|Year : 2022 | Volume
| Issue : 4 | Page : 322-327
Historical Evolution and the Future of Global Health Security
Anas A Khan1, Fahad A Alamri2, Ahmed A Alahmari3, Yasir S Almuzaini3, Shaker A Al Omary4, Hani A Jokhdar5
1 Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Global Centre of Mass Gatherings Medicine, Ministry of Health; Family Medicine Department, Primary Health Centre, Ministry of Health, Riyadh, Saudi Arabia
3 Global Centre of Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
4 Department of Health Programs and Chronic Diseases, Ministry of Health, Riyadh, Saudi Arabia
5 Deputyship of Public Health, Ministry of Health, Riyadh, Saudi Arabia
|Date of Submission||17-May-2022|
|Date of Decision||09-Jul-2022|
|Date of Acceptance||05-Sep-2022|
|Date of Web Publication||12-Oct-2022|
Fahad A Alamri
Global Centre of Mass Gatherings Medicine, Ministry of Health; Family Medicine Department, Primary Health Centre, Ministry of Health, Riyadh
Source of Support: None, Conflict of Interest: None
Health security has become an integral part of global health after many epidemics, the latest of which was the COVID-19 pandemic, from which the world is still suffering. The term “health security” was first used in the mid-twentieth century. Now that a globalized transportation industry has allowed for the mass movement of travelers and public health emergencies, such as global warming, affect everyone, “health security” has become a top priority of countries around the world. This article breaks down the stages in the development of health security as a concept and discusses them. To that end, it reviews the most prominent international and regional initiatives in the field of global health security, including the efforts of the World Health Organization (WHO). This review will help to anticipate the future development of global health security and offer some suggestions for further research. The article thus concludes with a call for countries to work together to develop a shared method of measuring health security. Whether such initiative is taken by the WHO or by low- and middle-income countries, greater collaboration is needed to discuss shared concerns and develop new strategies, particularly in the field of digital health.
Keywords: Global health security, international health conventions, international health regulations, public health
|How to cite this article:|
Khan AA, Alamri FA, Alahmari AA, Almuzaini YS, Al Omary SA, Jokhdar HA. Historical Evolution and the Future of Global Health Security. J Nat Sci Med 2022;5:322-7
|How to cite this URL:|
Khan AA, Alamri FA, Alahmari AA, Almuzaini YS, Al Omary SA, Jokhdar HA. Historical Evolution and the Future of Global Health Security. J Nat Sci Med [serial online] 2022 [cited 2023 Feb 9];5:322-7. Available from: https://www.jnsmonline.org/text.asp?2022/5/4/322/358413
| Introduction|| |
Health security has evolved over time to become an important aspect of both global and national security. After outbreaks of Cholera, the plague, the Spanish Flu, the SARS pandemic in 2002, Ebola in 2013, MERS in 2015, and COVID-19 in 2019, the importance of health security has increased dramatically.,,, The aims and requirements of global health security, however, have changed in response to the pandemic, environmental disasters, or biological threats., Countries must protect society by ensuring economic stability and physical health, insofar as the consequences of failing to do so can be catastrophic as COVID-19 has demonstrated around the world.,
This article helps to introduce the concept of global health security to health practitioners and others who have a vested interest in maintaining it. The goal of this article is thus to raise awareness of the following topics: the definition and concept of global health security, the evolutionary phases of the history of global health security, and the prospects for its future.
| The Origin of the Term|| |
Global health security is sometimes also called “international health security,” “public health security,” or “global public health security,” and it can be defined in different ways., In 1947, the US Department of State first referred to it as “international health security.” In 1994, the United Nations referred to it in response to threats to human security.,, The WHO has defined global public health security as “the activities required, both proactive and reactive, to minimize the danger and impact of acute public health events that endanger people's health across geographical regions and international boundaries.”, The Centers for Disease Control and Prevention, on the other hand, has defined it as “the existence of strong and resilient public health systems that can prevent, detect, and respond to infectious disease threats, wherever they occur in the world.” The latter two definitions suggest that public health threats are not limited to infectious diseases, but also include a variety of risks.
| The Historical Background of Global Health Security|| |
Health security is developed in three stages: the preevolution phase, the civil development phase, and the modern global health security phase.
