concerns about international spread of disease and expanding use of early disease detection surveillance methods, the field of syndromic surveillance has received increased attention over the last decade. The purpose of this article is to clarify the various meanings that have been assigned to the term syndromic surveillance and to propose a refined categorization of the characteristics of these systems. Existing literature and conference proceedings were examined on syndromic surveillance from 1998 to 2010, focusing on low- and middle-income settings. Based on the 36 unique definitions of syndromic surveillance found in the literature, five commonly accepted principles of syndromic surveillance systems were identified, as well as two fundamental categories: specific and non-specific disease detection. Ultimately, the proposed categorization of syndromic surveillance distinguishes between systems that focus on detecting defined syndromes or outcomes of interest and those that aim to uncover non-specific trends that suggest an outbreak may be occurring. By providing an accurate and comprehensive picture of this field’s capabilities, and differentiating among system types, a unified understanding of the syndromic surveillance field can be developed, encouraging the adoption, investment in, and implementation of these systems in settings that need bolstered surveillance capacity, particularly low- and middle-income countries.

Post-Ebola reforms: ample analysis, inadequate action

Reports on the response to Ebola broadly agree on what needs to be done to deal with disease outbreaks. But Suerie Moon and colleagues find that the world is not yet prepared for future outbreaks

Can an attribution assessment be made for Yellow Rain? Systematic reanalysis in a chemical-and-biological-weapons use investigation

Abstract In intelligence investigations, such as those into reports of chemical- or biological-weapons (CBW) use, evidence may be difficult to assemble and, once assembled, to weigh. We propose a methodology for such investigations and then apply it to a large body of recently declassified evidence to determine the extent to which an attribution can now be made in the Yellow Rain case. Our analysis strongly supports the hypothesis that CBW were used in Southeast Asia and Afghanistan in the late 1970s and early 1980s, although a definitive judgment cannot be made. The proposed methodology, while resource-intensive, allows evidence to be assembled and analyzed in a transparent manner so that assumptions and rationale for decisions can be challenged by external critics. We conclude with a discussion of future research directions, emphasizing the use of evolving information-extraction (IE) technologies, a sub-field of artificial intelligence (AI).

The International Health Regulations: The Governing Framework for Global Health Security

The International Health Regulations (IHR) are the governing framework for global health security yet require textual and operational reforms to remain effective, particularly as parallel initiatives are developed. The World Health Organization (WHO) is the agency charged with oversight of the IHR, and its leadership and efficient functioning are prerequisites for the effective implementation of the IHR. We reviewed the historical origins of the IHR and their performance over the past 10 years and analyzed all of the ongoing reform panel efforts to provide a series of politically feasible recommendations for fundamental reform. This article offers proposals for fundamental reform — with politically feasible pathways — of the IHR, their operations and implementation, WHO oversight, and State Party conformance.

Assessing physicians' in training attitudes and behaviors during the 2009 H1N1 influenza season: A cross-sectional survey of medical students and residents in an urban academic setting

Please cite this paper as: May et al. (2010) Assessing physicians’ in training attitudes and behaviors during the 2010 H1N1 influenza season: a cross‐sectional survey of medical students and residents in an urban academic setting. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2010.00151.x.

Moving Forward to 2014: Global IHR (2005) Implementation

When the Member States of the World Health Assembly agreed to adopt the revised International Health Regulations in 2005 (IHR [2005]), no one thought that the next steps would be easy. The original 194 States Parties committed to improve global health security by strengthening the framework for managing public health emergencies. IHR (2005) represented a response to the challenge posed by emerging infectious diseases, from the insidious spread of HIV/AIDS over decades to the SARS crisis, in an era of commonplace international trade and travel. The revised regulations aimed to improve early detection and response to public health events that might affect populations across borders by increasing the transparency and timeliness of reporting. The agreement replaced historical lists of notifiable diseases with an algorithm for assessing public health threats in context, and it conferred new authorities on the World Health Organization (WHO) to collect information and facilitate rapid evidence-based responses. Countries agreed not only to share information promptly, but to develop and sustain the capabilities needed to detect, assess, report, and respond to any potential public health emergency of international concern. This unprecedented commitment offered a foundation for a truly global disease detection and response network, capable of containing emerging disease threats when and where they occur to reduce the toll on economies and human lives. IHR (2005) entered into force in June 2007, beginning a 5-year period for each nation to evaluate its own current core capacities from the local to the national level and to develop a plan of action for closing any gaps. In June 2012, all States Parties were obligated to report to WHO either that they had achieved the core capacities required to implement the revised IHR fully or that they would require a 2-year extension to implement their action plans. As of late March 2013, 42 countries (out of 194 reporting States Parties) had indicated to WHO that they had achieved all of the core capacities required to implement IHR (2005) fully; 110 countries requested a 2-year extension with an implementation plan. An additional 42 countries neither submitted an extension plan nor indicated that they are in compliance (Figure 1). As each nation assessed and reported its own capacities, the self-imposed stringency of the evaluations most likely varied. However, we can clearly say that approximately 80% of the world’s countries have not met their international legal obligations to implement IHR (2005). These shortfalls reflect the scope of the tasks rather than a lack of commitment on the part of health ministries worldwide. Countries must be prepared to carry out the core functions of public health surveillance and response for infectious and noninfectious hazards (including zoonotic, foodborne, chemical, and radiological/nuclear events as well as communicable disease outbreaks) at the local, intermediate, and national levels and at points of entry. These capabilities depend on an adequately trained and equipped public health workforce, a strong surveillance and response framework, a functional national public health laboratory

Costing framework for international health regulations (2005)

Costs can be estimated by identifying functional pathways toward achieving all 8 core capacities and global indicators.