The preevolution phase
Spanning c. 1300–1851, this phase began with limited possibilities for the local population to establish the practice of sanitary isolation when confronting infectious diseases, such as cholera and the plague. Few people traveled abroad, and most did not know the origins of illness. Consequently, there was no international consensus on health security issues.,, This stage ended in 1851 when the French Government held the first International Sanitary Conference.,,
The civil development phase
By the turn of the 19th century, conferences on combating infectious diseases had been held in many countries around. These conferences were organized in response to epidemics that had spread throughout the world. As a multinational event, this phase witnessed new possibilities for countries to collaborate, and policies were implemented to protect health. The international health conference held in 1851 was the first in a series of 14 conferences that followed. This conference series aimed to streamline international quarantine regulations and thus curb the spread of three infectious diseases: the plague, cholera, and yellow fever. The conferences are listed in [Table 1].,
|Table 1: Chronology and description of the international sanitary conference series|
Click here to view
The modern global health security phase
After World War II, the League of Nations disbanded, and a new global health security system emerged. Then followed a period of internationalism and multilateralism that resulted in collective support of global health security. A single, comprehensive health agency, the World Health Organization (WHO), was established in 1948. In 1951, the first set of legally binding international regulations aimed at controlling infectious diseases and limiting their spread. Finally, the International Health Regulations (IHR) were announced in 2005.,,
| International Convention Series|| |
International Health Conventions were first organized in 1851 when an international sanitary conference was held in Paris, however, this conference failed to ratify new regulations. In 1892, the first International Sanitary Convention (ISC) was signed. This act focused on quarantining cholera through Suez Canal and was a step toward the institution of IHR., European countries adopted additional policies in 1893 and 1894 and added the plague to the list of infectious diseases in the convention of 1897. The ISC held in Paris in 1903 focused exclusively on cholera and the plague. The convention stipulated what protocols all countries that signed it would have in place, were there a breakout of plague or cholera within their borders. Countries that signed the 84 articles of this convention were obliged to the following procedures: to notify other nations in the event of cholera or plague within its borders; to publish the measures taken against this disease; to disinfect merchandise; to protect ports and frontiers, with the exception of travelers on pilgrimage., In 1912 and 1918, the ISC was replaced with new conventions that added yellow fever, typhoid, and smallpox to the list of infectious diseases. The conventions of 1912, 1926, and 1938 prioritized maritime navigation, whereas aerial navigation was the focus in 1933 and 1944.,,,
| Modern Global Health Security|| |
International health regulations and tools
In 1969, the WHO issued its IHR for the first time. The original regulations pertained to six infectious diseases; however, after the amendments of 1973, only the following three infectious diseases were included: cholera, yellow fever, and the plague 1981., From that point until the 1990s, international trade sped up, and travel between countries increased. To help stop the spread of infectious diseases, in 1995 the WHO called for amendments to the aforementioned regulations based on objective, scientific research. These amendments were put into effect with the publication of the first edition of the IHR (2005) that entered into force on June 15, 2007., These regulations effectively expanded the three diseases above to include any public health emergency that may threaten health at a global level. Such threats could now include the natural, accidental, or intentional release of biological, chemical, or nuclear radioactive materials. Between 2010 and 2017, an IHR Monitoring Survey was sent to countries, 196 of which used it at least once. A summary of the survey results was reported to the Assembly, and country profiles were made available on the WHO Global Health Observatory data page.,
The IHR (2005) requires all 196 signatories to report annually on progress toward the implementation of IHR core capacity. They are to complete this report through the process of multisectoral self-assessment known as the state parties self-assessment annual reporting (SPAR). The SPAR tool identifies 24 indicators of 13 IHR capacities. These 13 IHR capacities are required to detect, assess, notify, report, and respond to public health risks and acute events of domestic and international concern., These obligatory procedures work in tandem with voluntary, external, and peer-reviewed joint external evaluations (JEE), all of which are essential components of the IHR monitoring and evaluation framework. JEE's purpose is to measure country-specific progress toward the completion of strategic goals. Those goals include the prevention and detection of public health threats and the response to them. The member state is to report on the status of these goals' completion once every 4–5 years after making a voluntary request. This report includes 49 indicators within the 19 technical sections., In 2016, the WHO instituted a National Action Planning for Health Security (NAPHS). This was a flexible, multi-year planning process that attempted to organize national health security priorities; bring different sectors together; identify partners; and allocate resources for the improvement of health security capacity. The NAPHS also articulated a method for documenting all active preparedness measures in a country, as well as a transnational framework for managing emergency and disaster risk., This framework has thus helped nationals to understand immediate consequences as well as long-term strategies for improving IHR capacity. Although these tools are very useful, what countries may need is a unified, comprehensive strategy for adhering to the IHR and achieving their goals. Only then will they be sure that continued effort toward global health security will be made.
The Global Health Security Agenda (GHSA) is a coalition of more than 70 nations, international organizations, and civil societies. Together, they attempt to make their dream of a world without the risk of infectious diseases a reality. GHSA was launched in February 2014 to hasten countries' progress toward achieving compliance with the IHR.,, Together with the WHO, the GHSA created a JEE tool, which is an essential component of the IHR Monitoring and Evaluation in 2016.
The purpose of the Global Health Security Index (GHSI) is to assess the state of health security and related competencies across 195 nations. The GHSI was developed by the following groups and organizations working together: Nuclear Threat Initiative, a global nonpartisan security organization dedicated to reducing nuclear and biological threats to humanity; the Johns Hopkins Centre for Health Security; and The Economist Impact., The 2017 GHSI ranks countries in six categories, with 37 indicators and 171 questions. The GHSI measures health security in relation to political challenges, as well as the overall soundness of the health system and its compliance with global norms. The GHSI will help governments create long-term investment plans, to re-prioritize every 2–3 years, and to prevent future outbreaks. By so doing, they plan to enhance political incentive to redress imbalances and reallocate resources. A study conducted during the COVID-19 pandemic has shown that countries with lower preparedness scores actually took less time to detect the first COVID-19 cases than their so-called better-prepared counterparts. Long-term investment in health infrastructure for pandemic preparedness is thus essential, but the true test of its efficacy is a real pandemic. According to another study, the GHSI is a useful tool for assessing health security, but it is woefully underdeveloped. This is to say nothing about the anthropogenic hazards that still go disregarded. Further validation of the GHSI as a measure of preparation, therefore, is necessary to counter these threats. Likewise, it is important to identify potential gaps in global health security capacities.
| International Centres of Health Security Initiatives|| |
At the end of the 1990s, health security centers were created. In 1998, the Johns Hopkins Center for Health Security was founded and became one of the most prominent of these centers. This center aims to keep people safe from epidemics and natural catastrophes while also building community resiliency. The goal of the organization is to ensure people's safety around the world from new and emerging infectious diseases and epidemics. They do this by increasing preparedness for medical and public health emergencies, for purposeful biological threats, as well as for opportunities and risks in the field of life sciences. Another similar institution is the Georgetown University Center for Global Health Science and Security, which was founded in 2016. By enhancing the knowledge base that allows for informed decision-making and by encouraging sustainable capacity development, they hope to diminish the dangers posed by epidemics and other public health emergencies. “Infectious disease response and biodefense research,” on the other hand, is the focus of the University of Nebraska Medical Center's Global Center for Health Security. Among the factors that contributed to the relocation were its concerns about the spread of viruses and contagious diseases, as well as the threat of a bioterrorist assault. At the regional level, on the other hand, the Indo-Pacific Centre for Health Security, established in 2017 by the Australian government, works to prevent and limit the threat of infectious diseases in the Indo-Pacific. Some of these infectious diseases have the potential to cause social and economic harm at the national, regional, or global level. In Australia, Flinders University has established a Centre for Health Security, and in the United Kingdom, the UK Health Security Agency has founded a Centre for Emergency Preparedness, both of which are WHO collaborating centers. These centers aim to provide enhanced emergency preparedness capabilities in all countries. In Saudi Arabia, the Global Centre of Mass Gathering at the Ministry of Health, a WHO collaborating center, is attempting to implement health early warning and response systems at mass gatherings. It also encourages collaboration with travel-associated surveillance networks to detect potential international outbreaks.
It appears that health security centers are vital to most countries, especially those that have a large number of travelers or provide logistical services. These centers offer services with an advanced level of health protection and make rapid decisions to ensure the health security of the country. National and regional centers could therefore help to improve global health security both in the short term and the long term.
| Journals for Health Security|| |
Despite the importance of health security, especially in recent decades, there are very few academic journals dedicated to this field. The most prominent is health security, a journal that provides research to help protect people's health before and after epidemics or disasters and to ensure that societies are resilient in the face of major challenges. The journal explores the many issues that not only an outbreak of disease or epidemic can raise but also natural disasters, biological, chemical, and nuclear accidents or intentional threats, outbreaks of foodborne diseases and other health emergencies. There are also journals such as Global Security: Health, Science and Politics, which provide security and health information. The journal's goal is to help make the world a safer place and thus attempts to mitigate problems across a range of global issues. The International Journal of Natural Disasters and Health Security also publishes research on biosecurity that aims to protect the world from threats such as bioterrorism. The journals also explain many of the security issues raised by natural disasters. More journals in this field may be needed in the future. There is also an urgent need for research to benefit low-income countries throughout the world.,
| Global Health Security in the Future|| |
There is a considerable amount of scholarly work on the future of global health security and the various avenues to a safe and healthy world. The Riyadh Global Digital Health Summit 2020 articulated points of consensus on the following five themes: team, technology, techquity, transparency, and trust. Together, these consensus points provide a roadmap for all stakeholders, including governments, to execute digital health policy.,
Implementing these principles could significantly reduce deaths and unite nations against the threat of pandemics. Building public health capacity should be a priority for governments and the global community. To this end, the WHO should collaborate with member states to develop clear norms and benchmarks, as well as an impartial and transparent review procedure. Government support is essential for planning and implementing core capacity improvement projects. It is also crucial that resource-constrained countries, fragile and failing states, and other development partners are subsidized. This financing, however, should of course be contingent on a country's consent to follow the external assessment procedure. The technical assistance that the WHO uses to help states implement these strategies is vital. In addition to preventing new outbreaks, enhancing already existing public health systems can help combat global health threats, such as antimicrobial resistance.
The COVID-19 pandemic has exposed a severe lack of preparedness for public health emergencies. The chief failing was the health facilities ill-equipped to respond properly. After each health crisis, states rush to offer emergency funds, which leads to a long-term decline in health care. Building capacity in public health and hospitals as well as strategic planning are necessary to break the cycle of panic and neglect. It is clear from the experience of Saudi Arabia that the key to halting the catastrophes of the COVID-19 pandemic in the early preparedness and response phases is for many sectors with clearly defined roles and responsibilities to collaborate early on.
| Conclusion|| |
Despite global efforts to address public health threats, such as the spread of epidemics, and implementing robust global health security, the world is still far from having adequate health security. For this reason, much of the scholarly literature has focused on health hazards in history. During the modern age of global health security, progress has been made in emergency preparedness and response time, as well as the formation of new agreements and initiatives in response to public health emergencies. This work involves anticipating and addressing any dangers to public health, as well as filling in any gaps that may exist in current health regulations. Global health security will improve if low-income countries are included in health research, resources, and initiatives. By utilizing digital health and artificial intelligence advancements, we can reduce the time it takes to achieve ideal global health security.
Financial support and sponsorship
This work was supported by Pfizer Saudi Arabia.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Piret J, Boivin G. Pandemics throughout history. Front Microbiol 2020;11:631736.
Sampath S, Khedr A, Qamar S, Tekin A, Singh R, Green R, et al.
Pandemics throughout the history. Cureus 2021;13:e18136.
Schwartz RA, Kapila R. Pandemics throughout the centuries. Clin Dermatol 2021;39:5-8.
Tognotti E. Lessons from the history of quarantine, from plague to influenza A. Emerg Infect Dis 2013;19:254-9.
Bakanidze L, Imnadze P, Perkins D. Biosafety and biosecurity as essential pillars of international health security and cross-cutting elements of biological nonproliferation. BMC Public Health 2010;10 Suppl 1:S12.
World Health Organization. The World Health Report 2007: A Safer Future: Global Public Health Security in the 21st
Century. Geneva: World Health Organization; 2007.
Ventura DF, Giulio GM, Rached DH. Lessons from the covid-19 pandemic: Sustainability is an indispensable condition of Global Health Security. Ambiente Soc 2020;23:1-11.
Malik SM, Barlow A, Johnson B. Reconceptualising health security in post-COVID-19 world. BMJ Glob Health 2021;6:e006520.
Aldis W. Health security as a public health concept: A critical analysis. Health Policy Plan 2008;23:369-75.
Chiu YW, Weng YH, Su YY, Huang CY, Chang YC, Kuo KN. The nature of international health security. Asia Pac J Clin Nutr 2009;18:679-83.
Kramer MA. International Health Security in the Modern World: The Sanitary Conventions and the World Health Organization: US Government Printing Office; 1947.
UNDP (United Nations Development Programme). 1994. Human Development Report 1994: New Dimensions of Human Security. New York.
Hoffman SJ. The evolution, etiology and eventualities of the global health security regime. Health Policy Plan 2010;25:510-22.
Fidler DP. From international sanitary conventions to global health security: The new international health regulations. Chin J Int Law 2005;4:325-92.
Huber V. The unification of the globe by disease? The International Sanitary Conferences on Cholera, 1851–1894. Hist J 2006;49:453-76.
Howard-Jones N. The scientific background of the International Sanitary Conferences, 1851-1938. 3. WHO Chron 1974;28:369-84.
Cliff A, Smallman-Raynor M. Quarantine: Spatial Strategies Oxford Textbook of Infectious Disease Control A Geographical Analysis from Medieval Quarantine to Global Eradication. Oxford, UK: Oxford University Press; 2013.
McCarthy M. A brief history of the World Health Organization. Lancet 2002;360:1111-2.
Fidler DP. The globalization of public health: The first 100 years of international health diplomacy. Bull World Health Organ 2001;79:842-9.
World Health Organization. World Health Assembly. WHO Regulations No. 2: International Sanitary Regulations. Geneva: World Health Organization; 1951.
International sanitary convention: Proces verbal of the deposit of the ratifications by the United States and other governments, October 7, 1920, of the International Sanitary Convention Signed at Paris January 17, 1912. Public Health Rep (1896-1970) 1921;36:36-8. Available from: https://www.jstor.org/stable/4575858
. [Last accessed on 2022 Feb 10].
Howard-Jones N, World Health Organization. International Public Health between the Two World Wars: The Organizational Problems. Geneva: World Health Organization; 1978.
World Health Organization. International health regulations (1969): Third annotated edition=Règlement sanitaire international (1969): Troisième édition annotée. Wkly Epidemiol Rec 1983;58:146.
Delon PJ, World Health Organization. The International Health Regulations: A Practical Guide. Geneva: World Health Organization; 1975.
Fidler DP, Gostin LO. The new International Health Regulations: An historic development for international law and public health. J Law Med Ethics 2006;34:85-94.
World Health Organization. International Health Regulations (2005): IHR Monitoring and Evaluation Framework. Report No.: Contract No.: WHO/WHE/CPI/2018.51. Geneva: World Health Organization; 2018.
World Health Organization. Global Health Observatory 2022; 2022. Available from: https://www.who.int/data/gho
. [Last accessed on 2022 Mar 12].
Razavi A, Collins S, Wilson A, Okereke E. Evaluating implementation of International Health Regulations core capacities: Using the Electronic States Parties Self-Assessment Annual Reporting Tool (e-SPAR) to monitor progress with Joint External Evaluation indicators. Global Health 2021;17:69.
World Health Organization. International Health Regulations (2005): State Party Self-Assessment Annual Reporting Tool. International Health Regulations (2005): State Party Self-Assessment Annual Reporting Tool; 2018.
World Health Organization. Joint External Evaluation Tool: International Health Regulations (2005). Geneva: World Health Organization; 2018.
Kandel N, Sreedharan R, Chungong S, Sliter K, Nikkari S, Ijaz K, et al.
Joint external evaluation process: Bringing multiple sectors together for global health security. Lancet Glob Health 2017;5:e857-8.
World Health Organization. NAPHS for All: A 3 Step Strategic Framework for National Action Plan for Health Security. Geneva: World Health Organization; 2018.
World Health Organization. NAPHS for All: A Country Implementation Guide for National Action Plan for Health Security (NAPHS). Geneva: World Health Organization; 2019.
Agenda GHS. Global Health Security Agenda (GHSA) 2022. Available from: https://ghsagenda.org/
. [Last accessed on 2022 Feb 12].
Centers for Disease Control and Prevention. Global Health Security Agenda: Action Packages. Atlanta, Georgia: CDC; 2014.
Katz R, Sorrell EM, Kornblet SA, Fischer JE. Global health security agenda and the international health regulations: Moving forward. Biosecur Bioterror 2014;12:231-8.
Lakoff A. Preparedness indicators: Measuring the condition of global health security. Sociologica 2021;15:25-43.
Razavi A, Erondu N, Okereke E. The Global Health Security Index: What value does it add? BMJ Glob Health 2020;5:e002477.
Cameron E, Nuzzo J, Bell J. Global Health Security Index: Building Collective Action and Accountability. Nucl. Threat Initiat. Johns Hopkins Bloomberg School of Public Health; 2019.
Bell J, Nuzzo J. Global Health Security Index: Advancing Collective Action and Accountability Amid Global Crisis. 2021. Available from: https://www.GHSIndex.org
. [Last accessed on 2022 Feb 21].
Assefa Y, Hill PS, Gilks CF, Damme WV, Pas RV, Woldeyohannes S, et al.
Global health security and universal health coverage: Understanding convergences and divergences for a synergistic response. PLoS One 2020;15:e0244555.
Ravi SJ, Warmbrod KL, Mullen L, Meyer D, Cameron E, Bell J, et al.
The value proposition of the Global Health Security Index. BMJ Glob Health 2020;5:e003648.
Haider N, Yavlinsky A, Chang YM, Hasan MN, Benfield C, Osman AY, et al.
The Global Health Security index and Joint External Evaluation score for health preparedness are not correlated with countries' COVID-19 detection response time and mortality outcome. Epidemiol Infect 2020;148:e210.
Boyd MJ, Wilson N, Nelson C. Validation analysis of Global Health Security Index (GHSI) scores 2019. BMJ Glob Health 2020;5:e003276.
Center for Global Health Science and Security at Georgetown University: Georgetown University; 2022. Available from: https://ghss.georgetown.edu
. [Last accessed on 2022 Feb 14].
Khan A, Yezli S, Ciottone G, Borodina M, Ranse J, Gautret P, et al.
Recommendations from the 4th
International Conference on Mass Gatherings Medicine, Saudi Arabia. East Mediterr Health J 2020;26:503-5.
Sands P, Mundaca-Shah C, Dzau VJ. The neglected dimension of global security – A framework for countering infectious-disease crises. N Engl J Med 2016;374:1281-7.
Decoster K, Appelmans A, Hill PS, editors. A Health Systems Research mapping exercise in 26 low- and middle income countries: Narratives from health systems researchers, policy brokers and policy-makers. Geneva:2012. Available from: https://ahpsr.who.int/alliance-hpsr/
. [Last accessed on 2022 Mar 15].
Al Knawy B, McKillop MM, Abduljawad J, Tarkoma S, Adil M, Schaper L, et al.
Successfully implementing digital health to ensure future global health security during pandemics: A consensus statement. JAMA Netw Open 2022;5:e220214.
Al Knawy B, Adil M, Crooks G, Rhee K, Bates D, Jokhdar H, et al.
The Riyadh Declaration: The role of digital health in fighting pandemics. Lancet 2020;396:1537-9.
Gostin LO, Nuzzo JB. Twenty years after the anthrax terrorist attacks of 2001: Lessons learned and unlearned for the COVID-19 response. JAMA 2021;326:2009-10.
Khan A, Alsofayan Y, Alahmari A, Alowais J, Algwizani A, Alserehi H, et al.
COVID-19 in Saudi Arabia: The national health response. East Mediterr Health J 2021;27:1114-24.